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  • 101.
    Lundqvist, Christina
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Jämlik och personcentrerad strokerehabilitering: En fallstudie av ett förbättringsarbete på Rehabenheten i Luleå kommun2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Personer med stroke behöver få bättre tillgång till en jämlik och personcentrerad rehabilitering i kommunerna. Ett förbättringsarbete initierades i Luleå kommun för att förbättra rehabiliteringen för personer med stroke. Ett förbättringsteam med arbetsterapeuter och fysioterapeuter från olika verksamheter tillsattes tillsammans med enhetschef tillika förbättringsledare.

     

    Syfte med förbättringsarbetet var att förbättra rehabiliteringen så att strokepatienter inom ordinärt boende erbjuds och påbörjar rehabiliteringsperioder med personcentrerade rehabiliteringsmål.

     

    Syfte med studien var att beskriva stödjande och hindrande faktorer för att starta förbättring av en jämlik och personcentrerad strokerehabilitering.

     

    Metod: Förbättringsarbetet utvärderades kvantitativt med mätningar per vecka av processmått för rehabplaner och personcentrerade mål. Fallstudien genomfördes med induktiv ansats med fokusgrupper. Materialet analyserades med kvalitativ innehållsanalys.

     

    Resultat: Förbättringsarbetet resulterade i en ICF-baserad rehabplan och ett nytt instrument, Canadian Occupational Perfomance Measure (COPM), som stöd för personcentrerat arbetssätt. Studiens analys visade sammanlagt 13 faktorer.  Stödjande var erfarenhetsutbyte, förändringsvilja, ledning och samverkan, lärande, strukturerat arbetssätt och tid medan hindrande var att komma igång, kommunikation, målformulering, samarbete och dialog, resurser, tillräcklig kompetens och uppdrag.

     

     

    Slutsats: Fortsatt testning behövs för att utvärdera om förändringsförslagen leder mot jämlik och personcentrerad strokerehabilitering.  De i studien identifierade stödjande faktorerna kan användas för att överbrygga hinder i starten av förbättringsarbetet.

  • 102.
    Lupaszkoi Hizden, Thomas
    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.
    Creating a community of practice to prevent readmissions: An improvement work on shared learning between an intensive care unit and a surgical ward2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background

    ICU readmissions within 72 hours after discharge from the intensive care unit (ICU) is a problem because this leads to higher mortality and longer hospital stays.

    This is a particular problem for the hospital studied for this thesis because there are only three fully equipped ICU beds available.

     

    Aim

    To prevent readmissions by introducing nursing rounds as a concept of “communities of practice” (CoP) and to identify supportive and prohibitive mechanisms in the improvement work and knowledge needed for further improvement work in similar settings.

     

    Methods

    Questionnaires, focus groups, Nelson’s improvement ramp, and qualitative content analysis.

     

    Results

    There were no readmissions from the participating ward after the nursing rounds started, but the reason for this is not clear. The staff experienced the nursing rounds as valuable and they reported greater feelings of confidence, increased exchange, and use of their own knowledge.

     

    Discussion

    The findings presented here support that hypothesis that CoP builds knowledge that can improve patient care. The information provided to the participants during the improvement project was identified as the most supportive mechanism for improvement work, and a lack of resources was seen as the most prohibitive mechanism.

  • 103.
    Magnusson, Karin
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Kan förbättringsarbete ge ökad kunskap och bättre kvalitet?: Ett förbättringsprojekt om Non-Invasiv-Ventilation på en akutvårdsavdelning2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    This improvement project took place in an acute care setting. The aim was to improve the level of self-estimated knowledge in NIV-treatment among the staff, increase the level of adherence to existing guidelines and to describe the staff´s experiences of the improvement project. The project was designed according to Nolan’s model of improvement and was performed in four PDSA-cycles. Ten qualitative individual interviews were conducted and analysed with content analysis according to Graneheim-Lundman. The project improved the self-estimated level of knowledge among the staff, but showed no improvement on the use of guidelines at all. The PDSA-cycles proved to be a successful concept showing a gradually improvement of self-estimated level of knowledge after each cycle. The participants of the study described the necessity of repetitive education, discussions among the staff and the need of support from leaders and colleagues if improvement of knowledge should take place. The interviews revealed the importance for leaders to clarify witch level of knowledge they expected the staff to have and the need for a system for follow-up on development for each person of the staff. The study also revealed that guidelines must be useful, understood and have a clearly identified owner.

  • 104.
    Malin, Sköld
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Callcenter för ökad telefontillgänglighet: En fallstudie av en ny verksamhet för att höja telefontillgängligheten i ett specifikt område i Närhälsan i Västra Götaland2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Low phone call accessibility to health centers entails that patients will not reach their health center on the day that they wish. This may be one of the reasons patients are dissatisfied.

    Purpose: The improvement study was to improve phone call accessibility in a limited geographical area in Västra Götaland. Sub-target: 90% of the population should reach their health center the same day. Main-target: 100% of the patients should reach their health center the same day. The purpose was to investigate weather cooperation could function between staff on separate locations and how this affects phone call accessibility.

    Method: Exploratory case study within a limited context. Data: semi-structured focus groups were analyzed using an inductive approach connected to the improvement study. 

    Results: Phone call accessibility improved to begin with which was presented using statistics from the phone system, available in Västra Götalandsregionen. Staff displayed positive attitudes towards the new call center.

    Conclusions: It’s possible to change phone call accessibility using nurses supporting different centers, despite not being employed by those centers. An issue for the center was the journal system where color codes had different meanings in the booking system.

  • 105.
    Malm, Dan
    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.
    Sandgren, Anna
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Regaining normalcy in relatives of patients with a pacemaker2014In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 4, no 3, p. 139-149Article in journal (Refereed)
    Abstract [en]

    Patients with chronic diseases, such as those with pacemakers, have shown that they have a worsened well-being, which means an increased interest in investigating how relatives of patients with pacemakers experience their situations and how the disease affects their life situations. The aim of this study was to explore the main concerns for the relatives of patients with a pacemaker and how they resolve these issues. A classic grounded theory was used throughout the study for data collection and analysis. Interviews were conducted with ten participants. Striving for normalcy emerged as the main concern for relatives of patients with a pacemaker and was handled through a process of regaining normalcy where the relatives strive to find a way to live as normal as possible. Regaining normalcy is done through developing trust, dwindling and finally life stabilizing, in which they are either holding back or new normalizing. Distinguishing signs are constantly done during the process to quickly notice possible symptoms of the patient. Increased knowledge and understanding of how the relatives of patients with a pacemaker regain normalcy can be used as a guide in order to support and inform the patient as well as their relatives in conjunction with implantation occasions but also in connection with recurring and lifelong follow-up occasions.

  • 106.
    Mazzocato, Pamela
    et al.
    Karolinska Institutet.
    Thor, Johan
    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. Karolinska Institutet.
    Bäckman, Ulrika
    Karolinska Institutet.
    Brommels, Mats
    Karolinska Institutet.
    Carlsson, Jan
    Karolinska Institutet.
    Jonsson, Fredrik
    Karolinska Institutet.
    Hagmar, Magnus
    Karolinska Institutet.
    Savage, Carl
    Karolinska Institutet.
    Complexity complicates lean: lessons from seven emergency services2014In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 28, no 2, p. 266-288Article in journal (Refereed)
    Abstract [en]

    Purpose – The purpose of this paper is to explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in hospital process performance data.

    Design/methodology/approach – A multiple case study based on a realistic evaluation approach to identify mechanisms for how lean impacts process performance and services’ capability to learn and continually improve. Four years of process performance data were collected from seven emergency services at a Swedish University Hospital: ear, nose and throat (ENT) (two), pediatrics (two), gynecology, internal medicine, and surgery. Performance patterns were linked with qualitative data collected through realist interviews.

    Findings – The complexity of the care process influenced how improvement in access to care was achieved. For less complex care processes (ENT and gynecology), large and sustained improvement was mainly the result of a better match between capacity and demand. For medicine, surgery, and pediatrics, which exhibit greater care process complexity, sustainable, or continual improvement were constrained because the changes implemented were insufficient in addressing the higher degree of complexity.

    Originality/value – The variation in process performance and sustainability of results indicate that lean efforts should be carefully adapted to the complexity of the care process and to the educational commitment of healthcare organizations. Ultimately, the ability to adapt lean to a particular context of application depends on the development of routines that effectively support learning from daily practices.

  • 107.
    Moberg, Anne-May
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Från lag till handling: En fallstudie av hur lagkravet om patientsäkerhetsberättelse nyttiggjordes i Stockholms läns landsting2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Caregivers shall according to the patient safety act 2010:659 annually write a patient safety declaration. Review of 76 patient safety declarations in Stockholm County Council (SCC), Sweden, showed a lack of knowledge about how to write and inadequate understanding of patient safety, particularly among smaller caregivers. Healthcare administrators could not answer caregivers’ questions on the patient safety declaration, why an improvement project was initiated to create support and to make the patient safety declaration useful.  

     

     

    Aim: To illustrate how a state steering initiative was handled in practice in the SCC and the experiences associated with the improvement project in health care administration, among caregivers and the interaction between them, and whether the efforts contributed to increased understanding of patient safety.

     

     

    Method: The study was a descriptive case study. The data collection was interviews of caregivers and healthcare administrators and document analysis. The analysies performed were qualitative and quantitative content analysis.

     

     

    Results: The patient safety declaration was made useful in the follow up process of caregivers with support of a template and a manual. The interaction between caregivers and healthcare administrators went from monitoring to dialogue. Learning increased and also understanding of patient safety to some degree.

     

    Conclusion: By being proactive and prepare support for caregivers to fulfill their commitment on patient safety declarations, several caregivers became aware of their responsibilities and obligations. The improvement project was accomplished with improvement knowledge and high level of participation, an approach that is recommended. Further research on the steering effects is suggested.

  • 108.
    Morténius, Helena
    et al.
    Department of Research and Development, Region Halland, Hospital of Halland, Halmstad, Sweden.
    Marklund, Bertil
    Palm, Lars
    Center 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. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Baigi, Amir
    Department of Research and Development, County Council of Halland, Halmstad, Sweden and Department of Primary Healthcare, University of Gothenburg, Gothenburg, Sweden.
    The utilization of knowledge of and interest in research and development among primary care staff by means of strategic communication - a staff cohort study2012In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 18, no 4, p. 768-775Article in journal (Refereed)
    Abstract [en]

    Objective: The obvious gap between evidence and practice in health care is unfavourable for patient care and requires the promotion of a scientific attitude among health care professionals. The aim of the present study was to determine the utilization of knowledge of and interest in research and development among primary care staff by means of a strategic communication process.

    Method: A cohort consisting of primary care staff (n = 1276) was designed and strategic communication was utilized as a platform over a 7-year period. Quantitative and qualitative methods were taken in account.

    Results: We found that 97% of the staff had gained knowledge of research and development, 60% of whom remained interested in the subject. The oral communication channel was the most powerful for creating research interest. Organizational culture was a barrier to interest in science.

    Conclusion: The study demonstrates a significant increase in knowledge and interest among primary care staff as a result of a strategic communication process.

    Practice implications: Strategic communication should lead to a more evenly distributed research commitment among all health care professionals, thus facilitating communication between them and patients in order to clarify, for example, the causes of disease.

  • 109.
    Muhic, Elizabet
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hälsosam vikt på sikt2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 110.
    Munck, Berit
    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.
    Sandgren, Anna
    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.
    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.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Next-of-kin's conceptions of medical technology in palliative homecare2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 13/14, p. 1868-1877Article in journal (Refereed)
    Abstract [en]

    Aims and objectives.  Describe next-of-kin’s conceptions of medical technology in palliative homecare.

    Background.  Next-of-kin to palliative patients are in an exposed position with increasing responsibility. The more involved they are in the care, the greater caregiver burden they describe. Medical technology has become increasingly common in palliative homecare, and previous research suggests that the devices transform the homes to a hospital ward, thus shifting responsibility from the personnel to the next-of-kin.

    Design.  An explorative descriptive design with a phenomenographic approach was chosen to describe qualitatively different conceptions of the phenomenon medical technology.

    Method.  Interviews with 15 next-of-kin to patients in palliative homecare were analysed in a seven-step process where 10 conceptions emerged in five description categories.

    Results.  Medical technology in palliative homecare required next-of-kin’s responsibility in monitoring or providing practical help. It also implied uncertainty among the next-of-kin because of worries about its safety or because of an improper handling. The technology trespassed on daily life because it restricted and affected the private sphere. Medical technology enabled comfort as it implied security and was a prerequisite for the patient to be cared for at home. It also required an adjustment to comprehend and manage the medical technology.

    Conclusions.  Medical technology resulted in an increased caregiver burden and uncertainty among the next-of-kin. Although it meant restrictions and affected their social life, they had great confidence in its possibilities.

    Relevance to clinical practice.  It is important to limit the amount of personnel and materials in the home to avoid trespassing on the family’s daily life. Medical personnel also have to be sensitive to what next-of-kin have the strength to do and not use them as informal caregivers.

  • 111.
    Munck, Berit
    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.
    Sandgren, Anna
    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.
    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.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Patients' understanding of medical technology in palliative home care: a qualitative analysis2012In: Journal of Hospice and Palliative Nursing, ISSN 1522-2179, E-ISSN 1539-0705, Vol. 14, no 3, p. 191-198Article in journal (Refereed)
    Abstract [en]

    Healthcare reforms and reductions in the number of hospital beds are leading to an increasing amount of medical technology moving from hospitals into home care, affecting the daily lives of patients. The aim of this study was therefore to describe the ways patients understand medical technology in palliative home care. With use of a phenomenographic approach, 15 patients with medical technology were interviewed, and data were analyzed in a 7-step process. Three ways of understanding the phenomenon emerged: a masterful patient, an adjustable patient, and a restricted patient. Masterful patients took control over the medical technology and were mostly independent of assistance from personnel. Adjustable patients accepted and adapted their lives to the medical technology and were satisfied with assistance from the personnel. Restricted patients were reminded daily of the medical technology and dependent on assistance from personnel. Depending on the patients’ health conditions, the support from the personnel, and the impact of medical technology, a transfer between the different ways of understanding occurred with a simultaneous movement between independence and dependence. The patient exhibited various ways of understanding, although one way of understanding was more dominant.

  • 112.
    Müllern, Tomas
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Marketing and Logistics. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Nordin, Annika
    Jönköping University, Jönköping International Business School, JIBS, Marketing and Logistics. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Revisiting empowerment: a study of improvement work in health care teams2012In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 21, no 2, p. 81-92Article in journal (Refereed)
    Abstract [en]

    This article reports on a study of team empowerment in a large clinic at a Swedish hospital. The focus of the study was to understand how a high degree of empowerment enabled the teams to develop and sustain a high level of performance. More specifically, a model of empowerment was used to identify important factors that contribute to team empowerment in 3 teams at the clinic. In the analysis of the empirical data, 21 factors were identified and the degree of empowerment in the 3 teams was assessed.

  • 113.
    Nes, Pia
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Kunskapens paradox- i diabetesvården av den äldre2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 114.
    Neubeck, Truls
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Elg, Mattias
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Linköping University.
    Quality improvement in the case of sheltered housingIn: Article in journal (Other academic)
  • 115.
    Neubeck, Truls
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Elg, Mattias
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Management and Engineering, Linköping University.
    Schneider, Thomas
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Managing the gap between policy and practice through Intermediaries for Quality Improvement2014In: Scandinavian Journal of Public Administration, ISSN 2001-7405, E-ISSN 2001-7413, Vol. 18, no 4, p. 73-89Article in journal (Refereed)
    Abstract [en]

    A gap exists between policymaking for quality improvement and the realization of these policies in practice. Using previous research on intermediaries, a conceptual model of an Intermediary for Quality Improvement (IQI) is developed. The model highlights the characteristics of structural positions, mediating approaches, and duration as a way to describe an IQI. The conceptual model is used to examine two cases in which Famna, the Swedish Association for Non-profit Health and Social Service Providers, has supported both policymaking and the implementation of policies at a provider level. The cases are the national strategy for quality improvement by open comparisons in health care and social services and a new regulation on quality management systems in health care and social services. Using the concept of an IQI deepens the understanding of how top-down and bottom-up perspectives may be managed to realize good quality of services.

  • 116.
    Neubeck, Truls
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Elg, Mattias
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Schneider, Thomas
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Famna - the Swedish Association for Non-Profit Health Care and Social Service.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Prospects and problems of transferring quality-improvement methods from health care to social services: two case studies2014In: The Permanente Journal, ISSN 1552-5767, E-ISSN 1552-5775, Vol. 18, no 2, p. 38-42Article in journal (Refereed)
    Abstract [en]

    Introduction: This study examines the use of quality-improvement(QI) methods in social services. Particularly the keyaspects—generalizable knowledge, interprofessional teamwork,and measurements—are studied in projects from the QI programForum for Values in Sweden.Methods: This is a mixed-method case study. Two projectsusing standard QI methods and tools as used in health carewere chosen as critical cases to highlight some problems andprospects with the use of QI in social services. The cases wereanalyzed through documented results and qualitative interviewswith participants one year after the QI projects ended.Results: The social service QI projects led to measurableimprovements when they used standard methods and tools forQI in health care. One year after the projects, the improvementswere either not continuously measured or not reported in anyinfrastructure for measurements. The study reveals that socialservices differ from health care regarding the availability and useof evidence, the role of professional expertise, and infrastructurefor measurements.Conclusions: We argue that QI methods as used in healthcare are applicable in social services and can lead to measurableimprovements. The study gives valuable insights for QI,not only in social services but also in health care, on howto assess and sustain improvements when infrastructures formeasurements are lacking. In addition, when one forms QIteams, the focus should be on functions instead of professions,and QI methods can be used to support implementation ofevidence-based practice.

  • 117.
    Nilsson, Jonas
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hur många stenar ska man vända på?: En kvalitativ studie om kvalitetsförbättrande åtgärder för enhetliga bedömningar inom tillsynen av hälso- och sjukvård2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The Health and Social Care Inspectorate, IVO, is a regionalized regulatory authority with responsibility for, inter alia, the supervision of the health care system. It has been noted that the Authority's assessment gaps in uniformity. Assessments affect health care conditions to conduct an equal quality care which requires that decisions of the authority have a high degree of uniformity.

     

    The purpose of this study is to examine how health care inspectors perceive their capabilities to assess internal investigations. A focus group was conducted with on one of IVO's regional departments. The interview has been analyzed with a qualitative content analysis. To enhance the results of the study follow-up individual interviews, two years after the focus group, were conducted. According to the result a long process of induction and mentoring to become an experienced Inspector were required. Colleagues were perceived as the primary source of knowledge. Clear leadership and clear evaluation support is seen as key elements for uniform assessments.

     

    The study's conclusion is that there are several incentives for a basic education to become an inspector to strengthen the conditions for uniform assessments.

     

    Keywords: Inspectors, quality improvement, regulatory, street level bureaucrats.

  • 118.
    Norman, Ann-Charlott
    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, The Jönköping Academy for Improvement of Health and Welfare. Linnéuniversitetet.
    Fritzén, Lena
    Linnéuniversitetet, Institutionen Pedagogik.
    Lindblad-Fridh, Marianne
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    One lens missing? Clarifying the clinical microsystem framework with learning theories2013In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 22, no 2, p. 126-136Article in journal (Refereed)
    Abstract [en]

    Introduction: The clinical microsystem (CMS)approach is widely used and is perceived as helpfulin practice but, we ask the question: “Is its learningpotential sufficiently utilized?”

    Objectives: Toscrutinize aspects of learning within the CMSframework and to clarify the learning aspects theframework includes and thereby support theframework with the enhanced learning perspectivethat becomes visible.

    Methods: Literature on theCMS framework was systematically searched andselected using inclusion criteria. An analytical toolwas constructed in the form of a theoretical lensthat was used to clarify learning aspects that areassociated with the framework.

    Findings: Theanalysis revealed 3 learning aspects: (1) The CMSframework describes individual and social learningbut not how to adapt learning strategies forpurposes of change. (2) The metaphorical languageof how to reach a holistic health care system foreach patient has developed over time but can stillbe improved by naming social interactions totranscend organizational boundaries. (3) Powerstructures are recognized but not as a characteristicthat restricts learning due to asymmetriccommunication.

    Conclusion: The “lens” perspectivereveals new meanings to learning that enhance ourunderstanding of health care as a social system andprovides new practical learning strategies.

  • 119.
    Norrman Brandt, Eva
    et al.
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Sjölander, Per
    Akademi Norr, Storuman.
    Stålne, Kristian
    Lunds tekniska högskola.
    Leader capabilities in the 21st century2014Conference paper (Refereed)
    Abstract [en]

    We know from decades of empirical research in adult development that leaders at more advanced stages of development are more effective than their counterparts in carrying out a variety of leaderships’ tasks, but also that few leaders have these advanced level of leadership (Joiner & Josephs 2007; Torbert 1987). But are leaders up to the task of handling complex issues at work? Knowing that the complexity and speed of change requires higher levels of adult development it seems obvious that there is a need for supporting managers to develop their level of development and maybe recruit leaders with a higher level of development. There is a need for research focusing on the link between adult ego development in leaders and transformational leadership (McCauley, Drath, Palus, O´Connor&Baker 2006), and studies on leader-follower interaction.

    The aim of this study is firstly to examine the correlation between leadership behaviors, value systems and complexity, and secondly if the correlation between self report and subordinates evaluation of leadership are higher for individuals with more advanced levels of value systems and/or levels of leadership.

    Participants are managers in 4 Scandinavian organizations in different market segments including municipalities. The mangers are invited to answer a basic web survey including three instruments: a value system questionnaire (Sjölander et al.2013); Developmental Leadership Questionnaire which is a hierarchical test based on the theory of transformational leadership and it measures leadership behaviors through a self-evaluation and a 360 test where subordinates evaluate leadership of the manager; and a complexity test. Some managers do only the self-evaluation and some a full 360 feedback test. The study is carried out in the spring 2014 and preliminary results will be presented.

  • 120.
    Nygårdh, Annette
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. 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, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Wikby, Kerstin
    Linneus University.
    Ahlström, Gerd
    Swedish Institute for Health Sciences, Department of Health Sciences, Lund University.
    Empowerment Intervention in Outpatient Care of Persons with Chronic Kidney Disease Pre-Dialysis2012In: Nephrology Nursing Journal : Journal of The American Nephrology Nurses Association, ISSN 1526-744X, E-ISSN 2163-5390, Vol. 39, no 4, p. 285-294Article in journal (Refereed)
    Abstract [en]

    Empowering interventions can improve person-centered care. A pre- and post-evaluation using interactive research involving two years of empowering interventions was designed to improve quality of care in outpatients with chronic kidney disease who were pre-dialysis. The results showed significantly increased empowerment in the intervention group. Interactive research facilitated the implementation of the empowerment intervention, which may increase sustainability over time.

  • 121.
    Nygårdh, Annette
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. 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, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Wikby, Kerstin
    Ahlström, Gerd
    Facilitators and barriers in the implementation process of an improvement intervention in chronic kidney care: a case studyManuscript (preprint) (Other academic)
  • 122.
    Nygårdh, Annette
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. 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, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Wikby, Kerstin
    Linneus University, Växjö SE- 351 95, Sweden.
    Ahlström, Gerd
    Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 187, Lund SE-221 00, Sweden.
    The complexity in the implementation process of empowerment-based chronic kidney care: a case study2014In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 13, no 22, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Background: This study is part of an interactive improvement intervention aimed to facilitate empowerment-based chronic kidney care using data from persons with CKD and their family members. There are many challenges to implementing empowerment-based care, and it is therefore necessary to study the implementation process. The aim of this study was to generate knowledge regarding the implementation process of an improvement intervention of empowerment for those who require chronic kidney care.

    Methods: A prospective single qualitative case study was chosen to follow the process of the implementation over a two year period. Twelve health care professionals were selected based on their various role(s) in the implementation of the improvement intervention. Data collection comprised of digitally recorded project group meetings, field notes of the meetings, and individual interviews before and after the improvement project. These multiple data were analyzed using qualitative latent content analysis.

    Results: Two facilitator themes emerged: Moving spirit and Encouragement. The healthcare professionals described a willingness to individualize care and to increase their professional development in the field of chronic kidney care. The implementation process was strongly reinforced by both the researchers working interactively with the staff, and the project group. One theme emerged as a barrier: the Limitations of the organization. Changes in the organization hindered the implementation of the intervention throughout the study period, and the lack of interplay in the organization most impeded the process.

    Conclusions: The findings indicated the complexity of maintaining a sustainable and lasting implementation over a period of two years. Implementing empowerment-based care was found to be facilitated by the cooperation between all involved healthcare professionals. Furthermore, long-term improvement interventions need strong encouragement from all levels of the organization to maintain engagement, even when it is initiated by the health care professionals themselves.

  • 123.
    Nygårdh, Annette
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. 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, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Wikby, Kerstin
    Jönköping University, School of Health and Welfare.
    Ahlström, Gerd
    Swedish Institute for Health Sciences (Vårdalinstitutet), Lund University, Lund, Sweden.
    The experience of empowerment in the patient-staff encounter: the patient's perspective2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 5/6, p. 897-904Article in journal (Refereed)
    Abstract [en]

    Aim and objective.  The aim was to explore empowerment within the patient–staff encounter as experienced by out-patients with chronic kidney disease.

    Background.  Empowerment has an important role to play in the patient–staff relationship in the case of patients with a chronic disease. When it comes to patients with chronic kidney disease, there has been little research on empowerment, for which reason interviewing such patients about their experiences of empowerment will provide useful knowledge within the context of out-patient care.

    Design.  A qualitative interview study was chosen to gain an understanding of empowerment from the patient perspective.

    Method.  The study was carried out at an out-patient clinic in Sweden and involved 20 patients with chronic kidney disease. The interviews were subjected to latent content analysis.

    Results.  Five of the seven sub-themes emerging from the analysis represented empowerment: Accessibility according to need, Confirming encounter, Trust in the competence of the healthcare staff, Participation in decision-making, Learning enables better self-management. The other two represented non-empowerment: Meeting with nonchalance, Lack of dialogue and influence. From the seven sub-themes, one comprehensive theme was generated: Creation of trust and learning through encounter.

    Conclusion.  The main finding regarding the central role of the creation of trust and learning through the patient–staff encounter underlines the importance of understanding empowerment from the patient’s perspective.

    Relevance to clinical practice.  Nursing and other healthcare staff need knowledge and understanding of the meaning of empowerment from the patients’ perspective to meet their needs in out-patient care.

  • 124.
    Nyman, Monica
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hur systematiskt kvalitetsarbete kan leda till nya arbetssätt och positiva hälsoeffekter inom äldreomsorgen: En interventionsstudie av ett förbättringsarbete på ett privat vårdboende i Sydsverige2019Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    Title

    How systematic quality work can lead to new work ways and health benefits in elderly care – an intervention study.

    Background

    Deviations and complains from external collaborators and reduced staff- and patient´s satisfaction at this privately- owned elderly care home in 2017 pointed at the need for improvement.

    Purpose

    The purpose of the quality improvement work was to create local basis to implement new work-ways. The study´s purpose was to describe the impacts on the staff’s experiences, performance in quality work and effects on the elderly.

    The intervention

    A quality improvement work has been in progress since the beginning of 2018. Efficiency in routines and adherence to the quality management system was prioritized.

    Methods

    Methods used in the quality improvement work was Nolan’s model of Improvement with PDSA cycles, Ishikawa and SWOT analysis. The study was performed by content analysis with focus group interviews and data from a survey to the staff.

    Results

    Implementation of new routines, meetings and staff-education led to an increase in health benefits with 60% of the elderly and increase with the elderly´s contentment by up to 72%. The study showed that new work-ways led to improvement by structure, teamwork and learning.

    Conclusions

    Implementation of new work-ways in this quality improvement-work led to higher adherence to routines and the quality management system.

  • 125.
    Nyquist, Patrick
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    ”Vi har rott men ingen har styrt”: En fallstudie av ett förbättringsarbete på en ortopedteknisk produktionsenhet där produktion, teknik och sjukvård möts2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund

    2007 genomgick det ortopedtekniska företaget ”TeamOlmed” en organisationsförändring i form av att gå från en lokal till en central produktion av ortopedtekniska hjälpmedel. Detta medförde problem inom kommunikations- och informationsområdet som resulterade i en ökad andel tillverkade ortopedtekniska hjälpmedel som inte motsvarade patienthandläggarnas förväntningar. Detta ökade risken för att leveransen av hjälpmedlen försenades och att hjälpmedlen inte uppfyller de uppsatta funktionskraven. Utifrån problemet på TeamOlmed utfördes ett förbättringsarbete samt en studie på förbättringsarbetet då kunskap angående förbättringsarbeten inom denna kontext behöver stärkas.

     

    Syfte

    Syftet med förbättringsarbetet var att förbättra beställnings- och produktionsprocessen vid tillverkningen av de individuella ortopedtekniska hjälpmedlen. Studiens syften var att undersöka vilka påverkande faktorer som föreligger vid genomförandet av ett förbättringsarbete på en ortopedteknisk produktionsenhet samt att genom att tillämpa modellen ”Model for Understanding Success in Quality” (MUSIQ) jämföra om resultatet från denna studie skiljer sig från tidigare forskning.

     

    Metod

    Förbättringsarbetet planerades och genomfördes med ”förbättringsrampen” som ramverk och guide. Datainsamlingen i studien utfördes genom semistrukturerade fokusgruppsintervjuer. Intervjudata analyserades induktivt enligt metoden kvalitativ innehållsanalys. Även en deduktiv innehållsanalys utfördes med MUSIQ-modellen som underlag.

     

    Resultat

    Resultatet från förbättringsarbetet visade att produktionsenheten blev bättre på att leverera ortopedtekniska hjälpmedel som motsvarade beställarnas förväntningar. Andelen produkter levererade produkter som beställarna var ”helt nöjda” med ökade från 75 % till 88 %. Dessutom minskade andelen beställningar med bristfälliga beställningsunderlag från 13 % vid början på projektet till 6,5 % vid projektets slut.

     

    Studiens resultat visade att de faktorer som hade störst påverkan på genomförandet av förbättringsarbetet var ”Kunskap & förståelse”, ”Delaktighet”, ”Metod & Resurser”, ”Ledarskap & stöd” och ”Mätningar”. Kunskapsbilden kompletterades ytterligare av tillämpningen av MUSIQ-modellen som visade att faktorerna ”Gruppledarskapet över förbättringsgruppen” och ”Motivation till förbättring i mikrosystemet” var de två faktorer som hade störst effekt på det genomförda förbättringsarbetet.

     

    Slutsats

    Två av de tre målen kopplade till förbättringsarbetet uppnåddes vilket innebar att förbättringsarbetet genom tillämpning av förbättringskunskap till stor del lyckades uppfylla sitt syfte. Studien resulterade i ökade kunskaper om vilka påverkande faktorer som föreligger vid genomförande av förbättringsarbeten. Resultatjämförelsen visade en samstämmighet i form av att fyra av de sex faktorer med störst påverkan på förbättringsarbeten fanns med i båda studierna: Gruppledarskapet för förbättringsgruppen, Motivation till förbättring i mikrosystemet, Mikrosystemets förbättringskultur, och Resurstillgänglighet tid.

  • 126.
    Oldaeus Almerén, Anna
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Kvalitetshöjande förbättringsinsatser inom cancervården: En fallstudie med fokus på behov2015Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Att skapa förutsättningar för en förbättrad cancervård, genom att fördjupa kunskapen och förståelsen om behov hos huvud- och halscancerpatienter under cancerprocessen. Därutö- ver önskas ett förbättrat omhändertagande genom att implementera och utvärdera kvalitetshö- jande förbättringsinsatser. Satsningen ska resultera i en trygg och smidig resa genom vården med ett minimum av avbrott mellan olika vårdhändelser.

    Metod: Patientens vårdkedja studerades med en fallstudie, utifrån en aktionsforskningsansats. Behoven identifierades med patientskuggning, reflektion från observationer och semistruktu- rerade fokusgruppsintervjuer med mikrosystemet, före (referensgrupp) och efter intervention (jämförelsegrupp). Analys genomfördes med kvalitativ innehållsanalys och Kano-modell.

    Resultat: En fast vårdkontakt var en viktig faktor i vårdkedjan. Den fasta vårdkontakten till- mötesgick behov såsom trygghet och tillgänglighet, vilket medförde en smidigare vårdkedja. Under hela vårdförloppet fanns ett stort behov av stöd, praktiskt liksom psykosocialt, från både profession och närstående. Oberoende av position i vårdkedjan önskades individanpas- sad information och ett gott bemötande. Interventionsgruppen rapporterade bättre tillgänglig- het och stöd i förhållande till jämförelsegruppen, som inte hade tillgång till kontaktsjukskö- terska. Involvering av hela mikrosystemet vid analys med Kano-modell medför att behov och förbättringsmöjligheter identifieras och valideras.

    Slutsatser: En kontaktsjuksköterska kan utgöra en fast vårdkontakt som tillmötesgår och sä- kerställer cancerpatienters behov. Närstående är en viktig del av mikrosystemet och måste beredas utrymme och resurser. En förbättringsinsats genom implementering av kontaktsjuk- sköterska, utformning av nutritions- och kvalitetsregisterrutiner baserat på patientens behov bidrar till god vård och minskar risken för resursslöseri. Studien har även bidragit med fördju- pad kunskap gällande applicering av Kano-modellen i Hälso- och sjukvårdsmiljö. 

  • 127.
    Ottosson, Ann
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Minimera separation av föräldrar och nyfött barn med neonatal andningsstörning och maximera hudnära vård2019Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    At Södersjukhuset the mother and her newborn with transient tachypnoea (TTN) have two separate care chains. This leads to newborns with TTN being separated from their mothers as they are admitted to the neonatal unit to receive CPAP (Continuous Positive Airway Pressure) therapy.

    The aim of the improvement work is to minimise the separation of mother and newborn with TTN, during the time when the mother still requires obstetric care. The change idea consists of a mobile neonatal team who cares for the newborn with TTN on its mother’s chest skin-to-skin, wherever she currently is in her care chain. The study of the improvement aims at investigating how parents and neonatal care staff experience the new work procedure and the care form with a mobile neonatal team.

    During the period from 1 November 2017 until 30 April 2019 a total of 103 newborns with TTN have received care from the mobile team. These newborns have a shorter average length of stay and CPAP therapy duration and an earlier start of breastfeeding compared to the newborns with TTN who have received care in the neonatal unit. The healthcare staff in the neonatal unit experience that the reduced flow of patients contributes to an improvement of the working environment and the care environment. Parents express a feeling of high participation and security as well as a facilitated attachment to their child.

  • 128.
    Peterson, Anette
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Learning and understanding for quality improvement under different conditions: An analysis of quality registry-based collaboratives in acute and chronic care2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The demands that are placed on healthcare systems continue to increase, but several studies show that patient care and healthcare system outcomes are not as good as they could be. To come to terms with these problems, many stakeholders turn to systematic quality improvement methods. However, research and practice also shows that change in organisations is difficult. Consequently many quality improvement projects fail. Quality Improvement Collaboratives (QICs), introduced through the use of the Breakthrough series model, represent a commonly used approach. Despite their widespread application, uncertainty remains regarding the effectiveness of QICs. In Sweden, a number of national quality registries document healthcare actions and outcomes for different patient-groups and problem-areas. While these registries have long been used for follow-up purposes and for clinical research, they have not been used extensively for systematic clinical improvement purposes. The overall aim of this thesis was to examine if, and how, QICs which are supported by national quality registries can contribute to quality improvement in the provision of healthcare. The aim was also to examine what learning and new understanding occurred in the application of QICs in different settings.

    The empirical material in this thesis comes from three QICs which included participating teams from different hospitals and health centres in Sweden. Each QIC included a national quality registry: the National Quality Registry for Acute Myocardial Infarction Care (RIKS-HIA); the National Diabetes Registry (NDR); and the Swedish Paediatric Diabetes Quality Registry (SWEDIABKIDS).

    The thesis draws on an interactive research approach. The data collection and analysis employed both qualitative and quantitative methods. Data fromthe National Quality Registries, final team reports, focus-group interviews, and team members’ experiences were analysed and triangulated.

    The studies shows that QICs which are supported by national quality registries helped teams to close a number of gaps between ordinary clinical practice and evidence-based guidelines, thereby contributing to the provision of better care and better clinical outcomes (Study I, Study II, and Study III). Important factors for success included stakeholders’ learning andunderstanding of the organisational context; structures that supported improvement efforts; and team members’ and managers’ commitment to improvement (Study IV). Furthermore, support by an internal team coach also promoted success (Study IV).

    This thesis shows how national quality registries can be used in combination with systematic improvement efforts to produce better clinical results. It concludes that different areas of QIC application pose different challenges; for example, addressing care for acute disease versus chronic disease and evaluating professionally influenced process measures versus patient dependent outcome measures. While different organizational contexts and care characteristics can pose challenges to QIC efforts, the formation of “Communities of Practice” during QICs enhanced the learning for improvement with and from others.

  • 129.
    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)
  • 130.
    Peterson, Anette
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Hanberger, Lena
    Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes. Research Center, Linköping University Hospital, Linköping, Sweden.
    Åkesson, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Pediatric, County Hospital Ryhov, Jönköping, Sweden.
    Bojestig, Mats
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Samuelsson, Ulf
    Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes. Research Center, Linköping University Hospital, Linköping, Sweden.
    Improved results in paediatric diabetes care using a quality registry in an improvement collaborative: a case study in Sweden2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 5(e97875), p. 1-6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Several studies show that good metabolic control is important for children and adolescents with type 1 diabetes. In Sweden, there are large differences in mean haemoglobin A1c (HbA1c) in different hospitals and difficulties implementing national guidelines in everyday practice. This study shows how the participation in an improvement collaborative could facilitate improvements in the quality of care by paediatric diabetes teams. The Swedish paediatric diabetes quality registry, SWEDIABKIDS was used as a tool and resource for feedback and outcome measures.

    METHODS:

    Twelve teams at paediatric diabetes centres, caring for 30% (2302/7660) of patients in Sweden, participated in an 18-month quality improvement program. Each team defined treatment targets, areas needing improvement, and action plans. The main outcome was the centre patients' mean HbA1c levels, but other clinical variables and change concepts were also studied. Data from the previous six months were compared with the first six months after starting the program, and the long-term follow up after another eleven months.

    RESULTS:

    All centres reduced mean HbA1c during the second and third periods compared with the first. The mean reduction for all was 3·7 mmol/mol (p<0.001), compared with non-participating centres who improved their mean HbA1c with 1·7 mmol/mol during the same period. Many of the participating centres reduced the frequency of severe hypoglycaemia and/or ketoacidosis, and five centres reached their goal of ensuring that all patients had some sort of physical activity at least once weekly. Change concepts were, for example, improved guidelines, appointment planning, informing the patients, improving teamwork and active use of the registry, and health promotion activities.

    CONCLUSIONS:

    By involving paediatric diabetes teams in a quality improvement collaborative together with access to a quality register, the quality of paediatric diabetes care can improve, thereby contributing to a reduced risk of late complications for children and adolescents with diabetes.

  • 131.
    Pettersson, Gunilla
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Kontinuitet för patienter med svårläkta bensår: En studie av ett förbättringsarbete på en distriktssköterskemottagning2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Enligt Hälso- och Sjukvårdslagen ska goda kontakter mellan patienter och hälso- och sjukvårdspersonalen främjas samt att patientens behov av kontinuitet och säkerhet ska tillgodoses. Studier har visat att patienter får träffa många olika vårdare. Kontinuitet är en viktig förutsättning för att sår ska läka så snabbt som möjligt. Det finns tydliga riktlinjer för hur svårläkta sår ska skötas men studier har visat att följsamheten till dessa många gånger är dålig. Patienter får också ofta olika information från olika vårdpersonal och det skapar förvirring.

    Studien belyser de erfarenheter som patienter och medarbetare har av processen att skapa en ökad kontinuitet; i betydelsen kontinuerlig relation, information och behandling för patienter med svårläkta bensår på en distriktssköterskemottagning. Syftet med förbättringsarbetet var att skapa en förbättrad kontinuitet för patienter med svårläkta bensår. Syftet med studien av förbättringsarbetet var att belysa de erfarenheter som sjuksköterskor har av processen att skapa en ökad kontinuitet.

    Studien har en beskrivande och utvärderande design med kvalitativ ansats. Interventionen bestod av utbildning, ny bokningsrutin, ändrad schemaläggning, broschyr om svårläkta bensår och datoriserad sårläkningsjournal. Före interventionen intervjuades fem patienter och tolv sjuksköterskor och efter interventionen fem patienter och sex sjuksköterskor. Journalgranskning utfördes för att följa hur många olika sjuksköterskor patienter fått träffa under en åttaveckorsperiod före och efter förändring. Alla sjuksköterskor fick besvara frågor om förändringsklimatet genom enkäten PARIHS.

    Enkäten PARIHS visade att förändringsklimatet var bra på arbetsplatsen och stöddes av ledningen men att det fanns dåligt med tid för att kunna diskutera och reflektera över forskningsresultat. Sjuksköterskorna upplevde att kontakten med patienterna blev bättre när det blev ett mindre vårdlag. Informationen kunde läggas på rätt nivå och patienten kunde då vara mer delaktig i sin behandling. Patienterna upplevde en förbättrad personalkontinuitet men tyckte det var svårt att vara delaktiga i vården. De hade fått information om kost, motion och kompression men de mindes inte att de fått broschyren.

    Målet att patienterna skulle få en kontinuerlig relation har blivit förbättrad men om kontinuitet i information och behandling har blivit bättre råder delade meningar. PARIHS var en bra metod för att beskriva förutsättningar för förbättringsarbetet.

  • 132.
    Ramfelt, Kerstin
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Stöd av egenförmåga med hjälp av coach- och mentor-program vid barn- och ungdomsdiabetes: Test av förbättringsförslag framtagna via Experienced Based Co-Design2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund

    Många barn och ungdomar med diabetes har svårt att nå nationella behandlingsmålet för HbA1c (långtidsblodsocker) vilket är förknippat med ökad risk för komplikationer. Detta gör det angeläget att ta reda på vad patienter och vårdnadshavare anser viktigt för att vardagen ska fungera.

    Experienced Based Co-design (EBCD) innebär en möjlighet för medarbetare och patienter att utifrån sina erfarenheter tillsammans utforma tjänster och processer.

     

    Kontext för studien

    Studien har genomförts inom ett barndiabetesteam där endast 27% av patienterna når upp till nationella målet för HbA1c.

     

    Studiens syfte

    Att genom EBCD ta reda på vad intressenter anser viktigt för en fungerande vardag med typ 1-diabetes samt undersöka vad förbättringsförslagen coach- och mentorskapsprogram innebär för personer med diabetes och deras vårdnadshavare.

     

    Metod

    Fokusgrupper med vårdnadshavare, medarbetare och skolpersonal, workshop, intervjuer med patienter och kvalitativ innehållsanalys.

     

    Resultat

    EBCD-metoden ledde till att flera förbättringsförslag identifierades. De två som testades gav effekter på både metabol kontroll och känsla av egenförmåga hos deltagarna. Erfarenheter från coach-programmet stämde väl överens med studier av coach-program från Storbritannien och USA.

     

    Slutsats

    EBCD innebär möjlighet att förbättra vården på patienternas villkor. Förbättringsförslagen var väl sanktionerade och gav önskad effekt. Föräldracoaching ansågs så värdefullt att det nu erbjuds alla nya patienter.

  • 133.
    Rejler, Martin
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Nätverk förbättrar vården för patienter med kroniska sjukdomar2014Report (Other academic)
    Abstract [sv]

    KRONISKA sjukdomar som hjärt- och kärlsjukdomar, diabetes och KOL står för en stor och växande del av Sveriges hälso- och sjukvårdskostnader. Nästan halva Sveriges befolkning lider av långvarig sjukdom. 80–85 procent av hälso- och sjukvårdsresurserna riktas till patienter med kroniska sjukdomar.

    I skriften diskuteras hur nätverk mellan specialistmottagningar kan förbättra vården för patienter med kroniska sjukdomar. Det amerikanska nätverket ImproveCareNow, som står i fokus, bildades 2004. I dag består det av 70 mottagningar specialiserade på vård av barn och unga med inflammatorisk tarmsjukdom, omfattar 19 000 patienter och engagerar över 500 läkare. Trots skillnader mellan det amerikanska och svenska vårdsystemet och det faktum att varje sjukdom har sina särdrag finns det lärdomar som kan överföras till Sverige och andra kroniska sjukdomar.

  • 134.
    Rejler, Martin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Medicine, Unit of Gastroenterology, Highland Hospital in Eksjö, Eksjö , Sweden.
    Tholstrup, Jörgen
    Department of Medicine, Unit of Gastroenterology, Highland Hospital in Eksjö, Eksjö , Sweden.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Spångéus, Anna
    Department of Endocrinology and Gastroenterology/Division of Internal Medicine, Department of Medical and Health Science, Linköping university hospital/Linköping University, Linköping , Sweden.
    Low prevalence of anemia in inflammatory bowel disease: a population-based study in Sweden2012In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 47, no 8-9, p. 937-942Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Anemia is a well-known complication of inflammatory bowel disease (IBD) with a reported prevalence of 8.8-73.7%. However, knowledge is sparse about the anemia prevalence in a population-based cohort of patients affected by IBD. MATERIALS AND METHODS: The aim of this retrospective, descriptive, population-based study was to determine and analyze the prevalence of anemia for ambulatory (n = 485) as well as for hospitalized patients diagnosed with IBD in 2008 in the Highland Health Care District, Jonkopings County, Sweden. RESULTS: The prevalence of anemia at the annual follow-up in the studied IBD population was 6%, 5% for patients with ulcerative colitis (UC), and 9% for those with Crohn's disease (CD). There was a higher rate of anemia at the yearly check up in patients requiring inpatient care during the year. IBD patients, prescribed anti-TNF-alpha treatment, had a higher rate of anemia. Of the hospitalized UC and CD patients (n = 31), 35% and 50%, respectively, had anemia at admission and 6% and 4% had severe anemia (Hb <100 g/L), respectively. CONCLUSIONS: The prevalence of anemia in this population was lower than reported previously, probably due to inclusion of all IBD patients in the area in combination with a proactive follow-up model. The prevalence of anemia in this IBD population was similar to the prevalence in the general population. This may indicate that efforts by health care professionals to prevent, identify, and treat anemia in the IBD population have been successful.

  • 135.
    Rejler, Martin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Medicine, Highland Hospital, Eksjö, Sweden.
    Tholstrup, Jörgen
    Department of Medicine, Highland Hospital, Eksjö, Sweden.
    Elg, Mattias
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Division of Quality Management and Technology and HELIX Vinn Excellence Centre, Linköping University, Linköping, Sweden.
    Spångéus, Anna
    Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Framework for assessing quality of care for inflammatory bowel disease in Sweden2012In: World Journal of Gastroenterology, ISSN 1007-9327, E-ISSN 2219-2840, Vol. 18, no 10, p. 1085-1092Article in journal (Refereed)
    Abstract [en]

    AIM: To create and apply a framework for quality assessment and improvement in care for inflammatory bowel disease (IBD) patients.

    METHODS: A framework for quality assessment and improvement was created for IBD based on two generally acknowledged quality models. The model of Donabedian (Df) offers a logistical and productive perspective and the Clinical Value Compass (CVC) model adds a management and service perspective. The framework creates a pedagogical tool to understand the balance between the dimensions of clinical care (CVC) and the components of clinical outcome (Df). The merged models create a framework of the care process dimensions as a whole, reflecting important parts of the IBD care delivery system in a local setting. Clinical and organizational quality measures were adopted from clinical experience and the literature and were integrated into the framework. Data were collected at the yearly check-up for 481 IBD patients during 2008. The application of the quality assessment framework was tested and evaluated in a local clinical IBD care setting in Jonkoping County, Sweden.

    RESULTS: The main outcome was the presentation of how locally-selected clinical quality measures, integrated into two complementary models to develop a framework, could be instrumental in assessing the quality of care delivered to patients with IBD. The selected quality measures of the framework noted less anemia in the population than previously reported, provided information about hospitalization rates and the few surgical procedures reported, and noted good access to the clinic.

    CONCLUSION: The applied local quality framework was feasible and useful for assessing the quality of care delivered to IBD patients in a local setting.

  • 136.
    Restom, Fadia
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hälsobokslutet för att ge chefer stöd i att främja personalens Välbefinnande  _ utvärdering av ett förbättringsinitiativ inom hälso- och sjukvården: _ utvärdering av ett förbättringsinitiativ inom hälso- och sjukvården2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Work environment and employee´s health are not new studied areas as it characterizes the production and quality of the labor market, and especially in the public sector as the county council. A new mindset, to measure the health effects and to follow them up, started to appear. Consequently, a new concept arrived and began to get a foothold, called health accounts. It is believed that the visibility of the relationship between health and economy is crucial to succeed in reducing ill health.

    Aim: The purpose is to study and understand the possibility of introducing health accounts in health care and to study its benefits. The purpose is answered by the following questions: - What are the manager’s attitudes to health care on health promotion projects and how do they monitor their results? – To what use will health accounts give the managers? - How do health accounts support the evaluation of health promotion actions?

    Method: The study has an interaction research approach as well as an inductive and qualitative approach with descriptive design. Two clinics in the HighlandHospital were included in the study because they both had ongoing health promotion actions directed towards its employees. Knowledge from these actions improvement results were used in the implementation of health accounts. Seven managers from these two clinics were interviewed in semi-structured interviews and the data then analyzed thru qualitative content analysis with the above questions in aim.

    Results: A dialogue was made with the managers where I reported some key data that both already existed and were developed during the study. The managers experienced health accounts as information longed for and therefore wanted to continue on the same track.

    Conclusions and Discussion: In order to create a workplace that promotes it requires a serious and long-term work, such as the work based health accounts model. Support in the form of a dialogue with the managers, plays an important role. The result also indicates that using health accounts can support managers with their leadership promoting health, but it can’t get health leadership.

    Keywords: Health accounting, workplace health promotion, health promotion leadership, human health, improvement of knowledge, improvement efforts.

  • 137.
    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 J.
    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.

  • 138.
    Rothlin, Maria
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Stockholms Läns Landsting.
    Ökad patientdelaktighet under hela vårdtillfället: -En studie av ett förbättringsarbete vid en avdelning på en geriatrisk klinik2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Jakobsberg Geriatric Clinic emphasizes the importance of value creation and working methods from a patient perspective that gives results of relevance to the patient, where participation is given as an essential part. Patient surveys have shown that there is a gap between the target and working processes, which does not promote participation sufficiently.

     

    The purpose of the improvement work was to increase patient participation throughout the hospital stay.

    The purpose of the study was to identify experiences that could be linked to the changing working methods, through a patient’s as well as an employee’s perspective. 

    The Improvement work was performed with a quality design and an interactive research approach where care-staff drafted proposals on useful methods that would better favor patient participation. These methods were then tested by repeated PDSA-wheels. 

    To answer the questions to the study, mixed method was used. Semi-structured focused group interviews were conducted and participation observations occurred. Individual interviews were held and patient’s surveys were filled out to evaluate the experience of the changing working method. 

    The improvement work resulted in a number of changes, from admission to discharge, where the patient’s own expectations, wishes and needs, became more central. Examples of changes; an increased focus on patient participation, from the enrollment, as well a reconciliation offered midway through the care episode with the purpose to catch arising issues and to identify additional needs.

     The findings in the study demonstrate the importance of clear communication / information within the team and with the patient as a partner in decision-making. Insights on team processes and activities that need to be further adapted during the care process to create better conditions for increased.

  • 139.
    Rotter, Thomas
    et al.
    College of Pharmacy and Nutrition/ University of Saskatchewan.
    Bath, Brenna
    University of Saskatchewan, Saskatoon, Kanada.
    Dobson, Roy
    University of Saskatchewan, Saskatoon, Kanada.
    Harrison, Liz
    University of Saskatchewan, Saskatoon, Kanada.
    Jeffery, Cathy
    University of Saskatchewan, Saskatoon, Kanada.
    Sari, Nazmi
    University of Saskatchewan, Saskatoon, Kanada.
    Stevenson, Katherine
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. University of Saskatchewan, Saskatoon, Kanada.
    Kinsman, Leigh
    University of Tasmania, Australia.
    Ronellenfitsch, Ulrich
    Universitätsklinikum Heidelberg.
    Westhorp, Gill
    Community Matters, Unley, South Australia, Australia.
    Kanadischer Kraftakt2015In: F & W - Fuehren und Wirtschaften im Krankenhaus, ISSN 0175-4548, no 6Article in journal (Other (popular science, discussion, etc.))
  • 140.
    Salmiranta, Elin
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    The child’s own Quality Improvement project: An improvement project and study resulting in a co-production framework of increasing participation and Shared Decision Making for children with long-term illness2018Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    Abbreviations

    SDM = Shared Decision Making

    GAS = Goal Attainment Scaling

    QI = Quality Improvement

     

    Introduction

    Participation and SDM are important for the health of children with a long-term illness. Most healthcare decisions for these children take place at home or in school.

     

    Aim of the QI project

    Create possibilities for children and parents to jointly engage in day-to-day health decisions, with the aim to increase GAS for the participating children with 100 % until 31 of March 2018.

     

    Aim of the interview study

    Increase the understanding of participation and SDM in families regarding day-to-day health decisions.

     

    Methods

    In the QI project, the Model for Improvement was used together with children and parents. Interviews with parents of children with a long-term illness were analyzed in a hermeneutical study.

     

    Results

    Three children planned their own mini QI-project and the GAS scores increased by 99, 123 and 123 %.

     

    The interview study resulted in the themes insight, ownership and environmental factors.

     

    Discussion and conclusions

    The results are presented in a framework showing the importance of co-production partnerships between children and parents to improve health outcomes. The framework can be used to identify, plan and evaluate projects. Future interventions should focus on promoting decision making for children to create better conditions for child-initiated and directed projects.

  • 141.
    Sandström, Emma
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Att genomföra venös kärlaccessplanering innan problem uppstår - lärdomar från ett förbättringsarbete och dess spridning av kunskap och information2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund:

    Av de patienter som vårdas inom slutenvården bedöms 90 % behöva venös kärlaccess. För att gå från det idag förhärskande reaktiva arbetssättet till ett proaktivt har förbättringskunskap applicerats på venös kärlaccessplanering. En framgångsfaktor för förbättringsarbete är kommunikation vilket i detta arbete har belysts extra.

    Syfte:

    Syftet med förbättringsarbetet är att samtliga patienter som vårdas på KAVA får/har en behovsanpassad infart för att undvika onödiga stick.  

    Syftet med studien av förbättringsarbetet är att beskriva förbättringsgruppens erfarenheter av att sprida kunskap och information samt ge en bild av hur dess mottagare har nåtts av budskapet.

    Metod:

    Nolans förbättringsmodell har applicerats på förbättringsarbetet. För studien har en mixad metod använts, innehållande intervjuer och enkät som analyserats med kvalitativ innehållsanalys respektive deskriptiv statistik.

    Resultat:

    Förbättringsarbetet resulterade i att merparten av patienterna får en individuell kärlaccessplan inom 24 timmar. Studien av förbättringsarbetet visar på att den interpersonella kommunikationen har stor vikt och att förbättringsgruppen är den enskilt största källan till spridning av budskapet vilket stämmer väl överrens med tidigare forskning.

    Slutsats:

    Ett proaktivt arbetssätt kan implementeras för planering av venös kärlaccess genom Nolans förbättringsmodell. Den interpersonella kommunikationen är av stor vikt för spridning av kunskap och bör tas i beaktande vid planering och utförande av förbättringsarbeten.

  • 142.
    Shafie, Maryam
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Förbättrad metod för tidig mobilisering av planerat kejsarsnittförlösta En kvalitativ studie av patienternas upplevelser2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 143.
    Siouta, Eleni
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Communication Patterns in Consultations Between Patients with Atrial Fibrillation and Health Professionals2012Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Patients’ preferences, needs and desires are important when discussing treatment. In consultations between patients with atrial fibrillation (AF) and health professionals, knowledge, understanding and insight about communication patterns are of vital importance for strengthening patient involvement in decision-making about their care and treatment.

    Aim

    The general aim of this thesis was to describe communication patterns in consultations between patients with AF and health professionals.

    Specific aims

    (1) To describe (i) the topics patients with AF and their nurses and physicians discuss; (ii) the use of discursive space in consultations between these participants; and (iii) the frequencies with which patients and nurses/physicians introduce the identified topics.

    (2) To describe the types of patient resistance to accepting treatment with warfarin and how cardiologists respond to such resistance.

    Methods

    An inductive design was used. In study I, the sample consisted of 23 consultations between patients with AF (13 women and 10 men) and health professionals (5 women and 5 men) who were employed in six different cardiologic outpatient clinics. Content analysis was used to obtain a description of topics discussed. The patterns of dominance for the various topics and participant were explored from the framework of an analysis of dominance (I). In study II, the sample consisted of 11 consultations between patients with AF (7 women and 4 men) and cardiologists (2 women and 3 men). Conversation analysis was used to describe interactions concerning resistance to treatment with warfarin.

    Findings

    Study I. Four topics were introduced by both nurses and physicians during the consultations. These were “pathophysiology”, “treatment”, “diagnostic procedures”, and “activity”. In the nurse–patient consultations 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 nurses and patients, and unequal between physicians and patients. The patients were the dominant initiators of the topic “activity”, which refers to adaptation of activities in daily life in relation to AF.

    Study II. There were four types of patient resistance to accepting treatment with warfarin. These included “Giving reasons for their resistance”, “Suggesting other treatment options”, “Stating treatment preferences” and “Questioning or challenging the cardiologist’s treatment recommendations”. The cardiologists’ responses to the patients’ resistance included “Repeating the treatment recommendation”, “Negotiation with the patient”, “Providing additional information about the recommended treatment” and “Extending their explanation of the purpose of the treatment”.

    Conclusions

    The medical-driven agenda dominated over the patient-driven agenda in consultations between health care professionals and patients with AF. During conversations in consultations with nurses, the patients initiated discussion of living with AF and were more talkative than they were with physicians. An awareness of types of patient resistance to treatment would enable cardiologists to consider patients’ experience-based views about their treatment;

  • 144.
    Siouta, Eleni
    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.
    Broström, Anders
    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.
    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.

  • 145.
    Siouta, Eleni
    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.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hedman, Karl
    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.
    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.

  • 146.
    Sjölander, Catarina
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Consequences for family members of being informal caregivers to a person with advanced cancer2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The overall aim is to generate knowledge about consequences of informal caregiving for the family members of patients diagnosed with advanced cancer, over a one-year period, including the family members’ health, health-related quality of life, health care utilization, and associated costs. Furthermore, the family members’ management of their stressful daily life and the meanings of social support networks in the early stage will be explored in order to get deeper understanding.

    Method: The thesis is based on two quantitative prospective studies (I–II) and two qualitative cross-sectional studies (III–IV). Studies I–II involved data from the same study group of 36 family members to relative with cancer. Use was made of questionnaires about sociodemographic characteristics, informal caregiving, leisure activities and absence from work (Study I), also of the Short Form 36 Health Survey (SF–36) and EuroQol (EQ–5D) (Study II), during a 1-year period starting 3 months after diagnosis. Study I also included a telephone interview and a review of medical records. Twenty family members were interviewed in Study III, 17 in Study IV; and the interviews were subjected to latent content analysis.

    Results: The findings indicate that family members’ informal caregiving influence the risk of morbidity with increased health care utilization and lower health-related quality of life the year following the diagnosis. The number of hours spent giving the patients was highest in respect of emotional support. If professional caregivers as home help care assistants had provided the support, it would be equivalent to a cost of 327,000 SEK per 15 months. The medical records indicated increased morbidity with increased health service use (physician consultations), more psychiatric disorders and more musculoskeletal diseases during the follow-up period (Study I). No statistically significant differences in health-related quality of life (HRQOL) were found within the study group over the 1-year follow-up in either physical or mental dimensions. However, the family members did have mental HRQOL scores significantly lower than the norm-based ones as measured throughout the year by SF–36. In addition, results showed that older age and being a partner had a negative influence on HRQOL (Study II). Management employed by family members during the early stage after patient diagnosis was expressed by the theme Striving to be prepared for the painful, based on emotion-focused strategies except the problem-focused strategy to ‘Making things easier in everyday life’ both for the sick person and for themselves (Study III). The meaning of the social support network was expressed by the theme Confirmation through togetherness, covering emotional and, to a lesser extent, instrumental support. Confirmation through togetherness derived principally from information, understanding, encouragement, involvement and spiritual community. Need of support, Desire for a deeper relationship with relatives and Network to turn to were identified as antecedents to social support. Social support involves reciprocal exchange of verbal and non-verbal information (Study IV).  

    Conclusions: The results of this thesis provide knowledge of family members’ risk of morbidity, which motivates developing guidelines for preventing both physical and mental morbidity. Developing valid measurement of the meaning of social support network for the individual patient could encourage nurses and other health-care professionals to focus on family members’ personal networks as a way to strengthen their mental health.

  • 147.
    Sjölander, Catarina
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Kunskap kan förbättra för de anhöriga som vårdar2013In: Onkologi i Sverige, ISSN 1653-1582, Vol. 13, no 1, p. 66-70Article in journal (Other academic)
  • 148.
    Sjölander, Catarina
    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.
    Ahlström, Gerd
    Lund University, The Swedish Institute for Health Sciences, Department of Health Sciences.
    The meaning and validation of social support networks for close family of persons with advanced cancer2012In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 11, no 17Article in journal (Refereed)
    Abstract [en]

    Background: To strengthen the mental well-being of close family of persons newly diagnosed as having cancer, it is necessary to acquire a greater understanding of their experiences of social support networks, so as to better assess what resources are available to them from such networks and what professional measures are required. The main aim of the present study was to explore the meaning of these networks for close family of adult persons in the early stage of treatment for advanced lung or gastrointestinal cancer. An additional aim was to validate the study’s empirical findings by means of the Finfgeld-Connett conceptual model for social support. The intention was to investigate whether these findings were in accordance with previous research in nursing.

    Methods: Seventeen family members with a relative who 8–14 weeks earlier had been diagnosed as having lung or gastrointestinal cancer were interviewed. The data were subjected to qualitative latent content analysis and validated by means of identifying antecedents and critical attributes.

    Results: The meaning or main attribute of the social support network was expressed by the theme Confirmation through togetherness, based on six subthemes covering emotional and, to a lesser extent, instrumental support. Confirmation through togetherness derived principally from information, understanding, encouragement, involvement and spiritual community. Three subthemes were identified as the antecedents to social support: Need of support, Desire for a deeper relationship with relatives, Network to turn to. Social support involves reciprocal exchange of verbal and non-verbal information provided mainly by lay persons.

    Conclusions: The study provides knowledge of the antecedents and attributes of social support networks, particularly from the perspective of close family of adult persons with advanced lung or gastrointestinal cancer. There is a need for measurement instruments that could encourage nurses and other health-care professionals to focus on family members’ personal networks as a way to strengthen their mental health. There is also a need for further clarification of the meaning of social support versus caring during the whole illness trajectory of cancer from the family members’ perspective.

  • 149.
    Sjölander, Catarina
    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.
    Rolander, Bo
    The Ryhov County Hospital, Jönköping.
    Järhult, Johannes
    The Ryhov County Hospital, Jönköping.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Ahlström, Gerd
    Lund University, The Swedish Institute for Health Sciences, Department of Health Sciences.
    Health-related quality of life in family members of patients with an advanced cancer diagnosis: A one-year prospective study2012In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 10, no 89Article in journal (Refereed)
    Abstract [en]

    Background: Receiving a cancer diagnosis affects family members as well as the person diagnosed. Familymembers often provide support for the sick person in daily life out of duty and love, and may not always think of their own vulnerability to illness. To individualise support for them, family members who are most at risk for becoming ill must be identified. The aim of this study was to investigate health-related quality of life (HRQOL) in family members of patients with advanced lung or gastrointestinal cancer 3 to 15 months after diagnosis.

    Methods: Data on mental and physical dimensions of HRQOL were collected from family members of these patients in this prospective quantitative study. Five assessments using the Short Form 36 Health Survey (SF-36) and EuroQol (EQ-5D) were conducted during a 1-year period starting 3 months after diagnosis. Thirty-six family members completed the study, i.e. participated in all five data collections.

    Results: No statistically significant changes in physical or mental HRQOL within the study group appeared over the 1-year follow-up. Compared with norm-based scores, family members had significantly poorer mental HRQOL scores throughout the year as measured by the SF-36. Family members also scored statistically significantly worse on the EQ-5D VAS in all five assessments compared to the norm-based score. Findings showed that older family members and partners were at higher risk for decreased physical HRQOL throughout the 1-year period, and younger family members were at higher risk for poorer mental HRQOL.

    Conclusions: It is well known that ill health is associated with poor HRQOL. By identifying family members with poor HRQOL, those at risk of ill health can be identified and supported. Future large-scale research that verifies our findings is needed before making recommendations for individualised support and creating interventions best tailored to family members at risk for illness.

  • 150.
    Sjölander, Catarina
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Rolander, Bo
    Järhult, Johannes
    Mårtensson, Jan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. ADULT.
    Carlsson, Per
    Ahlström, Gerd
    Health consequences and costs of informal caregiving among family members of patients with advanced cancer: a prospective follow-up studyArticle in journal (Other academic)
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