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  • 1.
    Hallgren, Jenny
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Dahl, Anna
    Ernsth Bravell, Marie
    Mölstad, Sigvard
    Midlöv, Patrik
    Östgren, Carl Johan
    Malmberg, Bo
    Josephson, Iréne
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Factors associated with a greater risk of hospitalization among nursing home residents2013Conference paper (Refereed)
    Abstract [en]

    Background: Nursing home residents are at a higher risk of hospital care as they represent the oldest and most frail segment of the population. At the same time, hospitalization is associated with a greater risk of various diseases, such as iatrogenic disorders, physical impairments and other adverse outcomes. Knowledge about factors associated with greater risk of hospitalization among nursing home residents is scarce. The aim of this study was to identify predictors of hospitalization among nursing home residents. Methods: Four hundred twenty-nine Swedish nursing home residents (mean age 84.9 years, ± 7.27, 71% females) were followed during three years in the longitudinal SHADES study. Participants were examined on physical, psychological, and social functioning, and information about hospitalization was recorded across the study period. Results: Of the 429 participants, 196 (45.7%) had at least one hospital admission during the three year follow-up period. The most common cause of admission was cardiovascular diseases (CVD) and complications due to falls.  Cox proportional hazard regression model controlling for dependency within nursing homes and municipalities showed that nursing home residents with previous falls (HR=1.59, p=.000), cognitive impairment (HR=1.28, p=.008) and malnutrition (HR=1.51, p=.018) were at a greater risk of hospitalization. Discussion: The results suggest that nursing home residents are at high risk of hospitalization, especially due to CVD and falls. Several modifiable factors associated with an increased risk of hospitalization were identified, including nutritional status and falls. Hospital admissions for older people could potentially be reduced by preventive measures aiming at fall reduction and malnutrition. 

  • 2.
    Hallgren, Jenny
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Ernsth Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Josephson, Iréne
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    In hospital we trust: Experiences of older peoples' decision to seek hospital care2015In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 36, no 4, p. 306-311Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to explore how older people experience and perceive decisions to seek hospital care while receiving home health care. Twenty-two Swedish older persons were interviewed about their experiences of decision to seek hospital while receiving home health care. The interviews were analyzed using qualitative content analysis. The findings consist of one interpretative theme describing an overall confidence in hospital staff to deliver both medical and psychosocial health care, In Hospital We Trust, with three underlying categories: Superior Health Care, People’s Worries, and Biomedical Needs. Findings indicate a need for establishing confidence and ensuring sufficient qualifications, both medical and psychological, in home health care staff to meet the needs of older people. Understanding older peoples’ arguments for seeking hospital care may have implications for how home care staff address individuals’ perceived needs. Fulfillment of perceived health needs may reduce avoidable hospitalizations and consequently improve quality of life.

  • 3.
    Josephson, Iréne
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    In what ways do physiotherapists utilize patient resources inintervention?: A qualitative analysis of the interaction in the context of non-specific low back pain2013Conference paper (Refereed)
    Abstract [en]

    This paper reports on an empirical study of how patient resources are explicitly utilized in intervention. A qualitative analysis of five videorecorded and observed first encounters between patients with nonspecific low back pain (NSLBP) and physiotherapists in primary care was conducted in southern Sweden. The analysis focuses on physiotherapists’ various ways of explicitly utilizing patient resources in intervention. The findings illuminate a gap between the number of occurring patient resources and the explicit utilization of these resources in intervention. Resources like objects, condition, personal characteristics and energies were identified and followed during the first encounter with physiotherapists. These resources were checked by the therapists or initiated by the patients. Resources concerning personal characteristics (such as optimism and motivation) and energies (such as experience-based knowledge) seem to be the underutilized. The findings raise questions about professional challenges beyond professional skill, indicating a need for clinical improvement regarding interaction, with potential implication for back pain recovery. The findings are discussed in relation to patient participation and professional ethics.

  • 4.
    Josephson, Iréne
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Meeting the challenges for the health and elderly care:Problematizing vulnerability in care encounters: The professional body in treatment2014Conference paper (Refereed)
  • 5.
    Josephson, Iréne
    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.
    Patterns of interaction about problem-identification in first face-to-face encounters between physiotherapists in primary care and patients with back pain2012Conference paper (Refereed)
  • 6.
    Josephson, Iréne
    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.
    Professionals' resistance regarding patients' experiences from encounters with 'Other' health professionals2012Conference paper (Refereed)
  • 7.
    Josephson, Iréne
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work.
    Utrymme för deltagande: Beslutsprocesser i möten mellan patienter med ospecifika ländryggsbesvär och sjukgymnaster i primärvård2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [sv]

    Hälso- och sjukvårdsmöten som föranleds av medicinskt ospecifika symptom innebär utmaningar för både patient och vårdprofessionell. Samtidigt erbjuder det ospecifika ett mer flexibelt utrymme för patienters aktiva deltagande i beslutsprocesser än vad som är fallet vid specifika hälsoproblem med ett begränsat antal vedertagna behandlingsalternativ. Syftet med forskningsprojektet var att undersöka utmaningar relaterade till utrymmet för patienters deltagande i beslutsprocesser avseende intervention. Avhandlingen baseras på fyra artiklar som undersöker erfarna sjukgymnasters föreställningar om, och interagerande i möten med patienter med ospecifika ländryggsbesvär.

    Forskningsprojektet genomfördes med explorativ empirisk ansats kombinerat med fokuserad etnografi. Det betyder att forskningen grundas på erfarenhetsbaserad kunskap som samlas in i naturligt förekommande verksamhet. Data samlades in via fokusgrupper med sjukgymnaster, samt via deltagande observationer av det första mötet mellan sjukgymnast och patient. Samtliga sammankomster videofilmades och transkriberades, och analyserades med fokus på beslutsprocesser avseende intervention.

    Forskningsprojektet resulterade i tre mönster: i) kontrasten mellan sjukgymnasternas förställningar om helhetsperspektiv i förhållande till det biomedicinska intresse som de utövade, ii) omvandlingen av patienternas resursorientering till biomedicinskt hälsoproblem, samt iii) överensstämmelse mellan sjukgymnasternas inställning till, och deras hantering av andra aktörer. Resultatet tyder på att sjukgymnasterna resonerade om element från flera systemnivåer men fattade beslut på sin egen systemnivå, det vill säga utifrån professionell metodik och teori. Det innebär att utrymmet för patienters aktiva deltagande i beslutsprocesser avseende intervention inte togs tillvara i den omfattning som var möjlig. Genom att vårdprofessionella utvecklar kommunikativa och interaktiva förmågor kan patienters resurser bättre tas tillvara i intervention, vilket indirekt kan leda till ökad nöjdhet och bättre funktionsförmåga.

  • 8.
    Josephson, Iréne
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work.
    Bülow, Pia H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work.
    In what ways do physiotherapists utilize patient resources in intervention?: A qualitative analysis of the interaction in the context of non-specific low back painManuscript (preprint) (Other academic)
  • 9.
    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.

  • 10.
    Josephson, Iréne
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work.
    Hedberg, Berit
    ’Not physically present actors’ in encounters between physiotherapists in primary care and patients with nonspecific low back painManuscript (preprint) (Other academic)
  • 11.
    Josephson, Iréne
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of 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, Quality Improvement and Leadership in Health and Welfare.
    Bülow, Pia H.
    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 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.

  • 12.
    Josephson, Iréne
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Woodward-Kron, Robyn
    Melbourne University.
    Delaney, Clare
    Melbourne University.
    Hiller, Amy
    Melbourne University.
    Therapists’ and patients’ use of evaluation in physiotherapy: implications for understandings of patient-centredness2014Conference paper (Refereed)
  • 13.
    Josephson, Iréne
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Woodward-Kron, Robyn
    Melbourne University, Australia.
    Delany, Clare
    Melbourne University, Australia.
    Hiller, Amy
    Melbourne University, Australia.
    Therapists' and patients' use of evaluation inphysiotherapy: implications for understandings of patient-centredness2014Conference paper (Refereed)
  • 14.
    Nordström, Erik
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of 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).
    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.

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