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  • 51.
    Kaltenbrunner, Monica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Bengtsson, Lars
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, Lishui Shi, China.
    A questionnaire measuring staff perceptions of Lean adoption in healthcare: development and psychometric testing2017In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, no 1, article id 235Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

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

    METHODS:

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

    RESULTS:

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

    CONCLUSIONS:

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

  • 52.
    Kaltenbrunner, Monica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Bengtsson, Lars
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Institutionen för folkhälso- och vårdvetenskap, Uppsala universitet, Uppsala, Sverige; Nursing Department, Medicine and Health College, Lishui University, China.
    Lean i primärvården - en bild av hur Lean tillämpas2018In: FALF KONFERENS 2018 Arbetet – problem eller potential för en hållbar livsmiljö?   10-12 juni 2018 Gävle: Program och abstracts / [ed] Per Lindberg, Gävle: Gävle University Press , 2018, p. 112-Conference paper (Other academic)
    Abstract [sv]

    Bakgrund

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

    Syfte

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

    Metod

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

    Resultat

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

    Konklusion

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

     

  • 53.
    Kaltenbrunner, Monica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Bengtsson, Lars
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Management, Industrial Design and Mechanical Engineering, Industrial Management. University of Gävle, Center for Logistics and Innovative Production.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Lean maturity and quality in primary care2019In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 32, no 2, p. 141-154Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 54.
    Kaltenbrunner Nykvist, Monica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Bengtsson, Lars
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Towards a Questionnaire to Measure Lean in Health Care2014In: 8th NOVO Symposium, Sustainable health care production systems - Abstract book / [ed] Kasper Edwards och Jørgen Winkel, Lyngby: Danmarks Tekniske Universitet, DTU, 2014, p. 19-20Conference paper (Refereed)
    Abstract [en]

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

  • 55.
    Kaltenbrunner Nykvist, Monica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Bengtsson, Lars
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Management, Industrial Design and Mechanical Engineering, Industrial Management. University of Gävle, Center for Logistics and Innovative Production.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Högberg, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Staff perception of Lean, care-giving, thriving and exhaustion: a longitudinal study in primary care2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 652Article in journal (Other academic)
    Abstract [en]

    Background

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

    Method

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

    Results

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

    Conclusion

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

  • 56.
    Kristofferzon, Marja-Leena
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, Lishui, China.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Coping mediates the relationship between sense of coherence and mental quality of life in patients with chronic illness: a cross-sectional study2018In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 27, no 7, p. 1855-1863Article in journal (Refereed)
    Abstract [en]

    Purpose

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

    Methods

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

    Results

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

    Conclusions

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

  • 57.
    Lian, Zhengmei
    et al.
    Department of Nursing Sciences, Faculty of Medicine and Health, Lishui University, China.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Li, Caifu
    Department of Nursing Sciences, Faculty of Medicine and Health, Lishui University, China.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Nursing Sciences, Faculty of Medicine and Health, Lishui Universiity, China; Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Nursing students’ reflections on caring for end-of-life patients in a youth volunteer association2019In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 34, p. 204-209Article in journal (Refereed)
    Abstract [en]

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

  • 58.
    Lindberg, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Centre for research and Development, Uppsala University, Gävle. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Carlsson, Marianne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala; Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    Nursing student's expectations for their future profession and motivating factors - a longitudinal descriptive study from Sweden2020In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, article id 104218Article in journal (Refereed)
    Abstract [en]

    Background

    The shortage of registered nurses is a global concern. Motives to become registered nurses can be to help others, altruism, personal development and career security. Motives in combination with student expectations regarding the role are not explored.

    Objective

    To describe students' motives to become registered nurses and their expectations regarding their future profession.

    Design

    A longitudinal descriptive design with a qualitative approach was used to follow nursing students in the beginning, during and at the end of their education.

    Participants and setting

    A purposive sampling of a group with initially 75 students starting a three-year nursing program at a university in Sweden.

    Methods

    A study specific questionnaire with open-ended questions was used in the beginning, during and the end of the students' education. At data collection two and three, a copy of the earlier answers was attached. Data were analysed using manifest and latent content analysis.

    Results

    An important profession with career opportunities, interesting duties and team work were described. Students expected diversified duties, possibilities for development and work satisfaction. Increased concerns regarding their upcoming work life was described at the end of the education.

    Conclusion

    The students had a positive understanding of the profession and perceived their forthcoming role as interesting. The leading role of coordinating patient care was more comprehensive than expected. Supportive conditions and well planned transition periods could strengthen newly graduated nurses in their professional role and could be an important aspect in the future retention of RNs.

  • 59.
    Löfmark, Anna
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Ugland Vae, Karen Johanne
    Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Sweden; Nursing Department, Medicine and Health College, Lishui University, China.
    Lecturers' reflection on the three-part assessment discussions with students and preceptors during clinical practice education: A repeated group discussion study2019In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 36, p. 1-6Article in journal (Refereed)
    Abstract [en]

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

  • 60.
    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.

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

    Background

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

    Methods

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

    Results

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

    Conclusion

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

    Trial registration

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

  • 62.
    Muntlin Athlin, Åsa
    et al.
    Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; University of Adelaide, Adelaide, Australia.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, School of Medicine and Health, Lishui University, Lishui, China.
    Gunningberg, Lena
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Quality Department, Uppsala University Hospital, Uppsala, Sweden.
    Bååth, Carina
    Department of Health Sciences, Faculty of Health, Sciences and Technology, Karlstad University, Karlstad, Sweden; County Council of Värmland, Karlstad, Sweden.
    Heel pressure ulcer, prevention and predictors during the care delivery chain - when and where to take action?: a descriptive and explorative study2016In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, article id 134Article in journal (Refereed)
    Abstract [en]

    Background

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

    Methods

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

    Results

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

    Discussion and Conclusions

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

  • 63. Muntlin Athlin, Åsa
    et al.
    Gunningberg, Lena
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Bååth, Carina
    Pressure ulcer prevention – Why don’t we start from the beginning?2014In: Pressure Ulcers from Birth to Death : Prevention,Treatment and Rehabilitation: Programme and Abstract book, 2014Conference paper (Refereed)
  • 64.
    Mårtensson, Gunilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Mamhidir, Anna-Greta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    What are the structural conditions of importance to preceptors' performance?2013In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 33, no 5, p. 444-449Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

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

    OBJECTIVES:

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

    METHODS:

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

    RESULTS:

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

    CONCLUSIONS:

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

  • 65.
    Mårtensson, Gunilla
    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, Sweden.
    Westerberg Jacobson, Josefin
    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, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Mental health nursing staff's attitudes towards mental illness: an analysis of related factors2014In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 21, no 9, p. 782-788Article in journal (Refereed)
    Abstract [en]

    Employer/workplaces have an impact on mental health nursing staff's general attitudes towards persons with mental illness. Staff have more positive attitudes if their knowledge about mental illness is less stigmatized and currently have or have once had a close friend with mental problem. More favourable attitudes among staff towards persons with mental illness could be developed and transmitted in the subculture at work places.

    ABSTRACT: There is growing awareness that mental illness is surrounded by negative attitudes and stigmas. The aim of the present study was to investigate factors associated with mental health nursing staff's attitudes towards persons with mental illness. Data were collected from 256 mental health nursing staff employed by one county council and 10 municipalities. The findings show that staff have more positive attitudes towards persons with mental illness if their knowledge about mental illness is less stigmatized, their work places are in the county council, and they currently have or have once had a close friend with mental health problems. The multiple regression model explained 16% of the variance; stigma-related knowledge and employer had significant Beta-coefficients. To account for unknown correlations in data, a linear generalized estimating equation was performed. In this model, stigma-related knowledge and employer remained significant, but a new significant factor also emerged: personal contact, i.e. currently having or having once had a close friend with mental health problems. This indicates correlations at unit level in the county council and in the municipalities. The conclusion is that more favourable attitudes among staff towards persons with mental illness could be developed and transmitted in the subculture at work places.

  • 66.
    Nilsson, Annika
    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.
    Andrén, Marianne
    University of Gävle, Faculty of Health and Occupational Studies.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University.
    E-assessment of prior learning: a pilot study of interactive assessment of staff with no formal education who are working in Swedish elderly care2014In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 14, p. 52-Article in journal (Refereed)
    Abstract [en]

    Background: The current paper presents a pilot study of interactive assessment using information and communication technology (ICT) to evaluate the knowledge, skills and abilities of staff with no formal education who are working in Swedish elderly care.

    Methods: Theoretical and practical assessment methods were developed and used with simulated patients and computer-based tests to identify strengths and areas for personal development among staff with no formal education.

    Results: Of the 157 staff with no formal education, 87 began the practical and/or theoretical assessments, and 63 completed both assessments. Several of the staff passed the practical assessments, except the morning hygiene assessment, where several failed. Other areas for staff development, i.e. where several failed (>50%), was the theoretical assessment of the learning objectives: Health, Oral care, Ergonomics, hygiene, esthetic, environmental, Rehabilitation, Assistive technology, Basic healthcare and Laws and organization. None of the staff passed all assessments. Number of years working in elderly care and staff age were not statistically significantly related to the total score of grades on the various learning objectives.

    Conclusion: The interactive assessments were useful in assessing staff members’ practical and theoretical knowledge, skills, and abilities and in identifying areas in need of development. It is important that personnel who lack formal qualifications be clearly identified and given a chance to develop their competence through training, both theoretical and practical.

  • 67.
    Nilsson, Annika
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden.
    E-assessment and an e-training program among elderly care staff lacking formal competence: results of a mixed-methods intervention study2015In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, no 1, article id 189Article in journal (Refereed)
    Abstract [en]

    Background

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

    Methods

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

    Results

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

    Conclusion

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

  • 68.
    Nilsson, Jan
    et al.
    Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden; Department of Health Promotion Sciences, Sophiahemmet University, Stockholm, Sweden; Japanese Red Cross Institute for Humanitarian Studies, Tokyo, Japan.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Florin, Jan
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Gardulf, Ann
    Japanese Red Cross Institute for Humanitarian Studies, Tokyo, Japan; Unit of Clinical Nursing Research, Immunotherapy and Immunology, Clinical Research Center, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden.
    Carlsson, Marianne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    A short version of the nurse professional competence scale for measuring nurses' self-reported competence2018In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 71, p. 233-239, article id S0260-6917(18)30695-6Article in journal (Refereed)
    Abstract [en]

    Background: The Nurse Professional Competence (NPC) Scale with 88-items has been used to measure self-reported competence among nursing students and registered nurses in many national and international nursing research projects. However, a shorter version of the scale with maintained quality has been requested to further enhance its usability.

    Objectives: To develop and evaluate the construct validity and internal consistency of a shorter version of the NPC Scale. Design: A developmental and methodological design. Participants and Settings: The study was based on a sample of 1810 nursing students at the point of graduation from 12 universities in Sweden.

    Methods: The number of items in the original NPC Scale was reduced using several established research steps and then evaluated for data quality and construct validity using principal component analysis and confirmatory factor analysis. Reliability was measured as internal consistency using Cronbach's alpha.

    Results: The extensive process of reducing the number of items resulted in a version with 35 items. Principal component analysis resulted in six factors explaining 53.6% of the variance: “Nursing Care” “Value-based Nursing Care” “Medical and Technical Care” “Care Pedagogics” “Documentation and Administration of Nursing Care” and “Development, Leadership, and Organization of Nursing Care”. All factors showed Cronbach's alpha values of >0.70. The confirmative factor analysis goodness-of-fit indexes were for root mean square error of approximation 0.05 and for comparative fit index 0.89.

    Conclusions: The NPC Scale Short Form (NPC Scale-SF) 35-items revealed promising results with a six-factor structure explaining 53.6% of the total variance. This 35-item scale can be an asset when used alone and together with other instruments it can provide the possibility of more complex analyses of self-reported competence among nursing students and registered nurses. 

  • 69.
    Olsson, Annakarin
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Lampic, Claudia
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Skovdahl, Kirsti
    Faculty of Health Sciences, Buskerud University College, Drammen, Norway, and School of Health and Medical Sciences, Örebro University, Örebro.
    A passive positioning alarm used by persons with dementia and their spouses: a qualitative intervention study2013In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 13, no 11, p. 1-9Article in journal (Refereed)
  • 70.
    Olsson, Annakarin
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Skovdahl, Kirsti
    Örebro Universitet.
    Lampic, Claudia
    Karolinska Institutet.
    My, your and our needs for safety and security: relatives’ reflections on using information and communication technology in dementia care2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 1, p. 104-112Article in journal (Refereed)
  • 71.
    Olsson, Annakarin
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Åsenlöf, Pernilla
    Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden .
    Skovdahl, Kirsti
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden ; Faculty of Health Sciences, Buskerud University College, Drammen, Norway.
    Lampic, Claudia
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.
    Effects of Tracking Technology on Daily Life of Persons With Dementia: Three Experimental Single-Case Studies2015In: American Journal of Alzheimer’s Disease and Other Dementia, ISSN 1533-3175, E-ISSN 1938-2731, Vol. 30, no 1, p. 29-40Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the effects of using tracking technology on independent outdoor activities and psychological well-being in 3 persons with dementia (PwDs) and their spouses.

    Methods: Three experimental single-case studies with an A1B1A2B2 design. The intervention entailed access to a passive positioning alarm and technical support. Continual daily measures of independent outdoor activities among PwDs’ and spouses’ worries about these activities were made during all phases.

    Results: Access to a tracking technology consistently increased the independent outdoor activities of 2 PwDs. One of the spouses consistently reported decreased worry during B phases, another’s worry decreased only in B2, and the third showed little variability in worrying across all phases.

    Conclusion: Tracking technology may support PwDs to engage in independent outdoor activities and decrease spouses’ worries; however, randomized controlled group studies are needed to investigate whether these results can be replicated on a group level.

  • 72.
    Olsson, Annakarin
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Kirsti, Skovdahl
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Strategies used by people with Alzheimer´s disease for outdoor wayfinding: a repeated observational study2019In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684Article in journal (Refereed)
    Abstract [en]

    This study aimed to describe the wayfinding strategies used during outdoor walks by people with Alzheimer’s disease. Inspired by an ethnographic approach, observations and conversations during repeated outdoor walks with five people with Alzheimer’s disease living in their own homes were conducted. Data were analyzed using qualitative content analysis. The wayfinding strategies the participants described were: (1) landmarks, (2) used their senses, (3) stopped, looked around, and thought, (4) walking the same way or loop and in familiar areas, and (5) only walked in places and on routes where they could see other people and houses. Using wayfinding strategies might help people with Alzheimer’s disease to be independent during outdoor walks, and discussing these strategies with relatives and nursing care staff may help finding people with Alzheimer’s disease if lost outdoors. Wayfinding during the winter might be facilitated if temporary and changeable objects are avoided in people with Alzheimer’s disease’s walking route.

  • 73.
    Olsson, Annakarin
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Lampic, Claudia
    Karolinska institutet.
    Skovdahl, Kirsti
    Örebro Universitet.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Persons with early-stage dementia reflect on being outdoors: a repeated interview study2013In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 17, no 7, p. 793-800Article in journal (Refereed)
    Abstract [en]

    Objectives:The aim of this study was to describe how persons with early-stage dementia reflect on being outdoors.

    Method: Data were collected through repeated interviews with a purposive sample of 11 persons with early-stage dementia in Sweden during the period 2009–2010 and were analysed using qualitative content analysis.

    Results: Informants described being outdoors as a confirmation of the self. Confirmation of their ability to maintain desired activities, despite the dementia disease, was important to the informants. However, some confirmations were not positive; the realisation that one could no longer perform certain activities could be devastating. Two sub-themes emerged: shifting between ‘still being part of it all’ and a sense of grief and loss and striving to keep on despite perceived barriers. Past, but no longer possible, outdoor activities were greatly missed and the informants longed to be able to perform these activities once again. To resolve possible difficulties associated with being outdoors, the informants used various adaptation strategies. Despite the described barriers, being outdoors was of great value to them.

    Conclusion: Independent outdoor activities seem to contribute to the well-being and feelings of self-worth among persons with early-stage dementia who want to be and are able to be outdoors. If a person with dementia, despite cognitive limitations, wants and is able to engage in outdoor activities, it is important for relatives and health-care staff to encourage and facilitate this, for example, by discussing adaptation strategies to deal with orientation problems.

  • 74.
    Olsson, Annakarin
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Skovdahl, Kirsti
    Buskerud and Vestfold University College, Kongsberg, Norway.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala University, Uppsala, Sweden.
    Using diffusion of innovation theory to describe perceptions of a passive positioning alarm among persons with mild dementia: a repeated interview study2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, article id 3Article in journal (Refereed)
    Abstract [en]

    Background

    Problems with memory and decline in cognitive abilities are common during development of dementia. Different kinds of technologies may be useful in supporting persons with dementia and their relatives in daily life. Tracking technologies have the potential to improve independence among persons with dementia. Consequently, the aim of the present study was to describe perceptions of a passive positioning alarm (PPA) among persons with mild dementia.

    Methods

    A repeated interview study was conducted in Sweden with a strategic sample of 11 persons with mild dementia. Roger’s Diffusion of Innovation Theory was used to deductively analyse the data.

    Results

    Regarding the advantages of the PPA, participants described perceived safety and security for, both themselves, and their relatives, as well as freedom and independence. However, they also expressed concern about the cost of the PPA, reflected on who might be the receiver of the alarm from the PPA, emphasized the importance of opportunities to test the device before becoming a user and early introduction before their problems start, thus allowing them to decide for themselves.

    Conclusions

    Supporting persons with dementia in their own homes using, e.g., a PPA may enable them and their relatives to remain longer in their own homes and be safer in their own neighbourhoods.

  • 75.
    Pålsson, Ylva
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala,Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala,Sweden; Nursing Department, Medicine and Health College, Lishui University, China.
    Leo Svenne, Christine
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences, Thoracic Surgery Uppsala University, Uppsala, Sweden.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala,Sweden.
    A peer learning intervention targeting newly graduated nurses: a feasibility study with a descriptive design based on Medical Research Council framework2018In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 74, no 5, p. 1127-1138Article in journal (Refereed)
    Abstract [en]

    AIMS:

    To describe the feasibility of a peer learning intervention targeting newly graduated nurses. Feasibility was tested concerning consistency of the theoretical description of peer learning with empirical findings in a new context, compliance and acceptability, as well as usability of a questionnaire measuring the intended future outcome variables.

    BACKGROUND:

    Newly graduated nurses who meet, socialize and share experiences have described supporting each other's ability to cope with stress. Peer learning involves individuals in a similar situation learning from and with each other through interaction. When implementing new interventions, feasibility studies are used to minimize problems in future evaluation studies.

    DESIGN:

    Quasi-experimental design with an intervention group, followed over time using descriptive methods. The study was based on the Medical Research Council framework.

    METHODS:

    Repeated semi-structured interviews, a checklist for fidelity and a questionnaire were conducted with 10 newly graduated nurses from January - March 2015. The intervention's main component included pairs of newly graduated nurses working the same shift and having joint responsibility for a group of patients for a period of three weeks. The intervention also included three months of regular reflection by the pair.

    FINDINGS:

    Using deductive analysis, the peer learning intervention was found to be consistent with the theoretical description. Due to the compliance and acceptability, there were lessons learned. The tested questionnaire was found to be useful.

    CONCLUSIONS: This peer learning intervention seems to be feasible in this context. The present study will serve as the basis for a future full-scale evaluation study.

  • 76.
    Pålsson, Ylva
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Hellström-Hyson, Eva
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Leo Swenne, Christine
    Uppsala universitet.
    An intervention study on peer learning2019Conference paper (Refereed)
  • 77.
    Pålsson, Ylva
    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.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Leo Svenne, Christine
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Ädel, Eva
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, China .
    A peer learning intervention for nursing students in clinical practice education: a quasi-experimental study2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 51, p. 81-87Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Studies of peer learning indicate that the model enables students to practice skills useful in their future profession, such as communication, cooperation, reflection and independence. However, so far most studies have used a qualitative approach and none have used a quasi-experimental design to study effects of nursing students' peer learning in clinical practice.

    OBJECTIVES: To investigate the effects of peer learning in clinical practice education on nursing students' self-rated performance.

    DESIGN: Quasi-experimental.

    SETTING: The study was conducted during nursing students' clinical practice.

    PARTICIPANTS: All undergraduate nursing students (n=87) attending their first clinical practice were approached. Seventy students out of 87 answered the questionnaires at both baseline and follow-up (42 of 46 in the intervention group and 28 of 39 in the comparison group).

    METHODS: During the first two weeks of the clinical practice period, all students were supervised traditionally. Thereafter, the intervention group received peer learning the last two weeks, and the comparison group received traditional supervision. Questionnaire data were collected on nursing students' self-rated performance during the second (baseline) and last (follow-up) week of their clinical practice.

    RESULTS: Self-efficacy was improved in the intervention group and a significant interaction effect was found for changes over time between the two groups. For the other self-rated variables/tests, there were no differences in changes over time between the groups. Studying each group separately, the intervention group significantly improved on thirteen of the twenty variables/tests over time and the comparison group improved on four.

    CONCLUSIONS: The results indicate that peer learning is a useful method which improves nursing students' self-efficacy to a greater degree than traditional supervision does. Regarding the other self-rated performance variables, no interaction effects were found.

  • 78.
    Randmaa, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences. Uppsala universitet.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences. Uppsala universitet.
    Leo Swenne, Christine
    Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences. Uppsala universitet.
    Different professionals´descriptions of and reflections on postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists, and PACU nursesManuscript (preprint) (Other academic)
  • 79.
    Randmaa, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, China .
    Leo Swenne, Christine
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    The postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists, and PACU nurses2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 8, article id e015038Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES To investigate different professionals’ (nurse anaesthetists’, anaesthesiologists’, and postanaesthesia care unit nurses’) descriptions of and reflections on the postoperative handover.

    DESIGN A focus group interview study with a descriptive design using qualitative content analysis of transcripts.

    SETTING One anaesthetic clinic at two hospitals in Sweden.

    PARTICIPANTS Six focus groups with 23 healthcare professionals involved in postoperative handovers. Each group was homogeneous regarding participant profession, resulting in two groups per profession: nurse anaesthetists (n=8), anaesthesiologists (n=7) and postanaesthesia care unit nurses (n=8).

    RESULTS Patterns and five categories emerged: 1) Having different temporal foci during handover, 2) Insecurity when information is transferred from one team to another, 3) Striving to ensure quality of the handover, 4) Weighing the advantages and disadvantages of the bedside handover, and 5) Having different perspectives on the transfer of responsibility. The professionals’ perceptions of the postoperative handover differed with regard to temporal foci and transfer of responsibility. All professional groups were insecure about having all information needed to ensure the quality of care. They strived to ensure quality of the handover by: focusing on matters that deviated from the normal course of events, aiding memory through structure and written information, and cooperating within and between teams. They reported that the bedside handover enhances their control of the patient, but also that it could threaten the patient’s privacy and that frequent interruptions could be disturbing.

    CONCLUSIONS The present findings revealed variations in different professionals’ views on the postoperative handover. Healthcare interventions are needed to minimize the gap between professionals’ perceptions and practices and to achieve a shared understanding of postoperative handover. Furthermore, to ensure high-quality and safe care, stakeholders/decision-makers need to pay attention to the environment and infrastructure in postanaesthesia care.

  • 80.
    Randmaa, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala university; Lishui university, China.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala university.
    Leo Swenne, Christine
    Uppsala university.
    Högberg, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Psychometric properties of an instrument measuring communication within and between the professional groups licensed practical nurses and registered nurses in anaesthetic clinics.2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 950Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 81.
    Randmaa, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala universitet.
    Leo Swenne, Christine
    Uppsala universitet.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala universitet.
    Högberg, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala universitet.
    Implementing situation-background-assessment-recommendation in an anaesthetic clinic and subsequent information retention among receivers: a prospective interventional study of postoperative handovers2016In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 3, p. 172-178Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Communication errors cause clinical incidents and adverse events in relation to surgery. To ensure proper postoperative patient care, it is essential that personnel remember and recall information given during the handover from the operating theatre to the postanaesthesia care unit. Formalizing the handover may improve communication and aid memory, but research in this area is lacking.

    OBJECTIVE: The objective of this study was to evaluate whether implementing the communication tool Situation-Background-Assessment-Recommendation (SBAR) affects receivers' information retention after postoperative handover.

    DESIGN: A prospective intervention study with an intervention group and comparison nonintervention group, with assessments before and after the intervention.

    SETTING: The postanaesthesia care units of two hospitals in Sweden during 2011 and 2012.

    PARTICIPANTS: Staff involved in the handover between the operating theatre and the postanaesthesia care units within each hospital.

    INTERVENTION: Implementation of the communication tool SBAR in one hospital.

    MAIN OUTCOME MEASURES: The main outcome was the percentage of recalled information sequences among receivers after the handover. Data were collected using both audio-recordings and observations recorded on a study-specific protocol form.

    RESULTS: Preintervention, 73 handovers were observed (intervention group, n = 40; comparison group, n = 33) involving 72 personnel (intervention group, n = 40; comparison group, n = 32). Postintervention, 91 handovers were observed (intervention group, n = 44; comparison group, n = 47) involving 57 personnel (intervention group, n = 31; comparison group, n = 26). In the intervention group, the percentage of recalled information sequences by the receivers increased from 43.4% preintervention to 52.6% postintervention (P = 0.004) and the SBAR structure improved significantly (P = 0.028). In the comparison group, the corresponding figures were 51.3 and 52.6% (P = 0.725) with no difference in SBAR structure. When a linear regression generalised estimating equation model was used to account for confounding influences, we were unable to show a significant difference in the information recalled between the intervention group and the nonintervention group over time.

    CONCLUSION: Compared with the comparison group with no intervention, when SBAR was implemented in an anaesthetic clinic, we were unable to show any improvement in recalled information among receivers following postoperative handover.

    TRIAL REGISTRATION: Current controlled trials http://www.controlled-trials.com Identifier: ISRCTN37251313.

  • 82.
    Randmaa, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. County Council Gävleborg; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    Leo Swenne, Christine
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    An Observational Study of Postoperative Handover in Anesthetic Clinics: The Content of Verbal Information and Factors Influencing Receiver Memory2015In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 30, no 2, p. 105-115Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim was to examine the handover process in the postanesthesia care unit, how much the receiver remembered, and what factors influenced memory. Design: An observational study with a descriptive and correlational design. Methods: A total of 73 handovers were investigated, and data were collected using observation, audiotape recordings of the handovers, and the patient's anesthetic record. Finding: Interruptions occurred at 56 (77%) handovers and the sender expressed unclear information at 51 (70%) handovers. The mean of the verbally given information remembered by the receivers was 47%; the items mostly likely not to be remembered were the drugs used during anesthesia. A linear generalized estimating equation was used and identified variables that were significantly associated with receivers' retention of information were structure and handover duration. Conclusion: Lack of structure and long duration of the verbal handover decrease how much the receiver will remember.

  • 83.
    Randmaa, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Leo Swenne, Christine
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    An Observational Study of Postoperative Handover in Anesthetic Clinics: The Content of Verbal Information and Factors Influencing Receiver Memory2015Conference paper (Refereed)
    Abstract [en]

    Purpose The aim was to examine the handover process at the post-anaesthesia care unit, how much the receiver remembers and what factors influence memory.

    Design An observational study with a descriptive and correlational design.

    Methods Seventy-three handovers were investigated, and data were collected using observation, audio-tape recordings of the handovers and the patient´s anaesthetic record.

    Finding Interruptions occurred at 56 (77%) handovers and the sender expressed unclear information at 51 (70%) handovers. The mean of the verbally given information remembered by the receivers was 47%; the items mostly likely not to be remembered were the drugs used during anaesthesia. A linear generalized estimating equation was used and identified variables that were significantly associated with in receivers´ retention of information were structure and handover duration.

    Conclusion Lack of structure and long duration of the verbal handover decrease how much the receiver will remember.

  • 84.
    Randmaa, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala University, Uppsala, Sweden.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala University, Uppsala, Sweden.
    Leo Swenne, Christine
    Uppsala University, Uppsala, Sweden, and Department of Anaesthesia, County Council of Gävleborg, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala University, Uppsala, Sweden.
    SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 1Article in journal (Refereed)
    Abstract [en]

    Objectives: We aimed to examine staff members’ perceptions of communication within and between different professions, safety attitudes and psychological empowerment, prior to and after implementation of the communication tool Situation-Background-Assessment-Recommendation (SBAR) at an anaesthetic clinic. The aim was also to study whether there was any change in the proportion of incident reports caused by communication errors.

    Design: A prospective intervention study with comparison group using preassessments and postassessments. Questionnaire data were collected from staff in an intervention (n=100) and a comparison group (n=69) at the anaesthetic clinic in two hospitals prior to (2011) and after (2012) implementation of SBAR. The proportion of incident reports due to communication errors was calculated during a 1-year period prior to and after implementation.

    Setting: Anaesthetic clinics at two hospitals in Sweden.

    Participants: All licensed practical nurses, registered nurses and physicians working in the operating theatres, intensive care units and post anaesthesia care units at anaesthetic clinics in two hospitals were invited to participate.

    Intervention: Implementation of SBAR in an anaesthetic clinic.

    Primary and secondary outcomes: The primary outcomes were staff members’ perception of communication within and between different professions, as well as their perceptions of safety attitudes. Secondary outcomes were psychological empowerment and incident reports due to error of communication.

    Results: In the intervention group, there were statistically significant improvements in the factors “Between-group communication accuracy” (p=0.039) and “Safety climate” (p=0.011). The proportion of incident reports due to communication errors decreased significantly (p<0.0001) in the intervention group, from 31% to 11%.

    Conclusions: Implementing the communication tool SBAR in anaesthetic clinics was associated with improvement in staff members’ perception of communication between professionals and their perception of the safety climate as well as with a decreased proportion of incident reports related to communication errors.

  • 85.
    Roos, Charlotte
    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.
    Silén, Marit
    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.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    An intervention targeting fundamental values among caregivers at residential facilities: Effects of a cluster-randomized controlled trial on residents' self-reported empowerment, person-centered climate and life satisfaction.2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, no 1, article id 130Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In Sweden the national fundamental values for care of older people state that care should ensure that they can live in dignity and with a sense of well-being. Our hypothesis was that a caregiver intervention targeting the national fundamental values would improve perceived empowerment, person-centered climate and life satisfaction among older people living in residential facilities.

    METHODS: The study was a cluster-randomized controlled trial with a pre- and one post-test design, conducted in 27 units (17 study units) at 12 residential facilities for older people in five municipalities in central Sweden. The units in each municipality were randomly assigned to intervention or control group. The caregiver intervention was carried out using an interpretative approach with eight guided face-to-face seminars, where self-reflection and dialogue were used. Data were collected using questionnaires. The number of residents was 43 (78 %) in the intervention group and 37 (71 %) in the control group. The Chi-square test and Mann-Whitney U-tests were performed to detect differences between groups and Wilcoxon signed rank tests to explore differences in change over time within groups. Furthermore, generalized estimating equation (GEE) models were used to study effects of the intervention controlling for clustering effects.

    RESULTS: Primary outcome measures were empowerment, person-centered climate and life satisfaction. In the intervention group, improvements at follow-up were found in residents' self-reported empowerment (n = 42; p = 0.001, Median difference 4.0, 95 % CI 1.5;6.0), person-centered climate (n = 42; p ≤0.001, Median difference 8.0, 95 % CI 4.5;11.4) and life satisfaction regarding the factor quality of everyday activities (n = 40; p = 0.033, Median difference 9.7, 95 % CI 1.0;21.9) while disempowerment decreased (n = 43; p = 0.018, Median difference -1.3, 95 % CI -2.0;0.0). In the control group person-centered climate decreased (n = 37; p = 0.002, Median difference -8.5, 95 % CI -13.6;-3.0) and quality of everyday activities (n = 36; p = 0.012, Median difference -11.6, 95 % CI-21.7;-3.4). Change over time between groups was significant for empowerment (p = 0.001, Median difference 6.0, 95 % CI 3.0;9.0), disempowerment (p = 0.006, Median difference -2.0, 95 % CI -4.0;-1.0) and person-centered climate (p ≤ 0.001, Median difference 16.0, 95 % CI 9.7;23.0) and for life satisfaction regarding the factor quality of everyday activities (p = 0.002, Median difference 22.1, 95 % CI 8.2;37.4). Results of GEE confirmed earlier results; revealed interaction effects for empowerment (parameter estimate -5.0, 95 % CI -8.3;-1.8), person-centered climate (parameter estimate -16.7, 95 % CI -22.4;-10.9) and life satisfaction regarding the factor quality of everyday activities (parameter estimate -25.9, 95 % CI -40.3;-11.5).

    CONCLUSION: When the Swedish national fundamental values were put into practice increases in empowerment, person-centered climate and quality of everyday activities were found among older people with intact cognitive ability living in residential facilities. Limitations to consider are the differences between the two groups at baseline, drop-outs and that neither the data collector nor the outcome assessors were blinded to group assignment of participants.

    TRIAL REGISTRATION: The study was registered in ISRCTN92658034 in January 2013.

  • 86.
    Saunamäki, Nina
    et al.
    Registered Nurse,The County Council of Gävleborg, Sweden.
    Andersson, Matilda
    Registered Nurse,The County Council of Gävleborg, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Discussing sexuality with patients: nurses' attitudes and beliefs2010In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 66, no 6, p. 1308-16Article in journal (Refereed)
    Abstract [en]

    Aim: This paper is a report of a study of Registered Nurses' attitudes and beliefs towards discussing sexuality with patients. Background: The World Health Organization regards sexuality as an essential and integrated part of being human. Studies show that diseases and treatments can affect sexuality and that a positive and respectful attitude towards sexuality is important to achieving sexual health. Method: The study had a correlative and comparative design. The Sexual Attitudes and Beliefs Survey was distributed to a convenience sample of 100 Swedish nurses in 2006, with a response rate of 88%. Results: Over 90% of nurses understood how patients' diseases and treatment might affect their sexuality. About two-thirds felt comfortable talking about sexual issues and agreed that it was their responsibility to encourage talk about sexual concerns. However, 80% did not take time to discuss sexual concerns, and 60% did not feel confident in their ability to address patients' sexual concerns. Older nurses felt more confident in their ability to address patients' sexual concerns, and the older the nurses, the more positive were their attitudes towards discussing sexuality. Nurses with further education also had a more positive attitude towards discussing sexuality. Conclusion: Education is essential to improve nurses' ability to give patients the holistic care they deserve. Studies are needed to understand fully what mechanisms underlie the barriers that clearly prevent nurses from addressing patients' sexuality.

  • 87.
    Saunamäki, Nina
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Cty Council Gavleborg, Gavle, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala University, Dept Publ Hlth & Caring Sci, Uppsala, Sweden.
    Registered Nurses' Reflections on Discussing Sexuality with Patients: Responsibilities, doubts and fears2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, p. 531-540Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To describe registered nurses' reflections on discussing sexuality with patients. Background: It is known that many diseases and treatments have a negative impact on sexual health. Despite these facts, registered nurses typically do not address sexual issues with patients. Design: A descriptive design and a qualitative approach were used. Methods: Interviews were conducted in 2010 with 10 registered nurses. The data were analysed using qualitative content analysis. Results: The themes 'Doing the right thing and doing good', 'Could've, would've, should've: a nurse's conflicting feelings' and 'I just don't talk about it: sexuality as a nontopic' confirmed the notion that discussing sexuality in nursing care is still challenging and difficult for nurses, but also revealed that nurses who do talk to patients about sexual issues do so based on their strong sense of wanting to help. They felt a responsibility because of their knowledge in the area, but the topic also brought out conflicting feelings such as fear and embarrassment. Lack of time, support and places to talk to patients in private as well as prejudice were contributing factors to their not addressing sexuality. Some nurses also felt that sexuality was someone else's responsibility and a taboo subject. Conclusions: Patients' sexuality is still surrounded by silence. But factors exist that can facilitate discussion of sexuality. Nurses have a key role in detecting ill-health. This study suggests that when nurses use their knowledge and go beyond their comfort zone and address sexuality, they can identify patients' sexual problems. Relevance to clinical practice: Nurses need to understand how their knowledge can help patients who are experiencing sexual problems; they also need support from the workplace and to have access to routines that reinforce the notion that sexuality is a topic worth discussing. © 2013 John Wiley & Sons Ltd.

  • 88. Scandurra, Isabella
    et al.
    Hägglund, Maria
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Koch, Sabine
    Heuristic evaluation performed by usability educated clinicans: education and attitudes2007In: Information technology in health care: proceedings of the 3rd International conference on information technology in health care : socio-technical approaches, Amsterdam: IOS Press , 2007, p. 205-216Conference paper (Refereed)
  • 89.
    Silén, Marit
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, China.
    Relationships between structural and psychological empowerment, mediated by person-centred processes and thriving for nursing home staff2019In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 40, no 1, p. 67-71Article in journal (Refereed)
    Abstract [en]

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

  • 90.
    Sjölund, Britt-Marie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Mamhidir, Anna-Greta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Pain prevalence among residents living in nursing homes and factors associated with quality of life and well-being2017In: Article in journal (Other academic)
  • 91.
    Sjölund, Britt-Marie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Wimo, Anders
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    von Strauss, Eva
    The Swedish Red Cross University College, Stockholm, Sweden; Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Incidence of ADL Disability in Older Persons, Physical Activities as a Protective Factor and the Need for Informal and Formal Care: Results from the SNAC-N Project2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 9, article id e0138901Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of the study was to examine 1) the incidence of disability in Activities of Daily Living (ADL), in persons 78 years and older 2) explore whether being physical active earlier is a significant predictor of being disability free at follow-up and 3) describe the amount of informal and formal care in relation to ADL-disability.

    METHODS: Data were used from a longitudinal community-based study in Nordanstig (SNAC-N), a part of the Swedish National Study on Aging and Care (SNAC). To study objectives 1) and 2) all ADL-independent participants at baseline (N = 307) were included; for objective 3) all participants 78 years and older were included (N = 316). Data were collected at baseline and at 3- and 6-year follow-ups. ADL-disability was defined as a need for assistance in one or more activities. Informal and formal care were measured using the Resource utilization in Dementia (RUD)-instrument.

    RESULTS: The incidence rates for men were similar in the age groups 78-81and 84 years and older, 42.3 vs. 42.5/1000 person-years. For women the incidence rate for ADL-disability increased significantly from the age group 78-81 to the age group 84 years and older, 20.8 vs.118.3/1000 person-years. In the age group 78-81 years, being physically active earlier (aOR 6.2) and during the past 12 month (aOR 2.9) were both significant preventive factors for ADL-disability. Both informal and formal care increased with ADL-disability and the amount of informal care was greater than formal care. The incidence rate for ADL-disability increases with age for women and being physically active is a protective factor for ADL-disability.

    CONCLUSION: The incidence rate for ADL-disability increases with age for women, and being physical active is a protective factor for ADL-disability.

  • 92.
    Sjölund, Britt-Marie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Aging Research Center (ARC), Karolinska Institutet-Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden .
    Wimo, Anders
    Aging Research Center (ARC), Karolinska Institutet-Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden .
    Qiu, Chengxuan
    Aging Research Center (ARC), Karolinska Institutet-Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden .
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    von Strauss, Eva
    Aging Research Center (ARC), Karolinska Institutet-Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden .
    Time trends in prevalence of activities of daily living (ADL) disability and survival: Comparing two populations (aged 78+ years) living in a rural area in Sweden2014In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 58, no 3, p. 370-375Article in journal (Refereed)
    Abstract [en]

    The aim was to study time trends in prevalence of disability in ADL and survival among men and women 78 years and older comparing two cohorts. The study was a time trend study based on two population-based community cohorts, the Nordanstig Project (NP), collected 1995-1998 and the Swedish National Study on Aging and Care in Nordanstig (SNAC-N), collected 2001-2003. The participants were people aged 78 years and older from the NP cohort (N = 303) and from the SNAC-N cohort (N = 406). All were clinically examined by physicians and nurses using standardized protocols. Disability was defined as a need for assistance in one or more ADL activities. The prevalence of disability and survival were compared using logistic and Cox models. The prevalence of ADL disability was stable for men, while women became more disabled in ADL during the time period, OR 2.36 (1.12-4.94). There was no significant difference in survival time between the cohorts in either ADL disabled persons or nondisabled persons. There was a tendency for increased survival for non-disabled persons in SNAC-N compared with NP, although not significant; this was particularly true for women. In general, women survived longer than men did regardless of whether they were ADL disabled or not. The time trends for ADL disability found in the study show that ADL disability had increased in women but not in men. More studies are needed to identify risk factors for ADL disability with a view to preventing it in time. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

  • 93.
    Skytt, Bernice
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Centre for Research and Development, Uppsala University, County Council of Gävleborg, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Carlsson, Marianne
    Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Ljunggren, Birgitta
    Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Psychometric testing of the leadership and management inventory: a tool to measure the skills and abilities of first-line nurse managers2008In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 16, no 7, p. 784-794Article in journal (Refereed)
    Abstract [en]

    Aim: To estimate the validity and reliability of the Leadership and Management Inventory, a tool to measure the skills and abilities of first-line nurse managers. Background: The decision to develop an inventory reflects the need for an instrument that can measure the various skills and abilities first-line nurse managers should possess. Method: Factor analysis was conducted and internal consistency initially estimated on data from 149 registered nurses; a second sample of 197 health care personnel was used to test these results. Results: Principal component analysis of the first sample resulted in a preferred three-factor solution that explained 65.8% of the variance; Cronbach's alpha coefficient varied between 0.90 and 0.95. Analysis of the second sample also resulted in a three-factor solution that explained 64.2% of the variance; Cronbach's alpha coefficient varied from 0.88 to 0.96. For both samples, the factors were labelled 'interpersonal skills and group management', 'achievement orientation' and 'overall organizational view and political savvy'. Conclusion: Results indicate that estimates of validity and reliability for the Leadership and Management Inventory can be considered acceptable. Implications for nursing management: The Leadership and Management Inventory can be used when first-line nurse managers' leadership and management skills and abilities are to be measured.

  • 94.
    Skytt, Bernice
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Mamhidir, Anna-Greta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    A longitudinal qualitative study of health care personnel’s perceptions of simultaneous implementation of three risk assessment scales on falls, malnutrition and pressure ulcers2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 13/14, p. 1912-1922Article in journal (Refereed)
    Abstract [en]

    Aims and objectives

    In this study, the aim was to understand health care personnel's expectations and experiences of participating in an intervention aimed at the implementation of three assessment scales for fall injuries, malnutrition and pressure ulcers, and the performance of preventive measures in these areas over the period of 18 months.

    Background

    Fall injuries, malnutrition and pressure ulcers among older people are challenging issues for caregivers at different levels in the health care system.

    Design

    A descriptive design with a qualitative approach was used to follow health care personnel before, during and after implementation of a care prevention intervention.

    Methods

    Twelve health care personnel with different professions at the hospital, primary care and municipal care levels participated in a preventive care introduction. Seminars were held at four occasions, with assignments to be completed between seminars. Lectures and group discussions were performed, and three risk assessment scales were introduced. The participants were interviewed before, during and after the introduction. Manifest and latent content analysis were used.

    Results

    The main results are presented in the theme ‘Patient needs are visualised through a gradually developed shared understanding’ and in five categories. The work approach of performing three risk assessments simultaneously was perceived as positive and central to ensuring quality of care; it was not, however, perceived as unproblematic.

    Conclusion

    The participants as well as health care team members showed a positive attitude towards and described the advantages of being given opportunities for shared understanding to improve patient safety and to provide structure for the provision of good care.

    Relevance to clinical practice

    The managerial approach of listening to and acting on issues stressed by health care personnel is important to ensure ongoing and future improvement initiatives.

  • 95.
    Skytt, Bernice
    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.
    Hagerman, Heidi
    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.
    Strömberg, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    First-line managers' descriptions and reflections regarding their staff's access to empowering structures2015In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 23, no 8, p. 1003-1010Article in journal (Refereed)
    Abstract [en]

    Aim: To elucidate first-line managers' descriptions and reflections regarding their staff's access to empowering structures using Kanter's theory of structural empowerment. Background: Good structural conditions within workplaces are essential to employees' wellbeing, and their ability to access empowerment structures is largely dependent on the management. Method: Twenty-eight first-line managers in elderly care were interviewed. Deductive qualitative content analysis was used to analyse data. Results: Managers perceived that staff had varying degrees of access to the empowering structures described in Kanter's theory - and that they possessed formal power in their roles as contact persons and representatives. The descriptions mostly started from the managers' own actions, although some started from the needs of staff members. Conclusion: All managers described their staff's access to the empowering structures in Kanter's theory as important, yet it seemed as though this was not always reflected on and discussed as a strategic issue. Implications for nursing management: Managers could make use of performance and appraisal dialogues to keep up to date on staff's access to empowering structures. Recurrent discussions in the management group based on such current information could promote staff's access to power through empowering structures and make job definitions a strategic issue in the organisation.

  • 96.
    Skytt, Bernice
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Ljunggren, 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.
    Carlsson, Marianne
    Uppsala universitet.
    Different development programmes: does it make a difference?2011In: Leadership in Health Services, ISSN 1751-1879, Vol. 24, no 1, p. 29-50Article in journal (Refereed)
  • 97.
    Strömberg, Annika
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Hagerman, Heidi
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    First-line managers dealing with different management approaches2019In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 32, no 4, p. 543-557Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 98.
    Vae, Karen Johanne U.
    et al.
    Faculty of Health Education, Stord/Haugesund University College, Norway.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Sweden; Nursing Department, Medicine and Health College, Lishui University, China.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Löfmark, Anna
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Faculty of Health Education, Stord/Haugesund University College, Norway.
    Nursing students' and preceptors’ experience of assessment during clinical practice: a multilevel repeated-interview study of student–preceptor dyads2018In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 30, p. 13-19Article in journal (Refereed)
    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.

  • 99. Virk, Gurvinder
    et al.
    Sjöström, Christer
    University of Gävle, Department of Technology and Built Environment, Ämnesavdelningen för byggnadskvalitet.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Trinius, Wolfram
    University of Gävle, Department of Technology and Built Environment, Ämnesavdelningen för byggnadskvalitet.
    Standards and/or ethics for service robots?2006In: Ethics of Human Interaction with Robotic, Bionic, and AI Systems: concepts and policies, 2006, p. 69-75Conference paper (Refereed)
  • 100.
    Wadensten, Barbro
    et al.
    Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden.
    Häggström, Elisabeth
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Public nursing home staff's experience of participating in an intervention aimed at enhancing their self-esteem2009In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 17, no 7, p. 833-842Article in journal (Refereed)
    Abstract [en]

    Aim The aim of the present study was to gain an understanding of how nursing staff experienced participating in a training programme aimed at strengthening their self-esteem and empowering them, to determine whether participation benefited them in any way, and to describe their opinions about possible benefits or disadvantages. Background Staff working in institutions such as nursing homes have a low status in society. A training programme was introduced to staff in a public nursing home. It focused on helping them understand factors in the work situation that influence them and on empowering them. Method The study was explorative and qualitative in design. Findings The participants in the programme were generally satisfied with it. Their opinions about the benefits they received from the programme can be described using three themes: 'improved communication skills', 'enhanced self-esteem' and 'sees work in a different light'. Conclusions The most important finding of the present study is that it was possible to strengthen and empower staff. Staff members were generally pleased and satisfied with the content/organization of the training programme. They felt the programme had been of value to them by improving their communication skills and increasing their self-esteem. Implications for nursing management The present result could be of value to managers and educators working in the area of nursing home care when planning education and development activities for staff. Learning to communicate better and understand the social structure at the workplace could improve staff members' self-esteem, thereby enhancing the work situation and atmosphere as well as empowering the individuals.

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