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Brännström, M., Grönlund, C. F., Zingmark, K. & Söderberg, A. (2019). Meeting in a 'free-zone': Clinical ethical support in integrated heart-failure and palliative care. European Journal of Cardiovascular Nursing, 18(7), 577-583
Open this publication in new window or tab >>Meeting in a 'free-zone': Clinical ethical support in integrated heart-failure and palliative care
2019 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 7, p. 577-583Article in journal (Refereed) Published
Abstract [en]

Background: Integrating heart-failure and palliative care combines expertise from two cultures, life-saving cardiology and palliative care, and involves ethically difficult situations that have to be considered from various perspectives. We found no studies describing experiences of clinical ethical support (CES) in integrated cardiology and palliative care teams.Objective: Our aim is to describe experiences of CES among professionals after a period of three years working in a multidisciplinary team in integrated heart-failure and palliative homecare.Method: The study design was descriptive qualitative, comprising interviews with seven professionals from one integrated heart-failure and palliative care team who received CES over a three-year period. The interview data were subjected to qualitative content analysis.Results: The CES was found to offer possibilities for meeting in an ethical ‘free-zone’ where the participants could relate to each other beyond their various professional roles and specialties. The trust within the team seemed to increase and the participants were confident enough to express their points of view. Together they developed an integrated understanding, and acquired more knowledge and a comprehensive view of the ethically difficult situation of concern. The CES sessions were considered a means of becoming better prepared to deal with ethical care issues and developing action strategies to apply in practice, from shared standpoints.Conclusion: Participating in CES was experienced as meeting in an ethical ‘free-zone’ and seemed to be a means of facilitating integration of palliative and heart-failure care.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Clinical ethical support, heart failure, implementation, palliative care, PREFER study, RiFECC
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-74598 (URN)10.1177/1474515119851621 (DOI)000487801400008 ()31088300 (PubMedID)2-s2.0-85072628164 (Scopus ID)
Note

Validerad;2019;Nivå 2;2019-10-02 (johcin)

Available from: 2019-06-17 Created: 2019-06-17 Last updated: 2019-10-10Bibliographically approved
Karlsson, M., Garvare, R., Zingmark, K. & Nordström, B. (2019). Organizing for sustainable inter-organizational collaboration in health care processes. Journal of Interprofessional Care
Open this publication in new window or tab >>Organizing for sustainable inter-organizational collaboration in health care processes
2019 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567Article in journal (Refereed) Epub ahead of print
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, 2019
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)
Available from: 2019-08-19 Created: 2019-08-19 Last updated: 2019-08-22
Grönlund, C. F., Söderberg, A., Dahlqvist, V., Sandlund, M. & Zingmark, K. (2018). Communicative and organizational aspects of clinical ethics support. Journal of Interprofessional Care
Open this publication in new window or tab >>Communicative and organizational aspects of clinical ethics support
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2018 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567Article in journal (Refereed) Epub ahead of print
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, 2018
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)
Available from: 2018-12-05 Created: 2018-12-05 Last updated: 2018-12-05
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: 2019-10-10Bibliographically 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
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5953-8970

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