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  • 1.
    Alfredsson, Anette
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Samma arbete, med mer samarbete: En fallstudie om hur Kundcentrerad planering kan tillämpas i syfte att öka patientdelaktighet inom kommunal hemsjukvård2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 2.
    Algurén, Beatrix
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Food and Nutrition, and Sport Science, UNIVERSITY OF GOTHENBURG.
    Coenen, Michaela
    Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University (LMU) Munich, Germany .
    Årestedt, Kristofer
    School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Content-comparison of patient-reported outcomes in disease specific scales for patients with different types of cardiac diseases - a literature review2014In: EuroHeartCare 2014, April 4-5, 2014, Stavanger, Norway, 2014Conference paper (Refereed)
  • 3.
    Algurén, Beatrix
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of 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, Quality Improvement and Leadership in Health and Welfare.
    Cieza, Alarcos
    Ludwig-Maximilians-University, Munich, Germany .
    Sunnehagen, Katharina S
    University of Gothenburg, Gothenburg, Sweden.
    Christensson, Lennart
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Factors Associated With Health-Related Quality of Life After Stroke: A 1-Year Prospective Cohort Study2012In: Neurorehabilitation and Neural Repair, ISSN 1545-9683, E-ISSN 1552-6844, Vol. 26, no 3, p. 266-274Article in journal (Refereed)
    Abstract [en]

    Background. In line with patient-centered health care, it is necessary to understand patients’ perceptions of health. How stroke survivors perceive their health at different time points after stroke and which factors are associated with these feelings provide important information about relevant rehabilitation targets. Objective. This study aimed to identify the independent factors of health-related quality of life (HRQoL) from a biopsychosocial perspective using the methods of multivariate regression at 3 different time points poststroke. Methods. Included in the study were 99 patients from stroke units with diagnosed first-ever stroke. At admission and at 6 weeks, 3 months, and 1 year poststroke, HRQoL was assessed using the EuroQoL-5D Visual Analogue Scale (EQ-5D VAS). Consequences in Body Functions and Activities and Participation, and Environmental Factors were documented using 155 categories of the International Classification of Functioning, Disability and Health (ICF) Core Set for Stroke. Results. For a period of 1 year, problems with recreation and leisure, personality functions, energy and drive functions, and gait pattern functions were repeatedly associated with worse HRQoL. Whereas Body Functions and Activities and Participation explained more than three-fourths of the variances of HRQoL at 6 weeks and 3 months (R 2 = 0.80-0.93), the variation at 1 year was best explained by either Body Functions or Environmental Factors (R 2 = 0.51). Conclusions. The results indicate the importance of Body Functions and Activities and Participation (mainly personality functions and recreation and leisure) on HRQoL within 3 months poststroke, but increased impact of Environmental Factors on HRQoL at 1 year.

  • 4.
    Andersson, Ann-Christine
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Idvall, Ewa
    Malmö Högskola.
    Perseius, Kent-Inge
    Röda Korsets högskola, Stockholm.
    Elg, Mattias
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Linköpings Universitet.
    Two Different Strategies to Facilitate Involvement in Healthcare Improvements: A Swedish County Council Initiative2014In: Global Advances in Health and Medicine, ISSN 2164-957X, E-ISSN 2164-9561, Vol. 3, no 5, p. 22-28Article in journal (Refereed)
    Abstract [en]

    Background: From a management point of view, there are many different approaches from which to choose to engage staff members in initiatives to improve performance.

    Objective: The present study evaluated how two different types of improvement strategies facilitate and encourage involvement of different professional groups in health-care organizations.

    Methods/Design: Empirical data of two different types of strategies were collected within an improvement project in a County Council in Sweden. The data analysis was carried out through classifying the participants' profession, position, gender, and the organizational administration of which they were a part, in relation to their participation.

    Setting: An improvement project in a County Council in Sweden.

    Participants: Designed Improvement Processes consisted of n=105 teams and Intrapreneurship Projects of n=202 projects.

    Intervention: Two different types of improvement strategies, Designed Improvement Processes and Intrapreneurship Projects.

    Main Outcome Measures: How two different types of improvement strategies facilitate and encourage involvement of different professional groups in healthcare organizations.

    Results: Nurses were the largest group participating in both improvement initiatives. Physicians were also well represented, although they seemed to prefer the less structured Intrapreneurship Projects approach. Assistant nurses, being the second largest staff group, were poorly represented in both initiatives. This indicates that the benefits and support for one group may push another group aside.

    Conclusions: Managers need to give prerequisites and incentives for staff who do not participate in improvements to do so. Comparisons of different types of improvement initiatives are an underused research strategy that yields interesting and thoughtful results.

    Read More: http://www.gahmj.com/doi/abs/10.7453/gahmj.2014.040

  • 5.
    Andersson, Sverker
    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.
    Byt perspektiv! Från vårdgivare till individ.: En kvalitativ studie om samverkan i samband med framtagande av nytt Hälso- och sjukvårdsavtal i Västra Götaland2017Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    The follow-up of the Health Care Agreement in Västra Götaland proved that it was poorly known among healthcare professionals. The patients thus risked of being without necessary care. An overview and development of the Healthcare Agreement was conducted. One of the sub processes was to develop an application manual aimed at concretizing the healthcare agreement.

    The improvement work consisted of developing patient cases aimed at guiding the interaction between patients in need of care both from Västra Götaland region and the municipality. The purpose of the study is to describe and analyze the professional experiences of collaboration in the health care sector in Västra Götaland.

     

    The improvement model with the four-phase PGSA wheel was used as a structure for improvement work. As methods, focus groups in combination with surveys have been used. Qualitative content analysis of the focus group interviews was conducted with a deductive approach from collaborative frameworks.

     

    The indicative patient cases are perceived by the participants as relevant, reality-based and that they provide guidance for collaboration. Hospitals and primary care cooperate more with the municipality's health care than with each other, despite common main organization. Collaboration occurs mainly because of Employee motivation to facilitate, assist or support a patient. However, when the partner does not meet expectations, they rely on treaties and agreements.

  • 6. Antonsson, Helen
    et al.
    Eriksson Korjonen, Susanne
    Rosengren, Kristina
    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.
    First-line managers’ experiences of alternative modes of funding in elderly care in Sweden2012In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 20, no 6, p. 737-747Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to describe first-line managers’ experiences of alternative modes of funding elderly care in two communities in western Sweden.

     Background: A growing elderly population demands alternative modes of funding elderly care for better outcomes for patients and better efficiency as it is publicly funded through taxation.

     Methods: The study comprised a total of eight semi-structured interviews with first-line managers working within elderly care. The interviews were analysed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study.

     Results: One category, quality improvement, and four subcategories freedom of choice, organisational structure, quality awareness and market forces effects were identified to describe first-line managers’ experiences of the operation of elderly care.

     Conclusions: Quality improvement was an important factor to deal with when elderly care was operated in different organisational perspectives, either private or public. The first-line manager is a key person for developing a learning organisation that encourages both staff, clients and their relatives to improve the organisation. Moreover, person-centred care strengthens the client’s role in the organisation, which is in line with the government’s goal for the quality improvement of elderly care. However, further research is needed on how quality improvement could be developed when different caregivers operate in the same market in order to improve care from the elderly perspective.

    Implications for nursing management: This study highlights alternative modes of funding elderly care. The economical perspectives should not dominate without taking care of quality improvement when the operation of elderly care is planned and implemented. Strategies such as a learning organisational structure built on person-centred care could create quality improvement in elderly care.

  • 7.
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Improving hydrotherapy interventions and physical activity intensity for persons with rheumatological diseases2015In: Evidensbaserad träningsintensitet i bassäng vid reumatisk sjukdom, 2015Conference paper (Refereed)
  • 8.
    Areskoug-Josefsson, Kristina
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    HBTQ - Fysioterapeutens roll2015Conference paper (Refereed)
  • 9.
    Areskoug-Josefsson, Kristina
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Haraldsson, Patrik
    AME, Region Jönköpings län.
    SMAK - Nyttan av ett strukturerat, validerat multidisciplinärt bedömningsinstrument inom företagshälsovården2015Conference paper (Refereed)
  • 10.
    Aronsson, Frida
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Johansson, Sofia
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Organisatoriskt lärande för att öka vårdkvalitet: Lärdomar av att utveckla processledning vid en operations- och intensivvårdsklinik2018Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    Background: Complex organizations need to be patient centred, focus on processes, have holistic view and promote organizational learning to secure quality. Operation and intensive care unit, Ryhov, has potential to develop its Process Management (PM) and there is room for improved patient participation.

     

    Purpose: The purpose of the quality improvement project (QIP) was to identify and reduce quality gaps affecting patients, by develop PM and organizational learning. The purpose of the study was to describe co-workers’ understanding of the connection between PM and quality of care and describe their experiences from QIP.

     

    Methods: The QIP has developed organizational learning concerning two pilot processes by using Nolan’s model for improvement. The study of the QIP is qualitative, based on six focus group interviews. Qualitative content analysis was used to analyse the interviews.

     

    Results: PM demands access to improvement and professional knowledge. The organization need to create conditions for sustainability, make benefits obvious and ensure enough resources. Quality of care increases when the organization works structured and patient centred.

     

    Conclusions: PM creates conditions for continual improvements with focus on organizational learning and increased quality of care. The organization need to actively make PM an integral and living part.

  • 11.
    Bartholdson, Pamela
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Så förhindrar vi fallolyckor - Observationsstudie av en multifaktoriell intervention2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 12.
    Bektesevic, Senada
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    ”Som en blixt från klar himmel”: En kvalitativ studie om patienter som insjuknar i stroke under sin sjukhusvistelse2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Scientific articles has shown that patients that have had a stroke during their hospitalization receive lesser degree of care, than patients that has been admitted with a stroke. Literature has shown we need more knowledge how to improve stroke care to get a secure, knowledge based and effective stroke care in hospitals. Aim: The study aims to identify the events that have been critical in the management of hospitalized patients who suffer a stroke. Method: CIT has been used as a data collection method to bring in information, it has been used in the airforce and more recently has been used more widely in national healthcare. Qualitative contents analysis, according to Burnard (1996), gives basis for analyzing the material. The analysis was based on 10 interviews with nurses who have experience of patients diagnosed with stroke during hospitalization. Interviews were conducted at 5 (five) different departments within the Sahlgrenska Hospital in spring 2016. Result: Critical events occur in connection with care in all parts of the care of in-hospital patients who suffer a stroke. Overall categories: unexpected event, the safety of patients affected by department resources and the backside of specialist care. The categories identified in the micro, meso and macro systems are interacting between the different systems. Conclusion: Access to current measurements is important to get an overview of the current state of in-hospital stroke patients in the form of numbers and where they occur. The study shows that there is a great need for a well-functioning stroke chain for in-hospital stroke patients and that there are implemented projects in the US that could be helpful for future improvements in stroke care. It is also important to focus on communication and information to relatives.

  • 13.
    Berg, Jenny
    et al.
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Widell, Yvonne
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Förbättring av sjukskrivningsprocess med Sex Sigma och mikrosystem perspektiv2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: The sickness absence in Sweden 2004 was highest inWestern Europe and the country's main economic problem. The government gave incentives to make the sick-leave process included in healthcare management system, partly because of changing requirements and deficiencies in the quality of medical-certificates quality. A local study at an orthopedic clinic showed that 23% of patients were dissatisfied with sick-leave.

    Purpose: Through Six Sigma's DMAIC problem-solving model in combination with micro-systems perspective, improving the quality of medical certificates, create goals and routines in the sick-leave process and increase patient satisfaction

    Method: Interviews of project participants were carried out using a micro-systems perspective. Through Six Sigma problem-solving model areas of improvement were focused on information exchange to patients and physicians as well as formulating goals and written routines. Fifty-eight patients were interviewed about their sick-leave satisfaction. Measurements of "unnecessary" actions were performed and the quality of medical certificates was followed with control-charts. The improvement project was evaluated by reflection in the group continuously.

    Results: Improvements with Six Sigma and micro-systems perspective has contributed to improving the quality of medical certificates significantly p<0.001. Routines and goals for sick-leave process have been implemented in the management system. 100% of the patients at the orthopedic clinic are satisfied. Phone calls about deficiencies and incorrect cases have decreased. This methodology has contributed to a broadened understanding of patients´ experiences and between different staff-categories. The actions have had impact because the improving proposals came from and were carried out by its own staff.

    Discussion: The Six Sigma and the micro-systems perspective has patient focus which can affect the values and willingness to change. The result from this study supports other studies and the approach in this study resulted in significantly improved results. Improvement actions are not generalizable, but the approach can be usefully applied in improvement efforts. Further studies of the approach and its sustainability over time are needed to strengthen the evidence.

  • 14.
    Bergerum, Carolina
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Quality Improvement in a Maternity Ward and Neonatal Intensive Care Unit: What are staff and patients´ experiences of Experience-based Co-design? Part 1: A qualitative study2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Recent focus on quality and patient safety has underlined the need to involve patients in improving healthcare. “Experience-based Co-design” (EBCD) is an approach to capture and understand patient and staff (i. e. users) experiences, identifying so called “touch points” and then working together equally in improvement efforts.

    Purpose: This article elucidates patient (defined as the mother-newborn couple with next of kin) and staff experiences following improvement work carried out according to EBCD in a maternity ward and neonatal intensive care unit (NICU) in a small, acute hospital in Sweden.

    Method: An experience questionnaire, derived from the EBCD approach tool set, was used for continuously evaluating each event of the EBCD improvement project. Furthermore, a focus group interview with staff and in-depth interviews with mother-father couples were held in order to collect and understand the experiences of working together according to EBCD. The analysis and interpretation of the interview data was carried through using qualitative, problem-driven content analysis. Themes, categories and sub-categories presented in this study constitute the manifest and latent content of the participants’ experiences of Experience-based Co-design.

    Results: The analysis of the experience questionnaires, prior to the interviews, revealed mostly positive experiences of the participation. Both staff and patient participants stated generally happy, involved, safe, good and comfortable experiences following each event of the improvement project so far.

    Two themes emerged during the analysis of the interviews. For staff participants the improvement project was a matter of learning within the microsystem through managing practical issues, moving beyond assumptions of improvement work and gaining a new way of thinking. For patients, taking part of the improvement project was expressed as the experience of involvement in healthcare through their participation and through a sense of improving for the future.

    Discussion: This study confirms that, despite practical obstacles for participants, the EBCD approach to improvement work provided an opportunity for maternity ward /NICU care being explored respectfully at the experience level, by assuring the sincere sharing of useful information within the microsystem continuously, and by encouraging and supporting the equal involvement of both staff and patients. Staff and patients wanted and were able to contribute to the EBCD process of gathering information about their experiences, analyzing and responding to collected data, and engaging themselves in improving the same. Furthermore, the EBCD approach provided staff and patients the opportunity of learning within the microsystem. Nevertheless, the responsibility of the improvement work remained the responsibility of the healthcare professionals.

    Keywords: Quality Improvement, Maternity Care, Neonatal Intensive Care, Experience-based Co-design

  • 15.
    Bergerum, Carolina
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Quality Improvement in a Maternity Ward and Neonatal Intensive Care Unit. What are staff and patients' experiences of Experience-based Co-design?: Part 1: A qualitative study2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Recent focus on quality and patient safety has underlined the need to involve patients in improving healthcare. “Experience-based Co-design” (EBCD) is an approach to capture and understand patient and staff (i. e. users) experiences, identifying so called “touch points” and then working together equally in improvement efforts.

    Purpose:This article elucidates patient (defined as the mother-newborn couple with next of kin) and staff experiences following improvement work carried out according to EBCD in a maternity ward and neonatal intensive care unit (NICU) in a small, acute hospital in Sweden.

    Method: An experience questionnaire, derived from the EBCD approach tool set, was used for continuously evaluating each event of the EBCD improvement project. Furthermore, a focus group interview with staff and in-depth interviews with mother-father couples were held in order to collect and understand the experiences of working together according to EBCD. The analysis and interpretation of the interview data was carried through using qualitative, problem-driven content analysis. Themes, categories and sub-categories presented in this study constitute the manifest and latent content of the participants’ experiences of Experience-based Co-design.

    Results:The analysis of the experience questionnaires, prior to the interviews, revealed mostly positive experiences of the participation. Both staff and patient participants stated generally happy, involved, safe, good and comfortable experiences following each event of the improvement project so far.

    Two themes emerged during the analysis of the interviews. For staff participants the improvement project was a matter of learning within the microsystem through managing practical issues, moving beyond assumptions of improvement work and gaining a new way of thinking. For patients, taking part of the improvement project was expressed as the experience of involvement in healthcare through their participation and through a sense of improving for the future.

    Discussion: This study confirms that, despite practical obstacles for participants, the EBCD approach to improvement work provided an opportunity for maternity ward /NICU care being explored respectfully at the experience level, by assuring the sincere sharing of useful information within the microsystem continuously, and by encouraging and supporting the equal involvement of both staff and patients. Staff and patients wanted and were able to contribute to the EBCD process of gathering information about their experiences, analyzing and responding to collected data, and engaging themselves in improving the same. Furthermore, the EBCD approach provided staff and patients the opportunity of learning within the microsystem. Nevertheless, the responsibility of the improvement work remained the responsibility of the healthcare professionals.

  • 16.
    Berggren, Elisabeth
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Daily life after Subarachnoid Haemorrhage: Identity construction, patients’ and relatives’ statements about patients’ memory, emotional status and activities of living2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to describe patients’ experience and reconstruction regarding the onset of, and events surrounding being struck by a Subarachnoid Haemorrhage (SAH), and to describe patients’ and relatives’ views of patients’ memory ability, emotional status and activities of living, in a long-term perspective.

    Methods: Both inductive and deductive approaches were used. Nine open interviews were carried out in home settings, in average 1 year and 7 seven months after the patients’ onset, and discourse analysis was used to interpret the data. Eleven relatives and 11 patients, 11 years after the onset, and 15 relatives and 15 patients, 6 years after the onset, participated in two studies. Interviews using a questionnaire with structured questions and memory tests were used to collect data. Fischer’s exact test and Z-scores were used for the statistical analysis.

    Results: Patients with experience of a SAH were able to judge their own memory for what happened when they became ill. The reconstruction of the illness event may be interpreted as an identity creating process. The process of meaning-making is both a matter of understanding SAH as a pathological event and a social and communicative matter, where the SAH is construed into a meaningful life history, in order to make life complete (I). Memory problems, changes in emotional status and problems with activities of living were common (II-IV). There was correspondence between relatives’ and patients’ statements regarding the patients’ memory in general and long-term memory. Patients judged their own memory ability better than relatives, compared with results on memory tests. Relatives stated that some patients had meta-memory problems (II). The episodic memory seemed to be well  reserved, both concerning the onset and in the long-term perspective (I, II). There were more problems with social life than with P- and I-ADL (III), and social company habits had changed due to concentration difficulties, mental fatigue, and  patients’ sensitivity to noisy environments and uncertainty (IV). Relatives rated the patients’ ability concerning activities of living and emotional status, and in a similar manner to patients’ statements (III-IV).

    Conclusions: The reconstruction of the illness event can be used as a tool in nursing for understanding the patient’s identity-construction. Relatives and patients stated the patients’ memory, emotional status and activities of living in a similar manner, and therefore both patients’ and relatives’ statements can be used as a tool in nursing care, in order to support the patient. However, the results showed: meta-memory problems (relatives’ statements) and that the patients’ judged their own memory ability better than relatives in comparison with results on memory tests. Nevertheless, there was a high degree of concordance between relatives’ and patients’ evaluations concerning patients´ memory ability, emotional status, emotional problems, social company habits and activities of living. Therefore both relatives’ and patients’ statements can be considered to be reliable. However, sometimes the patients and the relatives judge the patients’ memory differently. Consequently, memory tests and formalized dialogues between the patient, the relative and a professional might be required, in order to improve the mutual family relationship in a positive way. Professionals however, must first assume that patients can judge their own memory, emotional status and ability in daily life.

  • 17.
    Berggren, Elisabeth
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Sidenvall, B
    Gifford, M
    Sandgren, A
    Larsson, D
    Social company habits and emotional status following a Subarachnoid Haemorrhage: A study based on relatives´ and patients´ statements, in a long term perspective2012Manuscript (preprint) (Other academic)
  • 18.
    Bergman, Eva
    et al.
    Department of Internal Medicine, Division of Cardiology, County Hospital Ryhov, Jönköping, Sweden .
    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.
    Ljungqvist, Birgit
    Jönköping University, School of Health and Welfare.
    Karlsson, Jan-Erik
    Department of Medicine and Health Sciences, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Berterö, Carina
    Department of Medicine and Health Sciences, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Karlsson, Jan-Erik
    Department of Internal Medicine, Division of Cardiology, County Hospital Ryhov, Jönköping, Sweden.
    Meaningfulness is not the most important component for changes in sense of coherence2012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11, no 3, p. 331-338Article in journal (Refereed)
    Abstract [en]

    Background Sense of coherence is a theoretical construct which is used to measure the degree to which a person finds the world comprehensible, manageable and meaningful.

    Aim The main aim of the present study was to assess the hypothesis of Antonovsky that meaningfulness is the most crucial component in sense of coherence. The second aim was to explore the importance of its components and factors at baseline on sense of coherence changes and if the findings can be used in cardiac rehabilitation.

    Methods One hundred patients, who suffered a primary myocardial infarction were followed during two years. The instruments used were; sense of coherence questionnaire-13, 12-item short-form health survey questionnaire, the Seattle Angina Questionnaire and Health Curve.

    Results Thirty-nine percent of the participants fulfilled Antonovsky's hypothesis. Comprehensibility and the baseline factors of smoking, alcohol use, marital status and disease perception proved to be of importance for sense of coherence changes over time.

    Conclusion The hypothesis that meaningfulness is the most crucial component in sense of coherence is rejected for patients with primary myocardial infarction. Comprehensibility is more important than meaningfulness for changes in sense of coherence. Nurses therefore have an important task to increase comprehensibility and sense of coherence by providing information and knowledge about myocardial infarction and lifestyle changes at an early stage. The information should be given in an individualized and easily understandable way from a salutogenic perspective, which means to identify and work with factors that can contribute to preserving and promoting health.

  • 19. Bergman, Eva
    et al.
    Årestedt, Kristofer
    County Hospital Ryhov.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Karlsson, Jan-Erik
    County Hospital Ryhov.
    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.
    The impact of comprehensibility and sense of coherence in the recovery of patients with myocardial infarction: a long-term follow-up study2012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11, no 3, p. 276-283Article in journal (Refereed)
    Abstract [en]

    Background: After being through a myocardial infarction (MI), a severe recovery period ensues for the patient. Long-term follow-ups are helpful, but what this should include differs between patients. Today there is no established approach to identify needs for support after an MI.

    Aim: The aim was to describe sense of coherence (SOC) over time in relation to sex, as well as further SOC in relation to quality of life (QoL) and treatment satisfaction in patients with an MI. Methods. This study had an observational and longitudinal design and followed 18 women and 60 men with an acute MI for 49–67 months after the onset of MI. Instruments used were the SOC-13 and the Seattle Angina Questionnaire.

    Results: Women scored lower SOC than men. A main effect of time was shown for comprehensibility which increased significantly from baseline to the long-term follow-up. Women increased from a lower level to an equal level as men at the long-term follow-up. The total SOC was significantly associated with QoL and treatment satisfaction.

    Conclusion: High comprehensibility and high SOC give the patient a better basis to handle life after MI. Thus, healthcare professionals should keep in mind that SOC and especially comprehensibility have meaning for the patient’s ability to handle her or his recovery. Healthcare professionals need to together with the patient identify and work with lifestyle factors that contribute to increased comprehensibility about the disease, which gives the patient the foundation to preserve and promote her or his health both in the short and long term.

  • 20.
    Bertilsson, L.
    et al.
    Department of Rheumatology and Inflammation Research, University of Gothenburg, 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.
    Fasth, A
    Department of Paediatrics, University of Gothenburg, Sweden.
    Forsblad-d'Elia, H.
    Department of Rheumatology and Inflammation Research, University of Gothenburg, Sweden.
    A 5-year prospective population-based study of juvenile chronic arthritis: onset, disease process, and outcome2012In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 41, no 5, p. 379-82Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate, in a population-based cohort of patients with juvenile chronic arthritis (JCA), onset characteristics, progression, outcome, and prognostic factors longitudinally for 5 years. Methods: This cohort consisted of 132 incidence cases identified between 1984 and 1986 in southwestern Sweden followed for 5 years with annual reports of subgroup, joint assessment, disease activity, eye examinations, laboratory measurements, and medication. At the 5-year follow-up, the Childhood Health Assessment Questionnaire (Child-HAQ) was evaluated. European League Against Rheumatism (EULAR) criteria for diagnosis and disease activity were used. Results: During the 5 years only four patients were lost to follow-up, 34% changed subgroup and 8% developed uveitis. At the 5-year follow-up the disease was active in 12% of the patients, stable in 28%, inactive in 25%, and in remission in 34%. Among those examined, 24% had radiological changes, of whom half had advanced changes. The Child-HAQ median score at the 5-year follow-up was 0.13 (range 0.0-1.9). The number of involved joints at inclusion correlated positively with active disease at the 5-year follow-up. Age at disease onset, the number of involved joints, and the number of joints with arthritis correlated positively with continuous disease and Child-HAQ score. Conclusion. Our study shows a diverse disease course during the first 5 years of JCA where one-third changed subgroup and two-thirds did not reach remission. Age of disease onset, the number of involved joints, and the number of joints with arthritis at inclusion were associated with poor outcome at the 5-year follow-up.

  • 21.
    Bertilsson, Lennart
    et al.
    Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Fasth, Anders
    Department of Pediatrics, University of Gothenburg.
    Petersson, Ingemar F.
    Department of Orthopedics, Clinical Sciences, and Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund.
    Forsblad-D'elia, Helena
    Department of Rheumatology and Inflammation Research, University of Gothenburg.
    Disease course, outcome, and predictors of outcome in a population-based juvenile chronic arthritis cohort followed for 17 years2013In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 40, no 5, p. 715-724Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate disease course, outcome, and predictors of outcome in an unselected population-based cohort of individuals diagnosed with juvenile chronic arthritis (JCA) followed for 17 years. METHODS: The cohort consisted of 132 incidence JCA cases identified 1984-1986 according to EULAR criteria. At 5-year followup, 129 individuals underwent joint assessment, laboratory measurements, radiographic examination, and medication and functional assessment. At 17-year followup, 86 were examined with joint assessment, laboratory measurements, medication assessment, Health Assessment Questionnaire (HAQ), Keitel functional test (KFT), and Medical Outcomes Study Short Form-36 (SF-36). RESULTS: At 17-year followup, 40% were in remission, 44% changed subgroups, median HAQ score was 0.0 (range 0.0-1.5), and median KFT was 100 (range 54-100). SF-36 scores were significantly lower compared to a reference group. Thirty-nine percent of those in remission at 5-year followup were not in remission at 17-year followup. In multivariate analyses of variables from the 17-year followup: remission was predicted by remission at 5-year followup (OR 4.8); HAQ > 0 by rheumatoid factor (RF)-positivity at 5-year followup (OR 3.6); KFT < 100 by nonremission (OR 11.3); and RF-positivity (OR 5.6) at 5-year followup; and the SF-36 physical component summary score above average of the reference group by remission at 5-year followup (OR 5.8). CONCLUSION: This longterm study of 86 individuals with JCA showed large variability of disease courses and of impaired health-related quality of life. Sixty percent were not in remission at 17-year followup. Longterm outcome was best predicted by and associated with characteristics at 5-year followup rather than those at onset.

  • 22.
    Björk, Petra
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Vad behövs för att förbättra en remissprocess?: En kvalitativ studie om socialsekreterares upplevelser av remissprocessen.2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 23.
    Bonnivier, Anna
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Då; DiabetespatientNu; En människa med diabeteserfarenhet: Ett förbättringsarbete och en fallstudie om vård på ändrade villkor när en diabetesmottagning införde samskapad vård.2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background

    Enhancement for people with elevated HbA1c. Improvement area was described differently from the patient and the coworkers perspective and perceived the experience of participation and the need of standardized working methods.

     

    Purpose

    Improve patients diabetic related health and their experience of participation and decrease the average of HbA1c > 9%.

     

    Study if coproduction contributes to better diabetes care and outcomes by introducing a new working method based on PROM/PREM.

     

    Method

    Nolan's Improvement Model

    Qualitative case study with content analysis

     

    Results

    Total average of HbA1c fell by 15,2%.

    13 out of 14 patients lowered their HbA1c.

    PROM; two out of three quliaty parameters had a positive shift.

    PREM; one out of three had a positive shift.

    The study indicated that a new working method enhanced both the interaction and the relationship between patient and health care providers and simultaneously created a more valuable balance between shared knowledge and experience of the disease.

     

    Discussion

    The results of this thesis indicates that coproduction creates a better environment for quality and an opportunity for a mutual relationship. Patients' answers to PROM / PREM identified areas that enabled the healthcare provider to respond to patient needs, which strengthened the role of the patient in the meeting.

     

    Conclusion

    Coproduction provides opportunities for a qualitative relationship that creates an enhanced environment for knowledge exchange and development for patients and healthcare providers.

  • 24.
    Borén, Kristina
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Co-production design av ett beslutsstöd för patienter med rotatorkuffruptur2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Presently, there is a range of support programs aimed to help patients in the decision making process, in regards to their health and care. The purposes of these programs are to give the patient a reliable source of information, and allowing the patient to make their own decisions based on their personal values. However, there are no Swedish support programs for patients who suffer from rotator cuff tears. The purpose of this study was to develop the decision aid program from the United States, "Treatment Options for Rotator Cuff Tears: A Guide for Adults" from 2010, in order to function in a Swedish context. A further aim was to examine the similarities and differences between Swedish practice concerning rotator cuff tears in comparison to the version from 2010, and to describe how the decision support were perceived by patients. A co-production design with a deductive qualitative content analysis was used. The process included translation of the rotator cuff tear decisions aid program from 2010 to Swedish. Interviews with experienced physiotherapists, orthopedic surgeons and patients who have had experienced a rotator cuff tear were performed.

    The main similarities presented by the comparison of providers and patient perceptions were the patient’s active role in the treatment process, descriptions of relevant treatment options, and the patient understanding of the injury. Main differences were that the physician's role was more prominent compared to the physiotherapist in the decision aid program. Also, details in regard to the conservative and postoperative treatments were missing. Physiotherapists and orthopedic physicians described a lack of support systems for decision-making in current clinical practice. Patients found the decision aid to be simple and easy to understand with regard to the content and layout, as well as being a good start for the dialogue and interaction between the patient and the provider. Overall, patients were positively inclined to the decision aid program and felt that such could be an aid in the selection of treatment and decision making process. Physiotherapists and orthopedic physicians were also optimistic about decision aid, and it could act as a catalyst for the establishment of clinical consensus. The patients felt that the decision aid provided a feeling of safety and reassurance, as well as a platform for dialogue between themselves and physiotherapists and orthopedic physicians.

    Further research is needed in order to determine whether the patient experiences any benefits of decision aid in the actual decision making process. In order to improve the content of the program, it is also imperative to determine the level of detail, as well as the impact of overall cost and healthcare effectiveness regarding treatment of rotator cuff tears. 

  • 25.
    Bäärnhielm, Åsa
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Ett tryggare och säkrare omhändertagande av patienter med urinretention: En studie utförd på en akutmottagning i syfte att identifiera förbättringsområden under och efter behandling med urinkateter2018Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
  • 26.
    Börjesson, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Everyday Knowledge in Elder Care: An Ethnographic Study of Care Work2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This dissertation is about how knowledge is constructed in interactions and what knowledge entails in practical social work. It is about how a collective can provide a foundation for the construction and development of knowledge through the interactions contextualized in this study on Swedish elder care, organized by the municipality. This study follows a research tradition that recognizes knowledge as socially constructed, and focuses on the practice of knowledge within an organizational context of care.

    This is an ethnographic study. The empirical material consists primarily of field notes from participant observations at two elder care units in a midsized city in Sweden. Moreover, the collected materials include national and municipal policy documents, local policy documents and guidelines, and notes from observations in staff meetings and interviews with care workers and managers. This thesis uses Institutional Ethnography as a departure point for analyzing the contextual factors for workers in elder care, mainly women, and the situational factors for acquiring knowledge.

    The overall aim of this dissertation was to explore knowledge in elder care practice by analyzing the construction and application of knowledge for and by staff in elder care. This sheds light to the Mystery of Knowledge in Elder Care Practice: Locally Enabled and Disabled.

    In order to pursue this aim, two questions were addressed in the study:

    1. How and what kind of knowledge is expressed and made visible in daily elder care practice?

    2. How is knowledge shared interactively in the context of elder care?

    The findings shed light to the situation for care workers in elder care and the conditions for using and gaining knowledge. This situation is problematic as the local conditions both enables and disables knowledge use and sharing of knowledge. Contributing challenging factors are lack of recognition and equal valuing of various forms of knowledge; the organizational cultures and a limiting reflective work to the individual.

    The main findings in this thesis are presented in three areas:

    - a way of understanding tacit knowledge, which refers to knowledge gained by care workers through working in elder care;

    - the connection between an organizational culture and the knowledge shared within the organizational culture;

    - reflective practice in elder care work and the imbalance between individual and collective reflectivity.

    These findings have implications for specific knowledge in social work practice and the need for education linked to this knowledge. Formal knowledge alone is insufficient for effective elder care practice; however, informal knowledge is also insufficient alone. Both are needed, and they should be linked to create synergy between the two types of knowledge.

  • 27.
    Börjesson, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    From shadow to person: Exploring roles in participant observations in an eldercare context2014In: Qualitative Social Work, ISSN 1473-3250, E-ISSN 1741-3117, Vol. 13, no 3, p. 406-420Article in journal (Refereed)
    Abstract [en]

    This article explores participant observation as a research method and more specifically addresses the intriguing situation of the researcher's role in interacting with participants in the setting. The materials used in the analysis are field notes from participant observations focused on staff at two eldercare units in a mid-sized city in Sweden. Because limitations when referring to Raymond Gold's roles of participant observations are known but sparsely described and discussed, this text attempts to provide that description and discussion. The specific question posed in the article is, (How) do roles for the researcher in participant observations change during the course of fieldwork? Randall Collins' theory on interaction ritual chains is used as an analytical tool to identify symbols in the two staff groups. The examples chosen from the field are symbols displayed at the units, which moreover illustrate that the researcher’s roles in participant observations not only change once or twice during the course of fieldwork but also change continuously. Consequently, fieldworkers shift roles in different situations when observing a variety of people and settings. Observations are developed in the interaction between the researcher and the participants; therefore, referring observations to a number of roles is restrictive and limiting.

  • 28.
    Börjesson, Ulrika
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Bengtsson, Staffan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Cedersund, Elisabet
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    “You have to have a certain feeling for this”: Exploring tacit knowledge in elder careManuscript (preprint) (Other academic)
  • 29.
    Börjesson, Ulrika
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Bengtsson, Staffan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Henning, Cecilia
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    A Free regulated work?: Organizational culture and shared knowledge in elder careManuscript (preprint) (Other academic)
  • 30.
    Börjesson, Ulrika
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Cedersund, Elisabet
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Bengtsson, Staffan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Reflection in Action: A multi-layered approach. “Cause I am good at that, you are supposed to say what you are good at these days!”Manuscript (preprint) (Other academic)
  • 31.
    Börjesson, Ulrika
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Cedersund, Elisabet
    NISAL ‒ National Institute for the Study of Ageing and Later Life, Linköping University, Norrköping, Sweden.
    Bengtsson, Staffan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work.
    Reflection in action: implications for care work2015In: Reflective Practice, ISSN 1462-3943, E-ISSN 1470-1103, Vol. 16, no 2, p. 285-295Article in journal (Refereed)
    Abstract [en]

    This paper addresses the issue of reflective practice, as suggested by Schon. The aim is to analyze instances of reflective practice in elder care, in order to depict individual and collective work. Reflective practice is prevailing as a way of emphasizing the value of practical knowledge and enhancing its status. Reflexivity is thinking about what and why we do something. Moreover, reflexivity is a way of incorporating knowledge with our own personal selves, making it a very personal matter. Using reflective practice in elder care enables learning, leading to improved quality of care. However, individual reflection must be accompanied by collective reflection; this is crucial to improve quality of care.

  • 32.
    Carlsson, Noomi
    et al.
    Jönköping University, School of Health and Welfare, HHJ. CHILD. Department of Clinical and Experimental Medicine, Division of Paediatrics, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Johansson, AnnaKarin
    Department of Medicine and Health, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Abrahamsson, Agneta
    Department of Health and Society, University College of Kristianstad, Kristianstad, 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.
    How to minimize children's environmental tobacco smoke exposure: an intervention in a clinical setting in high risk areas2013In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 13, no 76Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite the low prevalence of daily smokers in Sweden, children are still being exposed to environmental tobacco smoke (ETS), primarily by their smoking parents. A prospective intervention study using methods from Quality Improvement was performed in Child Health Care (CHC). The aim was to provide nurses with new methods for motivating and supporting parents in their efforts to protect children from ETS exposure. METHOD: Collaborative learning was used to implement and test an intervention bundle. Twenty-two CHC nurses recruited 86 families with small children which had at least one smoking parent. Using a bundle of interventions, nurses met and had dialogues with the parents over a one-year period. A detailed questionnaire on cigarette consumption and smoking policies in the home was answered by the parents at the beginning and at the end of the intervention, when children also took urine tests to determine cotinine levels. RESULTS: Seventy-two families completed the study. Ten parents (11%) quit smoking. Thirty-two families (44%) decreased their cigarette consumption. Forty-five families (63%) were outdoor smokers at follow up. The proportion of children with urinary cotinine values of >6 ng/ml had decreased. CONCLUSION: The intensified tobacco prevention in CHC improved smoking parents' ability to protect their children from ETS exposure.

  • 33.
    Dahlin, Sofia
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Jämlikt stöd för jämlik hälsa: En fallstudie av förbättringsmetodik i primärvårdens hälsofrämjande arbete för jämlik hälsa2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 34.
    Dalteg, Tomas
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Benzein, Eva
    School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
    Sandgren, Anna
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Managing uncertainty in couples living with atrial fibrillation2014In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, no 3, p. E1-E10Article in journal (Refereed)
    Abstract [en]

    Background: Living with a chronic disease such as atrial fibrillation (AF) not only affects the patient but also has implications for the partner. There is a lack of research on couples living with AF and, in particular, how they experience and deal with the disease.

    Objective: The aim of this study was to explore couples’ main concerns when one of the spouses is afflicted with AF and how they continually handle it within their partner relationship.

    Methods: Classical grounded theory was used throughout the study for data collection and analysis. Interviews were conducted with 12 couples (patient and partner together). There were follow-up interviews with 2 patients and 2 partners separately.

    Results: Couples living with AF experience uncertainty as a common main concern. This uncertainty was fundamentally rooted in not knowing the cause of AF and apprehension about AF episodes. Couples managed this uncertainty by either explicitly sharing concerns related to AF or through implicitly sharing their concerns. Explicit sharing incorporated strategies of mutual collaboration and finding resemblance, whereas implicit sharing incorporated strategies of keeping distance and tacit understanding. Time since diagnosis and time being symptom-free were factors influencing afflicted couples’ shifting between implicit and explicit sharing.

    Conclusions: Atrial fibrillation affects the partner relationship by bringing uncertainty into couples’ daily lives. Even though this study shares similarities with previous studies on couples living with chronic disease, it contributes to the existing knowledge by presenting a set of strategies used by couples in managing uncertainty when living with AF.

  • 35.
    Ehrencrona, Kristina
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Experience-Based Co-Design ett användbart arbetssätt för psykiatrisk heldygnsvård?: Erfarenheter från ett förbättringsarbete inom psykiatrisk heldygnsvård i Stockholm.2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Patient involvement and patient participation within health care has been more and more important the last years. One method for patient involvement that has been tested (mostly in somatic care) is Experience-Based Co-Design (EBCD). 

    Local problem: The organization has structures to gather experiences from patients, but there is no structure to gather experiences from dependants or staff. There is no forum for patients, dependants and staff to meet and together work with improvement.

    Aim: For the Quality Improvement project (QIP) try methods from EBCD in the context of psychiatric in-patient care. For the study of the QIP describe participant’s experiences of being part of a QIP based on EBCD, and highlight what makes it difficult to engage patients in QIP.

    Method: The main structure for the QIP is Nolan’s model of change and PDSA. The study consists of a qualitative content analysis based on two semi-structured focus group interviews.

    Interventions: Methods from EBCD has been adjusted according to the context and then tested.

    Result: To participate in a QIP based on EBCD has been appreciated and developing. Difficulties have above all been the recruiting of patients.

    Conclusions: EBCD is possible to use in psychiatric in-patient care, modifications are necessary. Which modifications and how needs to be examined further. EBCD affects both the individual and the organization. To achieve asked goals and to engage patients there are some conditions that need to be fulfilled according to structures and equalisation of power between patients, dependants and staff.

  • 36.
    Eivarsson, Marie
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Ett tryggare och säkrare överflyttningssätt från intensivvård till vårdavdelning.: Ett förbättringsarbete med fokus på övervakningsutrustning och läkemedelslistor.2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 37.
    Ekblad, Helena
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Malm, Dan
    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. ADULT.
    Conlon, Lisa
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Rönning, Helén
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    The well-being of relatives of patients with atrial fibrillation: a critical incident technique analysis2014In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 8, p. 48-55Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The well-being of relatives of patients having chronic heart diseases (CHD) has been found to be negatively affected by the patient's condition. Studies examining relatives of patients with atrial fibrillation (AF) indicate that their well-being may be affected in a similar manner, but further research is needed.

    AIM: To explore and describe critical incidents in which relatives of patients experience how AF affects their well-being and what actions they take to handle these situations.

    DESIGN AND METHOD: An explorative, descriptive design based on the critical incident technique (CIT) was used. Interviews were conducted with 19 relatives (14 women and five men) of patients hospitalised in southern Sweden due to acute symptoms of the AF.

    RESULTS: The well-being of relatives was found to be affected by their worries (patient-related health), as well as the sacri-ficing of their own needs (self-related health). In handling their own well-being, these relatives adjusted to and supported the patient (practical involvement), along with adjusting their own feelings and responding to the mood of the patients (emotional involvement).

    CONCLUSION: The well-being of relatives of patients with AF was affected depending on the patients' well-being. In their attempt to handle their own well-being, the relatives adjusted to and supported the patients. Further research is needed in order to evaluate the effects of support to relatives and patients respectively and together.

  • 38.
    Ekblad, Helena
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Rönning, Helen
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    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.
    Patients' well-being: experience and actions in their preventing and handling of atrial fibrillation2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 2, p. 132-139Article in journal (Refereed)
    Abstract [en]

    Background: Atrial fibrillation (AF) influences the lives of patients in the form of worsened well-being. Patients’ own experience of and how to handle AF is rarely investigated. These are important aspects for healthcare services to understand in order to support the well-being of patients with AF.

    Aim: To explore and describe critical incidents in which patients experience how AF affects their well-being and what actions they take to prevent and handle it.

    Design and methods: An explorative, descriptive design based on the critical incident technique (CIT) was used. Interviews were conducted with 25 patients (16 men and 9 women) with AF in a healthcare area in southern Sweden.

    Results: Patients experienced discomfort and limitations in daily life. The actions they took were self-care related actions and healthcare related actions.

    Conclusion: AF affects well-being when it is uncomfortable and leads to pronounced limitations in daily life with the patients trying to maintain or restore well-being through adapting and developing strategies for self-care. Patients base the handling of AF on their personal experience.

  • 39.
    Elmqvist, Carina
    et al.
    Centre for Acute & Critical Care, School of Health and Caring Sciences, Linneaus University.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Ekebergh, Margaretha
    Centre for Lifeworld-Led Education, School of Health and Caring Sciences, Linneaus University, Växjö.
    On a hidden game board: the patient's first encounter with emergency care at the emergency department2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 17/18, p. 2609-2616Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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

  • 40.
    Engström, Karl
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Snabbare och säkrare övergång för patienter från primärvård till specialistpsykiatri: En empirisk fallstudie av antagandens betydelse för ett förbättringsarbete kring remisser och samverkan2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background

    In Sandviken, the adult psychiatric care is divided between Primary Health Centers and Psychiatry. The transferral of patients was unsafe and meant prolonged time before psychiatric treatment was started as 50 % of the referrals were declined.

    Purpose

    The improvement project aimed to reduce the proportion of declined referrals and to reduce time between referral and psychiatric treatment.

    The study aimed to find out beliefs existing among stakeholders and the effect of these on the improvement work.

    Methods

    The idea to test, a referral template, was chosen in advance of the project start. Several improvement tools were used and one primary focus was to base decisions upon facts.

    The study was an empirical case study with qualitative analysis made on documents and interviews.

    Results

    The improvement project didn’t achieve the set aims. The study showed that beliefs about what was needed and possible to do, contributed to the results of the improvement work.

    Conclusions

    The improvement project showed the importance of testing new ideas. The referral template wasn’t a working solution. Stakeholders beliefs about what was needed and possible to do, and how to do it, was shown to contribute to the results of the improvement work.

  • 41.
    Evenholt, Karin
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Den förberedda patienten: En studie av chefer och ledares uppfattningar av ett förbättringsarbete för äldre patienter i samband med läkarbesök på en husläkarmottagning.2018Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
  • 42.
    Fabisch, Anna
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping Academy.
    Möte och mätetal – Vad ger vad egentligen?: Lärdomar av att använda Experience Based Co-Design för att utveckla kvalitetsindikatorer för ungdomsmottagningar2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund

    Kvalitetsindikatorer beskrivs underlätta styrning och kvalitetsutveckling av hälso- och sjukvårdsverksamheter. Det finns dock begränsat vetenskapligt stöd för patientinvolvering vid framtagande av kvalitetsindikatorer.

     

    Kontext för studien

    Studien tog utgångspunkt i ett förbättringsarbete på en regions ungdomsmottagningar, som uppvisat omotiverade skillnader avseende tillgänglighet och kompetens. Förbättringsarbetets målsättning var att utveckla kvalitetsindikatorer som ungdomar och personal upplevde speglar en välfungerande ungdomsmottagning. Arbetet genomfördes med Experience Based Co-Design-metodiken (EBCD). Förbättringsarbetets målsättning utvärderades genom 49 oinvigda ungdomars fritextbeskrivningar, samt fokusgrupper med medarbetare. Utvärderingen visade att förbättringsarbetets målsättning hade uppnåtts.

     

    Studien syfte

    Att beskriva lärdomar i organisationen av att utveckla kvalitetsindikatorer genom EBCD, samt jämföra framtagna indikatorer med andra ungdomsmottagningars kvalitetsindikatorsuppsättningar.

     

    Metod

    Fokusgrupper med personal, intervju med processägare och dokumentanalys av kvalitetsindikatorsuppsättningar.

     

    Resultat

    I informanternas beskrivningar vävdes reflektioner om framtagna indikatorer samman med erfarenheter från co-designprocessen. Personbunden förändringsmotivation och bred delaktighet synliggjordes. Dokumentanalysen visade att framtagna indikatorer hade större andel mått med kundperspektiv än jämförda indikatorsuppsättningar.

     

    Diskussion

    EBCD-metodiken integrerade explicit och implicit kunskap om olika kvalitetsaspekter av verksamheten, vilket främjade förändringsmotivation och personligt lärande. Att metodiken inkluderade konkreta förbättringsarbeten stimulerade till formativ användning av kvalitetsindikatorerna, vilket understöddes av bred delaktighet. Det var möten genom co-designprocessen som främjade dessa effekter, snarare än valet av indikatorer.

     

    Nyckelord: kvalitetsindikator, patientinvolvering, ungdomsmottagning, ungdomsvänlig vård

  • 43.
    Fransson, Eleonor I.
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Stadin, Magdalena
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Nordin, Maria
    Umeå Universitet.
    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.
    Knutsson, Anders
    Mittuniversitetet.
    Alfredsson, Lars
    Karolinska Institutet.
    Westerholm, Peter J. M.
    Uppsala universitet.
    The association between job strain and atrial fibrillation: Results from the Swedish WOLF Study2015In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, Vol. 2015, p. 1-7, article id 371905Article in journal (Refereed)
    Abstract [en]

    Introduction. Atrial fibrillation (AF) is a common heart rhythm disorder. Several life-style factors have been identified as risk factors for AF, but less is known about the impact of work-related stress. This study aims to evaluate the association between work-related stress, defined as job strain, and risk of AF. Methods. Data from the Swedish WOLF study was used, comprising 10,121 working men and women. Job strain was measured by the demand-control model. Information on incident AF was derived from national registers. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between job strain and AF risk. Results. In total, 253 incident AF cases were identified during a total follow-up time of 132,387 person-years. Job strain was associated with AF risk in a time-dependent manner, with stronger association after 10.7 years of follow-up (HR 1.93, 95% CI 1.10–3.36 after 10.7 years, versus HR 1.11, 95% CI 0.67–1.83 before 10.7 years). The results pointed towards a dose-response relationship when taking accumulated exposure to job strain over time into account. Conclusion. This study provides support to the hypothesis that work-related stress defined as job strain is linked to an increased risk of AF.

  • 44.
    Fransson, Eleonor
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. ADULT.
    Stadin, Magdalena
    Jönköping University, School of Health Science, HHJ. ADULT.
    Nordin, Maria
    Malm, Dan
    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.
    Knutsson, Anders
    Alfredsson, Lars
    Westerholm, Peter
    Job strain and the risk of atrial fibrillation: Results from the Swedish WOLF study2015Conference paper (Refereed)
  • 45.
    Fridlund, Bengt
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. ADULT.
    Malm, DanJönköping 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.Mårtensson, JanJönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. ADULT.
    Kardiologisk Omvårdnad2012Collection (editor) (Other academic)
  • 46.
    Fristedt, Sofi
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Fransson, Eleonor
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. ADULT.
    Fysisk aktivitet och träning - möjlig prevention av arbetsrelaterade belastningsbesvär2015Report (Other academic)
  • 47.
    Fristedt, Sofi
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Wretstrand, Anders
    Faculty of Engineering, Lund University.
    Björklund, Anita
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Corr, Susan
    School of Health, the University of Northampton.
    Falkmer, Torbjörn
    Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Viewpoints on community mobility and participation in older age2012In: Journal of Human Subjectivity, ISSN 1598-8643, Vol. 10, no 1, p. 103-123Article in journal (Refereed)
    Abstract [en]

    Background/Aim: Community mobility supports participation in activities. However, knowledge about issues that influence community mobility and, hence, participation in activities outside the home is limited. Since participation and community mobility are subjectively defined phenomena, further knowledge from an insider’s perspective is needed. The aim of this study was to identify and describe viewpoints on community mobility and participation in older age. Methods: A Q-methodology study was conducted with 36 male and female participants, including drivers and non-drivers. Participants sorted 45 Q-statements along a most to least continuum, indicating their current habitual situation of mobility and participation in activities outside their homes. Results: Three viewpoints were found and assigned content-describing denominations; “Prefer being mobile by car, “Prefer being mobile by public transport” and “Prefer flexible mobility”. Conclusions: All participants were satisfied with their actual participation in activities outside their homes. However, those who preferred to use public transport were less satisfied with their opportunities and possibilities to participate in activities outside their homes. The existing demand-responsive Special Transportation System was not considered to be an attractive enough alternative by any of the participants. Intermediate community mobility options are thus needed for those who can no longer drive or use public transport.

  • 48.
    Fåhraeus, Christina
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Wendt, Lill-Kari
    Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Nilsson, Mats
    Isaksson, Helen
    Alm, Anita
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Overweight and obesity in twenty-year-old Swedes in relation to birthweight and weight development during childhood2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 6, p. 637-42Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the frequency of overweight and obesity from birth to 20 years of age and analyse weight at 20 years of age in relation to weight and weight development during early childhood and adolescence.

    METHODS: A longitudinal, population-based study, which followed 496 children from birth to 20 years of age. Information about weight and height was collected from health records at child health centres and school health care. At 20 years of age, weight and height measurements were taken by one of the authors.

    RESULTS: At 20 years of age, 124 (25%) of the youth were obese or overweight. Of these youths, 60% had normal weight at 5.5 years. Of the teenagers who were overweight/obese at 15 years, 79% remained overweight/obese at 20 years of age. Out of the 124 overweight/obese at 20, 47% had normal weight at 15 years. [Corrections added after online publication on April 18, 2012: 'Out of the 124 obese at 20' has been changed to 'Out of the 124 overweight/obese at 20']. No relation was found between rapid weight gain during preschool age and overweight and obesity in 20-year-olds.

    CONCLUSIONS: The majority of those who were overweight/obese at 20 years of age were recruited after 5.5 years of age, and half of them in their late teens. Thus, during the preschool period, the entire population should be the target of primary prevention from overweight/obesity and, in the case of teenagers, prevention strategies should be developed for the whole population as well as treatment strategies for teenagers with established overweight/obesity.

  • 49.
    Gashi, Fitnete
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Evidensbaserad praktik i socialt arbete: En fallstudie av ett förbättringsarbete om hur ESL kan bidra till ökat brukarinflytande och delaktighet inom socialpsykiatri2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 50.
    Godfrey, Marjorie M.
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Improvement Capability at the Front Lines of Healthcare: Helping through Leading and Coaching2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    SUMMARY

    This thesis addresses improvement capability at the front lines of healthcare with a focus on interprofessional health care improvement teams who provide care and improve care. The overall aim is to explore high performing clinical microsystems and evaluate interventions to cultivate health care improvement capabilities of frontline interprofessional teams.

    Methods

    Descriptive and evaluative study designs were employed in the five studies which comprise this thesis. A total of 495 interprofessional health care providers from a variety of health care contexts in the United States (Study I, II, III & IV) and Sweden (Study V) participated in the studies. The mixed methods research included qualitative observation, interviews, focus groups and surveys analyzed with qualitative manifest content analysis. The quantitative data were analyzed with statistics appropriate for non-parametric data.

    Findings

    Study I and II describe how leaders who understand health care improvement can create conditions for interprofessional teams to provide care and simultaneously improve care. Study III evaluates adapted clinical microsystem processes and tools successfully adapted in two different hospitals. Frontline staff reported that they needed help to balance providing care and improving care. Study IV and V explored and tested team coaching to help interprofessional teams to increase their improvement capabilities within improvement collaboratives. The participants perceived team coaching mostly positively and identified supportive coaching actions. In Study V an intervention with “The Team Coaching Model” was tested in Sweden and showed increased acquisition of improvement knowledge in the intervention teams compared to teams who did not receive the coaching model.

    Conclusions

    The thesis findings show leaders can help cultivate health care improvement capability by designing structures, processes and outcomes of their organizational systems to support health care improvement activities, setting clear improvement expectations of all staff, developing the knowledge of every staff member in the microsystem to know their operational processes and systems to promote action learning in their daily work, and providing help with team coaching using a Team Coaching Model.

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