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  • 1.
    Lindberg, Magnus
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Bäckström-Andersson, Helena
    Gävle Hospital, Gävle, Sweden.
    Lindström, Rosmarie
    Gävle Hospital, Gävle, Sweden.
    Lindberg, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Dry weight from the haemodialysis patient perspective2013In: Renal Society of Australasia Journal, ISSN 1832-3804, Vol. 9, no 2, p. 68-73Article, review/survey (Refereed)
    Abstract [en]

    Background:The concept of dry weight is central to fluid control in patients on haemodialysis (HD). Few studies have explored the concept from the patient perspective. Thus, the aim of the present study was to explore how patients on HD perceive the concept of dry weight and how they act in relation to it.

    Methods:A purposive sample of 10 HD patients was interviewed once during a dialysis session in May–June 2009. The narratives were analysed using manifest qualitative content analysis.

    Findings: The findings indicated that the concept was regarded as either an aid to securing treatment-related health, as indicating the fluid surplus volume or as a reminder of the daily fluid allotment. Some informants, however, did not report any specific perception. Plans for dealing with the perceptions were expressed in terms of using self-care strategies to control fluid balance, transferring responsibility to the HD team, and managing the physical consequences or social and psychological concerns.

    Conclusion: Four ways in which HD patients perceived the dry weight concept were demonstrated. It is important that HD patients understand the significance of dry weight, both for their own wellbeing and for treatment adequacy. Prevalent misunderstandings about the dry weight concept have to be addressed by the dialysis team in order to prevent further suffering. By acknowledging the patient’s perspective of the dry weight concept, the dialysis team could help the patient to successfully develop self-care strategies for dealing with the consequences of chronic renal failure.

  • 2.
    Lindberg, Magnus
    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.
    Wågström, Britt-Mari
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Arvidsson, Lisa
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Lindberg, 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; Centre for Research and Development, Uppsala University / County Council of Gävleborg, Gävle, Sweden.
    Risk behaviours for organism transmission in daily care activities: a longitudinal observational case study2018In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 100, no 3, p. e146-e150Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To understand healthcare personnel's infection prevention behaviour has long been viewed as a key factor in preventing healthcare-associated infections. Suboptimal hand hygiene compliance and handling of materials, equipment and surfaces present the main risks for potential organism transmission. Further exploration is needed regarding the role of context-specific conditions and the infection prevention behaviours of healthcare personnel. Such knowledge could enable the development of new intervention strategies for modifying behaviour.

    AIM: To describe risk behaviours for organism transmission in daily care activities over time.

    METHODS: Unstructured observations of healthcare personnel carrying out patient related activities were performed on 12 occasions over a period of 18 months.

    FINDINGS: Risk behaviours for organism transmission occur frequently in daily care activities and the results shows that the occurrence is somewhat stable over time. Interruptions in care activities contribute to an increased risk for organism transmission that could lead to subsequent healthcare-associated infection.

    CONCLUSION: Interventions aimed at reducing the risks of healthcare-associated infections need to focus on strategies that address: hand hygiene compliance; the handling of materials, equipment, work clothes and surfaces; as well as the effects of interruptions in care activities if they are to alter healthcare personnel's infection prevention behaviour sufficiently.

  • 3.
    Lindberg, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Methicillin-resistant Staphylococcus aureus (MRSA) an Unclear and Untoward Issue: Patient-Professional Interactions, Experiences, Attitudes and Responsibility2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of the present thesis was to investigate experiences of living with multidrug-resistant bacteria (MDRB), using methicillin-resistant Staphylococcus aureus (MRSA) colonization as an illustration, and to develop and validate a tool to describe healthcare personnel’s attitudes towards patients with MDRB. A further objective was to study MRSA-colonized persons’ and healthcare personnel’s experiences of patient-professional interactions and responsibilities for infection prevention.

    Four empirical studies were conducted. A total of 18 MRSA-colonized persons and 20 healthcare personnel were interviewed regarding their experiences, and a total of 726 RNs responded the MDRB Attitude Questionnaire.

    The findings revealed the difficulties associated with living with MRSA colonization, which was described as something uncertain, and as an indefinable threat that has to be managed in both everyday life and in contacts with healthcare. Interactions with healthcare personnel were described as unprofessional owing to personnel’s inappropriate behaviour and insufficient information provision. According to the personnel, achieving adequate patient-professional interactions required having knowledge and experiences of MRSA. They also experienced difficulties in providing tailored information to patients. The MRSA-colonized persons described their unwanted responsibility to inform healthcare personnel about the colonization, but also felt responsible for limiting the spread of infection to others. Furthermore, responsibility for infection control was regarded as shared between healthcare personnel and patients. The personnel described such responsibility as a natural part of their daily work, although it was not always easy to adhere to hygiene precautions. The MRSA-colonized persons felt that healthcare personnel have insufficient knowledge of the bacteria and of hygiene precautions. The MDRB Attitude Questionnaire showed that registered nurses do have knowledge deficiencies. The MDRB Attitude Questionnaire has adequate psychometric properties.

    In conclusion, MRSA colonization constitutes a psychological strain for carriers, and interactions with healthcare personnel resulted in feelings of stigmatization. The present thesis indicates that there is a need to improve healthcare personnel’s knowledge, behaviour and emotional response in relation to patients with MDRB, in order to ensure patient safety and address patients’ needs. The heads of department is responsible for such improvements, and the MDRB Attitude Questionnaire is useful in identifying areas in need for improvement.

  • 4.
    Lindberg, Maria
    et al.
    Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden; Section for Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Carlsson, Marianne
    Section for Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Högman, Marieann
    Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden.
    Skytt, Bernice
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Section for Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Suffering from meticillin-resistant Staphylococcus aureus: experience and understanding of colonisation2009In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 73, no 3, p. 271-277Article in journal (Refereed)
    Abstract [en]

    The objective was to explore individuals' experiences and understandings of meticillin-resistant Staphylococcus aureus (MRSA) colonisation. Thirteen interviews were performed and processed using content analysis, resulting in the theme ‘Invaded, insecure and alone’. The participants experienced fears and limitations in everyday life and expressed a need to protect others from contagion. Moreover, they experienced encounters with, and information from, healthcare workers differently: some were content, whereas others were discontent. The described fears, limitations and inadequate professional–patient relationship generated unacceptable distress for MRSA-colonised persons. Thus, the healthcare sector should assume responsibility for managing MRSA, and healthcare workers must improve their professionalism and information skills, so as to better meet MRSA-colonised persons' needs

  • 5.
    Lindberg, 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; Centre for Research and Development, Uppsala University/County Council of Gävleborg.
    Carlsson, Marianne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University.
    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.
    MRSA-colonized persons’ and healthcare personnel's experiences of patient-professional interactions in and responsibilities for infection prevention in Sweden2014In: Journal of Infection and Public Health, ISSN 1876-0341, Vol. 7, no 5, p. 427-435Article in journal (Refereed)
    Abstract [en]

    Background: Patient-professional interactions and adherence to infection control measures are central to the quality of care and patient safety in healthcare. Persons colonized with methicillin-resistant Staphylococcus aureus (MRSA) describe insufficient support and unprofessional behavior among healthcare personnel. Methods: A descriptive qualitative study was conducted to investigate managers', physicians', registered nurses' and MRSA-colonized persons' experiences of patient-professional interactions in relation to and responsibilities for infection prevention in the care of colonized patients. Five persons with MRSA colonization and 20 healthcare personnel employed within infection, hematology, nephrology or primary healthcare settings participated. The data were collected using open-ended semi-structured individual interviews with the MRSA-colonized persons and semi-structured focus group interviews with the healthcare personnel. Results: The participants perceived MRSA as an indefinable threat and described that the responsibility for infection prevention is important, but such adherence was a neglected and negotiable issue. The described actions that were acknowledged as unprofessional and inappropriate adherence to infection prevention resulted in stigmatized patients. Conclusion: Colonized persons' and healthcare personnel's understanding of MRSA determines whether the personnel's behavior is perceived as proper or improper. Individual responsibility for patient-professional interactions in relation to MRSA colonization and adherence to infection control measures should be more stringent.

  • 6.
    Lindberg, Maria
    et al.
    Uppsala universitet.
    Lindberg, Magnus
    Uppsala universitet.
    Haemodialysis nurses knowledge about methicillin-resistant Staphylococcus aureus2012In: Journal of renal care, ISSN 1755-6686, Vol. 38, no 2, p. 82-85Article in journal (Refereed)
    Abstract [en]

    Healthcare workers may lack knowledge about antibiotic-resistant bacteria and thereby increase the spread of such organisms. The aim of the present study was to describe the relationship between self-rated knowledge and actual knowledge about methicillin-resistant Staphylococcus aureus (MRSA) among 326 Swedish haemodialysis nurses. Data were collected through a postal questionnaire. The findings suggest that ongoing education about MRSA should be provided to haemodialysis nurses, but also that standardised evaluation of adequate knowledge, skills and competencies' regarding safe practices is warranted. Future research should focus on effective mechanisms to ensure that haemodialysis nurses provide safe MRSA care.

  • 7.
    Lindberg, Maria
    et al.
    Centre for Research and Development, Uppsala University/Country Council of Gävleborg.
    Lindberg, Magnus
    Centre for Research and Development, Uppsala University/Country Council of Gävleborg.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Högman, Marieann
    Centre for Research and Development, Uppsala University/Country Council of Gävleborg.
    Carlsson, Marianne
    Department of Public Health and Caring Sciencies, Uppsla University.
    Attitudes toward patients with multidrug-resistant bacteria: scale development and psychometric evaluation2011In: Journal of Infection Prevention, ISSN 1757-1782, Vol. 12, no 5, p. 196-203Article in journal (Refereed)
    Abstract [en]

    There is a need for validated assessment tools for measuring attitudes towards patients with multidrug- resistant bacteria. Such an assessment tool was developed and psychometrically evaluated in the present study. A literature review and discussions with experts and key informants were used to develop the questionnaire. To ensure item adequacy and interpretability, face validity and pre-tests were performed. Item validity, content validity and internal consistency reliability were evaluated in a non-random sample of 329 hemodialysis nurses. The psychometric properties were satisfactory, indicating good item validity. The content validity revealed three appropriate factors with good internal consistency reliability. The haemodialysis nurses’ knowledge about multidrug-resistant bacteria was not suf. cient, and their intentional behaviour was unsatisfactory with respect to infection control precautions. The multidrug-resistant bacteria Attitude Questionnaire would be a valuable tool, in nursing practice and nursing education, in promoting quality improvements in patient safety with regard to healthcare associated infections.

  • 8.
    Lindberg, Maria
    et al.
    Centre for Research and Development, Uppsala University/Country Council of Gävleborg.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Högman, Marieann
    Centre for Research and Development, Uppsala University/Country Council of Gävleborg.
    Carlsson, Marianne
    Department of Public Health and Caring Sciencies, Uppsla University.
    The Multidrug-Resistant Bacteria Attitude Questionnaire: validity and understanding of responsibility for infection control in Swedish registered district, haematology and infection nurses2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 3-4, p. 424-436Article in journal (Refereed)
    Abstract [en]

    Aim. To assess the discriminative and construct validity of the Multidrug-Resistant Bacteria Attitude Questionnaire and to study registered nurses knowledge of, behaviour toward and emotional responses to patients with multidrug-resistant bacteria in relation to how they understand their own, managers and politicians responsibility for adherence to preventive measures for infection control. Background. Multidrug-resistant organisms are a global problem and an essential topic in healthcare regarding patient safety improvement. Design. Descriptive and correlational cross-sectional survey. Method. Data were collected in a non-random sample consisting of 397 registered nurses; district, haematology or infection registered nurses. One-way analysis of variance and independent t-tests were used for comparisons and a principal component analysis was performed. Results. Discriminative and construct validity were supported, as the infection registered nurses generally had higher scores on knowledge, behaviour and emotional response, compared with district registered nurses and haematology registered nurses and the three-factor solution was confirmed. Registered nurses with higher scores on knowledge and emotional response attributed greater responsibility to themselves and to politicians. The Multidrug-Resistant Bacteria Attitude Questionnaire was translated using a forward-back translation process. Conclusion. The questionnaire has adequate psychometric properties. Insufficient knowledge of, behaviour toward and emotional response to patients with multidrug-resistant bacteria were described, but the registered nurses did estimate their own responsibility for adherence to preventive measures for infection control as being great or very great. Relevance to clinical practice. There is a considerable need to improve knowledge, behaviour and emotional response regarding infection prevention measures among healthcare workers. The hospital management are responsible for such improvements and the Multidrug-Resistant Bacteria Attitude Questionnaire is useful in identifying such needs, as it has adequate psychometric properties and is able to discriminate between groups. Evaluation among healthcare workers may indicate where to situate additional training, as this is of clinical significance for safe care.

  • 9.
    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.

  • 10.
    Wijk, Katarina
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Åberg Jönsson, Fredrik
    Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden.
    Lindberg, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Perceived enabling factors and barriers for the implementation of improvements in health care in order to achieve patient-centred care: A case report from Sweden2019In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753Article in journal (Refereed)
    Abstract [en]

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

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