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  • 251.
    Svantesson, Mia
    et al.
    Örebro University, Örebro, Sweden; University of Warwick, Coventry, West Midlands, England.
    Silén, Marit
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Uppsala university, Uppsala, Sweden.
    James, Inger
    Örebro University, Örebro, Sweden.
    It’s not all about moral reasoning: Understanding the complex content of Moral Case Deliberation2018Inngår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 25, nr 2, s. 212-229Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain.

    Objective:

    To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces.

    Methods:

    A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority.

    Ethical considerations:

    No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation.

    Findings:

    Other than ‘moral reasoning’ (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of ‘reflections on the psychosocial work environment’ to a varying extent (md: 29%). Additional content comprised ‘assumptions about the patient’s psychosocial situation’ (md: 6%), ‘facts about the patient’s situation’ (md: 5%), ‘concrete problem-solving’ (md: 6%) and ‘process’ (md: 3%).

    Conclusion:

    The findings suggest that a restorative function of staff’s wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants’ own emotional needs and to develop the use of their emotional knowing to focus on the ethically difficult patient situation.

  • 252.
    Svennberg, Lena
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Idrottsvetenskap. The Swedish School of Sport and Health Sciences, Stockholm, Sweden.
    Högberg, Hans
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Who gains?: Sociological parameters for obtaining high grades in physical education2018Inngår i: Nordic Journal of Studies in Educational Policy, ISSN 2002-0317, Vol. 4, nr 1, s. 48-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to investigate factors contributing to higher grades in Swedish physical education (PE) by analysing register data from the Swedish National Agency for Education for all students graduating from compulsory school in 2014 (n = 95,317). The results show that the chances of gaining a high grade in PE are affected by (in decreasing order) migration background, parents? education, attending an independent or a municipally operated school and gender, and that this also holds true after controlling for the other background factors. The results also show that PE grade differences between boys and girls are bigger in the group that moved to Sweden after school start than in the group that had lived in Sweden since school start. In addition, the results point to substantial inequalities between students with a combination of the highest odds and those with a combination of the lowest odds. Bernstein?s concept of the pedagogic device is used to discuss ways of understanding what knowledge becomes valued in PE and which groups have better possibilities to assimilate this valued knowledge.

  • 253.
    Sving, Eva
    et al.
    Clinical Training Centre, Region Gävleborg, Sweden; Centre for Research & Development, Uppsala University/Region Gävleborg; Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Sweden.
    Frediksson, Lennart
    Centre for Research & Development, Uppsala University/Region Gävleborg.
    Gunningberg, Lena
    Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Sweden.
    Mamhidir, Anna-Greta
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Sweden.
    Getting evidence-based pressure ulcer prevention into practice: a process evaluation of a multi-faceted intervention in a hospital setting2017Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, nr 19-20, s. 3200-3211Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM:

    The aim of the present study was to describe registered nurses', assistant nurses' and first-line managers' experiences and perceptions of a multi-faceted hospital setting intervention focused on implementing evidence-based pressure ulcer prevention.

    BACKGROUND:

    Pressure ulcer prevention is deficient. Different models exist to support implementation of evidence-based care. Little is known about implementation processes.

    DESIGN:

    A descriptive qualitative approach.

    METHOD:

    Five focus-group nurse interviews and five individual first-line manager interviews were conducted at five Swedish hospital units. Qualitative content analysis was used.

    RESULT:

    The findings support that the intervention and the implementation process changed the understanding and way of working with pressure ulcer prevention: from treating to preventing. This became possible as 'Changed understanding enables changed actions - through one's own performance and reflection on pressure ulcer prevention'. Having a common outlook on pressure ulcer prevention, easy access to pressure-reducing equipment, and external and internal facilitator support were described as important factors for changed practices. Bedside support, feedback and discussions on current results increased the awareness of needed improvements.

    CONCLUSION:

    The multi-faceted intervention approach and the participants' positive attitudes seemed to be crucial for changing understanding and working more preventatively. The strategies used and the skills of the facilitators need to be tailored to the problems surrounding the context. Feed-back discussions among the staff regarding the results of the care provided also appear to be vital.

  • 254.
    Sving, Eva
    et al.
    Clinical Training Centre, County Council of Gävleborg, Gävle; Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle; Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University.
    Högman, Marieann
    Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle; Department of Medical Sciences, Lung Medicine and Allergology, Uppsala University.
    Mamhidir, Anna-Greta
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Gunningberg, Lena
    Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University.
    Getting evidence-based pressure ulcer prevention into practice: a multi-faceted unit-tailored intervention in a hospital setting2016Inngår i: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 13, nr 5, s. 645-654Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of the study was to evaluate whether a multi-faceted, unit-tailored intervention using evidenced-based pressure ulcer prevention affects (i) the performance of pressure ulcer prevention, (ii) the prevalence of pressure ulcers and (iii) knowledge and attitudes concerning pressure ulcer prevention among registered and assistant nurses. A quasi-experimental, clustered pre- and post-test design was used. Five units at a hospital setting were included. The intervention was based on the PARIHS framework and included a multi-professional team, training and repeated quality measurements. An established methodology was used to evaluate the prevalence and prevention of pressure ulcers. Nurses' knowledge and attitudes were evaluated using a validated questionnaire. A total of 506 patients were included, of whom 105 patients had a risk to develop pressure ulcer. More patients were provided pressure ulcer prevention care (P = 0·001) and more prevention care was given to each patient (P = 0·021) after the intervention. Corresponding results were shown in the group of patients assessed as being at risk for developing pressure ulcers. Nurses' knowledge about pressure ulcer prevention increased (P < 0·001). Positive attitudes towards pressure ulcer prevention remained high between pre- and post-test surveys. This multi-faceted unit-tailored intervention affected pressure ulcer prevention. Facilitation and repeated quality measurement together with constructed feedback of results seemed to be the most important factor for pressure ulcer prevention.

  • 255.
    Theander, Kersti
    et al.
    Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Wilde-Larsson, Bodil
    Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden; Faculty of Public Health, Department of Nursing and Mental Health, Hedmark University College, Hedmark, Norway.
    Carlsson, Marianne
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Florin, Jan
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Gardulf, Ann
    Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital, Huddinge, Stockholm, Sweden; The Japan Red Cross Institute for Humanitarian Studies, Tokyo, Japan .
    Johansson, Eva
    Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital, Huddinge, Stockholm, Sweden; The Japan Red Cross Institute for Humanitarian Studies, Tokyo, Japan .
    Lindholm, Christina
    Sophiahemmet University, Stockholm, Sweden.
    Nordström, Gun
    Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden; Faculty of Public Health, Department of Nursing and Mental Health, Hedmark University College, Hedmark, Norway.
    Nilsson, Jan
    Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden; The Japan Red Cross Institute for Humanitarian Studies, Tokyo, Japan.
    Adjusting to future demands in healthcare: curriculum changes and nursing students' self-reported professional competence2016Inngår i: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 37, s. 178-183Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Nursing competence is of significant importance for patient care. Newly graduated nursing students rate their competence as high. However, the impact of different designs of nursing curricula on nursing students' self-reported nursing competence areas is seldom reported.

    OBJECTIVES: To compare newly graduated nursing students' self-reported professional competence before and after the implementation of a new nursing curriculum. The study had a descriptive comparative design. Nursing students, who graduated in 2011, having studied according to an older curriculum, were compared with those who graduated in 2014, after a new nursing curriculum with more focus on person-centered nursing had been implemented.

    SETTING: A higher education nursing program at a Swedish university.

    PARTICIPANTS: In total, 119 (2011 n=69, 2014 n=50) nursing students responded.

    METHODS: Nursing students' self-reported professional competencies were assessed with the Nurse Professional Competence (NPC) scale.

    RESULTS: There were no significant differences between the two groups of nursing students, who graduated in 2011 and 2014, respectively, with regard to age, sex, education, or work experience. Both groups rated their competencies as very high. Competence in value-based nursing was perceived to be significantly higher after the change in curriculum. The lowest competence, both in 2011 and 2014, was reported in education and supervision of staff and students.

    CONCLUSIONS: Our findings indicate that newly graduated nursing students - both those following the old curriculum and the first batch of students following the new one - perceive that their professional competence is high. Competence in value-based nursing, measured with the NPC scale, was reported higher after the implementation of a new curriculum, reflecting curriculum changes with more focus on person-centered nursing.

  • 256.
    Thern, Emelie
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Jia, Ting
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Willmer, Mikaela
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    de Munter, Jeroen
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Norström, Thor
    Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden.
    Ramstedt, Mats
    The Swedish Council for Information on Alcohol and Other Drugs, Stockholm, Sweden.
    Davey Smith, George
    MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
    Tynelius, Per
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden.
    Rasmussen, Finn
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden.
    No effects of increased alcohol availability during adolescence on alcohol-related morbidity and mortality during four decades: a natural experiment2017Inngår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, nr 11, s. 1072-1077Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: A strict high legal age limit for alcohol purchases decreases adolescents' access to alcohol, but little is known about long-term health effects. The aim was to estimate the effect of increased alcohol availability during adolescence on alcohol-related morbidity and mortality.

    METHODS: A nationwide register-based study using data from a natural experiment setting. In two regions of Sweden, strong beer (4.5%-5.6% alcohol by volume) became temporarily available for purchase in grocery stores for individuals 16 years or older (instead of 21) in 1967/1968. The intervention group was defined as all individuals living in the intervention area when they were 14-20 years old (n=72 110). The remaining Swedish counties excluding bordering counties, without the policy change, were used as the control group (n=456 224). The outcomes of alcohol-related morbidity and mortality were collected from the Hospital Discharge Register and Cause of Death Register, in which average follow-up times were 38 years and 41 years, respectively. HRs with 95% CIs were obtained by Cox regression analysis.

    RESULTS: In the fully adjusted model, no clear evidence of an association between increased alcohol availability during adolescence and alcohol-related morbidity (HR: 0.99, 95% CI 0.96 to 1.02) or mortality (HR: 1.02, 95% CI 0.95 to 1.10) was found.

    CONCLUSION: The initial elevated risk of alcohol-related morbidity and mortality later in life among adolescents exposed to increased access to strong beer in Sweden vanished when a regional measure population density of locality was included in the model, which is important to consider in future research.

  • 257.
    Thunander Sundbom, Lena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Förskrivning och följsamhet av antidepressiva hade koppling till kön2017Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, nr 51-52Artikkel, omtale (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

    Avhandling. Kvinnor diagnostiseras med depression dubbelt så ofta som män och förskrivs antidepressiva betydligt oftare. Syftet med denna avhandling var att studera hur psykisk ohälsa och kön påverkar läkemedelsanvändning när det gäller följsamhet respektive förskrivning.

    Vi lät 16 000 slumpmässigt utvalda personer mellan 18 och 84 år (svarsfrekvens 48 procent) skatta depression genom formuläret HADS (Hospital anxiety and depression scale). Männen hade rapporterad depression i något högre utsträckning än kvinnorna. Dessa data kopplades sedan på individnivå till förskrivna antidepressiva via Läkemedelsregistret. En högre andel av männen än kvinnorna hade rapporterad depression utan att använda antidepressiva, vilket kan bero på att män inte söker vård vid psykisk ohälsa eller på att mäns psykiska besvär inte upptäcks då symtomen ofta avviker från vårdens diagnoskriterier.

    Kvinnorna däremot använde antidepressiva utan att ha rapporterad depression betydligt oftare än männen, vilket kan bero på tillfrisknande från depressionen eller på att kvinnor förskrivs antidepressiva redan vid mycket lindriga besvär. Vi lät även 7 985 slumpmässigt utvalda personer mellan 18 och 84 år (svarsfrekvens 61 procent) svara på frågor gällande följsamhet.

    Kvinnorna rapporterade betydligt oftare än männen att de avstod från att ta sina läkemedel på grund av läkemedelsbiverkningar, medan männen oftare än kvinnorna rapporterade att de ändrade doserna och glömde att ta sina läkemedel. Resultaten tyder på att kön bör beaktas i riktlinjer för diagnostik och behandling av depression och vid bristande följsamhet: även om studiedesignen i form av tvärsnittsstudier inte möjliggör fastställande av orsakssamband belyser denna avhandling könsskillnader, vilka bör beaktas såväl inom klinisk praxis som framtida studier.

  • 258.
    Thunander Sundbom, Lena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Uppsala universitet, Institutionen för farmaci.
    The influence of gender and depression on drug utilization: Pharmacoepidemiological research in Sweden2017Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background Drug use has increased over recent decades, and is especially great among women and among people with mental health problems. To take advantage of the full potential of drugs and to avoid drug-related problems, drug prescription needs to be correct and the drugs need to be taken according to the prescribed regimens. Research on drug utilization is thus important to the public health.

    Aim To study the influence of gender and depression on drug utilization, prescription of drugs and self-reported use of drugs, i.e. adherence.

    Methods The thesis included two population-based questionnaires and data from the Swedish Prescribed Drug Register (SPDR) covering Swedish citizens 18-84 years. The questionnaire in Study I and II included items on prescription drug use and adherence to treatment regimens; Study II also included the Hospital Anxiety and Depression Scale (HADS) for self-estimation of anxiety/depression. The questionnaire in Study III included the HADS and data from the SPDR on prescribed antidepressants. Study IV included data from the SPDR on all types of prescribed drugs.

    Results Men and women differed in non-adherent behaviours and reasons for non-adherence, for example, men were more likely to report forgetting to take the drug, while women were more likely to report adverse drug reactions (ADRs) as a reason for non-adherence. Further, both anxiety and depression were associated with non-adherence and with ADRs as a reason for non-adherence. In addition, men reported depression to a greater extent than women did but used antidepressants to a lesser extent, while women used antidepressants without reporting depression more often than men did, which may be a sign of under-treatment among men and over-treatment among women. Moreover, the associations between antidepressants and other types of drugs differed by gender; they were often specific, or stronger, in women than in men, which may be a sign of a gender difference in comorbidity between depression and other conditions.

    Conclusions Although the cross-sectional study design prevented confirmation of causality, the thesis found that gender and depression influence both prescription of drugs and adherence, and are thus important to pay attention to in clinical practice as well as research.

  • 259.
    Thunander Sundbom, Lena
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Pharmacy, Uppsala University, Uppsala, Sweden.
    Bingefors, Kerstin
    Department of Pharmacy, Uppsala University, Uppsala, Sweden.
    Hedborg, Kerstin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Isacson, Dag
    Department of Pharmacy, Uppsala University, Uppsala, Sweden.
    Are men under-treated and women over-treated with antidepressants?: Findings from a cross-sectional survey in Sweden2017Inngår i: BJPsych bulletin, ISSN 2056-4694, E-ISSN 2056-4708, Vol. 41, nr 1, s. 145-150Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims and method To examine gender differences in self-reported depression and prescribed antidepressants (ADs). The Hospital Anxiety and Depression Scale was used to assess depression, and information on prescribed ADs was obtained from the Swedish Prescribed Drug Register.

    Results Depression was reported by 11.7% of the participants (12.3% men and 11.2% women). ADs were prescribed for 7.6% of the participants (5.3% men, 9.8% women). Among men, 1.8% reported depression and used ADs, 10.5% reported depression but did not use ADs, and 3.6% used ADs but did not report depression. The corresponding figures for women were 2.6%, 8.6% and 7.2%.

    Clinical implications Men report depression to a greater extent than women but are prescribed ADs to a lesser extent, possibly a sign of under-treatment. Women are prescribed ADs without reporting depression more often than men, possibly a sign of over-treatment. Although the causes remain unclear, diagnostic and treatment guidelines should benefit from considering gender differences in these respects.

  • 260.
    Thunander Sundbom, Lena
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Uppsala universitet, Institutionen för farmaci.
    Hedborg, Kerstin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Gender differences in the association between prescribed antidepressants and other prescribed drugs: a nationwide register-based study in SwedenManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

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

    Aim: Examine gender differences in the association between antidepressants, other drugs, and polypharmacy.

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

    Results: For both men and women, associations were found between antidepressants and drugs for alimentary tract problems, respiratory problems, drugs for the blood, and drugs for the nervous system, analgesics, and polypharmacy. For many of the drugs, for example those for respiratory problems and analgesics, the association was stronger in women than in men. However, concerning drugs for the nervous system and polypharmacy, the association was stronger in men than in women. Furthermore, for women, but not men, associations were found for drugs for diabetes, musculoskeletal problems, dermatological problems, and systemic hormones.

    Conclusions: Many of the associations between antidepressants and other drugs were found to be specific, or stronger, among women than among men. In some cases, however, the associations were stronger in men. Whether this indicates that men and women differ in comorbidity between depression and other conditions cannot be concluded based on this cross-sectional study. However, physicians should be aware that possible gender differences in comorbidity exist, and because comorbidity between depression and other conditions impairs the possibility of recovery, and decreases adherence, screening for depression could be valuable.

  • 261.
    Thunborg, Charlotta
    et al.
    Department of Neurobiology, Care Sciences and Society at the Karolinska Institutet Division of Neurogeriatrics, Center for Alzheimer Research in Huddinge, Sweden.
    Salzmann-Erikson, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    A qualitative inquiry into the complex features of strained interactions: analysis and implications for healthcare personnel2017Inngår i: The Permanente Journal, ISSN 1552-5767, E-ISSN 1552-5775, Vol. 21, artikkel-id 16-032Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Communication skills are vital for successful relationships between patients and healthcare professionals. Failure to communicate may lead to a lack of understanding and may result in strained interactions. Our theoretical point of departure was to make use of chaos and complexity theories. The aim of this study was to examine the features of strained interactions and to discuss their relevance for healthcare settings.

    Methods: A netnography study design was applied. Data were purposefully sampled, and video clips (122 minutes from 30 video clips) from public online venues were used.

    Results: The results are presented in four categories: a) unpredictability; b) sensitivity dependence; c) resistibility; and d) iteration. They are all features of strained interactions.

    Conclusion: Strained interactions are a complex phenomenon that exists in healthcare settings. The findings provide health care professionals guidance to understand the complexity and the features of strained interactions.

  • 262.
    Turen, Åke
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    “En känsla att bli lämnad vind för våg – men ett ljus i mörkret”: En intervjustudie om äldres upplevelse av vårdplanering i samband med sjukhusvistelse och första tiden efter hemkomst2017Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
  • 263.
    Tuvesson, Hanna
    et al.
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Hellström, A.
    Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
    Sjöberg, L.
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Sjölund, Britt-Marie
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Nordell, E.
    Department of Geriatric Medicine, Skåne University Hospital, Malmö, Sweden.
    Fagerström, C.
    Blekinge Centre of Competence, Blekinge County Hospital, Karlskrona, Sweden.
    Life weariness and suicidal thoughts in late life: a national study in Sweden2018Inngår i: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 22, nr 10, s. 1365-137Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: This study aimed at investigating the point prevalence of life weariness and suicidal thoughts and their relationship with socio-demographic characteristics in a population of older adults in Sweden. Method: Data from 7913 individuals aged 60 years and older were drawn from the Swedish National Study on Aging and Care, a collaborative study in Sweden. Life weariness and suicidal thoughts were measured by one item derived from the Montgomery–Åsberg Depression Rating Scale. A multinomial regression model was used to investigate the relationships of socio-demographic characteristics with life weariness and suicidal thoughts. Results: Living in urban and semi-urban areas, being of advanced age, being divorced and having lower educational levels were related to life weariness. Living in a residential care facility, being widowed or unmarried, being born in a non-Nordic European country and experiencing financial difficulties were related to both life weariness and suicidal thoughts. Sex was found to be unrelated to either life weariness or suicidal thoughts. Conclusion: This study found that several socio-demographic variables were associated with life weariness and suicidal thoughts among older adults. Specific attention to older individuals with these characteristics may be warranted as they might be more vulnerable to life weariness and suicidal thoughts.

  • 264.
    Vae, Karen Johanne U.
    et al.
    Faculty of Health Education, Stord/Haugesund University College, Norway.
    Engström, Maria
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Sweden; Nursing Department, Medicine and Health College, Lishui University, China.
    Mårtensson, Gunilla
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Löfmark, Anna
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Faculty of Health Education, Stord/Haugesund University College, Norway.
    Nursing students' and preceptors’ experience of assessment during clinical practice: a multilevel repeated-interview study of student–preceptor dyads2018Inngår i: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 30, s. 13-19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Nursing students' learning process during clinical practice is dependent on the quality of their assessment, and the feedback that is given, however an issue that is very little examined. The aim of this study was to investigate student-preceptor dyads and their experiences of mid-course discussions and final assessment. Data were collected through repeated semi-structured individual interviews with 13 dyads close in time to the assessment discussions, and were analyzed by searching for similarities and differences in their experiences. Both students and preceptors shared the view that the preparations before the discussions caused uncertainty, but they described different reasons. Both students and preceptors meant that the assessment tool was used in a structured way. The feedback mediated to students emphasized what was important to concentrate on in the next part or next period, but less about the individual students' progress. The student-preceptor dyads did not share the view of what content had been in focus in the discussions and there were variations in the details. Conclusions can be drawn that one of the crucial elements of an assessment discussion, to give students constructive feedback in relation to learning outcomes, was not fulfilled.

  • 265.
    Valan, Lotha
    et al.
    Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
    Kristiansen, Lisbeth Porskrog
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Sundin, Karin
    Department of Nursing, Umeå University, Örnsköldsvik, Sweden.
    Jong, Mats
    Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
    Health-Related Internet Information Both Strengthens and Weakens Parents’ Potential for Self-Care: A Mixed-Methods Study on Parents’ Search Patterns2018Inngår i: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 8, nr 10, s. 731-745, artikkel-id 88148Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Today’s parents belong to the digital generation and regularly use the Internet as a source of information. Parents’ quests for health-related online information comprise an effort to manage symptoms of illness or address questions about child development which may be an expression of self-management or self-care. Purpose: This study aims to describe health and child development related Internet search patterns used by parents of children ages zero to six, and further, how the obtained information was used in contacts with Child Health Care. Design and Methods: A two-step mixed- method approach is used in this study, comprising both a quantitative and a qualitative approach. First, a questionnaire was distributed to parents (n = 800) at 13 health centers in a medium sized county in Sweden. Second, one narrative interview with two parents total was conducted. Descriptive and non-parametric statistics were calculated, and qualitative manifest content analyses were performed. Results: A total of 687 completed the questionnaire, which corresponds to a response rate of 86%. The results show that 97% used the Internet for health-related and developmental child issues. The results show that parents often look at basic tips and the Internet is seen as a fast and accessible forum to obtain information. Parents often initiated their Internet searches using Google search for the specific subject, but the most common and most used website (used by 95% of parents), was the Swedish health site 1177.se. 98.4% of parents evaluated the general information searches they made on the Internet as reliable despite only 31% of the parents checking to see if the websites they used were scientifically based. Parents (81.7%) stated that they wanted their Child Health Nurses (CHN) to give them recommendations for valid websites. Conclusions: The results in this study show that, on the one hand, the Internet could strengthen parental knowledge (support self-care capacity), but, on the other hand, the found information could worry them and increase their anxiety—negatively affected self-care capacity. The parents suggested that the information should be double-checked to establish trust and develop self-care knowledge. Having a good resource to rely on, such as personal contact with a CHN, or using reliable websites seems to strengthen and reassure parents.

  • 266.
    Voraroon, Supaporn
    et al.
    Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden; Boromarajonani College of Nursing, Suphanburi, Thailand.
    Meebunmak, Yaowaluck
    Boromarajonani College of Nursing, Ratchaburi, Thailand.
    Enmarker, Ingela
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Centre for Care Research Mid-Norway, Steinkjer, Norway.
    Hellzen, Ove
    Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden.
    Shareholding Networks for Care in Rural Thailand: Experiences of Older Persons and Their Family Members2017Inngår i: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 7, s. 318-330Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Most members of the older population in Thailand live in rural areas while their children live in cities. With the joint family system separated, elderly Thai persons often have to care for themselves, and opportunities for them to get involved in community care remain limited. In response, the aim of this study was to describe olderpersons’ and their family members’ experiences with shareholding networks for the care of older people in rural Thailand. Paired interviews with five older persons and five of their family members were conducted, and collected data were subjected to content analysis, which yielded results organized around two themes:older persons’ outsider status and disregard for older persons’ individuality.Whereas the theme of outsider status describes shortcomings in healthcare encounters, the theme of disre-gard for individuality describes the lack of engagement of authorities and ca-regivers in older persons’ care. In that sense, the concept of participation emerged as a framework for understanding interviewees’ experiences. Given findings from local authorities, older individuals and theirfamily members should engage in dialogue in order to support healthcare based on shared un-derstanding.

  • 267.
    Voraroon, Supraon
    et al.
    Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden; Boromarajonani College of Nursing, Suphanburi, Thailand.
    Hellzén, Ove
    Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden.
    Meebunmak, Yaowaluck
    Boromarajonani College of Nursing, Suphanburi, Thailand.
    Enmarker, Ingela
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden; Centre of Care Research, Department of Health Sciences, Nord University, Steinkjer, Norway.
    Older People’s Lived Experiences with Participation in Shareholding Networks for the Care of Older People in Rural Areas of Thailand: A Phenomenological Hermeneutic Study2017Inngår i: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 7, nr 7, s. 875-892Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Older people participating in shareholding networks are exposed to diverse situations, which may be associated with dignity. Aims: This study aimed to illuminate the meaning of lived experiences when participating in shareholding networks for the care of older people in rural areas. Methods: This qualitative study is based on individual interviews. Ten older Thai persons with at least 12 months of lived experiences participating in shareholding networks for older people in rural areas were interviewed. A phenomenological-hermeneutic approach, inspired by Ricoeur, was used to understand the meaning of the narrated text. Findings: The structural analysis resulted in four themes: 1) being satisfied with activities, 2) being valued as important, 3) being frustrated and feeling sad, and 4) being bored and feeling disinterest. The meaning of participation in a shareholding network for the elderly can be understood as a pathway to feelings of confidence and presence of others. Confidence and allowing the presence of others mean facing humanity and sensing vulnerability, because in a trusting relationship the person who gives confidence is susceptible to the other’s betrayal. Conclusion: An individual’s dignity should be a high priority in health and social care strategies. Therefore, it is important for healthcare professionals to initiate a dialogue with the shareholding participants for support and information. The narrations in this study can be used as a basis for developing cooperating care with older people in shareholding network focusing on their needs and dignity.

  • 268.
    Wahlberg, Anna Carin
    et al.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Björkman, Annica
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Expert in nursing care but sometimes disrespected-Telenurses' reflections on their work environment and nursing care2018Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, nr 21/22, s. 4203-4211Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

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

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

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

  • 269.
    Wallin, E.
    et al.
    Department of Surgical Sciences/Anesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Larsson, I. M.
    Department of Surgical Sciences/Anesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Sellert-Rydberg, M.
    Department of Anesthesiology & Intensive Care, Intensive Care Unit, Falun, Sweden.
    Rubertsson, S.
    Department of Surgical Sciences/Anesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Kristofferzon, Marja-Leena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Support and impact on everyday life after survival from cardiac arrest: Relatives' descriptions 6 months after a significant other's cardiax arrest2011Inngår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 37, nr Suppl. 1, s. S74-S74, artikkel-id 0276Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    INTRODUCTION

    The aim was to describe relatives’ need of support and information whena significant other has survived cardiac arrest and the impact on everyday life 6 months after theevent.OBJECTIVES.Interviews with 20 relatives were conducted 6 months after a significantother’s cardiac arrest.

    METHODS

    The interviews were recorded and transcribed verbatim and were analyzed withqualitative content analysis.

    RESULTS

    The result illustrated various experiences by relatives. Six months after the sig-nificant other’s cardiac arrest relatives experienced support mainly from other family membersand friends. Relatives stated that the care, support and information in the intensive care unit hadbeen good but that they felt abandoned by the health care when the significant other wasdischarged from the intensive care unit. There were various requests to get more support fromthe health care mainly around issues concerning prognosis, rehabilitation and follow-up care.There were also requests to meet others in same situation, like family groups where they couldshare experiences. They experienced that the everyday life was affected especially withincreased responsibilities and requirements at home, restrictions in social life, a sense ofabandoned and a lack of understanding from the surroundings and a constant concern for thesignificant other.

    CONCLUSIONS

    Relatives’ everyday life was still affected 6 months after the event withincreased responsibilities at home and a constant concern for the person stricken by a cardiacarrest. The study illustrates that health care personnel need to offer relatives follow-upappointments to clarify issues concerning support and information.

  • 270.
    Wallin, Ewa
    et al.
    Department of Surgical Sciences Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Larsson, Ing-Marie
    Department of Surgical Sciences Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Kristofferzon, Marja-Leena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Larsson, Elna-Marie
    Department of Surgical Sciences Radiology, Uppsala University, Uppsala, Sweden.
    Raininko, Raili
    Department of Surgical Sciences Radiology, Uppsala University, Uppsala, Sweden.
    Rubertsson, Sten
    Department of Surgical Sciences Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest2018Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, nr 5, s. 625-647Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Magnetic resonance imaging (MRI) of the brain including diffusion-weighted imaging (DWI) is reported to have high prognostic accuracy in unconscious post-cardiac arrest (CA) patients. We documented acute MRI findings in the brain in both conscious and unconscious post-CA patients treated with target temperature management (TTM) at 32-34°C for 24 h as well as the relation to patients' neurological outcome after 6 months.

    METHODS:

    A prospective observational study with MRI was performed regardless of the level of consciousness in post-CA patients treated with TTM. Neurological outcome was assessed using the Cerebral Performance Categories scale and dichotomized into good and poor outcome.

    RESULTS:

    Forty-six patients underwent MRI at 3-5 days post-CA. Patients with good outcome had minor, mainly frontal and parietal, lesions. Acute hypoxic/ischemic lesions on MRI including DWI were more common in patients with poor outcome (P = 0.007). These lesions affected mostly gray matter (deep or cortical), with or without involvement of the underlying white matter. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum showed strongest associations with poor outcome. Decreased apparent diffusion coefficient, was more common in patients with poor outcome.

    CONCLUSIONS:

    Extensive acute hypoxic/ischemic MRI lesions in the cortical regions, deep gray matter and cerebellum detected by visual analysis as well as low apparent diffusion coefficient values from quantitative measurements were associated with poor outcome. Patients with good outcome had minor hypoxic/ischemic changes, mainly in the frontal and parietal lobes.

  • 271.
    Wallin, Ewa
    et al.
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Larsson, Ing-Marie
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Nordmark-Grass, Johanna
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Rosenqvist, Ivan
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Kristofferzon, Marja-Leena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Rubertsson, Sten
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Characteristics of jugular bulb oxygen saturationin patients after cardiac arrest: A prospective study2018Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, nr 9, s. 1237-1245Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Using cerebral oxygen venous saturation post-cardiac arrest (CA) is limited because of a small sample size and prior to establishment of target temperature management (TTM). We aimed to describe variations in jugular bulb oxygen saturation during intensive care in relation to neurological outcome at 6 months post- CA in cases where TTM 33°C was applied.

    METHOD:

    Prospective observational study in patients over 18 years, comatose immediately after resuscitation from CA. Patients were treated with TTM 33°C M and received a jugular bulb catheter within the first 26 hours post-CA. Neurological outcome was assessed at 6 months using the Cerebral Performance Categories (CPC) and dichotomized into good (CPC 1-2) and poor outcome (CPC 3-5).

    RESULTS:

    Seventy-five patients were included and 37 (49%) patients survived with a good outcome at 6 months post-CA. No differences were found between patients with good outcome and poor outcome in jugular bulb oxygen saturation. Higher values were seen in differences in oxygen content between central venous oxygen saturation and jugular bulb oxygen saturation in patients with good outcome compared to patients with poor outcome at 6 hours (12 [8-21] vs 5 [-0.3 to 11]% P = .001) post-CA. Oxygen extraction fraction from the brain illustrated lower values in patients with poor outcome compared to patients with good outcome at 96 hours (14 [9-23] vs 31 [25-34]% P = .008).

    CONCLUSIONS:

    Oxygen delivery and extraction differed in patients with a good outcome compared to those with a poor outcome at single time points. Based on the present findings, the usefulness of jugular bulb oxygen saturation for prognostic purposes is uncertain in patients treated with TTM 33°C post-CA.

  • 272.
    Wallin, Ewa
    et al.
    Department of Surgical Sciences – Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Rubertsson, Sten
    Department of Surgical Sciences – Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Larsson, Ing-Marie
    Department of Surgical Sciences – Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Kristofferzon, Marja-Leena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Larsson, Elna-Marie
    Department of Surgical Sciences – Radiology, Uppsala University, Uppsala, Sweden.
    Raininko, Raili
    Department of Surgical Sciences – Radiology, Uppsala University, Uppsala, Sweden.
    Acute brain lesion on MRI in relation to neorological outcome 6 months after cardiac arrest treated with hypothermia2015Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, nr Suppl. 1, s. 147-147, artikkel-id AP254Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Aim of the study: To document the acute magnetic resonance imaging (MRI) findings on the brain in cardiac arrest (CA) patients treated with therapeutic hypothermia (TH) and their relation to patients’ neurological outcome after 6 months.

    Method: A prospective observational study with MRI was performed regardless the level of consciousness in 56 post-CA patientstreated with TH.

    Results: MRI of the brain was obtained at a median of 4 days (3–13 days). At 6 months, 32/56 had survived with good neurological outcome. The MMSE was performed in 28/32 (88%) patients with a median of 28 (24–30). Acute ischemic lesions were found on diffusion-weighted MRI (DWI) in 34 (61%) patients and were more common in patients with poor outcome (p= 0.006). Acute ischemic injuries affected mostly gray matter, deep or cortical, and with or without involvement of the underlying white matter. Very few lesions were pure white matter lesions. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum were most associated with poor outcome. Reductions in the apparent diffusion coefficient (ADC) were more common in patients with poor outcome, particularly in the occipital lobes. None of the patients with an ADC below 600×10−6mm2/s in any region survived to 6months.

    Conclusions: In visual analyses of acute MRI, extensive acutelesions were found in the cortical regions and deep gray matter and were associated with poor outcome. In ADC measurements, low values were associated with poor outcome. Patients with good outcome showed a minor pathological pattern mainly in the frontal and parietal lobes.

  • 273.
    Wallström, Rebecca
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap.
    Ståleborg Persson, Renée
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap.
    Salzmann-Erikson, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Working with children in families with parental substance abuse: nurses' experiences and complexity in relationships2016Inngår i: Journal of Psychosocial Nursing and Mental Health Services, ISSN 0279-3695, E-ISSN 1938-2413, Vol. 54, nr 6, s. 38-44Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Children who grow up in families with parental substance abuse are exposed to increased risk of developing a variety of disorders. As nurses encounter these children, it is important for them to be supportive. The aim of the current study was to describe nurses' experiences and reflections regarding their work with children in families with parental substance abuse. A qualitative descriptive approach was adopted. Seven nurses were interviewed, and data were analyzed using inductive content analysis. The results were presented in four categories: (a) nurses' responsibilities; (b) identification of children's social network; (c) ethical concerns; and (d) assessment and evaluation of children's behavior. Nurses' preventive work and intervention in dysfunctional families may have direct consequences on children's present and future development and well-being. 

  • 274.
    Westerberg Jacobson, Josefin
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Lindberg, Magnus
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Bjuhr, Marie
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Willmer, Mikaela
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    A wish to be thinner increases the odds for disturbed eating 20 years later2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: Studies from various cultures show that a large number of adolescent girls have a wish to be thinner, and thus more often go on diets. The purpose of this longitudinal study was to examine if a wish to be thinner among Swedish girls contributes to the development of disturbed eating, and to describe motives for wishing to be thinner.

    Methods: Following ethical approval (reg. no: 258/94; 2014/401) the Demographic and Dieting Questionnaire and the Eating Disorder Examination Questionnaire were used in a general population cohort of 7-11year-old-girls (n=462), 20 years later in October 2015.Threshold for DE was 1 SD above general population mean. Chi-square tests providing OR were used.

    Results: A wish to be thinner during adolescence increases the likelihood 3-5 times to develop disturbed eating during the following 20-year period. Self-described motives for the wish to be thinner was to “correspond to the societal ideal” and to “dealing with difficulties”.

    Conclusions: For prevention, it is of importance to detect girls who wish to be thinner as early as possible. By considering the girls’ motives, preventive efforts might be perceived as more meaningful and relevant to the girls at risk of developing eating disorders.

  • 275.
    Wetterskog, Annika
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Sjuksköterskans hinder och möjligheter till att använda forskningsresultat i sitt arbete på särskilt boende: En enkätstudie2017Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund. Sjuksköterskan/specialistsjuksköterskan har som ansvar att omvårdnaden bygger på forskningsresultat och beprövad erfarenhet. Ett antal studier visar att det är gynnande för patienten när forskningsresultat används i omvårdnaden. Sjuksköterskorna har dock svårigheter med att använda forskningsresultat även om de inser vikten av användandet. Syfte. Att se vilka hinder och möjligheter det finns för sjuksköterskor, arbetande på särskilda boenden för äldre, att använda forskningsresultat i sitt arbete. Metod. Beskrivande och jämförande design med kvantitativ ansats. Huvudresultat. Denna studie visar att det största hindret, för sjuksköterskor arbetande på SÄBO, i användningen av forskningsresultat är tidsbrist. De minsta hindren var att sjuksköterskan anser att forskning är relevant för deras arbete och att sjuksköterskorna ser värdet som forskningen har för den kliniska verksamheten. En signifikant skillnad kan ses beroende av ålder hur stora hinder man upplever i användandet av forskningsresultat, där yngre sjuksköterskor skattar högre hinder. Underlättande faktorer var en intresserad och positiv ledning, kollegor att diskutera forskning med samt att forskningsartiklar ska vara tydliga och enkla att förstå. Slutsats. För att ge sjuksköterskor större möjlighet till att använda av forskningsresultat i sitt arbete bör det ges tid till dem att göra detta.

  • 276.
    Willmer, Mikaela
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Salzmann-Erikson, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    ‘The only chance of a normal weight life’: A qualitative analysis of online forum discussions about bariatric surgery2018Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, nr 10, artikkel-id e0206066Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    The only effective weight loss treatment for severe obesity is bariatric surgery, with Roux-en-Y gastric bypass being the most common method. Patients often have unrealistic expectations of surgery and expect a “miracle cure” even though the procedure requires major lifelong lifestyle changes. Most patients access information about the procedure online, and come into contact with others who have had the surgery.

    Objective

    The objective of this study was to describe shared values, feelings, and thoughts among visitors to a web-based forum for those undergoing bariatric surgery.

    Methods

    In this cross-sectional observation study using qualitative contents analysis, the material consisted of an online discussion forum thread about bariatric surgery, with 498 posts. These were saved in a document, read and re-read. Through coding of meaningful units of text, themes were established.

    Results

    Four themes were constructed during data analysis: a) A new life-anticipating dramatic changes of body and mind; b) Negotiating the system and playing the waiting game; c) A means to an end-managing the pre-operative diet; and d) Managing the attitudes of others. Posters described the process of bariatric surgery as a journey, riddled with roadblocks, setbacks and trials, but also with joy and expectations of a new life.

    Conclusion

    Professionals who encounter this group should be aware of their need for support throughout the process, and investigate the possibility of both pre- and postoperative support groups, either online or face-to-face. The results also show that the posters on the forum had very high, and often unrealistic, expectations on how the surgery would change their lives. It is important for those who encounter this group before surgery to be aware of this tendency and to take measures to ensure that patients undergo the surgery with realistic expectations.

  • 277.
    Willmes, Emma
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Björklund, Vera
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Hur personer med Hiv upplever hälsa i vardagslivet2019Independent thesis Basic level (professional degree), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Sammanfattning 

    Bakgrund: Hiv anses vara ett av världens största folkhälsoproblem, år 2017 uppgav

    Världshälsoorganisationen att ungefär 37 miljoner människor världen över lever med Hiv. I

    Sverige lever cirka 6500 människor med Hiv och varje år rapporteras mellan 400–500 nya fall

    av Hiv i Sverige. Trots god kunskap om Hiv framkommer fortfarande fördomar, rädsla och en

    negativ attityd mot personer med Hiv inom vården. Förståelsen för en individs vardagsliv är

    en viktig grund för sjuksköterskans arbete eftersom förståelsen styr de åtgärder

    sjuksköterskan kan sätta in för att underlätta upplevelsen av hälsa i vardagslivet. En bättre

    förståelse för en individs vardag kan även förbättra vårdrelationen mellan sjuksköterskan och

    patienten samt kan öka förutsättningen för personens delaktighet i sin egen vård.

    Syfte: Att beskriva hur personer med Hiv upplever hälsa i vardagslivet.

    Metod: En litteraturstudie med deskriptiv design baserad på 12 kvalitativa artiklar.

    Huvudresultat: Resultatet visar att personer med Hiv upplever svårigheter rörande

    medicinering, stigmatisering och diskriminering som hinder till hälsa i vardagslivet medan

    socialt stöd från familj, vänner, tro och vårdpersonal kan underlätta upplevelsen av hälsa i

    vardagslivet.

    Slutsats: Personer med Hiv upplever svårigheter rörande medicinering, stigmatisering och

    diskriminering som hinder till hälsa i vardagslivet medan socialt stöd från familj, vänner, tro

    och vårdpersonal kan underlätta upplevelsen av hälsa i vardagslivet. Det är av vikt att förstå

    hur individen upplever sitt vardagsliv och vad som påverkar upplevelsen av vardagslivet,

    detta då vardagslivet måste fungera för att en individ ska känna hälsa.

    Nyckelord: Hiv, Hälsa, Upplevelser, Vardagsliv.

  • 278.
    Wimo, Anders
    et al.
    Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden; Center for Alzheimer Research at Karolinska Institutet, Stockholm, Sweden; Centre for Research & Development, Uppsala University/County Council of Gävleborg, Sjukhuset i Gävle, Sweden.
    Sjölund, Britt-Marie
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Sköldunger, Anders
    Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Qui, Chengxuan
    Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Klarin, Inga
    Department of Geriatrics, Karolinska University Hospital, Stockholm, Sweden; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm Sweden.
    Nordberg, Gunilla
    The Swedish Dementia Centre, Stockholm, Sweden.
    von Strauss, Eva
    Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden; The Swedish Red Cross University College, Stockholm, Sweden.
    Cohort Effects in the Prevalence and Survival of People with Dementia in a Rural Area in Northern Sweden2016Inngår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 50, nr 2, s. 387-396Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Recent studies suggest that trends in cardiovascular risk may result in a decrease in age-specific prevalence of dementia. Studies in rural areas are rare.

    Objectives: To study cohort effects in dementia prevalence and survival of people with dementia in a Swedish rural area.

    Methods: Participants were from the 1995-1998 Nordanstig Project (NP) (n = 303) and the 2001-2003 Swedish National study on Aging and Care in Nordanstig (SNAC-N) (n = 384). Overall 6-year dementia prevalence and mortality in NP and SNAC-N were compared for people 78 years and older. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for dementia occurrence using the NP study population as the reference group. Cox regression models were used to analyze time to death.

    Results: The crude prevalence of dementia was 21.8% in NP and 17.4% in SNAC-N. When the NP cohort was used as the reference group, the age- and gender-adjusted OR of dementia was 0.71 (95% CI 0.48-1.04) in SNAC-N; the OR was 0.47 (0.24-0.90) for men and 0.88 (0.54-1.44) for women. In the extended model, the OR of dementia was significantly lower in SNAC-N than in the NP cohort as a whole (0.63; 0.39-0.99) and in men (0.34; 0.15-0.79), but not in women (0.81; 0.46-1.44). The Cox regression models indicated that the hazard ratio of dying was lower in the SNAC-N than NP population.

    Conclusions: Trends toward a lower prevalence of dementia in high-income countries seem to be evident in this Swedish rural area, at least in men.

  • 279.
    Åberg, Siri
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Hornegård, Sofia
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Sjuksköterskors erfarenheter och upplevelser av att arbeta inom akutsjukvård: En beskrivande litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund

    Arbetet inom akutsjukvård har ett högt tempo, är omväxlande och avancerat samt innefattar patienter som drabbats av trauma. Tidigare studier visar att trauma innebär ett lidande för den drabbade personen men de visar även att personer som bevittnar effekterna av dessa trauman kan påverkas av dem. Stora krav ställs på sjuksköterskorna som arbetar med akutsjukvård då de förväntas kunna hantera alla aspekter av arbetet.

     

    Syfte

    Syftet med studien var att beskriva sjuksköterskors erfarenheter och upplevelser av att arbeta inom akutsjukvård samt beskriva inkluderade artiklars undersökningsgrupp.

     

    Metod

    Studien är en beskrivande litteraturstudie som har sammanställts av tolv vetenskapliga artiklar. Av dessa var en av kvantitativ ansats och en av mixad metod med kvalitativ och kvantitativ ansats. Resterande artiklar var kvalitativa.

     

    Huvudresultat

    Sjuksköterskor inom akutsjukvård upplevde arbetet som oförutsägbart och hektiskt. Det beskrevs som ett givande men samtidigt utmanande jobb som var krävande för sjuksköterskan. Sjuksköterskorna påverkades emotionellt av de traumarelaterade skador som de bevittnade i arbetet, för att hantera dessa använde sig sjuksköterskorna av olika resurser och copingstrategier.

     

    Slutsats

    Genom att applicera copingstrategier och få stöd i form av olika resurser hade sjuksköterskorna lättare för att hantera och bearbeta arbetet inom akutsjukvård.

  • 280.
    Öhman, Michaela
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Östergrens, Lisa
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Sjuksköterskors upplevelser av att möta patienter med psykossjukdom inom den somatiska vården: En beskrivande litteraturstudie2019Independent thesis Basic level (professional degree), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Ungefär 2000 personer i Sverige insjuknar varje år i någon form av psykos. Psykossjukdom förknippas ofta med fördomar och stigmatisering. Forskning har visat att ju mer stigmatisering psykossjuka patienter förväntar sig från omgivningen, desto mer ökar deras stigmatisering av sig själva, vilket i sin tur påverkar deras återhämtning negativt. Personer med psykossjukdom har också beskrivit att de ej fått fullgod somatisk vård på grund av sin psykiska sjukdom.

    Syfte: Syftet med föreliggande litteraturstudie var att beskriva sjuksköterskors upplevelser av att möta patienter med psykossjukdom inom den somatiska vården.

    Metod: En beskrivande litteraturstudie baserat på 5 kvalitativa och 5 kvantitativa vetenskapliga artiklar. PubMed och Cinahl var de databaser som användes i sökningarna till de inkluderade artiklarna.

    Huvudresultat: Okunskapen kring psykossjukdomar beskrevs vara stor inom den somatiska vården. Sjuksköterskor upplevde ofta känslor som rädsla, anspänning och osäkerhet, vilket gjorde mötet med dessa patienter problematiskt. Begränsningar som tidsbrist i den somatiska vårdmiljön beskrevs bidra till ogynnsamma förutsättningar i mötet med psykossjuka patienter.

    Slutsats: Stigmatisering, okunskap och brister i vårdmiljön kan leda till att omvårdnaden för patienter med psykossjukdom blir bristfällig, och att de inte får vård på lika villkor som andra. Det är därför viktigt att sjuksköterskor blir medvetna om sina egna attityder och fördomar, och att de somatiska verksamheterna erbjuder sjuksköterskor mer kunskap om ämnet. De somatiska verksamheterna bör även se över möjligheter till förbättring i vårdmiljön.

  • 281.
    Östergårds, Anna-Karin
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Aburweileh, Hossam
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Vuxna patienters upplevelser av den palliativa vården i hemmet2016Independent thesis Basic level (professional degree), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Varje år dör omkring 90 000 personer i Sverige och de flesta har behov av palliativ vård. Den enskilde individen skall i största möjliga mån få avgöra om denne vill dö hemma eller inom den slutna vården. Historiskt sett har den palliativa vården behandlat personer med cancersjukdom men har med tiden utvecklats till att behandla flera typer av sjukdomstillstånd.

    Syfte: Syftet med föreliggande studie var att beskriva hur vuxna patienter upplever den palliativa vården i hemmet, samt att studera de valda artiklarnas datainsamlingsmetod.

    Metod: Föreliggande studie har en deskriptiv design. Studiens resultat baseras på elva vetenskapliga artiklar, tio med kvalitativ ansats och en med mixad ansats. Samtliga artiklar granskades av båda författarna och färgmarkerades beroende på innehåll. Artiklarna identifierades genom databaserna Cinahl och Pubmed.

    Huvudresultat: Den palliativa vården i hemmet upplevdes till stor del som positiv av patienterna. Det värderades högt att ha sina närstående nära och att få vistas i sin trygga hemmiljö den sista tiden i livet. Det framkom även att de palliativa patienterna var oroliga över att vara en börda för sina närstående. Genom att ha sjukvårdare i hemmet samt stöd från närstående gavs möjlighet att utföra vardagliga aktiviteter på egen hand, som visade sig generera livskvalitet. Värdighet hos de palliativa patienterna beskrevs genom begreppen integritet, välbefinnande och självbestämmande. God kommunikation och kontinuitet upplevdes som viktiga faktorer för de patienterna.

    Slutsats: Palliativa patienter som vårdats hemma såg i hög grad positivt på den vård de erhållit. De upplevde att samarbete mellan sjukvården och deras närstående är en förutsättning för trygg vård i hemmet. Hälso- och sjukvård bör prioritera dessa patienters önskan om att få vårdas och dö hemma eftersom detta genererar livskvalitet. Föreliggande studies resultat ger en tydlig indikation på utvecklingsområden inom palliativ vård.

  • 282.
    Östlund, Ann-Sofi
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Uppsala universitet.
    Motivational Interviewing in Primary Care: Nurses' experiences and actual use of the method2015Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Aim: The overall aim of the present thesis was to describe and examine primary care nurses´ self-reports on training, use and performance as well as experiences and actual performance of MI.

    Method: One qualitative and three quantitative studies were conducted among primary care nurses. A study-specific questionnaire was sent to 980 primary care nurses and 673 (69%) responded (Study I). Semi-structured interviews were conducted with 20 MI trained primary care nurses (Study II). MI sessions between 12 (Study III) respective 23 (Study IV) primary care nurses and patients (total 32 respective 50 sessions) were audio-recorded. Data were analyzed using qualitative content analysis, Motivational Interviewing Integrity Code, Motivational Interviewing Sequential Code for Observing Process Exchanges and statistical analysis.

    Results: The findings showed that primary care nurses reported and experienced lack of training in MI and lack of prerequisites for using MI (Study I-II), while training, knowledge, prerequisites and time were associated with use of MI. They also reported and experienced that MI facilitated their work with patients (Study I-II) as well as elicited their own ability to motivate and be empathetic (Study II). About half of the primary care nurses reported that they used MI (Study I), and none of the nurses (Study III) achieved the approved skill levels in MI in their recorded sessions. They overestimated their performance on six of eight aspects of MI (Study III). The most frequently used nurse talk in the recorded sessions was neutral, which is not consistent with MI. Questions and reflections directed toward change were most likely to be followed by change talk among patients (Study IV).

    Conclusions: Self-reported knowledge about MI and personal as well as workplace prerequisites for using it were associated with self-reported use of MI. Participating nurses´ experienced that MI requires openness, practice, support, feedback and willingness. The participating primary care nurses did not achieve approved levels of MI skills in their recorded MI sessions. Patients´ change talk is more likely to occur after open questions, complex reflections as well as after questions and reflections directed toward change.

  • 283.
    Östlund, Ann-Sofi
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala universitet.
    Kristofferzon, Marja-Leena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala universitet.
    Häggström, Elisabeth
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala universitet.
    Wadensten, Barbro
    Department of Public Health and Caring Sciences, Uppsala universitet.
    Primary care nurses' performance in motivational interviewing: a quantitative descriptive study2015Inngår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 16, nr 1, s. 89-100Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Motivational interviewing is a collaborative conversational style intended to strengthen motivation to change. It has been shown to be effective in addressing many different lifestyle problems as well as in chronic disease management, and many disease prevention guidelines promote use of motivational interviewing. The aim of the present study was twofold: to assess to what extent the primary care nurses in the study perform motivational interviewing according to the Motivational Interviewing Treatment Integrity Code and to investigate how the participating primary care nurses rated their own performance in motivational interviewing.

    Method: The study was based on twelve primary care nurses’ audio-recorded motivational interviewing sessions with patients (total 32 sessions). After each session, the nurses completed a questionnaire regarding their experience of their own performance in motivational interviewing. The audio-recorded sessions were analyzed using Motivational Interviewing Integrity Code 3.1.1.

    Results: None of the nurses achieved beginning proficiency in all parts of any motivational interviewing sessions and two nurses did not achieve beginning proficiency in any parts or sessions. Making more complex than simple reflections was the specific verbal behavior/summary score that most nurses achieved. Beginning proficiency/competency in “percent open questions” was the summary score that fewest achieved.

    Conclusion: Primary care nurses did not achieve beginning proficiency/competency in all aspects of motivational interviewing in their recorded sessions with patients, where lifestyle change was discussed. This indicates a need for improvement and thus additional training, feedback and supervision in clinical practice with motivational interviewing.

  • 284.
    Östlund, Ann-Sofi
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Wadensten, Barbro
    Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Häggström, Elisabeth
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Lindqvist, Helena
    Department of Clinical Neuroscience, MIC Lab, Karolinska Institutet, Stockholm, Sweden.
    Kristofferzon, Marja-Leena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Primary care nurses' communication and its influence on patient talk during motivational interviewing2016Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, nr 11, s. 2844-2856Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim

    To describe what verbal behaviors/kinds of talk occur during recorded motivational interviewing sessions between nurses in primary care and their patients. The aim was also to examine what kinds of nurse talk predict patient change talk, neutral talk and/or sustain talk.

    Background

    Motivational interviewing is a collaborative conversational style. It has been shown to be effective, in addressing health behaviors such as diet, exercise, weight loss and chronic disease management. In Sweden, it is one of the approaches to disease prevention conversations with patients recommended in the National Guidelines for Disease Prevention. Research on the mechanisms underlying motivational interviewing is growing, but research on motivational interviewing and disease prevention has also been called for.

    Design

    A descriptive and predictive design was used.

    Methods

    Data were collected during 2011-2014. Fifty audio-recorded motivational interviewing sessions between 23 primary care nurses and 50 patients were analyzed using Motivational Interviewing Sequential Code for Observing Process Exchanges. The frequency of specific kinds of talk and sequential analysis (to predict patient talk from nurse talk) were computed using the software Generalized Sequential Querier 5.

    Findings

    The primary care nurses and patients used neutral talk most frequently. Open and negative questions, complex and positive reflections were significantly more likely to be followed by change talk and motivational interviewing-inconsistent talk, positive questions and negative reflections by sustain talk.

    Conclusions

    To increase patients’ change talk, primary care nurses need to use more open questions, complex reflections as well as questions and reflections directed toward change.

  • 285.
    Östlund, Ann-Sofi
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap.
    Wadensten, Barbro
    Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap.
    Kristofferzon, Marja-Leena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap.
    Häggström, Elisabeth
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap.
    Motivational interviewing: Experiences of primary care nurses trained in the method2015Inngår i: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 15, nr 2, s. 111-118Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Motivational interviewing is a person-centered counseling style used to promote behavioral change regarding a wide variety of lifestyle problems. Use of motivational interview is growing worldwide and among many different healthcare professions, including primary care nursing. The study aim was to describe motivational interview trained nurses' experiences of motivational interviewing in primary care settings. The study had a qualitative descriptive design. It was carried out in Swedish primary care settings in two county council districts, with 20 primary care nurses trained in motivational interviewing. Half of them used the method in their work, half did not. Qualitative semi-structured interviews were used. Data were analyzed using qualitative content analysis. The nurses experienced that openness to the approach and an encouraging working climate are required to overcome internal resistance and to increase use of motivational interviewing. They also experienced mutual benefit: motivational interviewing elicits and develops abilities in both nurses and patients. For the nurses using it, motivational interviewing is perceived to facilitate work with patients in need of lifestyle change. Lack of training/education, support, interest and appropriate work tasks/patients are reasons for not using motivational interviewing.

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