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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
Wolters Kluwer, 2019
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-70033 (URN)10.1097/NCC.0000000000000559 (DOI)29334523 (PubMedID)
Funder
The Kamprad Family Foundation
Available from: 2018-01-22 Created: 2018-01-22 Last updated: 2018-12-11Bibliographically 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
Sockolow, P., Hellesø, R. & Ekstedt, M. (2018). Digitalization of Patient Information Process from Hospital to Community (Home) Care Nurses: International Perspectives. In: Ann Kristin Rotegård, Diane J. Skiba, Sayonara Barbosa & Angelica G. Davalos Alcázar (Ed.), Nursing Informatics 2018: . Paper presented at 14th International Congress on Nursing and Allied Health Informatics (NI 2018), Guadalajara, Mexico, June 6-8, 2018 (pp. 227-229). IOS Press, 250
Open this publication in new window or tab >>Digitalization of Patient Information Process from Hospital to Community (Home) Care Nurses: International Perspectives
2018 (English)In: Nursing Informatics 2018 / [ed] Ann Kristin Rotegård, Diane J. Skiba, Sayonara Barbosa & Angelica G. Davalos Alcázar, IOS Press, 2018, Vol. 250, p. 227-229Conference paper, Published paper (Refereed)
Abstract [en]

For older people who transition from hospital to home, home care is an increasingly important and effective way of managing chronic illness with skilled nursing care in the home. Communication between clinicians across care settings is fundamental for continuity of care. Poor communication of patient information is acknowledged to be a root cause of sentinel events. In Scandinavia and the United States, researchers study the communication of patient information from hospital to home care. The health care systems of these two countries differ. Differences are reflected in the characteristics of patients transferred from hospital to home care, as well as the characteristics of health information systems (ICT). These differences help to elucidate key issues related to the transfer of patient information from hospital to home care.

Place, publisher, year, edition, pages
IOS Press, 2018
Series
Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365 ; 250
Keywords
Communication, Continuity of Patient Care/standards, Home Care Services, Nursing Informatics
National Category
Other Health Sciences
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-75585 (URN)10.3233/978-1-61499-872-3-227 (DOI)29857442 (PubMedID)9781614998716 (ISBN)9781614998723 (ISBN)
Conference
14th International Congress on Nursing and Allied Health Informatics (NI 2018), Guadalajara, Mexico, June 6-8, 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
Sandlund, C., Hetta, J., Nilsson, G. H., Ekstedt, M. & Westman, J. (2018). Impact of group treatment for insomnia on daytime symptomatology: analyses from a randomized controlled trial in primary care. International Journal of Nursing Studies, 85(September), 126-135
Open this publication in new window or tab >>Impact of group treatment for insomnia on daytime symptomatology: analyses from a randomized controlled trial in primary care
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2018 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 85, no September, p. 126-135Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: People typically seek primary health care for daytime symptoms and impairments they experience in association with their insomnia. However, few studies address the question of whether insomnia treatment can improve such symptomatology.

OBJECTIVES: To investigate whether a nurse-led group treatment program, based on the techniques of cognitive behavioral therapy for insomnia (CBT-I), improved daytime symptomatology in primary care patients with insomnia.

OUTCOMES: Fatigue (Fatigue Severity Scale [FSS]; main outcome), mood (General Health Questionnaire and Montgomery-Asberg Depression Rating Scale), health-related quality of life (Short-Form Health Survey), general daytime functioning, specific daytime symptoms (individual items from the Insomnia Severity Index and Uppsala Sleep Inventory), and dysfunctional beliefs (Dysfunctional Beliefs and Attitudes about Sleep).

DESIGN: A randomized controlled trial including baseline and post-treatment assessment and a 1-year post-treatment follow-up of the intervention group.

SETTINGS: Seven primary health care centers (Stockholm, Sweden).

PARTICIPANTS: One hundred and sixty-five primary care patients who meet the criteria for insomnia disorder (mean age 54 years, SD 16). Most were women (73%).

EXCLUSION CRITERIA: severe untreated illness, bipolar disorder, current stressful life event, night shift work, and untreated sleep disorder other than insomnia.

METHODS: Data came from a randomized controlled trial of a 10-week nurse-led group treatment for insomnia based on CBT-I (n = 90). The control condition was treatment as usual (n = 75). In accordance with intention-to-treat principles, analyses included data on patients who completed baseline assessments (intervention n = 82, and control group n = 71; post-treatment dropout rate 20%). Fifty-four patients were included in the 1-year follow-up.

RESULTS: Fatigue severity improved significantly more (p < 0.001) in the intervention than in the control group (intervention, total FSS score 37.2 [SD 11.9] to 31.0 [SD 13.4] vs. control 35.9 [SD 12.1] to 35.7 [SD 12.8]). This was true also for measurements on mood (psychological distress and depressive symptoms), health-related quality of life (mental functioning), general daytime functioning, specific daytime symptoms (worry about sleep, sleepiness, bodily tiredness, and difficulty concentrating) and dysfunctional beliefs. All improvements were maintained one year after group treatment.

CONCLUSIONS: Many aspects of the daytime symptomatology of insomnia were improved via nurse-led group treatment based on CBT-I in primary health care.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Cognitions, Cognitive and behavioral therapy, Daytime symptoms, Fatigue, Group treatment, Insomnia, Nurse practitioners, Nursing, Primary health care, Randomized controlled trial
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-75586 (URN)10.1016/j.ijnurstu.2018.05.002 (DOI)000447570800012 ()29886347 (PubMedID)
Available from: 2018-07-11 Created: 2018-07-11 Last updated: 2018-11-01Bibliographically approved
Flink, M., Tessma, M., Cvancarova Småstuen, M., Lindblad, M., Coleman, E. A. & Ekstedt, M. (2018). Measuring care transitions in Sweden: validation of the care transitions measure. International Journal for Quality in Health Care, 30(4), 291-297
Open this publication in new window or tab >>Measuring care transitions in Sweden: validation of the care transitions measure
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2018 (English)In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 30, no 4, p. 291-297Article in journal (Refereed) Published
Abstract [en]

Objective: To translate and assess the validity and reliability of the original American Care Transitions Measure, both the 15-item and the shortened 3-item versions, in a sample of people in transition from hospital to home within Sweden.

Design: Translation of survey items, evaluation of psychometric properties.

Setting: Ten surgical and medical wards at five hospitals in Sweden.

Participants: Patients discharged from surgical and medical wards.

Main outcome measure: Psychometric properties of the Swedish versions of the 15-item (CTM-15) and the 3-item (CTM-3) Care Transition Measure.

Results: We compared the fit of nine models among a sample of 194 Swedish patients. Cronbach's alpha was 0.946 for CTM-15 and 0.74 for CTM-3. The model indices for CTM-15 and CTM-3 were strongly indicative of inferior goodness-of-fit between the hypothesized one-factor model and the sample data. A multidimensional three-factor model revealed a better fit compared with CTM-15 and CTM-3 one factor models. The one-factor solution, representing 4 items (CTM-4), showed an acceptable fit of the data, and was far superior to the one-factor CTM-15 and CTM-3 and the three-factor multidimensional models. The Cronbach's alpha for CTM-4 was 0.85.

Conclusions: CTM-15 with multidimensional three-factor model was a better model than both CTM-15 and CTM-3 one-factor models. CTM-4 is a valid and reliable measure of care transfer among patients in medical and surgical wards in Sweden. It seems the Swedish CTM is best represented by the short Swedish version (CTM-4) unidimensional construct.

Keywords
care transitions measure, patient discharge, patient transfer, psychometrics
National Category
Other Medical Sciences Other Medical Sciences not elsewhere specified
Research subject
Health and Caring Sciences, Caring Science; Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-75583 (URN)10.1093/intqhc/mzy001 (DOI)29432554 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-2200
Available from: 2018-07-11 Created: 2018-07-11 Last updated: 2018-10-03Bibliographically approved
Holmqvist, M., Ekstedt, M., Walter, S. R. & Lehnbom, E. C. (2018). Medication Management in Municipality-Based Healthcare: A Time and Motion Study of Nurses. Home Healthcare Now, 36(4), 238-246
Open this publication in new window or tab >>Medication Management in Municipality-Based Healthcare: A Time and Motion Study of Nurses
2018 (English)In: Home Healthcare Now, ISSN 2374-4537, Vol. 36, no 4, p. 238-246Article in journal (Refereed) Published
Abstract [en]

The objective of this observational time and motion study was to increase our understanding of how nurses in home healthcare currently distribute their work time with a focus on the medication management process. The research was conducted in four municipalities in the southern part of Sweden. Participants were nurses working in home healthcare. The study measured proportion of time, comparison of proportions of time, proportion of time spent multitasking, and rate of interruptions per hour. Of total observed time, 20.4% was spent on medication management and of these tasks the highest proportion of time was spent on communications and dispensing medications. Nurses in nursing homes spent more time (23.0% vs. 17.4%, p = 0.001) on medication management than nurses in private homes. Nurses spent 47.9% of their time completing tasks with someone else, including patients, but had minimal interaction with prescribers. We observed a rate of 1.2 (95% CI 1.1-1.4) interruptions per hour on average and 30% of all interruptions occurred during medication management tasks. Nurses spent 3.7% of their time multitasking. Interruptions while performing medication-related tasks were common, as well as multitasking. Causes and consequences of the results need to be addressed in order to improve the safety of medication management for patients receiving municipality-based home care.

Place, publisher, year, edition, pages
Alphen aan den Rijn: Wolters Kluwer, 2018
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-76766 (URN)10.1097/NHH.0000000000000671 (DOI)29979305 (PubMedID)
Available from: 2018-07-11 Created: 2018-07-11 Last updated: 2018-10-03Bibliographically approved
Berg, S. H., Akerjordet, K., Ekstedt, M. & Aase, K. (2018). Methodological strategies in resilient health care studies: an integrative review. Safety Science, 110(Part A, December), 300-312
Open this publication in new window or tab >>Methodological strategies in resilient health care studies: an integrative review
2018 (English)In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 110, no Part A, December, p. 300-312Article, review/survey (Refereed) Published
Abstract [en]

Resilient healthcare research focuses on everyday clinical work and a system’s abilities to adopt or absorb disturbing conditions as opposed to risk management approaches, which are based on retrospective analyses of errors. After more than a decade of theoretical development and a large quantity of empirical work, the field of resilience is beginning to recognize the methodological challenges related to operationalizing and designing studies of complexity. This paper reviews a sample of empirical articles on studies of resilient healthcare to describe and synthesize their methodological strategies. The review found that data collection by resilient healthcare studies has predominantly been conducted at the micro level (e.g. frontline clinical staff). Data sources at the meso level (i.e. hospital/institution) have been limited, and no studies were found that collected macro-level data. We argue that the methodological focus in the field should increase its embrace of complexity and the adaptive capacities of the system as a whole by integrating data sources at the micro, meso, and macro levels. To improve the methodological designs, we argue that the resilience construct, in which the complexity of multiple levels is integrated, must be developed. Improving the transparency and quality of future resilient healthcare research might be accomplished by reporting thorough descriptions of analytical strategies, in-depth descriptions of research design and sampling strategies, and discussing internal and external validity and reflexivity.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Resilient healthcare, Resilience engineering, Organizational resilience, Adaptation, Multi-level study
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-78030 (URN)10.1016/j.ssci.2018.08.025 (DOI)000449130500026 ()
Note

Finansiär: Western Norway Regional Health Authority, 911846

Available from: 2018-09-26 Created: 2018-09-26 Last updated: 2018-12-06Bibliographically approved
Sandlund, C., Kane, K., Ekstedt, M. & Westman, J. (2018). Patients' experiences of motivation, change, and challenges in group treatment for insomnia in primary care: a focus group study.. BMC Family Practice, 19, Article ID 111.
Open this publication in new window or tab >>Patients' experiences of motivation, change, and challenges in group treatment for insomnia in primary care: a focus group study.
2018 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 19, article id 111Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The majority of patients who seek help for insomnia do so in primary health care. Nurse-led group treatment in primary care based on cognitive behavioral therapy for insomnia (CBT-I) can lead to improvements in both day- and nighttime symptoms. This study aimed to explore patients' experiences of nurse-led group treatment for insomnia in primary health care.

METHODS: Seventeen patients who had participated in the group treatment program were interviewed in five focus groups. Interview transcriptions were analyzed with qualitative content analysis.

RESULTS: Four themes emerged that described patients' experiences of the group treatment program. Involvement and trust open the door for change: Motivation to engage in treatment arose from patients' own desire for change, from being together with others who shared or understood their struggles, and from feeling emotionally affirmed and trustful. Competence arising from deeper understanding: Patients obtained knowledge and made it their own, which enabled them to develop functional sleep habits and let go of sleep performance and worry. The ability to impact their insomnia increased patients' trust in their own efficacy and helped them persist in behavioral change. Struggling with vulnerability and failure: Treatment was tough, and patients could feel challenged by external circumstances. Moreover, they could distrust their own efficacy. Tailoring treatment to individual needs: Patients experienced different life circumstances and adapted the techniques to their needs and abilities by focusing on what felt right for them.

CONCLUSIONS: Patients went through a process of motivation, change, and challenges. They experienced certain aspects of treatment as essential to changing behavior and achieving improvements. Examples included being in a group with others who shared similar experiences, gaining knowledge about sleep, keeping a sleep diary, and practicing the sleep restriction technique. The study provides insights into patients' struggles during treatment, both those related to external circumstances and those related to feelings of vulnerability and failure. It also highlights the importance of adapting treatment to patients' differing needs, underscoring the value of person-centered care.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Behavioral change, General practice, Group therapy, Health behavior, Motivation, Nursing, Patient education, Self-efficacy, Sleep initiation and maintenance disorders
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-76941 (URN)10.1186/s12875-018-0798-2 (DOI)000437950300002 ()29986651 (PubMedID)
Available from: 2018-07-18 Created: 2018-07-18 Last updated: 2018-07-27Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4108-391x

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