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Schildmeijer, KristinaORCID iD iconorcid.org/0000-0002-0895-674x
Publications (10 of 46) Show all publications
Ericsson, C., Skagerström, J., Schildmeijer, K., Årestedt, K., Anders, B., Pakpour, A. & Per, N. (2019). Can patients contribute to safer care in meetings with healthcare professionals?: A cross-sectional survey of patient perceptions and beliefs. BMJ Quality and Safety, 28(8), 657-666
Open this publication in new window or tab >>Can patients contribute to safer care in meetings with healthcare professionals?: A cross-sectional survey of patient perceptions and beliefs
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2019 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 28, no 8, p. 657-666Article in journal (Refereed) Published
Abstract [en]

Objectives To investigate patients’ perceptions of their meetings with healthcare professionals and the extent to which they believe they can influence patient safety in these meetings.

Design Cross-sectional survey of patients using a study-specific questionnaire. Data were analysed using both parametric and non-parametric statistics.

Setting The study was conducted in primary and secondary care in three county councils in southeast Sweden by means of a survey questionnaire despatched in January 2017.

Participants Survey data were collected from 1445 patients, 333 of whom were complainants (patients who had filed a complaint about being harmed in healthcare) and 1112 regular patients (patients recruited from healthcare units).

Main outcome measures Patients’ perceptions of meetings with physicians and nurses, beliefs concerning patients’ contributions to safer care and whether the patients had suffered harm in healthcare during the past 10 years.

Results Most respondents reported that it was easy to ask physicians and nurses questions (84.9% and 86.6%) and to point out if something felt odd in their care (77.7% and 80.7%). In general, complainants agreed to a higher extent compared with regular patients that patients can contribute to safer care (mean 1.92 and 2.13, p<0.001). Almost one-third (31.2%) of the respondents (both complainants and regular patients) reported that they had suffered harm in healthcare during the past 10 years.

Conclusions Most respondents believed that healthcare professionals can facilitate patient interaction and increase patient safety by encouraging patients to ask questions and take an active part in their care. Further research will need to identify strategies to support such questioning in routine practice and ensure that it achieves its intended goals.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
patient safety, patient satisfaction, adverse events, epidemiology and detection, medical error, measurement, epidemiology
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-82217 (URN)10.1136/bmjqs-2018-008524 (DOI)000477894500008 ()31018984 (PubMedID)2-s2.0-85065298242 (Scopus ID)
Available from: 2019-04-25 Created: 2019-04-25 Last updated: 2019-08-29Bibliographically approved
Bertilsson, E., Semark, B., Schildmeijer, K., Bremer, A. & Carlsson, J. (2019). Do-not-attempt-to resuscitate-orders in a Swedish Community Hospital: does the wording of these orders point towards discrimination?. Paper presented at The Congress of the European Resuscitation Council, Ljubljana, Slovenia, September 19-21, 2019. Resuscitation, 142(s1), e5-e5
Open this publication in new window or tab >>Do-not-attempt-to resuscitate-orders in a Swedish Community Hospital: does the wording of these orders point towards discrimination?
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2019 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 142, no s1, p. e5-e5Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Ethics, Patient involvement, Documentation, Do not attempt to resuscitate orders
National Category
Medical Ethics
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-89325 (URN)10.1016/j.resuscitation.2019.06.022 (DOI)
Conference
The Congress of the European Resuscitation Council, Ljubljana, Slovenia, September 19-21, 2019
Available from: 2019-09-26 Created: 2019-09-26 Last updated: 2019-11-19Bibliographically approved
Ekstedt, M., Schildmeijer, K., Wennerberg, C., Nilsson, L., Wannheden, C. & Hellström, A. (2019). Enhanced patient activation in cancer care transitions: protocol for a randomized controlled trial of a tailored eectronic health intervention for men with prostate cancer. JMIR Research Protocols, 8(3), 1-13, Article ID e11625.
Open this publication in new window or tab >>Enhanced patient activation in cancer care transitions: protocol for a randomized controlled trial of a tailored eectronic health intervention for men with prostate cancer
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2019 (English)In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 8, no 3, p. 1-13, article id e11625Article in journal (Refereed) Published
Abstract [en]

Background: Prostate cancer has increased in incidence worldwide and is the leading cause of cancer death in 24 countries. The most common treatment is radical prostatectomy. However, surgery is associated with postoperative complications such as urinary incontinence and sexual dysfunction, causing decreased quality of life. If survivors are encouraged to be more active in self-care management, the symptom burden may decrease and quality of life may improve. An electronic health (eHealth) intervention based on motivational behavioral theory has been developed for this purpose.

Objective: This study aimed to compare the effectiveness of standard care in combination with a tailored eHealth and mobile health self-management support system, electronic Patient Activation in Treatment at Home (ePATH), with standard care of adverse effects of prostate cancer treatment (urinary incontinence and sexual functioning) in men undergoing radical prostatectomy. The secondary aim was to test the effect on patient activation, motivation, overall well-being, and health literacy over time in and between groups.

Methods: A pragmatic multicenter, block-randomized controlled trial with 2 study arms, standard care (control) and eHealth-assisted standard care (intervention), for patients undergoing radical prostatectomy. For 80% power, a sample of 242 men will need to be recruited.

Results: Recruitment started in January 2018 and is expected to be completed by August 2019. Data collection will be completed in August 2020. The first cross-sectional results from this trial are anticipated to be published in January 2020.

Conclusions: With the increasing number of prostate cancer survivors, attention should be paid to rehabilitation, psychosocial care, and support for endurance of self-care to reduce suffering from adverse treatment effects, poor quality of life, and depression because of postoperative complications. This project may increase knowledge of how patients can be supported to feel involved in their care and returning to as normal a life as possible. The anticipated effects of ePATH could improve health outcomes for individuals and facilitate follow-up for health care professionals.

Place, publisher, year, edition, pages
JMIR Publications, 2019
Keywords
medical informatics, eHealth, mHealth, motivation, patient activation, prostate cancer, self-management
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences, Health Informatics
Identifiers
urn:nbn:se:lnu:diva-81619 (URN)10.2196/11625 (DOI)000462890300001 ()30900999 (PubMedID)2-s2.0-85067901358 (Scopus ID)
Funder
The Kamprad Family Foundation, 2015-0067Swedish Cancer Society, CAN 2017/748Medical Research Council of Southeast Sweden (FORSS), FORSS-657211;FORSS-760131
Available from: 2019-04-03 Created: 2019-04-03 Last updated: 2019-08-29Bibliographically approved
Schildmeijer, K., Wallerstedt, B. & Ekstedt, M. (2019). Healthcare professionals' perceptions of risk when care is given in patients' homes. Home Healthcare Now, 37(2), 97-105
Open this publication in new window or tab >>Healthcare professionals' perceptions of risk when care is given in patients' homes
2019 (English)In: Home Healthcare Now, ISSN 2374-4529, E-ISSN 2374-4537, Vol. 37, no 2, p. 97-105Article in journal (Refereed) Published
Abstract [en]

Perceptions of risks in decision making for home healthcare were examined. Twenty home healthcare professionals were interviewed. Content analysis yielded one theme (management of known and unpredictable risks) and four categories. Healthcare professionals had to handle both known and unpredictable risks in daily work in patients' homes concerning communication challenges, a fragmented organization at several levels, risky medication management, and balancing respect for patient autonomy and involvement in care against risk taking. Priority must be given to creating safer care in this setting.

Place, publisher, year, edition, pages
Wolters Kluwer, 2019
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-81622 (URN)10.1097/NHH.0000000000000717 (DOI)30672823 (PubMedID)2-s2.0-85062417017 (Scopus ID)
Available from: 2019-04-03 Created: 2019-04-03 Last updated: 2019-08-29Bibliographically approved
Nilsen, P., Schildmeijer, K., Ericsson, C., Seing, I. & Birken, S. (2019). Implementation of change in health care in Sweden: a qualitative study of professionals' change responses. Implementation Science, 14, Article ID 51.
Open this publication in new window or tab >>Implementation of change in health care in Sweden: a qualitative study of professionals' change responses
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2019 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 14, article id 51Article in journal (Refereed) Published
Abstract [en]

Background: Implementation of evidence-based practices in health care implies change. Understanding health care professionals' change responses may be critical for facilitating implementation to achieve an evidence-based practice in the rapidly changing health care environment. The aim of this study was to investigate health care professionals' responses to organizational and workplace changes that have affected their work. Methods: We conducted interviews with 30 health care professionals (physicians, registered nurses and assistant nurses) employed in the Swedish health care system. An inductive approach was applied, using a semi-structured interview guide developed by the authors. We used an analytical framework first published in 1999 to analyze the informants' change responses in which change responses are perceived as a continuum ranging from a strong acceptance of change to strong resistance to change, describing seven forms of change responses along this continuum. Change response is conceptualized as a tridimensional attitude composed of three components: cognitive, affective and intentional/behavioral. Results: Analysis of the data yielded 10 types of change responses, which could be mapped onto 5 of the 7 change response categories in the framework. Participants did not report change responses that corresponded with the two most extreme forms of responses in the framework, i.e., commitment and aggressive resistance. Most of the change responses were classified as either indifference or passive resistance to changes. Involvement in or support for changes occurred when the health care professionals initiated the changes themselves or when the changes featured their active input and when changes were seen as well founded and well communicated. We did not identify any change responses that could not be fitted into the framework. Conclusions: We found the framework to be useful for a nuanced understanding of how people respond to changes. This knowledge of change responses is useful for the management of changes and for efforts to achieve more successful implementation of evidence-based practices in health care.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Change response, Attitude, Health care, Implementation, Evidence-based practice
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-84522 (URN)10.1186/s13012-019-0902-6 (DOI)000468112400001 ()31088483 (PubMedID)2-s2.0-85065737495 (Scopus ID)
Available from: 2019-06-05 Created: 2019-06-05 Last updated: 2019-08-29Bibliographically approved
Schildmeijer, K., Frykholm, O., Kneck, Å. & Ekstedt, M. (2019). Not a straight line: patient's experiences of prostate cancer and their journey through the healthcare system. Cancer Nursing, 42(1), E36-E43
Open this publication in new window or tab >>Not a straight line: patient's experiences of prostate cancer and their journey through the healthcare system
2019 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 42, no 1, p. E36-E43Article in journal (Refereed) Published
Abstract [en]

Background

Cancer and its treatment can severely impact quality of life, giving rise to complex needs with respect to follow-up care. To support patient needs and increase efficiency of care with limited resources, the Swedish government has launched national reforms to redesign cancer care pathways.

Objective

The aim of this study was to explore how prostate cancer patients experience their journey through the healthcare system when their care is provided according to the standardized care pathway, as described in healthcare policy documents.

Methods

A qualitative, descriptive approach with individual interviews was used. A template of a standardized prostate cancer pathway, created together with healthcare professionals, was used during interviews. Fourteen interviews were conducted with prostate cancer patients all operated on at a midsized hospital in southeast Sweden between October 2015 and April 2016. The interviews were analyzed with qualitative content analysis and illustrated in a patient journey map.

Results

We identified an overall theme, “walking a tightrope,” consisting of 4 categories: “waiting,” “becoming familiar with a troublesome body,” “adjusting to a different life,” and “information challenges.”

Conclusions

The clinical implementation of the standardized care pathway is described as a straight path through care, but patients described their experiences as walking a tightrope. Lack of information, especially about cancer treatment and its adverse effects, was the most common experience.

Implications for Practice

Our findings indicate areas where further healthcare tools could improve patient experiences of cancer treatment. This could include offering individualized information and tools to increase patient empowerment, as well as patient/caregiver collaboration (co-care).

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-70033 (URN)10.1097/NCC.0000000000000559 (DOI)000453788200010 ()29334523 (PubMedID)2-s2.0-85058698431 (Scopus ID)
Funder
The Kamprad Family Foundation
Available from: 2018-01-22 Created: 2018-01-22 Last updated: 2019-08-29Bibliographically approved
Magneli, M., Unbeck, M., Rogmark, C., Rolfson, O., Hommel, A., Samuelsson, B., . . . Sköldenberg, O. (2019). Validation of adverse events after hip arthroplasty: a Swedish multi-centre cohort study. BMJ Open, 9(3), 1-9, Article ID e02377.
Open this publication in new window or tab >>Validation of adverse events after hip arthroplasty: a Swedish multi-centre cohort study
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 3, p. 1-9, article id e02377Article in journal (Refereed) Published
Abstract [en]

Objectives Preventing adverse events (AEs) after orthopaedic surgery is a field with great room for improvement. A Swedish instrument for measuring AEs after hip arthroplasty based on administrative data from the national patient register is used by both the Swedish Hip Arthroplasty Register and the Swedish Association of Local Authorities and Regions. It has never been validated and its accuracy is unknown. The aim of this study was to validate the instrument’s ability to detect AEs, and to calculate the incidence of AEs following primary hip arthroplasties.

Design Retrospective cohort study using retrospective record review with Global Trigger Tool methodology in combination with register data.

Setting 24 different hospitals in four major regions of Sweden.

Participants 2000 patients with either total or hemi-hip arthroplasty were recruited from the SHAR. We included both acute and elective patients.

Primary and secondary outcome measures The sensitivity and specificity of the instrument. Adjusted cumulative incidence and incidence rate.

Results The sensitivity for all identified AEs was 5.7% (95% CI: 4.9% to 6.7%) for 30 days and 14.8% (95% CI: 8.2 to 24.3) for 90 days, and the specificity was 95.2% (95% CI: 93.5% to 96.6%) for 30 days and 92.1% (95% CI: 89.9% to 93.8%) for 90 days. The adjusted cumulative incidence for all AEs was 28.4% (95% CI: 25.0% to 32.3%) for 30 days and 29.5% (95% CI: 26.0% to 33.8%) for 90 days. The incidence rate was 0.43 AEs per person-month (95% CI: 0.39 to 0.47).

Conclusions The AE incidence was high, and most AEs occurred within the first 30 days. The instrument sensitivity for AEs was very low for both 30 and 90 days, but the specificity was high for both 30 and 90 days. The studied instrument is insufficient for valid measurements of AEs after hip arthroplasty.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Orthopaedics
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-81621 (URN)10.1136/bmjopen-2018-023773 (DOI)000471144900082 ()30850403 (PubMedID)2-s2.0-85062639586 (Scopus ID)
Available from: 2019-04-03 Created: 2019-04-03 Last updated: 2019-08-29Bibliographically approved
Wallerstedt, B., Benzein, E., Schildmeijer, K. & Sandgren, A. (2019). What is palliative care?: Perceptions of healthcare professionals. Scandinavian Journal of Caring Sciences, 33(1), 77-84
Open this publication in new window or tab >>What is palliative care?: Perceptions of healthcare professionals
2019 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 1, p. 77-84Article in journal (Refereed) Published
Abstract [en]

Background Despite increased attention and knowledge in palliative care, there is still confusion concerning how to interpret the concept of palliative care and implement it in practice. This can result in difficulties for healthcare professionals in identifying patients whom would benefit from palliative care, which, in turn, could lead to a delay in meeting patients' needs. Aim To explore healthcare professionals' perceptions of palliative care. Method Data were collected through twelve interprofessional focus group interviews in community care and hospital wards in south Sweden (n = 74). All interviews were analysed with latent content analysis. Results Three domains were revealed: first, a blurred conceptual understanding as participants described palliative care using synonyms, diagnoses, phases, natural care and holism; second, a challenge to communicate transitions concerned the importance of how and when the transition to palliative care was communicated and documented; finally, a need for interprofessional collaboration was described as well as the consequences for severely ill persons, relatives and healthcare professionals when it was not established. Conclusion The perceptions about how to interpret palliative care differed as well as when palliative care should be offered and decided, which might have practical consequences. How long a person has left to live is of great significance for decision-making, caregiving and preparation in palliative care. The challenge is to use interprofessional communication to promote understanding and collaborate across varied care levels. Integrating palliative care across diverse care levels could be one way to reduce the ambiguity of palliative care.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
palliative care, perceptions, healthcare professionals, focus group interviews, conceptual definition, communication, collaboration
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-81850 (URN)10.1111/scs.12603 (DOI)000462154100007 ()30101989 (PubMedID)2-s2.0-85053198936 (Scopus ID)
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-08-29Bibliographically approved
Schildmeijer, K., Unbeck, M., Ekstedt, M., Lindblad, M. & Nilsson, L. (2018). Adverse events in patients in home healthcare: a retrospective record review using trigger tool methodology. BMJ Open, 8(1), Article ID e019267.
Open this publication in new window or tab >>Adverse events in patients in home healthcare: a retrospective record review using trigger tool methodology
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 1, article id e019267Article in journal (Refereed) Published
Abstract [en]

Objective Home healthcare is an increasingly common part of healthcare. The patients are often aged, frail and have multiple diseases, and multiple caregivers are involved in their treatment. This study explores the origin, incidence, types and preventability of adverse events (AEs) that occur in patients receiving home healthcare.

Design A study using retrospective record review and trigger tool methodology. setting and methods Ten teams with experience of home healthcare from nine regions across Sweden reviewed home healthcare records in a two-stage procedure using 38 prede ned triggers in four modules. A random sample of records from 600 patients (aged 18 years or older) receiving home healthcare during 2015 were reviewed. Primary and secondary outcome measures The cumulative incidence of AEs found in patients receiving home healthcare; secondary measures were origin, types, severity of harm and preventability of the AEs.

results The patients were aged 20–79 years, 280 men and 320 women. The review teams identi ed 356 AEs in 226 (37.7%; 95% CI 33.0 to 42.8) of the home healthcare records. Of these, 255 (71.6%; 95% CI 63.2 to 80.8) were assessed as being preventable, and most (246, 69.1%; 95% CI 60.9 to 78.2) required extra healthcare visits or led to a prolonged period of healthcare. Most of the AEs (271, 76.1%; 95% CI 67.5 to 85.6) originated in home healthcare; the rest were detected during home healthcare but were related to care outside home healthcare. The most common AEs were healthcare-associated infections, falls and pressure ulcers.

conclusions AEs in patients receiving home healthcare are common, mostly preventable and often cause temporary harm requiring extra healthcare resources. The most frequent types of AEs must be addressed and reduced through improvements in interprofessional collaboration. This is an important area for future studies. 

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Health Sciences
Research subject
Health and Caring Sciences; Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-69507 (URN)10.1136/bmjopen-2017-019267 (DOI)000431743500241 ()2-s2.0-85040600022 (Scopus ID)
Available from: 2017-12-29 Created: 2017-12-29 Last updated: 2019-11-13Bibliographically approved
Schildmeijer, K., Nilsen, P., Ericsson, C., Broström, A. & Skagerström, J. (2018). Determinants of patient participation for safer care: a qualitative study of physicians' experiences and perceptions. Health Science Reports, 1(10), 1-10, Article ID e87.
Open this publication in new window or tab >>Determinants of patient participation for safer care: a qualitative study of physicians' experiences and perceptions
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2018 (English)In: Health Science Reports, ISSN 2398-8835, Vol. 1, no 10, p. 1-10, article id e87Article in journal (Refereed) Published
Abstract [en]

Objective: There is a paucity of research on physicians' perspectives on involving patients to achieve safer care. This study aims to explore determinants of patient participation for safer care, according to physicians in Swedish health care.

Methods: We used a deductive descriptive design, applying qualitative content analysis based on the Capability-Opportunity-Motivation-Behaviour framework. Semi-structured interviews were conducted with 13 physicians in different types of health care units, to achieve a heterogeneous sample. The main outcome measure was barriers and facilitators to patient participation of potential relevance for patient safety.

Results: Analysis of the data yielded 14 determinants (ie, subcategories) functioning as barriers and/or facilitators to patient participation of potential relevance for patient safety. These determinants were mapped to five categories: physicians' capability to involve patients in their care; patients' capability to become involved in their care, as perceived by the physicians; physicians' opportunity to achieve patient participation in their care; physicians' motivation to involve patients in their care; and patients' motivation to become involved in their care, as perceived by the physicians.

Conclusion: There are many barriers to patient participation to achieve safer care. There are also facilitators, but these tend to depend on initiatives of individual physicians and patients, because organizational-level support may be lacking. Many of the determinants are interdependent, with physicians' perceived time constraints influencing other barriers.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
Barriers, Determinants, Facilitators, Patient participation, Patient safety, Physicians
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-82911 (URN)10.1002/hsr2.87 (DOI)30623042 (PubMedID)
Available from: 2019-05-23 Created: 2019-05-23 Last updated: 2019-05-23Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0895-674x

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