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Wälivaara, B.-M., Zingmark, K. & Fischer-Gronlund, C. (2023). Descriptions of long-term impact from inter-professional ethics communication in groups. Nursing Ethics, 30(4), 614-625
Open this publication in new window or tab >>Descriptions of long-term impact from inter-professional ethics communication in groups
2023 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 30, no 4, p. 614-625Article in journal (Refereed) Published
Abstract [en]

Background

On a daily basis, healthcare professionals deal with various ethical issues and it can be difficult to determine how to act best. Clinical ethics support (CES) has been developed to provide support for healthcare professionals dealing with complex ethical issues. A long-term perspective of participating in inter-professional dialogue and reflective-based CES sessions is seemingly sparse in the literature.

Research aim

The aim was to describe experiences of impact of Inter-professional Ethics Communication in groups (IEC) based on Habermas’ theory of communicative actions, after 6 months from the perspective of an inter-professional team.

Research design

A qualitative inductive approach was chosen, and individual interviews (n = 13) were conducted. Interview data were analysed using qualitative content analysis.ParticipantsThe participants, 10 females and two males, represented assistant nurses, registered nurses, physicians, occupational therapists, physiotherapists, welfare officers and psychologists. Each had attended at least four IEC sessions.

Ethical considerations

The study was approved by the Regional Ethical Review Board in Umeå, Sweden, and it has been undertaken in accordance with the Helsinki Declaration.

Findings

Overall, the descriptions expressed a perceived achievement of a deepened and integrated ethical awareness that increased the participants’ awareness of ethically difficult situations as well as their own ethical thinking, actions and approaches in daily work. Perspectives were shared and the team become more welded. They carried the memories of the reflections within them, which was perceived as supportive when encountered new ethically situations.

Discussion

Putting words to unarticulated thoughts may stimulate repeated reflections, leading to new insights and alternative thoughts.

Conclusion

The outcome of IEC sessions 6 months following the last session can be described as an incorporated knowledge that enables actions in ethically difficult situations based on an ethical awareness both at a ‘We-level’ and an ‘I-level’.

Place, publisher, year, edition, pages
Sage Publications, 2023
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-96450 (URN)10.1177/09697330231160007 (DOI)000949004500001 ()36920799 (PubMedID)2-s2.0-85150949938 (Scopus ID)
Note

Licens fulltext: CC BY

Available from: 2023-04-14 Created: 2023-04-14 Last updated: 2023-11-14Bibliographically approved
Sirkka, M., Larsson-Lund, M. & Zingmark, K. (2023). Experiences with continuous quality improvement work based on the Occupational Therapy Intervention Process Model. Scandinavian Journal of Occupational Therapy, 30(7), 1085-1091
Open this publication in new window or tab >>Experiences with continuous quality improvement work based on the Occupational Therapy Intervention Process Model
2023 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 30, no 7, p. 1085-1091Article in journal (Refereed) Published
Abstract [en]

Background: Sustainability is an important issue in implementation processes in health care, and more knowledge is needed to facilitate improvement work in occupational therapy practice.

Aim: The aim of this study was to explore how occupational therapists experienced continuous quality improvement work based on the Occupational Therapy Intervention Process Model after 17 years.

Method: Two focus group interviews were conducted with a total of 12 occupational therapists. The data were analysed using qualitative content analysis.

Results: The analysis resulted in three themes with related subthemes describing the occupational therapists’ experiences of their model-based long-term improvement work. The themes were labelled as follows: ‘sharing a safe and well-known professional reasoning’, ‘reaching normality and empowerment’ and ‘questioning and reshaping the too safe and too well-known normality’. The model functioned as a sustainable framework both for ordinary clinical practice and for continuous improvement work.

Conclusion: By using the model, the occupational therapists had established a safe and well-known professional reasoning in which continual quality improvement work had become sustainable.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Models of practice, sustainability, occupational therapy, professional reasoning
National Category
Occupational Therapy
Research subject
Occupational Therapy; Nursing
Identifiers
urn:nbn:se:ltu:diva-93011 (URN)10.1080/11038128.2022.2121756 (DOI)000852161000001 ()36084242 (PubMedID)2-s2.0-85138224719 (Scopus ID)
Funder
Norrbotten County Council
Note

Validerad;2023;Nivå 2;2023-11-08 (joosat);

Full text license: CC BY-NC-ND 4.0

Available from: 2022-09-13 Created: 2022-09-13 Last updated: 2023-11-08Bibliographically approved
Almevall, A. D., Wennberg, P., Zingmark, K., Öhlin, J., Söderberg, S., Olofsson, B., . . . Niklasson, J. (2022). Associations between everyday physical activity and morale in older adults. Geriatric Nursing, 48, 37-42
Open this publication in new window or tab >>Associations between everyday physical activity and morale in older adults
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2022 (English)In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 48, p. 37-42Article in journal (Refereed) Published
Abstract [en]

Studies that objectively investigate patterns of everyday physical activity in relation to well-being and that use measures specific to older adults are scarce. This study aimed to explore objectively measured everyday physical activity and sedentary behavior in relation to a morale measure specifically constructed for older adults. A total of 77 persons (42 women, 35 men) aged 80 years or older (84.3 ± 3.8) wore an accelerometer device for at least 5 days. Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS). PGCMS scores were significantly positively associated with number of steps, time spent stepping, and time spent stepping at >75 steps per minute. Sedentary behavior did not associate with PGCMS. Promoting PA in the form of walking at any intensity–or even spending time in an upright position—and in any quantity may be important for morale, or vice versa, or the influence may be bidirectional.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Aged, 80 and over, Morale, Physical activity, Accelerometer, Well-being
National Category
Physiotherapy Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-92951 (URN)10.1016/j.gerinurse.2022.08.007 (DOI)000859439100006 ()36099778 (PubMedID)2-s2.0-85137619883 (Scopus ID)
Note

Validerad;2022;Nivå 2;2022-09-12 (hanlid)

Available from: 2022-09-12 Created: 2022-09-12 Last updated: 2023-04-06Bibliographically approved
Almevall, A., Nordmark, S., Niklasson, J. & Zingmark, K. (2022). Experiences of home as an aspect of well-being in people over 80 years: A mixed method study. Journal of Advanced Nursing, 78(1), 252-263
Open this publication in new window or tab >>Experiences of home as an aspect of well-being in people over 80 years: A mixed method study
2022 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 78, no 1, p. 252-263Article in journal (Refereed) Published
Abstract [en]

Aims To (1) describe experiences of home from a well-being perspective, (2) describe participant characteristics and well-being measures in relation to housing type (3) and how the aforementioned aspects may affect well-being in very old persons. Design Cross-sectional, convergent parallel-results mixed method design with semi-structured interviews analysed by qualitative content analysis, in relation to descriptive statistics and specific well-being outcome measures related to home. Methods A total of 50 persons 80 years or older living in ordinary housing were interviewed (July 2017 to November 2018) about home in relation to well-being, along with collection of participant characteristics and well-being measures related to home. Results Participants described how home had become increasingly important as it provided autonomy and acted as a social and occupational hub. However, autonomy was not unconditional, and home could also be perceived as a place of inactive solitude. Results were interpreted as relating to being in the margins of home and had a major impact on well-being. Housing type seemed of importance with higher measures of well-being for participants in single-living housing compared with those living in apartment. Conclusion Home is increasingly central to well-being in old age; however, very old persons also have to relate to being physically and mentally in the margins of being able to remain in the home. These aspects of home potentially have a major impact on well-being. Impact As very old persons living in ordinary housing will constitute a larger segment of society in coming years, aspects of home can potentially have a considerable impact on well-being for this age-group. This study describes aspects of home that contribute to, or has adverse impact on well-being. These aspects need thorough consideration in policy-making and planning of health care that can affect experiences of home.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
80 and over, aged, aging in place, independent living, nursing, ordinary housing, qualitative approaches, well-being
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-88125 (URN)10.1111/jan.15093 (DOI)000721418500001 ()34812517 (PubMedID)2-s2.0-85119698611 (Scopus ID)
Note

Validerad;2022;Nivå 2;2022-01-01 (johcin)

Available from: 2021-12-01 Created: 2021-12-01 Last updated: 2023-09-04Bibliographically approved
Nordmark, S., Lindberg, I. & Zingmark, K. (2022). “It’s all about time and timing”: nursing staffs’ experiences with an agile development process, from its initial requirements to the deployment of its outcome of ICT solutions to support discharge planning. BMC Medical Informatics and Decision Making, 22, Article ID 186.
Open this publication in new window or tab >>“It’s all about time and timing”: nursing staffs’ experiences with an agile development process, from its initial requirements to the deployment of its outcome of ICT solutions to support discharge planning
2022 (English)In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 22, article id 186Article in journal (Refereed) Published
Abstract [en]

Background

Agile projects are statistically more likely to succeed then waterfall projects. The overall aim of this study was to explore the nursing staffs’ experiences with an agile development process, from its initial requirements to the deployment of its outcome of ICT solutions aimed at supporting discharge planning.

Methods

An explorative design with quantitative and qualitative methods was used. Qualitative data was collected through seven focus group interviews. Quantitative data was collected via an ICT-system, and with an evaluation form submitted by fourteen registered nurses and nine district nurses.

Results

Qualitative result of the experiences with the agile development process and its outcome resulted in one theme, four categories, and ten subcategories. The theme was found to be about time and timing, namely the amount of time for the different activities and the timing of activities within and between organisations. The agile development process increased the participants’ readiness for change by offering time to learn, practice, engage and reflect, and then adopt the ICT as a support to daily practice. Quantitative results showed a variated adoption of the ICT.

Conclusion

There is a need for time to prepare, understand and adopt new tools, services and procedures and a need for additional time to prepare, understand and adopt the new among individuals, collectives, organizations, and sometimes even between different collectives or organizations. The agile development process offered the end-users involvement through the development process, which gave them time to change it both individually and collectively. However, there is a need for close collaboration between the development project team and management to reach an organizational change that is timely for both the individual and the collective change. When time or timing fails in the development or implementation process, there is a huge risk of non-adoption of new tools, services, or procedures or among the end-users.

Place, publisher, year, edition, pages
Springer Nature, 2022
Keywords
Collaboration, Agile, ICT, Experiences, Nurses, Homecare organizers, Discharge planning, Qualitative content analysis, Descriptive statistics
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-92207 (URN)10.1186/s12911-022-01932-4 (DOI)000826500500001 ()35843948 (PubMedID)2-s2.0-85134448589 (Scopus ID)
Funder
Luleå University of Technology, eHealth Innovation Centre
Note

Validerad;2022;Nivå 2;2022-07-19 (sofila)

Available from: 2022-07-19 Created: 2022-07-19 Last updated: 2022-10-28Bibliographically approved
Almevall, A., Juuso, P., Zingmark, K. & Nilsson, C. (2022). Perceptions of a good life for the oldest old living at home. International Journal of Ageing and Later Life, 16(1), 25-48
Open this publication in new window or tab >>Perceptions of a good life for the oldest old living at home
2022 (English)In: International Journal of Ageing and Later Life, E-ISSN 1652-8670, Vol. 16, no 1, p. 25-48Article in journal (Refereed) Published
Abstract [en]

An increasing number of people are growing older and living longer in their homes. This study aims to describe key stakeholders’ (politicians, managers, and professionals) perceptions of a good life for single-living oldest old persons living at home with extensive needs for support. Inter­views with stakeholders were analysed with content analysis. The analy­sis resulted in the theme: An incongruence between intentions and actions in promoting a good life for the oldest old. Our findings show a gap between intentions and actions, which caused feelings of powerlessness in the key stakeholders. To promote a good life for the oldest old persons, a congruence is needed between individual awareness and the prerequisite of promoting a good life. Developing methods that identify and bridge gaps between intentions and actions could support the abilities of organ­isations to promote a good life for the oldest old persons with extensive needs for support.

Place, publisher, year, edition, pages
Linköping University Electronic Press, 2022
Keywords
ageing in place, capabilities approach, caring, homecare, oldest old
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-92480 (URN)10.3384/ijal.1652-8670.2234 (DOI)2-s2.0-85142433609 (Scopus ID)
Note

Validerad;2022;Nivå 1;2022-11-25 (hanlid)

Available from: 2022-08-15 Created: 2022-08-15 Last updated: 2024-01-17Bibliographically approved
Almevall, A. D., Zingmark, K., Nordmark, S., Forslund, A.-S. & Niklasson, J. (2021). Accepting the inevitable: A mixed method approach with assessment and perceptions of well-being in very old persons within the northern Sweden Silver-MONICA study. Archives of gerontology and geriatrics (Print), 92, Article ID 104275.
Open this publication in new window or tab >>Accepting the inevitable: A mixed method approach with assessment and perceptions of well-being in very old persons within the northern Sweden Silver-MONICA study
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2021 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 92, article id 104275Article in journal (Refereed) Published
Abstract [en]

Background

As the group of very old persons will form an increasing part of society, the study of how well-being is described and affected by specific factors will be of importance to meet the future needs of these persons. The aim of the study was to increase knowledge of well-being in very old persons by combining assessments and perceptions using the Philadelphia Geriatric Morale Scale (PGCMS).

Method

In a mixed method, convergent parallel design, 52 persons 80 years or older were assessed and interviewed using the PGCMS to combine assessment of morale and descriptions of perceptions of well-being using a mixed method approach.

Results

Quantitative and qualitative results converged in four areas: not feeling lonely and being included, rating and perceiving health as good, high physical function/ability and being physically active, living in own house and feeling at home. Areas perceived as important to well-being captured only in qualitative analysis were having freedom and engagement. An example of insights not achievable from the quantitative or qualitative analysis alone was that individuals with high morale expressed anxiety about losing their health due to potential ageing-related threats and that individuals with low morale struggled with acceptance. Acceptance was the key strategy for handling adverse consequences of ageing in all described areas.

Conclusion

When using standardized assessment scales in clinical practice, it could be useful to combine quantitative and qualitative data. Acceptance was key for well-being; however, acceptance could be resigned or reorienting in nature.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Well-being, Quality of life, Oldest old, Subjective well-being, Life satisfaction
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-81054 (URN)10.1016/j.archger.2020.104275 (DOI)000600899700010 ()33032185 (PubMedID)2-s2.0-85092063262 (Scopus ID)
Note

Validerad;2020;Nivå 2;2020-10-07 (johcin)

Available from: 2020-10-07 Created: 2020-10-07 Last updated: 2023-09-04Bibliographically approved
Fischer- Grönlund, C., Brännström, M. & Zingmark, K. (2021). The ‘one to five’ method - A tool for ethical communication in groups among healthcare professionals. Nurse Education in Practice, 51, Article ID 102998.
Open this publication in new window or tab >>The ‘one to five’ method - A tool for ethical communication in groups among healthcare professionals
2021 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 51, article id 102998Article in journal (Refereed) Published
Abstract [en]

Healthcare professionals have expressed a wish for facilitated inter-professional communications about ethical difficulties experienced in clinical practice. The introduction of an easily accessible method for facilitating ethical communication in groups may promote its implementation in everyday clinical practice. The aim of this paper was to draw on previous studies and available knowledge in order to develop and describe a method that enables systematic implementation of inter-professional ethical communication in groups. The ‘one-to-five method’ for facilitated ethical communication in groups is theoretically inspired by Habermas's theory of communicative actions and base on previous studies that accords with the Helsinki Declaration (2013). The ‘one to five method’ supports guidance of ethical communication in five steps: telling the story about the situation; reflections and dialogue concerning the emotions involved; formulation of the problem/dilemma; analysis of the situation and the dilemma; and searching for a choice of action or approach. It offers an easily accessible method for teaching healthcare professionals how to facilitate ethics communication groups. Educating facilitators closely connected to clinical work may lead to ethical dialogue becoming a natural part of clinical practice for healthcare professionals.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Ethical communication method, Inter-professional, Healthcare professionals, Clinical ethics support
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-83175 (URN)10.1016/j.nepr.2021.102998 (DOI)000632918200025 ()33639607 (PubMedID)2-s2.0-85101422010 (Scopus ID)
Note

Validerad;2021;Nivå 2;2021-03-05 (johcin)

Available from: 2021-03-05 Created: 2021-03-05 Last updated: 2021-05-03Bibliographically approved
Karlsson, M., Garvare, R., Zingmark, K. & Nordström, B. (2020). Organizing for sustainable inter-organizational collaboration in health care processes. Journal of Interprofessional Care, 34(2), 241-250
Open this publication in new window or tab >>Organizing for sustainable inter-organizational collaboration in health care processes
2020 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 34, no 2, p. 241-250Article in journal (Refereed) Published
Abstract [en]

Integrating health care services has proven to be important from both the patient and organizational perspectives. This study explores what defines a perceived well-functioning collaboration in the inter-organizational process of providing assistive devices in Sweden. Two focus groups comprising participants with profound knowledge of collaboration were performed, and data were analyzed in five steps, resulting in a data structure. Results yield the identification of three interacting processes: coordinating efforts to patient needs, ensuring evidence-based practice, and planning for efficient use of resources. These processes affected one another, and, therefore, would likely not have been effectively managed separately. The study contributes to theories of process management and organization by specifically focusing on how to analyze and improve sustainable collaboration in health care processes at both the management and professional levels. Theoretical frameworks that show different ways of organizing collaboration, as well as the concepts of action nets and boundary objects, can support both analysis and planning of collaboration. The intention would be to develop integration in inter-organizational health care processes, resulting in more person-centered care.

Place, publisher, year, edition, pages
Taylor & Francis, 2020
Keywords
Focus groups, interprofessional collaboration, integration, partnership, health and social care
National Category
Reliability and Maintenance Nursing Physiotherapy
Research subject
Quality technology and logistics; Nursing; Physiotherapy
Identifiers
urn:nbn:se:ltu:diva-75581 (URN)10.1080/13561820.2019.1638760 (DOI)000477536400001 ()31329471 (PubMedID)2-s2.0-85080829036 (Scopus ID)
Note

Validerad;2020;Nivå 2;2020-02-28 (alebob)

Available from: 2019-08-19 Created: 2019-08-19 Last updated: 2023-09-05Bibliographically approved
Grönlund, C. F., Söderberg, A., Dahlqvist, V., Sandlund, M. & Zingmark, K. (2019). Communicative and organizational aspects of clinical ethics support. Journal of Interprofessional Care, 33(6), 724-733
Open this publication in new window or tab >>Communicative and organizational aspects of clinical ethics support
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2019 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 33, no 6, p. 724-733Article in journal (Refereed) Published
Abstract [en]

Studies show that healthcare professionals need inter-professional clinical ethics support (CES) in order to communicate and reflect on ethically difficult care situations that they experience in their clinical practice. Internationally, various CES interventions have been performed, but the communication processes and organisation of these interventions are rarely described in detail. The aim of this study was to explore communicative and organisational conditions of a CES intervention with the intention of promoting inter-professional communication about ethically difficult care situations. Eight audio- and video-recorded inter-professional CES sessions, inspired by Habermas' theory of communicative actions, were conducted. The observations were transcribed, sorted, and analysed using concept- and data-driven content analysis methods. The findings show three approaches to promoting communicative agreement, which include the CES facilitators' and participants' approaches to promoting a permissive communication, extended views, and mutual understanding. The CES sessions had organizational aspects for facilitating communicative agreement with both a given structure and openness for variation. The dynamic structure of the organization, promoted both safety and stability as well as a creativity and responsiveness, which in turn opened up for a free and dynamic inter-professional dialogue concerning ethically difficult care situations. The findings constitute a step towards a theory-based CES method inspired by Habermas' theory of communicative action. Further research is needed in order to fully develop the method and obtain increased knowledge about how to promote an inter-professional dialogue about ethically difficulties.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Clinical ethics support, care ethics, ethically difficult situations, healthcare professionals, inter-professional communication
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-71893 (URN)10.1080/13561820.2018.1551862 (DOI)000493764900015 ()30497309 (PubMedID)2-s2.0-85057527109 (Scopus ID)
Note

Validerad;2019;Nivå 2;2019-11-22 (johcin)

Available from: 2018-12-05 Created: 2018-12-05 Last updated: 2021-12-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5953-8970

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