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Werkander Harstäde, Carina
Publications (10 of 18) Show all publications
Wallin, K., Hörberg, U., Werkander Harstäde, C., Elmqvist, C. & Bremer, A. (2020). Preceptors’ experiences of student supervision in the emergency medical services: a qualitative interview study. Nurse Education Today, 84, 1-8, Article ID 104223.
Open this publication in new window or tab >>Preceptors’ experiences of student supervision in the emergency medical services: a qualitative interview study
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2020 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 84, p. 1-8, article id 104223Article in journal (Refereed) Published
Abstract [en]

Background

Clinical placements play a central part in the education of future emergency medical services (EMS) staff and their development of clinical skills and competence. A key aspect of students' integration of theory and praxis and development into an independent clinician is a supportive mentorship with the preceptor. However, students report barriers for learning within the EMS, while the preceptors' experiences of their role have received scant attention in research.

Objectives

To describe preceptors' experiences of student supervision in the EMS during clinical placements.

Design

A descriptive qualitative design was used.

Participants and setting

Twenty specialist nurses were recruited among EMS staff from all parts of Sweden.

Methods

Data were collected using individual interviews and analyzed with latent qualitative content analysis.

Findings

EMS preceptors develop a competence in combining caring and learning adapted to individual student needs when facing students with varying needs in an ever-changing healthcare setting. A trustful relationship between student and preceptor is fundamental when coping with a dual responsibility for student and patient needs. However, several aspects in the EMS setting hinders the preceptors' ability to support the development of the students' independence. Surrounding support structures are important if the preceptors are to feel safe and secure in their role as assessor, teacher and ambulance nurse.

Conclusions

Preceptors need to develop a didactic flexibility through preceptor courses adapted to the complex premises found in the EMS. Ambulance services and universities should recognize the importance of preceptors´ colleagues, student continuity, university support and cooperation for improving quality and clarity in supervision during clinical placements.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Ambulance nurse, Clinical placement, Emergency medical services, Learning environment, Preceptor, Specialist nurse, Supervision
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-89785 (URN)10.1016/j.nedt.2019.104223 (DOI)000501643800031 ()31726285 (PubMedID)
Available from: 2019-10-24 Created: 2019-10-24 Last updated: 2020-01-10Bibliographically approved
Bylund-Grenklo, T., Werkander Harstäde, C., Sandgren, A., Benzein, E. & Östlund, U. (2019). Dignity in life and care: the perspectives of Swedish patients in a palliative care context.. International Journal of Palliative Nursing, 25(4), 193-201
Open this publication in new window or tab >>Dignity in life and care: the perspectives of Swedish patients in a palliative care context.
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2019 (English)In: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 25, no 4, p. 193-201Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: How patients preserve their sense of dignity in life is an important area of palliative care that remains to be explored.

AIMS: To describe patients' perspectives of what constitutes a dignified life within a palliative care context.

METHODS: Twelve palliative care patients were interviewed about their views on living with dignity. Data were analysed using qualitative content analysis.

RESULTS: What constitutes a dignified life during end-of-life care was captured by the theme 'I may be ill but I am still a human being' and presented under the categories 'preserving my everyday life and personhood', 'having my human value maintained by others through 'coherence' and 'being supported by society at large'.

CONCLUSION: Patients' sense of dignity can be preserved by their own attitudes and behaviours, by others and through public support. Health professionals need to adopt a dignity-conserving approach, for which awareness of their own attitudes and behaviours is crucial.

Place, publisher, year, edition, pages
Mark Allen Group, 2019
Keywords
Care of the dying, Dignity, Health professionals, Palliative care
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-82230 (URN)10.12968/ijpn.2019.25.4.193 (DOI)000464949000006 ()31013197 (PubMedID)2-s2.0-85064863576 (Scopus ID)
Funder
The Kamprad Family Foundation, 20152002
Available from: 2019-04-26 Created: 2019-04-26 Last updated: 2019-08-29Bibliographically approved
Wallin, K., Hörberg, U., Werkander Harstäde, C., Elmqvist, C. & Bremer, A. (2019). Enablers and barriers in ambulance clinical placements – a mentor perspective. In: Presented at Ambulans2019PreHospen: Ambulanssjukvårdens roll i morgondagens akutsjukvård, Stockholm, Sweden, April 2-3, 2019: . Paper presented at Ambulans2019PreHospen: Ambulanssjukvårdens roll i morgondagens akutsjukvård, Stockholm, Sweden, April 2-3, 2019.
Open this publication in new window or tab >>Enablers and barriers in ambulance clinical placements – a mentor perspective
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2019 (Swedish)In: Presented at Ambulans2019PreHospen: Ambulanssjukvårdens roll i morgondagens akutsjukvård, Stockholm, Sweden, April 2-3, 2019, 2019Conference paper, Oral presentation only (Refereed)
Abstract [en]

Background: The importance of clinical placements for nursing students to be able to integrate theory and practice and develop clinical competence are described in literature. Recent research in the Swedish prehospital context has shown that there possibly are differences in the preparations among ambulance nursing students before entering their clinical placements in accordance with studies in other countries. Studies have also highlighted difficulties in creating a good learning environment in the context of prehospital emergency care. The role of the mentor in supporting these students during clinical placements via an individualized mentorship model has proven to be of most importance. At the same time the role of the mentor is described as demanding, undefined and lacking support from both universities and ambulance services. In the Swedish educational system, the voice of the mentor is missing in research in order to develop and enhance the learning environment during clinical placements.

Purpose: To describe mentors ‘experiences of enablers and barriers for supervision during ambulance clinical placements.

Methods: Individual interviews were conducted with 20 mentors from 10 ambulance districts from all parts of Sweden. The interviews were analysed according to qualitative content analysis.

Results/Conclusions: Preliminary findings indicates that the mentors need specific competence, further education and improved support from universities and ambulances services to feel competent and safe. They are forced to adjust their learning strategies to the unique context of prehospital emergency care and are constantly drawn between responsibilities towards the patient and the student. The role and the assignment are unclear and they are in need of support and structure. The competence and attitudes of the team colleague are of high importance for the mentors’ perceived support.

Keywords
Handledare, Erfarenheter, Ambulanssjukvård, Ambulanssjuksköterska, Intervju
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-82021 (URN)
Conference
Ambulans2019PreHospen: Ambulanssjukvårdens roll i morgondagens akutsjukvård, Stockholm, Sweden, April 2-3, 2019
Available from: 2019-04-17 Created: 2019-04-17 Last updated: 2019-11-19Bibliographically approved
Östlund, U., Blomberg, K., Söderman, A. & Werkander Harstäde, C. (2019). How to conserve dignity in palliative care: suggestions from older patients, significant others, and healthcare professionals in Swedish municipal care. BMC Palliative Care, 18, Article ID 10.
Open this publication in new window or tab >>How to conserve dignity in palliative care: suggestions from older patients, significant others, and healthcare professionals in Swedish municipal care
2019 (English)In: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 18, article id 10Article in journal (Refereed) Published
Abstract [en]

Background: An essential aspect of palliative care nursing is to conserve the dignity of the patient. A Dignity CareIntervention (DCI) has been developed in Scotland to facilitate this role for nurses. The DCI is now being adapted toa Swedish context (DCI-SWE) and a central step is to identify culturally relevant, dignity-conserving care actions.These care actions will be incorporated into the DCI-SWE. Therefore, the aim of this study was to suggest careactions for conserving dignity in palliative care from the perspectives of the patients, significant others (SOs), andhealth care professionals (HPs) in municipality care in Sweden.Methods: This study used a descriptive design with a qualitative approach. Data from 20 participants were collectedthrough semi-structured individual interviews with patients (n = 3), SOs (n = 4), two focus groups with nurses (n = 9)and one focus group with physicians (n = 4) in two Swedish municipalities. These data were deductively analysedusing qualitative content analysis with the Chochinov model of dignity as framework.Results: With the Chochinov model of dignity as a framework, care actions based on suggestions from the participantswere identified and presented under three themes: Illness related concerns, Dignity conserving repertoire, and Socialdignity inventory. The study found both specific concrete care actions and more general approaches. Such generalapproaches were found to be relevant for several dignity related issues as all-embracing attitudes and behaviours.However, these general approaches could also be relevant as specific care actions to conserve dignity in relation tocertain issues. Care actions were also found to be linked to each other, showing the importance of a holisticperspective in conserving dignity.Conclusions: As part of the adaption of the DCI from a Scottish to a Swedish context, this study added relevant careactions for collaborative planning of individualised care in mutual dialogues between nurses and those they care for. Theadapted intervention, DCI-SWE, has the potential to help the nurses in providing palliative care of evidence-based quality.Keywords: Care actions, Community nursing, DCI-SWE, Dignity, Dignity care intervention, End of life care, Palliative care,Person centred, Sweden

Place, publisher, year, edition, pages
BioMed Central, 2019
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-80017 (URN)10.1186/s12904-019-0393-x (DOI)000457121700002 ()30678669 (PubMedID)2-s2.0-85060556337 (Scopus ID)
Available from: 2019-01-29 Created: 2019-01-29 Last updated: 2019-08-29Bibliographically approved
Blomberg, K., Lindqvist, O., Werkander Harstäde, C., Söderman, A. & Östlund, U. (2019). Translating the Patient Dignity Inventory. International Journal of Palliative Nursing, 25(7), 334-343
Open this publication in new window or tab >>Translating the Patient Dignity Inventory
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2019 (English)In: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 25, no 7, p. 334-343Article in journal (Refereed) Published
Abstract [en]

Background: The Patient Dignity Inventory (PDI) is based on an empirically-driven dignity model that has been developed and used for clinically assessing the various sources of dignity-related distress. In a recent review, it received the highest score as a useful instrument in both practice and research in palliative care. The PDI has been adapted to and validated for use in various countries, but not yet Sweden. Aims: To translate the PDI into Swedish, including cultural adaptation for clinical use. Methods: A multi-step process of translation, negotiated consensus, expert group discussion (n=7: four invited experts and three researchers) and cognitive interviewing (n=7: persons with palliative care needs). Findings: Discussion, by the expert reviewers, of both linguistic and cultural issues regarding the content and readability of the translated Swedish version resulted in revisions of items and response alternatives, focusing mainly on semantic, conceptual, and experiential equivalence. A pilot version for cognitive interviews was produced. The analysis of data showed that most of the items were judged to be relevant by the persons with palliative care needs. Conclusion: The process of translation and adaptation added clarity and consistency. The Swedish version of the PDI can be used in assessing dignity-related distress. The next step will be to test this Swedish version for psychometric properties in a larger group of patients with palliative care needs before use in research.

Place, publisher, year, edition, pages
Mark Allen Group, 2019
Keywords
Dignity, End-of-life care, Patient Dignity Inventory, Patient-reported outcomes
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-88777 (URN)10.12968/ijpn.2019.25.7.334 (DOI)000476486800004 ()31339819 (PubMedID)
Available from: 2019-08-28 Created: 2019-08-28 Last updated: 2019-08-28Bibliographically approved
Werkander Harstäde, C., Blomberg, K., Benzein, E. & Östlund, U. (2018). Dignity-conserving care actions in palliative care: an integrative review of Swedish research. Scandinavian Journal of Caring Sciences, 32(1), 8-23
Open this publication in new window or tab >>Dignity-conserving care actions in palliative care: an integrative review of Swedish research
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 8-23Article in journal (Refereed) Published
Abstract [en]

Background: Previous research has proposed that persons in need of palliative care often have a loss of functions and roles that affects social and existential self-image. Moreover, these individuals also commonly suffer from complex multisymptoms. This, together with the situation of facing an impending death, can lead to a loss of dignity. Therefore, supporting these persons’ dignity is a crucial challenge for professional nurses. The ‘Dignity Care Intervention’ addresses the multidimensionality of dignity by identifying patients’ dignity-related concerns and suggests care actions to address them. At the present, the Dignity Care Intervention is adapted for implementation in Swedish care settings. Because expressions of dignity are influenced by culture, and an overview of care actions in a Swedish context is lacking, this integrative review aimed to find suggestions from Swedish research literature on what kind of care actions can preserve dignity.

Methods: An integrative literature review was conducted using the databases SwePub and SweMed+. Articles published from 2006 to 2015 and theses published from 2000 to 2015 were searched for using the terms ‘dignity’ and ‘palliative care’. Result sections of articles and theses were reviewed for dignity-conserving care actions synthesised by thematic analysis and categorised under themes and subthemes in Chochinov’s model of dignity.

Results: Fifteen articles and 18 theses were included together providing suggestions of care actions in all themes and subthemes in the dignity model. Suggested care actions included listening, communication, information, symptom control, facilitating daily living and including patients in decision-making. Additionally, nurses’ perceptiveness towards the patients was a core approach.

Conclusion: The review offers culturally relevant suggestions on how to address specific dignity-related concerns. The adapted Dignity Care Intervention will be a way for Swedish nurses to provide person-centred palliative care that will conserve patients’ dignity

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
Chochinov’s model of dignity, Dignity, End-of-life care, Integrative review, Palliative care, the Dignity Care Intervention
National Category
Other Medical Sciences not elsewhere specified
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-68993 (URN)10.1111/scs.12433 (DOI)000426524200002 ()28509335 (PubMedID)2-s2.0-85019609481 (Scopus ID)
Available from: 2017-11-24 Created: 2017-11-24 Last updated: 2019-08-29Bibliographically approved
Wallin, K., Hörberg, U., Werkander Harstäde, C., Elmqvist, C. & Bremer, A. (2018). Prehospital emergency nurses' experiences as clinical supervisors. In: Presented at the 3rd Global Conference on Emergency Nursing and Trauma Care, Noordwijkerhout, Netherlands, October 4-6, 2018: . Paper presented at The 3rd Global Conference on Emergency Nursing and Trauma Care, Noordwijkerhout, Netherlands, October 4-6, 2018.
Open this publication in new window or tab >>Prehospital emergency nurses' experiences as clinical supervisors
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2018 (English)In: Presented at the 3rd Global Conference on Emergency Nursing and Trauma Care, Noordwijkerhout, Netherlands, October 4-6, 2018, 2018Conference paper, Poster (with or without abstract) (Refereed)
Keywords
Prehospital, Ambulance nurse, Emergency medical services, Clinical supervisors, Qualitative research
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-80169 (URN)
Conference
The 3rd Global Conference on Emergency Nursing and Trauma Care, Noordwijkerhout, Netherlands, October 4-6, 2018
Available from: 2019-02-02 Created: 2019-02-02 Last updated: 2019-11-25Bibliographically approved
Werkander Harstäde, C. & Sandgren, A. (2016). Confronting the Forthcoming Death: A Classic Grounded Theory. Journal of Palliative Care & Medicine, 6, Article ID 289.
Open this publication in new window or tab >>Confronting the Forthcoming Death: A Classic Grounded Theory
2016 (English)In: Journal of Palliative Care & Medicine, E-ISSN 2165-7386, Vol. 6, article id 289Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to develop a classic grounded theory of patients in palliative care. Methods: A classic Grounded Theory methodology was used to conceptualize patterns of human behavior. Twenty-seven interviews with patients in palliative care and two autobiographies written by persons receiving palliative care were analyzed. Result: “Confronting the forthcoming death” emerged as the pattern of behavior through which patients deal with their main concern, living in uncertainty of a death foretold. The theory involves four strategies; Seeking concrete knowledge, Shielding off, Seeing things through, and Embracing life. Holding on to hope and Suffering are also ever present. Conclusion: The theory shows that there is no easy way straight ahead; patients strive to confront the situation as well as they can, both wanting and not wanting to know what lies ahead. For health professionals, knowledge about how patients use different strategies, which can be used in tandem or succession, or shifted back and forth between over time, to confront their imminent deaths, can create an awareness of how to encounter patients in this uncertainty.

National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-63537 (URN)10.4172/2165-7386.1000289 (DOI)
Available from: 2017-05-10 Created: 2017-05-10 Last updated: 2019-01-17Bibliographically approved
Werkander Harstäde, C. & Andershed, B. (2015). It was as Good as it Could be: A Family Member's Non-Experiences of Guilt and Shame in End-Of-Life Care. Journal of Palliative Care & Medicine, 5(5), 1-6, Article ID 1000232.
Open this publication in new window or tab >>It was as Good as it Could be: A Family Member's Non-Experiences of Guilt and Shame in End-Of-Life Care
2015 (English)In: Journal of Palliative Care & Medicine, E-ISSN 2165-7386, Vol. 5, no 5, p. 1-6, article id 1000232Article in journal (Refereed) Published
Abstract [en]

Objective: This study is part of a larger project, “Guilt and shame in end-of-life care – the next-of-kin’s perspective”. The aim was to explore and interpret a family member’s situation without feelings of guilt and shame and describe reasons for non-experiences of these feelings.

Methods: An exploratory case study was employed to investigate and achieve an in-depth, in context understanding of the phenomenon from an informant directly involved in the activities being studied. The data material consisted of two in-depth interviews, analyzed in a hermeneutic way in accordance with Gadamer. 

Result: Seven subthemes appeared “The mother received good care with clear planning”, “They became aware of the inevitable death”, “The mother knew how she wanted things to be”, “Mutual understanding and care between mother and daughter”, “They could make the most of the time that was left”, “The family was together during the dying”, and “Both the daughter and her mother could handle and see meaning in the situation”. These subthemes resulted in a main theme: “There wasn’t much we could have done differently. It was as good as it could be”. Three interpretations emerged that can decrease the risk of feelings of guilt and shame: 1) knowing that the loved one is receiving professional care of good quality, 2) family awareness of the situation and trusting and supportive relationship with the professionals, and 3) inner and external resources and open communication with each other.

Conclusion: The study shows the importance of professionals being involved in the family situation, having the courage to be sensitive towards the patient’s and the family member’s requests in situations where there is dying and death. Being aware of the suggested interpretations can decrease the risk of feelings of guilt and shame.

Place, publisher, year, edition, pages
OMICS International, 2015
Keywords
Cancer, Guilt, Hermeneutic research, Next-of-kin, Palliative care, Relatives, Shame
National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-52649 (URN)10.4172/2165-7386.1000232 (DOI)
Available from: 2016-05-25 Created: 2016-05-25 Last updated: 2018-11-26Bibliographically approved
Werkander Harstäde, C. & Roxberg, Å. (2015). The room as metaphor: next-of-kin's experiences in end-of-life care. International Journal of Palliative Care, 2015, Article ID 357827.
Open this publication in new window or tab >>The room as metaphor: next-of-kin's experiences in end-of-life care
2015 (English)In: International Journal of Palliative Care, ISSN 2356-7074, Vol. 2015, article id 357827Article in journal (Refereed) Published
Abstract [en]

The “room” in end-of-life is a phenomenon that needs deeper understanding as it is a dimension that shows how health and suffering are shaped. Research on the concept of room was chosen as theoretical foundation in this study in order to reach a profound understanding of the next-of-kin’s “room” in end-of-life care. Lassenius’s hermeneutic interpretation inmetaphorical language was used as an deductive-inductive approach to the empirical data. The data material comprised 33 interviews with next-of-kin about their experiences of end-of-life care when being close to a relative dying from a cancer disease. The analysis of the data formed four cases: the Standby, the Asylum, the Wall, and the Place.These cases lend their voices to the experiences of the next-of-kin in the study.The findings of this study explain and may well assist nurses to understand the experiences of being next-of-kin in end-of-life care as forming a room of rest from the suffering, a room of controlling the suffering, a room of hiding from the suffering, and a room of belonging.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2015
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-52153 (URN)10.1155/2015/357827 (DOI)
Available from: 2016-04-19 Created: 2016-04-19 Last updated: 2018-11-26Bibliographically approved
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