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  • 1.
    Lindgren, Eva
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Gabrielsson, Sebastian
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Kostenius, Catrine
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    A method to give voice to young people with experience of mental ill-health2019In: 5TH HORATIO FESTIVAL OF PSYCHIATRIC NURSING, 2019Conference paper (Refereed)
  • 2.
    Backman, Tess
    et al.
    Ambulance Care, Mora, Sweden.
    Juuso, Päivi
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Borg, Ronja
    Västerås Hospital, Region of Västmanland, Västerås, Sweden.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ambulance nurses' experiences of deciding a patient does not require ambulance care2019In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 3, p. 783-789Article in journal (Refereed)
    Abstract [en]

    Aim: To describe ambulance nurses’ experience of deciding a patient does not require ambulance care.

    Design:An inductive, empirical study with a qualitative approach.Methods: Data collection was conducted through semi‐structured interviews, and collected data were analysed with qualitative manifest content analysis. Data were collected during the spring 2017, and eight ambulance nurses participated.Results:The findings are presented in one main category, which is “Not very ill but a difficult decision” with totally three subcategories. The ambulance nurse's experi‐ence of making the assessment when the patient has no need for ambulance care is like walking the balance of slack line. This means that the assessment can be both easy and very difficult but something that definitely requires experience, knowledge and dedication.

  • 3.
    Selberg, Stina
    et al.
    The OLIN Studies, Norrbotten County Council, Luleå.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. The OLIN Studies, Norrbotten County Council, Luleå. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå.
    Backman, Helena
    The OLIN Studies, Norrbotten County Council, Luleå. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Asthma control and acute health care visits among young adults with asthma: A population‐based study2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 12, p. 3525-3534Article in journal (Refereed)
    Abstract [en]

    Aims

    To study asthma control and acute health care visits among young adults with asthma.

    Background

    Despite the access to effective treatment and nursing interventions, poor asthma control is still common among individuals with asthma. However, studies describing clinical characteristics among young adults with asthma are rare.

    Design

    A population‐based cohort study.

    Methods

    In 2015, as a part of the OLIN pediatric cohort I (recruited in 1996 at age 7‐8yr), N=2291 young adults (27‐28 yr) completed a postal questionnaire survey including questions on asthma and respiratory symptoms. Of these, N=280 (12%) were identified as having current asthma and were further studied.

    Results

    Of those with current asthma, women reported respiratory symptoms and smoking to a greater extent than men. Approximately one‐fourth had uncontrolled asthma and acute health care visits due to asthma was reported by 15% of women and 8% of men. Uncontrolled asthma was associated with smoking, lower educational level, use of reliever treatment most days and acute health care visits. Acute health care visits due to asthma were associated with periodic use of regular controller treatment also after adjustment for uncontrolled asthma.

    Conclusion

    The result indicate poor adherence to asthma treatment which may lead to decreased asthma control and acute health care visits.

    Impact

    Most young adults with asthma are diagnosed and treated in primary care, ideally in a team with a nurse. The main findings highlight the need for evidenced‐based nursing interventions, contributing to a more efficient asthma management in primary care.

  • 4.
    Grönlund, Catarina Fischer
    et al.
    Department of Nursing , Umeå University , Umeå.
    Söderberg, Anna
    Department of Nursing , Umeå University , Umeå.
    Dahlqvist, Vera
    Department of Nursing , Ersta Sköndal University College , Stockholm .
    Sandlund, Mikael
    Department of Clinical Science/Psychiatry , Umeå University , Umeå.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Communicative and organizational aspects of clinical ethics support2019In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 33, no 6, p. 724-733Article in journal (Refereed)
    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.

  • 5.
    Dabija, Marius
    et al.
    Division of Surgery, Sollefteå Hospital.
    Fedog, Fredrik
    Division of Surgery-Anaesthesia, Stavanger University Hospital.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Gustafsson, Silje
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Difficult airways: key factors for sucessful management2019In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 34, no 1, p. 151-159Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe anesthetic nurses’ experiences of key factors for thesuccessful management of difficult airways in adult patients.Design: This study had a qualitative observational and descriptive designfollowing the critical incident technique.Methods: Twelve experienced anesthetic nurses were interviewed.Findings: We identified five key factors for the successful management ofdifficult airways: identification of the difficult airway, creating a plan ofaction, remaining calm and focusing on the task, technical skills, and usingthe equipment. Identification of the difficult airway implies preassessmentwith standardized methods and actively observing for signsindicative of a difficult airway. Having all equipment available atbedside during induction and creating a backup plan increases the actionforce in unexpected situations. A calm and methodical work procedurefacilitates the management of the difficult airway as well as selectingtechniques and equipment according to the patient and situation.Conclusions: Reflective practice can aid the anesthetic nurse in drawingon experience and remaining calm in acute situations.

  • 6.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ett personligt ansvar för god och säker vård2019In: Vårdande vid psykisk ohälsa - på avancerad nivå / [ed] Lena Wiklund Gustin, Lund: Studentlitteratur AB, 2019, 3, p. 571-594Chapter in book (Other (popular science, discussion, etc.))
  • 7.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Gustafsson, Silje
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Evaluating reflective practice groups in a mental health context: Swedish translation and psychometric evaluation of the clinical supervision evaluation questionnaire2019In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 18, article id 2Article in journal (Refereed)
    Abstract [en]

    Background

    Implementation of reflective practice groups in psychiatric and mental health contexts might improve the quality of care through promoting self-awareness, clinical insight, and facilitating stress management and team building. There is a need for valid and reliable instruments to test the outcomes of reflective practice groups in the mental health context. This study aimed to test the validity and reliability of the Swedish version of the Clinical Supervision Evaluation Questionnaire.

    Methods

    The instrument was translated from English to Swedish using a translation and back-translation procedure. Data for the calculation of content validity was collected from an expert group. Data for the reliability analysis was collected from rehabilitation assistants and ward managers participating in reflective practice groups (n = 20). Content validity was measured by computing a content validity index. Construct validity was assessed by calculating the corrected item-total correlation statistics. Reliability was evaluated by analysing the Cronbach’s alpha coefficient, the intraclass correlation coefficient and inter-item correlations.

    Results

    The content validity index for the scale as a whole was 0.94. Item-total correlations ranged between 0.23 and 0.81, and deletion of an item did not notably improve Cronbach’s alpha. Cronbach’s alpha for the scale was 0.89. The intraclass correlation coefficient for single measures was 0.35. The mean inter-item correlation was .37.

    Conclusion

    The Swedish version of the Supervision Evaluation Questionnaire has a degree of reliability and validity that is comparable to the original version in English, indicating that it can be used as an assessment of reflective practice groups in the mental health context.

  • 8.
    Nilsson, Carina
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Birgitta
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Juuso, Päivi
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Olsson, Malin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Experiences of striving to maintain daily life among women with osteoporosis2019In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, article id 1647402Article in journal (Refereed)
    Abstract [en]

    In order to describe how women with osteoporosis strive to maintain daily life we interviewed11 women using a reflective lifeworld approach based on phenomenological analysis.Osteoporosis is a major public health concern in the Western world, and is predominantamong women. Our findings indicated that meanings of striving to maintain daily life implya belief in oneself and one’s own capabilities. The women expressly speak out for themselvesas a way of finding reconciliation without giving in to the illness. Women with osteoporosisexpect to gain support early in the course of their illness. They require advice on how tomanage the disease as well as support for striving to maintain daily living. Therefore, it iscrucial that the women not only are given information about the disease. Equally important isto establish continuity in healthcare encounters, and that health care offers support foundedin the women’s lived experiences with focus on their capacities.

  • 9.
    Sandström, Linda
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Nilsson, Carina
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Juuso, Päivi
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Experiences of suffering multiple trauma: A qualitative study2019In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 54, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Objectives

    In an effort to strengthen health care professionals’ ability to anticipate and address multiple trauma patients’ needs, this study aims to explore the experience of suffering from multiple trauma.

    Design

    This is a qualitative descriptive study. Nine interviews were analysed using content analysis.

    Setting

    The study included patients who had been registered in the Swedish Intensive Care registry [SIR] due to suffering multiple trauma.

    Findings

    The analysis revealed one theme, A detour in life, based on three sub-themes: (a) Feeling lost and not knowing what to expect, (b) Striving to get life back on track and (c) Dealing with ‘dead ends’ during rehabilitation. The theme showed that those who suffered multiple trauma did not know what to expect of their recovery and they expressed experiencing a lack of understanding and guidance from healthcare professionals. As it was important to focus on the present and find ways to move on in life, they sought for other ways to find direction in matters of rehabilitation and care.

    Conclusions

    A shared understanding is essential in order to define a person’s needs. By setting short-term goals and improving documentation, healthcare professionals across the trauma recovery continuum could more easily gain insight of their patients’ needs and address them with supportive guidance.

  • 10.
    Marklund, Lisa
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Wahlroos, Terese
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Gabrielsson, Sebastian
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    ‘I know what I need to recover’: Patients’ experiences and perceptions of forensic psychiatric inpatient care2019In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349Article in journal (Refereed)
    Abstract [en]

    Patients find forensic psychiatric care inadequate in that they are not treated as individuals and not involved in their own care. The purpose of this study was to describe patients’ experiences and perceptions of forensic psychiatric inpatient care. Semi‐structured interviews were conducted with 11 inpatients. A qualitative content analysis resulted in a recurring theme, ‘I know what I need to recover’, and three main categories: ‘A need for meaning in a meagre existence’, ‘A need to be a person in an impersonal context’, and ‘A need for empowerment in a restricted life’. Participants experienced and perceived forensic care as predominantly monotonous, predetermined, and not adapted to them as individuals, forcing them to fight and adapt to get through it and not lose themselves. Perceived needs were largely ignored or opposed by staff due to the content and structure of care. Findings suggest a need for reflective practices and patient involvement in order to develop and maintain a person‐centred and recovery‐oriented nursing practice. The study adds to previous research showing the importance of patients in forensic psychiatric inpatient care being listened to and involved in their care. The study is reported in accordance with the COREQ guidelines.

  • 11.
    Larson, Fanny
    et al.
    Anesthesia Unit, Piteå Hospital, Region Norrbotten, Piteå, Sweden.
    Nyström, Ingela
    Anesthesia Unit, Piteå Hospital, Region Norrbotten, Piteå, Sweden.
    Gustafsson, Silje
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Key Factors for Successful General Anesthesia of Obese Adult Patients2019In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 34, no 5, p. 956-964Article in journal (Refereed)
    Abstract [en]

    Purpose

    To study nurse anesthetists' experiences of key factors for successful airway management in general anesthesia of adult obese patients.

    Design

    The study was a qualitative observational study with a descriptive approach.

    Methods

    Eight semistructured interviews were conducted. Data were analyzed using the critical incident technique.

    Findings

    Five key factors for successful general anesthesia of adult obese patients were identified. These factors were preparing and planning the anesthesia, optimizing patient position, optimizing ventilation through proper preoxygenation and increasing positive end-expiratory pressure, quickly securing the airway, and working in teams.

    Conclusions

    Knowledge of key factors that facilitate and improve the anesthesia care of obese patients is important to provide safe and quality anesthesia to this patient group as obese patients often have small margins and urgent situations can quickly arise. This knowledge enables the nurse anesthetist to be one step ahead and to be ready to take action if complications occur.

    DOI:10.1016/j.jopan.2019.01.009

  • 12.
    Jobe, Ingela
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Birgitta
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Knowledge and views about coordinated individual planning from the perspective of active older adults2019In: Clinical Journal of Nursing Care and Practice, ISSN 2639-9911, Vol. 3, p. 17-26Article in journal (Refereed)
    Abstract [en]

    Background Today’s older adults are often well informed and want to participate in decision-making processes. The coordinated individual planning process offers them active involvement in deciding and owning how their care will be managed.

    Aim

    The aim of the study was to explore active older adults’ knowledge and views regarding coordinated individual planning.

    MethodsThe study has an exploratory inductive approach. Five focus-group discussions were conducted with 40 participants from different organizations and associations. A qualitative interpretive description framework was used, and the analysis resulted in four unique themes.

    ResultsThe four themes resulting from the analysis are collaboration and continuity, participation and involvement in decision, individual need for support, and access to information and service. Collaboration between different levels of the healthcare system and between professionals is crucial. Older adults wanted to be participating actors in their healthcare. They worried about the lack of continuity and thought that services were not responsive or did not meet individuals’ needs.

    ConclusionsOlder adults want their views and preferences to be taken into consideration, and they want to be actively engaged in the decision-making process regarding their care.

  • 13.
    Nord-Ljungquist, Helena
    et al.
    Department of Health and Caring Science, Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University,Växjö, Sweden,.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Fridlund, Bengt
    Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.
    Elmqvist, Carina
    Centre of Interprofessional Collaboration within Emergency care (CICE), Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Lone and lonely in a double ambivalence situation as experienced by callers while waiting for the ambulance in a rural environment2019In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article, review/survey (Refereed)
    Abstract [en]

    Background

    In a rural environment where distances and access to ambulance resources in people’s immediate area are limited, other responders like firefighters dispatched to perform a first aid before ambulance arrives in areas where a longer response time exists; an assignment called ‘While Waiting for the Ambulance’ (WWFA). Knowledge is limited about the experience from a caller’s perspective when a person has a life‐threatening condition needing emergency help and both firefighters in a WWFA assignment and ambulance staff are involved.

    Aim

    The aim of the study is to describe the emergency situation involving a WWFA assignment in a rural environment from the caller's perspective.

    Method

    A descriptive design using qualitative methodology with a reflective lifeworld research (RLR) approach was used for this study, including in‐depth interviews with eight callers.

    Results

    An emergency situation involving WWFA assignment in a rural environment mean a sense of being lone and lonely with a vulnerability in while waiting to hand over responsibility for the affected person. Ambivalence in several dimensions arises with simultaneous and conflicting emotions. A tension between powerlessness and power of action where the throw between doubt and hope are abrupt with a simultaneous pendulum between being in a chaos and in a calm.

    Conclusion

    A double ambivalence emerges between, on one hand feeling alone in the situation and having full control, on the other hand, with trust handing over the responsibility, thereby losing control. Contact with the emergency medical dispatcher becomes a saving lifeline to hold onto, and access to emergency help in the immediate area of WWFA is valuable and important. Trust and confidence are experienced when callers are met with empathy, regardless of personal acquaintance with arriving responders.

  • 14.
    Brännström, Margareta
    et al.
    Department of Nursing, Umeå University, Sweden. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Grönlund, Catarina Fischer
    Department of Nursing, Umeå University, Sweden.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Norrbotten County Council, Sweden.
    Söderberg, Anna
    Department of Nursing, Umeå University, Sweden.
    Meeting in a 'free-zone': Clinical ethical support in integrated heart-failure and palliative care2019In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 7, p. 577-583Article in journal (Refereed)
    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.

  • 15.
    Karlsson, Margareta
    et al.
    Luleå University of Technology, Department of Business Administration, Technology and Social Sciences, Business Administration and Industrial Engineering.
    Garvare, Rickard
    Luleå University of Technology, Department of Business Administration, Technology and Social Sciences, Business Administration and Industrial Engineering.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Nordström, Birgitta
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Organizing for sustainable inter-organizational collaboration in health care processes2019In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567Article in journal (Refereed)
    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.

  • 16.
    Gustafsson, Silje
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Wälivaara, Britt-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Gabrielsson, Sebastian
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Patient Satisfaction With Telephone Nursing: A Call for Calm, Clarity, and Competence2019In: Journal of Nursing Care Quality, ISSN 1057-3631, E-ISSN 1550-5065Article in journal (Refereed)
    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.

  • 17. Eklund, Ida
    et al.
    Larsson, Ann-Sofie
    Gustafsson, Silje
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Forsberg, Angelica
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Patients' experiences of pain and postoperative nausea and vomiting in the early postoperative period after knee arthroplasties, with focus on differences between women and men2019In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473Article in journal (Refereed)
  • 18.
    Jobe, Ingela
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Birgitta
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Perceptions of healthcare services and preference of factors related to care planning among active older persons2019Conference paper (Refereed)
    Abstract [en]

    Introduction

    The care-planning process offers people active involvement in deciding, agreeing and owning how their care will be managed. It is intended to be a process of collaboration supported by the principles of person-centredness, partnership and empowerment. According to Swedish legislation, coordinated individual planning must occur for patients transferring to another level of care or when an individual, living in their own home, has the need of efforts from different welfare actors. Awareness of older peoples’ preferences regarding different factors related to the care-planning process may generate knowledge that can facilitate bridging the gaps between care recipients’ preferences and caregivers’ decisions during the care-planning process. The aim of the study was to explore active older persons’ perceptions of healthcare services and preferences of factors related to care planning.

    Methods

    A qualitative interpretive description framework was chosen for the study. Five focus-group were conducted with 40 members, aged between 70 to 88 years, from six different organizations and associations. Participants represent the growing older population in society that remains active for many years after retirement. The general principles of interpretative descriptions were used in the analysis.

    Results

    The results showed that the participants thought that many organizational changes that had been made had not improved healthcare services. The participants wanted more flexibility regarding decisions and the possibility to change them. Personal freedom and making choices independently were momentous. They worried about the lack of continuity and perceived that no one assumed overall responsibility. Overall, participants cared more about the quality of the interactions with personnel than about how services were organized. The majority of participants were not aware of the development of a coordinated individual plan. A new service of being able to access the coordinated individual plan on the Internet is offered. A majority of the participants did not have Internet access; they saw themselves as the generation between the old and new systems. They did not resist the new technology but stressed the importance of not excluding anyone.

    Discussions

    Older persons want their views and preferences to be taken into consideration, and they want to be actively engaged in the decision-making process and make decisions themselves. Older people’s lives have become more individualized with the rest of society, and this requires healthcare service solutions that are more tailored and include different options.

    Conclusions

    Older persons’ want to be active partners in healthcare and social services and they value a personal relation with the professional actor, easy access and well-coordinated and more personalized and flexible services. They value their independency and want to stay active as long as possible.

    Lessons learned

    Older persons value their independency and want to remain active and maintain functioning. Views of older people must be considered on different levels, from planning healthcare and social services to individualized care-planning processes.

    Limitations

    It is important to remember that older people are not a homogeneous group. The participants in this study are active in society and chose to participate. Majority of the participants had no previous experiences of the coordinated individual planning however, they can still have other experiences of healthcare and social services that influence their preferences, and made them participate in the study. Their views do not necessarily correspond with older persons’ views in general.

    Suggestions for future research

    More knowledge is needed about how individuals and their relatives experiences the Coordinated individual planning process.

  • 19.
    Engström, Åsa
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Forsberg, Angelica
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Peripheral intravenous catheter difficulty: A clinical survey of registered nurse and critical care nurse performance2019In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 3-4, p. 686-694, article id 15960276Article in journal (Refereed)
    Abstract [en]

    Objectives To describe the characteristics, problems and interventions associated with performing peripheral intravenous catheterisation in difficult situations when registered nurses need support from critical care nurses. Background Only a few studies have focused on peripheral intravenous catheterisation problems or interventions to promote success. There is limited research on the education, knowledge, confidence and skills of registered nurses associated with successful peripheral intravenous catheterisations. Design A descriptive cross‐sectional survey design was used. Results A total of 101 questionnaires were completed by critical care nurses (n = 32) and 92 by registered nurses (n = 83); the total number of participants was 115. The same critical care nurses and registered nurses could participate several times on different occasions. Statistical analyses were performed using descriptive statistics. The patterns differed in part between the registered nurses who needed support and the critical care nurses who provided the support. Both registered nurses and critical care nurses used ultrasound to a very low extent (2.2% vs. 1.0%). The registered nurses indicated to a significantly higher extent (p = 0.02) that the veins were invisible and that they had performed the optional interventions. The success rate for critical care nurses was considerably high (86.1%). The most common place for successful insertion was the wrist. Critical care nurses performed fewer interventions, and they informed the patients and assessed that the veins were fragile to a higher extent. Conclusions Superior nursing skills are required in order to adapt and assess specific situations related to peripheral intravenous catheterisation difficulties and to choose the adequate interventions. Young and newly graduated registered nurses should be offered individualised training during the post‐educational period on how to assess problems and perform peripheral intravenous catheterisations in specific difficult situations. Relevance to Clinical Practice Simulation is suggested for practical training in order to increase patient safety related to the performance of technical skills such as peripheral intravenous catheterisation.

  • 20.
    Strömbäck, Ulrica
    et al.
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Wälivaara, Britt-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Realising the seriousness – the experience of suffering a second myocardial infarction: A qualitative study2019In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 51, p. 1-6Article in journal (Refereed)
    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.

  • 21.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Recovery-Oriented Reflective Practice Groups: Conceptual Framework and Group Structure2019In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673Article in journal (Refereed)
    Abstract [en]

    The recovery-oriented reflective practice group (RORPG) is a staff-directed intervention aimed at achieving the recovery-focused transformation of mental health settings. This discussion paper aims to outline and reflect on the conceptual framework and group structure of recovery-oriented reflective practice groups. RORPGs build on conceptualizations of reflective practice, personal recovery, mental health nursing as a relational and reflective practice, and abductive reasoning. Dewey’s phases of reflection, together with an understanding of nursing practice as a dynamic process of care, provide a structure for group sessions in which abductive reasoning can be considered a core activity. This paper outlines a sound theoretical foundation and suggests that RORPGs might prove useful for providing a space for learning in practice, informed by both theoretical and practical knowledge.

  • 22.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Reflekterande arbetssätt i psykiatrisk vård2019In: Omvårdnad vid psykisk ohälsa – på grundutbildningsnivå / [ed] Ingela Skärsäter och Lena Wiklund Gustin, Lund: Studentlitteratur AB, 2019, 3Chapter in book (Other academic)
  • 23.
    Backman, Helena
    et al.
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Jansson, Sven-Arne
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Eriksson, Berne
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden, 4 Dept of Internal Medicine, Cen tral County Hospital of Halland, Halmstad, Sweden.
    Hedman, Linnea
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Eklund, Britt-Marie
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Sandström, Thomas
    Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå university, Umeå, Sweden.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Lundbäck, Bo
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university.
    Severe asthma: A population study perspective2019In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 6, p. 819-828Article in journal (Refereed)
    Abstract [en]

    BackgroundSevere asthma is a considerable challenge for patients, health care professionals and society. Few studies have estimated the prevalence of severe asthma according to modern definitions of which none based on a population study.

    ObjectiveTo describe characteristics and estimate the prevalence of severe asthma in a large adult population‐based asthma cohort followed for 10‐28 years.

    MethodsN=1006 subjects with asthma participated in a follow‐up during 2012‐14, when 830 (mean age 59y, 56% women) still had current asthma. Severe asthma was defined according to three internationally well‐known criteria: the ATS workshop definition from 2000 used in the US Severe Asthma Research Program (SARP), the 2014 ATS/ERS Task force definition and the GINA 2017. All subjects with severe asthma according to any of these criteria were undergoing respiratory specialist care, and were also contacted by telephone to verify treatment adherence.

    ResultsThe prevalence of severe asthma according to the three definitions was 3.6% (US SARP), 4.8% (ERS/ATS Taskforce), and 6.1% (GINA) among subjects with current asthma. Although all were using high ICS doses and other maintenance treatment, >40% had uncontrolled asthma according to the asthma control test. Severe asthma was related to age >50 years, nasal polyposis, impaired lung function, sensitization to aspergillus, and tended to be more common in women. Further, neutrophils in blood significantly discriminated severe asthma from other asthma.

    Conclusions and clinical relevanceSevere asthma differed significantly from other asthma in terms of demographic, clinical and inflammatory characteristics, results suggesting possibilities for improved treatment regimens of severe asthma. The prevalence of severe asthma in this asthma cohort was 4‐6%, corresponding to approximately 0.5% of the general population.

  • 24.
    Persson, Anna-Carin
    et al.
    Ambulance Care in Ålem and Oskarshamn.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Burström, Oskar
    Resource unit in ambulance care, Jämtland/Härjedalen.
    Juuso, Päivi
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Specialist Ambulance Nurses' Experiences of Births Before Arrival2019In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 43, p. 45-49Article in journal (Refereed)
    Abstract [en]

    Background

    Working as an ambulance nurse means interacting with and caring for acutely ill and injured patients. It can even involve births before arrival to the hospital (BBA), which are rare but increasing due to the centralization of maternity wards.

    Aim

    This study describes the experiences of specialist ambulance nurses with BBA.

    Method

    A qualitative study was conducted, and nine specialist ambulance nurses who had assisted with one or more prehospital births were interviewed. Data were analysed with thematic content analysis.

    Findings

    The analysis revealed three categories that were compiled into a theme of feeling fright and exhilaration. The findings showed that BBA causes feelings of anxiety and stress. The experience is also associated with joy and relief when the baby is born. Childbirth is a situation for which specialist ambulance nurses feel less prepared, lack of knowledge, and wish for more education.

    Conclusion

    Specialist ambulance nurses face challenges in the pre-hospital care environment during BBA, with long distances, a lack of equipment aboard the ambulance, and no assistance from midwives. To feel secure in the complex role that is required when assisting with a BBA, specialist ambulance nurses should be given the opportunity to receive scenario training.

  • 25.
    Lindqvist, Maria
    et al.
    Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Sweden.
    Lindberg, Inger
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Nilsson, Margareta
    Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Sweden.
    Uustal, Eva
    Department of Molecular and Clinical Medicine, Division of obstetrics and Gynecology, Linköping university, Sweden.
    Persson, Margareta
    Department of Nursing, Umeå University, Sweden.
    “Struggling to settle with a damaged body”: a Swedish qualitative study of women’s experiences one year after obstetric anal sphincter muscle injury (OASIS) at childbirth2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 19, p. 36-41Article in journal (Refereed)
    Abstract [en]

    Objective

    This study aimed to explore women’s experiences related to recovery from obstetric anal sphincter muscle injuries (OASIS) one year after childbirth.

    Method

    This is a qualitative study based on written responses from 625 women approximately one year after childbirth in which OASIS occurred. Data was obtained from a questionnaire distributed by the national Perineal Laceration Register (PLR) in Sweden. Inductive qualitative content analysis was applied for analysis.

    Results

    The theme “Struggling to settle with a damaged body “indicated that the first year after OASIS involved a struggle to settle to and accept living with a changed and sometimes still-wounded body. Many participants described problems related to a non-functional sexual life, physical and psychological problems that left them feeling used and broken, and increased worries for their future health and pregnancies. However, some women had adjusted to their situation, had moved on with their lives, and felt recovered and strong. Encountering a supportive and helpful health care professional was emphasized as vital for recovery after OASIS.

    Conclusion

    This study provides important insights on how women experience their recovery approximately one year after having had OASIS at childbirth, wherein many women still struggled to settle into their damaged bodies. Clear pathways are needed within health care organizations to appropriate health care services that address both physical and psychological health problems of women with prolonged recovery after OASIS.

  • 26.
    Sandström, Linda
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    The trauma continuum: Experinces from injured persons and critical care nurses2019Doctoral thesis, comprehensive summary (Other academic)
  • 27.
    Lindqvist, Maria
    et al.
    Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University.
    Persson, Margareta
    Department of Nursing, Umeå University.
    Nilsson, Margareta
    Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University.
    Uustal, Eva
    Department of Molecular and Clinical Medicine, Division of obstetrics and Gynaecology, Linköping university.
    Lindberg, Inger
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    “A worse nightmare than expected”: a Swedish qualitative study of women's experiences two months after obstetric anal sphincter muscle injury2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 61, p. 22-28Article in journal (Refereed)
    Abstract [en]

    Objective

    This study explores women's experiences of the first two months after obstetric anal sphincter injury (OASIS) during childbirth with a focus on problematic recovery.

    Methods

    This qualitative study used inductive qualitative content analysis to investigate open-ended responses from 1248 women. The data consists of short and comprehensive written responses to open-ended questions focusing on recovery in the national quality register, the Perineal Laceration Register, two months after OASIS at childbirth.

    Results

    The theme “A worse nightmare than expected” illustrated women's experiences of their life situation. Pain was a constant reminder of the trauma, and the women had to face physical and psychological limitations as well as crushed expectations of family life. Furthermore, navigating healthcare services for help added further stress to an already stressful situation.

    Conclusions

    We found that women with problematic recovery two months after OASIS experienced their situation as a worse nightmare than expected. Extensive pain resulted in physical and psychological limitations, and crushed expectations of family life. Improved patient information for women with OASIS regarding pain, psychological and personal aspects, sexual function, and subsequent pregnancy delivery is needed. Also, there is a need for clear organizational structures and information to guide help-seeking women to needed care.

  • 28.
    Melander, Catharina
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Olsson, Malin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Välivaara, Britt-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Assessing BPSD with the support of the NPI-NH: a discourse analysis of clinical reasoning2018In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 30, no 4, p. 581-589Article in journal (Refereed)
    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.

  • 29.
    Hedman, Linnea
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care. he Obstructive Lung Disease in Northern Sweden Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Backman, Helena
    The Obstructive Lung Disease in Northern Sweden Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Bosson, Jenny A.
    Division of Respiratory Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Lundbäck, Magnus
    Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden.
    Lindberg, Anne
    The Obstructive Lung Disease in Northern Sweden Unit, Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Rönmark, Eva
    The Obstructive Lung Disease in Northern Sweden Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Ekerljung, Linda
    Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Association of Electronic Cigarette Use With Smoking Habits, Demographic Factors, and Respiratory Symptoms2018In: JAMA Network Open, E-ISSN 2574-3805, Vol. 1, no 3, article id e180789Article in journal (Refereed)
    Abstract [en]

    Importance  Increases in total knee arthroplasty (TKA) utilization rates suggest that its indications have been expanded to include patients with less severe symptoms. A recent study challenged the cost-effectiveness of TKA in this group of patients.

    Objective  To determine the association of the 36-Item Short Form Health Survey physical component summary score (SF-36 PCS) with patient satisfaction 2 years after TKA.

    Design, Setting, and Participants  This cohort study reviewed registry data from 2 years of follow-up of patients who underwent unilateral TKA from January 1, 2010, to December 31, 2014, at a single-center tertiary institution in Singapore. Data were acquired on April 27, 2017, and analyzed from August 15, 2017, to December 22, 2017.

    Main Outcomes and Measures  Patient satisfaction and SF-36 PCS. Preoperative disability and postoperative function as measured by the SF-36 PCS were correlated with Δ (2-year end point score minus baseline score) and patient satisfaction, scored on a 6-point Likert scale, with lower scores indicating greater satisfaction.

    Results  Of the 6659 patients, 5234 (78.6%) were female and 5753 (86.4%) were of Chinese ethnicity. Mean (SD) age was 67.0 (7.7) years, and mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 27.7 (4.6). At 2-year follow-up, the mean (SD) SF-36 PCS score improved from 32.2 (10.1) to 48.2 (9.5) (P < .001). There were 1680 patients (25.2%) who described their satisfaction as excellent, 2574 (38.7%) very good, 1879 (28.2%) good, 382 (5.7%) fair, 96 (1.4%) poor, and 48 (0.7%) terrible. The minimal clinically important difference (change in SF-36 PCS of 10 from baseline) was met in 4515 patients (67.8%), and overall satisfaction was 97.8% (6515 patients). Covariance analysis showed significantly higher satisfaction in patients with preoperative scores of 40 to less than 50. Patients who were unlikely to meet the minimal clinically important difference compared with those who were likely to meet it (SF-36 PCS of ≥42.1 vs <42.1) had significantly higher 2-year satisfaction (mean [SD], 2.15 [0.9] vs 2.23 [1.0]; P = .009).

    Conclusions and Relevance  The findings suggest that a general health score, such as SF-36, is not associated with patient satisfaction 2 years after TKA. Functional assessment, preoperative counseling, and modification of expectations appear to remain vital before TKA.

  • 30.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Bemötande i psykiatrin: Möten som främjar återhämtning2018 (ed. 1.1)Book (Other (popular science, discussion, etc.))
  • 31.
    Backman, Helena
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Muellerova, Hana
    Real-World Evidence&Epidemiology, GSK R&D.
    Wurst, Keele
    Real-World Evidence&Epidemiology, GSK R&D.
    Hedman, Linnea
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN Unit, Umeå University.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University.
    Chronic airway obstruction in a population-based adult asthma cohort: Prevalence, incidence and prognostic factors2018In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 138, p. 115-122Article in journal (Refereed)
    Abstract [en]

    Background

    Asthma and COPD may overlap (ACO) but information about incidence and risk factors are lacking. This study aimed to estimate prevalence, incidence and risk factors of chronic airway obstruction (CAO) in a population-based adult asthma cohort.

    Methods

    During 1986–2001 a large population-based asthma cohort was identified (n = 2055, 19-72y). Subsamples have participated in clinical follow-ups during the subsequent years. The entire cohort was invited to a clinical follow-up including interview, spirometry, and blood sampling in 2012–2014 when n = 983 subjects performed adequate spirometry. CAO was defined as post-bronchodilator FEV1/FVC<0.7.

    Results

    At study entry, asthmatics with prevalent CAO (11.4%) reported more respiratory symptoms, asthma medication use, and ischemic heart disease than asthmatics without CAO (asthma only). Subjects who developed CAO during follow-up (17.6%; incidence rate of 16/1000/year) had a more rapid FEV1 decline and higher levels of neutrophils than asthma only. Smoking, older age and male sex were independently associated with increased risk for both prevalent and incident CAO, while obesity had a protective effect.

    Conclusions

    In this prospective adult asthma cohort, the majority did not develop CAO. Smoking, older age and male sex were risk factors for prevalent and incident CAO, similar to risk factors described for COPD in the general population.

  • 32.
    Forsberg, Angelica
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Critical care nurses'  experiences of performing successful peripheral intravenous catherisation i difficult situations2018In: Journal of Vascular Nursing, ISSN 1062-0303, E-ISSN 1532-6578, Vol. 36, no 2, p. 64-70Article in journal (Refereed)
    Abstract [en]

    he aim of this study is to describe the experiences of critical care nurses (CCNs) when performing successful peripheral intravenous catheterization (PIVC) on adult inpatients in difficult situations. This study uses a descriptive design with a qualitative approach. Semistructured interviews were given to CCNs (n = 22) at a general central county hospital in northern Sweden. The interview text was analyzed with qualitative thematic content analysis. Three themes emerged: “releasing time and creating peace,” “feeling self-confidence in the role of expert nurse,” and “technical interventions promoting success.” CCNs stated that apart from experience, releasing enough time is the most crucial factor for a successful PIVC. They emphasized the importance of identifying the kinds of difficulties that may occur during the procedure, for example, fragile or/and invisible veins. CCNs explained that compared to when they were newly graduated, the difference in their approach nowadays has changed to using their hands more than their eyes and that they feel comfortable with bodily palpations. To further optimize PIVC performing skills, continued possibilities to train and learn in hospital settings are necessary, even after formal education has been completed.

  • 33.
    Kostenius, Catrine
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Lindgren, Eva
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Egenmakt, jämlikhet och effektivitet: hur kan e-hälsotjänster inom barn- och ungdomspsykiatrin möta de ungas behov?2018In: BUP kongress: Moderna tider på BUP, Luleå, april 24-25, 2018, 2018Conference paper (Other (popular science, discussion, etc.))
  • 34.
    Fisher, Duncan
    et al.
    The Family Initiative, Heron House, Chiswick Mall, London, UK.
    Khashu, Minesh
    Poole Hospital NHS Foundation Trust Poole, Dorset, UK. Bournemouth University, Bournemouth, UK.
    Adama, Esther A.
    Edith Cowan University School of Nursing and Midwifery in Perth, WA, Australia.
    Feeley, Nancy
    Centre for Nursing Research & Lady Davis Institute - Jewish General Hospital, McGill University, Montréal, Quebec, Canada.
    Garfield, Craig F.
    Departments of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
    Ireland, Jillian
    Poole Hospital NHS Foundation Trust Poole, Dorset, UK. Bournemouth University, Bournemouth, UK.
    Koliouli, Flora
    Centre d’Études des Rationalités et des Savoirs, Laboratoire Interdisciplinaire Solidarités, Sociétés, Territoires (LISST-CERS), University of Toulouse, Toulouse, France.
    Lindberg, Birgitta
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Nørgaard, Betty
    Department of Paediatrics, Lillebaelt Hospital, Kolding, Denmark.
    Provenzi, Livio
    0-3 Center for the at Risk Infant, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, LC, Italy.
    Thomson-Salo, Frances
    Centre for Women's Mental Health, Royal Women's Hospital, Carlton, Australia.
    van Teijlingen, Edwin
    Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth House, Bournemouth University, Bournemouth, UK.
    Fathers in neonatal units: Improving infant health by supporting the baby-father bond and mother-father coparenting2018In: Journal of Neonatal Nursing, ISSN 1355-1841, E-ISSN 1878-089X, Vol. 24, no 6, p. 306-312Article in journal (Refereed)
    Abstract [en]

    The Family Initiative's International Neonatal Fathers Working Group, whose members are the authors of this paper, has reviewed the literature on engaging fathers in neonatal units, with the aim of making recommendations for improving experience of fathers as well as health outcomes in neonatal practice. We believe that supporting the father-baby bond and supporting co-parenting between the mother and the father benefits the health of the baby, for example, through improved weight gain and oxygen saturation and enhanced rates of breastfeeding. We find, however, that despite much interest in engaging with parents as full partners in the care of their baby, engaging fathers remains sub-optimal. Fathers typically describe the opportunity to bond with their babies, particularly skin-to-skin care, in glowing terms of gratitude, happiness and love. These sensations are underpinned by hormonal and neurobiological changes that take place in fathers when they care for their babies, as also happens with mothers. Fathers, however, are subject to different social expectations from mothers and this shapes how they respond to the situation and how neonatal staff treats them. Fathers are more likely to be considered responsible for earning, they are often considered to be less competent at caring than mothers and they are expected to be “the strong one”, providing support to mothers but not expecting it in return. Our review ends with 12 practical recommendations for neonatal teams to focus on: (1) assess the needs of mother and father individually, (2) consider individual needs and wants in family care plans, (3) ensure complete flexibility of access to the neonatal unit for fathers, (4) gear parenting education towards co-parenting, (5) actively promote father-baby bonding, (6) be attentive to fathers hiding their stress, (7) inform fathers directly not just via the mother, (8) facilitate peer-to-peer communication for fathers, (9) differentiate and analyse by gender in service evaluations, (10) train staff to work with fathers and to support co-parenting, (11) develop a father-friendly audit tool for neonatal units, and (12) organise an international consultation to update guidelines for neonatal care, including those of UNICEF.

  • 35.
    Engström, Åsa
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Rogmalm, Katarina
    ICU, Piteå hospital.
    Marklund, Lisa
    Medical Division, Piteå hospital.
    Wälivaara, Britt-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Follow-up visit in an ICU: receiving a sense of coherence2018In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 23, no 6, p. 308-315Article in journal (Refereed)
    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.

  • 36.
    Strandkvist, Viktor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Department of Public Health and Clinical Medicine, The OLIN Unit, Division of Occupational and Environmental Medicine , Umea University.
    Andersson, Mikael
    Department of Neuroscience, Physiotherapy, Uppsala University , Uppsala.
    Backman, Helena
    Department of Public Health and Clinical Medicine, The OLIN Unit, Division of Occupational and Environmental Medicine , Umeå University , Umeå.
    Larsson, Agneta
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine , Umeå University , Umeå.
    Hand grip strength is associated with fatigue among men with COPD: epidemiological data from northern Sweden2018In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate if hand grip strength (HGS) is associated with: 1) fatigue, and specifically clinically relevant fatigue (CRF); 2) low physical activity; and 3) fatigue independent of physical activity level, among individuals with and without COPD. Data were collected from the Obstructive Lung Disease in Northern Sweden (OLIN) COPD-study in 2014. HGS was measured with a hand-grip dynamometer, fatigue and physical activity were assessed by questionnaires; FACIT-Fatigue respectively IPAQ. Among individuals with COPD (n = 389), but not without COPD (n = 442), HGS was lower among those with CRF than those without CRF, significantly so among men (p = 0.001) and close to among women (p = 0.051). HGS was not associated with physical activity levels within any of the groups. HGS was associated with fatigue among men, but not women, with COPD independent of physical activity level, age, height, and smoking habits (Beta = 0.190, 95% CI 0.061-0.319, respectively Beta = 0.048, 95% CI-0.056-0.152), while there were no corresponding significant findings among individuals without COPD. In summary, HGS was associated with CRF among individuals with COPD in this population-based study. Among men with COPD, HGS was associated with fatigue independent of physical activity level and common confounders.

  • 37.
    Melander, Catharina
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Välivaara, Britt-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Olsson, Malin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Human capabilities in advanced dementia: Nussbaum's approach2018In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 13, no 2, article id 12178Article in journal (Refereed)
    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.

  • 38.
    Skottheim, Andreas
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University.
    Lövheim, Hugo
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University.
    Isaksson, Ulf
    Department of Nursing, Umeå University.
    Sandman, Per-Olof
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Nursing, Umeå University.
    Gustafsson, Maria
    Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University.
    Insomnia symptoms among old people in nursing homes2018In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 30, no 1, p. 77-85Article in journal (Refereed)
    Abstract [en]

    Background:: Insomnia symptoms are common among old people, and hypnotics and sedative drugs are often prescribed in spite of small benefits. The aim of this study was to estimate the prevalence of insomnia symptoms and to analyze the association between insomnia symptoms, cognitive level, and prescription of hypnotics and sedatives among old people living in nursing homes. Methods:: The study comprised 2,135 people living in nursing homes in the county of Västerbotten, Sweden. Data concerning hypnotic and sedative drugs, cognitive function, and prevalence of insomnia symptoms were collected, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). Results:: The three most common insomnia symptoms were “sleeps for long periods during the day,” “interrupted night-time sleep,” and “wakes up early in the morning” with 57.8%, 56.4%, and 48.0%, respectively, of the residents exhibiting the symptoms at least once a week. Different insomnia symptoms showed different association patterns with sex and age. Most insomnia symptoms were more common among people with cognitive impairment compared to those with no cognitive impairment and seemed to reach their peak prevalence in people with moderate to severe cognitive impairment, subsequently decreasing with further cognitive decline. Of the study population, 24.0% were prescribed hypnotics and sedatives. Prescriptions were more common among those without cognitive impairment, and among those exhibiting the symptom “difficulty initiating sleep.” Conclusions:: Insomnia symptoms and prescription of hypnotics and sedatives are common among old people living in nursing homes. Considering the risk of adverse effects, it is important to regularly re-evaluate the need for these drugs

  • 39.
    Lindgren, Eva
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    It’s all about survival: Överflyttning från Barn- och Ungdomspsykiatrin till vuxenpsykiatrin - från unga vuxnas och närståendes perspektiv2018In: BUP kongress: Moderna tider på BUP, Luleå, april 24-25, 2018, 2018Conference paper (Other (popular science, discussion, etc.))
  • 40.
    Schyllert, Christian
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umea University.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umea University.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umea University.
    Ekström, Magnus
    Department of Respiratory Medicine and Allergology, Institution for Clinical Sciences, Lund University.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit, Umeå University.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Job titles classified into socioeconomic and occupational groups identify subjects with increased risk for respiratory symptoms independent of occupational exposure to vapour, gas, dust, or fumes2018In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 5, no 1, article id 1468715Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the ability of three different job title classification systems to identify subjects at risk for respiratory symptoms and asthma by also taking the effect of exposure to vapours, gas, dust, and fumes (VGDF) into account. Background: Respiratory symptoms and asthma may be caused by occupational factors. There are different ways to classify occupational exposure. In this study, self-reported occupational exposure to vapours, gas, dust and fumes was used as well as job titles classifed into occupational and socioeconomic Groups according to three different systems. Design: This was a large population-based study of adults aged 30-69 years in Northern Sweden (n = 9,992, 50% women). Information on job titles, VGDF-exposure, smoking habits, asthma and respiratory symptoms was collected by a postal survey. Job titles were used for classification into socioeconomic and occupational groups based on three classification systems; Socioeconomic classification (SEI), the Nordic Occupations Classification 1983 (NYK), and the Swedish Standard Classification of Occupations 2012 (SSYK). Associations were analysed by multivariable logistic regression. Results: Occupational exposure to VGDF was a risk factor for all respiratory symptoms and asthma (odds ratios (ORs) 1.3-2.4). Productive cough was associated with the socioeconomic groups of manual workers (ORs 1.5-2.1) and non-manual employees (ORs 1.6-1.9). These groups include occupations such as construction and transportation workers, service workers, nurses, teachers and administration clerks which by the SSYK classification were associated with productive cough (ORs 2.4-3.7). Recurrent wheeze was significantly associated with the SEI group manual workers (ORs 1.5-1.7). After adjustment for also VGDF, productive cough remained significantly associated with the SEI groups manual workers in service and non-manual employees, and the SSYK-occupational groups administration, service, and elementary occupations. Conclusions: In this cross-sectional study, two of the three different classification systems, SSYK and SEI gave similar results and identified groups with increased risk for respiratory symptoms while NYK did not give conclusive results. Furthermore, several associations were independent of exposure to VGDF indicating that also other job-related factors than VGDF are of importance.

  • 41.
    Zotterman, Anna Nygren
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Skär, Lisa
    Department of Health, Blekinge Institute of Technology, Karlskrona.
    Söderberg, Siv
    Department of Nursing Sciences, Mid Sweden University,Östersund.
    Meanings of encounters for close relatives of people with a long-term illness within a primary healthcare setting2018In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 19, no 4, p. 392-397Article in journal (Refereed)
    Abstract [en]

    Background

    Encounters play an important role in the relationship between healthcare personnel and the close relatives of people with a long-term illness.

    Aim

    The aim of this study was to elucidate the meanings of encounters for close relatives of people with a long-term illness within a primary healthcare setting.

    Methods

    Interviews using a narrative approach were conducted with seven women and three men, and the phenomenological hermeneutic method was used to interpret the interview texts.

    Results

    The structural analysis revealed three major themes: being confirmed as a family, being informed of the care, and being respected as a valuable person. Close relatives stated that they wanted to be confirmed as a family and have a familiar and trusting relationship with healthcare personnel. They valued being informed concerning the care of the ill person so that they could give support at home. It was also important to be compassionately viewed as an important person in a welcoming atmosphere based on respect and dignity.

  • 42.
    Nilsson, Åsa
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Birgitta
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Söderberg, Siv
    Department of Nursing Sciences, Mid Sweden University, Östersund, Sweden.
    Olsson, Malin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Meanings of participation in hospital care: as narrated by patients2018In: European Journal for Person Centered Healthcare, ISSN 2052-5648, E-ISSN 2052-5656, Vol. 6, no 3, p. 431-437Article in journal (Refereed)
    Abstract [en]

    Objective: Patient participation is said to be an important factor for patients to experience satisfaction and quality with hospital care. Still, little is known about what participation actually means for patients in the specific context of hospital settings. Therefore, the aim of this study was to elucidate meanings of participation as narrated by patients.

    Method: Narrative interviews were conducted during the Autumn of 2013 until the Spring of 2014 and then phenomenological hermeneutically interpreted. In this study, we suggest that the phenomenon of participation in hospital care is experienced by the patient when being a co-creator and seen as an important person in a trustful context.

    Results: The results illustrate that an experience of an open, cooperative and coherent environment invites and contributes to participate despite being in a vulnerable situation. The study highlights the importance of responding to each patient as a person, who sometimes has a need to participate actively and sometimes wants to hand over and assume the role of patient in the hospital care setting.

    Discussion: Meanings of participation among patients in hospital care can be understood as a phenomenon experienced when being an involved co-creator and seen as an important person in a trustful context. In this study, as well as in previous research it is obvious that participation in hospital care concerns more than being involved in decision-making and receiving information.

  • 43.
    Martinsson, Jesper
    et al.
    Luleå University of Technology, Department of Engineering Sciences and Mathematics, Mathematical Science.
    Gustafsson, Silje
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Modeling the effects of telephone nursing on healthcare utilization2018In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 113, p. 98-105Article in journal (Refereed)
    Abstract [en]

    Background

    Telephone nursing is the first line of contact for many care-seekers and aims at optimizing the performance of the healthcare system by supporting and guiding patients to the correct level of care and reduce the amount of unscheduled visits. Good statistical models that describe the effects of telephone nursing are important in order to study its impact on healthcare resources and evaluate changes in telephone nursing procedures

    Objective

    To develop a valid model that captures the complex relationships between the nurse's recommendations, the patients’ intended actions and the patients’ health seeking behavior. Using the model to estimate the effects of telephone nursing on patient behavior, healthcare utilization, and infer potential cost savings.

    Methods

    Bayesian ordinal regression modelling of data from randomly selected patients that received telephone nursing. Inference is based on Markov Chain Monte Carlo (MCMC) methods, model selection using the Watanabe-Akaike Information Criteria (WAIC), and model validation using posterior predictive checks on standard discrepancy measures.

    Results and Conclusions

    We present a robust Bayesian ordinal regression model that predicts three-quarters of the patients’ healthcare utilization after telephone nursing and we found no evidence of model deficiencies. A patient's compliance to the nurse's recommendation varies and depends on the recommended level of care, its agreement with and level of the patient's prior intention, and the availability of different care options at the time. The model reveals a risk reducing behavior among patients and the effect of the telephone nursing recommendation is 7 times higher than the effect of the patient's intended action prior to consultation if the recommendation is the highest level of care. But the effect of the nurse's recommendation is lower, or even non-existing, if the recommendation is self-care. Telephone nursing was found to have a constricting effect on healthcare utilization, however, the compliance to nurse's recommendation is closely tied to perceptions of risk, emphasizing the importance to address caller's needs of reassurance

  • 44.
    Gustafsson, Silje
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Martinsson, Jesper
    Luleå University of Technology, Department of Engineering Sciences and Mathematics, Mathematical Science.
    Välivaara, Britt-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Need for reassurance in self-care of minor illnesses2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 5-6, p. 1183-1191Article in journal (Refereed)
    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.

  • 45.
    Forsberg, Angelica
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care. ICU 57, Sunderby Hospital.
    Vikman, Irene
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Välivaara, Britt-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Rattray, Janice
    chool of Nursing and Health Sciences, University of Dundee.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Patient's perceptions of perioperative quality of care in relation to self-rated health2018In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, no 6, p. 834-843Article in journal (Refereed)
    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.

  • 46.
    Engström, Åsa
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Forsberg, Angelica
    Sunderby sjukhus.
    Patients’ perceptions of short-term recovery after a gastric bypass2018In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, no 5, p. 681-688Article in journal (Refereed)
    Abstract [en]

    Purpose

    To explore gastric bypass patients' perceptions of their postoperative recovery over 1 month.

    Design

    A standardized questionnaire, the postoperative recovery profile, was used.

    Methods

    Postoperative recovery profile is a multi-item questionnaire for self-assessment of general postoperative recovery. Participants were patients who had undergone gastric bypass surgery (n = 39). The changes in recovery between 1 day and 1 month postsurgery were evaluated by a statistical method developed specifically for analyzing changes in paired ordered data over time.

    Findings

    Most of the symptoms and/or functions were significantly improved on a group level. The most marked improvement was to pain and sleeping difficulties followed by mobilization. In terms of the psychological items, the proportion of patients who indicated no problems was high at both endpoints. The items that deviated from the improvement pattern were appetite changes and gastrointestinal function which demonstrated a relatively high proportion of deterioration, and the individual variability was prominent.

    Conclusions

    There is a need for interventions to improve recovery on a group as well as an individual level.

  • 47.
    Forsberg, Angelica
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Vikman, Irene
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Välivaara, Britt-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Patterns of changes in patients' postoperative recovery from a short-term perspective2018In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, no 2, p. 188-199Article in journal (Refereed)
    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.

  • 48.
    Melander, Catharina
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Piecing together a fragmented world: Structures to promote the understanding of people with advanced dementia2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Understanding people with dementia whose verbal ability has been impaired is a complex and challenging task, even for professional nursing staff. The aim of this PhD thesis was to explore structures that may promote the understanding of people with advanced dementia living in nursing homes. It focusses specifically on (I) the clinical reasoning employed by assistant nurses when utilizing the NPI-NH (Neuropsychiatric Inventory Nursing Home version) as a tool to assess frequency and severity of BPSD (behavioural and psychological symptoms in dementia, i.e. problematic behaviours) in people with advanced dementia, (II) whether a sensor measuring electrodermal activity (EDA) can improve the identification of agitation in individuals with dementia, (III) how an EDA sensor impacts assistant nurses’ structured assessments of problematic behaviours amongst people with dementia and their choices of care interventions, and (IV) how Martha Nussbaum’s approach to human capabilities can apply to dignity in the lives of people with advanced dementia living in nursing homes. Study I used a method of discourse analysis that focussed on clinical reasoning utilized by assistant nurses when assessing problematic behaviours. In study II, a nonexperimental and correlational observation of the relationship between a sensor measuring EDA and assistant nurses’ structured observations of agitation in people with advanced dementia was applied. Study III used both quantitative and qualitative approaches; data were collected during structured assessments of problematic behaviours conducted by assistant nurses, as well as by focus group interviews with assistant nurses. Study IV took an ethnographic approach with participatory observations that were analyzed with a recursive analysis using a theoretical framework for the conditions necessary for a dignified human life. The structure of the NPI-NH provided a supportive framework that encouraged assistant nurses to discuss and broaden their understanding of the person with dementia (I). The EDA sensor provided continuous information regardless of staff presence and the potential to identify EDA prior to observing these behaviours (II, III), which supported the understanding of the person and when to introduce timely interventions to prevent the onset of problematic behaviours (III). The structure of Nussbaum’s approach to human capabilities illuminated that people with advanced dementia were at risk of living a life in which their opportunities for human capabilities were limited, and hence, the possibility to live a dignified life (IV). An overview of the findings in this thesis indicates that the studied structures were used to piece together fragments of information to create a comprehensive understanding of the needs of the person with dementia. For the structures to support the understanding of the person with dementia, it was crucial that nursing staff were present, attentive and engaged in each person’s situation in order for them to figure out how to piece together and integrate the structures into the overall understanding of the person and, based on that, formulate caring actions in daily life that are meaningful from the perspective of the person with advanced dementia.

  • 49.
    Hemmingsson, Eva-Stina
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
    Gustafsson, Maria
    Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, Umeå, Sweden.
    Isaksson, Ulf
    Department of Nursing, Umeå University, Umeå, Sweden. Arctic Research Centre at Umeå University, Umeå, Sweden.
    Karlsson, Stig
    Department of Nursing, Umeå University, Umeå, Sweden.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
    Sandman, Per-Olof
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Nursing, Umeå University, Umeå, Sweden. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Lövheim, Hugo
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
    Prevalence of pain and pharmacological pain treatment among old people in nursing homes in 2007 and 20132018In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 74, no 4, p. 483-488Article in journal (Refereed)
    Abstract [en]

    Purpose

    Many elderly people living in nursing homes experience pain and take analgesic medication. The aim of this study was to analyze the prevalence of pain and pharmacological pain treatment among people living in nursing homes in Sweden, in two large, comparable, samples from 2007 to 2013.

    Methods

    Cross-sectional surveys were performed in 2007 and 2013, including all residents in nursing homes in the county of Västerbotten, Sweden. A total of 4933 residents (2814 and 2119 respectively) with a mean age of 84.6 and 85.0 years participated. Of these, 71.1 and 72.4% respectively were cognitively impaired. The survey was completed by the staff members who knew the residents best.

    Results

    The prescription of opioids became significantly more common while the use of tramadol decreased significantly. The staff reported that 63.4% in 2007 and 62.3% in 2013 had experienced pain. Of those in pain, 20.2% in 2007 and 16.8% in 2013 received no treatment and 73.4 and 75.0% respectively of those with pain, but no pharmacological treatment, were incorrectly described by the staff as being treated for pain.

    Conclusions

    There has been a change in the pharmacological analgesic treatment between 2007 and 2013 with less prescribing of tramadol and a greater proportion taking opioids. Nevertheless, undertreatment of pain still occurs and in many cases, staff members believed that the residents were prescribed analgesic treatment when this was not the case.

  • 50.
    Sandström, Linda
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Forsberg, Angelica
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Intensive Care Unit 57, Sunderby Hospital, Luleå, Sweden.
    Problems associated with performance of peripheral intravenous catheterization in relation to working experience2018In: Journal of Vascular Nursing, ISSN 1062-0303, E-ISSN 1532-6578, Vol. 36, no 4, p. 196-202Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore general registered nurses’ (RNs) assessments of problems associated with difficult peripheral intravenous catheterization (PIVC) depending on their years of working experience, that is, those who had worked 3 years or less and those who had worked more than 3 years. The design was a quantitative, nonexperimental, descriptive, and analytic survey. The participating RNs (n = 83) were divided into two groups according to the length of their working experience, and the analysis was performed using the SPSS, version 24, software. The RNs also had the opportunity to answer a free-text question related to the aim. The results showed that less experienced RNs assessed to a significantly higher extent that they lacked time, experience, and ability and that there was no blood return; however, they assessed that the peripheral venous catheters were in the vein. If critical care nurses had been requested for support earlier, this request was seen as a reason not to try PIVC at all because critical care nurses were assessed as more experienced and skilled. To develop the kind of effective problem-solving and clinical reasoning needed for practice, a supportive setting must be created throughout nursing education as well as after graduation. Further research should focus on the education needs associated with PIVC and seek to understand to what extent learning in clinical skill simulation laboratories is transferred to actions in the clinical setting.

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