Change search
Link to record
Permanent link

Direct link
Publications (5 of 5) Show all publications
Björkman, A. & Salzmann-Erikson, M. (2019). Giving advice to callers with mental illness: adaptation among telenurses at Swedish Healthcare Direct. International Journal of Qualitative Studies on Health and Well-being, 14(1), Article ID 1633174.
Open this publication in new window or tab >>Giving advice to callers with mental illness: adaptation among telenurses at Swedish Healthcare Direct
2019 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, article id 1633174Article in journal (Refereed) Published
Abstract [en]

Purpose: Our aim was to describe Swedish Healthcare Direct (SHD) and its features as a complex system.

Methods: Qualitative interviews were conducted with 20 SHD telenurses, covering their experiences and skills when encountering and advising callers with mental illness. Complexity science was used as an a priori theoretical framework to enhance understanding of the complex nature of telenursing.

Results: SHD was described as a complex system as nurses were constantly interacting with other agents and agencies. During these interactions, dynamic processes were found between the agents in which the nurses adapted to every new situation. They were constantly aware of their impact on the care-seekers, and perceived their encounters with callers with psychiatric illness as "balancing on a thin line". SHD was also described as both an authority and a dumping ground. The openness of the system did not give the nurses possibility to control the number of incoming calls and the callers' intentions.

Conclusions: These new insights into SHD have important implications for organization developers and nursing management in terms of overcoming linear thinking.

Complexity, nurses, organizations, qualitative, telemedicine
National Category
Other Medical Sciences
urn:nbn:se:hig:diva-30559 (URN)10.1080/17482631.2019.1633174 (DOI)000473007100001 ()31242817 (PubMedID)2-s2.0-85068076028 (Scopus ID)

Funding agency:

University of Gävle

Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-09-05Bibliographically approved
Chen, J. H., Björkman, A., Zou, J. H. & Engström, M. (2019). Self–regulated learning ability, metacognitive ability, and general selfefficacy in a sample of nursing students: A cross-sectional and correlational study. Nurse Education in Practice, 37, 15-21
Open this publication in new window or tab >>Self–regulated learning ability, metacognitive ability, and general selfefficacy in a sample of nursing students: A cross-sectional and correlational study
2019 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 37, p. 15-21Article in journal (Refereed) Published
Abstract [en]

The healthcare sector is fast-growing and knowledge-intensive, and to meet the demands associated with it, nursing students must have high levels of self-regulated learning (SRL), metacognition, and general self-efficacy (GSE). In this cross-sectional, correlational study, data were collected from 216 nursing students through a questionnaire. The aims were: 1) to describe the levels of SRL ability, metacognitive ability and GSE among second- and third-year nursing students; 2) to explore the relationships between the SRL ability, metacognitive ability and GSE of second- and third-year nursing students; 3) and to compare SRL ability, metacognitive ability and GSE between second- and third-year nursing students. Nursing students had moderate levels of SRL ability and metacognitive ability, but lower levels of GSE. Positive relationships between SRL ability, metacognitive ability, and GSE were observed. Third-year nursing students had a higher level of SRL ability but lower levels of GSE, compared to second-year students. In terms of metacognitive ability, no significant differences were observed between the student batches. Interventions are required for the improvement of nursing students’ SRL ability, metacognitive ability, and GSE.

Nursing students, Self-regulated learning ability, Metacognitive ability, General self-efficacy, Self-directed learning
National Category
urn:nbn:se:hig:diva-29507 (URN)10.1016/j.nepr.2019.04.014 (DOI)000473840000003 ()31035075 (PubMedID)2-s2.0-85065077368 (Scopus ID)

Funding agencies:

- University of Gävle

- Lishui University grant no. 15JY01 

Available from: 2019-04-30 Created: 2019-04-30 Last updated: 2019-08-22Bibliographically approved
Wahlberg, A. C. & Björkman, A. (2018). Expert in nursing care but sometimes disrespected-Telenurses' reflections on their work environment and nursing care. Journal of Clinical Nursing, 27(21/22), 4203-4211
Open this publication in new window or tab >>Expert in nursing care but sometimes disrespected-Telenurses' reflections on their work environment and nursing care
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 21/22, p. 4203-4211Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: To describe telenurses' reflections on their work environment and how it impacts on their nursing care.

BACKGROUND: Telenursing is one of the largest healthcare settings in Sweden today; approximately 5.5 million care-seekers call the designated number-1177-each year. Telenursing is regarded as highly qualified nursing care, and providing care over the telephone is considered a complex form of nursing. Within other fields of nursing, the work environment has been shown to affect the outcome of care, patient safety, nurse job satisfaction and burnout.

DESIGN: The study used a descriptive design and followed the COREQ checklist.

METHODS: Twenty-four interviews were performed and analysed using qualitative content analysis.

RESULTS: The main theme concerned "feeling like a nursing care expert but sometimes being disrespected." The telenurses reported that their work environment supported their work as nursing care experts via the telephone in some respects, but also hindered them. Appreciation and respect they received from the vast majority of callers positively impacted the work environment and contributed to work satisfaction. However, they also felt disrespected by both their employers and healthcare staff; they sometimes felt like a dumping ground. Receiving support from colleagues seemed invaluable in helping them feel like and be a nursing care expert.

CONCLUSION: Work was perceived as cognitively demanding and sometimes exhausting, but appreciation from care-seekers and the feeling of being able to provide qualified nursing care made working as a telenurse worthwhile.

RELEVANCE TO CLINICAL PRACTICE: If telenurses are to perform good nursing care over the telephone, managers must provide them with resources, for example, support, education and opportunities for recovery during shifts. It seems that the role of the 1177 service has not been properly implemented and accepted within the healthcare system, and politicians need to anchor its mission within the healthcare organisation.

ambulatory care nursing, nursing care, telenurses, telephone advice nursing, work environment
National Category
urn:nbn:se:hig:diva-27833 (URN)10.1111/jocn.14622 (DOI)000446561500037 ()29989235 (PubMedID)2-s2.0-85051214070 (Scopus ID)
Available from: 2018-09-04 Created: 2018-09-04 Last updated: 2019-01-07Bibliographically approved
Björkman, A., Andersson, K., Bergström, J. & Salzmann-Erikson, M. (2018). Increased Mental Illness and the Challenges This Brings for District Nurses in Primary Care Settings. Issues in Mental Health Nursing, 39(12), 1023-1030
Open this publication in new window or tab >>Increased Mental Illness and the Challenges This Brings for District Nurses in Primary Care Settings
2018 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 39, no 12, p. 1023-1030Article in journal (Refereed) Published
Abstract [en]

Patients with mental illness generally make their initial healthcare contact via a registered nurse. Although studies show that encountering and providing care to care-seekers with mental illness might be a challenge, little research exists regarding Primary Care Nurses' (PCN) view of the challenges they face. The aim of this study was to qualitatively explore PCNs' reflections on encountering care-seekers with mental illness in primary healthcare settings. The results consist of three themes: constantly experiencing patients falling through the cracks, being restricted by lack of knowledge and resources, and establishing a trustful relationship to overcome taboo, shame, and guilt.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
National Category
Health Sciences
urn:nbn:se:hig:diva-29325 (URN)10.1080/01612840.2018.1522399 (DOI)000461365600007 ()30624130 (PubMedID)2-s2.0-85059906887 (Scopus ID)
Available from: 2019-02-25 Created: 2019-02-25 Last updated: 2019-08-13Bibliographically approved
Holmberg, J., Masoumi, D., Elm, A., Fransson, G., Westelius, C., Björkman, A., . . . Toratti-Lindgren, M. (2017). Teachers’ and students’ understanding and use of ICT for teaching and learning – Combining different perspectives and methodologies in research on technology-enhanced learning. In: : . Paper presented at European Distance and E-Learning Network Conference (EDEN), 13-16 June 2017, Jönköping, Sweden.
Open this publication in new window or tab >>Teachers’ and students’ understanding and use of ICT for teaching and learning – Combining different perspectives and methodologies in research on technology-enhanced learning
Show others...
2017 (Swedish)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

More than half of the 14,000 students currently studying at the University of Gävle (HiG) are enrolled in courses that are totally or partly online based.  In 2015, a university-wide project on technology enhanced learning (TEL) (Steffens et al 2015) was initiated. The project focuses on course and programme development and is divided into four sub-projects, all of which contribute to the overall goals of project.

AIMS of the project

The aims of the project are to: (a) restructure teaching facilities and integrate digital technologies, (b) develop technology supported teaching methods, (c) integrate campus and distance education, (d) enhance teachers' and students' digital skills and (f) increase collaboration with relevant external actors.

These aims are achieved through the work of four project groups.

The digital environment group's (1) main focus is on digital tools for learning and the physical arrangement of learning spaces. The collaboration group's (2) main focus is on the maintenance and development of collaborative relationships and connections with communities in higher education for e-learning. The education and professional development group (3) focuses on issues such as professional development, learning design and the implementation of ICT in different courses and subjects. The research group (4) focuses on different issues connected to TEL.

One of the main principles of the project is that the above areas are interlinked and interdependent and that the different experiences and skills of each group and its members contribute to a broader perspective of TEL.

This poster focuses on the research conducted by the project's research group. Taking a multidisciplinary approach, the research focuses on issues and aspects of teaching and learning in higher education that contribute to multifaceted knowledge. The overall aim of the research is to generate knowledge about how conditions for teaching and learning change when the use of technology increases. The four research studies that are initiated are described below.

Study 1: Lecturers’ and students’ agency in encounters with digital media in higher education

This research study focus on issues related to lecturers’ digital teaching practices and students’ digital technological use in their everyday lives and for learning purposes.

Digital practices are defined as the different contexts in which lecturers teach and students participate in digital media (such as learning management systems, forums, communities etc.). Previous research shows that students’ own digital practices are not always made use of in higher education (Buzzard et al., 2011; Kelm, 2011).

A controversial issue in the Swedish higher education context is the discourse on students as customers. The perception of students as customers and “buyers” of ready-packaged content from lecturers is problematic. This view of what higher education stands for clashes with traditional academic views emphasizing critical thinking, reflection, self-directed learning, collaborative and individual learning etc.

In this study, the concept of agency is important in that it reflects “the capacity of actors to critically shape their own responsiveness to problematic situations” (Emirbayer & Mische, 1998, p. 971). In the different perceptions of students’ and lecturers’ tasks and roles in teaching and learning, especially in TEL, all the actors have to display agency in order to manoeuvre in the educational and digital contexts. Notably, agency is not something that people have, but is something that people achieve (Biesta & Tedder, 2006).


The aim of the research project is to study: (a) students’ use of digital technology in their everyday practices and in relation to teaching situations and (b) how lecturers’ agency is played out in teaching and learning when trying to facilitate TEL.


In spring 2017 an online survey involving up to 200 students will be conducted in order to generate knowledge about (a) students’ everyday experiences of digital practices and how these are utilized in higher education and (b) how higher education challenges and develops students’ digital skills and knowledge. In the same period, interviews with lecturers at the university will be conducted in order to generate knowledge about lecturers’ (c) everyday teaching practices with digital technologies and (d) the perceived challenges and development of teaching in relation to their use.

Study 2: Teachers’ understanding and enactment of practice in online and blended educational contexts

The knowledge that teachers need to develop is referred to as a ‘didaktik’ knowledge in the German/European tradition (cf. Kansanen 2009) and as pedagogical content knowledge (PCK) in the Anglo-Saxon literature (Shulman 1986; 1987). However, in what Castells (2011) describes as a network society, teachers are faced with new challenges and opportunities. Koehler et al (2014) argue that teachers’ development and integration of a new knowledge domain is not simply a matter of adding this “technology knowledge” to existing knowledge, but involves a reframing and reconceptualization of their existing professional practices and knowledge. They refer to this amalgam knowledge as technological pedagogical content knowledge (TPACK). The TPACK framework has been widely accepted as a useful theoretical construct. However, there is a need for research on the development and manifestation of TPACK in different disciplinary contexts (Koehler et al 2014).


The aim of this sub-project is to study: a) how teachers reframe and reconceptualize their practices and the kind of knowledge that is needed in online contexts b) how teachers practices are manifested when ICT is used to create (intended) added pedagogical values in educational designs c) the characteristics of educational designs regarded as adding pedagogical value


Three higher education teachers of different courses and subjects in three different departments participate in the study. A design-based research approach is applied, where one of the participating researchers engages in so-called design conversations with the teachers. As is characteristic of DBR, this researcher does not only observe and interview, but also acts as a “co-designer” on the understanding that the teachers are the context experts and the final decision makers (McKenney & Reeves 2012; Plomp & Nieveen 2013).

The data consists of recorded design conversations, educational designs and the artefacts used in the educational designs, the researcher’s/co-designer’s field notes and recorded “field-note conversations” between the researcher/co-designer and the other researcher.

Expected outcomes

The study is expected to contribute knowledge about how teachers’ knowledge and practices are understood and manifested in online and mixed higher educational contexts.

Study 3: Researching and developing student nurses’ drug calculation skills in an explorative design comprising digital technologies

This study is partly experimental in nature. It focuses on the challenges involved in student nurses’ development of accurate drug calculation skills. Challenges like this are not specific to nurse education at the University of Gävle, but appear to be universal (cf. Wright, 2009). However, it has also been claimed that written drug calculation tests do not accurately evaluate the skills involved in drug calculation, in that they are decontextualized from healthcare settings (Wright, 2005; 2012). It has also been claimed that this problem is more imaginary than factual, given that in practice nurses have been shown to handle drug calculation well (Wright, 2009).


The aims of this sub-project are to: (a) deepen the understanding of the challenges and mistakes that student nurses make in drug calculation exams, why they occur and how they might be prevented, (b) explore how the teaching and examination of drug calculation can be made more effective and contextualized and whether digital technologies can help in this.


A multiple design method is employed using empirical data from written examinations, analyses of the set tasks and interviews with student nurses.

Expected outcomes

It is expected that the study will contribute knowledge about why (some) student nurses find it difficult to pass exams and that sufficient knowledge will be developed to facilitate the exploration of an experimental design for teaching and learning that includes digital technologies.

Study 4: Situating ICT in teacher education programmes at the University of Gävle

Integrating ICT as an integral part of teacher education programmes has been addressed as the most significant factor in determining the future level of ICT use in teaching and learning practices (Davis, 2010). According to the Swedish Higher Education Act, ICT should be embedded across entire educational practices in teacher education programmes (Government Bill, 2009/10:89). Numerous teacher educationprogrammes have made extensive efforts to prepare and empower teacher education students’ ICT competences so that ICT-based technologies are seamlessly woven into the teaching and learning process. Most schools try to enhance teachers’ digital competences by in-service education and expect newly qualified teachers to be adequately trained to use digital technologies in their educational practices. However, in reality it would seem that many newly qualified teachers do not have the necessary skills for this (see Chigona, 2015; Koehler, Mishra, Akcaoglu, & Rosenberg, 2013). 


This study focuses on understanding why a large number of the newly qualified teachers in teacher education institution remain underprepared to use digital technologies in their educational practices, despite an increased investment in the provision of digital technologies in these institutions.


In order to explore how digital technologies are integrated into teacher education in higher education institutions, a sequential explanatory multiple sources design consisting of two distinct phases will be implemented (Creswell, 2012). In this design, a number of course syllabi in a programme will be analyzed. Interviews with key actors, including students, teacher educators and gatekeepers, will be conducted in order to contextualize and deepen the analysis of the syllabi.

Expected outcomes

The study is expected to deepen the understanding of how student teachers are pedagogically trained in ICT in teacher education institutions.

Concluding remarks

The four research studies in the project investigate how students and teachers understand and use educational ICT. This is done by using different methodologies and from different perspectives. It is expected that the research studies will contribute to the broader and more inclusive project perspective by their specific aims and generate knowledge that will contribute to the multifaceted field of TEL.


  1. Biesta, G. & Tedder, M. (2006). How is agency possible? Towards an ecological understanding of agency-as-achievement. Working paper 5, Learning Lives: Learning, Identity and Agency in the Life Course, University of Exeter, England.
  2. Buzzard, C., Crittenden, V.L., Crittenden, W.F. & McCarty, P. (2011). The Use of Digital Technologies in the Classroom: A Teaching and Learning Perspective. Journal of Marketing Education. 33 (2), 131-139.
  3. Buzzard, C., Crittenden, V.L., Crittenden, W.F. & McCarty, P. (2011). The Use of Digital Technologies in the Classroom: A Teaching and Learning Perspective. Journal of Marketing Education. 33 (2), 131-139.
  4. Castells, M. (2011) The Rise of the Network Society: The Information Age: Economy, Society, and Culture, 2nd edn (Vol. 1). Malden, MA: John Wiley & Sons. 
  5. Chigona, A. (2015). Pedagogical shift in the twenty-first century: Preparing teachers to teach with new technologies. Africa Education Review, 12(3), 478-492. doi:10.1080/18146627.2015.1110912
  6. Davis, N. (2010). Technology in Preservice Teacher Education. In P. Editors-in-Chief:  Penelope, B. Eva, E. B. Barry McGawA2 - Editors-in-Chief:  Penelope Peterson, & M. Barry (Eds.), International Encyclopedia of Education (Third Edition) (pp. 217-221). Oxford: Elsevier.
  7. Emirbayer, M., & Mische, A. (1998). What is agency? American Journal of Sociology, 103(4), 962-1023.
  8. Kansanen, P. (2009). The curious affair of pedagogical content knowledge. Orbis Scholae, 3(2), 5-18.
  9. Kelm, R. (2011). Social Media. It’s what students do. Business Communication Quarterly. 74, (4), 505-520.
  10. Koehler, M. J., Mishra, P., Akcaoglu, M., & Rosenberg, J. (2013). The technological pedagogical content knowledge framework for teachers and teacher educators. In R. Thyagarajan (Ed.), ICT integrated teacher education: A resource book. New Delhi, India: CEMCA.
  11. Koehler, M. J., Mishra, P., Kereluik, K., Shin, T. S., & Graham, C. R. (2014). The technological pedagogical content knowledge framework. In J.M. Spector, M.D. Merrill, J. Elen, & M.J. Bishop (Eds.), Handbook of research on educational communications and technology (pp. 101-111). Springer New York.
  12. McKenney, S., & Reeves, T. C. (2012). Conducting educational design research. London: Routledge.  
  13. Plomp, T. & Nieveen, N. (Eds.). (2013) Educational Design Research: Introduction and Illustrative Cases.  Enschede, Netherlands; SLO Netherlands Institute for Curriculum Development.
  14. Regeringens proposition, (2009/10:89) Regeringens proposition 2009/10:89 om lärarutbildning m.m. [Government Bill, 2009/10:89 regarding teacher education etc.]  (Stockholm, Gotab) (in Swedish).
  15. Shulman, L. S. (1986). Those who understand: Knowledge growth in teaching. Educational Researcher, 15, 4–14.
  16. Shulman, L. S. (1987). Knowledge and teaching: Foundations of the new reform. Harvard Educational Review, 57, 1–22.  
  17. Steffens, K., Bannan, B., Dalgarno, B., Bartolomé, A. R., Esteve-González, V., & Cela-Ranilla, J. M. (2015). Recent Developments in Technology- Enhanced Learning: A Critical Assessment. RUSC. Universities and Knowledge Society Journal, 12(2). pp. 73-86.
  18. Wright, K. (2005). An exploration into the most effective way to teach drug calculation skills to nursing students. Nurse Education Today, 25, 430–436. 
  19. Wright, K. (2009). The assessment and development of drug calculation skills in nurse education – A critical debate. Nurse Education Today, 29, 544–548. Doi: 10.1016/j.nedt.2008.08.019 
  20. Wright, K. (2012). Editorial. Drug calculation skills – Are we running scared? Nurse Education Today, *. Doi: 10.1016/j.nedt.2011.06.001 
National Category
Educational Sciences Didactics
urn:nbn:se:hig:diva-25694 (URN)
European Distance and E-Learning Network Conference (EDEN), 13-16 June 2017, Jönköping, Sweden
Nätbaserat lärande
Available from: 2017-11-29 Created: 2017-11-29 Last updated: 2018-07-03Bibliographically approved
ORCID iD: ORCID iD iconorcid.org/0000-0001-9513-3102

Search in DiVA

Show all publications