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  • 1.
    Axelsson, Clara
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Byrman, Gunilla
    Linnaeus University, Faculty of Arts and Humanities, Department of Swedish Language.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Skoglund, Astrid
    Linnaeus University, Faculty of Arts and Humanities, Department of Swedish Language.
    Stevenson-Ågren, Jean
    Linnaeus University, Faculty of Arts and Humanities, Department of Languages.
    "Det kan bli så mycket fel": Förstudie om barnmorskors upplevelser av kommunikation med gravida kvinnor utan funktionell behärskning av svenska.2016Report (Other academic)
  • 2.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Hospital, Sweden;Linköping University, Sweden.
    Lilja, Gisela
    Lund University, Sweden;Skåne University Hospital, Sweden.
    Bremer, Anders
    University of Borås, Sweden;Kalmar County Hospital, Sweden.
    Stevenson-Ågren, Jean
    Linnaeus University, Faculty of Arts and Humanities, Department of Languages. University of Sheffield, UK.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University, Sweden.
    Post cardiac arrest care and follow-up in Sweden: a national web-survey2016In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Recent decades have shown major improvements in survival rates after cardiac arrest. However, few interventions have been tested in order to improve the care for survivors and their family members. In many countries, including Sweden, national guidelines for post cardiac arrest care and follow-up programs are not available and current practice has not previously been investigated. The aim of this survey was therefore to describe current post cardiac arrest care and follow-up in Sweden.

    Methods: An internet based questionnaire was sent to the resuscitation coordinators at all Swedish emergency hospitals (n = 74) and 59 answers were received. Quantitative data were analysed with descriptive statistics and free text responses were analysed using manifest content analysis.

    Results: Almost half of the hospitals in Sweden (n = 27, 46 %) have local guidelines for post cardiac arrest care and follow-up. However, 39 % of them reported that these guidelines were not always applied. The most common routine is a follow-up visit at a cardiac reception unit. If the need for neurological or psychological support are discovered the routines are not explicit. In addition, family members are not always included in the follow-up.

    Conclusions: Although efforts are already made to improve post cardiac arrest care and follow-up, many hospitals need to focus more on this part of cardiac arrest treatment. In addition, evidence-based national guidelines will have to be developed and implemented in order to achieve a more uniform care and follow-up for survivors and their family members. This national survey highlights this need, and might be helpful in the implementation of such guidelines.

  • 3.
    Stevenson-Ågren, Jean
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    A project to promote equality in ante-natal care for women who do not speak Swedish2017Conference paper (Other academic)
    Abstract [en]

    Background

    Health care in Sweden aims to be equal. In antenatal care, women who do not speak Swedish have a higher rate of maternal and infant mortality (Essen et al. 2001, Wahlberg et al. 2013). Cultural and communicative problems have been identified as one reason for this disparity. Due to recent immigration, Arabic-speaking women (ASW) have been identified as a vulnerable group. Technology has the potential to solve language and cultural barriers (Haith-Cooper 2014). A pilot study in which midwives were interviewed suggested that an ‘app’ for a tablet with multimodal components could be an aid to cultural and linguistic understanding (Axelsson et al. 2016).

     

    Aim

    The aim of the project is to identify women’s and midwives’ information needs and cultural issues, and subsequently, to develop an app with norm-critical design for interactive communication in antenatal care (ANC). The app will serve as a complement to interpreters and provide essential information about ANC.

    Method

    Two data collection methods will be used. The first is to observe meetings between midwives and pregnant women. The second is to interview midwives in focus groups so that they can freely express their wishes. Following this, a trial version of the app will be constructed, which will then be tested and evaluated iteratively in midwifery practice. The material will be analysed in workshops using linguistic and norm critique methods.

    Results

    The app is expected to improve and ensure the quality of ANC for ASW and improve their understanding of pregnancy, fetal development and parenting. It will hlep midwives to be sure that women have been given the correct information and improve patient safety. We will improve our own understanding of the risks in communication that can arise when two parties do not understand each other, and of how communication can be promoted through an app.

     

    References

    Essen, B. et al. (2001) Increased perinatal mortality among sub-Saharan immigrants in a city-population in Sweden.  [Dissertation]. Malmö and Lund: Lund University; 2001.

    Haith-Cooper, M. (2014) Mobile translators for non-English-speaking women accessing maternity services. British Journal of Midwifery. 2014; 22: 795-803. http://www.magonlinelibrary.com/doi/abs/10.12968/bjom.2014.22.11.795

    Axelsson, C. et al. (2016). ”Det kan bli så mycket fel”: Förstudie om barnmorskors upp­levelser av kommunikation med gravida kvinnor utan funktionell behärskning av svenska. Kalmar/Växjö: Linnéuniversitetet.

    Wahlberg, A. et al. (2013) Increased risk of severe maternal morbidity (near-miss) among immigrant women in Sweden: a population register-based study  Epidemiology. 2013 Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala, Sweden

  • 4.
    Stevenson-Ågren, Jean
    University of Sheffield, UK.
    Documentation of Vital Signs in Electronic Health Records: A Patient Safety Issue2016Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Background and aim: Hospitals in the developed world are increasingly adopting digital systems such as electronic health records (EHRs) for all kinds of documentation. This move means that traditional paper case notes and nursing records are often documented in EHRs. Documentation of vital signs is important for monitoring a patient's physiological condition and how vital signs are presented in a clinical record can have a profound impact on the ability of clinicians to recognise changes, such as deterioration in a patient's condition. Vital signs have received minimal attention with regard to how they are documented in EHRs which suggests that there is an urgent need for this to be examined.

     

    Design, methodology and approach: A mixed methods study was conducted in a 372-bed county hospital in two phases. Phase one was a quantitative study, and was followed by a qualitative study in phase two. The aim of the quantitative study was to examine the vital signs documented in the electronic health records of patients who had previously suffered a cardiac arrest. The aim of the qualitative study was to investigate how medical and nursing staff measured, reported and retrieved information on vital signs. Observations were made and interviews were conducted in four clinical areas.

     

    Findings: The quantitative study found that documentation of vital signs was incomplete in relation to current universal standards for monitoring vital signs, and that vital signs were dispersed inconsistently throughout the EHR. The qualitative study provided a detailed understanding of the routines and practices for monitoring vital signs and demonstrated variation in routines and in methods of documentation in the four clinical areas. Documenting and retrieving vital signs in the EHR was problematic because of usability issues and led to workflow problems. Workflow problems were solved at ward level by the creation of paper workarounds.

     

    Contribution to knowledge: This thesis has shown that poor facilities for the documentation of vital signs in EHRs could have a negative impact on patient safety because it reduces the possibility of good record keeping. This leads to limited availability of easily accessible, up-to-date information, essential for identifying clinical deterioration and, thus, is a challenge to patient safety. Related to this, the thesis has identified possible solutions to usability problems in the EHR. Inconsistent routines and practices were also identified and suggestions were made for how this problem might be approached.

  • 5.
    Stevenson-Ågren, Jean
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Israelsson, J.
    Nilsson, Gunilla
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Bath, P. A.
    Variable documentation of vital signs in an electronic health record in patients at risk of in-hospital cardiac arrest could pose a threat to patient safety2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, p. S55-S56Article in journal (Other academic)
  • 6.
    Stevenson-Ågren, Jean
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Sheffield.
    Israelsson, Johan
    Kalmar County Hospital, Sweden.
    Nilsson, Gunilla
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Bath, Peter
    University of Sheffield, UK.
    Documentation of vital signs in electronic records: the development of workarounds2015In: Health informatics for enhancing health and well-being: Proceedings of the seventeenth International Symposium for Health Information Management Research, York, UK 24-26 June 2015 / [ed] P. Bath, H. Spring, &, B Sen, B, 2015Conference paper (Refereed)
    Abstract [en]

    Workarounds are commonplace in health care settings. An increase in the use of electronic health records (EHR) has led to an escalation of workarounds as health care professionals cope with systems which are inadequate for their needs. Closely related to this, the documentation of vital signs in EHR has been problematic. The accuracy and completeness of vital sign documentation has a direct impact on the recognition of deterioration in a patient’s condition. We examined work flow processes to identify workarounds related to vital signs in a 372-bed hospital in Sweden. In three clinical areas, a qualitative study was performed with data collected during observations and interviews and analysed through thematic content analysis. We identified paper workarounds in the form of hand-written notes and a total of eight pre-printed paper observation charts. Our results suggested that nurses created workarounds to allow a smooth workflow and to ensure patients safety.

  • 7.
    Stevenson-Ågren, Jean
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Sheffield, UK.
    Israelsson, Johan
    Kalmar County Hospital.
    Nilsson, Gunilla
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Bath, Peter
    University of Sheffield, UK.
    Dokumentation av vitalparametrar i datorjournaler: En risk för patientsäkerheten?2014In: VITALIS - Nordens ledande eHälsomöte: Vetenskapliga papers presenterade vid Vitalis konferens, Svenska Mässan, Göteborg, 8-10 april 2014, Göteborg: Göteborgs universitet, 2014Conference paper (Other academic)
    Abstract [sv]

    Tidig upptäckt och snabb hantering av riskpatienter har betraktats som det ’första steget i kedjan till överlevnad’ i hjärtlungräddning (HLR)[1]. Patienter uppvisar ofta tecken på försämring av kliniskt tillstånd under perioden före oväntad hjärtstopp [2]. För att förbättra identifieringen av försämring i kliniskt tillstånd hos patienter har många varianter på system för snabb respons införts med fokus på mätning, rapportering och hantering av patienter med avvikande vitalparametrar [3]. Datorjournaler journaler används allt mer inom vården för i stort sett all dokumentation. Däremot är kunskapen begränsad kring betydelsen av dokumentationen i datorjournalen för att upptäcka försämring av patienternas kliniska tillstånd. Syftet med denna studie var att undersöka dokumentationen av vitala parametrar i datorjournalen för sjukhusvårdade patienter, som efter inläggning drabbats av oväntat hjärtstopp.

  • 8.
    Stevenson-Ågren, Jean
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. University of Sheffield, UK.
    Israelsson, Johan
    Kalmar County Hospital.
    Nilsson, Gunilla
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Bath, Peter
    University of Sheffield, UK.
    Electronic patient record and documentation of deterioration in patients at risk of in-hospital cardiac arrest: pilot study2011In: ISHIMR 2011: Proceedings of the Fifteenth International Symposium for Health Information Management Research, 8-9 September 2011, Zurich, Switzerland / [ed] Peter A. Bath, J R Collis Publications , 2011Conference paper (Other academic)
    Abstract [en]

    Early recognition of patients whose condition is deteriorating is essential to prevent cardiac arrest. To detect signs of deterioration, a patient’s vital signs, such as temperature, pulse, respiratory rate and blood pressure, are monitored. Poor design of vital sign charts is given as one of the reasons for deficiency in recognising patient deterioration. Little is known about the impact of documenting vital signs in electronic patient record (EPR) systems. The aim of this study is to examine to which extent the EPR supports the documentation of deterioration in patients at risk of in-hospital cardiac arrest. The poster reports on the pilot study which was performed to test the adequacy and appropriateness of the data collection tool and to examine the appropriateness of the data collected for statistical analyses.

  • 9.
    Stevenson-Ågren, Jean
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Sheffield, UK.
    Israelsson, Johan
    Kalmar County Hospital, Sweden.
    Nilsson, Gunilla
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Bath, Peter
    University of Sheffield, UK.
    Recording signs of deterioration in acute patients: The documentation of vital signs within electronic health records in patients who suffered in-hospital cardiac arrest2016In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 22, no 1, p. 21-33Article in journal (Refereed)
    Abstract [en]

    Vital sign documentation is crucial to detecting patient deterioration. Little is known about the documentation of vital signs in electronic health records. This study aimed to examine documentation of vital signs in electronic health records. We examined the vital signs documented in the electronic health records of patients who had suffered an in-hospital cardiac arrest and on whom cardiopulmonary resuscitation was attempted between 2007 and 2011 (n = 228), in a 372-bed district general hospital. We assessed the completeness of vital sign data compared to VitalPACTM Early Warning Score and the location of vital signs within the electronic health records. There was a noticeable lack of completeness of vital signs. Vital signs were fragmented through various sections of the electronic health records. The study identified serious shortfalls in the representation of vital signs in the electronic health records, with consequential threats to patient safety. 

  • 10.
    Stevenson-Ågren, Jean
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Sheffield, UK.
    Israelsson, Johan
    Kalmar County Hospital.
    Nilsson, Gunilla
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Bath, Peter A.
    University of Sheffield, UK.
    Vital sign documentation in electronic records: the development of workarounds2018In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 24, no 2, p. 206-215Article in journal (Refereed)
    Abstract [en]

    Workarounds are commonplace in health care settings. An increase in the use of electronic health records (EHR) has led to an escalation of workarounds as health care professionals cope with systems which are inadequate for their needs. Closely related to this, the documentation of vital signs in EHR has been problematic. The accuracy and completeness of vital sign documentation has a direct impact on the recognition of deterioration in a patient’s condition. We examined work flow processes to identify workarounds related to vital signs in a 372-bed hospital in Sweden. In three clinical areas a qualitative study was performed with data collected during observations and interviews and analysed through thematic content analysis. We identified paper workarounds in the form of hand-written notes and a total of eight pre-printed paper observation charts. Our results suggested that nurses created workarounds to allow a smooth workflow and to ensure patients safety.

  • 11.
    Stevenson-Ågren, Jean
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Sheffield, UK.
    Israelsson, Johan
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Hospital ; Linköping University.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Bath, Peter
    University of Sheffield, UK.
    Factors influencing the quality of vital signs data in electronic health records: a qualitative study2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 5-6, p. 1276-1286Article in journal (Refereed)
    Abstract [en]

    Aims and objectives

    To investigate reasons for inadequate documentation of vital signs in an electronic health record.

    Background

    Monitoring vital signs is crucial to detecting and responding to patient deterioration. The ways in which vital signs are documented in electronic health records have received limited attention in the research literature. A previous study revealed that vital signs in an electronic health record were incomplete and inconsistent.

    Design

    Qualitative study.

    Methods

    Qualitative study. Data were collected by observing (68 hr) and interviewing nurses (n = 11) and doctors (n = 3), and analysed by thematic analysis to examine processes for measuring, documenting and retrieving vital signs in four clinical settings in a 353-bed hospital.

    Results

    We identified two central reasons for inadequate vital sign documentation. First, there was an absence of firm guidelines for observing patients’ vital signs, resulting in inconsistencies in the ways vital signs were recorded. Second, there was a lack of adequate facilities in the electronic health record for recording vital signs. This led to poor presentation of vital signs in the electronic health record and to staff creating paper “workarounds.”

    Conclusions

    This study demonstrated inadequate routines and poor facilities for vital sign documentation in an electronic health record, and makes an important contribution to knowledge by identifying problems and barriers that may occur. Further, it has demonstrated the need for improved facilities for electronic documentation of vital signs.

    Relevance to clinical practice

    Patient safety may have been compromised because of poor presentation of vital signs. Thus, our results emphasised the need for standardised routines for monitoring patients. In addition, designers should consult the clinical end-users to optimise facilities for electronic documentation of vital signs. This could have a positive impact on clinical practice and thus improve patient safety.

  • 12.
    Stevenson-Ågren, Jean
    et al.
    Linnaeus University, Faculty of Humanities and Social Sciences, School of Language and Literature.
    Nilsson, Gunilla
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Nurses’ perceptions of an electronic patient record from a patient safety perspective: A qualitative study.2012In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 68, no 3, p. 667-676Article in journal (Refereed)
    Abstract [en]

    Aims: The overall aim of this study was to explore nurses’ perceptions of using an electronic patient record in everyday practice, in general ward settings. This paper reports on the patient safety aspects revealed in the study.

    Background: Electronic patient records (EPR) are widely used and becoming the main method of nursing documentation. Emerging evidence suggests that they fail to capture the essence of clinical practice and support the most frequent end-users: nurses. The impact of using EPR in general ward settings is under-explored.

    Method: In 2008, focus group interviews were conducted with 21 registered nurses (RNs). This was a qualitative study and the data were analysed by content analysis. At the time of data collection, the EPR system had been in use for approximately one year.

    Findings: The findings related to patient safety were clustered in one main category: ‘documentation in everyday practise’. There were three sub-categories: vital signs, overview and medication module. Nurses reported that the EPR did not support nursing practice when documenting crucial patient information, such as vital signs.

    Conclusions: Efforts should be made to include the views of nurses when designing an EPR to ensure it suits the needs of nursing practice and supports patient safety. Essential patient information needs to be easily accessible and provide support for decision-making. 

  • 13.
    Stevenson-Ågren, Jean
    et al.
    Linnaeus University, Faculty of Humanities and Social Sciences, School of Language and Literature.
    Nilsson, Gunilla
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Johansson, Pauline
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Nurses' experience of using electronic patient records in everyday practice: a literature review2010In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 16, no 1, p. 63-72Article in journal (Refereed)
    Abstract [en]

    Electronic patient record (EPR) systems have a huge impact onnursing documentation. Although the largest group of end-usersof EPRs, nurses have had minimal input in their design. Thisstudy aimed to review current research on how nurses experienceusing the EPR for documentation. A literature search was conductedin Medline and Cinahl of original, peer-reviewed articles from2000 to 2009, focusing on nurses in acute/ inpatient ward settings.After critical assessment, two quantitative and three qualitativearticles were included in the study. Results showed that nursesexperience widespread dissatisfaction with systems. Currentsystems are not designed to meet the needs of clinical practiceas they are not user-friendly, resulting in a potentially negativeimpact on individualized care and patient safety. There is anurgent need for nurses to be directly involved in software designto ensure that the essence and complexity of nursing is notlost in the system.

  • 14.
    Stevenson-Ågren, Jean
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Sheffield, UK.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Israelsson, Johan
    Kalmar County Hospital.
    Bath, Peter
    University of Sheffield, UK.
    Reasons for poor vital sign documentation in electronic health records: A qualitative study2017In: European Society of Cardiology Congress, Barcelona, 26-30 August, 2017, 2017Conference paper (Refereed)
  • 15.
    Stevenson-Ågren, Jean
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Sheffield, UK.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Nilsson, Gunilla
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bath, Peter
    University of Sheffield, UK.
    Documentation of vital signs in electronic health records: issues for patient safety2013In: Proceedings of the sixteenth International Symposium for Health Information management Research, ISHIMR 2013: Exploiting Health Informatics for Connected, Collaborative and Customized Patient Care / [ed] Syed Sibte Raza Abidi, Peter A. Bath, Halifax: Dalhousie University & University of Sheffield , 2013, p. 153-154Conference paper (Other academic)
    Abstract [en]

    Inadequate design and poor user-interface are given as reasons for unsuccessful implementation of electronic health records (EHR) [1,2]. However, rather than designing more suitable technology, the trend has been to 'muddle through' [2] and to urge health care workers to adapt to poorly designed systems [3]. This may work to some degree but little is known about the impact this could have on patient safety. The design of vital sign charts has an impact on the ability of clinicians to detect deterioration in patients' clinical status [4-6]. Changes in a patient's vital signs may indicate a lifethreatening event [7,8] so charts should be user-friendly to support clinicians in decision-making [9,10]. The aim of this study was to examine the documentation of physiological vital signs in an EHR. In this paper, we present the results regarding accessing information on a patient's physiological vital signs.

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