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Schildmeijer, Kristina
Publications (10 of 33) Show all publications
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)
Funder
The Kamprad Family Foundation
Available from: 2018-01-22 Created: 2018-01-22 Last updated: 2019-01-22Bibliographically 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 ()
Available from: 2017-12-29 Created: 2017-12-29 Last updated: 2018-10-03Bibliographically approved
Schildmeijer, K., Wannheden, C., Nilsson, L., Frykholm, O., Hellström, A., Flink, M. & Ekstedt, M. (2018). Developing an eHealth Tool to Support Patient Empowerment at Home. In: Adrien Ugon, Daniel Karlsson, Gunnar O. Klein & Anne Moen (Ed.), Building Continents of Knowledge in Oceans of Data: The Future of Co-Created eHealth. Paper presented at MIE2018, Gothenburg, Sweden, April 24-26, 2018 (pp. 925-929). IOS Press, 247
Open this publication in new window or tab >>Developing an eHealth Tool to Support Patient Empowerment at Home
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2018 (English)In: Building Continents of Knowledge in Oceans of Data: The Future of Co-Created eHealth / [ed] Adrien Ugon, Daniel Karlsson, Gunnar O. Klein & Anne Moen, IOS Press, 2018, Vol. 247, p. 925-929Conference paper, Published paper (Refereed)
Abstract [en]

In previous research we have learned that patients with chronic or complex diseases often experience difficulties when transitioning from hospital care to self-care in their home. We address these difficulties by developing an eHealth tool for patients - ePATH (electronic Patient Activation in Treatment at Home) - intended to empower each patient to manage their individual situation. We have employed a user-centered design process involving both patients and healthcare personnel to specify the content and functionality of ePATH. The system is deployed as a web application with secure login for patients. In this article, we describe the main content and functionality of the system that makes it possible for a patient to manage symptoms development in relation to treatment progression Interactive functionality, e.g., reminders and social support, is included to make the ePATH a useful and informative bridge between patients, next-of-kin and different caregivers. One lesson learned is that it is necessary to incorporate motivational components in the development of an eHealth tool to successfully overcome the "intention-behavior" gap. The self-determination theory of motivation can be used to ensure that important aspects are not missed.

Place, publisher, year, edition, pages
IOS Press, 2018
Series
Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365 ; 247
Keywords
eHealth, patient participation, personalized care, transitions in care, user-centered design
National Category
Health Sciences
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-75584 (URN)10.3233/978-1-61499-852-5-925 (DOI)29678096 (PubMedID)9781614998518 (ISBN)9781614998525 (ISBN)
Conference
MIE2018, Gothenburg, Sweden, April 24-26, 2018
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4948
Available from: 2018-07-11 Created: 2018-07-11 Last updated: 2018-11-01Bibliographically approved
Lindblad, M., Schildmeijer, K., Nilsson, L., Ekstedt, M. & Unbeck, M. (2018). Development of a trigger tool to identify adverse events and no-harm incidents that affect patients admitted to home healthcare. BMJ Quality and Safety, 27(7), 502-511
Open this publication in new window or tab >>Development of a trigger tool to identify adverse events and no-harm incidents that affect patients admitted to home healthcare
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2018 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 27, no 7, p. 502-511Article in journal (Refereed) Published
Abstract [en]

Background Adverse events (AEs) and no-harm incidents are common and of great concern in healthcare. A common method for identification of AEs is retrospective record review (RRR) using predefined triggers. This method has been used frequently in inpatient care, but AEs in home healthcare have not been explored to the same extent. The aim of this study was to develop a trigger tool (TT) for the identification of both AEs and no-harm incidents affecting adult patients admitted to home healthcare in Sweden, and to describe the methodology used for this development.

Methods The TT was developed and validated in a stepwise manner, in collaboration with experts with different skills, using (1) literature review and interviews, (2) a five-round modified Delphi process, and (3) two-stage RRRs. Ten trained teams from different sites in Sweden reviewed 600 randomly selected records.

Results In all, triggers were found 4031 times in 518 (86.3%) records, with a mean of 6.7 (median 4, range 1–54) triggers per record with triggers. The positive predictive values (PPVs) for AEs and no-harm incidents were 25.4% and 16.3%, respectively, resulting in a PPV of 41.7% (range 0.0%–96.1% per trigger) for the total TT when using 38 triggers. The most common triggers were unplanned contact with physician and/or registered nursemoderate/severe painmoderate/severe worry, anxiety, suffering, existential pain and/or psychological pain. AEs were identified in 37.7% of the patients and no-harm incidents in 29.5%.

Conclusion This study shows that adapted triggers with definitions and decision support, developed to identify AEs and no-harm incidents that affect patients admitted to home healthcare, may be a valid method for safety and quality improvement work in home healthcare.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Health Sciences
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-69475 (URN)10.1136/bmjqs-2017-006755 (DOI)000439842800002 ()28971884 (PubMedID)
Available from: 2017-12-22 Created: 2017-12-22 Last updated: 2018-11-01Bibliographically approved
Årestedt, K., Allert, C., Djukanovic, I., Israelsson, J., Schildmeijer, K., Agerström, J., . . . Bremer, A. (2018). Health-related quality of life among in-hospital cardiac arrest survivors in working age. Paper presented at The Congress of the European Resuscitation Council, 20th – 22th September. Bologna, Italy. Resuscitation, 130(s1), Article ID e18.
Open this publication in new window or tab >>Health-related quality of life among in-hospital cardiac arrest survivors in working age
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2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, article id e18Article in journal, Meeting abstract (Refereed) Published
Keywords
Health-related quality of life, in-hospital, cardiac arrest, working age, anxiety, depression
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-77900 (URN)10.1016/j.resuscitation.2018.07.342 (DOI)
Conference
The Congress of the European Resuscitation Council, 20th – 22th September. Bologna, Italy
Available from: 2018-09-20 Created: 2018-09-20 Last updated: 2018-10-03Bibliographically approved
Schildmeijer, K., Skagerström, J., Ericsson, C. & Nilsen, P. (2018). Så ville patienter förbättra vårdmötet för att få säkrare vård. Läkartidningen, 115, 1-4, Article ID EXIL.
Open this publication in new window or tab >>Så ville patienter förbättra vårdmötet för att få säkrare vård
2018 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, p. 1-4, article id EXILArticle in journal (Refereed) Published
Abstract [sv]

Patienterna i denna enkätstudie hade många förslag på hur mötet i vården kan förbättras för att åstadkomma ökad patientsäkerhet.

Patienternas åtgärdsförslag avsåg både individnivå (vårdpersonalens kunskaper och tilltro till patienten) och systemnivå (kommunikationssätt, vårdstruktur och personalplanering samt arbetsförhållanden).

Det finns en förbättringspotential avseende mötet mellan patienter och vårdpersonal för att främja en säkrare vård.

Abstract [en]

Patients had several suggestions on how to improve healthcare meetings in order to create safer care

An open question "Do you have suggestions on how to improve meetings between patients and healthcare professionals in order to create safer care?" was incorporated into a questionnaire survey to 2673 patients in Sweden. The survey addressed patient participation for safer care. The open question was answered by 591 respondents. Content analysis was used to analyze the responses. The proposed suggestions concerned both the individual level (healthcare staff's competence and trust in the patient) and the system level (forms of communication, planning and structure, and time and staffing). The study findings show that there are many ways to improve meetings in healthcare of potential relevance for patient safety. Further research is needed to develop, apply and evaluate interventions based on patient suggestions.

Place, publisher, year, edition, pages
Läkartidningen Förlag AB, 2018
National Category
Other Health Sciences
Identifiers
urn:nbn:se:lnu:diva-72081 (URN)29485674 (PubMedID)
Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2018-04-11Bibliographically approved
Bertilsson, E., Semark, B., Schildmeijer, K., Bremer, A. & Carlsson, J. (2018). Usage of Do-not-attempt-to resuscitate-orders in a Swedish community hospital: patient involvement, documentation and compliance. Paper presented at The Congress of the European Resuscitation Council, Bologna, Italy, September 20–22, 2018. Resuscitation, 130(s1), e93-e94
Open this publication in new window or tab >>Usage of Do-not-attempt-to resuscitate-orders in a Swedish community hospital: patient involvement, documentation and compliance
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2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e93-e94Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Do-not-attempt-to resuscitate-orders, Cardiopulmonary resuscitation, Compliance, Patient involvement, Documentation
National Category
Medical Ethics
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-77920 (URN)10.1016/j.resuscitation.2018.07.193 (DOI)
Conference
The Congress of the European Resuscitation Council, Bologna, Italy, September 20–22, 2018
Note

Part of special issue: RESUSCITATION 2018 - New technologies in resuscitation: Abstracts

Available from: 2018-09-20 Created: 2018-09-20 Last updated: 2018-10-30Bibliographically approved
Lindblad, M., Schildmeijer, K., Nilsson, L., Ekstedt, M. & Unbeck, M. (2017). Development and validation of a trigger tool to identify adverse events and no-harm incidents in home healthcare. In: Presented at the 6th World Congress of Clinical Safety(6WCCS), Rome, Italy, September 6-8, 2017: . Paper presented at 6th World Congress of Clinical Safety (6WCCS), Rome, Italy, September 6-8, 2017.
Open this publication in new window or tab >>Development and validation of a trigger tool to identify adverse events and no-harm incidents in home healthcare
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2017 (English)In: Presented at the 6th World Congress of Clinical Safety(6WCCS), Rome, Italy, September 6-8, 2017, 2017Conference paper, Poster (with or without abstract) (Other academic)
National Category
Other Health Sciences
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-72089 (URN)
Conference
6th World Congress of Clinical Safety (6WCCS), Rome, Italy, September 6-8, 2017
Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2018-12-10Bibliographically approved
Nilsen, P., Skagerström, J., Ericsson, C. & Schildmeijer, K. (2017). Många faktorer påverkar om patienter kan medverka till säkrare vård: intervjustudie visar läkares och sjuksköterskors perspektiv. Läkartidningen, 114, 1-5, Article ID EDWP.
Open this publication in new window or tab >>Många faktorer påverkar om patienter kan medverka till säkrare vård: intervjustudie visar läkares och sjuksköterskors perspektiv
2017 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, p. 1-5, article id EDWPArticle in journal (Refereed) Published
Abstract [sv]

Stora förhoppningar knyts till att patienter ska kunna bidra till ökad patientsäkerhet. 

I en studie genomfördes intervjuer med 13 läkare och 11 sjuksköterskor som representerade ett brett spektrum av erfarenheter och uppfattningar beträffande patientmedverkan för säkrare vård.

Studien identifierade nio faktorer som underlättar och/eller försvårar patientmedverkan för att uppnå säkrare vård. 

Många av faktorerna beskrevs huvudsakligen som hinder för patientmedverkan med relevans för patientsäkerheten.

Abstract [en]

Patient participation for safer health care – interviews with physicians and nurses

Patient participation to achieve safer care is an area of growing policy, research and health care management and practice interest. Patients are uniquely placed to observe their treatment, care and physical environment throughout their journey in the health care system. However, very few studies have investigated health care providers’ attitudes and beliefs concerning patient participation for improved patient safety. This study explored factors that acted as facilitators and/or barriers to patient participation for safer care, as perceived by physicians and nurses in Swedish health care. Interviews were conducted with 13 physicians and 11 nurses, using a purposeful sampling strategy to achieve a heterogeneous sample of providers. We identified nine categories of factors, many of which functioned as barriers to patient participation to achieve safer care.

Place, publisher, year, edition, pages
Läkartidningen Förlag AB, 2017
National Category
Other Health Sciences
Identifiers
urn:nbn:se:lnu:diva-72083 (URN)28350419 (PubMedID)
Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2018-04-11Bibliographically approved
Skagerström, J., Ericsson, C., Nilsen, P., Ekstedt, M. & Schildmeijer, K. (2017). Patient involvement for improved patient safety: A qualitative study of nurses’ perceptions and experience. Nursing Open, 4(4), 230-239
Open this publication in new window or tab >>Patient involvement for improved patient safety: A qualitative study of nurses’ perceptions and experience
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2017 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 4, no 4, p. 230-239Article in journal (Refereed) Published
Abstract [en]

Aim: To explore nurses' perceptions and experiences of patient involvement relevant to patient safety. Design: Qualitative design using individual semi-structured interviews. Methods: Interviews with registered nurses (n = 11) and nurse assistants (n = 8) were conducted in 2015-2016. Nurses were recruited from five different healthcare units in Sweden. The material was analysed using conventional content analysis. Results: The analysis resulted in four categories: healthcare professionals' ways of influencing patient involvement for safer care; patients' ways of influencing patient involvement for safer care; barriers to patient involvement for safer care; and relevance of patient involvement for safer care. The nurses expressed that patient involvement is a shared responsibility. They also emphasized that healthcare provider has a responsibility to create opportunities for the patient to participate. According to the nurses, involvement can be hindered by factors related to the patient, the healthcare provider and the healthcare system. However, respondents expressed that patient involvement can lead to safer care and benefits for individual patients.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2017
Keywords
barriers, determinants, facilitators, nurses, patient involvement, patient safety
National Category
Health Sciences Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-69477 (URN)10.1002/nop2.89 (DOI)000418555300006 ()29085649 (PubMedID)
Available from: 2017-12-22 Created: 2017-12-22 Last updated: 2018-05-17Bibliographically approved
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