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  • 1.
    Gustafsson, Silje
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Wälivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Gabrielsson, Sebastian
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Patient Satisfaction With Telephone Nursing: A Call for Calm, Clarity, and Competence2019Ingår i: Journal of Nursing Care Quality, ISSN 1057-3631, E-ISSN 1550-5065Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:Studies of patient satisfaction with telephone nursing can provide a better understanding of callers' needs and inform the improvement of services.Purpose:This study described patients' experiences and perceptions of satisfaction with telephone nursing.Methods:The design was nonexperimental and descriptive, with an inductive approach. Data were collected using open-ended questions in a questionnaire that was dispatched to 500 randomly selected callers to the Swedish Healthcare Direct in Northern Sweden.Results:Patients' satisfaction with telephone nursing was related to calm, clarity, and competence. Calm referred to the nurse remaining calm and composed during the call. Clarity was described as distinct, concrete, and practical advice on how to act, what to observe, and where to seek further assistance. Competence referred to both health care knowledge and caring skills.Conclusion:These aspects of nursing are dependent on each other and on-call telephone nursing services, which value patient satisfaction need to target all 3.

  • 2.
    Strömbäck, Ulrica
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    Engström, Åsa
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Wälivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Realising the seriousness – the experience of suffering a second myocardial infarction: A qualitative study2019Ingår i: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 51, s. 1-6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives

    The aim of this study was to describe people’s experiences of suffering a second myocardial infarction.

    Research methodology

    A descriptive qualitative design. Interviews were conducted with eight persons afflicted by two myocardial infarctions. Data were analysed with qualitative content analysis.

    Findings

    The analysis resulted in one theme and four categories. The theme was ‘Realising the seriousness’ and the categories were: 1) Knowledge from previous experience; 2) A wake-up call for lifestyle changes; 3) The future becomes unpredictable; 4) Trying to find balance in life. The participant’s previous experience contributed to a better understanding of the symptoms of myocardial infarction and how to act when suffering a second myocardial infarction. After their second myocardial infarction, the participants became really aware of the need to implement a healthier lifestyle, as doing so might avoid a third myocardial infarction. The risk of suffering or even dying due to yet another myocardial infarction felt more tangible after their second one.

    Conclusion

    A second myocardial infarction is a different event in comparison to the first one, which makes afflicted people realise the seriousness and importance of making life style changes. They are more affected both physically and psychologically.

  • 3.
    Melander, Catharina
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Olsson, Malin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Välivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Assessing BPSD with the support of the NPI-NH: a discourse analysis of clinical reasoning2018Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 30, nr 4, s. 581-589Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The ability of nursing staff to assess and evaluate behavioral and psychological symptoms of dementia (BPSD) to determine when intervention is needed is essential. In order to assist with the assessment process, the current use of the Neuropsychiatric Inventory Nursing Home version (NPI-NH) is internationally accepted. Even though the NPI-NH is thoroughly validated and has several advantages, there are also various challenges when implementing this system in practice. Thus, the aim of this study was to explore clinical reasoning employed by assistant nurses when utilizing the NPI-NH as a tool to assess frequency and severity of BPSD in individuals with advanced dementia.

    Twenty structured assessment sessions in which assistant nurses used the NPI-NH were audio recorded and analyzed with a discourse analysis focusing on the activities in the communication.

    Four categories were identified to convey assistant nurses' clinical reasoning when assessing and evaluating BPSD using the NPI-NH: considering deteriorations in ability and awareness, incorporating individual and contextual factors, overcoming variations in behaviors and ambiguous formulations in the instrument, and sense-making interactions with colleagues.

    The NPI-NH served as a supportive frame and structure for the clinical reasoning performed during the assessment. The clinical reasoning employed by assistant nurses became a way to reach a consensual and broader understanding of the individual with dementia, with the support of NPI-NH as an important framework.

  • 4.
    Engström, Åsa
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Rogmalm, Katarina
    ICU, Piteå hospital.
    Marklund, Lisa
    Medical Division, Piteå hospital.
    Wälivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Follow-up visit in an ICU: receiving a sense of coherence2018Ingår i: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 23, nr 6, s. 308-315Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimTo describe patients' experiences of a follow-up visit to an intensive care unit (ICU) after being critically ill and nursed there.BackgroundKnowledge about the follow-up visit needs to be developed, with the previously critically ill patient in focus.DesignQualitative descriptive.MethodSemi-structured interviews were conducted with nine patients and analysed using qualitative content analysis. The data collection occurred during spring 2014.FindingsDuring the follow-up visits in ICU, the relatives, the patient diary, and those who took part in the care contribute to fill memory gaps to create a picture and an explanation of the care period.ConclusionThe follow-up visit is an important tool in the patients' struggle to create a context and coherence from a missing or unreal time. The patient diary is essential to subsequently be able to relate to the period of care.Relevance to clinical practiceThe follow-up visit, together with a personal diary, after an ICU stay could be seen as significant for strengthening the patients' feeling of coherence and better health.

  • 5.
    Melander, Catharina
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Välivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Olsson, Malin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Human capabilities in advanced dementia: Nussbaum's approach2018Ingår i: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 13, nr 2, artikel-id 12178Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectives

    To explore how Martha Nussbaum's approach to human capabilities can apply to dignity in the lives of people with advanced dementia living in nursing homes.

    Background

    Challenges experienced when supporting people with advanced dementia who express problematic behaviours include understanding their needs and ensuring a dignified life for them.

    Design and methods

    Data were gathered using an ethnographic approach based on participatory observation. Nussbaum's capability approach was then used as a framework for the analysis. Four women diagnosed with advanced dementia who also expressed problematic behaviours were recruited from a nursing home in Northern Sweden. The data collection was performed during 2015.

    Findings

    Individuals with advanced dementia had difficulties in participating in the planning of their lives and achieving the human capability of practical reasoning. They were also at risk of being placed outside the social group, thus hindering them from attaining the human capability of affiliation. A dignified life for individuals with advanced dementia requires nursing staff to be present and to provide adapted support to ensure that the individual can actually pursue human capabilities.

    Conclusion

    Creating opportunities for the human capabilities of practical reasoning and affiliation is essential as they permeate all other human capabilities. For these individuals, it was crucial not only to create opportunities for human capabilities but also to attend to their expressions and needs and to guide and steer them towards a dignified life.

    Implications for Practice

    The normative structure of the capability approach described by Nussbaum can ensure that nursing staffs move beyond fulfilling patients’ basic needs to consider other capabilities vital for a dignified life.

  • 6.
    Gustafsson, Silje
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Martinsson, Jesper
    Luleå tekniska universitet, Institutionen för teknikvetenskap och matematik, Matematiska vetenskaper.
    Välivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Need for reassurance in self-care of minor illnesses2018Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, nr 5-6, s. 1183-1191Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS AND OBJECTIVES:

    This study describes people's need for reassurance in self-care of minor illnesses.

    BACKGROUND:

    Self-care and active surveillance are advocated as important strategies to manage minor illnesses. Reassurance influences patient satisfaction and confidence in the practicing of self-care.

    DESIGN:

    This study is a descriptive and interpretive qualitative study.

    METHODS:

    Twelve persons with experience in self-care and receiving self-care advice were recruited, and data were collected using semi-structured interviews between September and December 2014. Data were analyzed using qualitative content analyses.

    RESULTS:

    Having previous experience and the ability to actively manage symptoms using self-care interventions was described as reassuring. Participants became stressed and concerned when the symptoms persisted and interventions lacked the desired effect, which often resulted in a decision to consult. Participants wanted to feel that the nurse was an actual person, who was sympathetic, present and understanding, when they received self-care advice. The nurse's assessment and reasoning of the symptoms facilitated care-seekers' assessments of risk, and clear and concrete advice on how to manage the symptoms exerted a calming effect. Patients needed to trust that the nurse understood their situation to embrace the advice, and being invited to return created a feeling that the nurse had listened and taken them seriously.

    CONCLUSION:

    Reassurance has the potential to allay doubts and fears to build confidence, which influences self-care and consultation behavior. Personal presence in the encounter, receiving an assessment and an explanation of the symptoms and precise advice are reassuring. This article is protected by copyright. All rights reserved.

  • 7.
    Forsberg, Angelica
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad. ICU 57, Sunderby Hospital.
    Vikman, Irene
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Välivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Rattray, Janice
    chool of Nursing and Health Sciences, University of Dundee.
    Engström, Åsa
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Patient's perceptions of perioperative quality of care in relation to self-rated health2018Ingår i: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, nr 6, s. 834-843Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To explore (1) associations between patient and perioperativefactors and dimensions of quality of care and (2) perioperative patients’self-rated physical health in relation to information, encouragement, andparticipation.Design: A nonexperimental descriptive exploratory design (n 5 170participants).Methods: Analyses were performed using quantitative techniques;collected data were quantitative in nature. Multiple logistic regressionand Mann-Whitney U tests were used to analyze the data.Findings: The factor associatedwith patients’ satisfaction within the dimensionof ‘‘identity-oriented approach of the caregivers,’’ including the qualityof information, encouragement, and participation, was self-estimated physicalhealth. Those who estimated their physical health as being good weregenerally more satisfied. Patients who rated their physical health as beingless thangoodwere significantly less satisfiedwith the informationprovidedbefore surgery about their stay in the postanesthesia care unit (PACU).Conclusions: Nurses should chart patients’ estimations of their physicalhealth initially in care to provide reinforced support for patients who estimatetheir physical health is less than good. Before surgery, patients whohave estimated their physical health as being less than good should begiven realistic information about their stay in the PACU—that they willbe in a PACU after surgery, what that stay means, and why it is necessary.

  • 8.
    Forsberg, Angelica
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Vikman, Irene
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Välivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Engström, Åsa
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Patterns of changes in patients' postoperative recovery from a short-term perspective2018Ingår i: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, nr 2, s. 188-199Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    To explore patterns of changes in patients' postoperative recovery over 1 month within different surgery groups.

    Design

    A quantitative longitudinal survey design was used.

    Methods

    A standardized questionnaire was used (N = 167 patients); the postoperative recovery profile for self-assessment of recovery. The postoperative recovery profile developed for hospitalized patients contains 17 items distributed over five dimensions: physical symptoms, physical function, psychological function, social function, and activity.

    Findings

    Overall, orthopaedic patients perceived a lower recovery than general surgery patients. All major surgery groups and subgroups except for joint replacement patients indicated significant systematic changes toward lower levels of problems. The orthopaedic patients assessed their psychological functioning as impaired, and the gastric bypass group was the most recovered.

    Conclusions

    The patients' expectations should be charted initially, and patients should be given realistic information to achieve a realistic hope for a good life in the future. A patient's recovery trajectory may not start after the surgery is completed. Rather, it has already commenced before surgery.

  • 9.
    Melander, Catharina
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Kikhia, Basel
    Faculty of Health and Sport Sciences, Centre for EHEALTH, University of Agder, Grimstad, Norway.
    Olsson, Malin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Wälivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    The impact of using measurements of electrodermal activity in the assessment of problematic behaviour in dementia2018Ingår i: Dementia and geriatric cognitive disorders extra, E-ISSN 1664-5464, Vol. 8, nr 3, s. 333-347Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A major and complex challenge when trying to support individuals with dementia is meeting the needs of those who experience changes in behaviour and mood. Aim: To explore how a sensor measuring electrodermal activity (EDA) impacts assistant nurses' structured assessments of problematic behaviours amongst people with dementia and their choices of care interventions. Methods: Fourteen individuals with dementia wore a sensor that measured EDA. The information from the sensor was presented to assistant nurses during structured assessments of problematic behaviours. The evaluation process included scorings with the instrument NPI-NH (Neuropsychiatric Inventory-Nursing Home version), the care interventions suggested by assistant nurses to decrease problematic behaviours, and the assistant nurses' experiences obtained by focus group interviews. Results: The information from the sensor measuring EDA was perceived to make behavioural patterns more visual and clear, which enhanced assistant nurses' understanding of time-related patterns of behaviours. In turn, this enhancement facilitated timely care interventions to prevent the patterns and decrease the levels of problematic behaviour. Conclusion: With the addition of information from the sensor, nursing staff could target causes and triggers in a better way, making care interventions more specific and directed towards certain times throughout the day to prevent patterns of problematic behaviours.

  • 10.
    Forsberg, Angelica
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Vikman, Irene
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Välivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Engström, Åsa
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Patients' perceptions of quality of care during the perioperative procedure2017Ingår i: ACORN: The Journal of Perioperative Nursing in Australia, ISSN 1448-7535, Vol. 30, nr 3, s. 13-22Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To describe patients' perceptions of quality of care during the perioperative period and to identify areas for quality improvement. Design: A cross-sectional descriptive survey design was used. Method: The data was collected (N=170) using a questionnaire for perioperative care. The methods were descriptive statistics, reported as percentages, and a manifest content analysis of the free text. Finding: The areas identified for improvement were information and participation. The participants lacked knowledge, preferred to hand over decision making to the hospital staff, and indicated that having personalised information about the surgery and perioperative period was important. However, too detailed information before surgery could cause increased anxiety. Conclusions: This study indicates that participation and information needs in perioperative settings seem to be situation specific. In addition, these needs seem to be personal and surgery specific. Further studies are required to clarify the differences in the satisfaction and quality of care between groups of patients in the perioperative context.

  • 11.
    Gustafsson, Silje
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Martinsson, Jesper
    Luleå tekniska universitet, Institutionen för teknikvetenskap och matematik, Matematiska vetenskaper.
    Välivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Vikman, Irene
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Influence of self-care advice on patient satisfaction and healthcare utilization2016Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, nr 8, s. 1789-1799Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimThe aim of this study is to explore the influence of nurse-led self-care advice on healthcare utilization and patients' satisfaction with telephone nursing.BackgroundMany consultations in high-cost settings are for conditions that are manageable through self-care and callers with greater satisfaction with the nurse interaction are nearly four times more likely to engage in self-care.DesignCross-sectional study.MethodsQuestionnaires were sent out to 500 randomly selected callers to the Swedish Healthcare Direct in Northern Sweden during March 2014. Callers were asked about their satisfaction with the consultation, their intended actions prior to consultation, the recommendation given by the nurse and the action undertaken after the call.ResultsYoung callers and persons recommended watchful waiting or recurrence if no improvements were significantly less satisfied with their care. When calling on their own behalf, both men and women rated the severity of their symptoms equally and were advised to self-care to the same extent. Self-care advice had a constricting influence on self-reported healthcare utilization, with 66·1% of cases resulting in a lower level of care than first intended. Feeling reassured after the call was the aspect of nursing care that influenced satisfaction the most.ConclusionReceiving self-care advice rather than referral to a general practitioner influences patient satisfaction negatively. Feeling reassured after consultation is strongly related to satisfaction, which in turn has been found to increase the likelihood of engaging in self-care behaviour.

  • 12.
    Melander, Catharina
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Kikhia, Basel
    Olsson, Malin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Välivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Assessment and evaluation of interventions in bpsd with the help of a multiple sensor system2015Ingår i: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 11, nr 7, s. P164-P165Artikel i tidskrift (Refereegranskat)
  • 13.
    Forsberg, Angelica
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Vikman, Irene
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Wälivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Engström, Åsa
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Patients' perceptions of quality of care during the perioperative procedure2015Ingår i: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 30, nr 4, s. 280-289Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    To describe patients' perceptions of quality of care during the perioperative period and to identify areas for quality improvement. Design: A cross-sectional descriptive survey design was used. Methods: The data were collected (N = 170) using a questionnaire for perioperative care. The methods were descriptive statistics, reported as percentages, and a manifest content analysis of the free text. Finding: The areas identified for improvement were information and participation. The participants lacked knowledge, preferred to hand over decision making to the hospital staff, and indicated that having personalized information about the surgery and perioperative period was important. However, too detailed information before surgery could cause increased anxiety. Conclusions: This study indicates that participation and information needs in perioperative settings seem to be situation specific. In addition, these needs seem to be personal and surgery specific. Further studies are required to clarify the differences in the satisfaction and quality of care between groups of patients in the perioperative context

  • 14.
    Forsberg, Angelica
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Vikman, Irene
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Wälivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Engström, Åsa
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Patients' perceptions of their postoperative recovery for one month2015Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, nr 13-14, s. 1825-1836Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectivesTo explore orthopaedic and general surgery patients' perceptions of their postoperative recovery for one month.BackgroundIn general, nursing research in the postoperative context has been directed towards a single symptom or area, which is valuable. However, there is a lack of studies of orthopaedic and general surgery patients' perceptions of postoperative recovery from a short-term perspective.DesignA quantitative approach with a longitudinal design was used.MethodsA total of 180 patients participated in the study. Data were collected using a standardised questionnaire, the Postoperative Recovery Profile, for self-assessment of recovery. Descriptive statistics reported as proportions were used for the categorical variables. Analytic statistics were used to identify statistically significant differences. Mean values and t-tests were used for quantity variables, and Mann–Whitney U-tests and Chi-squared tests were used for nonparametric variables.ResultsOverall, the orthopaedic patients were substantially less recovered than the general surgery patients. Two-thirds of the orthopaedic patients and half of the general surgery patients perceived severe or moderate pain in the acute recovery phase. Within the general surgery group, there were significant differences in the recovery between the Gastric Bypass patients and colon/ileum surgery patients. The gastric bypass patients were overall more recovered than the other groups of patients. The Gastric Bypass patients reported that they had improved after one month compared to their own status prior to surgery.Conclusions and relevance to clinical practiceNursing support for orthopaedic patients must be improved, especially after they are discharged from the hospital. To structure and monitor individual recovery, a top-five priority profile of the most important problems should be used during follow-up calls after the patient is discharged from the hospital. Postoperative pain continues to represent a clinical problem that requires attention. Heterogeneity in the perceptions of recovery within the general surgery group was indicated, which may depend on the surgical procedure as well as the patients' expectations and comparisons with their lives before surgery. Rather than return to their preoperative levels, certain patients tend to continue towards a new or different life postoperatively.

  • 15.
    Wälivaara, Britt-Marie
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Axelsson, Karin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Caring relationships in home-based nursing care: registered nurse's experiences2013Ingår i: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 7, s. 89-95Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The caring relationship between the nurse and the person in need of nursing care has been described as a key concept in nursing and could facilitate health and healing by involving the person's genuine needs. The aim of this study was to explore registered nurses' experiences of their relationships with persons in need of home-based nursing care. Individual interviews with nurses (n=13 registered nurses and 11 district nurses) working in home-based nursing care were performed. A thematic content analysis was used to analyze the transcribed interviews and resulted in the main theme Good nursing care is built on trusting relationship and five sub-themes, Establishing the relationship in home-based nursing care, Conscious efforts maintains the relationship, Reciprocity is a requirement in the relationship, Working in different levels of relationships and Limitations and boundaries in the relationship. A trusting relationship between the nurse and the person in need of healthcare is a prerequisite for good home-based nursing care whether it is based on face-to-face encounters or remote encounters through distance-spanning technology. A trusting relationship could reduce the asymmetry of the caring relationship which could strengthen the person's position. The relationship requires conscious efforts from the nurse and a choice of level of the relationship. The trusting relationship was reciprocal and meant that the nurse had to communicate something about themself as the person needs to know who is entering the home and who is communicating through distance-spanning technology.

  • 16.
    Wälivaara, Britt-Marie
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Axelsson, Karin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Encounters in home-based nursing care: registered nurses' experiences2013Ingår i: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 7, nr 1, s. 73-81Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The encounter between registered nurses and persons in need of healthcare has been described as fundamental in nursing care. This encounter can take place face-to-face in physical meetings and through meetings via distance-spanning technology. A strong view expressed in the literature is that the face-to-face encounter is important and cannot entirely be replaced by remote encounters. The encounter has been studied in various healthcare contexts but there is a lack of studies with specific focus on the encounter in home-based nursing care. The aim of this study was to explore the encounter in home-based nursing care based on registered nurses' experiences. Individual interviews were performed with 24 nurses working in home-based nursing care. The transcribed interviews were analyzed using thematic content analysis and six themes were identified: Follows special rules, Needs some doing, Provides unique information and understanding, Facilitates by being known, Brings energy and relieves anxiety, and Can reach a spirit of community. The encounter includes dimensions of being private, being personal and being professional. A good encounter contains dimensions of being personal and being professional and that there is a good balance between these. This is an encounter between two human beings, where the nurse faces the person with herself and the profession steadily and securely in the back. Being personal and professional at the same time could encourage nurses to focus on doing and being during the encounter in home-based nursing care.

  • 17.
    Wälivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Contemporary home-based care: encounters, relationships and the use of distance-spanning technology2012Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Encounters and relationships are basic foundations of nursing care and the preconditions for these foundations are changing along with a change in healthcare towards an increase of home-based care. In this development the use of distance-spanning technology is becoming increasingly common. There is a need to develop more knowledge and a theory base about the role of the encounter and the relationship in home-based care. Most studies so far cover the topic in the context of hospital care. There is also need to develop more knowledge of experiences of distance-spanning technology in home-based care.The overall aim of this doctoral thesis was to explore home-based care with specific focus on the use of distance-spanning technology, encounters and relationships from the perspectives of persons in need of care, general practitioners (GPs) and registered nurses (RNs).The thesis contains studies with persons in need of home-based care (n=9), general practitioners (n=17) and registered nurses (n=24). The study with RNs consisted of registered nurses (n=13) and district nurses (n=11). The data was collected through individual interviews and group interviews and were analyzed by qualitative content analysis with various degrees of interpretations.Home-based care with mobile distance-spanning technology (MDST) was experienced as positive and it opens up possibilities, however MDST also has limitations. It was considered that MDST should be used by care professionals and not by the person in need of care or their family members. The MDST affects home-based care and the work and cooperation in home-based care. The expression was that a face-to-face encounter should be the norm and MDST cannot replace all face-to-face encounters in home-based care. MDST could work in some situation, but should be used with caution. The findings also show that good encounters in home-based nursing care contain dimensions of being personal and professional, and that the challenge is to create a good balance between these. Being together in the encounter is a prerequisite for the development of relationships and good nursing care at home is built on a trusting relationship. The relationship is a reciprocal relationship that the person and the nurse develop together and nurses have to consciously work on the relationship. It seems that a good encounter and a trusting relationship could affect the views on the use of distance-spanning technology in homebased care. The participants in the studies in general expressed positive attitude towards distancespanning technology at the same time as they expressed caution about an extensive use of it in home-based care. They highlighted the importance of positive encounters and the importance of the relationship in order to receive and provide good care and nursing care in the homes. The context of home-based care has changed and will continue to change over time. This change leads to that the use of distance-spanning technology is increasing and challenges the nurses to develop work strategies that can promote competence, caring and communication in the encounter, and building and maintaining relationships in home-based nursing care.

  • 18.
    Välivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Aktivitet: Vård i hemmet via mobil distansöverbryggande teknologi2011Konferensbidrag (Övrig (populärvetenskap, debatt, mm))
  • 19.
    Wälivaara, Britt-Marie
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Andersson, Staffan
    Axelsson, Karin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    General practitioners' reasoning about using mobile distance-spanning technology in home care and in nursing home care2011Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, nr 1, s. 117-125Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The trend for health care and nursing care turns from hospital to health care and nursing care at home. Studies have shown that health care professionals have no access to patient records in home and nursing home settings. Technological development creates opportunities for a host of mobile technology solutions. The aim of this study was to describe the reasoning among general practitioners (GPs) about the use of mobile distance-spanning technology (MDST) in care at home and in nursing homes. Seventeen GPs were divided in five groups for a group interview. The interviews were tape-recorded and transcribed verbatim. The qualitative content analysis resulted in four areas about the MDST, MDST has an impact on GPs' work, the nurses' profession, and the patient and the family, with nine adherent categories. The findings were interpreted and formulated in the theme: MDST should be used with caution. The results show quite a few expressions about the MDST as useful and valuable in health care at home and in nursing home settings; however, in every category, there were text that we interpreted as caution when using the MDST. The MDST cannot be used in all situations and cannot replace human meetings in health care and nursing care at home and in nursing homes. The MDST should primarily be a tool for the profession, and understanding the professions' reasoning about technology use in health care at home and in nursing home settings must be the base for implementing MDST.

  • 20.
    Wälivaara, Britt-Marie
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Andersson, Staffan
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Axelsson, Karin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Trust and relationship when using mobile distance-spanning technology in healthcare at home2011Ingår i: e-health and nursing: How Can E-Health Promote Patient Safety? : ACENDIO 2011, 8th European Conference of ACENDIO / [ed] Fintan Sheerin, Dublin: Association for Common European Nursing Diagnoses, Interventions and Outcomes , 2011, s. 344-350Konferensbidrag (Refereegranskat)
  • 21.
    Axelsson, Karin
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Harrefors, Christina
    Sävenstedt, Stefan
    Wälivaara, Britt-Marie
    E-Health in care of older persons in the future2010Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr Suppl. 1, s. 54-Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: To achieve quality care in the person's home implies that the way we perform the care has to be developed. In this development new technology services, including mobile distance-spanning technology and information- and communication technology, has to be used. The aim of this presentation is to explore some issues important to consider before implementation of e-health services in care of older persons at home. Method: The presentation is based on studies where healthy older persons (n=23), older persons who had experience of being cared for with mobile distance-spanning technology (n=9) and general practitioners (n=17) were interviewed about their perceptions, views and experiences concerning the use of technology in care at home and quality care. The interviews were analysed by qualitative content analysis. Results: In the results from the different studies there were some common results. One was the importance of human meetings; another was that the person in need of care and the health professional need to know each other if virtual meetings should be possible. Other issues brought up in the different studies were trust, quality care, the need of combining home care services with visits at health care centres and hospitals, different technical equipment are only useful in specific circumstances, and mobile distance-spanning technology should not be looked at separately but as one part of a complex chain of health care services where all parts of the chain are needed. Conclusion: E-health including mobile distance-spanning technology and information- and communication technology is on its way to be accepted and used in home care for older persons. It is important that nurses as professionals actively take part in the development, designing and testing of the technical devices.

  • 22. Axelsson, Karin
    et al.
    Andersson, Staffan
    Välivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Projekt: Omvårdnad - Informations- och kommunikationsteknik2010Övrigt (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Upplevelser och erfarenheter av undersökningar i hemmet med hjälp av informations- och kommunikationsteknik beskrivet ur patienters och läkares perspektiv.Projektets övergripande syfte  Syftet med projektet är att belysa upplevelser och erfarenheter av undersökningar i hemmet med hjälp av informations. och kommunikationsteknik.    Kort beskrivning av projektet   I den första studien intervjuades 9 personer som fick vård i hemmet om deras syn på den nya teknik som distriktssköterskorna använde i hemsjukvården för diagnostik och kommunikation. I intervjuerna framkom stor tilltro till denna teknik men den kan inte överlåtas till patienterna själva eller deras anhöriga att sköta.I den andra studien gjordes gruppintervjuer omfattande totalt 17 distriktsläkare med varierande erfarenhet av en ny teknik som prövades i projektform. Uppfattningen om användbarheten av den nya tekniken vid intervjutillfället och i ett framtidsperspektiv varierade stort. Samtliga framhöll vikten av det personliga mötet med patienten som aldrig kan ersättas.I båda studierna användes kvalitativ innehållsanalys för att analysera intervjutexterna.

  • 23.
    Wälivaara, Britt-Marie
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Andersson, Staffan
    Axelsson, Karin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    The importance of human meetings in health care at home with mobile distance-spanning technology2010Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr Suppl. 1, s. 91-Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: New solutions could be a challenge for both the persons in need of health care at home and the health care professions when the person's individual needs in health care at home have to be met. The mobile distances-spanning technology (MDST) could come into use to support the health care at home. Before implementing the MDST the voices of persons in need of health care at home need to be heard about the use of MDST. Methods and Materials: The aim was to describe views and experiences about the use of MDST in health care at home from the perspectives of persons in need of health care at home. The persons were living in ordinary homes and all had experiences of MDST when district nurses were caring for them at home. Persons in need of health care at home (n=9) participated in individual qualitative research interviews for data collection. Qualitative content analysis was used for data analysis. Results: Participants put health care at home in the first place and the MDST was put in the second place. The importance of human meetings was put forwards. The results indicate in different ways opportunities, possibilities and risks with using MDSTs. When the MDST was used, it was important to have established a relationship and trust to the district nurses and the general practitioners, and to know them and to be known by them. The participants expressed that the health care professionals need to see the person behind the technology. Conclusion: Human meetings can never be excluded in health care at home even when a virtual meeting for some issues is relevant. The MDST can never capture or replace the human meetings but human meetings and virtual meetings can be used as complement to each other.

  • 24.
    Wälivaara, Britt-Marie
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Andersson, Staffan
    Axelsson, Karin
    The mobile distance-spanning technology in health care at home2010Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr Suppl. 1, s. 92-Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Health care at home could be a challenge for both the persons in need of health care at home and the health care professions when the person's individual needs in health care at home have to be met. There is a need for different technical solutions in order to create opportunities for persons in need of health care to stay in their own homes and get health care. The mobile distances-spanning technology (MDST) could come into use to support the health care at home for the future. Methods and Materials: The aim of this presentation is to describe the usefulness of MDST in health care at home. During a project MDST have been tested as an addition in health care at home. The district nurses used 11 different mobile equipments in home care. During the home visits they filled out a form (n=154) about which equipment they used when caring for persons in home care. Results: The district nurses did totally 184 home visits and in 154 cases they used the equipments during the test period. The most frequently used equipment was the mobile computer with access to the patient record (73%) and the access to the patient record was reported as useful at home. The district nurses noted importance to use the bladder scanner even if it was not used so often (11%). The digital camera was used (8%) and was reported as complicated but useful when documenting the healing process of wounds. When the electronic stethoscope was used (7%) some reported a disturbing sound that hampered the assessment. Conclusion: There are several equipments that could be useful and it is important to test and identify the equipments that are most suitable for use in home care.

  • 25.
    Wälivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Mobile distance-spanning technology in home care: views and reasoning among persons in need of health care and general practitioners2009Licentiatavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The overall aim of this licentiate thesis was to describe views and reasoning about the use of mobile distance-spanning technology (MDST) in health care at home, from the perspectives of persons in need of health care and general practitioners (GP). A descriptive qualitative approach was chosen to achieve the overall aim. Individual qualitative research interviews and qualitative group research interviews were used for data collection. Qualitative content analysis and qualitative thematic content analysis were used for data analysis.The findings show that persons in need of health care at home recognized MDST as being similar to the technology used at hospital. They described the MDST at home as acceptable but still in its infancy. The limited experiences in using MDST led to some persons doubting the reliability of the examinations routinely carried out at home instead of at hospital. When using the MDST, more examinations can be performed at home but there was some overconfidence concerning the possibility of what MDST can achieve. They saw the staff as users of the MDST, and the MDST should not be used by the persons or their family members. The MDST was seen as possible for distance communication but personal meetings with a GP or a nurse also have to be possible. The GPs must know the person concerned before making decisions at a distance. The persons felt that as long as it is easy to go to the healthcare centre or to the hospital the examinations should be done there, but if they are in a bad condition and there are long distances, then examinations at home become relevant. In an emergency situation, going to hospital rather than staying at home was inevitable and obvious. The MDST at home was described as a part of a chain which can be efficient only when other parts of the chain are taken good care of. When the MDST was assumed to be safe and secure then it could be used on a permanent basis at home, but this decision had to be made by DNs and GPs. The GPs reasoned that the MDST should be used with caution. There is a professional caution, which is based on the GPs' professional experiences, responsibilities and skills. Human meetings were seen as important for performing secure judgments and as the basis for health care, but some meetings can be replaced by virtual meetings. A virtual meeting could be useful for the patients and their families but it depends on their expectations. It could benefit them but there is also an overconfidence concerning what MDST can do. The GPs reasoned about the MDST in general and the usability of different diagnostic tools. The MDST was described as being not yet fully developed. Sometimes the MDST could support the GPs' decisions, but when handling very complicated cases, meeting the patient and understanding his or her context was seen as highly important. Expanded access to patient records facilitates the GPs work but the patient's integrity has to be ensured. It is easy for nurses to do more during home visits, but there must be an agreement between the nurse and the GP regarding how to handle the responsibility.The results in this thesis indicate that the participants attach both positive values about MDST as well as believing that some tools have no value at all. This is important when attempting to understand what is important for persons in need of health care and for GPs benefit when planning health care at home for the future.

  • 26.
    Wälivaara, Britt-Marie
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Andersson, Staffan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    Axelsson, Karin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Views on technology among people in need of health care at home2009Ingår i: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 68, nr 2, s. 158-169Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives. The aim of this study was to describe how people in need of health care at home view technology.Study design. A qualitative approach was used based on qualitative interviews, followed by qualitative content analysis.Methods. District nurses (DNs) from 4 health care centres in Northern Sweden had access to different kinds of distance-spanning technology with mobile devices and who used it in their health care at home. Persons in whose home the technology was being used were asked to participate in an interview. The interviewed persons were selected consecutively. Results. The results fall into 2 categories: (1) The well-known technology at hospital is new at home, (2) the new technology opens up possibilities but it also has limitations, with seven adherent subcategories.Conclusions. The participants viewed the technology at home as something good and as something that could open up possibilities. At the same time, they placed the use of the technology in the hands of the staff which indicates some degree of dissociation from the technology. The importance of personal meetings between patient and caregiver was very clearly stressed even when distance meetings could be performed and accepted. The participants expressed immense trust in the nursing staff and considered them responsible for the new technology at home.

  • 27.
    Wälivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Människan och teknologin vid vård i hemmet2008Ingår i: Forskning i Norr, 21-22 maj 2008, Mittuniversitetet , 2008, s. 181-Konferensbidrag (Övrigt vetenskapligt)
  • 28.
    Välivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Aktivitet: Teknologins möjligheter och begränsningar vid vård i hemmet2007Konferensbidrag (Övrig (populärvetenskap, debatt, mm))
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