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  • 1.
    Björkman, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, Lishui, China .
    Olsson, Annakarin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Wahlberg, Anna Carin
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Identified obstacles and prerequisites in telenurses’ work environment: a modified Delphi study2017In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, no 1, article id 357Article in journal (Refereed)
    Abstract [en]

    Background: Telenursing is an expanding part of healthcare, staffed with registered nurses whose work environment is typical of a call centre. Work-related stress has been shown to be a major problem in nurses’ work environments and of importance to the outcome of care, patient safety, nurse job satisfaction and burnout. Today, however, we have a limited understanding of and knowledge about the work environment for telenurses. The aim of the present study is to explore and reach consensus on perceived important obstacles and prerequisites in telenurses’ work environment.

    Methods: A modified Delphi design, using qualitative as well as quantitative data sequentially through three phases, was taken. Data were initially collected via semi-structured interviews (Phase I) and later using a web survey (Phase II-III) between March 2015 and March 2016.

    Results: The findings present a consensus view of telenurses’ experiences of important obstacles and prerequisites in their work environment. Central to the findings are the aspects of telenurses having a demanding work, cognitive fatigue and having no opportunity for recovery during the work shift was ranked as important obstacles. Highly ranked prerequisites for managing were being able to focus on one caller at a time, working in a calm and pleasant environment and having technical support 24/7.

    Conclusions: Managers need to enable telenurses to experience control in their work, provided with possibilities to control their work and to recover during work; shortening work time could improve their work environment. Limited possibilities to perform work might contribute to feelings of stress and inability to perform work. 

  • 2.
    Broda, Anja
    et al.
    Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Sciences, Halle (Saale), Germany.
    Bieber, Anja
    Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Sciences, Halle (Saale), Germany.
    Meyer, Gabriele
    Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Sciences, Halle (Saale), Germany.
    Hopper, Louise
    Dublin City University, School of Nursing and Human Sciences, Dublin, Ireland.
    Joyce, Rachael
    Dublin City University, School of Nursing and Human Sciences, Dublin, Ireland.
    Irving, Kate
    Dublin City University, School of Nursing and Human Sciences, Dublin, Ireland.
    Zanetti, Orazio
    IRCCS S. Giovanni di Dio "Fatebenefratelli", Brescia, Italy.
    Portolani, Elisa
    IRCCS S. Giovanni di Dio "Fatebenefratelli", Brescia, Italy.
    Kerpershoek, Liselot
    Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.
    Verhey, Frans
    Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.
    de Vugt, Marjolein
    Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.
    Wolfs, Claire
    Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.
    Eriksen, Siren
    Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Oslo, Norway.
    Røsvik, Janne
    Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
    Marques, Maria J.
    CEDOC, Chronic Diseases Research Center, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
    Gonçalves-Pereira, Manuel
    CEDOC, Chronic Diseases Research Center, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
    Sjölund, Britt-Marie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Woods, Bob
    Bangor University, Dementia Services Development Centre, Bangor, UK.
    Jelley, Hannah
    Bangor University, Dementia Services Development Centre, Bangor, UK.
    Orrell, Martin
    Nottingham University, Institute of Mental Health, Nottingham, UK.
    Stephan, Astrid
    Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Sciences, Halle (Saale), Germany.
    Perspectives of policy and political decision makers on access to formal dementia care: expert interviews in eight European countries2017In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, no 1, article id 518Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers.

    METHODS: Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries.

    RESULTS: The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness.

    CONCLUSIONS: Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.

  • 3.
    Kaltenbrunner, Monica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Bengtsson, Lars
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, Lishui Shi, China.
    A questionnaire measuring staff perceptions of Lean adoption in healthcare: development and psychometric testing2017In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, no 1, article id 235Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    During the past decade, the concept of Lean has spread rapidly within the healthcare sector, but there is a lack of instruments that can measure staff's perceptions of Lean adoption. Thus, the aim of the present study was to develop a questionnaire measuring Lean in healthcare, based on Liker's description of Lean, by adapting an existing instrument developed for the service sector.

    METHODS:

    A mixed-method design was used. Initially, items from the service sector instrument were categorized according to Liker's 14 principles describing Lean within four domains: philosophy, processes, people and partners and problem-solving. Items were lacking for three of Liker's principles and were therefore developed de novo. Think-aloud interviews were conducted with 12 healthcare staff from different professions to contextualize and examine the face validity of the questionnaire prototype. Thereafter, the adjusted questionnaire's psychometric properties were assessed on the basis of a cross-sectional survey among 386 staff working in primary care.

    RESULTS:

    The think-aloud interviews led to adjustments in the questionnaire to better suit a healthcare context, and the number of items was reduced. Confirmatory factor analysis of the adjusted questionnaire showed a generally acceptable correspondence with Liker's description of Lean. Internal consistency, measured using Cronbach's alpha, for the factors in Liker's description of Lean was 0.60 for the factor people and partners, and over 0.70 for the three other factors. Test-retest reliability measured by the intra-class correlation coefficient ranged from 0.77 to 0.88 for the four factors.

    CONCLUSIONS:

    We designed a questionnaire capturing staff's perceptions of Lean adoption in healthcare on the basis of Liker's description. This Lean in Healthcare Questionnaire (LiHcQ) showed generally acceptable psychometric properties, which supports its usability for measuring Lean adoption in healthcare. We suggest that further research focus on verifying the usability of LiHcQ in other healthcare settings, and on adjusting the instrument if needed.

  • 4.
    Kaltenbrunner Nykvist, Monica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Bengtsson, Lars
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Management, Industrial Design and Mechanical Engineering, Industrial Management. University of Gävle, Center for Logistics and Innovative Production.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Högberg, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Staff perception of Lean, care-giving, thriving and exhaustion: a longitudinal study in primary care2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 652Article in journal (Other academic)
    Abstract [en]

    Background

    Lean is commonly adopted in healthcare to increase quality of care and efficiency. Few studies of Lean involve staff-related outcomes, and few have a longitudinal design. Thus, the aim was to examine the extent to which changes over time in Lean maturity are associated with changes over time in care-giving, thriving and exhaustion, as perceived by staff, with a particular emphasis on the extent to which job demands and job resources, as perceived by staff, have a moderated mediation effect.

    Method

    A longitudinal study with a correlational design was used. In total, 260 staff at 46 primary care units responded to a web survey in 2015 and 2016. All variables in the study were measured using staff ratings. Ratings of Lean maturity reflect participants’ judgements regarding the entire unit; ratings of care-giving, thriving, exhaustion and job demands and resources reflect participants’ judgements regarding their own situation.

    Results

    First, over time, increased Lean maturity was associated with increased staff satisfaction with their care-giving and increased thriving, mediated by increased job resources. Second, over time, increased Lean maturity was associated with decreased staff exhaustion, mediated by decreased job demands. No evidence was found showing that job demands and job resources had a moderated mediation effect.

    Conclusion

    The results indicate that primary care staff may benefit from working in organizations characterized by high levels of Lean maturity and that caregiving may also be improved as perceived by staff.

  • 5. Kaminsky, Elenor
    et al.
    Carlsson, Marianne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden .
    Holmström, Inger K
    Larsson, Jan
    Fredriksson, Mio
    Goals of telephone nursing work - the managers' perspectives: a qualitative study on Swedish Healthcare Direct2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, p. 188-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Swedish Healthcare Direct (SHD) receives 6 million calls yearly and aims at increased public sense of security and healthcare efficiency. Little is known about what SHD managers perceive as the primary goals of telephone nursing (TN) work and how the organisation matches goals of health promotion and equitable healthcare, so important in Swedish healthcare legislation. The aim of the study was to explore and describe what the SHD managers perceive as the goals of TN work and how the managers view health promotion and implementation of equitable healthcare with gender as example at SHD.

    METHODS: The study was qualitative using an exploratory and descriptive design. All 23 managers employed at SHD were interviewed and data analysis used deductive directed content analysis.

    RESULTS: The findings reveal four themes describing the goals of TN work as recommended by the SHD managers. These are: 'create feelings of trust', 'achieve patient safety', 'assess, refer and give advice', and 'teach the caller'. Most of the managers stated that health promotion should not be included in the goals, whereas equitable healthcare was viewed as an important issue. Varying suggestions for implementing equitable healthcare were given.

    CONCLUSIONS: The interviewed managers mainly echoed the organisational goals of TN work. The managers' expressed goal of teaching lacked the caller learning components highlighted by telenurses in previous research. The fact that health promotion was not seen as important indicates a need for SHD to clarify its goals as the organisation is part of the Swedish healthcare system, where health promotion should always permeate work. Time used for health promotion and dialogues in a gender equitable manner at SHD is well invested as it will save time elsewhere in the health care system, thereby facing one of the challenges of European health systems.

  • 6.
    Nilsson, Annika
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden.
    E-assessment and an e-training program among elderly care staff lacking formal competence: results of a mixed-methods intervention study2015In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, no 1, article id 189Article in journal (Refereed)
    Abstract [en]

    Background

    Among staff working in elderly care, a considerable proportion lack formal competence for their work. Lack of formal competence, in turn, has been linked to higher staff ratings of stress symptoms, sleep disturbances and workload. Objectives: 1) To describe the strengths and weaknesses of an e-assessment and subsequent e-training program used among elderly care staff who lack formal competence and 2) to study the effects of an e-training program on staff members’ working life (quality of care and psychological and structural empowerment) and well-being (job satisfaction and psychosomatic health). The hypothesis was that staff who had completed the e-assessment and the e-training program would rate greater improvements in working life and well-being than would staff who had only participated in the e-assessments.

    Methods

    An intervention study with a mixed-methods approach using quantitative (2010–2011) and qualitative data (2011) was conducted in Swedish elderly care. Participants included a total of 41 staff members. To describe the strengths and weaknesses of the e-assessment and the e-training program, qualitative data were gathered using semi-structured interviews together with a study-specific questionnaire. To study the effects of the intervention, quantitative data were collected using questionnaires on: job satisfaction, psychosomatic health, psychological empowerment, structural empowerment and quality of care in an intervention and a comparison group.

    Results

    Staff who completed the e-assessments and the e-training program primarily experienced strengths associated with this approach. The results were also in line with our hypotheses: Staff who completed the e-assessment and the e-training program rated improvements in their working life and well-being.

    Conclusion

    Use of the e-assessments and e-training program employed in the present study could be one way to support elderly care staff who lack formal education by increasing their competence; increased competence, in turn, could improve their self-confidence, working life, and well-being.

  • 7.
    Randmaa, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala university; Lishui university, China.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala university.
    Leo Swenne, Christine
    Uppsala university.
    Högberg, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Psychometric properties of an instrument measuring communication within and between the professional groups licensed practical nurses and registered nurses in anaesthetic clinics.2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 950Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The most common cause of clinical incidents and adverse events in relation to surgery is communication error. There is a shortage of studies on communication between registered nurses and licenced practical nurses as well as of instruments to measure their perception of communication within and between the professional groups. The aim of the present study was to evaluate the psychometric properties of the Swedish version of the adapted ICU Nurse-Physician Questionnaire, designed to also measure communication within and between two professional groups: licensed practical nurses and registered nurses. Specifically, the aim was to examine the instrument's construct validity using confirmatory factor analysis and its internal consistency using Cronbach's Alpha.

    METHODS: A cross-sectional and correlational design was used. The setting was anaesthetic clinics in two Swedish hospitals. A total of 316 questionnaires were delivered during spring 2011, of which 195 were analysed to evaluate the psychometric properties of the questionnaire. Construct validity was assessed using confirmatory factor analysis and internal consistency using Cronbach's Alpha. To assess items with missing values, we conducted a sensitivity analysis of two sets of data, and to assess the assumption of normally distributed data, we used Bayesian estimation.

    RESULTS: The results support the construct validity and internal consistency of the adapted ICU Nurse-Physician Questionnaire. Model fit indices for the confirmative factor analysis were acceptable, and estimated factor loadings were reasonable. There were no large differences between the estimated factor loadings when comparing the two samples, suggesting that items with missing values did not alter the findings. The estimated factor loadings from Bayesian estimation were very similar to the maximum likelihood results. This indicates that confirmative factor analysis using maximum likelihood produced reliable factor loadings. Regarding internal consistency, alpha values ranged from 0.72 to 0.82.

    CONCLUSIONS: The tests of the adapted ICU Nurse-Physician Questionnaire indicate acceptable construct validity and internal consistency, both of which need to be further tested in new settings and samples.

    TRIAL REGISTRATION: Current controlled trials http://www.controlled-trials.com Communication and patient safety in anaesthesia and intensive care. Does implementation of SBAR make any differences? Identifier: ISRCTN37251313, retrospectively registered (assigned 08/11/2012).

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