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  • 1.
    Andreassen Devik, Siri
    et al.
    Centre for Care Research Mid-Norway, Norway; Nord University, Norway.
    Enmarker, Ingela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Hellzén, Ove
    Mid Sweden University, Sweden.
    Nurses’ experiences of compassion when giving palliative care at home2019In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989Article in journal (Refereed)
    Abstract [en]

    Background: Compassion is seen as a core professional value in nursing and as essential in the effort of relieving suffering and promoting well-being in palliative care patients. Despite the advances in modern healthcare systems, there is a growing clinical and scientific concern that the value of compassion in palliative care is being less emphasised. Objective: This study aimed to explore nurses’ experiences of compassion when caring for palliative patients in home nursing care. Design and participants: A secondary qualitative analysis inspired by hermeneutic circling was performed on narrative interviews with 10 registered nurses recruited from municipal home nursing care facilities in Mid-Norway. Ethical considerations: The Norwegian Social Science Data Services granted permission for the study (No. 34299) and the re-use of the data. Findings: The compassionate experience was illuminated by one overarching theme: valuing caring interactions as positive, negative or neutral, which entailed three themes: (1) perceiving the patient’s plea, (2) interpreting feelings and (3) reasoning about accountability and action, with subsequent subthemes. Discussion: In contrast to most studies on compassion, our results highlight that a lack of compassion entails experiences of both negative and neutral content. Conclusion: The phenomenon of neutral caring interactions and lack of compassion demands further explorations from both a patient – and a nurse perspective. © The Author(s) 2019.

  • 2.
    Asylbekova, Gulmira
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science.
    Upplevelser av livskvalité hos patienter med bensår: Litteraturstudie2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Omkring 100 000 svenskar beräknas lida av bensår vilka kräver långa behandlingstider och medför ekonomiska kostnader för samhället. Olika sjukdomstillstånd såsom trauma och försämrad blodcirkulation anses som riskfaktorer. Att leva med bensår kan ha negativ inverkan på människors dagliga liv. Det är viktigt för sjuksköterskor att informera patienterna kring behandlingen, ge stöd samt ha förmågan att bemöta dem med respekt och empati. Syfte: Syftet med föreliggande studie var att beskriva hur patienter med bensår upplever sin livskvalitet samt att beskriva undersökningsgrupperna som ingick i de inkluderade artiklarna. Metod: Beskrivande litteratur studie som inkluderade tolv vetenskapliga artiklar som söktes fram i databasen Cinahl. Huvudresultat: Patienterna beskrev smärta som påverkade deras dagliga liv både fysiskt och psykiskt. Sömnproblem påverkade det psykiska måendet negativt. Rädslan för att skada sig begränsade patienterna fysiskt och man beskrev även känslan av skam, missmod, ensamhet, oro, ångest, depression och förlust av hopp. Bensår upplevdes tidssamt energikrävande och brister i kunskap hos sjukvårdpersonalen hade negativ påverkan på patienternas livskvalité. Undersökningsgrupperna varierade i antal från 5 till 247 deltagare, majoriteten var kvinnor, åldern var mellan 18 till 99 år. De flesta deltagarna hade haft venösa bensår, vilka varade mellan 6 veckor till 43 år. Slutsats: Att leva med bensår påverkade livskvaliteten. Relationen mellan sjuksköterska – patient hade stort betydelse för sårläkningen och välbefinnande. Det är viktigt att sjuksköterskor har tillräcklig kunskap om denna patientgrupp samt att ge ett professionellt bemötande, stöd och information om en egenvård. 

  • 3.
    Birgisdóttir, Dröfn
    et al.
    Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lunds University, Lund, Sweden.
    Bylund-Grenklo, Tove
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
    Nyberg, Tommy
    Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Kreicbergs, Ulrika
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Caring Sciences, Palliative Research Center, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
    Steineck, Gunnar
    The Sahlgrenska Academy, Department of Oncology, Division of Clinical Cancer Epidemiology, University of Gothenburg Institute of Clinical Sciences, Gothenburg, Sweden.
    Fürst, Carl J.
    Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lunds University, Lund, Sweden.
    Losing a parent to cancer as a teenager: Family cohesion in childhood, teenage, and young adulthood as perceived by bereaved and non-bereaved youths2019In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 28, no 9, p. 1845-1853Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate levels of perceived family cohesion during childhood, teenage years, and young adulthood in cancer-bereaved youths compared with non-bereaved peers.

    METHODS: In this nationwide, population-based study, 622 (73%) young adults (aged 18-26) who had lost a parent to cancer 6 to 9 years previously, when they were teenagers (aged 13-16), and 330 (78%) non-bereaved peers from a matched random sample answered a study-specific questionnaire. Associations were assessed using multivariable logistic regression.

    RESULTS: Compared with non-bereaved youths, the cancer-bereaved participants were more likely to report poor family cohesion during teenage years (odds ratio [OR] 1.6, 95% CI, 1.0-2.4, and 2.3, 95% CI, 1.5-3.5, for paternally and maternally bereaved youths, respectively). This was also seen in young adulthood among maternally bereaved participants (OR 2.5; 95% CI, 1.6-4.1), while there was no difference between paternally bereaved and non-bereaved youths. After controlling for a number of covariates (eg, year of birth, number of siblings, and depression), the adjusted ORs for poor family cohesion remained statistically significant. In a further analysis stratified for gender, this difference in perceived poor family cohesion was only noted in females.

    CONCLUSION: Teenage loss of a parent to cancer was associated with perceived poor family cohesion during teenage years. This was also noted in young adulthood among the maternally bereaved. Females were more likely to report poor family cohesion. Our results indicate a need for increased awareness of family cohesion in bereaved-to-be families with teenage offspring, with special attention to gender roles.

  • 4.
    Björkman, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Salzmann-Erikson, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Giving advice to callers with mental illness: adaptation among telenurses at Swedish Healthcare Direct2019In: 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)
    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.

  • 5.
    Bylund-Grenklo, Tove
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden.
    Werkander-Harstäde, Carina
    Department of Health and Caring Sciences, Linnaeus University, Växjö; Center for Collaborative Palliative Care, Växjö, Sweden; Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Sandgren, Anna
    Department of Health and Caring Sciences, Linnaeus University, Växjö; Center for Collaborative Palliative Care, Växjö, Sweden; Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Benzein, Eva
    Department of Health and Caring Sciences, Linnaeus University, Kalmar; Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden .
    Östlund, Ulrika
    Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle; Faculty of Medicine and Health, School of Health Sciences, Örebro University; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    Dignity in life and care: The perspectives of Swedish patients in a palliative care context2019In: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 25, no 4, p. 193-201Article in journal (Refereed)
    Abstract [en]

    Background: How patients preserve their sense of dignity in life is an important area of palliative care that remains to be explored. Aims: To describe patients' perspectives of what constitutes a dignified life within a palliative care context. Methods: Twelve palliative care patients were interviewed about their views on living with dignity. Data were analysed using qualitative content analysis. Results: What constitutes a dignified life during end-of-life care was captured by the theme 'I may be ill but I am still a human being' and presented under the categories 'preserving my everyday life and personhood', 'having my human value maintained by others through 'coherence' and 'being supported by society at large'. Conclusion: Patients' sense of dignity can be preserved by their own attitudes and behaviours, by others and through public support. Health professionals need to adopt a dignity-conserving approach, for which awareness of their own attitudes and behaviours is crucial. 

  • 6.
    Carlsson, Marianne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University.
    Self-reported competence in female and male nursing students in the light of theories of hegemonic masculinity and femininity2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In most parts of the world, nursing historically has been considered an occupation for women. Gender stereotypes are associated with the nursing profession.

    AIM: The aim was to describe and compare the self-reported competence in female and male nursing students. The students were also compared according to their different background college educations. The theoretical framework of hegemonic masculinity and femininity was used.

    DESIGN: A cross-sectional design with a questionnaire was used at two points in time, 2012 and 2017.

    METHODS: Nursing students completed a questionnaire on graduation from a three-year university nursing program from 12 universities/university colleges in Sweden. In total, 1,810 students were participating, 1577 female and 227 male students. The Nurse Professional Competence scale was used for data collection.

    RESULTS: There were statistical significant differences in the self-reported competence between female and male students (t-tests and ANOVAs). These differences are in agreement with the patterns of hegemonic masculinity and femininity. Female students estimated their competence in giving value-based nursing care as higher than male did. Male students estimated their competence in development and leadership higher than female did.

    CONCLUSION: The pattern of hegemonic masculinity and femininity could be identified. This indicates a difference in power between female and male students.

    IMPACT: The study addresses the self-reported competence of female and male nursing students. The results indicated that male students possibly looked on themselves as superior to the female students. In order to change the image of nursing as a woman's work, the self-images should be discussed in nursing education as well as in college education. Women interested in development, research and leadership and men interested in nursing care and administration must feel that nursing is a suitable profession for them. The stereotypical image of nursing as a women's work is a barrier to nurses' professional development.

  • 7.
    Chen, Jian Hua
    et al.
    Department of Nursing, Medicine and Health College, Lishui University, Lishui, Zhejiang Province, China.
    Björkman, Annica
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Zou, Ji Hua
    Department of Nursing, Medicine and Health College, Lishui University, Lishui, Zhejiang Province, China.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Self–regulated learning ability, metacognitive ability, and general selfefficacy in a sample of nursing students: A cross-sectional and correlational study2019In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 37, p. 15-21Article in journal (Refereed)
    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.

  • 8.
    Dahlkvist, Eva
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Residents’ use and perceptions of residential care facility gardens: a behavior mapping and conversation study2019In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743Article in journal (Refereed)
  • 9.
    Eivergård, Kristina
    et al.
    Department of Nursing Sciences, Mid-Sweden University, Östersund, Sweden; Department of Health Care Science, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
    Enmarker, Ingela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Livholts, Mona
    Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
    Aléx, Lena
    Department of Nursing, Umeå University, Umeå, Sweden.
    Hellzén, Ove
    Department of Nursing Sciences, Mid-Sweden University, Östersund, Sweden.
    The Importance of Being Acceptable - Psychiatric Staffs' Talk about Women Patients in Forensic Care2019In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 40, no 2, p. 124-132Article in journal (Refereed)
    Abstract [en]

    Currently, women comprise about ten percent of those sentenced to psychiatric forensic clinics in Sweden. Those who are sentenced to forensic care because of offending and violent behaviour have already taken a step away from the usually expected female behaviour. On the other hand, there are many women in forensic care who have not committed crimes, but who instead self-harm. Studies have identified a gender bias in diagnosing and care in psychiatric settings, but there are few studies conducted on women in forensic care. The present study therefore examined how the situation of women patients and female norms are expressed in the staff's talk about these women during verbal handovers and ward rounds at a forensic clinic in Sweden. The aim was to explore how psychiatric staff, in a context of verbal handovers and ward rounds, talk about women who have been committed to forensic psychiatric care, and what consequences this might have for the care of the patients. The content of speech was examined using audio recordings and a method of analysis that was inspired by thematic analysis. The analysis identified that the staff talked about the women in a way that indicates that they expected the women to follow the rules and take responsibility for their bodies in order to be regarded as acceptable patients.

  • 10.
    Eriksson, Elisabet
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Wejåker, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Danhard, Anna
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Living with a spouse with chronic illness – the challenge of balancing demands and resources2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, no 1, article id 422Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To describe the partners’ experiences of living with a person with chronic illness and how they manage everyday life.

    Background. The number of partners providing informal care for their chronically ill spouse is rising, and they describe their daily life as demanding.

    Design. A descriptive design with a qualitative approach was used.   

    Methods. A purposive sample of 16 partners with a chronically ill spouse were interviewed. The interviews were recorded, transcribed, and analyzed using qualitative content analysis.

    Results Four main themes were identified: ‘Living with challenges caused by the spouse's disease,’ ‘Seeking support for living with the spouse’s illness,’ ‘Appreciating the good parts of life’ and ‘Adapting to constant changes and an uncertain future.’ The participants rated their health as rather good and had great confidence in their own ability to cope with daily life. Their experiences of support from formal care providers varied; they expressed the need for more assistance from the health care sector.

    Conclusions. The partners experienced many challenges in everyday life when providing informal care for their chronically ill spouse. This affected both their physical and psychological health, as they had limited time for themselves. The partners seemed to receive more support from their informal network than from formal care providers. In handling daily life, the partners balanced demands and resources to identify possibilities to move forward and find meaning in life.

    Relevance to clinical practice. Formal care providers must acknowledge partners' needs, develop evidence-based assessment guidelines, and provide efficient support to partners with a chronically ill spouse. 

  • 11.
    Forsman, Henrietta
    et al.
    Högskolan Dalarna.
    Inger, Jansson
    Göteborgs Universitet.
    Leksell, Janeth
    Högskolan Dalarna.
    Lepp, Margret
    Göteborgs Universitet.
    Sundin Andersson, Christina
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Nilsson, Jan
    Sophiahemmet Högskola.
    Clusters of competence: Relationship between self-reported professional competence and achievement on a national examination among graduating nursing students2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed)
    Abstract [en]

    Aims

    To identify clusters based on graduating nursing students’ self‐reported professional competence and their achievement on a national examination. Furthermore, to describe and compare the identified clusters regarding sample characteristics, students’ perceptions of overall quality of the nursing programme and students’ general self‐efficacy.

    Design

    A cross‐sectional study combining survey data and results from a national examination.

    Methods

    Data were collected at two universities and one university college in Sweden in January 2017, including 179 students in the final term of the nursing programme. The study was based on the Nurse Professional Competence Scale, the General Self‐Efficacy scale and results from the National Clinical Final Examination. A Two‐Step Cluster Analysis was used to identify competence profiles, followed by comparative analyses between clusters.

    Results

    Three clusters were identified illustrating students’ different competence profiles. Students in Cluster 1 and 2 passed the examination, but differed in their self‐assessments of competence, rating themselves under and above the overall median value respectively. Students in Cluster 3 failed the examination but rated themselves at the overall median level or higher.

    Conclusion

    The study illustrates how nursing students’ self‐assessed competence might differ from competency assessed by examination, which is challenging for nursing education. Self‐evaluation is a key learning outcome and is, in the long run, essential to patient safety.

    Impact

    The study has identified clusters of students where some overestimate and others underestimate their competence. Students who assessed their competence low but passed the exam assessed their general self‐efficacy lower than other students. The findings illuminate the need for student‐centered strategies in nursing education, including elements of self‐assessment in relation to examination to make the students more aware of their clinical competence.

  • 12.
    Hagerman, Heidi
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.
    Working Life Among First-Line Managers and Their Subordinates in Elderly Care: an Empowerment Perspective2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The aim of this thesis was to study the working life of first-line managers and their subordinates in elderly care from an empowerment perspective. Methods: Paper I and II used a qualitative approach, and semi-structured interviews were conducted with 14 male and 14 female first-line managers. Data were analyzed using qualitative content analysis. Paper III and IV used a quantitative approach with a longitudinal, correlational and multilevel design. 78 first-line managers and 1398 subordinates filled in the questionnaire at T1 and 56 first-line managers and 769 subordinates at T2. Data were analyzed using descriptive statistics, multivariate analyses (III & IV) and multilevel modelling (IV). Results: In Paper I and II, the first-line managers reported having a challenging and complex work situation. Although the first-line managers sometimes expressed a need for better access to structural empowerment in terms of information, resources and support, they experienced psychological empowerment in their work. In Paper III, the results indicated that the more access the first-line managers had to structural empowerment over time, the more likely they were to feel psychologically empowered over time, resulting in lower ratings of their stress symptoms and higher ratings of their own self-rated leadership-management performance over time. Another finding in Paper III was the influence the number of subordinates per first-line manager had on the first-line managers’ ratings of structural empowerment and the subordinates’ ratings of structural empowerment and stress symptoms. In Paper IV, the results indicate that the more access the first-line managers had to structural empowerment at T1, the more access the subordinates had to structural empowerment at T2, and the higher the subordinates rated their first-line manager’s leadership-management performance at T2, when controlling for psychological empowerment. Conclusions: The working life of first-line managers in elderly care is complex and challenging, and they seem to need better access to structural empowerment (Paper I-IV). However, although deficiencies in access to structural empowerment were reported, the first-line managers experienced their work as a positive challenge (Paper 1) and felt that, though the work was not easy, it was worth it (Paper II).

  • 13.
    Hagerman, Heidi
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, 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 Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, Lishui, China .
    Wadensten, Barbro
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    How do first-line managers in elderly care experience their work situation from a structural and psychological empowerment perspective?: An interview study2019In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 27, no 6, p. 1208-1215Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The work situation for first-line managers in elderly care is complex and challenging. Little is known about these managers' work situation from a structural and psychological empowerment perspective.

    AIM:

    To describe first-line managers' experiences of their work situation in elderly care from a structural and psychological empowerment perspective.

    METHOD:

    Interviews from 14 female first-line managers were analysed using qualitative content analysis.

    RESULTS:

    The theme described the managers' work situation as "It's not easy, but it's worth it." In the four subthemes, the managers described their work in terms of "Enjoying a meaningful job," "A complex and demanding responsibility that allows great authority within set boundaries," "Supported by other persons, organisational preconditions and confidence in their own abilities" and "Lacking organisational preconditions, but developing strategies for dealing with the situations."

    CONCLUSION:

    The managers described having various amounts of access to structural empowerment and experienced a feeling of meaning, competence, self-determination and impact, that is, psychological empowerment in their work.

    IMPLICATIONS FOR NURSING MANAGEMENT:

    It is vital that first-line managers have access to organisational support. Therefore, upper management and first-line managers need to engage in continuous dialogue to customize the support given to each first-line manager.

  • 14.
    Hedlund, Åsa
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Nordström, Tina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    New insights and access to resources change the perspective on life among persons with long-term illness - An interview study2019In: Nursing Open, E-ISSN 2054-1058Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to describe individuals’ experiences of living with long-term illness.

    Methods: A qualitative approach with a descriptive design was used. Semi-structured interviews were conducted with 16 persons (50–80 years). They were also asked to self-rate their perceptions of their current health status and confidence in their ability to cope with everyday life.

    Results: One main theme was identified: new insights and access to resources change the perspective on life. Personal characteristics and support from others were advantageous in finding ways to deal with limitations related to the illness. Most of the persons experienced a changed approach to life, in that they now valued life more than they had before. However, some persons also experienced lost values and found it difficult to accept medications. The persons rated their current health status as slightly above average, but their confidence in their ability to cope with everyday life as high.

  • 15.
    Hedman, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science. Uppsala University, Sweden.
    Häggström, Elisabeth
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science. Uppsala University, Sweden.
    Mamhidir, Anna-Greta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science. Uppsala University, Sweden.
    Pöder, Ulrika
    Uppsala University, Sweden.
    Caring in nursing homes to promote autonomy and participation2019In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, no 1, p. 280-292, article id 969733017703698Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Autonomy and participation are threatened within the group of older people living in nursing homes. Evidence suggests that healthcare personnel act on behalf of older people but are still excluding them from decision-making in everyday care.

    OBJECTIVE: The purpose was to describe registered nurses' experience of caring for older people in nursing homes to promote autonomy and participation.

    RESEARCH DESIGN: A descriptive design with a phenomenological approach was used. Data were collected by semi-structured individual interviews. Analysis was inspired by Giorgi's method. Participants and research context: A total of 13 registered nurses from 10 nursing homes participated. Ethical considerations: Ethical approval was obtained from the Regional Research Ethics Committee. Informed consent was achieved and confidentiality guaranteed.

    FINDINGS: The essence of caring for older people in nursing homes to promote autonomy and participation consisted of registered nurses' awareness of older people's frailty and the impact of illness to support health and well-being, and awareness of acknowledgement in everyday life and trusting relationships. Paying attention to older people by being open to the persons' wishes were aspects that relied on registered nurses' trusting relationships with older people, their relatives and surrounding healthcare personnel. The awareness reflected challenges in caring to promote older people's right to autonomy and participation in nursing homes. Registered nurses' strategies, hopes for and/or concerns about development of everyday life in nursing homes were revealed and mirrored their engagement in caring for older people.

    DISCUSSION AND CONCLUSION: Awareness of older people's frailty in nursing homes and the importance of maintained health and well-being were described as the main source for promoting autonomy and participation. Everyday life and care in nursing homes needs to be addressed from both older people's and healthcare personnel's perspectives, to promote autonomy and participation for residents in nursing homes.

  • 16.
    Jarnulf, Therese
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, 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 Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, Lishui, Zhejiang, China.
    District nurses experiences of precepting district nurse students at the postgraduate level2019In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 37, p. 75-80Article in journal (Refereed)
    Abstract [en]

    District nurses are preceptors of district nurse students at the postgraduate level. These district nurse students are already registered nurses who have graduated and are now studying to become district nurses; this training is at the postgraduate level. As preceptors at the postgraduate level, district nurses play an important role in helping these students to achieve the learning outcomes of the clinical practice part of their education. However, there is a lack of studies on precepting at this level. Thus, the aim was to describe district nurses' experiences of precepting district nurse students at the postgraduate level. The study was descriptive in design and used a qualitative approach. Purposive sampling was used and nine district nurses from seven primary health care units in Sweden were interviewed. Data were analysed using qualitative content analysis. An overall theme ”Fluctuating between transferring knowledge and striving for reflective learning” and two subthemes emerged. The preceptors’ views on precepting and performance varied depending on the situation. The conclusions is that given the current learning outcomes for clinical practice education at the postgraduate level, district nurses need to bemore influenced by preception focused on reflective learning.

  • 17. Jelley, H.
    et al.
    Kerpershoek, L.
    Verhey, F.
    Wolfs, C.
    De Vugt, M.
    Bieber, A.
    Stephan, A.
    Meyer, G.
    Michelet, M.
    Norwegian National Advisory Unit on Ageing and Health, V.
    Selbaek, G.
    Sjölund, Britt-Marie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland.
    Sköldunger, A.
    Hopper, L.
    Irving, K.
    Marques, M.
    Balsinha, M. C.
    Gonçalves-Pereira, M.
    Portolani, D. M.
    Zanetti, O.
    Woods, B.
    Carers' experiences of timely access to and use of dementia care services in eight European countries2019In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779Article in journal (Refereed)
    Abstract [en]

    Timely access to care services is crucial to support people with dementia and their family carers to live well. Carers of people with dementia (N = 390), recruited from eight countries, completed semi-structured interviews about their experiences of either accessing or not using formal care services over a 12-month period in the Access to Timely Formal Care (Actifcare) study. Participant responses were summarised using content analysis, categorised into clusters and frequencies were calculated. Less than half of the participants (42.3%) reported service use. Of those using services, 72.8 per cent reported timely access and of those not using services 67.2 per cent were satisfied with this situation. However, substantial minorities either reported access at the wrong time (27.2%), or feeling dissatisfied or mixed feelings about not accessing services (32.8%). Reasons for not using services included use not necessary yet, the carer provided support or refusal. Reasons given for using services included changes in the condition of the person with dementia, the service's ability to meet individual needs, not coping or the opportunity to access services arose. Facilitators and barriers to service use included whether participants experienced supportive professionals, the speed of the process, whether the general practitioner was helpful, participant's own proactive attitude and the quality of information received. To achieve timely support, simplified pathways to use of formal care services are needed.

  • 18.
    Kaltenbrunner, 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.
    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.
    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.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Lean maturity and quality in primary care2019In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 32, no 2, p. 141-154Article in journal (Refereed)
    Abstract [en]

    Purpose - The purpose of this paper is to 1) describe Lean maturity in primary care using a questionnaire based on Liker’s description of Lean, complemented with observations, and 2) determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines. High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff.

    Design/methodology/approach - Data were collected using a survey based on Liker’s four principles, divided into 16 items (n = 298 staff in 45 units). Complementary observations (n = 28 staff) were carried out at four units.

    Findings - Lean maturity varied both between and within units. The highest Lean maturity was found for ‘adhering to routines’ and the lowest for ‘having a change agent at the unit’. Lean maturity was positively associated with satisfaction with care and with adherence to national guidelines to improve healthcare quality. 

    Practical implications - Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker’s principles and using the results as guidance for further development.

    Originality/value - This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker’s principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.

  • 19.
    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.

  • 20.
    Kerpershoek, Liselot
    et al.
    Alzheimer Centre Limburg, Maastricht University, Maastricht, Netherlands.
    Wolfs, Claire
    Alzheimer Centre Limburg, Maastricht University, Maastricht, Netherlands.
    Verhey, Frans
    Alzheimer Centre Limburg, Maastricht University, Maastricht, Netherlands.
    Jelley, Hannah
    Bangor University, Bangor, UK.
    Woods, Bob
    Bangor University, Bangor, UK.
    Bieber, Anja
    Martin-Luther University Halle-Wittenberg, Halle, Germany.
    Bartoszek, Gabriele
    Martin-Luther University Halle-Wittenberg, Halle, Germany.
    Stephan, Astrid
    Martin-Luther University Halle-Wittenberg, Halle, Germany.
    Selbaek, Geir
    Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital, Tonsberg, Norway; Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, Ottestad, Norway;Faculty of Medicine, University of Oslo, Oslo, Norway.
    Eriksen, Siren
    Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital, Tonsberg, Norway.
    Sjölund, Britt-Marie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Hopper, Louise
    School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland.
    Irving, Kate
    School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland.
    Marques, Maria J.
    CEDOC, Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
    Goncalves-Pereira, Manuel
    CEDOC, Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
    Portolani, Daniel
    Zanetti, Orazio
    IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
    Vugt, Marjolein
    Alzheimer Centre Limburg, Maastricht University, Maastricht, Netherlands.
    Optimizing access to and use of formal dementia care: Qualitative findings from the European Actifcare study2019In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 27, no 5, p. e814-e823Article in journal (Refereed)
    Abstract [en]

    This paper reports on qualitative data from the Actifcare study investigating experiences, attitudes, barriers and facilitators concerning access to and use of formal care. A total of 85 semi-structured in-depth interviews were conducted in eight European countries. Results were analysed with a deductive content analysis, first within country and then integrated in a cross-national analysis. Overall, analysis of the in-depth interviews revealed two major themes with five subcategories. The results can be summarised in an optimal pathway for access to dementia care. This pathway includes fixed factors such as disease-related factors and system-related factors. In addition there are personal factors that are subject to change such as attitudes towards care. An important finding consisted of the necessity of having sufficient information about the disease and available care and having a key contact person to guide you through the process of finding suitable care while monitoring your needs. In addition, it is important to involve your social network as they can take on care-giving tasks. It is helpful to have a diagnosis (in most countries). Concerning decision-making, the person closest to the person with dementia is in the majority of cases the one who makes the ultimate decision to access and use services and he/she should therefore be supported in this process. These results provide insight into the factors that influence the pathway to formal care use and help professionals to enhance access to formal dementia care by focusing on factors that can be modified.

  • 21.
    Källquist, A.
    et al.
    Löwenströmska Hospital, Section North, Forensic Psychiatry Care, Upplands Väsby, Sweden.
    Salzmann-Erikson, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Experiences of Having a Parent with Serious Mental Illness: An Interpretive Meta-Synthesis of Qualitative Literature2019In: Journal of Child and Family Studies, ISSN 1062-1024, E-ISSN 1573-2843, Vol. 28, no 8, p. 2056-2068Article, review/survey (Refereed)
    Abstract [en]

    Objectives: Previous research found that burdens are put on relatives to patients with serious mental illness. A majority of the studies have described the situation of being a husband/wife or parent of someone who is mentally ill. However, little is known about the perspective of childhood experiences and the effect on adult life from having a parent with mental illness. Hence, the purpose of this review was to investigate experiences of having a parent with serious mental illness. Methods: We used a qualitative interpretive meta-synthesis. Five relevant databases were chosen: Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PsycINFO, PubMed and Psychology and Behavioral Sciences Collection. We found 4302 studies in our initial search. Fourteen met the inclusion criteria and the quality assessment. Results: The findings are presented in four themes: (1) Growing up in a dysfunctional home environment; (2) The child’s feelings and thoughts; (3) The need of support; and (4) The lingering effects in adult life. Conclusions: We found that experiences of growing up in a dysfunctional home can result in relational issues later in life and that the need for support can persist into adult life. This has implications for clinical practice when encountering these patients. 

  • 22.
    Lian, Zhengmei
    et al.
    Department of Nursing Sciences, Faculty of Medicine and Health, Lishui University, China.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Li, Caifu
    Department of Nursing Sciences, Faculty of Medicine and Health, Lishui University, China.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Nursing Sciences, Faculty of Medicine and Health, Lishui Universiity, China; Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Nursing students’ reflections on caring for end-of-life patients in a youth volunteer association2019In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 34, p. 204-209Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe nursing students' reflections on caring for end-of-life patients in a youth volunteer service. A purposive sample of 11 nursing students in one province in China were interviewed and diaries were collected. The data were analysed using qualitative content analysis. The students described the service as “an empowering care that makes a difference – but not without challenges on different levels”. The service was said to provide devoted caring adjusted to the person's need, condition and wishes. According to the students, the service had an impact on them; the internal and/or external support was stimulating and rewarding, whereas deficient support was frustrating and made them feel helpless. They emphasized the need for improvements at different levels. In conclusions, the youth volunteer service empowers both patients and students and can be seen as person-centred care. The students' professional knowledge, skills and ability improved, while these aspects were still perceived as deficient. Appropriate curriculum and training for nursing students are necessary and should be tailored to improving students' caring ability and confidence. Expanding the service was emphasized and suggestions for improvements were identified.

  • 23.
    Lindberg, Magnus
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Single-case experimental designs: a clinical research opportunity in renal care2019In: Journal of Renal Care, ISSN 1755-6678, E-ISSN 1755-6686, Vol. 45, no 2, p. 72-73Article in journal (Other academic)
  • 24.
    Lindberg, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Centre for research and Development, Uppsala University, Gävle .
    Carlsson, Marianne
    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.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Nursing student's expectations for their future profession and motivating factors - a longitudinal descriptive study from Sweden2019In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793Article in journal (Refereed)
  • 25.
    Lindberg, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Centre for Research and Development, Uppsala University, Gävle.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Lindberg, Magnus
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Perceptions of infection control practices and the use of vignettes to alter infection control behavior: A feasibility study: Infection control practices2019In: Florence Nightingale Journal of Nursing, ISSN 2147-4923Article in journal (Refereed)
  • 26.
    Löfmark, Anna
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science. Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Ugland Vae, Karen Johanne
    Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Sweden; Nursing Department, Medicine and Health College, Lishui University, China.
    Lecturers' reflection on the three-part assessment discussions with students and preceptors during clinical practice education: A repeated group discussion study2019In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 36, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Assessment of students' learning and achievement requires active involvement of participating students, preceptors and lecturers. The lecturers have overall responsibility for both the content of the assessment and students' learning. The aim of the present study was to investigate lecturers' reflections on the mid-course discussion and final assessment that are part of nursing students' clinical practice education. The design was descriptive and had a qualitative approach. Repeated group discussions were undertaken with 14 lecturers at two university campuses in Norway. Five categories were identified: preparing for the three-part discussion, creating a collaborative atmosphere, facilitating student learning, verifying student learning, using the assessment tool to create the assessment discussion; one theme emerged: ‘being able to see and justify students’ learning processes'. Lecturers' reflections on both assessment discussions and students' learning proceeded from a clear pedagogical viewpoint.

  • 27.
    Marques, Maria J.
    et al.
    CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal.
    Woods, Bob
    Dementia Services Development Centre (DSDC) Wales, Bangor University, United Kingdom.
    Hopper, Louise
    School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland.
    Jelley, Hannah
    Dementia Services Development Centre (DSDC) Wales, Bangor University, United Kingdom.
    Irving, Kate
    School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland.
    Kerpershoek, Liselot
    Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands.
    Meyer, Gabriele
    Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
    Bieber, Anja
    Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
    Stephan, Astrid
    Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
    Sköldunger, Anders
    Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Sjölund, Britt-Marie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm.
    Selbaek, Geir
    Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg.; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
    Rosvik, Janne
    Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg.; Faculty of Medicine, University of Oslo, Oslo.; Centre for Old Age Psychiatric Research, Ottestad, Norway.
    Zanetti, Orazio
    Alzheimer's Research Unit-Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
    Portolani, Elisa
    Alzheimer's Research Unit-Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
    de Vugt, Marjolein
    Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands.
    Verhey, Frans
    Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands.
    Gonçalves-Pereira, Manuel
    CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal.
    Relationship quality and sense of coherence in dementia: results of a European cohort study2019In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 34, no 5, p. 745-755Article in journal (Refereed)
    Abstract [en]

    Objective: Quality of life of people with dementia and their family carers is strongly influenced by interpersonal issues and personal resources. In this context, relationship quality (RQ) and sense of coherence (SOC) potentially protect and promote health. We aimed to identify what influences RQ in dyads of people with dementia and their carers and to examine differences in their perspectives.

    Methods: Cross-sectional data from the Actifcare cohort study of 451 community-dwelling people with dementia and their primary carers in eight European countries. Comprehensive assessments included the Positive Affect Index (RQ) and the Orientation to Life Questionnaire (SOC).

    Results: Regression analyses revealed that RQ as perceived by people with dementia was associated with carer education, stress and spouse caregiving. RQ as perceived by carers was associated with carer stress, depression, being a spouse, social support, reported neuropsychiatric symptoms of dementia and carer SOC. Neuropsychiatric symptoms and carer stress contributed to discrepancies in RQ ratings within the dyad. The only factor associated with both individual RQ ratings and with discrepancies was carer stress (negative feelings sub-score). No significant differences in the overall perception of RQ were evident between spouses and adult children carers, but RQ determinants differed between the two.

    Conclusions: In this European sample, carer SOC was associated with carer-reported RQ. RQ determinants differed according to the perspective considered (person with dementia or carer) and carer subgroup. A deeper understanding of RQ and its determinants will help to tailor interventions that address these distinct perspectives and potentially improve dementia outcomes.

  • 28.
    Persson, Amanda
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science.
    Pihl Kugge, Emil
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science.
    Makars upplevelser av hur livet påverkas av att leva ihop med en person med demens2019Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 29.
    Persson, Carl
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences. Region Gävleborg.
    Adielsson, Johanna
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science. Region Gävleborg.
    Anestesisjuksköterskors upplevelser av att vårda patienter under sekundärtransport: En kvalitativ studie2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Background: The nurse anesthetist is responsible for the patient care during interhospital transport in Sweden and therefore has an important role. Current research describes how nurse anesthetists’ often experience difficulties in their work, in the forms of inadequate communication and the challenges of out-of-hospital patient care. When it comes to nurse anesthetists’ experiences of patient care, however, there is a lack of research in the area of interhospital transport, which thus deserves further attention.

    Purpose: The purpose of the study was to describe nurse anesthetists’ experiences of caring for patients during interhospital transports.

    Method: The study was conducted according to a descriptive design using a qualitative approach. Semi-structured interviews were conducted with ten nurse anesthetists’ at two hospitals located in the middle part of Sweden to collect data. A qualitative content analysis was used to transcribe and analyze the interviews.

    Result: The study results were divided into four categories: To be one step ahead, Profession and responsibility, Patient care during specific circumstances and Teamwork with eight subcategories. These subcategories were; To have a plan of action, To be prepared, Responsibility and personal development, Work experience and competence, To care for young patients, Patient care in ambulance, Support from colleagues and Communication and information.

    Conclusion: To have a plan of action, previous work experience, communication and support from colleagues were factors that affected the nurse anesthetists’ experiences of caring for patients during interhospital transport. These factors were decisive for whether the nurse anesthetists’ experienced caring as positive or negative. The study results indicate that there is a need for clear routines as well as team-based training sessions for every professional involved within interhospital transport.

    Keywords: experiences, interhospital transport, nurse anesthetist

  • 30.
    Pålsson, Ylva
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Mårtensson, Gunilla
    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.
    Hellström-Hyson, Eva
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Leo Swenne, Christine
    Uppsala universitet.
    An intervention study on peer learning2019Conference paper (Refereed)
  • 31.
    Rasmussen, Hege
    et al.
    Clinic for Mental Health and Substance Abuse, Nord-Trøndelag Hospital Trust, Namsos Hospital, Norway; Department of Mental Health, Norwegian University of Science and Technology, Norway.
    Hellzen, Ove
    Mid Sweden University, Mid Sweden University, Sweden.
    Stordal, Eystein
    Clinic for Mental Health and Substance Abuse, Nord-Trøndelag Hospital Trust, Namsos Hospital, Norway; Department of Mental Health, Norwegian University of Science and Technology, Norway.
    Enmarker, Ingela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Family caregivers experiences of the pre-diagnostic stage in frontotemporal dementia2019In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 40, no 3, p. 246-251Article in journal (Refereed)
    Abstract [en]

    Frontotemporal dementia (FTD) is a neurodegenerative disease with symptoms that differs from other dementias. Commonly early symptoms in FTD are changes in personality and behavior, which can be interpreted as psychiatric disease. The delay in FTD diagnosis contributes to the burden of family caregivers. Therefore, it is important to have more knowledge about the pre-diagnostic stage. In this qualitative interview study, we explored fourteen family caregiver's experiences of the pre-diagnostic stage of frontotemporal dementia (FTD). Our findings suggest that the family caregivers experienced the pre-diagnostic stage of FTD as changes in the interpersonal relationship with their loved one. These changes were often subtle and difficult for family caregivers to explain to others. The findings from our study illuminate the importance of medical staff paying attention when a next of kin is concerned about subtle changes in a loved one. The findings also illuminate that awareness of FTD should be raised.

  • 32.
    Richter, Hans
    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. Högskolan i Gävle.
    Domkin, Dmitry
    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.
    Elcadi, Guilherme H.
    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.
    Andersson, H. W.
    Skogforsk, the forestry research institute of Sweden, Uppsala, Sweden.
    Högberg, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Englund, Martin
    Skogforsk, the forestry research institute of Sweden, Uppsala, Sweden.
    A Comparison of Mental and Visual Load Resulting from Semi-automated and Conventional Forest Forwarding: An Experimental Machine Simulation Study2019In: Proceedings of the 20th Congress of the International Ergonomics Association (IEA 2018): Volume X: Auditory and Vocal Ergonomics, Visual Ergonomics, Psychophysiology in Ergonomics, Ergonomics in Advanced Imaging / [ed] Bagnara S., Tartaglia R., Albolino S., Alexander T., Fujita Y., Cham, 2019, 827, Vol. X, p. 199-208Conference paper (Refereed)
    Abstract [en]

    The purpose of the present study was to extend the knowledge offunctional linkages between visual and mental load, performance, and prefrontalcortex (PFC) activity, during forestry forwarding work. Eleven healthy participants,range 21–51 years old, with a minimum of 1-year work experience,carried out the task of loading logs along a standardized path in a machinesimulator during two counterbalanced test conditions: (i) conventional cranecontrol, and; (ii) semi-automated crane control. Mental load was assessed byquantification of oxygenated hemoglobin (HbO2) concentration changes overthe right dorsolateral prefrontal cortex (dlPFC) via non-invasive functional nearinfrared spectrometry (fNIRS). Visual, autonomic, and motoric control variableswere measured and analyzed in parallel along with the individual level of performance.Linear Mixed Models (LMM) analysis indicated more mental loadduring conventional crane work. Collectively, our data suggest that fNIRS is aviable tool which can be used in neuroergonomic research to evaluate physiologicalactivity levels in PFC.

  • 33.
    Rubensson, Anton
    et al.
    Inpatient Care Unit for Patients with Bipolar Disorder, Section for Affective Disorders, Northern Stockholm Psychiatry, Stockholm, Sweden.
    Salzmann-Erikson, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    A document analysis of how the concept of health is incorporated in care plans when using the nursing diagnosis classification system (NANDA-I) in relation to individuals with bipolar disorder2019In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
    Abstract [en]

    Introduction: Nursing diagnosis classification systems have been developed to help nurses identify problems and patient needs. However, the question of how classification systems have adopted the concept of health has been given little attention. Aim: The aim was to explore and analyse which perspectives on health are incorporated into the NANDA-I-based care plans of individuals with bipolar disorder. Methods: A document analysis was used to systematically review and analyse care plans based on nursing diagnosis classification system. Thematic analysis was used as an analytic tool. Findings: The results are presented in three themes: (i) health as strengths; (ii) health as satisfaction; and (iii) health as behaviour and functionality. Discussion: We discuss how health is deeply embedded in nursing diagnosis classification system-based care plans. The care plans correspond to the holistic perspective, as they acknowledge the existence of health even during illness. Further, health is viewed as nonstatic and discussed from the perspective of person-centred care. 

  • 34.
    Salzmann-Erikson, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Stabilitet, rytm och rörelser: att konstruera vårdande i intensiv psykiatri2019In: Vårdande vid psykisk ohälsa: på avancerad nivå / [ed] Lena Wiklund Gustin, Studentlitteratur , 2019, 3, p. 411-432Chapter in book (Other academic)
  • 35.
    Sellberg, Fanny
    et al.
    Department of Public Health Sciences (PHS), Karolinska Institutet, Stockholm, Sweden.
    Possmark, Sofie
    Department of Public Health Sciences (PHS), Karolinska Institutet, Stockholm, Sweden.
    Willmer, Mikaela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Tynelius, Per
    Department of Public Health Sciences (PHS), Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.
    Persson, Margareta
    Department of Nursing, Umeå University, Umeå, Sweden.
    Berglind, Daniel
    Department of Public Health Sciences (PHS), Karolinska Institutet, Stockholm, Sweden.
    Meeting physical activity recommendations is associated with health-related quality of life in women before and after Roux-en-Y gastric bypass surgery2019In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 28, no 6, p. 1497-1507Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Meeting physical activity (PA) recommendations is positively associated with health-related quality of life (HRQoL), but it is still unclear whether PA (specifically objectively measured) is associated with HRQoL in bariatric surgery candidates, both before and after surgery. Thus, the aim of this study was to examine the cross-sectional association between meeting objectively measured PA recommendations and HRQoL before and after Roux-en-Y gastric bypass (RYGB) surgery.

    METHODS: Sixty-six women undergoing RYGB with pre-surgery and 62 women with post-surgery valid PA and HRQoL data were included from the control group of a RCT study aiming at improving HRQoL and PA post-RYGB surgery. Measures before and 12 months after RYGB included the Short Form Health Survey (SF-36) and objectively measured PA, sedentary time (ST), and step counts with GT3X+ accelerometers. Multiple linear regression models were used to analyze the associations between PA and HRQoL.

    RESULTS: Participants who engaged in more than 150 min of moderate to vigorous PA (MVPA)/week (PA recommendations) had considerably higher SF-36 scores (HRQoL) than those who did not, both pre and 12-month post-surgery, with greatest difference in the subscale bodily pain, 15.5 (p = 0.021) higher score (higher scores means less pain) pre-surgery and a 19.7 (p = 0.004) higher score post-surgery. Higher LPA and step counts and lower ST also showed positive associations in some of the subscales of SF-36.

    CONCLUSIONS: Meeting the PA recommendations and overall engaging in more PA was associated with higher HRQoL, pre-, and post-RYGB surgery, highlighting the importance of PA both pre- and post-surgery.

  • 36.
    Silén, Marit
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of 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 Caring Sciences, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, China.
    Relationships between structural and psychological empowerment, mediated by person-centred processes and thriving for nursing home staff2019In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 40, no 1, p. 67-71Article in journal (Refereed)
    Abstract [en]

    Person-centred care has been shown to have positive outcomes for patients and for staff. However, the complexity of the link between structural conditions, work in a person-centred manner and outcomes for staff is insufficiently described. We tested the relationship between structural empowerment and psychological empowerment, as mediated by nursing home staff members’ self-ratings of working in a person-centred manner, the person-centred climate and thriving. Questionnaires were distributed to staff working in 12 nursing homes in Sweden. A serial mediation model was tested. The results showed that higher access to structural empowerment was related to higher psychological empowerment mediated by staff working in a more person-centred manner, improved person-centred climate, and improved staff ratings of thriving. These results point to the importance of strengthening the preconditions for staff to work in a person-centred manner and nursing home managers play an important role in this.

  • 37.
    Silén, Marit
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Svantesson, Mia
    Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Impact of clinical ethics support on daily practice-First-line managers' experiences in the Euro-MCD project2019In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834Article in journal (Refereed)
    Abstract [en]

    AIM: To explore first-line managers' experiences of what Moral Case Deliberation has meant for daily practice, to describe perceptions of context influence and responsibility to manage ethically difficult situations.

    BACKGROUND: In order to find measures to evaluate Moral Case Deliberation, the European Moral Case Deliberation Outcome instrument was developed and is now in the stage of revision. For this, there is a need of several perspectives, one of them being the managerial bird-eye perspective.

    METHOD: Eleven first-line managers at workplaces, participating in the European Moral Case Deliberation Outcome instrument project, were interviewed and thematic analysis was applied.

    RESULTS: Managers' experiences were interpreted as enhanced ethical climate: a closer-knit and more emotionally mature team, morally strengthened individuals, as well as ethics leaving its marks on everyday work and morally grounded actions. Despite organizational barriers, they felt inspired to continue ethics work.

    CONCLUSION AND IMPLICATIONS: This study confirmed, but also added ethical climate aspects, such as morally grounded actions. Furthermore, adding ethical climate as a construct in the European Moral Case Deliberation Outcome instrument should be considered. First-line managers need clear directives from their managers that ethics work needs to be prioritized for the good of both the staff and the patients.

  • 38.
    Silén, Marit
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Svantesson, Mia
    Örebro universitet.
    Is ethical climate an outcome of Moral Case Deliberation?2019Conference paper (Refereed)
  • 39.
    Stenberg, Jenny
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Melin, Jan
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Lindberg, Magnus
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Furuland, Hans
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Brain natriuretic peptide reflects individual variation in hydration status in hemodialysis patients2019In: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 23, no 3, p. 402-413Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Fluid management in hemodialysis patients is a controversial topic. Brain natriuretic peptide (BNP) is secreted from the heart in response to volume overload, and may be a marker of overhydration in hemodialysis patients. Our aim was to investigate the correlation between BNP and overhydration in a cohort of hemodialysis patients, and to find out whether BNP and overhydration correlate in repeated measurements within individuals with elevated BNP.

    METHODS: The study was prospective, observational, and had a cross-sectional part and a longitudinal follow-up. The distribution of BNP was investigated in a cohort of 64 hemodialysis patients. Blood samples and bioimpedance spectroscopy measurements were performed before midweek dialysis. Subsequently, 11 study participants with elevated BNP concentrations (>500 pg/mL) were assessed in another nine dialysis sessions each. These individuals also had their cardiac function and heart rate variability (HRV) examined.

    FINDINGS: BNP was above 500 pg/mL in 38% of the participants, and correlated positively with overhydration (rs = 0.381), inflammation and malnutrition, but not with systolic blood pressure. In comparison to participants with BNP below 500 pg/mL, participants with elevated BNP were older, had lower muscle strength, lower bodyweight and lower levels of hemoglobin and albumin. Echocardiography revealed cardiac anomalies in all 11 participants in the longitudinal follow-up, and HRV, as measured by SDNN, was pathologically low. In repeated measurements, the between-individuals variation of BNP in relation to overhydration was greater (SD = 0.581) than the within-person variation (SD = 0.285).

    DISCUSSION: BNP correlates positively to overhydration, malnutrition, and inflammation. In a subgroup of patients with elevated BNP, who are mainly elderly and frail, BNP reflects individual variation in hydration status, and hence seems to be a modifiable marker of overhydration. These data suggest that BNP is best applied for measuring changes in hydration status within an individual over time.

  • 40.
    Stephan, Astrid
    et al.
    Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
    Bieber, Anja
    Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
    Hopper, Louise
    School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland.
    Joyce, Rachael
    School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland.
    Irving, Kate
    School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland.
    Zanetti, Orazio
    Alzheimer Unit, Brescia (BS), Italy.
    Portolani, Elisa
    Alzheimer Unit, Brescia (BS), 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, Tønsberg, Norway.
    Røsvik, Janne
    Department of Geriatric Medicine, Oslo University Hospital, Aldring og Helse, Oslo, Norway.
    Marques, Maria J.
    Chronic Diseases Research Center, Nova Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portuga.
    Gonçalves-Pereira, Manuel
    Chronic Diseases Research Center, Nova Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portuga.
    Sjölund, Britt-Marie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science.
    Jelley, Hannah
    Dementia Services Development Centre Wales, Bangor University, Bangor, UK.
    Woods, Bob
    Dementia Services Development Centre Wales, Bangor University, Bangor, UK.
    Meyer, Gabriele
    Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
    Broda, A. (Contributor)
    Bartoszek, G. (Contributor)
    Orrell, M. (Contributor)
    Wimo, A. (Contributor)
    Sköldunger, A. (Contributor)
    Engedal, K. (Contributor)
    Selbæk, G. (Contributor)
    Michelet, M. (Contributor)
    Irving, K. (Contributor)
    Conceição Balsinha, M. (Contributor)
    Bárrios, H. (Contributor)
    Machado, A. (Contributor)
    Barriers and facilitators to the access to and use of formal dementia care: findings of a focus group study with people with dementia, informal carers and health and social care professionals in eight European countries2018In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, no 1, article id 131Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: People with dementia and informal carers often access formal care late in the process of dementia. The barriers and facilitators to service use from the perspectives of different stakeholders involved are not well understood. Thus, we aimed to explore the barriers and facilitators of access to and utilisation of formal care from the perspectives of people with dementia, their informal carers and health and social care professionals.

    METHOD: Focus groups with people with dementia, informal carers and professionals were conducted in eight European countries. Recruitment targeted people with dementia, informal carers with experience of formal care and professionals involved in providing (access to) formal care. Qualitative content analysis using open coding was used on a national level. Cross-national synthesis was based on the translated national reports.

    RESULTS: Overall, 55 focus groups with 261 participants were conducted, involving 51 people with dementia, 96 informal carers and 114 professionals. Sixteen categories describing barriers and facilitators were identified, referring to three global themes: Aspects related to 1) individuals involved, 2) the system or 3) overarching aspects. The attitudes and beliefs of people with dementia and their carers may have a major impact, and they often serve as barriers. Formal care was perceived as a threat to the individual independence of people with dementia and was thus avoided as long as possible. A healthcare professional serving as a constant key contact person could be an essential facilitator to overcome these barriers. Contact should be initiated proactively, as early as possible, and a trusting and consistent relationship needs to be established. Beyond that, the findings largely confirm former research and show that barriers to accessing and using formal care still exist across Europe despite a number of national and European initiatives.

    CONCLUSION: Further investigations are needed to elaborate how the concept of a key contact person could be integrated with existing case management approaches and how the independence and autonomy of people with dementia can be strengthened when formal care needs to be accessed and used. These may be meaningful facilitators regarding enhanced access to formal care for people with dementia and their families.

  • 41.
    Strömberg, Annika
    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.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Hagerman, Heidi
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    First-line managers dealing with different management approaches2019In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887Article in journal (Refereed)
    Abstract [en]

    Purpose – The purpose of this paper is to contribute new knowledge about how first line managers (FLMs) in elderly care perceive their situation, with a focus on differences in management approaches at the intersection of the central and local parts of the organization.

    Design/methodology/approach – The present study has a qualitative approach and is part of a larger project on FLMs in elderly care. The results presented here are based on a secondary analysis of 15 of the totalof 28 interviews carried out in the project.

    Findings – Themain results are twofold: the majority of FLMs perceived differences in management approaches between local and central management; the differences caused some struggle because FLMs perceived that the management system did not support the differences. The two main aspects that caused the FLMs to struggle were differences in the foci of the management levels and difficulties in influencing the conditions ofmanagement.

    Originality/value – The results contribute to the debate on what aspects are important to sustainable management of elderly care. It is common knowledge that FLMs have a complex position, intermediate to the central, upper level management and their subordinates at the local level – levels with different foci and interests. The study contributes new knowledge about what these differences consist of and the dilemmas they cause and offers suggestions as to what can be done to reduce both energy waste and the risk of low job satisfaction.

  • 42.
    Sundbom Thunander, Lena
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Hedborg, Kerstin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Association between prescribed antidepressants and other prescribed drugs differ by gender: a nationwide register-based study in Sweden2019In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 73, no 1, p. 73-79Article, review/survey (Refereed)
    Abstract [en]

    Background: People with depression are prescribed more drugs than people in general,partly due to comorbidity with other conditions. However, little research has been done on depression-related drug use from a gender perspective.

    Aim: Examine the association between antidepressants, other types of prescribed drugs, and polypharmacy, by gender.

    Methods: Data on drugs dispensed October to December 2016 to all Swedish citizens aged 18-84 years were collected from the Swedish prescribed drug register. Logistic regression analyses were performed to examine the associations between antidepressantsand other drugs, by gender.

    Results: For both men and women, associations were found between antidepressants and drugs for alimentary tract problems, respiratory problems, blood, nervous system, analgesics, and polypharmacy. However, for women, but not men, associations were alsofound for drugs for diabetes, musculoskeletal problems, dermatological problems, and systemic hormones. 

    Conclusions: Associations were found between antidepressants and many other types of drugs for both men and women; indicating comorbidity between depression and other conditions.Further, several of the associations between antidepressants and other drugs were found to be specific among women. Whether this indicates that men and women differ in comorbidity between depression and other conditions cannot be concluded based on this cross-sectional study. However, comorbidity impairs the possibility of recovery; in the somatic condition as well as the depression. Thus,physicians need to be aware of that the association between antidepressants and other types of drugs are more common among women than men.

  • 43.
    Voraroon, Supaporn
    et al.
    Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden; Boromarajonani College of Nursing, Suphanburi, Thailand.
    Hellzen, Ove
    Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden.
    Enmarker, Ingela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Meebunmak, Yaowaluck
    Boromarajonani College of Nursing, Ratchaburi, Thailand.
    Devik, Siri Andreassen
    Centre for Care Research Mid-Norway, Steinkjer, Norway.
    The impact of shareholding networks for facilitating care in rural Thailand.2019In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 40, no 4, p. 392-398Article in journal (Refereed)
    Abstract [en]

    This study explored the existential meaning of being a participant in shareholding networks for the care of older people in Thailand. Ten older persons were interviewed about their experiences of participating in the networks. A reflective lifeworld perspective based on phenomenological philosophy was used. The findings show that participating in shareholding network activities entails an always-present existence of aging intertwined with life. Its constituents further describe the essential meaning of the phenomenon: "experience of improved self-management", "feeling of increased self-esteem", and "bridging a gap in the care of older people". Participation in shareholding network activities means keeping contact with oneself and being able to have a life that corresponds to how one perceives oneself to be and must therefore be understood from a holistic perspective. The present study recommends that older persons' need for support include places where safe and profound reflection on existential issues.; Copyright © 2019. Published by Elsevier Inc.

  • 44.
    Wiitavaara, Birgitta
    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.
    Rissén, Dag
    Region Gävleborg.
    Högberg, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala universitet.
    Psychometric testing of a short form questionnaire for measurement of health experiences among people with musculoskeletal disorders undergoing multimodal rehabilitation2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e025103Article in journal (Refereed)
    Abstract [en]

    Aim

    The aim of present study was to assess if a previously suggested short-form questionnaire tested among women with non-specific neck-shoulder pain is suitable also for use among men and women with non-specific musculoskeletal disorders in any part of the body, by testing its construct validity by a confirmatory factor analysis. If not, the secondary aim was to investigate the evolving factor structure when performing an explorative factor analysis of data in the expanded sample.

    Methods

    Questionnaire data was collected in three different contexts, in primary care via eight different multimodal rehabilitation teams, in specialised care via two different specialist care centres. The sample consisted of 116 participants, male (n=29) and female (n=87) with non-specific musculoskeletal disorders.

    Data was analysed using confirmatory and exploratory factor analysis and a visual comparison between the result of the Principal Component Analysis in present study, and the results attained in a previous study with a similar aim and design.

    Results

    The confirmatory factor analyses did not end up in a model with acceptable measures for validity. Three models were tested, none of them met the criterion for an acceptable model and the goodness-of-fit statistics were not fully acceptable. The exploratory factor analysis had an only partly comparable result, compared to previous study.

    Conclusion

    The results of present study did not prove the suggested short form questionnaire to be suitable for evaluation of symptoms among men and women with non-specific musculoskeletal disorders in any part of the body. Further studies including larger samples are recommended.

  • 45.
    Wijk, Katarina
    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. Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Åberg Jönsson, Fredrik
    Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden.
    Lindberg, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Perceived enabling factors and barriers for the implementation of improvements in health care in order to achieve patient-centred care: A case report from Sweden2019In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753Article in journal (Refereed)
    Abstract [en]

    Abstract Rationale, aim, and objectives More knowledge is needed regarding the complex factors and perceptions that enable the implementation of change in health care. The study aimed to examine the enabling factors and barriers encountered in the implementation of improvements in health care in order to achieve patient-centred care (PCC) and to study if there was a correlation in the extent the improvements were perceived to be implemented and the preconditions that were considered to affect them. Methods Using a mixed method design, data were gathered via a questionnaire and individual interviews with health care personnel, clinic managers, and first-line managers. The data collection and analyses were based on the framework for Promoting Action on Research Implementation in Health Services (PARiHS). Correlations between PCC improvements and preconditions for improvements were performed. Results A high level of involvement, knowledge, and adequate resources were considered important to achieve an implementation of PCC with joint responsibility. Leadership and management need to be explicit and promote continuous follow-up and feedback. Preconditions for improvement had a linear correlation with the perceived level of implementation. Knowledge-related preconditions had greatest impact on implementation. Conclusions The PARiHS framework was appropriate to use since the three components of evidence, context, and facilitation present different important preconditions in the implementation process. Evidence was the highest rated contributor since evidence-based practices in health care are necessary. It is vital that the important role of the context and facilitators is acknowledged in the implementation process to enable a successful implementation of change. There is a need to incorporate a clear strategy involving all levels in the organization. Furthermore, leaders play an important role in the implementation by facilitating communication and support and by having trust in facilitators and health care personnel. The results are applicable to other interventions implementing change in health care.

  • 46.
    Wijk, Katarina
    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. Uppsala university; Region Gävleborg.
    Åberg Jönsson, Fredrik
    Region Gävleborg.
    Lindberg, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala university; Region Gävleborg.
    Perceived enabling factors and barriers for the implementation of improvements in health care in order to achieve patient‐centred care: A case report from Sweden2019In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753Article in journal (Refereed)
    Abstract [en]

    Rationale, aim, and objectives

    More knowledge is needed regarding the complex factors and perceptions that enable the implementation of change in health care. The study aimed to examine the enabling factors and barriers encountered in the implementation of improvements in health care in order to achieve patient‐centred care (PCC) and to study if there was a correlation in the extent the improvements were perceived to be implemented and the preconditions that were considered to affect them.

    Methods

    Using a mixed method design, data were gathered via a questionnaire and individual interviews with health care personnel, clinic managers, and first‐line managers. The data collection and analyses were based on the framework for Promoting Action on Research Implementation in Health Services (PARiHS). Correlations between PCC improvements and preconditions for improvements were performed.

    Results

    A high level of involvement, knowledge, and adequate resources were considered important to achieve an implementation of PCC with joint responsibility. Leadership and management need to be explicit and promote continuous follow‐up and feedback. Preconditions for improvement had a linear correlation with the perceived level of implementation. Knowledge‐related preconditions had greatest impact on implementation.

    Conclusions

    The PARiHS framework was appropriate to use since the three components of evidence, context, and facilitation present different important preconditions in the implementation process. Evidence was the highest rated contributor since evidence‐based practices in health care are necessary. It is vital that the important role of the context and facilitators is acknowledged in the implementation process to enable a successful implementation of change. There is a need to incorporate a clear strategy involving all levels in the organization. Furthermore, leaders play an important role in the implementation by facilitating communication and support and by having trust in facilitators and health care personnel. The results are applicable to other interventions implementing change in health care.

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