| 1. |
- Ahlstedt, Carina, 1969-, et al.
(författare)
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Do illegitimate tasks matter for registered nurses' work motivation? : A cross-sectional study based on a nationally representative sample of Swedish nurses
- 2023
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Ingår i: International Journal of Nursing Studies Advances. - : Elsevier. - 2666-142X. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- Background: A challenge in Western countries is the growing need for registered nurses (RNs') in hospitals, primary care and home healthcare. Decreasing illegitimate tasks and strengthening RNs' work motivation are some strategies to address this challenge.Objective: Our overall aim was to explore the association between RNs' experiences of illegitimate tasks and work motivation operationalised as four dimensions: work engagement, opportunities to provide high-quality care, employer satisfaction and intention to remain at the workplace. To address this aim, three specific research questions were asked: (1) Is there an association between illegitimate tasks and work motivation? (2) Do the levels of reported illegitimate tasks differ between RNs working in hospitals and those working in primary care or home healthcare settings? (3) Do associations between illegitimate work tasks and work motivation differ with type of workplace?Design: A cross-sectional design.Methods: We used responses from a stratified population of RNs in Sweden, n = 2,333, working either in hospitals, primary care or home healthcare. Calibrating weights were applied in all analyses to ascertain the generalisability of the findings. Illegitimate tasks were measured with the Bern Illegitimate Tasks Scale. Data were analysed using chi-squared tests and linear or logistic regression analysis. Interaction was measured on the multiplicative scale by adding an interaction term to the fully adjusted models.Results: Overall, approximately 25 % of RNs reported frequently experiencing illegitimate tasks. There were statistically significant associations between higher perceptions of illegitimate tasks and lower ratings in the four dimensions of work motivation: work engagement [beta coefficient [beta] = -0.14, confidence interval [CI] 95 % = -0.18; -0.10], opportunities to provide highquality care [beta = -0.46, CI 95 % = -0.51; -40] and employer satisfaction [beta = -0.60, CI 95 % = -0.67; -0.54]. Experiencing higher levels of illegitimate tasks also related to a decreased intention to remain at the workplace [illegitimate tasks: odds ratio = 0.32, CI 95 % = 0.27; 0.29]. RNs who worked in home healthcare reported higher levels of illegitimate tasks than RNs who worked in hospitals.Conclusions: Reducing the amount of illegitimate tasks may contribute to counteracting the shortage of RNs by increasing work motivation and willingness to remain at the workplace.
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| 2. |
- Fu, Cong, et al.
(författare)
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The ‘good death’ in Mainland China : A Scoping Review
- 2022
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Ingår i: International Journal of Nursing Studies Advances. - : Elsevier BV. - 2666-142X. ; 4
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Forskningsöversikt (refereegranskat)abstract
- BackgroundSince the mid 80’ies, the western palliative care philosophy has influenced the development of palliative care in mainland China. However, it has caused several challenges.ObjectiveTo explore the understanding of the ‘good death’ among authorities, professionals, patients, and their relatives in end-of-life care settings in mainland China.DesignScoping review. The PRISMA-ScR checklist was used. The study is not registered.SettingsEnd-of-life care settings, Mainland ChinaParticipantsAuthorities, healthcare professionals, adult patients, and general population in mainland China.MethodLiterature searches were performed through Medline, CINAHL, PsycInfo, and Web of Sciences from 2001-2021, last search 21.4.2021. Inclusion criteria were: Empirical research studies investigating ‘good death’ or political documents about ‘good death’, perspectives from authorities, professionals, patients, and/or relatives, and studies following the Declaration of Helsinki. Exclusion criteria were: Literature reviews, languages other than English and Chinese, editorials, letters, comments, and children's death/dying.The analysis consisted of analysing the data including a descriptive numerical summary analysis and a qualitative thematic analysis.ResultsNineteen articles and two political documents were included. The 19 studies were carried out from 2003-2020, with data collected from 1999 to 2019. The political documents were written in 2012 and 2017, respectively. The thematic analysis resulted in three themes: ‘Medicalisation of death’, ‘Communication about death - a clash between two philosophies’, and ‘Dying and death were socially dependent’. The medicalisation of death meant the understanding of the ‘good death’ primarily focused on physical symptoms and treatments. The good death was understood as painless and symptom-free, where all symptoms could be measured and assessed. Dignity and shared decision-making were connected to the understanding of the ‘good death’. However, the contents of the ‘good death’ varied across the different actors. The understanding of the ‘good death’ in mainland China was a negotiation between Chinese traditional philosophy and contemporary western medicine practice. There was a tension between openness and silence about death, which reflected the importance of death education. The understanding of the ‘good death’ consisted partly of a timely and practical preparation for the death and afterlife, partly of a matter of social and financial issues.ConclusionsThere seemed to be a clash between two different cultures in the understanding of a good death in Mainland China, where western philosophy seemed to rule the political medical actors while traditional Chinese philosophy seemed to rule parts of the population.
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| 3. |
- Gudnadottir, Gunnhildur, et al.
(författare)
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The effect of telephone counseling and internet-based support on pain and recovery after tonsil surgery in children – a systematic review
- 2021
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Ingår i: International Journal of Nursing Studies Advances. - : Elsevier BV. - 2666-142X. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The recovery after tonsil surgery is often troublesome for children and caregivers often feel insecure regarding optimal post-operative care for their children at home. The aim was to study what the current literature reports regarding the effect of post-operative telephone counselling and Internet support on pain and recovery after paediatric tonsil surgery. Method: A systematic literature review was conducted where only randomised clinical trials were included. Outcome measures: Primary outcome measure was pain after surgery. Secondary outcomes also included nausea, anxiety, children's knowledge, use of analgesics, fluid intake and health care service use. Results: Only four studies fulfilled the inclusion criteria. The studies were heterogeneous, rendering a meta-analysis impossible. The results of the included studies showed a possible positive effect on postoperative pain, as well as level of anxiety, use of analgesics, fluid intake and health care service use. However, the studies were few with few included participants. Conclusion: There were indications, but no definitive evidence supporting the positive effect of telephone counselling or Internet-based support on pain and recovery after tonsil surgery in children. More research is needed to further examine these effects. ClinicalTrials.gov 12/03/2017 (NCT03292068). © 2021 The Author(s)
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| 4. |
- Hasselgren, Caroline, 1987, et al.
(författare)
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Conditions for distributed leadership practices among managers in elder- and disability care organizations: A structural equation modeling approach
- 2021
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Ingår i: International Journal of Nursing Studies Advances. - : Elsevier BV. - 2666-142X. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Background Against the backdrop of worldwide increases in life expectancy, there is a growing concern about the future of health and social care services in many countries, including Sweden. This is not least due to expected cutbacks in tax revenues and increasing staff shortages in the welfare sector. Challenges such as these have spurred leadership reforms aimed at mobilizing employee engagement and promoting job attractiveness. For instance, distributed leadership, whereby leader responsibilities are distributed and shared among team members, has gained momentum in recent decades. Nevertheless, there is still limited knowledge as to whether and how organizational conditions impact first-line managers’ inclination to distribute influence and control. Objective This study aims to examine the organizational precursors of two interrelated aspects of distributed leadership among first-line managers in municipal elder- and disability care: collaborative decision-making and the presence (or lack of) a participatory leadership approach. Methods Utilizing survey data from managers working in the elder- and disability care sectors in the municipality of Gothenburg, Sweden (N = 250), associations between conditions and aspects of distributed leadership were analyzed by means of Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM). Results Both aspects of distributed leadership were positively and significantly associated with managers’ perceptions of having well-functioning collaborations with their employees (β = 0.277 [0.122–0.432]; β = 0.492 [0.346–0.637]) as well as with the managers’ active participation in development work aimed at, e.g., promoting organizational trust (β = 0.242 [0.039–0.446]; β = 0.251 [0.103–0.398]). No significant associations between distributed leadership and support from senior management or positive collaborations with support functions were observed in the controlled analyses. However, managers’ perceptions of organizational governance deficits were shown to be significantly and positively associated with having a more participatory leadership approach (β = 0.261 [0.032–0.491]). Conclusions In line with the notion of distributed leadership as a “collective activity”, which is realized in the interaction between managers and their employees, the findings demonstrate that trusting collaborations with responsible and knowledgeable employees play a key role in its practical implementation. Also, distributed leadership, and the work team relations through which it is enabled, are likely to mutually and positively reinforce each other. Additionally, the analyses revealed that managers’ experiences of poor organizational governance appear to promote certain distributed leadership practices. Potentially, this could be because such deficits encourage them to seek support and guidance from their employees, but more research exploring these mechanisms is needed.
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| 5. |
- Holm, Anna, et al.
(författare)
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Strengthening and supporting nurses’ communication with mechanically ventilated patients in the intensive care unit : Development of a communication intervention
- 2021
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Ingår i: International Journal of Nursing Studies Advances. - : Elsevier. - 2666-142X. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Nurse-patient communication in intensive care units is challenged by the fact that patients are voiceless due to intubation and mechanical ventilation. Difficult communication affects nurses negatively, and it requires knowledge and expertise to facilitate communication in this complex and technologically tense setting. Augmentative and alternative communication has been suggested as a way of optimising communication; several approaches can be combined in a multi-component intervention. Also, a communication algorithm has been proposed as a way of providing structure in patient communication. To enhance transparency and avoid poorly reported interventions, this paper describes the process, rationale and reflections behind developing a communication intervention called the ICU-COM.Objectives: To present the development process of a communication intervention prototype that aims to support and strengthen nurses’ communication with mechanically ventilated patients in an intensive care unit.Design: The Medical Research Council's framework for developing complex interventions in health was applied. The approach was target-population centred.Settings: The intervention was developed and tailored to four intensive care unit departments at Aarhus University Hospital in Denmark.Participants: Intensive care nurses and various experts, namely, speech-language pathologists, graphic designers, a software company, the local Centre for E-learning and nurse specialists were involved in its development.Results: An intervention consisting of: 1) a multi-component communication bundle, 2) delivery of the bundle via a teaching session and 3) initial implementation via nurse communication guides was developed. The communication bundle contained: 1) a communication strategy with a BASIS framework and algorithm, 2) a nurse education programme and 3) low-tech and high-tech communication tools.Conclusions: A systematic approach was applied in the development process. However, the acceptability and feasibility of the intervention is at present unknown.
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| 6. |
- Melander, Sara, et al.
(författare)
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Critical incidents and post-traumatic stress symptoms among experienced registered nurses during the COVID-19 pandemic : a cross-sectional study
- 2024
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Ingår i: International Journal of Nursing Studies Advances. - : Elsevier. - 2666-142X. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Registered nurses working on the frontline during the COVID-19 pandemic encountered significant challenges, including exposure to critical incidents. Critical incidents refer to sudden unexpected clinical events that surpass an individual's ability to cope, leading to considerable psychological distress, which could potentially result in the development of post-traumatic stress disorder symptoms. Research has shown a high prevalence of post-traumatic stress disorder symptoms among healthcare workers, particularly those in close contact with COVID-19 patients.Objective: To assess the levels of post-traumatic stress symptoms among registered nurses in relation to exposure to working conditions during the COVID-19 pandemic, such as how much their work was affected by the pandemic, re-deployment, working hours hindering sufficient recovery between shifts and critical incidents.Design: Cross sectional study.Setting(s): The registered nurses working in multiple health care services covering all 21 geographic regions in Sweden.Participants: A total of 1,923 registered nurses, who are part of a Swedish national cohort and have been followed since their nursing education, were invited to participate in a survey in late September 2021 (15 to 19 years post graduation).Methods: The data were analyzed using descriptive statistics, unpaired t-tests, and one-way analysis of variance. Cohen's d was employed to quantify differences in mean levels between subgroups.Results: The response rate were 56.5 %. Over 50 % of experienced registered nurses reported significant disruptions to their work environments. In total, 85 % of registered nurses were exposed to at least one critical incident in their work during the pandemic, with 60 % facing organisational changes and nearly 50 % experiencing emotionally distressing situations. The exposure to work situations involving critical incidents consistently demonstrated strong associations with higher levels of post-traumatic stress disorder symptoms compared to those not exposed, with effect sizes ranging from moderate to high.Conclusions: This study underscores the profound impact that working conditions, such as redeployment and exposure to critical incidents, have on the mental health of registered nurses. We offer valuable insights into registered nurses’ pandemic-related challenges, highlighting the need for support and interventions to prevent and manage critical incidents, ultimately promoting their well-being. We also highlight the significance of thorough workforce readiness planning for future pandemics and other challenging health care scenarios, such as staff shortage.
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| 7. |
- Mihailovic, Marko, et al.
(författare)
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The personality of newly graduated and employed nurses : Temperament and character profiles of Swedish nurses
- 2022
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Ingår i: International Journal of Nursing Studies Advances. - : Elsevier BV. - 2666-142X. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Background: One of the challenges of the 21st century is the high turnover rate in the nursing profession due to burnout and mental illness. From a biopsychosocial perspective, an individual's personality is an important vulnerability-resilience factor that comprises four temperament traits (i.e., a person's emotional reactions) and three character traits (i.e., self-regulation systems). Indeed, different personality profiles are associated to different coping strategies and health outcomes. Objective: We investigated and mapped the temperament and character of Swedish newly graduated and employed nurses’ in relation to the Swedish general population and an age-matched sub-sample. Design: In this cross-sectional study, nurses self-reported their personality (Temperament and Character Inventory) at the beginning of their employment. Setting: The data collection was conducted at a hospital in the South of Sweden. Participants: A total of 118 newly graduated and employed nurses (Mage = 25.95±5.58) and 1,564 individuals from the Swedish general population participated in the study. Methods: We calculated T-scores and percentiles for all seven personality dimensions using the Swedish norms (N = 1,564). The profiles were calculated by combining high/low percentiles scores in three temperament dimensions (Novelty Seeking: N/n, Harm Avoidance: H/h, and Reward Dependence: R/r) and in the three character dimensions (Self-Directedness: S/s, Cooperativeness: C/c and Self-Transcendence: T/t). Results: Regarding T-scores, the nurses reported moderately lower Novelty Seeking (> 0.5 SD), slightly higher Harm-Avoidance (about 0.5 SD), moderately higher Persistence (> 0.5 SD) and Reward Dependence (> 0.5 SD), and extremely lower Self-Directedness (> 1 SD). The prevalence of the most common temperament profiles among the nurses (Swedish general population in brackets) were: 39.80% [10.90%] Cautious (nHR), 21.20% [10.90] Reliable (nhR), and 15.30% [16.50%] Methodical (nHr). The prevalence of the most common character profiles among the nurses were: 31.40% [4.90%] Dependent (sCt), 25.40% [14.40%] Apathetic (sct), and 19.50% [8.80%] Moody (sCT). Conclusions: The analyses of the personality profiles showed that High Novelty Seeking (79%), high Harm Avoidance (65%) high Reward Dependence (80%), low Self-Directedness (95%), and low Self-Transcendence (60%) were more prevalent among the newly graduated and employed nurses. This may partially explain newly graduated nurses’ difficulties at work and high turnover rate. After all, a well-developed character is of special importance when working with patients with serious and terminal illness or under large global crises, such as the current pandemic. Hence, both education at universities and development at work need to be person-centered to reduce stress levels and promote positive self-regulation strategies.
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| 8. |
- Neziraj, Merita, et al.
(författare)
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Prevention of pressure ulcers, malnutrition, poor oral health and falls in nursing homes : A focus group study with nurse aides, registered nurses and managers
- 2021
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Ingår i: International Journal of Nursing Studies Advances. - : Elsevier. - 2666-142X. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite available knowledge how to prevent the risk of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes, these risks still frequently occur and cause a major burden for older persons; furthermore, for the health care system, they are extremely costly. One way to combat these risks is to register the prevention process in quality registries. However, the increasing older population worldwide is going to put high demands on those working with this group of people. Objective: To explore how nurse aides, registered nurses and managers in nursing homes experience working with the prevention of pressure ulcers, malnutrition, poor oral health and falls in general and according to the quality register Senior Alert care process. Methods: A qualitative study was conducted in nursing homes in a municipality in southern Sweden. We purposively sampled nurse aides, registered nurses and managers (n = 21) working in nursing homes registered in the quality register Senior Alert, who then participated in one of five focus group semistructured digital interviews held between February and April 2020. The interviews were audio recorded. Data were analysed using reflexive thematic analysis. Results: Our findings explore how nurse aides, registered nurses and managers experience working with the prevention of pressure ulcers, malnutrition, poor oral health and falls in nursing homes both in general and according to Senior Alert. The following four themes were generated during the analysis: (1) is included in the everyday work, (2) requires team effort, (3) requires handling many challenges and (4) requires finding strategies. Conclusion: The prevention of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes is complex. There is a commitment and responsibility among nurse aides, registered nurses and managers regarding preventive work and team effort, and finding useful strategies is necessary for the work to be successful. However, challenges, both at the individual and organizational levels, are involved, which implies that smoother organizational routines facilitating this preventive work are needed. Although nurse aides, registered nurses and managers are good at finding strategies that facilitate this work, one of the main challenges seems to lie in the variety of knowledge found among those working in nursing homes, particularly among nurse aides. This challenge was voiced by all the professionals, which suggests the need for a tailored educational intervention aimed at increasing the related knowledge among those working in nursing homes to enhance preventive work.
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| 9. |
- Olausson, Alexander, et al.
(författare)
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Patients’ perioperative experiences of an opioid-free versus opioid-based care pathway for laparoscopic bariatric surgery : A qualitative study
- 2024
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Ingår i: International Journal of Nursing Studies Advances. - 2666-142X. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite recent evidence supporting the adoption of opioid-free anaesthetic and analgesic alternatives in the perioperative context, opioid-based regimens remain standard of care. There is limited knowledge about the patients’ perioperative experiences of bariatric surgery, with no study yet investigating their experiences within an opioid-free care pathway. Objective: We aimed to describe similarities and differences in patients’ perioperative experiences of undergoing bariatric surgery with either an opioid-free or opioid-based care pathway. Design: A qualitative interview study Setting: A strategic sample of patients enrolled in an ongoing randomized controlled trial investigating the effects of opioid-free anaesthesia for bariatric surgery were recruited. In the randomized controlled trial, participants were randomized to either opioid-based anaesthesia or opioid-free anaesthesia, including transcutaneous electrical nerve stimulation as primary postoperative pain management. Participants: Twenty patients were interviewed 3 months after surgery: 10 participants in the opioid-free group versus 10 in the opioid-based group. Methods: Semi-structured interviews were conducted between December 2020 and February 2022 and analysed with qualitative content analysis. Results: The analysis yielded four categories and 12 subcategories. In Category 1, participants shared diverse emotions before surgery, including anticipation of a healthier life, but also apprehensions and feelings of failure. In Category 2, describing liminality of general anaesthesia, there were similar descriptions of struggling to remember the anaesthesia induction and struggling to surface when recovering from anaesthesia. However, some participants in the opioid-free group shared descriptions of struggling to keep control, describing accentuated memories of the anaesthesia induction. Category 3, managing your pain, showed similar experiences and strategies but different narrations of pain management, with the opioid-free group stating that transcutaneous electrical nerve stimulation works but not when it really hurts, and the opioid-based group describing confidence in but awareness of opioids. Throughout the overall perioperative time period, participants acknowledged Category 4, a patient-professional presence, stating that preparations boost the feeling of confidence before surgery and that they felt confidence in a vulnerable situation although vulnerability challenges communication. Conclusions: We highlighted the overall similarities in perioperative experiences of patients undergoing bariatric surgery. However, the differences in experiences during opioid-free anaesthesia induction need to be addressed in further implementation and research studies investigating strategies to reduce the sense of loss of control. More research is needed to facilitate the implementation of opioid-free treatment strategies into clinical practice and improve the patient care experience.
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| 10. |
- Olausson, Alexander, et al.
(författare)
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Patients' perioperative experiences of an opioid-free versus opioid-based care pathway for laparoscopic bariatric surgery: A qualitative study
- 2024
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Ingår i: INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES. - : Elsevier. - 2666-142X. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite recent evidence supporting the adoption of opioid-free anaesthetic and analgesic alternatives in the perioperative context, opioid-based regimens remain standard of care. There is limited knowledge about the patients ' perioperative experiences of bariatric surgery, with no study yet investigating their experiences within an opioid-free care pathway. Objective: We aimed to describe similarities and differences in patients ' perioperative experiences of undergoing bariatric surgery with either an opioid-free or opioid-based care pathway. Design: A qualitative interview study Setting: A strategic sample of patients enrolled in an ongoing randomized controlled trial investigating the effects of opioid-free anaesthesia for bariatric surgery were recruited. In the randomized controlled trial, participants were randomized to either opioid-based anaesthesia or opioid-free anaesthesia, including transcutaneous electrical nerve stimulation as primary postoperative pain management. Participants: Twenty patients were interviewed 3 months after surgery: 10 participants in the opioid-free group versus 10 in the opioid-based group. Methods: Semi -structured interviews were conducted between December 2020 and February 2022 and analysed with qualitative content analysis. Results: The analysis yielded four categories and 12 subcategories. In Category 1, participants shared diverse emotions before surgery, including anticipation of a healthier life, but also apprehensions and feelings of failure . In Category 2, describing liminality of general anaesthesia , there were similar descriptions of struggling to remember the anaesthesia induction and struggling to surface when recovering from anaesthesia. However, some participants in the opioid-free group shared descriptions of struggling to keep control , describing accentuated memories of the anaesthesia induction. Category 3, managing your pain, showed similar experiences and strategies but different narrations of pain management, with the opioid-free group stating that transcutaneous electrical nerve stimulation works but not when it really hurts , and the opioid-based group describing confidence in but awareness of opioids . Throughout the overall perioperative time period, participants acknowledged Category 4, a patient -professional presence, stating that preparations boost the feeling of confidence before surgery and that they felt confidence in a vulnerable situation although vulnerability challenges communication . Conclusions: We highlighted the overall similarities in perioperative experiences of patients undergoing bariatric surgery. However, the differences in experiences during opioid-free anaesthesia induction need to be addressed in further implementation and research studies investigating strategies to reduce the sense of loss of control. More research is needed to facilitate the implementation of opioid-free treatment strategies into clinical practice and improve the patient care experience.
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