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  • 1.
    Ahlström, Gerd
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Experiences of loss and chronic sorrow in persons with severe chronic illness2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 3A, p. 76-83Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. The aims of the present study were to describe losses narrated by persons afflicted with severe chronic physical illness and to identify the concomitant occurrence of chronic sorrow. Background. Reactions connected with repeated losses are referred to in the literature as chronic sorrow, which has recently been described in conjunction with chronic illness. Design. A qualitative study with an abductive approach of analysis, including both inductive and deductive interpretations. Method. The study is based on 30 persons of working age with average disease duration of 18 years. The average age was 51 years. All of the persons had personal assistance for at least three months because of considerable need for help in daily life due to physical disability. Each person was interviewed twice. There was also an independent assessment of the deductive results concerning chronic sorrow. Results. The inductive findings show that all persons had experienced repeated physical, emotional and social losses. Most common were 'Loss of bodily function', 'Loss of relationship', 'Loss of autonomous life' and 'Loss of the life imagined'. 'Loss of identity' included the loss of human worth, dignity and a changed self-image. In addition, the deductive findings suggest that chronic sorrow exists in the study population. Sixteen of 30 participating subjects were assessed by both assessors to be in a state of chronic sorrow and there was an especially high agreement with respect to one criterion of chronic sorrow 'Loss experience, ongoing or single event' (28 of 30 subjects). Conclusions. This study shows that persons with severe chronic illness often experience recurring losses. These experiences are consistent with the phenomenon of chronic sorrow. Relevance to clinical practice. Knowledge of the existence of chronic sorrow in persons with chronic illness will enable nurses to support these persons in a more sensitive and appropriate way.

  • 2.
    Almborg, Ann-Helene
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Ulander, K.
    Thulin, A.
    Berg, Stig
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Discharge planning of stroke patients: The relatives' perceptions of participation2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 6, p. 857-865Article in journal (Refereed)
  • 3.
    Almborg, Ann-Helene
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Ulander, Kerstin
    Thulin, Anders
    Berg, Stig
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Discharged after stroke - important factors for health-related quality of life.2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 15-16, p. 2196-2206Article in journal (Refereed)
    Abstract [en]

    AIMS: This study examines different correlates to health-related quality (HRQoL) of life after discharge in patients with stroke.

    BACKGROUND: HRQoL is an important aspect of life after suffering a stroke. Previous research has revealed several variables associated with poststroke quality of life, including age, gender, depression, fatigue, length of hospital stay, functional status and amount of social participation. However, the time span after stroke varies greatly in the different studies. Although the multiple factors that contribute to short-term postdischarge HRQoL have potential importance for discharge planning, to our knowledge, these factors have not been systematically investigated during the earlier days following discharge.

    DESIGN: Cross-sectional study.

    METHODS: The sample consisted of 188 consecutively included individuals (mean age 74 years, 56% men) from a stroke unit in southern Sweden. The interviews were performed two to three weeks after discharge and included use of the SF-36, the Center for Epidemiological Studies Depression Scale, the Barthel Index, the Frenchay Activities Index, performance of interests and survey of patients' perceived participation in discharge planning. Multiple linear regression analysis was conducted to identify variables associated with HRQoL.

    RESULTS: Multiple regression analyses with the eight scales of SF-36 as dependent variables revealed eight models, one for each scale, which were statistically significant. Depressive symptoms were associated with lower HRQoL. Ability to perform personal and social activities, interests, younger age, education (elementary school) and shorter hospital stay were related to higher HRQoL. Patients' perceived participation in discharge planning was both positively and negatively associated with HRQoL.

    CONCLUSIONS: Several variables were related to good HRQoL two to three weeks post-discharge, particularly fewer depressive symptoms, participation in social activities such as outdoor activities and performance of interests.

    RELEVANCE TO CLINICAL PRACTICE: These results can be used to design needs assessment forms of discharge planning to promote adaptation and recovery after stroke.

  • 4.
    Almborg, Ann-Helene
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Ulander, Kerstin
    Thulin, Anders
    Berg, Stig
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Patients' perceptions of their participation in discharge planning after acute stroke.2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 2, p. 199-209Article in journal (Refereed)
  • 5.
    Andersson, Ingegerd
    et al.
    Department of Public Health and Carinng Sciences.
    Pettersson, Elisabet
    Department of Public Health and Carinng Sciences.
    Sidenvall, Birgitta
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Daily life after moving into a care home: experiences of older people, relatives and contact persons.2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 9, p. 1712-1718Article in journal (Refereed)
    Abstract [en]

    Background: When older persons move into a care home, the whole family often play an important part. Thus, it is interesting to study how newly admitted older people, their relatives and staff members experience daily life in a modern care home. Aims and objectives: To describe older people’s experiences of daily life at the care home after admittance with respect to their perceptions of participation in the decision to move. Furthermore, the aim was to study the experiences of their relatives and contact persons with respect to the daily life of the same residents. Methods: Qualitative design. The participants comprised a purposive sample of thirteen residents, recently admitted to a care home, 69-90 years old, both single living and married, both moving from their own homes and from different institutions. Interviews were carried out with the older people (n=13), their relatives (n=10) and contact persons (n=11). Results: The majority of the residents reported satisfaction with care home living. The relatives were also satisfied, secure and appreciated the privacy and homely atmosphere of the flat. The disadvantage of one-room flats was that the residents might have felt lonely. The relatives felt that the residents were bored, but few residents desired more activities, even if some of them longed for people to socialize with. For many older people, perhaps talking is the most important ‘activity’ at care homes. Concerning self-determination, some residents did not find it satisfactory. Relevance to Clinical Practice: Staff members must pay attention to residents’ need to talk with people. For many older people, talking is perhaps the most important ”activity” at care homes. Nurses must safeguard residents’ self-determination. When residents are in control of their lives, they may become satisfied with time

  • 6. Arenhall, Eva
    et al.
    Kristofferzon, Marja-Leena
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health Science, HHJ. ADULT.
    Nilsson, Ulrica
    The female partners' experiences of intimate relationship after a first myocardial infarction2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 11/12, p. 1677-1684Article in journal (Refereed)
    Abstract [en]

    Aim. This study aimed to explore and describe women’s experience of intimate relationships in connection to and after their partner’s first myocardial infarction (MI).

    Background. Support from partners is important for recovery, but little is known about partners’ experience of intimate relationships after MI.

    Design. The study used an explorative, qualitative design.

    Methods. The first author interviewed 20 women having a partner who had suffered a first MI during the preceding year. Qualitative content analysis was used to analyse the data.

    Findings. Three themes emerged: ‘limited life space’, ‘sense of life lost’ and ‘another dimension of life’. The women described how their self-assumed responsibility led to a more stifling and limited life. Their sense of life lost was described in terms of deficits and feeling the loss. The women also described experiencing another dimension of life characterised by three subthemes: ‘uncertainty of life’, ‘certain of relationship’ and ‘share life more’.

    Conclusions. The partners’ MI had an impact on the interviewees’ intimate relationships; they suffered a major loss and missed their ‘former’ partner, both emotionally and sexually. They struggled with the new asymmetry in their intimate relationship and felt compelled to adapt to their partners’ lack of sexual desire or function. Also, their partner controlled them, which lead towards a stifling, more limited life space.

    Relevance to clinical practice. Caregivers in hospital and primary care settings could apply the findings in their efforts to help couples recover or maintain intimate relationships following MI.

  • 7. Bachrach-Lindström, Margareta
    et al.
    Jensen, Sara
    Lundin, Rickard
    Christensson, Lennart
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Attitudes of nursing staff working with older people towards nutritional nursing care2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 11, p. 2007-2014Article in journal (Refereed)
  • 8.
    Bala, Sidona-Valentina
    et al.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Samuelson, Karin
    Department of Health Sciences, Lund University, Lund, Sweden .
    Hagell, Peter
    The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Health Sciences, Lund University, Lund, Sweden .
    Forslind, Kristina
    Section of Rheumatology, Department of Medicine, Helsingborg Hospital, Helsingborg, Sweden.
    Svensson, Björn
    Section of Rheumatology at the Institution of Clinical Science, Lund University, Lund, Sweden.
    Thomé, Bibbi
    Department of Health Sciences, Lund University, Lund, Sweden .
    Living with persistent rheumatoid arthritis: A BARFOT study2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 17-18, p. 2646-2656Article in journal (Refereed)
    Abstract [en]

    Aim and objective: To describe and understand the meaning of living with persistent rheumatoid arthritis.

    Background: A considerable number of patients with rheumatoid arthritis live with an ongoing active and symptomatic illness despite access to potent antirheumatic treatment. There is, however, a lack of knowledge about the meaning of living with this severe long-term illness, defined as persistent rheumatoid arthritis.

    Design: A descriptive design based on a hermeneutic phenomenological method was used.

    Methods: Ten adults with persistent rheumatoid arthritis and at least five years disease duration were interviewed. The interviews were analysed according to van Manen's method.

    Results: Living with persistent rheumatoid arthritis revealed four overall themes: an existence dominated by painful symptoms and treatment, radical changes and limitations in one's life, a continual struggle to cope with one's life and to master the illness, and a dependency on those who are close by and the world around. The lifeworld was affected to a varying extent and in various ways by the illness but also by the dependence on its treatment and care that was not experienced as sufficiently meeting needs in terms of security, access to and coordination of care as well as team and rehabilitation services.

    Conclusions: Persistent rheumatoid arthritis and its treatment entail a radical effect on the person's life and quality of life. Current ordinary rheumatology care does not seem to meet the individual needs of the person with persistent rheumatoid arthritis in an optimal way.

    Relevance to clinical practice: A greater knowledge about and understanding of the person who lives with persistent rheumatoid arthritis is important for facilitating the development of care and the relief of suffering. A holistic alternative to conventional clinical practice, such as person-centred care, could be tested as an innovative model of care. Our findings might serve as material for educational and counselling purposes for healthcare professionals. 

  • 9. Boström, B
    et al.
    Sandh, M
    Lundberg, D
    Fridlund, Bengt
    Högskolan i Halmstad.
    A Comparison of pain and health-related quality of life between two groups of cancer patients with differing average levels of pain2003In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 5, p. 726-735Article in journal (Refereed)
  • 10. Broström, A
    et al.
    Strömberg, A
    Dahlström, U
    Fridlund, Bengt
    Högskolan i Halmstad.
    Congestive heart failure, spouses' support and the couple's sleep situation: a critical incident technique analysis2003In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 2, p. 223-233, 234Article in journal (Refereed)
  • 11.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum – Academy for Health and Care, Region Jönköping County, Sweden.
    Nilsen, Per
    Division of Health Care Analysis, Department of Health and Society, Faculty of Medicine, Linköping University Linköping, Sweden.
    Ulander, Martin
    Department of Clinical Neurophysiology, University Hospital Linköping, Sweden.
    Communication between patients with obstructive sleep apnoea syndrome and healthcare personnel during the initial visit to a continuous positive airway pressure clinic2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 3-4, p. 568-577Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To describe facilitators and barriers from a patient perspective in communications between patients with obstructive sleep apnoea syndrome and healthcare personnel during the first meeting when continuous positive airway pressure is initiated.

    Background: Adherence to continuous positive airway pressure treatment tends to be poor, especially at the initial phase of treatment. Communication between the patient and healthcare personnel has not been studied from the patient perspective, as either a barrier or facilitator for adherence.

    Methods: A descriptive design using qualitative content analysis was used. Interviews with 25 patients with obstructive sleep apnoea syndrome took place after their initial visit at four continuous positive airway pressure clinics. A deductive analysis based on The 4 Habits Model (i.e. emphasise the importance of investing in the beginning of the consultation, elicit the patient's perspective, demonstrate empathy and invest in the end of the consultation) was conducted.

    Results: Building confidence (i.e. structure building, information transfer, commitment) or hindering confidence (i.e. organisational insufficiency, stress behaviour, interaction deficit) was associated with investing in the beginning. Motivating (i.e. situational insight, knowledge transfer, practical training) or demotivating (i.e. expectations, dominance and power asymmetry, barriers) was associated with eliciting the patient's perspective. Building hope (i.e. awareness, sensitivity, demonstration of understanding) or hindering hope (i.e. unprepared, uncommitted, incomprehension) was associated with showing empathy. Agreement (i.e. confirmation, responsibilities, comprehensive information) or disagreement (i.e. structural obscurity, irresponsibility, absent-mindedness) was associated with investing in the end.

    Conclusions: Understanding of facilitators and barriers, as described by patients, can be used to improve contextual conditions and communication skills among healthcare personnel.

    Relevance to clinical practice: A patient-centred communication technique should be used in relation to all stages of The 4 Habits Model to facilitate shared decision-making and improve adherence to continuous positive airway pressure treatment.

  • 12.
    Broström, Anders
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Nilsen, Per
    Division of Social Medicine and Public Health Science Department of Health and Society Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Development and psychometric evaluation of the Swedish propensity to achieve healthy lifestyle scale in patients with hypertension2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 21-22, p. 4040-4049Article in journal (Refereed)
    Abstract [en]

    Purpose: To develop and validate a Swedish questionnaire to measure propensity for behaviour change regarding food habits, physical activity and weight reduction in patients with hypertension.

    Design: Cross-sectional design.

    Methods: A total of 270 consecutive patients with hypertension diagnosed at four primary care centres in Sweden were included. The 6-item Swedish version of the Propensity to Achieve Healthy Lifestyle Scale (PAHLS) was developed to measure propensity for behaviour change regarding food habits, physical activity and weight reduction. The PAHLS (i.e., including three items for preparedness and three items for capacity) was developed by three multiprofessional researchers inspired by the transtheoretical model of behaviour change in collaboration with clinically active nurses. Data were collected by questionnaires on food habits (i.e., the Food Frequency Questionnaire), physical activity (the International Physical Activity Questionnaire), propensity for a healthy lifestyle (the PHLQ), as well as during a clinical examination. Exploratory (EFA) and confirmatory factor analyses (CFA), as well as Rasch analysis, were used.

    Results: Of the 270 patients (50% women), 27% scored low levels of physical activity on the International Physical Activity Questionnaire, and 34% of the patients were obese (body mass index ≥30 kg/m2). The EFA (explaining 54% of the variance) showed unidimensionality for the PAHLS that was supported by both CFA and Rasch analyses. No floor and 1.9% ceiling effects were found. Multiple group CFA (an extension of structural equation modelling) showed that the PAHLS operated equivalently across both male and female patients. Internal consistency (Cronbach's alpha 0.83) and composite reliability (0.89) were good.

    Conclusion: The initial testing of PAHLS provided good validity and reliability scores to measure propensity for behaviour change in patients with hypertension.

    Relevance to Clinical Practice: The PAHLS can be used by nurses as a tool to simplify shared decision-making in relation to behavioural changes. 

  • 13.
    Browall, Maria
    et al.
    Högskolan i Skövde, Institutionen för hälsa och lärande.
    Forsberg, Christina
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
    Wengström, Yvonne
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden / Karolinska University Hospital, Breast and Sarcoma Unit, Radiumhemmet, Sweden.
    Assessing patient outcomes and cost effectiveness of nurse-led follow-up for women with breast cancer: have relevant and sensitive evaluation measures been used?2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 13-14, p. 1770-1786Article, review/survey (Refereed)
    Abstract [en]

    Aim

    To explore how interventions using nurse-led follow-up in breast cancer care have been evaluated with a focus on patient outcomes and cost effectiveness.

    Background

    As part of the advancement of breast care, nurse-led follow-up is increasingly used as an alternative to routine hospital follow-up in outpatient clinics. There is evidence suggesting that patients appear to be satisfied with the nurse-led follow-up, but there is a lack of evidence of whether this perception equates to patients’ satisfaction with the model of physician-led follow-up.

    Design

    Systematic review.

    Method

    Three databases were searched, and 29 RCT were initially screened. Finally, 13 articles were critically appraised. Searches included articles between 2005 and 2013. The quality of appraisal assessment was inspired by the GRADE system.

    Results

    The results show that there are many different instruments used when evaluating nurse-led follow up which makes it difficult to compare the studies. Several of the studies used QoL as an outcome measure; this is a broad concept that includes several aspects ranging from social role and psychosocial issues to symptoms and therefore difficult to use as an outcome measure. Only two of the studies made any cost-effective analyses and the results are hard to interpret.

    Conclusions

    Nurse-led follow-up can potentially result in better continuity of care and the availability of more time to provide psychosocial support and address patients’ information needs. However, more well-conducted research is needed before equivalence to physician-led follow-up can be assessed in terms of survival, recurrence, patient well-being and cost-effectiveness.

  • 14.
    Carlsson, N.
    et al.
    Division of Paediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University.
    Johansson, A.
    Division of Nursing Science, Department of Medicine and Health, Faculty of Health Sciences, Linköping University.
    Hermansson, G.
    Faculty of Health Sciences, Linköping University.
    Andersson-Gäre, Boel
    Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, The Jönköping Academy for Improvement of Health and Welfare.
    Child health nurses' roles and attitudes in reducing children's tobacco smoke exposure2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 3-4, p. 507-516Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate and analyse the attitudes to tobacco prevention among child healthcare nurses, to study how tobacco preventive work is carried out at child healthcare centres today. To evaluate how the tobacco preventive work had changed in child health care since the Swedish National Board of Health and Welfare's national evaluation in 1997.

    BACKGROUND: Exposure to environmental tobacco smoke has adverse health effects. Interventions aiming at minimising environmental tobacco smoke have been developed and implemented at child healthcare centres in Sweden but the long-term effects of the interventions have not been studied.

    DESIGN: Survey.

    METHODS: In 2004, a postal questionnaire was sent to all nurses (n = 196) working at 92 child healthcare centres in two counties in south-eastern Sweden. The questionnaire was based on questions used by the National Board of Health and Welfare in their national evaluation in 1997 and individual semi-structured interviews performed for this study.

    RESULTS: Almost all the nurses considered it very important to ask parents about their smoking habits (median 9.5, range 5.1-10.0). Collaboration with antenatal care had decreased since 1997. Nearly all the nurses mentioned difficulties in reaching fathers (70%), groups such as immigrant families (87%) and socially vulnerable families (94%) with the tobacco preventive programme. No nurses reported having special strategies to reach these groups.

    CONCLUSIONS: Improvement of methods for tobacco prevention at child healthcare centres is called for, especially for vulnerable groups in society. However, the positive attitude among nurses found in this study forms a promising basis for successful interventions.

    RELEVANCE TO CLINICAL PRACTICE: This study shows that launching national programmes for tobacco prevention is not sufficient to achieve sustainable work. Nurses working in child healthcare centres have an overall positive attitude to tobacco prevention but need continuous education and training in communication skills especially to reach social vulnerable groups. Regular feedback from systematic follow-ups might increase motivation for this work.

  • 15.
    Christensson, Lennart
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Ek, Anna-Christina
    Unosson, Mitra
    Individually adjusted meals for older people with protein-energy malnutrition: a single-case study2001In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 10, p. 491-502Article in journal (Refereed)
  • 16.
    Dalteg, Tomas
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Sandberg, Jonas
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Internal Medicine County Hospital Ryhov Jönköping Sweden.
    Sandgren, Anna
    The Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden.
    Benzein, Eva
    The Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden.
    The heart is a representation of life: an exploration of illness beliefs in couples living with atrial fibrillation2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 21-22, p. 3699-3709Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To explore illness beliefs in couples where one spouse has atrial fibrillation.

    Background: Beliefs are the lenses through which we view the world, guiding our behaviour and constructing our lives. Couples evolve an ecology of beliefs from their interaction whereby their actions and choices arise from their beliefs. Atrial fibrillation is a common cardiac arrhythmia that has implications for both patients and partners. A couple's illness beliefs play an important role in convalescence and illness management, and no previous studies have explored illness beliefs in couples living with atrial fibrillation.

    Design: A qualitative hermeneutic design.

    Methods: Data collection constituted in-depth interviews with nine couples (patient and partner together). Hermeneutic philosophy as described by Gadamer was used to interpret and to understand illness beliefs in couples living with atrial fibrillation.

    Results: The findings revealed both core illness beliefs and secondary illness beliefs. From the core illness belief 'The heart is a representation of life', two secondary illness beliefs were derived: atrial fibrillation is a threat to life and atrial fibrillation can and must be explained. From the core illness belief 'Change is an integral part of life', two secondary illness beliefs were derived: atrial fibrillation is a disruption in our lives and atrial fibrillation will not interfere with our lives. Finally, from the core illness belief 'Adaptation is fundamental in life', two secondary illness beliefs were derived: atrial fibrillation entails adjustment in daily life and atrial fibrillation entails confidence in and adherence to professional care.

    Conclusion: Couples' interaction has developed mutual illness beliefs regarding atrial fibrillation that guide them in their daily lives and influence their decisions. The adoption of a family-centred perspective in cardiovascular care settings is warranted. 

  • 17.
    Elmqvist, Carina
    et al.
    Centre for Acute & Critical Care, School of Health and Caring Sciences, Linneaus University.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Ekebergh, Margaretha
    Centre for Lifeworld-Led Education, School of Health and Caring Sciences, Linneaus University, Växjö.
    On a hidden game board: the patient's first encounter with emergency care at the emergency department2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 17/18, p. 2609-2616Article in journal (Refereed)
    Abstract [en]

    Aims and objectives.  Describe and understand the patient’s first encounter in emergency care at the emergency department, as experienced by the patient, next of kin and first providers from different professions.

    Background.  The emergency department is most often described as having high levels of satisfaction with the quality of care delivered. Although the patients appreciate clinical competence, quick assessment and technical skills, a close connection between patient satisfaction and vulnerability has been shown.

    Design.  A lifeworld research perspective was used in four different situations at the emergency department.

    Methods.  The data consisted of 14 open-ended interviews with patients, next of kin and first providers.

    Results.  The analysis showed that narratives of the past, present and future characterises the encounter where mutual narratives form a foundation for those involved in the encounter. Five constituents further described the variations; vague rules and conflicting expectations in the encounter, an encounter with the biological body, ‘courtesy encounters’, isolated in a timeless encounter, striving for meaning in the encounter.

    Discussion.  Instead of expecting the patients to know the unwritten rules of the emergency department, the first providers could give clear information about expected waiting times and what to expect in the encounter. The challenge is to make a meaningful comprehensible context for all involved which can be generated in the interpersonal encounter.

    Relevance to clinical practice.  The findings highlight the importance of disclosing the rules of the game by means of giving clear information which would give possibilities for the patient to maintain control, for strengthening the nurse’s role as the patients’ advocate and for strengthening the effort for an emergency department to become more of a learning organisation.

  • 18.
    Emsfors, Åsa
    et al.
    Department of Ophthalmology Central Hospital Kristianstad Sweden.
    Christensson, Lennart
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Elgán, Carina
    School of Health and Society Kristianstad University Kristianstad Sweden.
    Nursing actions that create a sense of good nursing care in patients with wet age-related macular degeneration2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 17-18, p. 2680-2688Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To identify and describe nursing actions performed by nurses that create a sense of good nursing care in patients with wet age-related macular degeneration.

    Background: People who suffer from wet age-related macular degeneration risk central vision loss. Treatment with antivascular endothelial growth factor is the only available option at present that preserves vision and no definitive cure currently exists. Patients feel that they are compelled to accept this treatment because they might otherwise become blind.

    Design: An explorative and descriptive design based on the critical incident technique was used.

    Method: Interviews with 16 Swedish patients who all had received intravitreal treatment for wet age-related macular degeneration.

    Results: Two main areas of good nursing care were identified: 'Being perceived as an individual' and 'Being empowered'. The first area was divided into two categories: being respectful and being engaged. Being respectful was observed when nurses had a benevolent attitude towards their patients and answered questions kindly and politely. Patients saw themselves as individuals when nurses were available for conversation and focused on them. The second area was divided into two categories: encouraging participation and creating confidence. Encouraging participation refers to when nurses provided information continuously. Nurses instilled confidence and trust in their patients by keeping promises and by being honest.

    Conclusions: A respectful interaction between patients and caregivers is necessary for patients to obtain beneficial health care.

    Relevance to clinical practice: Patient interviews revealed important information about nursing actions that created a sense of good nursing care in patients with wet age-related macular degeneration. Nurses acknowledged people as individuals and created trust by building partnerships and sharing decision-making. To address each patient's concerns, nurses need to prioritise each patient's narrative and participation by documenting agreements in their medical record. 

  • 19.
    Ericsson, Iréne
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Malmberg, Bo
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Langworth, Sven
    Haglund, Anders
    Almborg, Ann-Helene
    KUD- a scale for clinical evaluation of moderate-to-severe dementia2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 11-12, p. 1542-1552Article in journal (Refereed)
    Abstract [en]

    Aim.  To develop a test of cognitive performance in persons with moderate-to-severe dementia.

    Background.  Various instruments are used to assess the course of dementia and to evaluate treatments in persons with dementia. Most neuropsychological assessments are inappropriate for measuring cognitive abilities in persons with severe dementia, because these persons perform at floor level in such measurements.

    Design.  A cross-sectional research design.

    Methods.  The test (Clinical Evaluation of Moderate-to-Severe Dementia; Swedish acronym: KUD) was developed from a pool of 25 test items with the final KUD consisting of 15 items. Reliability and validity were established using 220 subjects (with various dementia diagnoses) with scores of Mini-Mental State Examination between 0–20. Approximately two weeks after the first test, 116 of the original 220 subjects were retested.

    Results.  A factor analysis with the 15-item scale revealed an interaction factor comprising three items and a cognitive performance factor with 12 items. The internal consistence reliability was 0·93 for the KUD (Cronbach’s alpha). Test–retest reliability was also high (0·92) and correlation between the KUD and the MMSE (≤20) was high (r = 0·80).

    Conclusion.  The KUD seems to be a valid, reliable performance-based assessment scale for measuring cognitive performance in persons with MMSE score below 12 or 15 points.

    Relevance to clinical practice.  It is of outmost interest that cognitive performance can be easily followed for persons with moderate-to-severe dementia in, for example, drug therapies and other therapies, but also in terms of treatment of and support to the person based on his or her abilities.

  • 20.
    Eriksson, Kerstin
    et al.
    Ryhov County Hospital, Jönköping.
    Wikström, Lotta
    Ryhov County Hospital, Jönköping.
    Lindblad-Fridh, Marianne
    Jönköping University, School of Health and Welfare.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Using mode and maximum values from the Numeric Rating Scale when evaluating postoperative pain management and recovery2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 5-6, p. 638-647Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To (1) examine the clinical applicability of compiled mode and maximum values from the Numeric Rating Scale (NRS) by comparing the correspondence between patient perceptions of pain and pain values from monitoring records, as well as (2) to study the relationship between mode and maximum values and self-assessed ability for early postoperative recovery.

    Background: Documentation of pain remains a problem despite recommendations of quality improvements. To examine the correlation between patient perceptions and documented pain therefore becomes important. Few have studied how pain affects recovery.

    Design: A quantitative cross-sectional design was used in which 157 postoperative patients answered a questionnaire on pain intensity and recovery. A parallel examination of pain in monitoring records was conducted.

    Results: A total of 57% had a mode value calculated from records between 0 and 3 on postoperative day 1 and 69% on day 2. A maximum value between 4 and 10 was found in monitoring records for 73% on day 1 and for 67% on day 2. The correspondence between mode value from monitoring records and the patients’ retrospective perceptions was 88% for NRS 0–3 and 92% between maximum value and NRS 4–10. The correlation between documented pain and retrospectively identified pain for mode value of the NRS in all (0–10) was rather weak (r = 0·37), while maximum value had a stronger correlation (r = 0·53).

    Conclusion: Mode and maximum values could be used as outcome measures when evaluating postoperative pain. Pain affects recovery negatively, but more research is needed to strengthen the evidence for the use and clarify the link between pain and recovery.

    Relevance to clinical practice: International organisations emphasise the importance of improving pain assessment. Mode and maximum values are easy to compile for nurses and can, together with assessments of how experienced pain levels affect postoperative recovery, improve treatment of postoperative pain.

  • 21.
    Feo, Rebecca
    et al.
    Adelaide Nursing School, University of Adelaide, Australia.
    Conroy, Tiffany
    Adelaide Nursing School, University of Adelaide, Australia.
    Jangland, Eva
    Department of Surgical Sciences, Uppsala University, Sweden / Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
    Muntlin Athlin, Åsa
    Department of Medical Sciences Uppsala University, Uppsala University Hospital, Sweden / Department of Public Health and Caring Sciences, Uppsala University, Sweden / Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Sweden.
    Browall, Maria
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Skövde, Institutionen för hälsa och lärande.
    Parr, Jenny
    Auckland University of Technology, New Zealand / Counties Manukau Health District Health Board, Middlemore Hospital, Auckland, New Zealand.
    Blomberg, Karin
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Kitson, Alison
    College of Nursing and Health Sciences, Flinders University, Australia / Adelaide Nursing School, University of Adelaide, Australia.
    Towards a standardised definition for fundamental care: a modified Delphi study2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 11-12, p. 2285-2299Article in journal (Refereed)
    Abstract [en]

    AIMS: To generate a standardised definition for fundamental care and identify the discrete elements that constitute such care.

    BACKGROUND: There is poor conceptual clarity surrounding fundamental care. The Fundamentals of Care Framework aims to overcome this problem by outlining three core dimensions underpinning such care. Implementing the Framework requires a standardised definition for fundamental care that reflects the Framework's conceptual understanding, as well as agreement on the elements that comprise such care (i.e., patient needs, such as nutrition, and nurse actions, such as empathy). This study sought to achieve this consensus.

    DESIGN: Modified Delphi study.

    METHODS: Three phases: (1) engaging stakeholders via an interactive workshop; (2) using workshop findings to develop a preliminary definition for, and identify the discrete elements that constitute, fundamental care; and (3) gaining consensus on the definition and elements via a two-round Delphi approach (Round 1 n=38; Round 2 n=28).

    RESULTS: Delphi participants perceived both the definition and elements generated from the workshop as comprehensive, but beyond the scope of fundamental care. Participants questioned whether the definition should focus on patient needs and nurse actions, or more broadly on how fundamental care should be delivered (e.g., through a trusting nurse-patient relationship), and the outcomes of this care delivery. There were also mixed opinions whether the definition should be nursing specific.

    CONCLUSIONS: This study has initiated crucial dialogue around how fundamental care is conceptualised and defined. Future work should focus on further refinements of the definition and elements with a larger, international group of practising nurses and service users.

  • 22. Flemme, I
    et al.
    Bolse, K
    Ivarsson, A
    Jinhage, BM
    Sandstedt, B
    Edvardsson, N
    Fridlund, Bengt
    Högskolan i Halmstad.
    Life situation of patients with an implantable cardioverter defibrillator: a descriptive longitudinal study2001In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 10, no 4, p. 563-572Article in journal (Refereed)
  • 23. Folke, S
    et al.
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Paulsson, G
    Views of xerostomia among health care professionals: a qualitative study2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 6, p. 791-798Article in journal (Refereed)
  • 24.
    Fransson, Eleonor
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Arenhall, Eva
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Steinke, Elaine E.
    School of Nursing, Wichita State University, Wichita, Kansas, USA.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Nilsson, Ulrica G.
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Perceptions of intimate relationships in partners before and after a patient's myocardial infarction2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 15-16, p. 2196-2204Article in journal (Refereed)
    Abstract [en]

    Aims and objectives To describe and explore how partners rate their intimate relationship before and after the patients' first myocardial infarction. A further aim was to investigate the association between partners' rating of their intimate relationship and self-rated health.

    Background To date, information on how partners experience the intimate relationship before and after a patient's myocardial infarction is sparse.

    Design A descriptive and exploratory design with longitudinal data collection.

    Methods The study comprised 127 partners, aged 34–87 years. Data collection included self-reported information on socio-demographic data, intimate relationship and self-rated health one year before and one year after patients' first myocardial infarction. Intimate relationship was assessed by the Swedish version of the Relationship Assessment Scale. Self-rated health was evaluated by the EuroQoL visual analogue scale.

    Results In general, partners reported high satisfaction with their intimate relationship both before and after the patients' myocardial infarction. Women reported somewhat lower ratings in their intimate relationship than men before the myocardial infarction. Women increased their ratings after one year, while men on average decreased their ratings. Partners with higher education reported lower ratings for intimate relationship after one year. Those with children living at home rated intimate relationship lower than those without children living at home after one year. Partners' self-rated health status was stable over time. No significant association between intimate relationship and self-rated health was found.

    Conclusions This study provides important insights regarding couples' relationships from the perspective of the partner. Socio-demographic factors such as sex, educational level, having children living at home and employment status may influence how the relationship, from the partners' perspective, is affected by a myocardial infarction event.

    Relevance to clinical practice This study provides insight into how partners rate their intimate relationship and self-rated health over time before and after patients' myocardial infarction.

  • 25.
    Fridlund, Bengt
    et al.
    Högskolan i Halmstad.
    Lindgren, Eva-Carin
    Ivarsson, Anette
    Bolse, Kärstin
    Flemme, Inger
    Sandstedt, Bengt
    Mårtensson, Jan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Patients with implantable cardioverter-defibrillator and their conceptions of the life situation: a qualitative analysis2000In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 9, no 1, p. 37-45Article in journal (Refereed)
  • 26.
    Fridlund, Bengt
    et al.
    Högskolan i Halmstad.
    Pihlgren, C
    Wannestig L-B,
    A supportive-educative caring rehabilitation programme: improvements of physical health after myocardial infarction1992In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 1, no 3, p. 141-146Article in journal (Refereed)
  • 27.
    Golsäter, Marie
    et al.
    Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Sidenvall, Birgitta
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Lingfors, Hans
    Primärvårdens fou-enhet Jönköpings läns landsting.
    Enskär, Karin
    Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Adolescents' and school nurses' perceptions of using a health and lifestyle tool in health dialogues2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, p. 2573-2583Article in journal (Refereed)
    Abstract [en]

    Aim and objective. To describe and explore adolescents’ and nurses’ perceptions of using a health and lifestyle tool in healthdialogues in the School Health Service.

    Background. In Sweden, dialogues concerning health and lifestyle are offered to adolescents aged 14 years with the purpose of encouraging an interest in a healthy lifestyle. A health and lifestyle tool including a health questionnaire and a health profile has recently been developed, with the aim of facilitating the communication about health and lifestyle in these dialogues.

    Design.Qualitative descriptive design.

    Method. Twenty-nine adolescents and 23 nurses participated in focus group interviews, which were subjected to qualitative content analysis.

    Results. The health and lifestyle tool was perceived as constituting a structure for the dialogues and as a clear and applicable starting point, focusing on individual aspects. The tool contributed to an understanding of the health situation and to the transmittal of health information on an individual as well as a group level.

    Conclusion.The tool was perceived as constituting a useful structure for the dialogues about health and lifestyle. When it was used the individual’s health and lifestyle were concretised, which opened up for a dialogue and different aspects of health and lifestyle were detected. However, in some cases the outcome of the tool could be conceived as a stringent assessment and thereby complicate the dialogues.

    Relevance to clinical practice.The use of a tool, such as the one used in this study, is one way to improve the dialogues in the School Health Service, allowing them to be more focused on the individual’s needs and to detect aspects that would otherwise not be so easily detected. The implications of this study include using the findings to guide counselling sessions in the schools and other health care settings.

  • 28. Gustafsson, Margareta
    et al.
    Ahlström, Gerd
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Problems experienced during the first year of an acute traumatic hand injury: a prospective study.2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 8, p. 986-995Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Evidence-based nursing of patients with acute traumatic hand injuries treated at the hand-surgical clinic calls for knowledge about long-term implications. AIMS AND OBJECTIVES: The aim of the study was to investigate consequences of an acute traumatic hand injury during the first year after the accident. Specifically, the objectives were to investigate changes in the experience of physical and psychological problems over time, frequencies of remaining problems and the impact of the injury on work situation and life situation 1 year after the accident. DESIGN: The study was prospective and followed the patients from the first weeks to 1 year after the accident. METHOD: Ninety-one patients were assessed three times during the year. Each time the patients answered study-specific questions, the Impact of Event Scale and the Hospital Anxiety and Depression Scale. RESULTS: Problems experienced decreased during the first 3 months but tended to remain unchanged during the rest of the year. In the 1-year follow-up, the majority of the patients experienced slight or moderate functional limitations in the hand, one-third had symptoms of trauma-related distress and one out of seven had troublesome pain. Half of the patients who had returned to work reported a worse work situation and 16% were still on the sick list. One-third of all patients considered their whole life situation to be worse as a result of the injury. Patients with amputations more often experienced a worse life situation. Blue-collar workers reported functional limitations and a worse life situation more often than white-collar workers. CONCLUSIONS: Patients with acute traumatic hand injuries requiring surgical treatment may experience problems, such as functional limitations, trauma-related distress and troublesome pain, with long-term implications for their work situation and life situation. RELEVANCE TO CLINICAL PRACTICE: Caring for hand-injured patients should include, not only surgical treatment and other actions for restoring the function of the hand, but also preventive action and follow-up of trauma-related distress and pain.

  • 29.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Johanson, Marita
    Cederborg, Ann-Christin
    Communicating stroke survivors' health and further needs for support in care-planning meetings2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 11, p. 1481-91Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. This study will illustrate how stroke survivors, their relatives and different professionals communicated in care-planning meetings when planning care for patients after their discharge from hospital. We wanted to know what topics participants were talking about, to what extent they were involved in the discussion and how the communication was organized.

    Background. Communication in health care is sometimes problematic because of the participants’ asymmetrical positions when negotiating how to understand the patients’ future care.

    Methods. A qualitative and a quantitative design were adopted with a sample of 14 authentic audio-recorded care-planning meetings. The transcribed meetings were, together with observational notes, analysed from a data-driven approach.

    Findings. Five topics emerged. The professionals tended to dominate the discourse space even if their involvement varied depending on the topic talked about. The most noteworthy finding was the patients’ need of communicative alliances with other participants when negotiating their needs and desires of further care. When making decisions two approaches emerged. The ‘aim-driven’ approach was characterized by alliances between those participants who seemed to share a common goal for the patient’s further care. When the participants used the ‘open-minded’ approach they merged information and discussed different solutions leading to a goal step by step.

    Conclusions. The importance of strengthening stroke survivors’ participation in care-planning meetings is highlighted. Professionals have to increase their knowledge about how to involve the patients as well as their awareness of how to avoid power struggles between various professionals, patients and relatives.

  • 30.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Larsson, US
    Environmental elements affecting the decision-making process in nursing practice.2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 3, p. 316-324Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In their practice nurses constantly make decisions in a dynamic context including complex situations. Besides affecting elements related to the decision-maker and the task itself, the setting where the decision-making process takes place are of decisive importance to the quality of the decision-making outcome.

    AIM: The aim of this study was to explore environmental elements related to the decision-making process in nursing practice.

    METHODS: Six expert nurses, from three Swedish nursing settings, participated voluntarily in the study, which were designed of participated observations in everyday nursing practice. Permission to carry out the study was given by the clinics and an ethical committee. A content analysis was used to analyse the field notes where themes emerged which were found to be environmental elements affecting decision-making process of nurses.

    CONCLUSIONS: The most striking theme, environmental elements, included the sub-themes interruptions and the work procedures are presented in this report. The implications of environmental elements, are discussed from a perspective of nurses' competence, where the elements could be seen as a facilitator or as a hindrance to developing nursing competence. It were concluded that environmental elements have to be well considered before knowledge can be reached about decision-making in practice.

    RELEVANCE TO CLINICAL PRACTICE: Interpersonal and technological interruptions were features highlighted in the study, features which could jeopardize the decision-making outcome. Therefore, it is of greatest importance that nurses learn to use decision-making strategies to guarantee patient care security and patient care quality.

  • 31.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Sätterlund Larsson, Ullabeth
    Observations, confirmations and strategies: useful tools in decision-making process for nurses in practice?2003In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 2, p. 215-222Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe how nurses make decisions on measures in clinical practice. The data-collection method consisted of audio-taped interviews with six nurses. The interviews were then transcribed verbatim. The questions in the interviews were based on nursing situations observed earlier when the nurses initiated and implemented patient-related measures and the focus was on the nurses' experience of decision making. A content analysis was performed. The results show that the nurses' decisions on measures were based on three themes: observation of cues related to the patient's situation, confirmation of information gathered and implementation of action strategies. The results are discussed in relation to earlier empirical research on decision-making activities in the nurse's clinical practice and the nurse's utilization of knowledge during the decision-making process. It is concluded that the nurse's awareness of the patient's situation, together with a well-founded basis for decisions, can have positive effects on the nursing care provided by the nurse.

  • 32. Henricson, Maria
    et al.
    Berglund, Anna-Lena
    Määttä, Sylvia
    Segesten, Kerstin
    Ekman, Rolf
    The outcome of tactile touch on oxytocin in intensive care patients: a randomised controlled trial2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 19, p. 2624-2633Article in journal (Refereed)
    Abstract [en]

    Aim.  To explore the effects of five-day tactile touch intervention on oxytocin in intensive care patients. The hypotheses were that tactile touch increases the levels of oxytocin after intervention and over a six-day period.

    Background.  Research on both humans and animals shows a correlation between touch and increased levels of oxytocin which inspired us to measure the levels of oxytocin in arterial blood to obtain information about the physiological effect of tactile touch.

    Design.  Randomised controlled trial.

    Method.  Forty-four patients from two general intensive care units, were randomly assigned to either tactile touch (= 21) or standard treatment – an hour of rest (= 23). Arterial blood was drawn for measurement of oxytocin, before and after both treatments.

    Results.  No significant mean changes in oxytocin levels were found from day 1 to day 6 in the intervention group (mean −3·0 pM, SD 16·8). In the control group, there was a significant (= 0·01) decrease in oxytocin levels from day 1 to day 6, mean 26·4 pM (SD 74·1). There were no significant differences in changes between day 1 and day 6 when comparing the intervention group and control group, mean 23·4 pM (95% CI −20·2–67·0).

    Conclusion.  Our hypothesis that tactile touch increases the levels of oxytocin in patients at intensive care units was not confirmed. An interesting observation was the decrease levels of oxytocin over the six-day period in the control group, which was not observed in the intervention group.

    Relevance to clinical practice.  Tactile touch seemed to reduce the activity of the sympathetic nervous system. Further and larger studies are needed in intensive care units to confirm/evaluate tactile touch as a complementary caring act for critically ill patients.

  • 33.
    Hernar, Ingvald
    et al.
    Department of Medicine, Haukeland University Hospital, Bergen, Norway.
    Haltbakk, Johannes
    Faculty of Health and Social Sciences, Department of Nursing, Western Norway University of Applied Sciences, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Faculty of Health and Social Sciences, Department of Nursing, Western Norway University of Applied Sciences, Bergen, Norway.
    Differences in depression, treatment satisfaction and injection behaviour in adults with type 1 diabetes and different degrees of lipohypertrophy2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 23-24, p. 4583-4596Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To assess the prevalence of lipohypertrophy, and to compare differences in external, personal and regimen factors in adults with type 1 diabetes and different degrees of lipohypertrophy.

    Background: Suboptimal insulin injection behaviour is associated with lipohypertrophy, which may affect insulin absorption and lead to blood glucose fluctuations. Few, if any studies have investigated how external, personal and regimen factors differ in people with type 1 diabetes and different degrees of lipohypertrophy.

    Design: A cross-sectional study including adults with type 1 diabetes at a diabetes outpatient clinic in a Norwegian university hospital. Methods: Participants (n = 215) were included consecutively at scheduled appointments. Sociodemographic, diabetes and insulin treatment data, and self-report questionnaires concerning patient activation (Patient Activation Measure), depression (Patient Health Questionnaire-2), diabetes distress (Diabetes Distress Scale), type D personality (14-item Type D scale), treatment satisfaction (Insulin Treatment Satisfaction Questionnaire) and motivation (Treatment Self-Regulation Questionnaire), were collected. Lipohypertrophic injection sites were identified by palpation by diabetes specialist nurses.

    Results: Lipohypertrophy was present in 53% and was more frequent in insulin pen users (63%) compared to insulin pump users (34%). Participants with two or more lipohypertrophic areas had higher depression scores, lower treatment satisfaction with glycaemic control, higher bolus doses and reported suboptimal injection behaviour compared to those with no lipohypertrophic areas. There were no differences in patient activation, diabetes distress, type D personality or motivation between the groups.

    Discussion and conclusion: Compared to pump treatment, pen treatment requires greater awareness of injection technique. Symptoms of depression and lower treatment satisfaction might affect diabetes self-management and glycaemic control, but the association with lipohypertrophy needs further exploration.

    Relevance to clinical practice: Lipohypertrophy is more frequent in insulin pen users compared to pump users. Nurses should focus on injection technique education, and should also consider screening for depressive symptoms and treatment satisfaction as these factors could be associated with development of lipohypertrophy.

  • 34. Hildingh , C
    et al.
    Fridlund , Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Baigi, A
    Sense of coherence and experiences of social support and mastery in the early discharge period after an acute cardiac event2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 10, p. 1303-1311Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim of this study was to examine sense of coherence and experiences of change in social support and mastery from a short-term perspective in patients who had been admitted to hospital with a suspected myocardial infarction. BACKGROUND: The early discharge period after an acute cardiac event can be a stressful and vulnerable time when psychosocial resources are of the utmost importance. A positive outcome in an encounter with a stressor is thought to be linked to a strong sense of coherence, social support and mastery. DESIGN: A multi-centre survey was conducted in three hospitals in southern Sweden. METHODS: The sample was 300, 241 of whom completed the questionnaires; while in hospital and two weeks postdischarge. RESULTS: In the early discharge period a low sense of coherence was found in over 60% of the sample. There was an association between social support and mastery and between sense of coherence and mastery. Differences in social support ratings, with lower ratings two weeks postdischarge, were found among women and persons over 65 years of age. CONCLUSIONS: This study adds knowledge about experiences in the early discharge period. Changes in ratings of social support but not in ratings of mastery were found between baseline and two weeks postdischarge. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals need to be sensitive to patients' sense of coherence, mastery and need for social support during the early discharge period. They can help patients to identify adequate support strategies and prevent future potential complications. However, to routinely assess sense of coherence, social support and mastery, there is a need for a simple and useful instrument in clinical practice.

  • 35. Hildingh, C
    et al.
    Fridlund, Bengt
    Högskolan i Halmstad.
    Supporting elderly coronary patients in self-help groups with a guidebook: a nurse intervention for public health1992In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 1, no 5, p. 259-264Article in journal (Refereed)
  • 36. Hildingh, C
    et al.
    Segesten, K
    Bengtsson, C
    Fridlund, Bengt
    Högskolan i Halmstad.
    Experiences of social support among participants in self-help groups related to coronary heart disease1994In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 3, no 4, p. 219-226Article in journal (Refereed)
  • 37.
    Hjelm, Carina
    et al.
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University.
    Dahl, Anna
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Johansson, Boo
    Department of Psychology, University of Gothenburg.
    Strömberg, Anna
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University.
    The influence of heart failure on longitudinal changes in cognition among individuals 80 years of age and older2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 7-8, p. 994-1003Article in journal (Refereed)
    Abstract [en]

    Aim. The aim of this study was to examine the relationship between heart failure and specific cognitive abilities in octogenarians with regard to level and change over time.

    Background. Cognitive impairment is influenced by many factors, and the impact of heart failure is debated. Intact cognitive ability is crucial for successful self-care in patients with heart failure. Middle-aged patients with heart failure seem to have an increased risk of cognitive impairment. No studies have examined the association between heart failure and longitudinal cognitive changes in octogenarians (individuals 80 years and older).

    Design. A prospective longitudinal design.

    Methods. Cognitive tests were carried out five times (1991–2002) in 702 octogenarians from the Swedish Twin Registry, including same-sex twin pairs. The test battery included the measurement of processing speed, visuospatial ability, short-term, episodic and semantic memory. Latent growth curve modelling was employed to measure change and performance over time and compares the group diagnosed with heart failure to individuals without a heart failure diagnosis.

    Results. At baseline, the participants’ mean age was 83·5 years, 67% were women and 13% suffered from heart failure. Individuals diagnosed with heart failure scored significantly lower in spatial abilities and episodic memory than participants not diagnosed with heart failure. Moreover, measures of episodic memory declined more over time in individuals diagnosed with heart failure. There were no significant differences between the groups in other cognitive tests.

    Conclusion. Spatial problems and episodic memory have implications for everyday life. This might contribute to decreased adherence to prescribed therapy and self-care management and lead to socio-behavioural problems because of an impaired capacity to drive, read and write.

    Relevance to clinical practice. Nurses should take into account in their assessment that cognitive impairment may restrain elderly heart failure patient’s ability to make decisions and perform self-care actions. Patient education strategies should also be adapted to cognitive ability.

  • 38. Hägglund, Doris
    et al.
    Ahlström, Gerd
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    The meaning of women's experience of living with long-term urinary incontinence is powerlessness2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 10, p. 1946-1954Article in journal (Refereed)
    Abstract [en]

    AIM: The aim was to illuminate the meaning of women's experiences of living with urinary incontinence (UI). BACKGROUND: Living with long-term UI means a variety of consequences for everyday life. Women's narratives about their lived experiences are important in enabling nurses to better understand and to help women achieve symptom control. No previous study could be found that has focused on the meaning of women's experience of living with UI from a symptom management perspective. METHOD: Fourteen women with UI (range: 34-52 years) who had sought professional help were interviewed. A phenomenological hermeneutic method was used to analyse and interpret the interview texts. FINDINGS: The women's experiences of living with UI are presented in terms of two interlaced themes of being in a vulnerable situation and striving for adjustment. Being in a vulnerable situation means that the women had no control over UI and experienced powerlessness. The sub-themes in this case were living with an uncontrolled body, living with incontinence as taboo and experiencing a less satisfying encounter. Striving for adjustment means that the women tried to handle their incontinence in different ways to regain power and continue to live as normal. The sub-themes here were living in readiness, making urine leakage comprehensible, accepting living with UI and being familiar with the situation. CONCLUSION: The meaning of women's experience of living with UI is powerlessness. RELEVANCE TO CLINICAL PRACTICE: Nurses should supervise women in pelvic floor muscle training to achieve control over incontinence, thereby helping them regain power. Additionally, Integrated Approach to Symptom Management can help nurses enhance women's self-care abilities.

  • 39. Isaksson, Ann-Kristin
    et al.
    Gunnarsson, Lars-Gunnar
    Ahlström, Gerd
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    The presence and meaning of chronic sorrow in patients with multiple sclerosis2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 11C, p. 315-324Article in journal (Refereed)
    Abstract [en]

    Aim and objectives: The aim of this study was to explore the presence and meaning of chronic sorrow and the presence of depression in a fairly large group of persons with multiple sclerosis (MS). Background: MS is a chronic and progressive neurological disease with a variety of symptoms. The patients have to live with losses of different kinds. A few earlier studies have used the concept of chronic sorrow to illustrate the emotional situation of such patients. Method: Sixty-one patients were interviewed about the occurrence of chronic sorrow and, thereafter, screened for depression. Thirty-eight (62%) of them fulfilled the criteria for chronic sorrow. The interviews were analysed with latent content analysis. Results: Seven themes describe the losses that caused sorrow: loss of hope, loss of control over the body, loss of integrity and dignity, loss of a healthy identity, loss of faith that life is just, loss of social relations and loss of freedom. The sorrow was constantly present or periodically overwhelming. Only four of the 38 patients with chronic sorrow had symptoms of being mildly depressed. Conclusion: Chronic sorrow meant loss of hope, of control over the body, of integrity and of identity. The concept of chronic sorrow complements that of depression in providing important new knowledge relevant to understanding the consequences MS can have for the individual. Relevance to clinical practice: Knowledge of the meaning of chronic sorrow can contribute to the nurse's ability to give psychological support and promote a sense of hope and control in the MS patient.

  • 40.
    Jiang, Nan
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. School of Nursing, Tianjin Medical University, Tianjin, China.
    Zhao, Yue
    School of Nursing, Tianjin Medical University, Tianjin, China.
    Jansson, Henrik
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Periodontology, Centre for Oral Health, Malmö University, Malmö, Sweden.
    Chen, Xiaocen
    Departments of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Experiences of xerostomia after radiotherapy in patients with head and neck cancer: A qualitative study2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 1-2, p. e100-e108Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe the experiences of radiation-induced xerostomia in patients with head and neck cancer.

    BACKGROUND: Xerostomia is the most commonly occurring complication during and following radiotherapy. It can persist for several months or years and can have a significant impact on patients' quality of life.

    DESIGN: This was a qualitative descriptive study.

    METHODS: Semi-structured interviews were conducted with a sample of 20 participants. Inductive content analysis was used to analyse the qualitative data.

    RESULTS: Analysis of the manifest content identified five categories: communication problems, physical problems, psychosocial problems, treatment problems and relief strategies. The latent content was formulated into a theme: due to lack of information from professionals, the patients had to find their own solutions for their problems.

    CONCLUSIONS: Xerostomia is not only a biophysical symptom but also has a profound effect on the emotional, intellectual and sociocultural dimensions of life. The majority of patients continued to suffer from xerostomia and its associated symptoms after radiotherapy, in part, because of a lack of professional support, including the inability of nurses to provide oral health care.

    RELEVANCE TO CLINICAL PRACTICE: Nurses need to be knowledgeable about the effects of radiotherapy on oral mucosa and about appropriate interventions. The healthcare system requires a symptom management platform for radiation-induced complications, to help patients, their families and healthcare professionals obtain information about self-care, treatments and relief strategies.

  • 41.
    Johansson, Linda
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Christensson, Lennart
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Sidenvall, Birgitta
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Managing mealtimes tasks: told by persons with dementia2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17, p. 2552-2562Article in journal (Refereed)
    Abstract [en]

    AIM: To capture the self-description of managing mealtime tasks by persons with dementia.

    BACKGROUND: There are several factors that negatively affect food intake in persons with dementia that may increase the risk of developing malnutrition. Difficulties in managing daily activities increase gradually and mealtime tasks like food shopping, cooking and eating often become troublesome. Still, little is known about how persons with dementia themselves experience this issue.

    DESIGN: A qualitative study with an ethnographic approach.

    METHOD: Ten women and five men aged 69-86 with dementia were interviewed. Interviews were carried out in the informants' own homes and a thematic analysis was performed.

    RESULTS: The informants described that they wanted to be independent and that the memory loss was not affecting them to a great extent. Old habits and routines, as well as newly developed strategies, helped them manage mealtime tasks despite the disease. Informants were satisfied with their current situation, even though it sometimes meant that they had changed their way of managing mealtime tasks, for instance receiving meals-on-wheels.

    CONCLUSIONS: Persons with dementia seem to be able to manage mealtime tasks and these activities were based on old habits and routines. Independence was highly valued and managing mealtime tasks seems to be one way to appear independent.

    RELEVANCE TO CLINICAL PRACTICE:

    It is important for caregivers to understand that persons with dementia might not express difficulties in managing mealtime tasks for fear of losing their independence. It is, therefore, important to create a trustful relationship even before problems arise to be able to support the persons when necessary.

  • 42.
    Johansson, Rose-Marie
    et al.
    Ryhovs sjukhus, Jönköping.
    Christensson, Lennart
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Urinary retention in older patients in connection with hip fracture surgery2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 15-16, p. 2110-2116Article in journal (Refereed)
  • 43.
    Johansson, Rose-Marie
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Malmvall, Bo-Eric
    Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Larsson, Bruno
    Unit of Urology, County Hospital Ryhov, Jönköping.
    Erlandsson, Ingrid
    Unit of Urology, County Council Ryhov, Jönköping.
    Sund-Levander, Märtha
    Unit of Research and Development, Hoegland Hospital, Eksjö.
    Rensfelt, Gunhild
    Infection Control, County Hospital Ryhov, Jönköping.
    Mölstad, Sigvard
    Unit of R&D in Primary Care, Futurum, Jönköping.
    Christensson, Lennart
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Guidelines for preventing urinary retention and bladder damage during hospital care2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 3/4, p. 347-355Article in journal (Refereed)
    Abstract [en]

    Aims and objectives.  To develop evidence-based guidelines for adult patients in order to prevent urinary retention and to minimise bladder damage and urinary tract infection.

    Background.  Urinary retention causing bladder damage is a well known complication in patients during hospital care. The most common treatment for urinary retention is an indwelling urinary catheter, which causes 80% of hospital-acquired urinary tract infections. Appropriate use of bladder ultrasonography can reduce the rate of bladder damage as well as the need to use an indwelling urinary catheter. It can also lead to a decrease in the rate of urinary tract infections, a lower risk of spread of multiresistant Gram-negative bacteria, and lower hospital costs.

    Design.  An expert group was established, and a literature review was performed.

    Methods.  On the basis of literature findings and consensus in the expert group, guidelines for clinical situations were constructed.

    Results.  The main points of the guidelines are the following: identification of risk factors for urinary retention, managing patients at risk of urinary retention, strategies for patients with urinary retention and patient documentation and information.

    Conclusion.  Using literature review and consensus technique based on a multiprofessional group of experts, evidence-based guidelines have been developed. Although consensus was reached, there are parts of the guidelines where the knowledge is weak.

    Relevance to clinical practice.  These guidelines are designed to be easy to use in clinical work and could be an important step towards minimising bladder damage and hospital-acquired urinary tract infections and their serious consequences, such as bacteraemia and the spread of multidrug-resistant bacteria in hospitals.

  • 44.
    Johnsson, Anette
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Health Sciences, University West, Trollhättan, Sweden.
    Boman, Åse
    Department of Health Sciences, University West, Trollhättan, Sweden.
    Wagman, Petra
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Pennbrant, Sandra
    Department of Health Sciences, University West, Trollhättan, Sweden.
    Voices used by nurses when communicating with patients and relatives in a department of medicine for older people - An ethnographic study.2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 7-8, p. e1640-e1650Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe how nurses communicate with older patients and their relatives in a department of medicine for older people in western Sweden.

    BACKGROUND: Communication is an essential tool for nurses when working with older patients and their relatives, but often patients and relatives experience shortcomings in the communication exchanges. They may not receive information or are not treated in a professional way. Good communication can facilitate the development of a positive meeting and improve the patient's health outcome.

    DESIGN: An ethnographic design informed by the sociocultural perspective was applied.

    METHODS: Forty participatory observations were conducted and analysed during the period October 2015-September 2016. The observations covered 135 hours of nurse-patient-relative interaction. Field notes were taken, and 40 informal field conversations with nurses and 40 with patients and relatives were carried out. Semistructured follow-up interviews were conducted with five nurses.

    RESULTS: In the result, it was found that nurses communicate with four different voices: a medical voice described as being incomplete, task-oriented and with a disease perspective; a nursing voice described as being confirmatory, process-oriented and with a holistic perspective; a pedagogical voice described as being contextualised, comprehension-oriented and with a learning perspective; and a power voice described as being distancing and excluding. The voices can be seen as context-dependent communication approaches. When nurses switch between the voices, this indicates a shift in the orientation or situation.

    CONCLUSION: The results indicate that if nurses successfully combine the voices, while limiting the use of the power voice, the communication exchanges can become a more positive experience for all parties involved and a good nurse-patient-relative communication exchange can be achieved.

    RELEVANCE TO CLINICAL PRACTICE: Working for improved communication between nurses, patients and relatives is crucial for establishing a positive nurse-patient-relative relationship, which is a basis for improving patient care and healthcare outcomes.

  • 45.
    Johnsson, Anette
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Health Sciences, University West, Trollhättan, Sweden.
    Wagman, Petra
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Boman, Åse
    Department of Health Sciences, University West, Trollhättan, Sweden.
    Pennbrant, Sandra
    Department of Health Sciences, University West, Trollhättan, Sweden.
    What are they talking about? Content of the communication exchanges between nurses, patients and relatives in a department of medicine for older people - An ethnographic study.2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 7-8, p. e1651-e1659Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore and describe the content of the communication exchanges between nurses, patients and their relatives in a department of medicine for older people in western Sweden.

    BACKGROUND: Information, messages and knowledge are constantly being communicated between nurses, older patients and relatives in the healthcare sector. The quality of communication between them has a major influence on patient outcomes. A prerequisite for good care to be given and received is that there is mutual understanding between the parties involved.

    DESIGN: An ethnographic study was informed by a sociocultural perspective.

    METHOD: Data were collected through 40 participatory observations of meetings between nurses and older patients and/or relatives which covered 135 hr of nurse-patient-relative interaction, field notes, 40 field conversations with 24 nurses and 40 field conversations with patients (n = 40) and relatives (n = 26). Five semi-structured interviews were conducted with nurses. An ethnographic analysis was performed.

    RESULTS: The analysis identified three categories of content of the communication exchanges: medical content focusing on the patient's medical condition, personal content focusing on the patient's life story and explanatory content focusing on the patient's health and nursing needs. The content is influenced by the situation and context.

    CONCLUSIONS: Nurses would benefit from more awareness and understanding of the importance of the communication content and of the value of asking the didactic questions (how, when, what and why) to improve the patients' and relatives' understanding of the information exchanges and to increase patient safety.

    RELEVANCE TO CLINICAL PRACTICE: Nurses can use the communication content to create conditions enabling them to obtain a holistic view of the patient's life history and to develop an appropriate person-centred care plan.

  • 46.
    Karlsson, Christina
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Sidenvall, Birgitta
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Bergh, Ingrid
    Högskolan i Skövde.
    Ernsth Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Certified nursing assistants' perception of pain in people with dementia: a hermeneutic enquiry in dementia care practice2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 13/14, p. 1880-1889Article in journal (Refereed)
    Abstract [en]

    Aim.To interpret certified nursing assistants’ perception of pain in people with dementia in nursing care practice.

    Background. Detection and understanding of pain in people with dementia remains a challenge due to their difficulty in verbalising their pain. Nursing assistants provide daily nursing care and therefore play a vital role in pain detection. Nevertheless, pain research from the nursing assistants’ perspective is sparse.

    Design. A qualitative approach within the interpretive tradition was adopted.

    Method. Individual interviews with twelve certified nursing assistants, all working in dementia care, were conducted and interpreted using philosophical hermeneutics.

    Results. Nursing assistants’ perception of pain is on three levels. Each level consists of a theme. The first theme ‘Being in the facing phase’ refers to the initial perception of the person’s expressions. The second theme ‘Being in the reflecting phase’ means ability to reflect more deeply on one’s perception, together with other colleagues and next-of-kins. The third theme ‘Being in the acting phase’ means perception arising from preventive and protective care focusing on contributing to well-being.The themes served as a basis for comprehensive understanding, where perception of pain arise from closeness, compassion and dialogue based on personhood, accompanied by professional knowledge of pain and dementia.

    Conclusion. Nursing assistants’ perception of pain is based on ethical concerns and on their own subjective pain experiences rather than on medical skills.Their perception derives from fundamental values which are important aspects of nursing care. Interdisciplinary solidarity may strengthen co-operation amongst CNAs and RNs in order to achieve best pain management practice.

    Relevance to clinical practice. Attention to nursing assistants’ perception of pain needs to be highlighted when they are front line staff and have developed important pain detection skills. Their skills are essential complements and must be utilised in the development of pain management in dementia care practice.

     

  • 47.
    Knutsson, Susanne
    et al.
    Faculty of Health and Caring Sciences Institute of Nursing The Sahlgrenska Academy at Göteborg University.
    Bergbom, Ingegerd L.
    Faculty of Health and Caring Sciences Institute of Nursing The Sahlgrenska Academy at Göteborg University.
    Custodians’ viewpoints and experiences from their child’s visit to an ill or injured nearest being cared for at an adult intensive care unit2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 2, p. 362-71Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe custodians' experiences of their child's visit to an ill/injured nearest being cared for at an adult intensive care unit (ICU), their thoughts about the visit in relation to the child's health/well being and who initiated the visit.

    BACKGROUND: Custodians can feel undecided about whether to allow their children to visit the ICU or not. They wonder how important it is for the child to visit, as well as the consequences, and attempt to protect the child from information/experiences that could provoke anxiety or threaten the child's health.

    DESIGN: Quantitative and descriptive.

    METHOD: Thirty custodians answered a questionnaire.

    RESULTS: It was mainly custodians and their children and not staff who initiated the children's visits. Many children were not informed by staff and the responsibility lay instead with the custodians. The importance of giving children adequate information before, during and after the visit was pointed out. The custodians reported that their child's reactions to the visit differed, i.e. reactions reflecting happiness but also sadness; the visit was good for the child, increased awareness of the nearest's condition and appreciation of the hospital staff and their work; if the visit did not take place the child would be left with thoughts and conjectures; their children were not frightened when they saw the equipment and instead they became curious; older children were more focused on the patient while younger children were interested in both the equipment and the patient. Many children asked questions/made comments during the visit. Many custodians were of the opinion that visiting is not a risk to future health and well being.

    CONCLUSIONS: This issue must be addressed and discussed and strategies need to be developed to improve the nurses' obligation to involve visiting children in the care that is/should be provided to a member of the patient's family.

    RELEVANCE TO CLINICAL PRACTICE: Nurses need to take more initiative when discussing children's visits with the custodians. Nurses also need to discuss how to meet, inform, support and care for visiting children and their custodians in relation to health and well being. Recommendations/guidelines about children visiting that take both the patient's and child's needs into consideration needs to be developed based on scientific knowledge. Findings from this study may draw attention to children visiting ICUs and encourage nurses to discuss children visiting with custodians and to develop family-centred care at the ICU that includes children.

  • 48.
    Lannering, Christina
    et al.
    Unit of Research and Development in Primary Care, Futurum, Jönköping.
    Ernsth Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Midlöv, Patrik
    Lund University.
    Östgren, Carl-Johan
    Linköping University.
    Mölstad, Sigvard
    Lund University.
    Factors related to falls, weight-loss and pressure ulcers – more insight in risk assessment among nursing home residents2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 7-8, p. 940-950Article in journal (Refereed)
    Abstract [en]

    Aims and objectives

    To describe how the included items in three different scales, Downton Fall Risk Index, the short form of Mini Nutritional Assessment and the Modified Norton Scale are associated to severe outcomes as falls, weight loss and pressure ulcers.

    Background

    Falls, malnutrition and pressure ulcers are common adverse events among nursing home residents and risk scoring are common preventive activities, mainly focusing on single risks. In Sweden the three scales are routinely used together with the purpose to improve the quality of prevention.

    Design

    Longitudinal quantitative study.

    Methods

    Descriptive analyses and Cox regression analyses.

    Results

    Only 4% scored no risk for any of these serious events. Longitudinal risk scoring showed significant impaired mean scores indicating increased risks. This confirms the complexity of this population's status of general condition. There were no statistical significant differences between residents categorised at risk or not regarding events. Physical activity increased falls, but decreased pressure ulcers. For weight loss, cognitive decline and the status of general health were most important.

    Conclusions

    Risk tendencies for falls, malnutrition and pressure ulcers are high in nursing homes, and when measure them at the same time the majority will have several of these risks. Items assessing mobility or items affecting mobility were of most importance. Care processes can always be improved and this study can add to the topic.

    Relevance to clinical practice

    A more comprehensive view is needed and prevention can not only be based on total scores. Mobility is an important factor for falls and pressure ulcers, both as a risk factor and a protective factor. This involves a challenge for care – to keep the inmates physical active and at the same time prevent falls.

  • 49.
    Lindmark, Ulrika
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Jansson, Henrik
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Periodontology, Centre of Oral Health Sciences, Malmö University, Malmö, Sweden.
    Lannering, Christina
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Region Jönköping County, Futurum, Ryhov, Jönköping, Sweden.
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Oral health matters for the nutritional status of older persons: A population-based study2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 5-6, p. 1143-1152Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore the association between oral health and nutritional status in the context of daily care for older people.

    BACKGROUND: Oral problems often increase with age and affect a person's ability to chew and swallow. They might also influence the ability to maintain a satisfactory nutritional status. Oral health awareness is therefore of great importance in nursing care for older people.

    DESIGN: A retrospective cross-sectional study.

    METHODS: Data from the Swedish quality register, Senior Alert, were used, including structured assessments of both oral and nutritional status using the Revised Oral Assessment Guide-Jönköping and the Mini Nutritional Assessment. In total, 1,156 persons (mean age: 82.8 ± 7.9) had both oral and nutritional assessments registered by the nursing staff in daily care.

    RESULTS: Approximately 29% of participants had moderate oral health problems. Another 12% had severe problems. Over 60% of the persons were considered at risk of malnutrition or were malnourished. There was a weak correlation between poor nutritional status and poor oral health, and approximately one-third of the persons who were at risk or malnourished had simultaneous oral problems. A multivariate logistic regression revealed that when problems involving voice and swallowing were present, there was also a greater possibility of being assessed as at risk of malnourishment or being malnourished.

    CONCLUSION: There is a relationship between oral health problems and nutritional status, indicating the importance of evaluating oral health status in older persons with nutritional problems.

    RELEVANCE TO CLINICAL PRACTICE: Nursing staff involved in care for older people should be aware of the importance of including regular oral health check-ups in their work. There is also a need for nursing staff members and oral health professionals to exchange knowledge.

  • 50.
    Lindroth, Malin
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    "Competent persons who can treat you with competence, as simple as that" - An interview study with transgender people on their experiences of meeting health care professionals2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 23-24, p. 3511-3521Article in journal (Refereed)
    Abstract [en]

    Background

    Transgender people face prejudice and discrimination world-wide. Little is known of their experiences in sexual health promoting settings.

    Aim

    With a focus on sexual health and rights, this study describes how transgender people experience meetings with health care professionals.

    Method

    Within a descriptive design, 20 persons aged 18-74 and identifying as transgender and non-binary were interviewed. The results were analysed with constructivist Grounded Theory.

    Results

    Disrespect among health care professionals is the core category connected to the experiences in the result; transgender people experience estrangement, expectations and eviction in different sexual health-promoting settings.

    Conclusion

    Transgender knowledge needs to be increased in general, in both specialized transgender health care and many other health care settings, in order to prevent transgender peoples’ experiences of estrangement. Moreover, an increased knowledge of, and respect for, sexual health and rights is needed to prevent transgender peoples’ exposure to gender binary, cis- and heteronormative expectations. In addition, access to sexual health care is essential following gender confirmatory care as well in order to avoid transgender peoples’ experiences of eviction from the health care system.

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