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Publications (10 of 51) Show all publications
Sirkka, M., Larsson-Lund, M. & Zingmark, K. (2017). Arbetsterapeuters erfarenheter av förbättringsarbete: en resa mot hållbar evidensbaserad praktik. In: : . Paper presented at Arbetsterapiforum 2017, Malmö, 10-11 maj 2017.
Open this publication in new window or tab >>Arbetsterapeuters erfarenheter av förbättringsarbete: en resa mot hållbar evidensbaserad praktik
2017 (Swedish)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [sv]

Bakgrund: Arbetsterapeuter har skyldighet att bedriva en evidensbaserad verksamhet baserad på bästa tillgängligavetenskapliga kunskap, professionens expertkunnande, patienternas erfarenheter och tillgängliga resurser. Forskningvisar dock att implementering av evidensbaserade åtgärder kan vara besvärliga att omsätta i praktiken och påbörjadeförbättringsarbeten kan vara svåra att få hållbara över tid. Det har även visat sig att praxismodeller där de används gerförutsättningar för ett evidensbaserat arbetssätt men användandet har studerats i begränsad omfattning.Syfte: var att utforska arbetsterapeuters erfarenheter av att delta i ett långsiktigt förbättringsarbete baserad påOccupational Therapy Intervention Process Model (OTIPM).Metod: Data utgjordes av semistrukturerade intervjuer med 19 arbetsterapeuter i tre fokusgrupper år 2006 ochuppföljande tre fokusgruppsintervjuer år 2011. Materialet analyserades med kvalitativ innehållsanalys.Resultat/preliminärt resultat: Det långsiktiga förbättringsarbetet beskrevs som en resa mot en hållbar ochevidensbaserad praktik. Resultatet visar på en förändringsresa med tre sammanflätade perspektiv; 1) omvandla tankaroch handlingar genom återkommande kollegial reflektion, 2) hantera den upplevda dubbelheten av förändring, 3)utveckla en ömsesidigt professionell kultur.Slutsats: Studien visar hur ett reflekterande kollegialt förhållningssätt och användning av en arbetsterapeutisk praxismodell kan leda till implementering av evidensbaserad kunskap som stödjer kontinuerliga hållbara förbättringar ipraktiken.

National Category
Occupational Therapy Nursing
Research subject
Occupational therapy; Nursing
Identifiers
urn:nbn:se:ltu:diva-62943 (URN)
Conference
Arbetsterapiforum 2017, Malmö, 10-11 maj 2017
Available from: 2017-04-07 Created: 2017-04-07 Last updated: 2018-02-07Bibliographically approved
Karlsson, E., Zingmark, K., Axelsson, K. & Sävenstedt, S. (2017). Aspects of Self and Identity in Narrations About Recent Events: Communication With Individuals With Alzheimer's Disease Enabled by a Digital Photograph Diary. Journal of Gerontological Nursing, 43(6), 25-31
Open this publication in new window or tab >>Aspects of Self and Identity in Narrations About Recent Events: Communication With Individuals With Alzheimer's Disease Enabled by a Digital Photograph Diary
2017 (English)In: Journal of Gerontological Nursing, ISSN 0098-9134, E-ISSN 1938-243X, Vol. 43, no 6, p. 25-31Article in journal (Refereed) Published
Abstract [en]

The ability to narrate autobiographical memories is important for maintaining the identity of individuals with Alzheimer's disease (AD). The current study explored how the sense of self is manifested in narrations about recent events, enabled via a digital photograph diary. Use of a digital photograph diary was tested with seven individuals with AD and their household members. Narrative analysis was used to analyze audiorecordings of the pairs' communication about recent events shown in the photographs. The results show how individuals with AD understand events illustrated in recent photographs in relation to their sense of self and associated skills and abilities that are facets of their selfhood. This type of digital photograph diary has the potential to support individuals with AD to maintain their sense of self and participation in everyday life, and strengthen their relationships with household members; it could be an important tool in person-centered care.

Place, publisher, year, edition, pages
SLACK, 2017
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-64200 (URN)10.3928/00989134-20170126-02 (DOI)000404264400004 ()2-s2.0-85021768839 (Scopus ID)
Note

Validerad;2017;Nivå 2;2017-08-14 (andbra)

Available from: 2017-06-19 Created: 2017-06-19 Last updated: 2018-07-10Bibliographically approved
Sirkka, M., Zingmark, K. & Larsson-Lund, M. (2017). En process för utveckling av hållbar evidensbaserad arbetsterapi. In: : . Paper presented at Arbetsterapiforum 2017, Malmö, 10-11 maj 2017.
Open this publication in new window or tab >>En process för utveckling av hållbar evidensbaserad arbetsterapi
2017 (Swedish)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [sv]

Bakgrund: För att uppnå hög kvalitet inom arbetsterapi måste ny kunskap hela tiden övervägas, reflekteras ochintegreras i det dagliga arbetet. Implementering av ny kunskap kräver ett långsiktigt förbättringsarbete med struktur, stödoch tid för att lyckas. Professionsanpassade modeller och ramverk avser att stödja arbetsterapeutisk intervention ochutveckla professionell kompetens. När modellerna används ger det förutsättningar för hållbart förbättringsarbete ochevidensbaserat arbetssätt men har i mycket begränsad utsträckning studerats ur detta perspektiv.Syfte: att utforska och beskriva hur ett långsiktigt förbättringsarbete vid en arbetsterapienhet baserat på OccupationalTherapy Intervention Process Model (OTIPM) utvecklades.Metod: Studien var en kvalitativ beskrivande studie av skriftliga dokument från långsiktigt förbättringsarbete. Dokumentenbestod av a) enhetsplaner, b) dokumentering från förbättringsarbetet, c) resultat av genomförda patientenkäter, d)resultat av genomförda journalgranskningar, e) ett generellt arbetsterapiprogram och sju specifika arbetsterapiprogram(både aktuella och reviderade versioner), f) aktuell journalföringsmanual, g) 20 patientinformationer, h) 90 rutindokument.Data analyserdes med mönsterjämförelser (pattern matching).Resultat/preliminärt resultat: Analysen av dokumenten bildade tre huvudmönster: a) omorientering mot OTIPM, b)implementeringen av OTIPM, c) säkerställande av hållbarheten av implementeringen. Varje mönster innehöll ett antalfaser som beskrev skälen till varför varje fas påbörjades, vad som påbörjades i varje fas och vad förbättringsarbetetresulterade i, flera av faserna blev startpunkter för nya förbättringar som fortsatte kontinuerligt genom åren.Slutsats: Resultatet visar hur en arbetsterapeutisk praxismodell som till exempel OTIPM, kan vägleda enförbättringsprocess och hålla den pågående under en länge tid och därigenom stödja hållbara kontinuerliga förbättringar ien arbetsterapi verksamhet

National Category
Occupational Therapy Nursing
Research subject
Occupational therapy; Nursing
Identifiers
urn:nbn:se:ltu:diva-62946 (URN)
Conference
Arbetsterapiforum 2017, Malmö, 10-11 maj 2017
Available from: 2017-04-07 Created: 2017-04-07 Last updated: 2018-02-07Bibliographically approved
Sjögren, K., Lindkvist, M., Sandman, P.-O., Zingmark, K. & Edvardsson, D. (2017). Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study. BMC Nursing, 16(1), Article ID 44.
Open this publication in new window or tab >>Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study
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2017 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 16, no 1, article id 44Article in journal (Refereed) Published
Abstract [en]

BACKGROUNDFew studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics.METHODSA cross-sectional design was used. Residents (n = 1460) and staff (n = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents. Descriptive and comparative statistics, independent samples t-test, Chi2 test, Eta Squared and Phi coefficient were used to analyse data.RESULTSHighly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care.CONCLUSIONSIt is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.

Place, publisher, year, edition, pages
BioMed Central, 2017
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-65162 (URN)10.1186/s12912-017-0240-4 (DOI)000407709500001 ()28808426 (PubMedID)2-s2.0-85027153006 (Scopus ID)
Note

Validerad; 2017; Nivå 2; 2017-08-17 (andbra)

Available from: 2017-08-17 Created: 2017-08-17 Last updated: 2018-07-10Bibliographically approved
Darehed, D., Norrving, B., Stegmayr, B., Zingmark, K. & Blom, M. C. (2017). Patients with acute stroke are less likely to be admitted directly to a stroke unit when hospital beds are scarce: A Swedish multicenter register study. European Stroke Journal
Open this publication in new window or tab >>Patients with acute stroke are less likely to be admitted directly to a stroke unit when hospital beds are scarce: A Swedish multicenter register study
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2017 (English)In: European Stroke Journal, ISSN 2396-9873, E-ISSN 2396-9881Article in journal (Refereed) Published
Abstract [en]

Introduction

It is well established that managing patients with acute stroke in dedicated stroke units is associated with improved functioning and survival. The objectives of this study are to investigate whether patients with acute stroke are less likely to be directly admitted to a stroke unit from the Emergency Department when hospital beds are scarce and to measure variation across hospitals in terms of this outcome.

Patients and methods

This register study comprised data on patients with acute stroke admitted to 14 out of 72 Swedish hospitals in 2011–2014. Data from the Swedish stroke register were linked to administrative daily data on hospital bed occupancy (measured at 6 a.m.). Logistic regression analysis was used to analyse the association between bed occupancy and direct stroke unit admission.

Results

A total of 13,955 hospital admissions were included; 79.6% were directly admitted to a stroke unit from the Emergency Department. Each percentage increase in hospital bed occupancy was associated with a 1.5% decrease in odds of direct admission to a stroke unit (odds ratio = 0.985, 95% confidence interval = 0.978–0.992). The best-performing hospital exhibited an odds ratio of 3.8 (95% confidence interval = 2.6–5.5) for direct admission to a stroke unit versus the reference hospital.

Discussion and conclusion

We found an association between hospital crowding and reduced quality of care in acute stroke, portrayed by a lower likelihood of patients being directly admitted to a stroke unit from the Emergency Department. The magnitude of the effect varied considerably across hospitals.

Place, publisher, year, edition, pages
Sage Publications, 2017
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-62809 (URN)10.1177/2396987317698328 (DOI)
Note

Validerad; 2017; Nivå 1; 2017-05-18 (andbra)

Available from: 2017-03-30 Created: 2017-03-30 Last updated: 2018-11-15Bibliographically approved
Karlsson, M., Garvare, R., Zingmark, K. & Nordström, B. (2016). Customer orientation in a Swedish county council (ed.). International Journal of Quality and Service Sciences, 8(1), 2-16
Open this publication in new window or tab >>Customer orientation in a Swedish county council
2016 (English)In: International Journal of Quality and Service Sciences, ISSN 1756-669X, E-ISSN 1756-6703, Vol. 8, no 1, p. 2-16Article in journal (Refereed) Published
Abstract [en]

PurposeThe use of the customer concept and ways of interacting with customers in support functions are relatively new areas of interest for public organizations. The aim of this study is to describe the development towards a stronger customer orientation in a support function in a Swedish county council from a management team perspective.Design/methodology/approachA revision of plans and annual reports and individual interviews with the members of a management team was done. The interviews were examined using qualitative content analysis.FindingsThe results are presented in one overarching theme: the double-edged customer concept, and three themes: meeting the customer’s needs, being the customer’s specialist, and developing in collaboration with the customer. The development of a customer orientation is illustrated as a spiral involving the concepts of understanding, wanting, and acting.Originality/valueThe paper contributes to new understanding of how customer orientation develops in the context of public organizations’ support functions.

National Category
Reliability and Maintenance
Research subject
Quality Technology and Management
Identifiers
urn:nbn:se:ltu:diva-5210 (URN)3412978d-34f8-4381-8a8a-b026642fdff7 (Local ID)3412978d-34f8-4381-8a8a-b026642fdff7 (Archive number)3412978d-34f8-4381-8a8a-b026642fdff7 (OAI)
Note

Validerad; 2016; Nivå 1; 20160212 (andbra)

Available from: 2016-09-29 Created: 2016-09-29 Last updated: 2018-02-07Bibliographically approved
Grönlund, C. F., Dahlqvist, V., Zingmark, K., Sandlund, M. & Söderberg, A. (2016). Managing Ethical Difficulties in Healthcare: Communicating in Inter-professional Clinical Ethics Support Sessions (ed.). HEC Forum, 28(4), 321-338
Open this publication in new window or tab >>Managing Ethical Difficulties in Healthcare: Communicating in Inter-professional Clinical Ethics Support Sessions
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2016 (English)In: HEC Forum, ISSN 0956-2737, E-ISSN 1572-8498, Vol. 28, no 4, p. 321-338Article in journal (Refereed) Published
Abstract [en]

Several studies show that healthcare professionals need to communicate inter-professionally in order to manage ethical difficulties. A model of clinical ethics support (CES) inspired by Habermas' theory of discourse ethics has been developed by our research group. In this version of CES sessions healthcare professionals meet inter-professionally to communicate and reflect on ethical difficulties in a cooperative manner with the aim of reaching communicative agreement or reflective consensus. In order to understand the course of action during CES, the aim of this study was to describe the communication of value conflicts during a series of inter-professional CES sessions. Ten audio- and video-recorded CES sessions were conducted over eight months and were analyzed by using the video analysis tool Transana and qualitative content analysis. The results showed that during the CES sessions the professionals as a group moved through the following five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, the revelation of the value conflict, enhancing realistic expectations, seeing opportunities to change the situation instead of obstacles. In the course of CES, the professionals moved from an individual interpretation of the situation to a common, new understanding and then to a change in approach. An open and permissive communication climate meant that the professionals dared to expose themselves, share their feelings, face their own emotions, and eventually arrive at a mutual shared reality. The value conflict was not only revealed but also resolved

National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-6937 (URN)10.1007/s10730-016-9303-2 (DOI)000410009400004 ()27147521 (PubMedID)2-s2.0-84966262549 (Scopus ID)544b3532-c426-4747-ade3-cd5be91d3373 (Local ID)544b3532-c426-4747-ade3-cd5be91d3373 (Archive number)544b3532-c426-4747-ade3-cd5be91d3373 (OAI)
Note

Validerad; 2016; Nivå 1; 2016-11-02 (rokbeg)

Available from: 2016-09-29 Created: 2016-09-29 Last updated: 2018-07-10Bibliographically approved
Nordmark, S., Zingmark, K. & Lindberg, I. (2016). Process evaluation of discharge planning implementation in healthcare using normalization process theory (ed.). BMC Medical Informatics and Decision Making, 16(1), Article ID 48.
Open this publication in new window or tab >>Process evaluation of discharge planning implementation in healthcare using normalization process theory
2016 (English)In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 16, no 1, article id 48Article in journal (Refereed) Published
Abstract [en]

BackgroundDischarge planning is a care process that aims to secure the transfer of care for the patient at transition from home to the hospital and back home. Information exchange and collaboration between care providers are essential, but deficits are common. A wide range of initiatives to improve the discharge planning process have been developed and implemented for the past three decades. However, there are still high rates of reported medical errors and adverse events related to failures in the discharge planning. Using theoretical frameworks such as Normalization Process Theory (NPT) can support evaluations of complex interventions and processes in healthcare. The aim of this study was to explore the embedding and integration of the DPP from the perspective of registered nurses, district nurses and homecare organizers.MethodsThe study design was explorative, using the NPT as a framework to explore the embedding and integration of the DPP. Data consisted of written documentation from; workshops with staff, registered adverse events and system failures, web based survey and individual interviews with staff.ResultsUsing the NPT as a framework to explore the embedding and integration of discharge planning after 10 years in use showed that the staff had reached a consensus of opinion of what the process was (coherence) and how they evaluated the process (reflexive monitoring). However, they had not reached a consensus of opinion of who performed the process (cognitive participation) and how it was performed (collective action). This could be interpreted as the process had not become normalized in daily practice.ConclusionThe result shows necessity to observe the implementation of old practices to better understand the needs of new ones before developing and implementing new practices or supportive tools within healthcare to reach the aim of development and to accomplish sustainable implementation. The NPT offers a generalizable framework for analysis, which can explain and shape the implementation process of old practices, before further development of new practices or supportive tools.

National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-4734 (URN)10.1186/s12911-016-0285-4 (DOI)000374854500001 ()27121500 (PubMedID)2-s2.0-84966291984 (Scopus ID)2ba24294-a80d-42c2-8ea1-26aa869f0575 (Local ID)2ba24294-a80d-42c2-8ea1-26aa869f0575 (Archive number)2ba24294-a80d-42c2-8ea1-26aa869f0575 (OAI)
Note

Validerad; 2016; Nivå 2; 20160428 (andbra)

Available from: 2016-09-29 Created: 2016-09-29 Last updated: 2018-07-10Bibliographically approved
Stridsman, C., Zingmark, K., Lindberg, A. & Skär, L. (2015). Creating a balance between breathing and viability: Experiences of well-being when living with chronic obstructive pulmonary disease (ed.). Paper presented at . Primary Health Care Research and Development, 16(1), 42-52
Open this publication in new window or tab >>Creating a balance between breathing and viability: Experiences of well-being when living with chronic obstructive pulmonary disease
2015 (English)In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 16, no 1, p. 42-52Article in journal (Refereed) Published
Abstract [en]

Aim To describe experiences of well-being among people with moderate to very severe chronic obstructive pulmonary disease (COPD). BACKGROUND: Living with COPD is related to a complex life situation, and quality of life (QOL) is shown to decrease because of respiratory symptoms and fatigue. However, studies describing well-being in COPD as a subjective description of QOL are rare. METHODS: Ten participants with moderate to very severe COPD from the Obstructive Lung Disease in Northern Sweden (OLIN) COPD study were interviewed about their experiences of well-being. A latent qualitative content analysis was used to analyse the data. Findings To achieve well-being despite breathlessness, the participants had to adapt to their limitations and live towards the future. They created a balance between breathing and viability by adjusting to a lifelong limitation, handling variations in illness, relying on self-capacity and accessibility to a trustful care. The participants adjusted to lifelong limitations through acceptance and replacement of former activities. They handled variations in illness by taking advantage of the good days and using emotional adaptation strategies. The participants relied on their own self-capacity, feeling that smoking cessation, physical activity and breathing fresh air increased their well-being. They requested accessibility to a trustful care and highlighted the need for continuous care relationships and access to medications. These findings can enhance health-care professionals' understanding of the possibilities for increased well-being for people living with COPD.

National Category
Other Health Sciences Nursing
Research subject
Health Science; Nursing
Identifiers
urn:nbn:se:ltu:diva-14231 (URN)10.1017/S1463423614000048 (DOI)000369919100007 ()24528672 (PubMedID)2-s2.0-84973413736 (Scopus ID)d95cb8fa-1c73-420b-ad6c-f9255541ff67 (Local ID)d95cb8fa-1c73-420b-ad6c-f9255541ff67 (Archive number)d95cb8fa-1c73-420b-ad6c-f9255541ff67 (OAI)
Note
Validerad; 2015; Nivå 1; 20140107 (andbra)Available from: 2016-09-29 Created: 2016-09-29 Last updated: 2018-07-10Bibliographically approved
Fischer Grönlund, C. E. C., Söderberg, A. I. .., Zingmark, K., Sandlund, S. M. & Dahlqvist, V. (2015). Ethically difficult situations in hemodialysis care: Nurses’ narratives. Nursing Ethics, 22(6), 711-722
Open this publication in new window or tab >>Ethically difficult situations in hemodialysis care: Nurses’ narratives
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2015 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, no 6, p. 711-722Article in journal (Refereed) Published
Abstract [en]

Background: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose. Research question: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses’ experiences of being in ethically difficult situations that give rise to a troubled conscience. Research design: This study has a phenomenological hermeneutic approach. Participants: Narrative interviews were carried out with 10 registered nurses working in dialysis care. Ethical considerations: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University. Results: One theme, ‘Calling for a deliberative dialogue’, and six sub-themes emerged: ‘Dealing with patients’ ambiguity’, ‘Responding to patients’ reluctance’, ‘Acting against patients’ will’, ‘Acting against one’s moral convictions’, ‘Lacking involvement with patients and relatives’ and ‘Being trapped in feelings of guilt’. Discussion: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience. Conclusion: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.

National Category
Nursing
Identifiers
urn:nbn:se:ltu:diva-61261 (URN)10.1177/0969733014542677 (DOI)
Available from: 2016-12-27 Created: 2016-12-27 Last updated: 2018-02-07Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5953-8970

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