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Wikby, Kerstin
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Ge, L., Wikby, K. & Rask, M. (2017). Lived experience of women with gestational diabetes mellitus living in China: a qualitative interview study. BMJ Open, 7(11), Article ID e017648.
Open this publication in new window or tab >>Lived experience of women with gestational diabetes mellitus living in China: a qualitative interview study
2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 11, article id e017648Article in journal (Refereed) Published
Abstract [en]

Objective To explore the lived experience of women with gestational diabetes mellitus (GDM) living in China in order to add knowledge about how the Chinese women suffer from GDM. Design A qualitative interpretive interview study. Data were collected with a snowball sampling technique. Phenomenological hermeneutics was used as the analysis method based on Ricoeur's phenomenological hermeneutical interpretation theory. Setting The study was performed at the participants' work places, or at the obstetric clinics or wards at two provincial hospitals and one municipal hospital in the southeast of China. Participants Inclusion criteria were age >= 18 years, diagnosis of GDM without other pregnancy complications, in 34th gestational weeks-postpartum 4th weeks and speaking Mandarin Chinese without speech impediment. 62 women, who met the inclusion criteria, took part in the study. Results The lived experience of the women with GDM living in China was formulated into a main theme: 'longing for caring care'. The main theme was derived from four themes: being stricken by GDM, wishing to receive caring GDM care, being left alone to struggle with GDM and trying to adjust and adapt to life with GDM. Conclusion The eagerness for caring care in China was highlighted. The lack of caring care could be one of the possible reasons why the professional-patient relations were deteriorating in China. It could be useful for health providers and health policymakers to receive education and training about caring care. Using the health metaphor of balance and 'patient participation' and 'patient-centred' approaches may benefit women with GDM and thus improve the quality of care in China.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017
National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-70941 (URN)10.1136/bmjopen-2017-017648 (DOI)000422898800120 ()2-s2.0-85050224292 (Scopus ID)
Available from: 2018-02-15 Created: 2018-02-15 Last updated: 2019-08-29Bibliographically approved
Ge, L., Wikby, K. & Rask, M. (2016). ‘Is gestational diabetes a severe illness?’: exploring beliefs and self‐care behaviour among women with gestational diabetes living in a rural area of the south east of China. The Australian journal of rural health, 24(6), 378-384
Open this publication in new window or tab >>‘Is gestational diabetes a severe illness?’: exploring beliefs and self‐care behaviour among women with gestational diabetes living in a rural area of the south east of China
2016 (English)In: The Australian journal of rural health, ISSN 1038-5282, E-ISSN 1440-1584, Vol. 24, no 6, p. 378-384Article in journal (Refereed) Published
Abstract [en]

Objective: This study explores beliefs about illnessand health and self-care behaviour among womenwith gestational diabetes living in a rural area of thesouth east of China.Design: A qualitative exploratory study using semistructuredinterviews and qualitative content analysis.

Setting: A hospital located in the outskirts of a city inthe south east of China.Participants: Seventeen women with gestational diabetesin 34–38th pregnant weeks.

Results: The beliefs about gestational diabetes amongthe women in the present study were found to be bidirectional.Some of them feared the illness and its negativeinfluence on health, while others believed that itwas not a severe illness and disbelieved the diagnosisof gestational diabetes. They related their illness andhealth to the individual, social and natural factors.They mainly sought help from the professional sector,but did not fully comply with the professionals’advice. Diet control and exercise were their main selfcaremeasures, but none of them self-monitored theirblood glucose. They demonstrated their misunderstandingabout diet control and self-monitoring ofblood glucose.

Conclusions: This study highlighted the serious lackof knowledge, lower level of risk awareness and poorself-care behaviour among women in this group.Health professionals were found to be the most importantsource of knowledge about gestational diabetesfor these women. The influence of Chinese culture was demonstrated. Gestational diabetes among thesewomen can most likely be improved by training thehealth professionals and by health education involvingindividuals, families and the rural communities.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
National Category
Nursing Endocrinology and Diabetes
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-52899 (URN)10.1111/ajr.12292 (DOI)000392707900006 ()2-s2.0-84963536815 (Scopus ID)
Available from: 2016-06-01 Created: 2016-06-01 Last updated: 2017-11-30Bibliographically approved
Ge, L., Wikby, K. & Rask, M. (2016). Quality of care from the perspective of women with gestational diabetes in China. International Journal of Gynecology & Obstetrics, 134(2), 151-155
Open this publication in new window or tab >>Quality of care from the perspective of women with gestational diabetes in China
2016 (English)In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 134, no 2, p. 151-155Article in journal (Refereed) Published
Abstract [en]

Objective: To explore the quality of gestational diabetes mellitus (GDM) care experienced by women in China and how it could be improved.

Methods: A qualitative study was conducted at a municipal hospital in south east China. Women who had been diagnosed with GDMat 34–38 weeks of pregnancy were enrolled during two periods;between May 1 and July 31, 2012, and between April 1 and July 31, 2013. Data regarding patient-perceived care quality were collected through semi-structured individual interviews and were analyzed by qualitative content analysis.

Results: The study enrolled 44 patients; the interviews recorded a lack of professional care resources for GDM, a lack of high-quality personalized care for women with GDM, and patients’ suggestions regarding how to improve GDM care.

Conclusion: The participants reported a lack of high-quality GDM care, describing the core problem as an imbalance between over-stretched hospitals and low-efficiency under-utilized primary healthcare centers. Clinical-practice reforms identified, particularly in primary healthcare settings, included improving services through increasing the number of health professionals and material resources to comply with diabetes guidelines, and incorporating a humanistic approach in the provision of care

Place, publisher, year, edition, pages
Elsevier, 2016
National Category
Nursing Endocrinology and Diabetes
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-54616 (URN)10.1016/j.ijgo.2016.01.013 (DOI)000380591300007 ()27198743 (PubMedID)2-s2.0-84967214917 (Scopus ID)
Available from: 2016-07-11 Created: 2016-07-11 Last updated: 2017-11-28Bibliographically approved
Nygårdh, A., Malm, D., Wikby, K. & Ahlström, G. (2014). The complexity in the implementation process of empowerment-based chronic kidney care: a case study. BMC Nursing, 13(1), 1-10, Article ID 22.
Open this publication in new window or tab >>The complexity in the implementation process of empowerment-based chronic kidney care: a case study
2014 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 13, no 1, p. 1-10, article id 22Article in journal (Refereed) Published
Abstract [en]

Background: This study is part of an interactive improvement intervention aimed to facilitate empowerment-based chronic kidney care using data from persons with CKD and their family members. There are many challenges to implementing empowerment-based care, and it is therefore necessary to study the implementation process. The aim of this study was to generate knowledge regarding the implementation process of an improvement intervention of empowerment for those who require chronic kidney care.

Methods: A prospective single qualitative case study was chosen to follow the process of the implementation over a two year period. Twelve health care professionals were selected based on their various role(s) in the implementation of the improvement intervention. Data collection comprised of digitally recorded project group meetings, field notes of the meetings, and individual interviews before and after the improvement project. These multiple data were analyzed using qualitative latent content analysis.

Results: Two facilitator themes emerged: Moving spirit and Encouragement. The healthcare professionals described a willingness to individualize care and to increase their professional development in the field of chronic kidney care. The implementation process was strongly reinforced by both the researchers working interactively with the staff, and the project group. One theme emerged as a barrier: the Limitations of the organization. Changes in the organization hindered the implementation of the intervention throughout the study period, and the lack of interplay in the organization most impeded the process.

Conclusions: The findings indicated the complexity of maintaining a sustainable and lasting implementation over a period of two years. Implementing empowerment-based care was found to be facilitated by the cooperation between all involved healthcare professionals. Furthermore, long-term improvement interventions need strong encouragement from all levels of the organization to maintain engagement, even when it is initiated by the health care professionals themselves.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
Case study, Empowerment, Healthcare professionals, Implementation process, Improvement intervention, Individualized care, Interactive research, Qualitative research, Quality of care
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-58415 (URN)10.1186/1472-6955-13-22 (DOI)2-s2.0-84905922592 (Scopus ID)
Available from: 2016-11-29 Created: 2016-11-29 Last updated: 2017-11-29Bibliographically approved
Nygårdh, A., Malm, D., Wikby, K. & Ahlström, G. (2012). Empowerment Intervention in Outpatient Care of Persons with Chronic Kidney Disease Pre-Dialysis. Nephrology Nursing Journal : Journal of The American Nephrology Nurses Association, 39(4), 285-293
Open this publication in new window or tab >>Empowerment Intervention in Outpatient Care of Persons with Chronic Kidney Disease Pre-Dialysis
2012 (English)In: Nephrology Nursing Journal : Journal of The American Nephrology Nurses Association, ISSN 1526-744X, E-ISSN 2163-5390, Vol. 39, no 4, p. 285-293Article in journal (Refereed) Published
Abstract [en]

Empowering interventions can improve person-centered care. A pre- and post-evaluation using interactive research involving two years of empowering interventions was designed to improve quality of care in outpatients with chronic kidney disease who were pre-dialysis. The results showed significantly increased empowerment in the intervention group. Interactive research facilitated the implementation of the empowerment intervention, which may increase sustainability over time.

National Category
Health Sciences
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-22120 (URN)000308118600004 ()
Available from: 2012-10-16 Created: 2012-10-16 Last updated: 2017-12-07Bibliographically approved
Mufunda, E., Wikby, K., Albin, B. & Hjelm, K. (2012). Level and determinants of diabetesknowledge in patients with diabetes in Zimbabwe: a cross-sectional study (Open Access). Pan-african medical journal, 13, Article ID: 78
Open this publication in new window or tab >>Level and determinants of diabetesknowledge in patients with diabetes in Zimbabwe: a cross-sectional study (Open Access)
2012 (English)In: Pan-african medical journal, ISSN 0031-0565, Vol. 13, p. Article ID: 78-Article in journal (Refereed) Published
Abstract [en]

A previous study of beliefs about health and illness in Zimbabweans with diabetes mellitus indicated limited knowledge about DM affecting self-management and care seeking behaviour. The aim of this study was to assess the level of diabetes knowledge in Zimbabwean adults with DM, to determine the main gaps in knowledge and identify the socio-demographic and DM-related determinants predict DM awareness and self-management.

Methods: A cross-sectional descriptive study was performed using a standardized self-report Diabetes Knowledge Test questionnaire (DKT) of 58 respondents. Results were analysed with  statistical methods.The majority of the respondents scored average knowledge on the sub-scales: general knowledge, insulin use and total knowledge, with an overall score of 63.1± 14, 2%. Major knowledge gaps were found concerning diet, insulin use and glycaemic control. No significant differences in mean scores were detected in the DM knowledge sub-scales when comparingb mean knowledge scores in relation to socio-demographic and DM characteristics. However, DM -related complications were significantly associated with lower total and general DM knowledge, and female gender was an independent determinant of low general knowledge. In conclusion, knowledge gaps were evident regarding insulin use, diet and glycaemic control. Low DM knowledge was associated with being a female and could be a risk factor for development of DM-related complications. Knowledge gaps need to be addressed in diabetes education to prevent development of complications.

Keywords
Diabetes mellitus, Knowledge, cross-sectional study
National Category
Endocrinology and Diabetes Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-23044 (URN)
Note

article in fulltext

Available from: 2012-12-19 Created: 2012-12-19 Last updated: 2015-03-03Bibliographically approved
Nygårdh, A., Malm, D., Wikby, K. & Ahlström, G. (2012). The experience of empowerment in the patient-staff encounter: The patient´s perspective. Journal of Clinical Nursing, 21(5-6), 897-904
Open this publication in new window or tab >>The experience of empowerment in the patient-staff encounter: The patient´s perspective
2012 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 5-6, p. 897-904Article in journal (Refereed) Published
Abstract [en]

Aim and objective.  The aim was to explore empowerment within the patient–staff encounter as experienced by out-patients with chronic kidney disease.

Background.  Empowerment has an important role to play in the patient–staff relationship in the case of patients with a chronic disease. When it comes to patients with chronic kidney disease, there has been little research on empowerment, for which reason interviewing such patients about their experiences of empowerment will provide useful knowledge within the context of out-patient care.

Design.  A qualitative interview study was chosen to gain an understanding of empowerment from the patient perspective.

Method.  The study was carried out at an out-patient clinic in Sweden and involved 20 patients with chronic kidney disease. The interviews were subjected to latent content analysis.

Results.  Five of the seven sub-themes emerging from the analysis represented empowerment: Accessibility according to need, Confirming encounter, Trust in the competence of the healthcare staff, Participation in decision-making, Learning enables better self-management. The other two represented non-empowerment: Meeting with nonchalance, Lack of dialogue and influence. From the seven sub-themes, one comprehensive theme was generated: Creation of trust and learning through encounter.

Conclusion.  The main finding regarding the central role of the creation of trust and learning through the patient–staff encounter underlines the importance of understanding empowerment from the patient’s perspective.

Relevance to clinical practice.  Nursing and other healthcare staff need knowledge and understanding of the meaning of empowerment from the patients’ perspective to meet their needs in out-patient care.

National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-16212 (URN)10.1111/j.1365-2702.2011.03901.x (DOI)2-s2.0-84857031316 (Scopus ID)
Available from: 2011-12-18 Created: 2011-12-18 Last updated: 2017-12-08Bibliographically approved
Nygårdh, A., Wikby, K., Malm, D. & Ahlström, G. (2011). Empowerment in outpatient care of persons with chronic kidney disease: The family members' perspective. BMC Nursing, 10, 10-21, Article ID 21.
Open this publication in new window or tab >>Empowerment in outpatient care of persons with chronic kidney disease: The family members' perspective
2011 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 10, p. 10-21, article id 21Article in journal (Refereed) Published
Abstract [en]

Background

Family members of persons with pre-dialysis chronic kidney disease may experience feelings of vulnerability and insecurity as the disease follows its course. Against this background, the aim of the present study was to explore empowerment in outpatient care as experienced by these family members.

Methods

An inductive approach for qualitative data analysis was chosen. The study sample comprised 12 family members of pre-dialysis patients at an outpatient kidney clinic. Two interviews with each family member were subjected to content analysis to gain an understanding of empowerment from the family members' perspective.

Results

Having strength to assume the responsibility was the main theme that emerged from the following five sub-themes: Being an involved participant, Having confirming encounters, Trusting in health-care staff, Comprehending through knowledge, and Feeling left out. Four of these five sub-themes were positive. The fifth subtheme illuminated negative experience, indicating the absence of empowerment.

Conclusions

Family members' experience of empowerment is dependent on their ability to assume the responsibility for a relative with chronic kidney disease when needed. The findings emphasise the need for a family perspective and the significance of a supportive environment for family members of persons in outpatient care.

National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-16211 (URN)10.1186/1472-6955-10-21 (DOI)2-s2.0-80055014847 (Scopus ID)
Available from: 2011-12-18 Created: 2011-12-18 Last updated: 2017-12-08Bibliographically approved
Wikby, K., Ek, A.-C. & Christensson, L. (2009). Implementation of a Nutritional Programme in Elderly People Admitted to Resident Homes. Scandinavian Journal of Caring Sciences, 23(3), 421-430
Open this publication in new window or tab >>Implementation of a Nutritional Programme in Elderly People Admitted to Resident Homes
2009 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 3, p. 421-430Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-16210 (URN)10.1111/j.1471-6712.2008.00632.x (DOI)19170960 (PubMedID)
Available from: 2011-12-18 Created: 2011-12-18 Last updated: 2017-12-08Bibliographically approved
Wikby, K., Ek, A.-C. & Christensson, L. (2008). The two-step Mini Nutritional Assessment (MNA) Procedure in Community Resident Homes. Journal of Clinical Nursing, 17(9), 1211-1218
Open this publication in new window or tab >>The two-step Mini Nutritional Assessment (MNA) Procedure in Community Resident Homes
2008 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 9, p. 1211-1218Article in journal (Refereed) Published
Abstract [en]

Aims and objectivities.  The aims were to test internal consistency and interrater reliability of Mini Nutritional Assessment during implementation of Mini Nutritional Assessment in community residential homes and to test sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment-short form vs. Mini Nutritional Assessment.

Background.  There is a need in clinical practice to assess nutritional status in older people and to identify those who could benefit from early intervention.

Methods.  The two-step Mini Nutritional Assessment procedure (Mini Nutritional Assessment-short form and Mini Nutritional Assessment) was used in 127 older people admitted to eight residential homes. In three of those homes (A, B and C), registered nurses simultaneously performed the assessment procedure, after receiving education and training. The intention was to offer the registered nurses a tool for independent practice use.

Results.  Internal consistency was 0·68 (Cronbach's alpha) (n = 127). In residential home A, B and C, the registered nurses carried out Mini Nutritional Assessment in 45 residents out of 68. The agreement level between the author's and the registered nurses’ assessments was 62% (kappa 0·41). In residential home A, B and C, the agreement level was 89%, 89% and 44%, respectively. Sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment-short form vs. Mini Nutritional Assessment were 89%, 82% and 92%, respectively.

Conclusions.  The two-step Mini Nutritional Assessment procedure seems to be a useful tool to identify residents in need of nutritional interventions, despite the registered nurses not carrying out Mini Nutritional Assessment in all residents and the low agreement in residential home C. It indicates that to implement and use Mini Nutritional Assessment in nursing care demands the creating necessary staff resources, such as adequate staffing, sufficient education and continual supervision.

Relevance to clinical practice.  Because of the high sensitivity of Mini Nutritional Assessment-short form and Mini Nutritional Assessment, Mini Nutritional Assessment-short form alone might be sufficient for practice use, as its simplicity might increase its usefulness.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:lnu:diva-16209 (URN)10.1111/j.1365-2702.2007.02012.x (DOI)18266849 (PubMedID)
Available from: 2011-12-18 Created: 2011-12-18 Last updated: 2017-12-08Bibliographically approved
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