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  • 1.
    Abdelrazek, Fathya
    et al.
    Faculty of Nursing, Suez Canal University, Port-Said, Egypt.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Aly, Magda
    Faculty of Nursing, Suez Canal University, Port-Said, Egypt.
    El-Sabour, Mona Abd
    Faculty of Nursing, Suez Canal University, Port-Said, Egypt.
    Ibrahim, Naglaa
    Faculty of Nursing, Suez Canal University, Port-Said, Egypt.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Leadership and management skills of first-line managers of elderly care and their work environment2010In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 18, no 6, p. 736-745Article in journal (Refereed)
    Abstract [en]

    Aim To study the leadership and management skills of first-line managers (FLMs) of elderly care and their work environment in Egypt and Sweden. Background FLMs in Egypt and Sweden are directly responsible for staff and quality of care. However, FLMs in Sweden, in elderly care, have smaller units/organizations to manage than do their colleagues in Egypt. Furthermore, family care of the elderly has been the norm in Egypt, but in recent years institutional care has increased, whereas in Sweden, residential living homes have existed for a longer period. Methods A convenience sample of FLMs, 49 from Egypt and 49 from Sweden, answered a questionnaire measuring leadership and management skills, structural and psychological empowerment, job satisfaction and psychosomatic health. Results In both countries, FLMs' perceptions of their leadership and management skills and psychological empowerment were quite high, whereas scores for job satisfaction and psychosomatic health were lower. FLMs had higher values in several factors/study variables in Egypt compared with in Sweden. Conclusion and implications The work environment, both in Egypt and Sweden, needs to be improved to increase FLMs' job satisfaction and decrease stress. The cultural differences and levels of management have an effect on the differences between the two countries.

  • 2.
    Björkman, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, Lishui, China .
    Olsson, Annakarin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Wahlberg, Anna Carin
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Identified obstacles and prerequisites in telenurses’ work environment: a modified Delphi study2017In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, no 1, article id 357Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 3.
    Blanck, Susanne
    et al.
    Baldersnäs Din Hälsocentral, Bollnäs, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    District nurses' prescribing practice and its link to structural conditions2015In: Journal of the American Association of Nurse Practitioners, ISSN 2327-6886, E-ISSN 2327-6924, Vol. 27, no 10, p. 568-575Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe district nurses' (DNs') prescribing practice and examine associations between DNs' self-reported prescribing frequency, opinions about prescribing, and structural conditions/empowerment.

    Data sources: A cross-sectional and correlational design was employed. Data were collected during 2012 using questionnaires and a prescribing register. A random sample of 150 DNs from 32 primary care centers in Sweden was invited.

    Conclusions: DNs' ability to prescribe is used to a relatively small extent and access to "opportunities" and "informal power" seems to be the most important structural empowerment conditions for increased prescribing frequency and positive opinions about prescribing. The results support Kanter's theory of structural empowerment.

    Implications for practice: This article regarding restricted prescribing shows how important structural conditions/empowerment is to DNs' prescribing and employers have to enhance nurses' access to especially the structures "opportunities" and "informal power" to increase nurse prescribing. More targeted support and training are needed in different prescribing areas to make use of DNs' prescription qualification to a greater extent.

  • 4.
    Bååth, Carina
    et al.
    Faculty of Health, Sciences and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden; County Council of Värmland, Karlstad, Sweden .
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    Gunningberg, Lena
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Surgery and Oncology Division, Uppsala University Hospital, Uppsala, Sweden .
    Muntlin Athlin, Åsa
    Uppsala University, Uppsala, Sweden; Uppsala University Hospital, Uppsala, Sweden; University of Adelaide, Adelaide, Australia; .
    Prevention of heel pressure ulcers among older patients - from ambulance care to hospital discharge: a multi-centre randomized controlled trial2016In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 30, p. 170-175Article in journal (Refereed)
    Abstract [en]

    The aim was to investigate the effect of an early intervention, a heel suspension device boot, on the incidence of heel pressure ulcers among older patients (aged 70 +). Background: Pressure ulcers are a global healthcare issue; furthermore, the heel is an exposed location. Research indicates that preventive nursing interventions starting during the ambulance care and used across the acute care delivery chain are seldom used. Methods: A multi-centre randomized control study design was used. Five ambulance stations, two emergency departments and 16 wards at two Swedish hospitals participated. Altogether, 183 patients were transferred by ambulance to the emergency department and were thereafter admitted to one of the participating wards. Results: Significantly fewer patients in the intervention group (n=15 of 103; 14.6%) than the control group (n=24 of 80; 30%) developed heel pressure ulcers during their hospital stay (p=0.017). Conclusions: Pressure ulcer prevention should start early in the acute care delivery chain to increase patient safety.

  • 5.
    Candell, Agneta
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Dental hygienists' work environment: motivating, facilitating, but also trying2010Conference paper (Other (popular science, discussion, etc.))
  • 6.
    Candell, Agneta
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala universitet.
    Dental hygienists’ work environment: motivating, facilitating, but also trying2010In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 8, no 3, p. 204-212Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to describe dental hygienists' experiences of their physical and psychosocial work environment. The study was descriptive in design and used a qualitative approach. Eleven dental hygienists participated in the study and data were collected during spring 2008 using semi-structured interviews. The material was analysed using qualitative content analysis. The results showed that the dental hygienists experienced their work environment as motivating and facilitating, but at the same time as trying. The three categories revealed a theme: Being controlled in a modern environment characterized by good relationships. Motivating factors were the good relationship with co-workers, managers and patients, seeing the results of your work, having your own responsibility and making your own decisions. The new, pleasant and modern clinics, good cooperation between co-workers and varying duties were described as facilitating factors. The trying factors, as described by the dental hygienists, were above all being controlled by time limits or by some elements of the work, such as teamwork. The dental hygienists also felt stress because appointments were too-short. To conclude, the participants described their work environment as trying in several ways, despite the modern clinics and good relationships.

  • 7.
    Dahlkvist, Eva
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Health and Medicine, Örebro University, Örebro, Sweden.
    Hartig, Terry
    Department of Psychology, Uppsala university, Uppsala, Sweden; Institute for Housing and Urban Research,Uppsala university, Uppsala, Sweden.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Högberg, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Skovdahl, Kirsti
    Faculty of Health Sciences, Buskerud and Vestfold university, Norway.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Garden greenery and the health of older people in residential care facilities: A multi-level cross-sectional study2016In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 9, p. 2065-2076Article in journal (Refereed)
    Abstract [en]

    AIMS:

    To test the relationship between greenery in gardens at residential facilities for older people and the self-perceived health of residents, mediated by experiences of being away and fascination when in the garden and the frequency of visitation there. To examine how these indirect effects vary with the number of physical barriers to visiting the garden.

    BACKGROUND:

    Many older people in residential facilities suffer from complex health problems. Access to a green outdoor environment may enable psychological distance, engage effortless attention, encourage more frequent visitation and promote resident health.

    DESIGN:

    A multi-level, cross-sectional, correlational design.

    METHODS:

    Questionnaires were administered June-August, 2011 to convenience samples of residents at 72 facilities for older people with complex healthcare needs. One to 10 eligible residents were sampled during self-motivated garden visits at each facility (n = 290). They reported on their garden experiences and health. Facility staff reported on objective garden characteristics and barriers to access. A serial mediation model was tested with multiple linear regression analysis.

    RESULTS:

    The total indirect effect of greenery on self-perceived health was positive and significant. Garden greenery appears to affect health by enhancing a sense of being away, affording possibilities to experience the outdoor environment as interesting and encouraging visitation. Among residents in homes with multiple barriers, only fascination mediated the relationship between greenery and self-perceived health.

    CONCLUSION:

    Ample greenery in outdoor space at residential facilities for older people appears to promote experiences of being away and fascination, more frequent visitation and better health.

  • 8.
    Dahlkvist, Eva
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Health and Medicine, Örebro University.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University.
    Skovdahl, Kirsti
    Örebro Universitet, Institutionen för Hälsovetenskap och medicin.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University.
    Is there a caring perspective in garden/patio design in elderly care?: a description and a comparison of residents' and staff members' perceptions of these outdoor spaces2014In: Journal of Housing for the Elderly, ISSN 0276-3893, E-ISSN 1540-353X, Vol. 28, no 1, p. 85-106Article in journal (Refereed)
    Abstract [en]

    This article aimed to describe characteristics of and design elements in gardens/patios at 87 residential living homes for older people and to describe and compare residents’ and staff members’ perceptions of these spaces. The result showed that many gardens/patios had several recommended design elements and at the same time obvious deficiencies. The residents (n=415) valued various aspects of the garden/patio more highly than the staff did (n=667). One conclusion is that managers responsible for residential living homes for older people should pay attention to and takes measures to ameliorate shortcomings and deficient elements in design and accessibility so that the garden/patio can be used as an important health promotion resource in the care of older people. Residents and staff can be seen as very important actors in such development work.

     

  • 9.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap..
    A Caregiver Perspective on Incorporating IT support into Dementia Care2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The overall aim of the present thesis was to describe and evaluate IT support in dementia care from the perspectives of staff and relatives. More specifically, it was to examine staff members’ satisfaction with work, life satisfaction and sense of coherence before and after increased IT support, to describe staff members’ opinions and perceptions of IT support during the process of implementation, to describe relatives’ opinions of IT support and to compare relatives’ perceptions of their irritations with care and life satisfaction before and after increased IT support. In addition, three questionnaires were further developed and tested among staff working in elderly care, and then used in the staff evaluation. Methods: A quasi-experimental design with baseline assessments and follow-ups and experimental and control groups was used in two studies to investigate the outcomes of IT support. A descriptive design was used to study staff views on IT support, and a correlative design was used in the methodological study. Participants were 33 staff members and 22 relatives in the evaluation, 14 staff members in the descriptive study and 299 staff members in the methodological study. Data collection methods were questionnaires and group interviews. The IT support consisted of passive passage alarms, fall detectors, sensor-activated night-time illumination of the lavatory, movement detectors, email communication, an Internet website and additional computers. Findings and conclusions: Staff job satisfaction and perceived quality of care increased in the experimental group. The relatives were generally positive about the IT support, and the experimental group showed a decrease in practical/logistical irritations. Staff described ‘moving from fear of losing control to perceived increase in control and security’ and ‘constant struggling with insufficient/deficient systems’. Conclusions are that IT support can be a resource in dementia care as perceived by caregivers if IT support is incorporated into the care system.

  • 10.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    IT-stöd i vården av personer med demens2007Other (Other (popular science, discussion, etc.))
  • 11.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Robotar i vård och omsorg: hur kan vi skapa en användar- och behovsdriven teknikutveckling som kompletterar den befintliga omsorgen/vården?2006In: Teknik & Vetenskap, ISSN 1402-5701, Vol. 22, no 4, p. 52-52Article in journal (Other (popular science, discussion, etc.))
  • 12.
    Engström, Maria
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Lindqvist, Ragny
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Ljunggren, Birgitta
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Carlsson, Marianne
    Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Relatives’ opinions of IT support, perceptions of irritations and life satisfaction in dementia care2006In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 12, no 5, p. 246-250Article in journal (Refereed)
    Abstract [en]

    We studied relatives' opinions of IT support at a residential home for persons with dementia. We also investigated the relatives' perceptions of irritations and life satisfaction before and after increased IT support. This was accomplished using an experimental group (n = 14) and a control group (n = 8) of subjects in dementia care. The design was quasi-experimental with baseline assessments and three follow-ups. Data were collected using two questionnaires measuring opinions of the IT support: irritations in care (the Nursing Home Hassles Scale) and life satisfaction (the Life Satisfaction Questionnaire). Results showed that relatives' opinions of IT support were generally positive. In the experimental group, relatives' perceptions of practical/logistical irritations decreased between baseline and 12-month follow-up. In the control group, there was an increase in the total Nursing Home Hassles score between baseline and three-month follow-up. This difference did not persist at seven- and 12-month follow-ups. No significant differences were found for life satisfaction. We conclude that relatives had positive opinions of IT support, and their perceptions of practical/logistical irritations decreased after implementation of the IT support package.

  • 13.
    Engström, Maria
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Lindqvist, Ragny
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Ljunggren, Birgitta
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Carlsson, Marianne
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Staff members' perceptions of a ICT support package in dementia care during the process of implementation2009In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 17, no 7, p. 781-789Article in journal (Refereed)
    Abstract [en]

    Aim The aim of the present study was to describe staff members' perceptions of an information and communication technology (ICT) support package during the process of implementation. Background ICT in dementia care will likely increase in the future. The diffusion of new innovations can be better understood through diffusion research. Methods Fourteen staff members in dementia care were interviewed, in groups, once before the new ICT, twice during its implementation and once after. Data were analysed using qualitative content analyses. The ICT included monitors/alarms: passage alarms, fall detectors, sensor-activated night-time illumination of the lavatory, and communication technology: Internet communication and additional computers. Results The results showed two themes 'Moving from fear of losing control to perceived increase in control and security' and 'Struggling with insufficient/deficient systems'. Conclusions Staff perceptions of ICT were diverse and changed during the implementation. Benefits were more pronounced than disadvantages, and improvements were described both in care and in staff job situation. Implications for nursing management Functioning and use of ICT may relate to design as well as by application and the surrounding structure, and the whole system: the organizational structure, the employers and the new product needs to be taken into consideration when implementing new technology.

  • 14.
    Engström, Maria
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Ljunggren, Birgitta
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Lindqvist, Ragny
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Carlsson, Marianne
    Staff perceptions of job satisfaction and life situation before and 6 and 12 months after increased information technology support in dementia care2005In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 11, no 6, p. 304-309Article in journal (Refereed)
    Abstract [en]

    We measured staff members' satisfaction with their work before and after increased information technology (IT) support in dementia care. Comparisons were also performed of perceived life satisfaction and sense of coherence. Data were collected before, and 6 and 12 months after implementation of the first part of an IT support project. Instruments used were the Satisfaction with Work Questionnaires, the Life Satisfaction Questionnaire (LSQ) and the Sense of Coherence (SOC) scale. The study was performed in a residential home for persons with dementia. The participants were 33 staff members. The IT technology included general and individualized passage alarms, sensor-activated night-time illumination, fall detectors and Internet communication. Results showed that staff members' job satisfaction and perceived quality of care improved in comparison with the control group. Personal development, workload, expectations and demands, internal motivation and documentation, as well as the total scores for 'psychosocial aspects of job satisfaction' and 'quality of care aspects', increased in the experimental group. There were significant interaction effects for the factors family relation, close friend relation (LSQ), the total SOC scale and the meaningfulness subscale. The study showed that IT support in dementia care increased staff members' satisfaction with their work in several ways.

  • 15.
    Engström, Maria
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Ljunggren, Birgitta
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Lindqvist, Ragny
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Carlsson, Marianne
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Staff satisfaction with work, perceived quality of care and stress in elderly care: psychometric assessments and associations2006In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 14, no 4, p. 318-328Article in journal (Refereed)
    Abstract [en]

    AIMS: To evaluate validity and reliability of three questionnaires measuring 'work satisfaction', 'patient care' and 'staff health' for staff in elderly care and to study the relationship between staff members' satisfaction with work and perceived stress.

    BACKGROUND: Increased workload, difficulties in recruiting and retaining nurses are reported in elderly care. Valid and reliable instruments measuring staffs' perceptions of work are needed.

    METHODS: A convenience sample of 299 staff answered the questionnaires.

    RESULTS: Factor analysis of 'work satisfaction' gave eight factors, 'patient care' four factors and 'staff health' two factors, explaining 52.2%, 56.4% and 56.8% of the variance. Internal consistency was mostly satisfactory. Multiple regression analysis revealed a model that explained 41% of the variance in perceived stress symptoms.

    CONCLUSIONS: There was support for the instruments' validity and reliability. Older age, higher scores/satisfaction with workload, cooperation, expectations and demands, personal development and lower scores on internal motivation contributed to less stress.

  • 16.
    Engström, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Sweden; Nursing Department, Medicine and Health College, Lishui University, China .
    Löfmark, Anna
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Faculty of Health Education, Stord/Haugesund University College, Norway.
    Ugland Vae, Karen Johanne
    Faculty of Health Education, Stord/Haugesund University College, Norway.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Nursing students' perceptions of using the Clinical Education Assessment tool AssCE and their overall perceptions of the clinical learning environment: a cross-sectional correlational study2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 51, p. 63-67Article in journal (Refereed)
    Abstract [en]

    Background

    Clinical education is a vital part of nursing students' learning; the importance of assessment tools and feedback in stimulating student learning has been stressed, but this needs to be studied in more detail.

    Objectives

    To examine relationships between nursing students' perceptions of using an Assessment tool in Clinical Education (AssCE) during their mid-course discussion and final assessment, the content discussed during these meetings between the student, preceptor and nurse teacher and the students' overall perception of the clinical learning environment.

    Design

    A cross-sectional, correlational design was used.

    Setting and Participants

    A convenience sample of 110 nursing students from one Norwegian university college with two campuses.

    Methods

    Data were collected with self-developed questionnaires and analysed using logistic regression with SPSS and the PROCESS macro for mediation analysis.

    Results

    There was a positive relationship between nursing students' perceptions of using the assessment tool AssCE and their overall perception of the clinical learning environment. This relationship was, in turn, mediated by the content discussed during the formative mid-course discussion and summative final assessment.

    Conclusions

    Our conclusion is that the assessment tool AssCE supported students' clinical learning and that this relationship, in turn, was mediated by the degree to which the conversation during the assessment meeting focused on the student's knowledge, skills and professional judgement.

  • 17.
    Engström, Maria
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Scandurra, Isabella
    Centre for eHealth, Uppsala University, Uppsala, Sweden.
    Ljunggren, Birgitta
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Lindqvist, Ragny
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Swedentet.
    Koch, Sabine
    Centre for eHealth, Uppsala University, Uppsala, Sweden.
    Carlsson, Marianne
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Evaluation of OLD@HOME virtual health record: staff opinions of the system and satisfaction with work2009In: Telemedicine journal and e-health, ISSN 1530-5627, E-ISSN 1556-3669, Vol. 15, no 1, p. 53-61Article in journal (Refereed)
    Abstract [en]

    The aim of the present research was to study outcomes of use of the OLD@HOME Virtual Health Record with regard to staff opinions about information, communication technology, and satisfaction with work. A quasi-experimental design was used. Staff opinions about the information and communication technology were assessed using a study-specific questionnaire at the test site (n =22) and at other settings in the municipality (n =172). Staff (n =22) job satisfaction, perceived quality of care, and psychosomatic health were assessed using the Satisfaction with Work Questionnaires before and after a 5-month period of testing the technology in an intervention and a comparison group. Staff opinions about the information and communication technology were significantly more positive at the test site compared to other settings in the municipality. For the total scale of quality of care and the factor documentation, there were significant differences in change scores between intervention and comparison groups, with improvements for the comparison group. For job satisfaction and psychosomatic health, there were no differences in change scores between the groups. Participatory design enhances staff opinions about information and communication technology. However, a 5-month test period showed no benefits regarding staff satisfaction with work when compared to a comparison group. On the contrary, the comparison group improved in documentation, and for the intervention group, there was a trend toward deterioration, which may be due to their knowing how to document, but not having time when using both paper-based and electronic systems.

  • 18.
    Engström, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Ernesäter, Annica
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Fläckman, Birgitta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Mamhidir, Anna-Greta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    District nurses' self-reported clinical activities, beliefs about and attitudes towards obesity management2013In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 26, no 4, p. 198-203Article in journal (Refereed)
    Abstract [en]

    AIM:

    To describe district nurses' self-reported clinical activities, beliefs about and attitudes towards obesity management; and to examine associations between the variables.

    BACKGROUND:

    Obesity is increasing worldwide and primary care could play a central role in the management.

    METHODS:

    Questionnaire data were collected from 247 nurses in 33 centres.

    RESULTS:

    The most common activities performed weekly were; advice about physical activity (40.1%) and general lifestyle advice (34.8%). However, nearly one third seldom/never performed these activities. Approximately half seldom/never performed BMI assessment and even fewer waist circumference (78.1%). Values for the factors Importance of obesity and Personal effectiveness were skewed towards a positive view and Negative view close to neutral. Multivariate analysis revealed that nurses with specialized tasks, longer working experience and higher perceived personal effectiveness performed more clinical activities.

    CONCLUSION:

    Managers need to make efforts to engage all personnel in obesity management; and strategies to increase self-efficacy are called for.

  • 19.
    Engström, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing 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 Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    Working life and stress symptoms among caregivers in elderly care with formal and no formal competence2011In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 19, no 6, p. 732-741Article in journal (Refereed)
    Abstract [en]

    Working life and stress symptoms among caregivers in elderly care with formal and no formal competence Aim  The aim of the present study was to describe and compare caregivers with formal and no formal competence on job satisfaction, psychosomatic health, structural and psychological empowerment and perceptions of care quality. A further aim was to study relationships among study variables. Methods  A convenience sample of 572 caregivers in elderly care participated. Results  Caregivers with no formal competence perceived higher workload, more communication obstacles, less competence, poorer sleep and more stress symptoms than did their colleagues. Linear regression analyses revealed that the factor self-determination was an explanatory variable of stress levels among caregivers with no formal competence, and self-determination and impact among caregivers with formal competence. Linear regression analysis revealed that different dimensions in structural and psychological empowerment explained the variance in staff job satisfaction, perceived stress symptoms and quality of care. Conclusions  No formal competence seems to be a risk factor for psychosomatic health problems. Implications for nursing management  Managers need to have a strategic plan for how to create a working environment for caregivers with no formal competence. Caregivers' self-determination seems to be important for stress symptoms. Meaning, self-determination, impact and opportunities appear to be important for job satisfaction and competence, opportunities, resources and formal power for quality of care.

  • 20.
    Engström, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Wadensten, Barbro
    Department of Public Health and Caring Sciences, Uppsala universitet.
    Häggström, Elisabeth
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Caregivers' job satisfaction and empowerment before and after an intervention focused on caregiver empowerment2010In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 18, no 1, p. 14-23Article in journal (Refereed)
    Abstract [en]

    Aims: To evaluate a training programme aimed at strengthening caregivers' self-esteem and empowering them, and also to study correlations between psychological empowerment and job satisfaction.

    Background: Structural and psychological empowerment have received increased attention in nursing management, yet few intervention studies on this topic, based on theoretical assumptions, have been conducted in elderly care.

    Method: Data on self-assessed psychological empowerment and job satisfaction were collected in an intervention (n = 14) and a comparison group (n = 32), before and after the intervention.

    Results: When compared over time in the respective groups, there were significant improvements in the intervention group regarding the factor criticism (job satisfaction scale). There were no statistically significant differences in the comparison group. Total empowerment and all factors of empowerment correlated positively with total job satisfaction. Six out of eight factors of job satisfaction correlated positively with total empowerment.

    Conclusions: Caregivers' perception of criticism can improve through an intervention aimed at strengthening their self-esteem and empowering them.

    Implications for nursing management: Intervention focused on psychological empowerment and especially caregivers' communication skills seems to be beneficial for caregivers. Recommendations are to increase the programme's length and scope and to include all staff at the unit. However, these recommendations need to be studied further.

  • 21.
    Engström, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Westerberg Jacobson, Josefin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala University and University Hospital, Uppsala, Sweden.
    Staff assessment of structural empowerment and ability to work according to evidence-based practice in mental health care2015In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 23, no 6, p. 765-774Article in journal (Refereed)
    Abstract [en]

    Aim: To study associations between staff members' self-rated structural empowerment in mental health care, organisational type, and the ability and willingness to work according to evidence-based practice.

    Method: Questionnaire data were collected from 253 mental health staff members.

    Result: Multivariate logistic regressions analyses revealed that participants who scored higher on opportunity (OR 2.5) and were employed by the county council (OR 1.9) vs. the municipality were more likely to report high evidence-based practice ability. A generalised estimating equation taking into account unknown correlations within units found opportunity and resources to be significant predictors of evidence-based practice ability. Regarding evidence-based willingness, increased odds were found for higher scores of opportunity (OR 2.2) and being employed by the county council (OR 2.9). The generalised estimating equation also found resources to be a significant predictor of evidence-based willingness. In both organisations, the values for empowerment were moderate.

    Conclusion: Structural conditions such as access to opportunities and resources are important for creating supporting structures for practice to be evidence-based. Implications for nursing management: Our results emphasise the managers' essential role in creating empowering structures, and especially access to opportunities and resources, for their staff to carry out evidence-based practice.

  • 22.
    Eriksson, Annelie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences. Vestre Viken HF, Baerum, Norway.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Distriktssköterskors beskrivningar av sjukdomsförebyggande arbete i daglig verksamhet och strukturella förutsättningar för detta arbete: [District nurses’ perceptions of their preventive work and structural conditions for this work]2015In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 35, no 2, p. 77-84Article in journal (Refereed)
    Abstract [en]

    Background There is much research about district nurses’ preventive work, effects of it and their perceptions of the preventive work. Less is known about how district nurses perceive their preventive work in relation to structural conditions for this work.

    Aim The aim was to describe district nurses’ perceptions of their preventive work in daily practice; and structural conditions for this using Kanter’s theory of structural empowerment.

    Methods Interviews were conducted 2012 with nine Swedish district nurses. Data were analysed using qualitative content analysis.

    Findings The analysis resulted in one theme; ‘To experience stimulation versus frustration; a consistency versus a discrepancy between will and structural conditions’. District nurses who worked with specialized tasks felt that they mostly had the structural conditions required to work in a preventive manner and that they could prioritize which unhealthy living habits to discuss with their patients. District nurses without specialized tasks described that their structural conditions for preventive work was limited in the present streamlined organization. This in turn led to a feeling of frustration.

    Conclusion Preventive work is described as stimulating when district nurses have the conditions required, yet the conditions required are sometimes lacking and especially for district nurses without specialized tasks. There is a will to work in a preventive manner but structural conditions need to be improved.

  • 23.
    Eriksson, Elisabet
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Internationally educated nurses’ descriptions of their access to structural empowerment while working in another country’s health care context2018In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 26, no 7, p. 866-873Article in journal (Refereed)
    Abstract [en]

    AIM:

    To examine internationally educated nurses' experiences of empowerment structures using Kanter's theory of structural empowerment.

    BACKGROUND:

    There has been an increase in the number of nurses working in other countries worldwide and concerns have been raised regarding their working conditions.

    METHOD:

    Semi-structured interviews were conducted with a purposive sample of 11 internationally educated nurses. Directed content analysis was used to analyse the data and Kanter's theory of empowerment was used as a framework.

    RESULTS:

    Access to information was generally good. Access to support for their relationship with their managers varied. Regarding access to resources, nurses unfamiliar with clinical leadership found team leadership challenging. Access to in-house learning opportunities were reported as good. Access to informal power was more common than access to formal power.

    CONCLUSIONS:

    The findings support Kanter's theory and demonstrate that internationally experienced nurses encountered varying degrees of access to empowering structures. Access to information and formal power was more general and related to the unit. Access to resources, support, opportunities and informal power were related to both the unit and the informants' specific situation as IENs.

    IMPLICATIONS FOR NURSING MANAGEMENT:

    Managers need to support IENs when having a team leadership role, facilitate encounters between IENs and ordinary staff, and establishing mentorship for IENs.

  • 24.
    Eriksson, Elisabet
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    The challenges of interviewing internationally educated nurses and doctors in another language than their native language2018Conference paper (Other academic)
    Abstract [en]

    Background: Globalization has increased the migration of internationally educated nurses’ (IENs) and International Medical Graduates (IMG) to high-income countries.

    Objective: To highlight the challenges of interviewing internationally educated nurses and doctors in another language than their native language regarding their working experiences in the Swedish health and social care system.

    Method: Semi-structured interviews with eleven IENs and eleven IMGs. Data were analyzed with qualitative content analysis.

    Results: Interviews with non-Swedish trained nurses and doctors provide important information about their working experiences in the host country, even if their language skills in the host country’s language can be poor. However, the data had a less nuanced language, the same word could be used repeatedly, English words were sometimes used when not finding the Swedish words and some questions were difficult for the informants to understand and had to be omitted. Performing the interview, transcribing and analyzing them took more time compared to interviews with native speakers. The informants clearly stated that they wanted the interview to be in Swedish and not in for example English.

  • 25.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Malpractice claims regarding calls to Swedish telephone advice nursing: what went wrong and why?2012In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 18, no 7, p. 379-383Article in journal (Refereed)
  • 26.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Holmström, Inger
    Mälardalens Högskola.
    Winblad, Ulria
    Uppsala Universiet.
    Identification of incident reporting within nurse-led national telephone triage in Sweden2010Conference paper (Refereed)
  • 27.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Holmström, Inger
    Winblad, Ulrika
    Comparison of malpractice claimed calls versus “normal calls” within Swedish HealthcareDirect – open-ended questions matters2014In: 12thInternational Conference on Communication in Healthcare (ICCH) Amsterdam- theNetherlands, 28 September to 1 October 2014, 2014Conference paper (Refereed)
  • 28.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Holmström, Inger
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Winblad, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Incident reporting in nurse-led national telephone triage in Sweden: The reported errors reveal a pattern that needs to be broken2010In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 16, no 5, p. 243-247Article in journal (Refereed)
    Abstract [en]

    We conducted a retrospective study of incident reports concerning the national, nurse-led telephone triage system in Sweden. The Swedish Health Care Direct organization (SHD) is staffed by registered nurses who act as telenurses and triage the callers' need for care, using a computerized decision support system. Data were collected during 2007 from all county councils that participated in the SHD and were analysed using content analysis. Incident reports were then compared concerning differences in reported categories and who reported the errors. The 426 incident reports included 452 errors. Of the analysed incident reports, 41% concerned accessibility problems, 25% incorrect assessment, 15% routines/guidelines, 13% technical problems and 6% information and communication. The most frequent outgoing incident reports (i.e. sent from SHD to other health-care providers) concerned accessibility problems and the most frequently incoming reports (i.e. sent to SHD from other health-care providers) concerned incorrect assessment. There was a significant difference (P < 0.001) between outgoing and incoming reports regarding the main category. Telenurses have limited possibilities for referring the caller to their primary health-care provider or specialist, which may cause them to over-triage or under-triage the callers' need for care. This over-triage or under-triage may in turn cause other health-care providers to report incorrect assessment to SHD. The implications for practice are that poor accessibility is a matter that should be addressed and that the reasons for incorrect assessment should be explored.

  • 29.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Holmström, Inger
    Mälardalens Högskola.
    Winbland, Ulrika
    Uppsala Universitet.
    Medical errors within Swedish national telephone advice nursing: what went wrong and why?2013Conference paper (Refereed)
  • 30.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Winblad Spångberg, Ulrika
    Uppsala universitet, Vårdvetenskap.
    Rahmqvist, M
    Holmström, Inger
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Communication challenges in Swedish telephone advice nursing: analysis of actual calls2011Manuscript (preprint) (Other academic)
  • 31.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala universitet.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala universitet.
    Winblad, Ulrika
    Uppsala universitet.
    Holmström, Inger
    Mälardalens Högskola, Uppsala universitet.
    A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish Healthcare Direct: a case–control study2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 10, p. e005961-Article in journal (Refereed)
    Abstract [en]

    Objectives: The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. Setting: In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. Participants: A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. Results: Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. Conclusions: The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems.

  • 32.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Winblad, Ulrika
    Uppsala Universitet.
    Holmström, Inger
    Örebro Universitet.
    Communication analysis of all malpractice claimed telephone calls to Swedish Health care Direct (SHD) during 2003-20112012In: / [ed] Kate Sampson, 2012Conference paper (Refereed)
  • 33.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Winblad, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Rahmqvist, Mikael
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Holmström, Inger K.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden .
    Telephone nurses' communication and response to callers' concern: a mixed methods study2016In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 29, p. 116-121Article in journal (Refereed)
    Abstract [en]

    Aims

    To describe telephone nurses’ and callers’ communication, investigate relationships within the dyad and explore telephone nurses’ direct response to callers’ expressions of concern

    Background

    Telephone nurses assessing callers’ need of care is a rapidly growing service. Callers with expectations regarding level of care are challenging.

    Method

    RIAS-and content analysis was performed on a criterion sampling of calls (n=25) made by callers who received a recommendation from telephone nurses of a lower level of care than expected.

    Results

    Telephone nurses mainly ask close-ended questions, whilst open-ended questions are sparsely used. Relationships between callers’ expressions of Concern and telephone nurses responding with Disapprovalwere found. Telephone nurses mainly responded to concern with close-ended medical questions whilst exploration of callers’ reason for concern was sparse.

    Conclusion

    Telephone nurses’ reluctance to use open-ended questions and to follow up on callers’ understanding might be a threat to concordance, and a potential threat to patient safety.

  • 34.
    Ernesäter, Annica
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Holmström, Inger
    Folkhälso- och vårdvetenskap Uppsala Universitet.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Computerized decision support systems in telenursing: how it is perceived by telenurses2009In: Med-e-Tel 2009: proceedings, 2009, p. 409-410Conference paper (Refereed)
    Abstract [en]

    Telephone advice nursing (telenursing) is an expanding service in many Western countries and in recent year’s centralization of telenursing services has occurred in some countries. Telenursing is a complex and knowledge intensive health service were registered nurses (RN’s) individually triage callers need for further care, give self care advice or refer the caller to appropriate care giver. These telenurses have numerous patient encounters every day, regarding all ages of callers and questions presented to the telenurses addresses a broad variation of medical conditions.  

    Telenursing has shown to be appreciated by the population as well as cost efficient.

     In an attempt to ensure quality and safety within telenursing the use of computerized decision support systems (CDSS) increased since CDSS enables uniformity and consistency of advices given to callers.   

    Traditionally, telenurses have relied on clinical knowledge, collegial support and books when triaging callers and few studies describe how telenurses perceive CDSS in their daily work.

    Eight telenurses from three different telephone advice call centres, all using CDSS took part in semi-structured interviews in 2006. Data were analysed using qualitative content analysis.

    The aim of the study was to describe telenurses experiences of working with CDSS. Telenurses described that the CDSS had both positive and negative influences of their work. They described that the CDSS simplified their work, complemented their knowledge and gave them a sense of security. They also described how the CDSS contributed to quality improvement of telenursing. The negative aspects of the CDSS were described as being inhibited by the system. Telenurses described how they perceived the system as partly incomplete and controlling and that they sometimes disagreed with the measures presented by the system.

    These advantages and disadvantages perceived within the system can be connected to the concepts of usability: user-worthiness and user-friendliness. Software should be easy to learn, contain few errors and be easy to orient in, to enhance usability. Hence usability could be further improved in the present system.

    There might be a risk that the CDSS will mechanize and undermine the communication between callers and telenurses. It is important, in order to increase the telenurses’ professional competence and the feeling of tele-presence that callers not only are given a correct estimation of their conditions but also a sense of security and confirmation. Otherwise callers may seek emergency care solely because of insecurity and anxiety.

  • 35.
    Ernesäter, Annica
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Holmström, Inger
    Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Telenurses' experiences of working with computerized decision support: Supporting, inhibiting and quality improving2009In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 5, p. 1074-1083Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of a study conducted to describe telenurses' experiences of working with computerized decision support systems and how such systems could influence their work. Background. Telenursing is an expanding service in many Western countries, and in recent years centralization of telenursing services has occurred in Sweden. In connection with this, the use of computerized decision support has increased. Method. Eight Registered Nurses from three telephone advice call centres in Sweden who were using computerized decision support took part in semi-structured interviews in 2006. The data were analysed using qualitative content analysis. Findings. The findings are presented as one theme and three categories. Telenurses experienced their work with a decision support system as supporting, inhibiting and quality improving. Based on two of the categories -'supporting' and 'inhibiting'- a theme was revealed: being strengthened, but simultaneously controlled and inhibited. This theme represents the individual level. The telenurses found that the decision support system simplified their work, complemented their knowledge, gave them security and enhanced their credibility. They also described experiencing the system as incomplete, sometimes in conflict with their own opinions and controlling. The third category referred to the organizational level: the decision support system ensured the quality of telenursing. Conclusions. Although the telenurses experienced computerized decision support as both supporting and inhibiting, they preferred working with it. They also described how a computerized decision support system cannot replace telenurses'knowledge and competence, and that it should be considered as complementary.

  • 36.
    Forsberg, Markus
    et al.
    Department of Anaesthesia, Gävle Sjukhus, Gävle, Sweden.
    Björn, Catrine
    Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden; Centre for Research & Development, Gävleborg, Gävle, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Nurse anesthetists' reflections on caring for patients with previous substance dependence: Balancing between professionalism and preconceptions2018In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, no 1, p. 69-77Article in journal (Refereed)
    Abstract [en]

    Purpose

    The study aim was to describe nurse anaesthetists’ reflections on provision of perioperative care to patients with previous substance dependence.

    Design

    A qualitative approach with a descriptive design.

    Methods

    Semi-structured interviews based on clinical vignettes were conducted with ten nurse anaesthetists.

    Findings

    The perioperative care provided to patients with previous substance dependence was perceived as balancing between professionalism and preconceptions for this specific patient group. The nurse anaesthetists felt that anesthetizing this group of patients constituted an anaesthesiological challenge with regard to knowledge, experience and time. However, the nurses also had feelings of distrust and uncertainty due to lack of knowledge.

    Conclusion

    The nurse anaesthetists strove to uphold the principle that patients who are/have been substance dependent have the same right to adequate treatment and care as all patients. If guidelines were developed for this patient group, care could be made safer and nurses’ sense of uncertainty minimized.

     

  • 37.
    Hagerman, Heidi
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Institutionen för folkhälso- och vårdvetenskap, Uppsala universitet.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Institutionen för folkhälso- och vårdvetenskap, Uppsala universitet.
    Häggström, Elisabeth
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Institutionen för folkhälso- och vårdvetenskap, Uppsala universitet.
    Wadensten, Barbro
    Institutionen för folkhälso- och vårdvetenskap, Uppsala universitet.
    Manliga första-linjenschefers upplevelser av sin arbetssituation i äldreomsorgen – med utgångspunkt i empowerment2018In: FALF KONFERENS 2018 Arbetet – problem eller potential för en hållbar livsmiljö?   10-12 juni 2018 Gävle: Program och Abstracts, 2018, p. 143-Conference paper (Other academic)
    Abstract [en]

    Bakgrund

    Den svenska äldreomsorgen blir allt mer ansträngande att arbeta inom. Stora organisa-toriska förändringar har lett till att arbetet upplevs som oroligt och stressfullt. Den administrativa rollen har ökat och första-linjens chefers möjligheter att delta i det dagliga arbetet har minskat. För att klara av de allt högre krav som ställs är det viktigt att cheferna känner att de har goda strukturella förutsättningar (empowerment), handlingsutrymme och känner att de har kontroll över sitt arbete.

    Syfte

    Att beskriva manliga första-linjens chefers upplevelser av sin arbetssituation i äldreomsorgen.

    Metod

    Semi-strukturerade intervjuer gjordes med fjorton manliga första-linjens chefer i äldreomsorgen i Sverige från hösten 2010 till våren 2011. Intervjuguiden var inspirerad av teorier om empowerment. Tolv chefer arbetade inom kommunal äldreomsorg och två chefer inom privat äldreomsorg. Deltagarna valdes utifrån ett ändamålsenligt urval med förhoppningen om att ge en variation i sina skildringar. De hade arbetat som chefer mellan 0.5-35 år. Intervjuerna varade mellan 1-2.5 timmar och materialet analyserades med kvalitativ innehållsanalys. Två teman och fem subteman skapades.

    Resultat

    Det första temat handlade om när organisatoriska krav var i balans med chefernas upplevda chefsansvar och strukturella förutsättningar. Där beskrevs upplevelserna av att vara ensam men inte utelämnad, att ha frihet inom givna ramar samt en känsla av tillfredsställelse och stimulans i arbetet. Det andra temat handlade om när organisatoriska krav var i obalans med chefernas upplevda chefsansvar och strukturella förutsättningar. Detta tema beskrev chefernas känsla av frustration och en känsla av uppgivenhet. Sammantaget upplevde de manliga första-linjens cheferna att arbetssituationen var både utmanande, komplex och föränderlig. Cheferna behövde bättre tillgång till strukturella förutsättningar, speciellt i form av resurser, stöd och information. Utmaningarna sågs dock som en ständig drivkraft för cheferna. De beskrev att deras arbete var ”mödan värt” även om de ibland upplevde arbetssituationen som negativ. Slutsatsen i studien var att cheferna upplevde sitt arbete som en positiv utmaning även om de beskrev brister i sitt stöd.

  • 38.
    Hagerman, Heidi
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Häggström, Elisabeth
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    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 Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Male first-line managers’ experiences of the work situation in elderly care: an empowerment perspective2015In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 23, no 6, p. 695-704Article in journal (Refereed)
    Abstract [en]

    Aim

    To describe male first-line managers' experiences of their work situation in elderly care.

    Background

    First-line managers' work is challenging. However, less attention has been paid to male managers' work situation in health care. Knowledge is needed to empower male managers.

    Method

    Fourteen male first-line managers were interviewed. The interview text was subjected to qualitative content analysis.

    Result

    Work situations were described as complex and challenging; challenges were the driving force. They talked about ‘Being on one's own but not feeling left alone’, ‘Having freedom within set boundaries’, ‘Feeling a sense of satisfaction and stimulation’, ‘Feeling a sense of frustration’ and ‘Having a feeling of dejection and resignation’.

    Conclusion

    Although the male managers report deficiencies in the support structure, they largely experience their work as a positive challenge.

    Implications for nursing management

    To meet increasing challenges, male first-line managers need better access to supportive structural conditions. Better access to resources is needed in particular, allowing managers to be more visible for staff and to work with development and quality issues instead of administrative tasks. Regarding organisational changes and the scrutiny of management and the media, they lack and thus need support and information from superiors.

  • 39.
    Hagerman, Heidi
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Högberg, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Wadensten, Barbro
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, Lishui, China.
    Empowerment and performance of managers and subordinates in elderly care: a longitudinal and multilevel study2017In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 25, no 8, p. 647-656Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate relationships between first-line managers' ratings of structural and psychological empowerment, and the subordinates' ratings of structural empowerment, as well as their ratings of the managers' leadership-management performance.

    BACKGROUND: Work situations in elderly care are complex. To date, few studies have used a longitudinal, correlational and multilevel design to study the working life of subordinates and managers.

    METHOD: In five Swedish municipalities, questionnaires were answered twice during 2010-12 by 56 first-line managers and 769 subordinates working in nursing homes or home-help services.

    RESULTS: First-line managers' empowerment at Time 1 partially predicted subordinate's structural empowerment and ratings of their managers' leadership-management performance at Time 2. Changes over time partially revealed that the more access managers had to structural empowerment, i.e. increase over time, the higher the ratings were for structural empowerment and managerial leadership-management performance among subordinates.

    CONCLUSIONS: Findings strengthen research and theoretical suggestions linking first-line managers' structural empowerment to their subordinates' structural empowerment and ratings of their manager's leadership-management performance.

    IMPLICATIONS FOR NURSING MANAGEMENT: Managers with high access to structural empowerment are more likely to provide subordinates access to structural empowerment.

  • 40.
    Hagerman, Heidi
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Wadensten, Barbro
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Högberg, Hans
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    A longitudinal study of working life among first-line managers in the care of older adults2016In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 32, p. 7-13Article in journal (Refereed)
    Abstract [en]

    Aim

    To study whether the number of subordinates plays a role in first-line managers’ and subordinates’ ratings of empowerment, stress symptoms, and leadership–management performance. The aim was also to study relationships between managers’ empowerment and stress symptoms and leadership–management performance.

    Methods

    A longitudinal and correlational design was used. All first-line managers (n = 98) and their subordinates (n = 2085) working in the care of older adults in five municipalities were approached.

    Results

    With fewer (≤ 30) subordinates per manager, there were higher ratings of structural empowerment among managers and subordinates and lower stress symptoms among subordinates, than with ≥ 31 subordinates. Furthermore, structural empowerment was related to the managers’ stress symptoms and leadership–management performance, mediated through psychological empowerment. Moreover, structural empowerment can control/adjust for large numbers of subordinates in relation to stress symptoms.

    Conclusion

    The higher FLMs rated their access to empowerment, the lower stress symptoms and higher leadership–management performance they rated over time.

  • 41.
    Häggström, Elisabeth
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Wadensten, Barbro
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Uppsala universitet.
    A nine-month intervention programme focusing on empowerment; caregivers' descriptions of changed behaviour and increased room for acting2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 6, p. 866-873Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe public nursing home Enrolled Nurses' and Nurses Aides' view of their work and their perceptions of themselves in their professional role while they were receiving a serious of role awareness sessions focusing on empowerment for nine months. BACKGROUND: According to several studies, it is typical that women may experience problems and injustices at work. The main focus of the intervention was to help enrolled nurses' and nurses aides' in developing their self-image and professional role. DESIGN: This study was descriptive and qualitative in design. METHODS: The present study comprises semi-structured interviews conducted with enrolled nurses and nurses aides (n = 14) from public nursing homes at start of the intervention and again nine months following the intervention. The text from the interviews was analysed using latent content analysis. RESULTS: The main findings primarily show an improved professional role for the caregivers, as described in the following themes: the move from passivity to activity, the move from complaining to understanding, the move from expectations to frustration and the move from being silent to speaking loud. CONCLUSIONS: For caregivers working with older people within public nursing home care, it seems to be a good form of clinical supervision to implement a serious of role awareness sessions in order to improve their professional role. RELEVANCE TO CLINICAL PRACTICE: The findings showed that an intervention providing opportunities with focus on empowerment improved the enrolled nurses' and nurses aides' professional role in working with older people. This can be useful information for managers and educators and they may want to adapt it when working in a public nursing home.

  • 42.
    Kaltenbrunner, Monica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Bengtsson, Lars
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, Lishui Shi, China.
    A questionnaire measuring staff perceptions of Lean adoption in healthcare: development and psychometric testing2017In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, no 1, article id 235Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

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

    METHODS:

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

    RESULTS:

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

    CONCLUSIONS:

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

  • 43.
    Kaltenbrunner, Monica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Bengtsson, Lars
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Institutionen för folkhälso- och vårdvetenskap, Uppsala universitet, Uppsala, Sverige; Nursing Department, Medicine and Health College, Lishui University, China.
    Lean i primärvården - en bild av hur Lean tillämpas2018In: FALF KONFERENS 2018 Arbetet – problem eller potential för en hållbar livsmiljö?, Gävle: Gävle University Press , 2018, p. 112-112Conference paper (Other academic)
    Abstract [sv]

    Bakgrund

    Lean har sitt ursprung i bilindustrin och har spridits till andra sektorer såsom hälso-och sjukvård. Implementering av Lean syftar vanligtvis till att öka vårdkvaliten. Vid utvärderingar av Lean saknas ofta en beskrivning av vilka principer av Lean som implementeras och i vilken utsträckning. Föreliggande studie utgår från Likers beskrivning av Lean. Liker beskriver Lean i fyra övergripande grupper kallad 4P modellen; philosophy, processes, people and partners, och problem-solving (filosofi, processer, anställda och partners, och problemlösning), som består av ett antal principer. Att implementera alla principer och involvera alla medarbetare är ovanlig, vilket Liker menar är avgörande om organisationen ska nå de mål de satt med att införa Lean.

    Syfte

    Syftet med studien var att illustrera hur Lean praktiseras inom primärvården. 

    Metod

    Studien utgår från ett större forskningsprojekt där både privata och landstingsägda primärvårdsenheter deltog. All personal vid enheterna fick 2016 besvara en enkät om Lean-principer, svarsfrekvens 35% (298 medarbetare vid 45 enheter). Höga Lean skattningar indikerade hög mognad av Lean vilket innebar att medarbetarna var kunniga rörande den efterfrågade Lean-principen; låg mognad av Lean innebar att man helt saknade principen på sin arbetsplats eller hade implementerat den i liten utsträckning av ett fåtal medarbetare. Baserat på enkätsvaren valdes fyra enheter ut för observationer, två med hög mognad av Lean och två med låg mognad. Observationerna inkluderade intervjuer och fältanteckningar som illustrerade hur 4P-modellen praktiserades på enheterna. Hälso- och sjukvårdspersonal med olika professioner deltog (n=28).

    Resultat

    Rörande filosofi ansåg medarbetarna vid alla fyra enheter att den närmaste chefen, återkommande men i varierande utsträckning, kommunicerade gemensamma mål. Patienternas behov styrde planeringen av vården. Processer kunde innefatta att medarbetarna baserade sin planering av vården på statistik. För vissa patientgrupper eller symtom fanns generella ordinationer, d.v.s. utan kontakt med läkare, t.ex. på vilka prover som skulle tas. Rörande anställda och partners var det vanligt att arbeta i team både inom och utanför sin enhet. Men det framkom även att medarbetarna inte arbetade tillsammans fast de borde det. Problemlösning förekom men ofta ostrukturerat med brister på uppföljning. En enhet hade påbörjat utvecklande av problemlösning genom dagliga möten och strullistor att dokumentera problemen på.

    Konklusion

    Tillämpning av Lean varierar i stor utsträckning mellan vårdcentralerna. Ett par enheter hade implementerat Lean i större utsträckning och dessa enheter var mer strukturerade rörande t.ex. problemlösning och teamarbete.

     

  • 44.
    Kaltenbrunner Nykvist, Monica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Bengtsson, Lars
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Towards a Questionnaire to Measure Lean in Health Care2014In: 8th NOVO Symposium, Sustainable health care production systems - Abstract book / [ed] Kasper Edwards och Jørgen Winkel, Lyngby: Danmarks Tekniske Universitet, DTU, 2014, p. 19-20Conference paper (Refereed)
    Abstract [en]

    The rapid spread of Lean implementation within the health care sector has made it urgent to evaluate the effects of Lean on productivity, working conditions and health. Therefor an instrument is needed to measure Lean in primary care. The aim with this research is to find an instrument that captures the character of Lean. A literature search was conducted in Academic Search Elite, WileyOnlineLibrary, PubMed, Cinahl, PsycInfo, JSTOR, ScienceDirect, Emerald and Scopus. Keywords used were reflecting Lean and measurement and the search resulted in 7933 hits. Included were articles that presented an instrument that had the possibilities to distinguish between high or low Lean adoption. Malmbrandt and Åhlstöm´s (2014) instrument fulfilled criteria and was chosen. The original instrument was firstly translated to Swedish. A back translation was made by a bilingual authorized translator. The prototype will be tested among health care professions in Sweden using the think aloud method (TA) with the aim to explore how the participants perceive and interpret the Swedish version (Collins 2003). Immediately afterwards, they will be interviewed about how they interprets specific expressions in the questionnaire. After every round of 5-15 interviews the prototype will be adjusted and when saturation is reached the TA will terminate. After psychometric tests the finalized Swedish version of the instrument is to be used in a longitudinal study to describe status of Lean and how Lean correlate with the health of primary health care staff, there working conditions and productivity over time.

  • 45.
    Kristofferzon, Marja-Leena
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, Lishui, China.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Coping mediates the relationship between sense of coherence and mental quality of life in patients with chronic illness: a cross-sectional study2018In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 27, no 7, p. 1855-1863Article in journal (Refereed)
    Abstract [en]

    Purpose

    The aim of the present study was to investigate relationships between sense of coherence, emotion-focused coping, problem-focused coping, coping efficiency, and mental quality of life (QoL) in patients with chronic illness. A model based on Lazarus’ and Folkman’s stress and coping theory tested the specific hypothesis: Sense of coherence has a direct and indirect effect on mental QoL mediated by emotion-focused coping, problem-focused coping, and coping efficiency in serial adjusted for age, gender, educational level, comorbidity, and economic status.

    Methods

    The study used a cross-sectional and correlational design. Patients (n = 292) with chronic diseases (chronic heart failure, end-stage renal disease, multiple sclerosis, stroke, and Parkinson) completed three questionnaires and provided background data. Data were collected in 2012, and a serial multiple mediator model was tested using PROCESS macro for SPSS.

    Results

    The test of the conceptual model confirmed the hypothesis. There was a significant direct and indirect effect of sense of coherence on mental QoL through the three mediators. The model explained 39% of the variance in mental QoL.

    Conclusions

    Self-perceived effective coping strategies are the most important mediating factors between sense of coherence and QoL in patients with chronic illness, which supports Lazarus’ and Folkman’s stress and coping theory.

  • 46.
    Mamhidir, Anna-Greta
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Lindberg, Maria
    Uppsala universitet.
    Larsson, Rigmor
    Landstinget Gävleborg.
    Fläckman, Birgitta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Deficient knowledge of multidrug-resistant bacteria and preventive hygiene measures among primary healthcare personnel2011In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, no 4, p. 756-762Article in journal (Refereed)
    Abstract [en]

    AIM:

    This paper is a report of a study conducted to describe primary healthcare personnel's knowledge of multidrug-resistant and preventive hygiene measures.

    BACKGROUND:

    The group of patients at risk for multi-drug resistant bacteria is largely cared for in primary care. Knowledge of multidrug-resistant and hygiene preventive measures among primary healthcare personnel is therefore essential.

    METHOD:

    A descriptive and comparative questionnaire survey among primary healthcare personnel was performed in 2008. In total, five urban and rural primary healthcare centres situated in one county in central Sweden were included. Convenient sampling was used and 10 physicians, 38 district nurses and 10 nursing assistants participated. Knowledge/medical facts concerning multidrug-resistant and hygiene preventive measures were investigated and data were analysed using a quantitative approach.

    RESULTS:

    Knowledge/medical facts concerning several aspects of multidrug-resistant bacteria, particularly Extended-Spectrum-Beta-Lactamase producing bacteria, were deficient as was knowledge of different aspects of hygiene preventive measures. Physicians showed significantly better results than district nurses and nursing assistants did. Awareness of proper hand-washing as an effective preventive method and use of aprons in nursing care was high among all participants. Staff who knew they had cared for these patients had significantly better results than the others did.

    CONCLUSION:

    Our findings suggest that evidence-based education of multidrug-resistant and hygiene preventive measures, in primary health with subsequent follow-ups should become a prioritized clinician and management concern. Research is needed that focus implementation of evidence-based educations, staff attitudes and responsibilities related to the work with patients at risk of multidrug-resistant bacteria.

  • 47.
    Mamhidir, Anna-Greta
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Sjölund, Britt-Marie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Neurobiology, Care Sciences and Society (NVS), Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Fläckman, Birgitta
    Department of Health Care Sciences of Ersta, Sköndal University College, Stockholm, Sweden.
    Wimo, Anders
    Department of Neurobiology, Care Sciences and Society (NVS), Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden; Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
    Sköldunger, Anders
    Department of Neurobiology, Care Sciences and Society (NVS), Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden; Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, Lishui, China.
    Systematic pain assessment in nursing homes: a cluster-randomized trial using mixed-methods approach2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 61Article in journal (Refereed)
    Abstract [en]

    Background

    Chronic pain affects nursing home residents’ daily life. Pain assessment is central to adequate pain management. The overall aim was to investigate effects of a pain management intervention on nursing homes residents and to describe staffs’ experiences of the intervention.

    Methods

    A cluster-randomized trial and a mixed-methods approach. Randomized nursing home assignment to intervention or comparison group. The intervention group after theoretical and practical training sessions, performed systematic pain assessments using predominately observational scales with external and internal facilitators supporting the implementation. No measures were taken in the comparison group; pain management continued as before, but after the study corresponding training was provided. Resident data were collected baseline and at two follow-ups using validated scales and record reviews. Nurse group interviews were carried out twice. Primary outcome measures were wellbeing and proxy-measured pain. Secondary outcome measures were ADL-dependency and pain documentation.

    Results

    Using both non-parametric statistics on residential level and generalized estimating equation (GEE) models to take clustering effects into account, the results revealed non-significant interaction effects for the primary outcome measures, while for ADL-dependency using Katz-ADL there was a significant interaction effect. Comparison group (n = 66 residents) Katz-ADL values showed increased dependency over time, while the intervention group demonstrated no significant change over time (n = 98). In the intervention group, 13/44 residents showed decreased pain scores over the period, 14/44 had no pain score changes ≥ 30% in either direction measured with Doloplus-2. Furthermore, 17/44 residents showed increased pain scores ≥ 30% over time, indicating pain/risk for pain; 8 identified at the first assessment and 9 were new, i.e. developed pain over time. No significant changes in the use of drugs was found in any of the groups. Nursing pain related documentation was sparse. In general, nurses from the outset were positive regarding pain assessments. Persisting positive attitudes seemed strengthened by continued assessment experiences and perceptions of improved pain management.

    Conclusion

    The implementation of a systematic work approach to pain issues in nursing homes indicates that an increased awareness, collaboration across and shared understanding among the team members of the pain assessment results can improve pain management and lead to decreased physical deterioration or the maintenance of physical and functional abilities among NH residents. However, pain (proxy-measured) and wellbeing level did not reveal any interaction effects between the groups over time.

    Trial registration

    The study was registered in ISRCTN71142240 in September 2012, retrospectively registered.

  • 48.
    Muntlin Athlin, Åsa
    et al.
    Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; University of Adelaide, Adelaide, Australia.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, School of Medicine and Health, Lishui University, Lishui, China.
    Gunningberg, Lena
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Quality Department, Uppsala University Hospital, Uppsala, Sweden.
    Bååth, Carina
    Department of Health Sciences, Faculty of Health, Sciences and Technology, Karlstad University, Karlstad, Sweden; County Council of Värmland, Karlstad, Sweden.
    Heel pressure ulcer, prevention and predictors during the care delivery chain - when and where to take action?: a descriptive and explorative study2016In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, article id 134Article in journal (Refereed)
    Abstract [en]

    Background

    Hazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Pressure ulcer prevalence is still at unreasonably high levels, causing increased healthcare costs and suffering for patients. Recent biomedical research reveals that the first signs of cell damage could arise within minutes. However, few studies have investigated optimal pressure ulcer prevention in the initial stage of the care process, e.g. in the ambulance care or at the emergency department. The aim of the study was to describe heel pressure ulcer prevalence and nursing actions in relation to pressure ulcer prevention during the care delivery chain, for older patients with neurological symptoms or reduced general condition. Another aim was to investigate early predictors for the development of heel pressure ulcer during the care delivery chain.

    Methods

    Existing data collected from a multi-centre randomized controlled trial investigating the effect of using a heel prevention boot to reduce the incidence of heel pressure ulcer across the care delivery chain was used. Totally 183 patients participated. The settings for the study were five ambulance stations, two emergency departments and 16 wards at two hospitals in Sweden.

    Results

    A total of 39 individual patients (21 %) developed heel pressure ulcer at different stages across the care delivery chain. Findings revealed that 47–64 % of the patients were assessed as being at risk for developing heel pressure ulcer. Preventive action was taken. However, all patients who developed pressure ulcer during the care delivery chain did not receive adequate pressure ulcer prevention actions during their hospital stay.

    Discussion and Conclusions

    In the ambulance and at the emergency department, skin inspection seems to be appropriate for preventing pressure ulcer. However, carrying out risk assessment with a validated instrument is of significant importance at the ward level. This would also be an appropriate level of resource use. Context-specific actions for pressure ulcer prevention should be incorporated into the care of the patient from the very beginning of the care delivery chain.

  • 49. Muntlin Athlin, Åsa
    et al.
    Gunningberg, Lena
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Bååth, Carina
    Pressure ulcer prevention – Why don’t we start from the beginning?2014In: Pressure Ulcers from Birth to Death : Prevention,Treatment and Rehabilitation: Programme and Abstract book, 2014Conference paper (Refereed)
  • 50.
    Mårtensson, Gunilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Mamhidir, Anna-Greta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    What are the structural conditions of importance to preceptors' performance?2013In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 33, no 5, p. 444-449Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Preceptors play a critical role in the process of developing nursing students' knowledge, skills and ability to make independent and critical judgments, however relatively little is known about what aspects are associated with nurses' performance as preceptors.

    OBJECTIVES:

    To investigate structural conditions and professional aspects of potential importance to nurses' perceptions of their performance as preceptors, and to evaluate the validity and reliability of a questionnaire measuring nurses' perceptions of being a preceptor.

    METHODS:

    The study had a correlational design. Total population sampling (N=1720) in a county council district in central Sweden was used to screen for nurses with recent preceptor experience, 933 nurses responded (response rate 54%), of those 323 nurses fulfilled the inclusion criteria. The present findings are based on data from 243 of these subjects. Data were collected with a questionnaire and analyzed using multiple regressions analyses, exploratory factor analyses and reliability coefficients.

    RESULTS:

    The results show that aspects such as receiving feedback on the function as a preceptor, being able to plan and prepare the clinical education period, receiving support from unit managers and having specific supervision education explain 31% of nurses' overall view of their performance as preceptors. However, structural conditions and professional experiences could not explain preceptors' use of reflection and critical thinking when acting as preceptors. These findings are discussed within the framework of Kanter's structural theory of power in organizations. Further, the psychometric evaluation showed that the questionnaire is a valid and reliable instrument for measuring nurses' structural conditions for and perceptions of their performance as preceptors.

    CONCLUSIONS:

    Structural conditions such as feedback and support seemed to strengthen nurses' general view of their performance as preceptors but did not seem to facilitate nurses' work toward the aim of higher education and helping nursing students develop critical thinking.

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