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  • 1.
    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.

  • 2.
    Hedberg, Berith
    Institutionen för vårdpedagogik, Sahlgrenska akademin vid Göteborgs univ..
    Beslutsfattande i klinisk verksamhet: En studie om sjuksköterskans beslutsfattande i praktiken2003Licentiate thesis, monograph (Other scientific)
    Abstract [en]

    The overall aim of the project was to investigate how decision-making is expressed by experienced nurses in practice. A research questions were to describe how nurses make decisions of measures in practice and another research question were to explore contextual elements related to decision-making in nursing practice.

    A problem-solving-model could be used by the nurse to systematize tasks in which she is responsible. Specific competence is required when nurses act from such a model, when it comes to ability to manage information and to make clinical assessments, necessary claims for decision-making on measures.

    The theoretical starting point draws on naturalistic decision theory, which is based within a phenomenological perspective. One of the assumptions herein is that actions from experienced nurses are based in intuition and not in rationalistic and analytical mental models.

    Participant observations and interviews with six nurses from three differ-ent domains constituted the data. To call on the experience of the nurses, limited decision-making activities, identified from the field notes, served as a spring-board during the interviews. The data were analysed by an inductive content analysis.

    The results reveal that nurses uses observation of cues, confirmation of information and acting from strategies, developed from experience, as tools in their decision-making process. Observation of cues emerged as a powerful tool, used by the nurses to as soon as possible get to know the patient. When the nurses used confirmation as a tool, they used it to vali-date their interpretation of noticed cues and to choose appropriate meas-ures. From their experience the nurses had developed strategies which they used to be able to act independently when to choose measures. An-other finding highlighted important environmental elements, such as dis-ruption and procedures the nurse has to do as a part of her professional function, affecting the decision-making process.

  • 3.
    Hedberg, Berith
    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.
    Communicative approaches in the decision making process2009In: 7th Interdisciplinary Conference on Communication, Medicine  Ethics (COMET), 2009Conference paper (Other academic)
    Abstract [en]

    Background: Communication in health care is sometimes problematic because of the participants' asymmetrical positions when negotiating the patients' future care. When decisions are made about stroke survivors' care treatment they should be involved despite communicative disabilities.

    Method: In a total of five hours recorded talk, data from care-planning meetings with elderly persons surviving stroke, has been transcribed and analyzed. To identify how the actors agreed upon decisions about care efforts after discharge, an inductive analyzing approach was used through the procedure of coding and categorization. By looking for patterns the two approaches emerged.

    Findings: Two distinctive approaches appeared in the communicative process, the open-minded and the aimdriven. The open-minded was characterized by questioning, merging information discussing alternative solutions leading to a goal step by step. The other communicative approach appeared to be aim-driven and was characterized by alliances between some of the participants. When the participants were involved in communicative alliances, they seemed to share a predetermined common goal for the patient's further care after discharge. The most significant alliance involved the patient together with relatives. The most noteworthy finding is that of the patient's need for communicative alliances with other participants when negotiating their needs and desires of further care. It was shown the stroke survivors are able to express their life world perspective when they are in alliances with relatives or healthcare professionals.

  • 4.
    Hedberg, Berith
    Utbildningsvetenskapliga fakulteten, GU.
    Decision Making and Communication: Aspects of Nursing Competence2005Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The overall aim of this thesis is to understand the conditions and prerequisites of nurses’ decision making on nursing measures and their communication in multiparty talk, activities nurses manage in their work. By analysing both environmental elements in nursing practice and how experienced nurses manage decision-making processes, the intention has been to understand how nurses’ competence occurs and is expressed in nursing practice. A specific problem concerns the attention given to the patients’ right to participate in co-operative care planning meetings when decisions are made about their further care and how the conditions for patient involvement and influence become visible in multiparty talk.

    In the theoretical framework, it is argued that competence generally speaking concerns the individual’s potential capacity for action in relation to a certain task, situation and context. The expectations as regards nursing competence at work are expressed in work regulations and recommendations; however, the content of nursing education and practice constitutes powerful institutional frames, influencing how nurses are able to perform their tasks. The individual’s cognitive ability, the context-specific and collaborative knowledge, can be seen as additionally elements of nursing competence.

    The thesis is based on two different datasets which have generated four sub-studies. Studies I and II focus on the nurses’ decision-making process and the influence of the simultaneous presence of environmental elements. The empirical data consist of 30 hours of participant observation and inter-views with 6 experienced nurses at three different wards. Studies III and IV concern nurses involve-ment in a dynamic communicative process with co-workers, patients and, at times, their relatives including data from audio-recordings of 14 co-operative care planning sessions concerning stroke survivors.

    Throughout the four studies, a gap is visible between nurses’ decision making and communication in practice and the expectations of how nurses should manage these activities related to work regulations and the goals formulated in the nursing educational programs. How nurses make their decisions depends on their competence, the complexity of the task and how much they involve themselves in talk with others. The medical perspective dominates when nurses give priority to what should and can be done in nursing activities. As regards patients’ participation in co-operative care planning meetings, the professionals dominate the discourse space. The nurses never openly invited the patients to elicit their own perspective of their illness or care planning. The nurses mostly suggest-ed opinions or asked the patients to confirm these opinions. There is, however a hidden power agenda when patients and relatives try to reach a desired decision. The same phenomenon may occur when patients are in alliances with health care professionals. The above-mentioned issues are discussed in the light of nursing competence and the need for nurses to discuss what it means to be a nurse in relation to institutional frames of power relationships. If the official regulations and recommendations are to be satisfied, there is an urgent need for increased collaboration between nurses, the health care system and the nursing education programs.

  • 5.
    Hedberg, Berith
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Flerpartssamtalet före utskrivning2008In: Stroke i fokus, Lund: Studentlitteratur , 2008Chapter in book (Other academic)
  • 6.
    Hedberg, Berith
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Kvalitet i samtalet ger möjlighet till delaktighet i beslutsprocessen.2006In: Vårdfacket, ISSN 0347-0911, no 7Article, review/survey (Other academic)
  • 7.
    Hedberg, Berith
    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.
    Problemlösning, en intellektuell omvårdnadsuppgift för sjuksköterskan1999In: Omvårdnadens mångfald, 1999, p. 235-Chapter in book (Other (popular scientific, debate etc.))
  • 8.
    Hedberg, Berith
    Jönköping University, The Jönköping Academy for Improvement of Health and Welfare.
    Shared Decision Making, a systematic review from a Swedish perspective. Part 12015Conference paper (Refereed)
  • 9.
    Hedberg, Berith
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Vem styr dig i jobbet?2006In: Omvårdnadsmagasinet, ISSN 1652-0858, no 2, p. 18-19Article, review/survey (Other academic)
  • 10.
    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.
    Cederborg, Ann-Christin
    Avd. för Beteendevetenskap, LiU.
    Johanson, Marita
    Universitetet Trollhättan-Uddevalla.
    Care-planning meetings with stroke survivors: nurses as moderators of the communication2007In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 15, no 2, p. 214-221Article in journal (Refereed)
    Abstract [en]

    Introduction: Stroke survivors often have communicative disabilities. They should, however, be involved when decisions are made about their care treatment.

    Aim: To explore and describe how nurses act as moderators of the communication in cooperative care-planning meetings and what kind of participant status the patients achieve in this type of multi-party talk.

    Method: Thirteen care-planning meetings were audio-recorded and transcribed. Nurses, social workers and stroke survivors were the main participants for the meetings. A coding scheme was created and three main categories were used for the analysis: pure utterance types, expert comments (EC) and asymmetries. Results The nurses never invited the patients to tell their own versions without possible influence from them. Mostly the nurses gave ECs. The nurses acted as the patients' advocates by talking for or about them. They rarely supported the patients' utterances.

    Conclusion: There is an urgent need for nurses to learn how to involve the patients in the communicative process about their treatment. Assessment of the patients' communicative abilities before the care-planning meetings as well as knowledge about how to invite them can improve the patients' participant status.

  • 11.
    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. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Gabrielsson Järhult, Felicia
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Vårdplanering: delat ansvar mellan vårdtagare och personal – är det möjligt?2010Conference paper (Other (popular science, discussion, etc.))
  • 12.
    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.

  • 13.
    Hedberg, Berith
    et al.
    Jönköping University.
    Johanson, Marita
    Högskolan Väst.
    Cederborg, Ann-Christin
    Avd. för Beteendevetenskap LiU.
    Mönster av delaktighet i samordnade vårdplaneringsmöten med patienter som överlevt stroke2006In: Vårdpedagogisk forskning i centrum, 2006, p. sid. 6 av 13-Conference paper (Other scientific)
  • 14.
    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.

  • 15.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Malm, Dan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Karlsson, J. E. K.
    Ryhov County Hospital, Jonkoping, Sweden, Department of Medicine, Jonkoping, Sweden.
    Arestedt, K. A.
    Ryhov County Hospital, Jonkoping, Sweden, Department of Medicine, Jonkoping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Ryhov County Hospital, Jonkoping, Sweden, Department of Medicine, Jonkoping, Sweden.
    Factors associated with involvement in risk communication and confidence in shared decision making among patients with atrial fibrillation.2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S74-S75Article in journal (Refereed)
    Abstract [en]

    Background: Atrial fibrillation (AF) is a highly prevalent arrhythmia. Effective communication of risks (e.g., risk for stroke) and benefits to patients (e.g., treatment with oral anticoagulants) is crucial for shared decision making. Knowledge about how patients experience confidence and satisfaction in communication in relation to their health status is limited.

    Aim: The aim was to explore factors associated with involvement in risk communication and confidence in shared decision making among patients with AF.

    Method: A cross-sectional design was used and 322 patients (39 % women), mean age 67 years (SD 10.3 years) with AF were included at four hospitals in Sweden. Clinical examinations and self-rating scales for risk communication (COMRADE), uncertainty in illness (MUIS-C), depressive symptoms (HADS), mastery of daily life (MDL), as well as physical and mental health (SF-36) were used to collect data after a follow-up visit at the outpatient clinic 3 months post an AF episode.

    Results: Paroxysmal, persistent and permanent AF occurred among 32%, 34% and 7% of the patients, respectively. Patients whom had undergone DC-conversion (53%) and had anticoagulants (37%). Seven percent had been treated by a percutan ablation. Heart failure (15%) and ischemic heart disease (12%) were the most common co-morbidities. CHA2DS2-VASc >2 were seen among 62% of the patients. Overall, multiple regression analyses showed that uncertainty in illness and mastery of daily life were significantly associated with confidence in decisions and uncertainty in illness and hypertension were significantly associated with satisfaction in communication. Higher uncertainty in illness and poorer mastery of daily life were associated with poor confidence in decisions. Higher uncertainty in illness and occurrence of hypertension were associated with poor satisfaction in communication. Clinical AF variables (i.e.,symptom or treatment related) or depressive symptoms were not significantly associated with satisfaction in communication or confidence in decisions in the multiple regression analysis. The final models explained 29% and 30% of the variance in confidence in decision making and satisfaction in communication.

    Conclusion: In this cross-sectional study, including patients with AF, confidence in decision making and satisfaction in communication are associated with uncertainty in illness, mastery of daily life and hypertension.

  • 16.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Futurum, Region Jönköpings län.
    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). Ryhov County Hospital, Region Jönköpings län Jönköping, Sweden.
    Karlsson, Jan-Erik
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Internal Medicine, Department of Medical and Health Sciences, Linköping University, Sweden.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Broström, Anders
    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, Sweden.
    Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 5, p. 446-455Article in journal (Refereed)
    Abstract [en]

    Background:

    Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making.

    Aim:

    The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms.

    Methods:

    A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale–Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data.

    Results:

    Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication.

    Conclusion:

    Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.

  • 17.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Nordström, Erik
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Josephson, Iréne
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    "We found a solution, sort of”: qualitative interview study with children and parents on their experiences of the coordinated individual plan (CIP) in Sweden2018In: Cogent Medicine, ISSN 2331-205X, Vol. 5, no 1, article id 1428033Article in journal (Refereed)
    Abstract [en]

    Children and adolescents receiving services from two professional parties may obtain support with a coordinated individual plan (CIP). The Swedish law prescribes that CIP must incorporate service user participation. This study aims to explore children and parents’ experiences of participating in CIP-process to generate knowledge with practical implications of how children and parents may be involved in the CIP-process. A descriptive qualitative interview study with 13 service users was conducted during November 2014 to March 2016. Data were audio-recorded and transcribed, and further subjected to qualitative content analysis. Three main descriptive categories with six subcategories emerged. The category “Struggle for coordination” includes service users’ need for participation which are limited by professionals’ lack of consensus. The category “Alliance for coordination” points out the importance of relationship and personal support to accomplish functional coordination. The category “Structure for coordination” shows how the structure facilitate service user involvement on a high level. Service user involvement seemed limited by professionals’ actions, but could be facilitated by support of professionals working in the child’s daily life. Structured coordination seems to relieve the pressure on parents, as well as children, but CIP needs to be individually tailored to reach its full potential.

  • 18.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Nygårdh, Annette
    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).
    Patientdelaktighet och medverkan hos vuxna med fysisk ohälsa2018In: Delaktighet och patientmedverkan / [ed] Ann Catrine Eldh, Lund: Studentlitteratur AB, 2018, p. 107-138Chapter in book (Other academic)
  • 19.
    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.
    Sund-Levander, Märtha
    Utvärdering av Samverkan i Vårdkedjan2008Report (Other academic)
    Abstract [sv]

    Syftet var att utvärdera samverkan i vårdkedjan genom att belysa om Esther får vård i eller nära hemmet, får lika vård på hela Höglandet, upplever vården och omsorgen som en vårdgivare, har en individuell vårdplan och vet vart hon/han ska vända sig.

    Kvantitativ data avseende åldersfördelning, vårdnivå, vårdtillfällen, medelvårdtid, väntetid på akutmottagningen, medicinklinikens rådgivande koordinatorsfunktion och ”Medicin direkt” samt avvikelserapportering har insamlats från befintlig statistik från Höglandets sjukvårdsvårdsområde. Kvalitativ data har insamlats genom fokusgruppsintervjuer med 29 äldre personer > 65 år och 21 vård- och omsorgspersonal inom Höglandets sjukvårdsområde.

    Statistiken visar att antalet inskrivna individer i hemsjukvården har ökat, primärvårdsbesöken likaså och antalet läkarbesök i patientens bostad/motsvarande har i det närmaste fördubblats. På motsvarande sätt visar statistiken att antalet inläggningar, medelvårdtid samt återinläggningar har minskat. För åldersgruppen 80 år och äldre har antal besök på kirurgisk mottagning ökat medan besöken på medicinsk mottagning har minskat. I samma åldersgrupp visar statistiken att medelväntetiden på kirurgkliniken respektive medicinkliniken har ökat med 52 respektive 53 minuter. Rådgivningar via medicinklinikens koordinator har ökat samtidigt som överföringen av patienten till akutmottagningen vid Höglandsjukhuset också har ökat.

    Resultatet från den kvalitativa analysen visar att Esther känner sig trygg när hon/han behöver hjälp och stöd av vårdgivaren. För ”Esther som individ” innebär samverkan i vårdkedjan tillgänglighet, kontinuitet och aktivitet men också delaktighet, integritet och trygghet. Sitt beroende av andra hanterar Esther genom att använda strategier som eget ansvar, anpassning, acceptans och passivisering. För personalen utgör ramar och villkor som omger deras arbete i relation till Esthers behov av vård och omsorg, faktorer som påverkar samverkan i vårdkedjan.

    Slutsatsen är att grundtanken i Esther nätverk finns förankrad i vårdkedjan. Personalens gemensamma synsätt avspeglas i att Esther i hög grad är nöjd med den vård och omsorg hon får och att hon känner sig trygg med den. Trygghet är grundläggande för Esther och innebär kontinuitet, tillgänglighet och att få en individ- och behovsanpassad vård och omsorg genom hela vårdkedjan. Inom ramen för samverkan är detta områden som skulle kunna förbättras ytterligare.

  • 20.
    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.

  • 21.
    Henricson, Maria
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    The validation of the Supervision of Thesis Questionnaire (STQ)2018In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 65, p. 11-16Article in journal (Refereed)
    Abstract [en]

    Background: The supervision process is characterized by differences between the supervisors’ and the students’ expectations before the start of writing a bachelor thesis as well as after its completion. A review of the literature did not reveal any scientifically tested questionnaire for evaluating nursing students’ expectations of the supervision process when writing a bachelor thesis.

    Objectives: The aim of the study was to determine the construct validity and internal consistency reliability of a questionnaire for measuring nursing students’ expectations of the bachelor thesis supervision process.

    Design & Methods: The study had a developmental and methodological design carried out in four steps including construct validity and internal consistency reliability statistical procedures: construction of the items, assessment of face validity, data collection and data analysis.

    Settings & Participants: This study was conducted at a university in southern Sweden, where students on the “Nursing student thesis, 15 ECTS” course were consecutively selected for participation. Of the 512 questionnaires distributed, 327 were returned, a response rate of 64%.

    Results: Five factors with a total variance of 74% and good communalities, ≥0.64, were extracted from the 10-item STQ. The internal consistency of the 10 items was 0.68. The five factors were labelled: The nature of the supervision process, The supervisor's role as a coach, The students’ progression to self-support, The interaction between students and supervisor and supervisor competence.

    Conclusions: A didactic, useful and secure questionnaire measuring nursing students’ expectations of the bachelor thesis supervision process based on three main forms of supervision was created.

  • 22.
    Johansson, Lisbeth
    et al.
    Unit for Research and Development in Primary Care, Futurum – Academy for Health and Care, Region Jönköping County, Sweden.
    Golsäter, Marie
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD. Futurum – Academy for Health and Care, Region Jönköping County, Sweden.
    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.
    Health dialogue with non-native-speaking parents: Child health nurses’ experiences2016In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore child health care nurses’ experiences of conducting health dialogues with non-native-speaking parents. In Sweden, it is not routine that all non-native-speaking parents are invited to a health dialogue. Regardless of language and cultural background, it is important that all parents have the same opportunities to participate. The data were obtained through two focus-group interviews and analysed using qualitative content analysis. The results revealed one theme Need for cultural awareness in the health dialogue and two categories: Overcoming feelings of uncertainty, with a need for more transcultural knowledge regarding what health and health promotion mean in other cultures; and Adapting the process of the health dialogue, whereby interpreters need knowledge about the intention of health dialogues and the content of the tool used in the encounter. Transcultural competence is needed in encounters with parents from other cultures.

  • 23.
    Johansson, Lisbeth
    et al.
    Unit for Research and Development in Primary Care, Futurum - Academy for Health and Care, Region Jönköping County, Sweden.
    Golsäter, Marie
    Jönköping University, School of Health Science, HHJ. CHILD.
    Hedberg, Berith
    Jönköping University, The Jönköping Academy for Improvement of Health and Welfare. Ryhov County Hospital, Region Jönköping County, Sweden.
    Health dialogue with non-Swedish-speaking first-time parents: nurses' perspectivesIn: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
  • 24.
    Josephson, Iréne
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work.
    Bülow, Pia
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Physiotherapists’ clinical reasoning about patients with non-specific low back pain, as described by the International Classification of Functioning, Disability and Health2011In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 23-24, p. 2217-2228Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore and describe what physiotherapists experience they need to know about patients with non-specific low back pain (NSLBP) to make decisions about intervention.

    Method: Four focus groups containing a total of 21 physiotherapists were carried out in Sweden. Interviews were transcribed and qualitative content analysis performed. The manifest content was coded and categorised, and a theme emerged. Extracted symptoms and signs were linked to ICF codes.

    Result: Physiotherapists’ clinical reasoning represented a broad view on low back pain (LBP) including codes from all ICF components. The participants argued for individualisation of intervention to a specific patient’s problems. A theme of case complexity emerged, involving three levels: easy case, characterised by impairment in body function with close relation to specific body structures; complex case, characterised by impairments in body function, particular mental functions, activity limitations and participation restrictions, particular management of activity level and very complex case, characterised by impairments in body function, activity limitations and participation restrictions, and contextual factors, with help-seeking behaviour as a particular feature.

    Conclusion: The physiotherapists’ clinical reasoning reflected a broad view on patients with NSLBP, with variations related to case complexity. The use of ICF codes contributed to understanding that the physiotherapists applied a broad perspective on NSLBP as a health condition as well as to knowledge about how physiotherapists’ understand patients with NSLBP.

    Physiotherapists’ use of the ICF in clinical practice might facilitate identification and assessment of specific patient’s back pain problem as they occur in daily life and therefore be helpful in rehabilitation planning. Findings might also have an educational value.

  • 25.
    Josephson, Iréne
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Bülow, Pia
    Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work.
    Problem-solving in physiotherapy - physiotherapists' talk about encounters with patients with non-specific low back pain2013In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 35, no 8, p. 668-677Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate how physiotherapists talk about the choice of intervention for patients with NSLBP, particularly how professionals manage clinical encounters that may be experienced as challenging.

    Method: Discourse analysis was performed of four focus groups’ talk. Twenty-one experienced physiotherapists working in primary health care in southern Sweden participated.

    Results: Four focal themes appeared: Responsibility for health and health-related problems; Normalization – what counts as a normal back pain problem in relation to living an ordinary life; Change process – how to lead one’s life; and Individualization of the intervention in relation to the individual patient but also from the physiotherapists’ point of view. The themes shape an over-arching pattern of Problem-solving – which concerned both the professional task and the back pain problem, and was related to varying case complexity. This may have implications for the intervention the individual patient will be offered and on outcome.

    Conclusions: Physiotherapists’ attitudes and approaches seem to entail components of professional and personal values which may influence patients’ access to health care, with a risk for unequal assessment and intervention as a consequence. We argue that enhanced physiotherapist-patient collaboration, including patient-led problem-investigation, is a prerequisite for improved outcome in terms of patient satisfaction, and for physiotherapy development. Future investigations of patients’ roles in specific face-to-face encounters are needed.

  • 26.
    Kvarnström, Susanne
    et al.
    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, Dep. of Behavioural Science and Social Work.
    Cedersund, Elisabet
    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, Dep. of Behavioural Science and Social Work.
    Hedberg, Berith
    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.
    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.
    Studying collaborative care in Clinical Microsystems Using a collaborative research design2009In: Microsystem Festival, Scientific workshop, Jönköping, 3 april 2009, 2009Conference paper (Other academic)
  • 27.
    Kvarnström, Susanne
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work.
    Cedersund, Elisabeth
    Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Andersson Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Multiparty team talk: Constructions of user participation in an interprofessional team context2009In: Communication, Medicine & Ethics: COMET Conference 2009 / [ed] Srikant Sarangi, 2009Conference paper (Refereed)
    Abstract [en]

    Background. Today health and social care delivery are largely team based but the question remains whether the voice of the user is perceived as a team member or merely as the recipient of the care. There have however been few efforts to understand or change the smallest interprofessional frontline units who generate the actual service, i.e. the microsystems.

    Purpose. This paper presents preliminary findings regarding descriptions of constructions of user participation in a multiparty negotiation context.

    Materials and methods. The material consisted of ethnographic field notes and audiotapes from observations (n=8) of interprofessional team meetings in one clinical healthcare microsystem. The teams included the user and health professionals, e.g. medical social worker, physician and psychologist. The users who participated in the observed team meetings had all long-term mainly physical conditions.

    Findings and discussion. Preliminary inductive analyses of observations of interprofessional team situations involving users indicates identity constructions in multiparty talk where the user is beheld primarily as a loyal and active member of the team. Discussions will relate to how user participation is learned and constructed by users and health professionals in collaborative care at the microsystem level.

  • 28.
    Kvarnström, Susanne
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Cedersund, Elisabet
    Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work.
    The dual faces of service user participation: Implications for empowerment processes in interprofessional practice2013In: Journal of Social Work, ISSN 1468-0173, E-ISSN 1741-296X, Vol. 13, no 3, p. 287-307Article in journal (Refereed)
    Abstract [en]

    Summary: This article reports on an empirical research study exploring and describing variations in how front-line practitioners perceive service user participation (SUP), specifically in interprofessional practice. The settings comprised three Swedish health and social care organizations where the professionals worked in interprofessional teams: a program for chronic pain rehabilitation, a program for surgical treatment of obesity, and a short-term municipal home for older adults. The qualitative study design was informed by a phenomenographic approach and conducted as semi-structured individual interviews with 15 professionals representing nine professions, including social work.

    Findings: The main findings show seven qualitative variations in understanding of SUP: 1) inclusion in activities and social events, 2) obtaining guidance, 3) having self-determination and choice, 4) getting confirmation from and contact with professionals, 5) negotiating for adjustment, 6) personal responsibility through insight, and 7) circumstance surrounding SUP.

    Applications: The interprofessional dimensions discerned in the meaning attributed to SUP are mainly described in terms of amplified opportunities for participation. An interesting aspect of the findings is that in all the variations of perceptions of SUP, there are potentials to reverse to their opposites, that is, paradoxes that can be termed ‘the dual faces of service user participation’. These aspects stress the need for continuing reflection on practices among both front-line practitioners and managers in empowering and paternalistic processes and on constantly improving organizational and policy conditions to facilitate SUP.

  • 29.
    Kvarnström, Susanne
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Willumsen, Elisabeth
    Department of Social Studies, University of Stavanger, Norway.
    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.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    How Service Users Perceive the Concept of Participation, Specifically in interprofessional practice2012In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, Vol. 42, no 1, p. 129-146Article in journal (Refereed)
    Abstract [en]

    This paper reports on empirical research exploring and describing the variations in service users' conceptions of service user participation (SUP), specifically in interprofessional practice. The social work practices in which front line workers were using interprofessional teamwork were explored at three Swedish welfare institutions. Service users included individuals with chronic pain disorders, obesity conditions or in need of short-term placement in elder care facilities. The qualitative study design was informed by a phenomenographical approach and conducted as semi-structured individual interviews with twenty-two service users. The main findings suggest five qualitative variations of service user's conceptions of SUP: (i) information transmission; (ii) choices and decisions among resources; (iii) comfortable relationship and communication; (iv) interaction for increased understanding; and (v) conditions for service user participation. The findings highlight the importance for the interprofessional team of social workers and other professionals to recognise the various ways of experiencing SUP by service users. The findings thereby support the possibilities to understand and to take into consideration the individual service user's conceptions of SUP in interprofessional practice.

  • 30.
    Morténius, Helena
    et al.
    Department of Research and Development, Region Halland, Halmstad, Sweden.
    Baigi, Amir
    Department of Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Palm, Lars
    Centre for Media and Communication Studies, Halmstad University, Halmstad, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Björkelund, Cecilia
    Department of Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare.
    Impact of the organisational culture on primary care staff members' intention to engage in research and development2015In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 29, no 2, p. 234-251Article in journal (Refereed)
  • 31.
    Nordström, Erik
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Josephson, Irene
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Agenda för samverkan eller verksamhetens agenda? Om professionellas erfarenheter av samverkan enligt samordnad individuell plan (SIP)2016In: Socialvetenskaplig tidskrift, ISSN 1104-1420, no 1, p. 37-57Article in journal (Refereed)
    Abstract [en]

    Agenda for collaboration or an agency agenda? Professionals’ experiences of colla­boration according to a coordinated individual plan (CIP)

    An increasing number of children and adolescents develop complex needs that require simultaneous action by different professionals. Several reports state that efforts for these children and adolescents have become increasingly specialized and fragmented. Since 2010, there are statutory requirements for collaboration according to a coordinated individual plan (SIP) between health care and social services. Pre-school and school can after regional agreement be involved in the co-ordination as equal partner. Collaboration in line with CIP is expected to offset the fragmentation for benefit of the service users’ ability to monitor and comprehend interventions. The aim was to investigate professionals’ experiences of CIP. The study consists of qualitative analysis of 12 focus group interviews with a total of 71 staff with different professions in health care, education and social services about their experiences of CIP. The results indicate that the participants act according to their core mission: nurturing, teaching and investigation. Two main categories with four sub-categories each appeared in the analysis. The main category, hindering factors, contains the categories: different mandates and requirements, requirements for presence initiative, questioning and censure, and timelines and prioritization. The main category of facilitating factors contains the categories: similar interpretation of common agreement, mutual respect and shared learning, common terminology and documentation, and willingness to collaborate. The analysis indicate that CIP was perceived as alternating between, on the one hand, a pro-active and service-focused tool, and on the other hand, a competing and compelling professional instrument.

  • 32.
    Peterson, Anette
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hanberger, L.
    Samuelsson, U.
    Åkesson, K.
    Andersson Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Hedberg, Berit
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Learning from a successful Quality ImprovementCollaborative. Why did it work? – Experience from teams and team coacheswho improved their care for children with diabetesManuscript (preprint) (Other academic)
  • 33.
    Rosengren, Kristina
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Höglund, Pär
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Quality registry, a tool for patient advantages - from a preventive caring perspective2012In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 20, no 2, p. 196-205Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to describe nurses' experiences of a recently implemented quality register, Senior Alert, at two hospitals in Sweden.

    Background: In Sweden, in recent decades, a system of national quality registries has been established in health and medical services for better outcomes for patients, professional development and a better functioning system. Senior Alert (SA) is one quality registry, aimed at preventing malnutrition, pressure ulcers and falls in elderly care.

    Methods: The study comprised a total of eight interviews with nurses working with SA at the ward level. The interviews were analysed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study. All persons who were asked to participate in the study consented to do so.

    Results: One category 'Patient Advantages' and three subcategories 'Conscious Persevering', 'Supporting Structure' and 'Committed Leadership' were identified to describe staff experiences of implementing SA.

    Conclusions: Implementation processes need to be sustainable at both staff and managerial levels. A key factor in implementing and using a quality registry in prevention care could be described as keeping the flame burning. However, further research is needed on how patient advantages could be developed using other quality registries in order to improve care from a patient perspective.

    Implications for nursing management: The results of this study could help other organizations implement quality registries or other change processes, for example new guidelines and treatment. Strategies concerning organizational structure and committed leadership could increase the usefulness of knowledge systems on all levels, which could enable continuous learning and quality improvement in health care.

  • 34.
    Siouta, Eleni
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Content and distribution of discursive space in consultations between patients with atrial fibrillation and healthcare professionals2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 1, p. 47-55Article in journal (Refereed)
    Abstract [en]

    Aim: To describe (i) the topics participants talk about, (ii) the use of discursive space in consultations between patients with atrial fibrillation (AF) and their nurses and physicians, and (iii) the frequencies of the ways the patients, nurses and physicians introduce the topics.

    Methods: Data were collected from 23 videotaped consultations concerning patients with AF as well as physicians and nurses, respectively. To obtain a description of topics discussed, the transcripts were analysed using content analysis. The patterns of dominance for the respective topic and participant were explored from the framework of analysis that treats dominance.

    Results: Four topics were used by both nurses and physicians in the consultations. These were ‘pathophysiology’, ‘diagnostic procedures’, ‘treatment’ and ‘activity’. In the nurse–patient consultation an additional topic, ‘routines related to the physician’s responsibilities’, emerged. With respect to the number of words and turns, the distribution of the discourse space was almost equal between the nurses and patients and unequal between the physicians and patients. The healthcare professionals initiated the topics more frequently compared to the patients, whereby the medical approach recommended in the guidelines for AF could be recognized. The patients were the dominating initiators in the topic ‘activity’, which refers to the adaptation of activities in daily life in relation to the AF.

    Conclusions: The medical-driven agenda dominates over the patient-driven agenda in consultations between healthcare professional and patients with AF. The patients initiated the conversations when discussing living with AF and were more talkative during conversations in nurse consultations.

  • 35.
    Siouta, Eleni
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Hedberg, Berith
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Hedman, Karl
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Broström, Anders
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Interactional resistance between patients with atrial fibrillation and cardiologists in consultation on treatment with warfarin: the value of shared decision-making2012In: The International Journal of Person Centered Medicine, ISSN 2043-7730, E-ISSN 2043-7749, Vol. 2, no 3, p. 427-436Article in journal (Refereed)
    Abstract [en]

    Rationale: Atrial fibrillation (AF) increases the risk of stroke and it can be reduced by treatment with warfarin. Some patients consider that warfarin is a stressful treatment with undesired effects and the perceived barriers include unwillingness to take it. Knowledge of patients resisting warfarin treatment may be useful for the potential threat to maintaining shared decision-making in the consultation as a central tenet of person-centered medicine.

    Aims and objectives: To identify how patients resist treatment with warfarin and how cardiologists respond to patients’ resistance. The co-constructive perspective of this work analyses the consultations by emphasizing the clinical communication strategies of both patients and cardiologists.

    Method: Eleven videotaped consultations, in 4 different hospitals, were selected for analysis. Treatment interactions regarding warfarin between patients with AF and cardiologists were analysed, according to the methodology of conversation analysis.

    Results: There were 4 types of resistance from patients for accepting treatment with warfarin. These included “Giving reasons for their resistance”, “Suggestion of another treatment option by the patient”, “Stating a treatment preference” and “Questioning or challenging the cardiologist’s treatment recommendation”. The cardiologists’ responses to the patients’ resistance included “Repeating the treatment recommendation”, “Negotiation with the patient”, “Providing additional information on the recommended treatment” and “Extending the explanation for the purpose of taking the treatment”.

    Conclusions: By showing resistance, patients are thought to want to participate in their treatment decisions and an awareness of patients’ resistance to treatment enables cardiologists to address the patients’ experience-based views on their treatment and individual concerns as part of clinical strategies to increase the person-centeredness of medical intervention.

  • 36.
    Sjölander, Catarina
    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.
    Hedberg, Berith
    Jönköping University, School of Health Science.
    Ahlström, Gerd
    Lund University, The Swedish Institute for Health Sciences.
    Striving to be prepared for the painful: Management strategies following a family member’s diagnosis of advanced cancer2011In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 10, no 18, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Background: Cancer has consequences not only for the sick person but also for those who have a close relationship with that person. Greater knowledge about how family members manage the situation in the period immediately following the diagnosis means greater opportunity to provide the best possible support for the family. The purpose of this study was to explore management strategies that family members use when the patient is in the early stage of treatment for advanced cancer.

    Methods: Twenty family members of cancer patients were included in the study shortly after the diagnosis. The patients had been diagnosed 8-14 weeks earlier with advanced lung cancer or gastrointestinal cancer. The data were collected in interviews with family members and subjected to qualitative latent content analysis. Through the identification of similarities and dissimilarities in the units of meaning, abstraction into codes and sub-themes became possible. The sub-themes were then brought together in one overarching theme.

    Results: The overall function of management strategies is expressed in the theme Striving to be prepared for the painful. The family members prepare themselves mentally for the anticipated tragedy. Family relationships become increasingly important, and family members want to spend all their time together. They try to banish thoughts of the impending death and want to live as normal a life as possible. It becomes important to family members to live in the present and save their energy for the time when they will need it the most. How participants handle their worries, anxiety and sadness can be categorized into seven sub-themes or management strategies: Making things easier in everyday life, Banishing thoughts about the approaching loss, Living in the present, Adjusting to the sick person’s situation, Distracting oneself by being with others, Shielding the family from grief, and Attempting to maintain hope.

    Conclusions: The findings revealed that the family members have their own resources for handling the early stage of the cancer trajectory in an acceptable way. There is a need for longitudinal studies to generate knowledge for designing evidence-based intervention programmes that can prevent future ill-health in these vulnerable family members.

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