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  • 1.
    Berglund, A.
    et al.
    Karolinska Inst, Sweden.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bohm, K.
    Karolinska Inst, Sweden.
    Schenck-Gustafsson, K.
    Karolinska Inst, Sweden.
    von Euler, M.
    Karolinska Inst, Sweden.
    Obstacles and facilitators in emergency calls about stroke: Nurses' skills enable identification of stroke2015In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, p. 113-113Article in journal (Other academic)
  • 2.
    Berglund, Annika
    et al.
    Södersjukhuset Hospital Stockholm ; Karolinska Institutet.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bohm, Katarina
    Södersjukhuset Hospital Stockholm.
    Schenck-Gustafsson, Karin
    Karolinska Institutet.
    von Euler, Mia
    Södersjukhuset Hospital Stockholm ; Karolinska Institutet.
    Factors facilitating or hampering nurses identification of stroke in emergency calls2015In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 71, no 11, p. 2609-2621Article in journal (Refereed)
    Abstract [en]

    Aims. To explore the factors that facilitate or hamper identification of stroke in emergency calls concerning patients with stroke who have fallen or been in a lying position.

    Background. Early identification of stroke in emergency calls is vital but can be complicated as the patients may be unable to express themselves and the callers generally are bystanders. In a previous study, we found presentation of fall or the patient being in a lying position to be the major problem in 66% of emergency calls concerning, but not dispatched as acute stroke.

    Design. A qualitative study using interpretive phenomenology.

    Methods. Analysis of transcribed emergency calls concerning 29 patients with stroke diagnoses at hospital discharge, in 2011 and presented with fall/lying position.

    Findings. Patients' ability to express themselves, callers' knowledge of the patient and of stroke, first call-takers' and nurses' authority, nurses' coaching and nurses' expertise skills facilitated or hindered the identification of stroke. Certain aspects are adjustable, but some are determined by the situation or on callers' and patients' abilities and thus difficult to change. Nurses' expertise skills were the only theme found to have a decisive effect of the identification of stroke on its own.

    Conclusion. To increase identification of stroke in emergency calls concerning stroke, the first call-takers' and nurses' action, competence and awareness of obstacles are crucial and if strengthened would likely increase the identification of stroke in emergency calls. In complicated cases, nurses' expertise skills seem essential for identification of stroke.

  • 3.
    Berlin Hallrup, Leena
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bengtsson-Tops, Anita
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Adults with intellectual disabilities experiences of institutional care in SwedenManuscript (preprint) (Other academic)
  • 4.
    Berlin Hallrup, Leena
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Bengtsson-Tops, Anita
    Högskolan i Kristianstad.
    Care workers´ experiences of working in a Swedish institutional care setting2010In: Learning Disability Practice, ISSN 1465-8712, Vol. 13, no 7, p. 21-25Article in journal (Refereed)
    Abstract [en]

    Despite the general move to support people with learning disabilities in their own homes or in home-like settings, many institutional settings still exist and little research has been carried out on the role of the care workers who work in them. In this study, participant observations over a 16-month period describe care workers’ experiences of working in an institutional care setting in Sweden, and 18 care workers were interviewed. The three main themes to emerge from the thematic analysis were: care workers were engaged in creating a family-like atmosphere; they were engaged in making the everyday ordered and structured; and they were exposed to stress factors. It became evident that care workers need additional support, training and opportunities for reflection to handle their complex work situation.

  • 5.
    Dalvandi, Asghar
    et al.
    Karolinska Institutet, Sweden ; University of Social Welfare and Rehabilitation Sciences, Iran.
    Ekman, Sirkka-Liisa
    Karolinska Institutet, Sweden.
    Khankeh, Hamid Reza
    University of Social Welfare and Rehabilitation Sciences, Iran.
    Maddah, Sadat Seyed Bagher
    University of Social Welfare and Rehabilitation Sciences, Iran.
    Heikkilä, Kristiina
    Karolinska Institutet, Sweden.
    Rehabilitation Experts' Experience of Community Rehabilitation Services for Stroke Survivors in Iran2012In: Topics in Stroke Rehabilitation, ISSN 1074-9357, E-ISSN 1945-5119, Vol. 19, no 5, p. 395-404Article in journal (Refereed)
    Abstract [en]

    Purpose: Successful stroke rehabilitation is a complex process involving teamwork by members of several professions. The aims of this study were to explore the experiences of Iranian rehabilitationexperts concerning community rehabilitation services for stroke survivors and obtain their opinions on how to further develop and improve these services. Method: A qualitative research method with grounded theory was used, including purposive and theoretical sampling. A constant comparative analysis was conducted. Data were gathered from 2 focus group discussions including 10 Iranian rehabilitation experts and 4 in-depth individual interviews. Results: Nonintegrated rehabilitation services emerged as the core concept of the study. The explored concepts were identified as deficiently allocated budget, inadequate public insurance, lack of availability of rehabilitative care, negative public opinion, lack of consistency in care, and split services and professional separation. Areas identified for potential improvement included need to change policymakers' attitudes, need to refine rehabilitation in the health care system, need to establish a registration system, need to provide information and skills, and need to see the family as a whole. Conclusion: Experts should participate in educational rehabilitation programs to become more aware of current rehabilitationservices within the community. Stroke survivors and their families should also participate in the rehabilitation programs as this would allow them to gain knowledge and skills for dealing withstroke management. This can help reduce problems, change public opinion, and eliminate mistrust between health care providers and families.

  • 6. Dalvandi, Asghar
    et al.
    Ekman, Sirkka-Liisa
    Maddah, Sadat Seyed Bagher
    Khankeh, Reza Hamid
    Heikkilä, Kristiina
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Post stroke life in iranian people: used recommendations and strategies2009In: Iranian Rehabilitation Journal, ISSN 1735-3603, Vol. 7, no 9, p. 17-24Article in journal (Refereed)
  • 7.
    Dalvandi, Asghar
    et al.
    Karolinska Institutet; University of Social Welfare and Rehabilitation, Iran.
    Ekman, Sirkka-Liüsa
    Karolinska Institutet.
    Khankeh, Hamid Reza
    University of Social Welfare and Rehabilitation, Iran.
    Maddah, Sadat Seyed Bagher
    University of Social Welfare and Rehabilitation, Iran.
    Lutzen, Kim
    Karolinska Institutet.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. Karolinska Institutet.
    Lack of continuity of rehabilitation care for stroke survivors: Iranian family caregivers' experience2011In: Middle East Journal of Age and Aging, ISSN 1449-8677, Vol. 8, no 4, p. 28-34Article in journal (Refereed)
    Abstract [en]

    Background and Objective: Stroke is a common disabling disorder that requires the involvement of family caregivers to successfully encourage the patient's rehabilitation. This is especially true in Iran, where the family members commonly have the main responsibility of care of disabled persons. The aim of this study was to explore the Iranian family caregivers' experience of providing rehabilitation care at home. Method: A grounded theory approach and the main tenets of constant comparative method were used. Twelve participants were interviewed using semi-structured in-depth interviews. Findings: The core concept was identified as "lack of continuity of rehabilitation care". Seven main categories were identified. Three of them were related to the problems family caregivers faced, including inadequate knowledge and skills, inappropriate accessibility to rehabilitative services, and inadequate social insurance. Four categories were about the strategies that family caregivers used to deal with the major concerns; modifying home environment, managing coexisting medical conditions, improving nurses' roles and, relying on family unity. Conclusion: Family caregivers need continuity of rehabilitative care besides their family engagement, to enable access to care. They also need support from adequate social insurance and increased access to rehabilitation care. Undergoing rehabilitation at home gives people the advantage of practicing skills and developing compensatory strategies in the context of their own living environment by training and helping family caregivers and stroke survivors in terms of modifying home environment and managing coexisting medical conditions. Here, nurses can have an important role by helping the family caregivers with education and training.

  • 8.
    Dalvandi, Asghar
    et al.
    Dept of NVS, Div. of Nursing, Karolinska Institutet.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Maddah, SSB
    University of Social Welfare and rehabilitation Sciences, Iran.
    Khankeh, Hamidreza
    University of Social Welfare and rehabilitation Sciences, Iran.
    Ekman, Sirkka-Liisa
    Dept of NVS, Div. of Nursing, Karolinska Institutet.
    Life experiences after stroke among Iranian stroke survivors2010In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 57, p. 247-253Article in journal (Refereed)
    Abstract [en]

    Background:  Stroke is a major cause of disability worldwide. It is a life-threatening and life-altering event, which leaves many physical and mental disabilities, thus creating major social and economic burdens. Experiencing a stroke and its aftermath can be devastating for patients and their families. In Iran, many services are not available for those who lack property; this may result in many difficulties and long-term problems for stroke survivors and their family members who are usually the main caregivers in Iranian cultural. Despite its effect on their lives, little is known about how the survivors perceive stroke in the Iranian context, therefore, knowing more about this process may enhance problem identification and problem solving.

    Aim:  To illuminate how stroke survivors experience and perceive life after stroke.

    Method:  A grounded theory approach was recruited using semi-structured interviews with 10 stroke survivors.

    Findings:  The survivors perceived that inadequate social and financial support, lack of an educational plan, lack of access to rehabilitative services, physical and psychological problems led them to functional disturbances, poor socio-economical situation and life disintegration. The core concept of life after stroke was functional disturbances.

    Conclusions:  The study shows the need to support the stroke survivors in their coping process with their new situation by providing appropriate discharge plans, social and financial support, social insurances and training programmes for the stroke survivors and their families.

  • 9.
    Dalvandi, Asghar
    et al.
    Dept of NVS, Div. of Nursing, Karolinska Institutet.
    Khankeh, Hamidreza
    University of Social Science and Rehabilitation, Tehran.
    Ekman, Sirkka-Liisa
    Dept of NVS, Div. of Nursing, Karolinska Institutet.
    Maddah, SBB
    University of Social Science and Rehabilitation, Tehran.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska INstitutet.
    Everyday Life Condition in Stroke Survivors and Their Family Caregivers in Iranian Context2013In: International Journal of Community Based Nursing & Midwifery, ISSN 2322-2476, Vol. 1, no 1, p. 3-15Article in journal (Refereed)
    Abstract [en]

    BackgroundStroke is an unexpected major life incident that effect on physical functioning and can lead tochanges in lifestyle and inability to manage self care, work or leisure. To explore the everydaylife situation as experienced by stroke survivors, and their family caregivers, this study wasconducted 3-6 month after stroke.MethodsTwelve stroke survivors and thirteen family caregivers were interviewed and a qualitativecontent analysis was conducted to analyze data.ResultsThe results were categorized into two central themes that were identified as; (1) Being challengedby changes in everyday life situation including; the struggle with physical dysfunctions,inappropriate daily plan for leisure activities, changes in mood, being faced with economicalproblems and being worried about changing roles (2) striving to cope with new conditionsincluding; trying to preserve self-worth, seeking to support from spirituality, learning andre-learning and regaining independency.ConclusionPhysical dysfunction was the major concern for both the survivors and their family caregiversin their everyday life situation. This problem led to, and forced them, to be dependent on others.Training is needed to teach stroke survivors and their families strategies of how to cope withand overcome ongoing challenges of everyday life after stroke and to re-organize their livesand improve skills of the survivors to deal with the new situation at home.A daily plan for spending their time and leisure activities would ease this work. Moreinvestigation will be needed to clarify the process of life after stroke to cover this gap.

  • 10.
    Ehrlich, Kethy
    et al.
    Karolinska Institutet ; Danderyd Hospital.
    Boström, Anne-Marie
    Karolinska Institutet ; Danderyd Hospital.
    Mazaheri, Monir
    Mälardalen University.
    Heikkilä, Kristiina
    Karolinska Institutet.
    Emami, Azita
    Karolinska Institutet ; University of Washington, USA.
    Family caregivers' assessment of caring for a relative with dementia: a comparison of urban and rural areas2015In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 10, no 1, p. 27-37Article in journal (Refereed)
    Abstract [en]

    AIM: This study aimed to describe and compare urban and rural family caregivers' reactions to caring for a relative with dementia and to examine the associations between caregiving and socio-demographic factors.

    BACKGROUND: Most studies on family caregivers' experiences caring for older people with dementia have been conducted in urban areas, and little is known about the experiences of family caregivers living in rural areas.

    DESIGN: A cross-sectional study design was used.

    METHODS: A total of 102 caregivers (response rate 85%) from urban (n=57) and rural (n=46) areas completed the Caregiver Reaction Assessment (CRA) Scale and demographic information. Data were analysed using descriptive and inferential statistics and linear regression models.

    RESULTS: Overall, family caregivers reported high satisfaction even if they also reported high impact on finances and daily living. Rural caregivers experienced a higher negative impact on finances but reported more support from family members than urban caregivers. Age, gender and relationship were significantly associated with four of the five CRA subscales. Educational level and geographical setting were not associated with any of the CRA subscales.

    CONCLUSIONS: The results of the study raise questions about the financial situation of older female caregivers and on the expectations of built-in family structures in urban and rural areas. Further studies focusing on the meaning and constitution of a family would help us to understand how these factors influence family caregiving both in rural and urban areas.

    IMPLICATIONS FOR PRACTICE: To provide person-centred care and to avoid stereotyped caregiving, a better picture of traditions in family caregiving can improve a more differentiated and appropriate professional caregiving pliable with the cultural context in which it is carried out.

  • 11.
    Ehrlich, Kethy
    et al.
    Karolinska Institutet.
    Emami, Azita
    Karolinska Institutet ; University of Washington, USA.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet.
    The relationship between geographical and social space and approaches to care among rural and urban caregivers caring for a family member with Dementia: a qualitative study2017In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 12, no 1, p. 1-11, article id 1275107Article in journal (Refereed)
    Abstract [en]

    Knowledge about family caregivers in rural areas remains sparse. No studies to date have addressed the sociocultural aspects in caregiving, thus neglecting potentially significant data. This study aimed to explore and better understand family caregivers’ experiences in rural and urban areas and the sociocultural spheres that these two areas represent. How do family caregivers approach their caregiving situation? A hermeneutical approach was chosen to uncover the underlying meanings of experiences. Open-ended in-depth interviews were conducted. The ontological and epistemological roots are based on hermeneutic philosophy, where a human being’s existence is viewed as socially constructed. The study followed a purposeful sampling. Semi-structured in-depth interviews were conducted with 12 rural and 11 urban family caregivers to persons with dementia. These were then analyzed in accordance with the hermeneutical process. The findings provide insight into the variations of family caregiver approaches to caregiving in rural and urban areas of Sweden. There seemed to be a prevalence of a more accepting and maintaining approach in the rural areas as compared to the urban areas, where caregiving was more often viewed as an obligation and something that limited one’s space. Differences in the construction of family identity seemed to influence the participants approach to family caregiving. Therefore, community-based caregiving for the elderly needs to become aware of how living within a family differs and how this affects their views on being a caregiver. Thus, support systems must be individually adjusted to each family’s lifestyles so that this is more in tune with their everyday lives.

  • 12.
    Fonad, Edith
    et al.
    KC-Kompetenscentrum.
    Robins-Wahlin, Tarja-Brita
    KC-Kompetenscentrum ; Karolinska Institute.
    Heikkilä, Kristiina
    KC-Kompetenscentrum ; Karolinska Institute.
    Emami, Azita
    KC-Kompetenscentrum ; Karolinska Institute.
    Moving to and living in a retirement home: focusing on older people´s sense of safety and security2006In: Journal of Housing for the Elderly, ISSN 0276-3893, E-ISSN 1540-353X, Vol. 3, no 20, p. 45-60Article in journal (Refereed)
    Abstract [en]

    Bad health combined witii deteriorating physical functions force many elderly people to move to a retirement home. The primary focus of this study was to investigate the resident's experience of safety and security. From a sample of 57 residents, 12 persons volunteered to participate in the interview. Data were analyzed with qualitative content analysis. The standard and design of the participant's previous home made mobility difficult and this affected their sense of security. This motivated them to move into an environment where they felt more secure. The environment at the retirement home was predominantly described as secure and safe. The finding shows that the participants felt that safety and security were more important than independence.

  • 13.
    Fryden, Hanna
    et al.
    Karolinska Institutet.
    Ponzer, Sari
    Karolinska Institutet.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Kihlstrom, Lars
    Karolinska University Hospital.
    Nordquist, Jonas
    Karolinska University Hospital.
    Roles, tasks and educational functions of postgraduate programme directors: a qualitative study2015In: Postgraduate medical journal, ISSN 0032-5473, E-ISSN 1469-0756, Vol. 91, no 1080, p. 588-593Article in journal (Refereed)
    Abstract [en]

    Background A programme director is often required to organise postgraduate medical education. This leadership role can include educational as well as managerial duties. Only a few published studies have explored programme directors' own perceptions of their role. There is a need to explore the use of theoretical frameworks to improve the understanding of educational roles.

    Objective To explore programme directors' own perceptions of their role in terms of tasks and functions, and to relate these roles to the theoretical framework developed by Bolman and Deal.

    Methods Semi-structured interviews were conducted with 17 programme directors between February and August 2013. The data were subjected to content analysis using a deductive approach.

    Results The various roles and tasks included by participants in their perceptions of their work could be categorised within the framework of functions described by Bolman and Deal. These included: structuring the education (structural function); supporting individuals and handling relations (human resource function); negotiating between different interests (political function); and influencing the culture at the departmental level (symbolic function). The functions most often emphasised by participants were the structural and human resource functions. Some tasks involved several functions which varied over time.

    Conclusions Programme directors' own perceptions of their roles, tasks and functions varied widely. The theoretical framework of Bolman and Deal might be helpful when explaining and developing these roles.

  • 14. Gustafsson, Birgitta Åkesdotter
    et al.
    Ponzer, Sari
    Heikkilä, Kristiina
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Ekman, Sirkka-Liisa
    The lived body and the perioperative period in replacement surgery: older people´s experiences2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 60, no 1, p. 20-28Article in journal (Refereed)
    Abstract [sv]

    Aim. This paper is a report of a study to explore older people´s expereinces of their lived bodies during the perioperative period of hip or knee replacement.

    Background. replacement surgery of a major joint for older people suffering from osteoarthtitis is an established treatment in developed countries. Scientific knowledge is awailable on replacement surgery from several perspectives, but not about older people´s experiences of the entire perioperative period of replacement procedure.

    Method. A qualitative longitudinal study was conducted between 2002 and 2004. Audiotaped interviews were carried out with 12 older people, on five different occasions during the perioperative period. The data was analysed using latent qualitative content analysis.

    Findings. The perioperative period of a hip or knee replacement can be regarded as a process of transition which includes six critical phases. The transition was supported with a dream of becoming as able-bodied as previously in life, by having surgery. In addition, our findings revealed that the care recipients lacked knowledge about the surgical intervention as a whole.

    Conclusion. The meaning of having joint replacement surgery was to overcome the confinement of living with a painful and unreliable body. Furthermore, care recipients struggled to regain a body in charge and control of their lives, yet from a new starting point. The care recipients were not prepared for the transitional changes through the perioperative period. Further research is needed to develop an appropriate programme for patient care during the perioperative period, in order to facilitate the process of transition.

  • 15.
    Gustafsson Åkesdotter, Birgitta
    et al.
    Dept. of NVS, Div. of Nursing, Karolinska INstituttet.
    Ekman, Sirkka-Liisa
    Dept of NVS, Div. of Nursing, Karolinska Institutet.
    Ponzer, Sari
    Karolinska Institutet.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    The hip and knee replacement operation:: a throrough life event2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 4, p. 663-670Article in journal (Refereed)
    Abstract [en]

    Background:  A total hip replacement and a total knee replacement have shown to effectively reduce pain and disability in patients with osteoarthritis of the hip and knee joint despite associated risks. Even though the intervention primarily concerns older people with additional health problems, the patients stand on their feet the day after the operation and are discharged a few days later. Previous research indicates that reflections about life are related to the operation.

    Aim:  The aim of this study was to illuminate the meaning of reflections related to hip and knee replacement surgery.

    Method:  A phenomenological hermeneutical approach with a longitudinal design was chosen in order to study the participants’ experiences of the hip and knee replacement intervention across the entire perioperative period.

    Findings:  Four themes emerged from the structural analysis; choosing the challenge, past memories connect to the current situation, moving from happiness to ordinary everyday life and moving from despair towards reluctant acceptance of unexpected bad conditions for everyday life. There was inner negotiations about having surgery or not, and existential anxiety that reminded people that life cannot be taken for granted.

    Conclusion:  Our findings indicate the operation was seen as an extensive life event including reflections about life and death and about hope and fear. Previous bad experiences of care seemed to influence the way patients dealt with fear and hope. Fear had to be overcome by inner negotiations about undergoing surgery or not. Relief was expressed about surviving the actual operation, but soon after fears arose about how to manage on the actual road to recovery. Hope for a good life grew either stronger or weaker, depending on the progress following the operation. The outcome eventually generated a transition from happiness to ordinary everyday life, or a transition from despair towards reluctant acceptance of unfulfilled expectations.

  • 16.
    Gustafsson Åkesdotter, Birgitta
    et al.
    Dept of NVS, Div of Nursing, Karolinska Institutet.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Ekman, Sirkka-Liisa
    Dept of NVS, Div. of Nursing, Karolinska Institutet.
    Ponzer, Sari
    In the hands of formal caregivers: older patients' expereinces of care across the perioperative period for hip and knee replacements2010In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 14, no 2, p. 96-108Article in journal (Refereed)
    Abstract [en]

    Summary

     

    Total joint replacements of the hip or knee have become standard surgical

    procedures and lately more focus has been placed on the patient’s perspective.

     

     

    Aim:

     

    The aim of this study was to illuminate the meaning of care from all formal

    carers before, during, and after joint replacement surgery of the hip or knee.

     

     

    Study design:

     

    A qualitative longitudinal design was chosen to capture the

    patients’ experiences from the time they were placed on the waiting list until

    one year after the operation. Analysis revealed that, initially, the operation itself

    was regarded as the key for reaching the goal of independence in every-day life.

    Patients became aware that all care related to the operation was essential. The

    meaning of care from formal carers appeared to be: wanting to be ‘in safe hands’

    with competent formal carers across the entire perioperative period for the

    replacement surgery.

     

     

    Conclusion:

     

    Our findings indicate that for a good outcome care characterized by

    continuous guidance from formal carers with expert knowledge of care and joint

    replacement surgery (competent) was necessary for patients to feel that they were

    ‘in safe hands’ across the perioperative period. This requires organisation of care

    that can offer guidance across the perioperative period.

     

     

     

     

     

     

  • 17.
    Hadziabdic, Emina
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Albin, Björn
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Hjelm, Katarina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Family members’ experiences of the use of interpreters in healthcare2014In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 15, no 2, p. 156-169Article in journal (Refereed)
    Abstract [en]

    Aim The aim was to explore adults’ experiences of their family members’ use of interpreters in health-care encounters.

    Background Language barriers are a major hindrance for migrants to receive appropriate healthcare. In a foreign country, family members often need support in care of migrant patients. No previous studies focusing on adult family members’ experiences of the use of interpreters in healthcare have been found.

    Method A purposive sample of 10 adult family members with experiences of the use of interpreters in health-care encounters. Data were collected between May and September 2009 by focus-group interviews and analysed with qualitative analysis according to a method described for focus groups.

    Findings Three categories emerged from the analysis: (1) Experiences of the use of professional interpreters, (2) Experiences of being used as an interpreter and (3) Experiences of what needs to be improved when using interpreters. The main findings showed no agreement in family members’ experiences; interpretation should be individually and situationally adapted. However, when family members acted as interpreters, their role was to give both practical and emotional support, and this led to both positive and negative emotions. Use of simple language, better collaboration in the health-care organization and developing the interpreters’ professional attitude could improve the use of professional interpreters. The type of interpreter, mode of interpretation and patient's preferences should be considered in the interpretation situation. In order to achieve high-quality healthcare, health-care professionals need to organize a good interpretation situation case-by-case, choose the appropriate interpreters with the patient in focus and cooperate with members of the patient's social network.

  • 18.
    Hadziabdic, Emina
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Albin, Björn
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Hjelm, Katarina
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Healthcare staffs perceptions of using interpreters:  a qualitative study2010In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 11, no 3, p. 260-270Article in journal (Refereed)
    Abstract [en]

    Aim: To describe how healthcare professionals experience and perceive the use of interpreters in their contacts with patients with whom they do not share a common language.

    Methods: An explorative descriptive study. The study was conducted in different healthcare settings in Sweden and included 24 healthcare staff, of whom 11 were physicians, 9 nurses, 2 physiotherapists and 2 assistant nurses. Data were generated through written descriptions of the use of interpreters in healthcare and  analysed using qualitative content analysis.

    Findings: Two main categories emerged: 1) aspects related to the interpreter and 2) organizational aspects. It was shown that having a face-to-face, professional, trained interpreter, with a good knowledge of both languages and of medical terminology, translating literally and objectively, was perceived positively. The organizational aspects that affected the perception were functioning or non-functioning technical equipment, calm in the interpretation environment, documentation of the patients’ language ability, respect for the appointed time, and the level of availability and service provided by the interpreter agency.

    Conclusion: It is important to develop a well-functioning interpreter organization that offers trained interpreters with a professional attitude to improve and ensure cost-effective and high-quality encounters and care.

  • 19.
    Hadziabdic, Emina
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Heikkilä, Kristiina
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Albin, Björn
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Hjelm, Katarina
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Migrants' perceptions of using interpreters in health care2009In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 56, no 4, p. 461-469Article in journal (Refereed)
  • 20.
    Hadziabdic, Emina
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Albin, Björn
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Hjelm, Katarina
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Problems and consequences in the use of professional interpreters: qualitative analysis of incidents from primary healthcare.2011In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 18, no 3, p. 253-261Article in journal (Refereed)
    Abstract [en]

    The aim was to explore what probklems were reported by healthcare straff in primary healthcare concerning the use of interpreters and what consequences that might lead to. A single-case study of a real life situation was implemented by analysing 60 incident reports written by different health care professionals. Qualitative content analysis was applied. The results showed that the main problems were related to language in terms of lack of available interpreters in a particular language, and to organisational routines with difficulties in availability of interpreters and access to the interpreter agency. The consequences reported were incorrect use of time and resources, with increased workload and thus delayed treatment. Other consequences were limited possibilities to communicate and consultations carried out without a professional interpreter and instead using family members.

  • 21.
    Heikkilä, Kristiina
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Förklaringsmodeller för äldre migranters tillgång till och nyttjande av vård och omsorg - en pilotstudie.2008In: Efterfrågat arbetskraft?: Årsbok 2008 från forskningsprofilen Arbetsmarknad, Migration och Etniska relationer (AMER) vid Växjö universitet., Växjö university press, Växjö , 2008, p. 177-190Chapter in book (Other academic)
  • 22.
    Heikkilä, Kristiina
    et al.
    karolinska Institutet.
    Ekman, Sirkka-Liisa
    Karolinska Institutet;Blekinge Institute of Technology.
    Elderly care for ethnic minorities: Wishes and expectations among elderly Finns in Sweden2003In: Ethnicity and Health, ISSN 1355-7858, E-ISSN 1465-3419, Vol. 8, no 2, p. 135-146Article in journal (Refereed)
    Abstract [en]

    Objectives. Although elderly people from immigrant and minority groups utilise elderly care facilities to a lesser extent than elderly people from majority groups, there is a lack of research on how elderly people with different ethnic backgrounds wish and expect to be cared for when they are in need of institutional elderly care. This study aims to illuminate the role that culturally appropriate care plays in elderly Finnish immigrants’ wishes and expectations of institutional elderly care in Sweden. Design. Thirty-nine elderly Finnish immigrants in Sweden, aged 75 years or more, were interviewed in their homes. The data were analysed with latent qualitative content analysis. Results. The elderly Finnish immigrants in Sweden wished to be able to continue living in their current homes for as long as possible. Later on, when entering institutional elderly care, they wanted to feel continuity, familiarity, security and companionship with others. As immigrants, they had to choose to be cared for either in well-known physical environments close to their current homes, or in a culturally appropriate care setting with familiar socio-cultural conditions. Conclusions. To be able to provide institutional elderly care for minority groups it is important to ease the access to elderly care amenities by providing care that results in maintaining as much continuity and familiarity as possible in the lives of the elderly people. This includes the care providers and other residents who share the familiar aspects of their lives. This involves providing culturally appropriate elderly care close to the elderly people’s current homes.

  • 23.
    Heikkilä, Kristiina
    et al.
    Karolinska Institutet.
    Ekman, Sirkka-Liisa
    Blekinge Institute of Technology.
    Health care experiences and beliefs of elderly Finnish immigrants in Sweden2000In: Journal of Transcultural Nursing, ISSN 1043-6596, E-ISSN 1552-7832, Vol. 11, no 4, p. 281-289Article in journal (Refereed)
    Abstract [en]

    Purpose: To elucidate the experiences and beliefs of care of elderly Finnish immigrants living in Sweden (Sweden-Finns) in order to gain an understanding of the role ethnic background plays in these experiences and beliefs. Design: 39 elderly Sweden-Finns living in Stockholm were interviewed. The data were analysed hermeneutically. Results: On a surface level, the care in Sweden was culturally congruent to elderly Sweden-Finns’ experiences and beliefs of care. However, care in Finland and the care providers with Finnish background were regarded as superior to Swedish caregivers, giving a deeper sense of familiarity and trust in anticipation of good care. Implications for practice: Culturally appropriate care with care providers sharing the same ethnic background is important for ethnic elderly persons in enabling familiarity and trust between staff and patients.

  • 24.
    Heikkilä, Kristiina
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Sarvimäki, Anneli
    Ekman, Sirkka-Liisa
    Culturally congruent care for older people: Finnish care in Sweden2007In: Scandinavian Journal of Caring Science, Vol. 21, p. 354-361Article in journal (Refereed)
    Abstract [en]

    An increasing number of older people belong to minority and immigrant groups. This calls for new models on the subject of how to provide culturally adjusted care for these populations. The aim of this study is to describe how culturally congruency is used in care for older Finnish immigrants in order to promote their well-being. The study was conducted with an ethnographic design, based on participant observations and interviews among residents, staff and visitors in the Finnish Home in Sweden. In the core of the cultural congruency is the use of the Finnish language, and the fact that both residents and staff have Finnish backgrounds. In addition to this, Finnish customs and celebrations, popular culture and topics of discussion, are actively used in order to create a common ground for communication and shared understanding of the individual person. Cultural congruency, based on the residents' mother language, shared athnic background with staff, and shared customs creates a common ground for communication and an understanding. This enables caring relationships, which, in turn, increases the residents' well-being.

  • 25.
    Kulla, Gunilla
    et al.
    Nordig School of Health.
    Ekman, Sirkka-Liisa
    Dept of NVS, Div. of Nursing, karolinska Insitutet.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Sarvimäki, Anneli
    Age Institute, Helsinki, Finland.
    Differences in self-rated health among older immigrants: A comparison between older Finland-Swedes and Finns in Sweden2010In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, no 1, p. 25-31Article in journal (Refereed)
    Abstract [en]

    Aims: Research has shown a tendency among immigrants and ethnic minorities to have a lower health status compared with the majority population. This applies to Finnish immigrants in Sweden. This group, however, also consists of persons who belong to a small ethnic minority in Finland, the Finland-Swedes, who speak Swedish as their mother tongue. In Finland, this minority has been shown to have better health and longer lives than the majority of Finnish-speaking people. Most of the previous research has studied the objective health of immigrants and minorities, while less is known about their subjective health. The aim of this study was to describe and compare self-rated health in older Finland-Swedes and Finns living as immigrants in Sweden. Methods: The study was carried out as a sample-based cross-sectional study. Data was collected by a postal structured questionnaire. The response rate among the Finland-Swedes was 47% (n = 169) and among the Finns was 54% (n = 643). Data was analyzed descriptively and tested with Pearson’s chi-square test. Results: The results showed significant differences between the language groups in self-rated health, age of retirement and causes for retirement. The Finland-Swede immigrants rated their health as better than the Finnish-speaking ones. They had retired at an older age and less frequently because of health problems. Conclusions: The results indicate that there may be significant differences in health, at least in subjective health, between immigrant groups. Due to the low response rate, the results cannot be generalized.

  • 26.
    Lindqvist, Gunilla
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Albin, Björn
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Hjelm, Katarina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Conceptions of daily life in women living with a man suffering from chronic obstructive pulmonary disease2013In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 14, no 01, p. 40-51Article in journal (Refereed)
    Abstract [en]

    Aim To describe conceptions of daily life in women living with a man suffering from chronic obstructive pulmonary disease (COPD) in different stages.

    Background The spouse is often the primary caregiver to someone with COPD, and thus also affected by the consequences of the disease. No previous studies have been found focusing on conceptions of daily life in women living with a man suffering from COPD in different stages.

    Methods A phenomenographic study was conducted. Data were collected in 2008–2009 through semi-structured interviews with 21 women living with men suffering from COPD in different stages.

    Findings Four main descriptive categories were found: unchanged life situation where no support was needed; socially restricted life and changed roles; changes in health; and changes in the couple's relationship where support was needed. The categories are described in relation to the woman herself, in relation to the man, and in relation to others. No support was needed from society or health care when the men had mild COPD and the women experienced no change in their daily life. As the disease progressed, the women's responsibilities increased and their role changed from being a spouse to being an informal carer. Social contacts became limited, and they began to feel isolated. The women prioritized their spouse's health and well-being and compromised their own health. They experienced lack of support from health professionals and from the municipality.

  • 27.
    Lindqvist, Gunilla
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Albin, Björn
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Hjelm, Katarina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Conceptions of daily life in men living with a woman suffering from chronic obstructive pulmonary disease2013In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 14, no 02, p. 140-150Article in journal (Refereed)
    Abstract [en]

    Aim To describe conceptions of daily life in men living with a woman suffering from chronic obstructive pulmonary disease (COPD) in different stages of the disease. BACKGROUND: A chronic disease like COPD affects not only the person living with the illness, but also the spouse. Significant tasks and demands are placed on husbands. COPD has for a long time been considered more a man's disease than a woman's disease, but according to new evidence COPD is a vast problem in women, which requires support from their spouses. The literature review did not reveal any previous studies concerning conceptions of daily life in men living with women suffering from COPD in different stages. METHODS: A phenomenographic study was conducted. Data were collected from October 2008 to October 2009 through semi-structured interviews with 19 men living with a woman suffering from COPD. Findings Two main descriptive categories were found: (1) unchanged life situation where no support was needed; (2) changed life situation related to severity of COPD, where support was needed. The categories were described from the perspective 'ME and my spouse'. Even in their caregiving situation, the men continued with their own life and activities and did not put themselves in second place. No support was needed from healthcare or municipality when the women had mild COPD, but this changed when the COPD progressed. The men felt that daily life was burdened, restricted and the partner relationship was affected, even if the disease had not reached the final stage. The COPD forced them gradually into a caregiving role, and their daily life changed. They become more of a caregiver than a spouse. The men experienced lack of knowledge and support, and they felt that health professionals and municipality did not care about them.

  • 28.
    Lindstrom, Veronica
    et al.
    Karolinska Institutet.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet.
    Bohm, Katarina
    Karolinska Institutet.
    Castren, Maaret
    Karolinska Institutet.
    Falk, Ann-Charlotte
    Karolinska Institutet.
    Barriers and opportunities in assessing calls to emergency medical communication centre: a qualitative study2014In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 22, article id 61Article in journal (Refereed)
    Abstract [en]

    Introduction: Previous studies have described the difficulties and the complexity of assessing an emergency call, and assessment protocols intended to support the emergency medical dispatcher's (EMD) assessment have been developed and evaluated in recent years. At present, the EMD identifies about 50-70 % of patients suffering from cardiac arrest, acute myocardial infarction or stroke. The previous research has primarily been focused on specific conditions, and it is still unclear whether there are any overall factors that may influence the assessment of the call to the emergency medical communication centre (EMCC). Aim: The aim of the study was to identify overall factors influencing the registered nurses' (RNs) assessment of calls to the EMCC. Method: A qualitative study design was used; a purposeful selection of calls to the EMCC was analysed by content analysis. Results: One hundred calls to the EMCC were analysed. Barriers and opportunities related to the RN or the caller were identified as the main factors influencing the RN's assessment of calls to the EMCC. The opportunities appeared in the callers' symptom description and the communication strategies used by the RN. The barriers appeared in callers' descriptions of unclear symptoms, paradoxes and the RN's lack of communication strategies during the call. Conclusion: Barriers in assessing the call to the EMCC were associated with contradictory information, the absence of a primary problem, or the structure of the call. Opportunities were associated with a clear symptom description that was also repeated, and the RN's use of different communication strategies such as closed loop communication.

  • 29.
    Mazaheri, Monir
    et al.
    Karolinska Institutet, Sweden ; Tehran University of Medical Sciences, Iran.
    Eriksson, Lars E
    Karolinska Institutet, Sweden.
    Heikkilä, Kristiina
    Karolinska Institutet, Sweden.
    Nasrabadi, Alireza Nikbakht
    Tehran University of Medical Sciences, Iran.
    Ekman, Sirkka-Liisa
    Karolinska Institutet, Sweden.
    Sunvisson, Helena
    Örebro University, Sweden.
    Experiences of living with dementia: qualitative content analysis of semi-structured interviews2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 21/22, p. 3032-3041Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To describe people’s experiences of living with dementia in Iran.

    Background. A knowledge gap exists regarding the experiences of living with dementia in nonWestern contexts. This gap may be especially apparent within the Iranian context, where dementia research is relatively new. Deeper understanding about context-related experiences of dementia is a prerequisite for nurses’ ability to provide adequate and meaningful care.

    Design. Qualitative, cross-sectional design.

    Methods. Qualitative content analysis of semi-structured interviews with people living with dementia in urban Iran (six women and nine men; 60–87 years old).

    Results. The participants experienced their condition as a state of forgetfulness that was accompanied by losses and dependency on others. They wanted to feel good about themselves and feel important, but they continually struggled with matters such as a loss of accountability, feelings of futility and the frustration of others. Economic dependency and a lack of economic resources were sources of feelings of futility.

    Conclusion. Experiences of living with dementia in Iran included a substantial struggle to stay connected to the social world and to deal with dramatic life changes, aspects of living with dementia that seem to be universal. However, the feelings of financial burden and the experience of being nagged for their shortfalls by family members have seldom been described in other studies and seem to represent a cultural aspect of their experience.

    Relevance to clinical practice. The results of the study call for further nursing efforts in supporting people living with dementia in their struggle with their altered lives and in retaining their connections to everyday life. Furthermore, their family members might benefit from specific nursing interventions including information about dementia and advice on how to help the family members with dementia to interact with others while exercising their individual strengths.

  • 30.
    Mazaheri, Monir
    et al.
    Mälardalen University.
    Eriksson, Lars E.
    Karolinska Institutet.
    Nasrabadi, Alireza Nikbakht
    Tehran University of Medical Sciences, Iran.
    Sunvisson, Helena
    Örebro University.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Experiences of dementia in a foreign country: qualitative content analysis of interviews with people with dementia2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, article id 794Article in journal (Refereed)
    Abstract [en]

    Background: Dementia is a worldwide health concern of epidemic proportions, Research in the field of subjective experience of dementia suffers from a lack of diversity of their participants including immigrants. Different portraits od life with dementia could help us understand how people with dementia conceptualise their experiences of dementia and how they live. Our study aimed to explore the subjective experiences of living with dementia among Iranian immigrants in Sweden.

    Methods: Qualitative content analysis of interviews with fifteen people with dementia from Iranian immigrant backgrounds were conducted (8 females and 7 males).

    Results: Three themes and seven associated subthemes were revealed. The themes included: Being a person with dementia means living with forgetfullness (personal sphere), living with forgetfullness in private sphere means feeling incompetent but still loved, living with forgetfullness iin the public sphere means feeling confident and secure but also isolated.

    Conclusions: Living with dementia for the participants meant living with forgetfullness, They experienced feeling incompetent but still loved within their families and feeling confident and secure but also isolated in the society. Educating people with dementia and their families about the course and process of dementia may help them understand the changes better and adjust their expectations. Our study can provide a basis for health care workers to understand the experiences of living with dementia from this specific perspective.

  • 31.
    Möller, Riitta
    et al.
    Karolinska Institutet.
    Shoshan, Maria
    Karolinska Institutet.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    What is the reward?: Medical students’ learning and personal development during a research project course2015In: Medical Education Online, ISSN 1087-2981, E-ISSN 1087-2981, Vol. 20, p. 1-9, article id 28441Article in journal (Refereed)
    Abstract [en]

    Background: Until recently, the outcome of medical students’ research projects has mainly been assessed in terms of scientific publications, whereas other results important for students’ development have been less studied. The aim of this study was to investigate medical students’ experiences of learning as an outcome of the research project course.

    Method: Written reflections of 50 students were analyzed by manifest inductive content analysis.

    Results: Three categories emerged: ‘thinking as a scientist’, ‘working as a scientist’, and ‘personal development’. Students became more aware about the nature of knowledge, how to generate new knowledge, and developed skills in scientific thinking and critical appraisal. Unexpectedly, effects on personal characteristics, such as self-confidence, self-discipline, independence, and time management skills were also acknowledged.

    Conclusions: We conclude that individual research projects enhance research-specific skills and competencies needed in evidence-based clinical work and are beneficial for personal and professional development.

  • 32.
    Qvistgaard, Maria
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Almerud Österberg, Sofia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Thorén, Ann-Britt
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Lovebo, Jenny
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Patients’ experiences with at-home preoperative skin disinfection before elective hip replacement surgery2017In: Journal of Perioperative Practice, ISSN 1750-4589, Vol. 27, no 7-8, p. 162-166Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe patients' experiences with preoperative skin disinfection carried out in their home before elective hip replacement surgery with the aim of lowering the microbial burden and avoiding surgical site infections. The literature was reviewed for relevant studies. Optimal preparations before surgery depend on patients being able to assimilate preoperative information and instructions. The study was based on 14 interviews with patients who had undergone elective hip replacement surgery. Data were analysed with qualitative manifest content analysis according to Graneheim and Lundman (2004). The main categories of findings were: patients' experience of obstacles and limitations, the importance of supportive surroundings, and personal resources as strength when performing preoperative skin disinfection. The findings of this study agree with earlier studies showing a lack of compliance to preoperative skin disinfection. The findings also suggest reasons for non-compliance. Preoperative skin disinfection involves many important steps that need to be accomplished to ensure the maximum effect on microbial burden on skin surface. These steps can be difficult for some patient groups. Perioperative dialogue is one way to identify patients' individual needs and to help patients participate in the process. The study concludes that patients who carried out skin disinfection at home before surgery have a great responsibility to prepare themselves. The challenge for perioperative nurses who work with preoperative information is to identify and individually guide those patients who need extended support so that all patients with elective hip replacement surgery receive the same quality of care. Further research should focus on how caregivers discover individuals with extended needs and on identifying the kind of support that is effective to achieve optimal conditions for hip replacement surgery.

  • 33. Rydholm Hedman, Ann-Marie
    et al.
    Heikkilä, Kristiina
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Grafström, Margareta
    Strömberg, Lars
    Hip fractures and cognitive state: patient outcomes and proxies' perceptions of the rehabilitation period2008In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 3, no 3, p. 178-186Article in journal (Refereed)
    Abstract [en]

    Background: Numerous studies are available on hip fracture and rehabilitation outcomes. Some mention dementia but very few from family/proxy perspective.

    Aim: To investigate whether cognitive state influences the hip fracture patients' rehabilitation outcomes as well as the proxies' perceptions of the 6-month rehabilitation period.

    Design: A survey with structured and unstructured questions. Statistics and content analysis.

    Methods: The questionnaire was sent to 40 proxies of hip fracture patients with and without cognitive impairement, 32 replied. Statistics and content analysis were used to analyse the data.

    results: In the cognitively impaired group, physical function decreased (P=0.0241) as well as locomotion (P=0.0005) compared to pre-fracture. This group mainly participated in rehabilitation sessions in institutions (P=0.0001) and their main support came from nursing staff. The cognitively impaired group assessed the rehabilitation period as being of a much lower quality than the cognitively intact group (P=0.0048). In the impaired group, hindrances to rehabilitation were low level of staffing, and lack of access to rehabilitation resources such as physiotherapists.

    Conclusions and relevance for clinical practice: Hip fracture patients are a dichotomous group and cognition is decisive for physical and social outcomes as well as type of rehabilitation support.

  • 34.
    Rydholm Hedman, Ann-Marie
    et al.
    NVS, Div. of Nursing, Karolinska Insitutet.
    Strömberg, lars
    Dept. of Clinical Science and Technology, Karolinska Institutet.
    Grafström, Margareta
    Dept. of NVS, Div.. of Nursing, Karolinska Institutet.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Hip fracture patients' cognitive state affects family members' expereinces - a diary study of the hip fracture recovery2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 3, p. 451-458Article in journal (Refereed)
    Abstract [en]

    Scand J Caring Sci; 2010 Hip fracture patients' cognitive state affects family members' experiences - a diary study of the hip fracture recovery Background:  Many patients with hip fractures suffer from dementia disease, which has shown to affect the outcome of recovery strongly, as well as care and treatment. As most hip fracture patients are discharged home early after surgery, caregiving often falls on family members - spouses, daughters, sons, or even neighbours become informal carers. Aim:  To explore how hip fracture patients' cognitive state affect family members' experiences during the recovery period. Methods:  Eleven diaries written by family members' of hip fracture patients were analysed by means of qualitative content analysis. Findings:  The analysis generated two main categories with four categories. The first main category was; 'Being a family member of a cognitively impaired patient' with the categories 'Dissatisfaction with lack of support' and 'Emotional distress due to the patient's suffering'. The second main category was 'Being a family member of a cognitively intact patient' with the categories 'Satisfaction with a relative's successful recovery' and 'Strain due to their caring responsibilities'. Being a family member of a patient with cognitive impairment and a hip fracture meant being solely responsible for protecting the interests of the patient; in regard to care, rehabilitation and resources. The family members were also burdened with feelings of powerlessness and sadness due to the patients' suffering. On the contrary, family members of cognitively intact hip fracture patients had positive experiences. The family members expressed pleasure from seeing their close ones make progress. However, when the healing process was delayed this led to strain on the family members. Conclusions:  The findings suggest the hip fracture patient's cognitive state is more decisive than the hip fracture itself for the family members' experiences

  • 35.
    Sarvimäki, Anneli
    et al.
    Age Institute, Finland.
    Kulla, Gunilla
    Age Institute, Finland.
    Palo-Bengtsson, Liisa
    Karolinska Institute.
    Heikkilä, Kristiina
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Ekman, Sirkka-Liisa
    Karolinska Institute.
    Äldre finländska emigranter berättar2006In: Mellan majoriteter och minoriteter: om migration, makt och mening / [ed] Marianne Junila & Charles Westin, Helsingfors: Svenska litteratursällskapet i Finland (SLS), 2006, 1, p. 47-74Chapter in book (Refereed)
  • 36.
    Sarvimäki, Anneli
    et al.
    Age Institute, Finland.
    Palo-Bengtsson, Liisa
    Karolinska Institute.
    Kulla, Gunilla
    Age Institute, Finland.
    Heikkilä, Kristiina
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Ekman, Sirkka-Liisa
    Karolinska Institute.
    Så blev livet: reflektioner kring migration2006In: Mellan majoriteter och minoriteter: om migration, makt och mening / [ed] Marianne Junila & Charles Westin, Helsingfors: Svenska litteratursällskapet i Finland (SLS), 2006, 1, p. 442-470Chapter in book (Refereed)
  • 37.
    Suvanto, Anna-Liisa
    et al.
    Karolinska institutet.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Att minnas kriget: sverigefinska erfarenheter2014In: Äldres psykiska hälsa och ohälsa: prevention, förhållningssätt och arbetsmetoder / [ed] Susanne Rolfner Suvanto, Stockholm: Gothia Förlag AB, 2014, 1, p. 64-89Chapter in book (Other academic)
  • 38. Thelander, Verus
    et al.
    Robins Wahlin, tarja-Brita
    Olofsson, Lotta
    Heikkilä, Kristiina
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Sonde, Lars
    Gardening activities for nursing home residents with dementia2008In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 10, no 1, p. 53-56Article in journal (Refereed)
  • 39.
    Wijk, Hanna
    et al.
    Karolinska Institutet.
    Ponzer, Sari
    Karolinska Institutet.
    Heikkilä, Kristiina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Kihlstroem, Lars
    Karolinska University Hospital.
    Nordquist, Jonas
    Karolinska Institutet;Karolinska University Hospital.
    Factors influencing effectiveness in postgraduate medical education - a qualitative study of experiences of the responsible clinical consultants2019In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 19, article id 3Article in journal (Refereed)
    Abstract [en]

    BackgroundMedical education leaders are important for educational quality in postgraduate medical education. Their work tasks are complex and contain different components. However, factors that are influencing leaders effectiveness in completing these tasks are unexplored. Understanding and developing these factors is most likely essential to strengthen postgraduate medical education and to consequently improve the quality in health care delivery. This study explores the experiences of factors that influence effectiveness of clinical consultants responsible for postgraduate medical education at clinical departments. Effectiveness was defined as fulfillment of work tasks.MethodsA qualitative study was performed with data gathered through semi-structured face-to-face interviews with 17 consultants responsible for postgraduate medical education. Data was analyzed by qualitative content analysis.ResultsFindings clustered into four themes of factors influencing effectiveness: individual (being an expert, social competence), relational (support and cooperation, communication), attitudinal (shared vision, organizational values, colleagues' attitudes) and structural (organizational characteristics, regulations and guidelines, conditions for the role). The factors were experienced to influence effectiveness in a positive or a negative direction.Conclusions This study shed light on the complex and interrelated factors experienced to have impact on the role of consultant responsible for postgraduate medical education. Viewing the result through the concept of power, the role mainly relies on personal power sources like expert and referent power whereas power connected to the position often are lacking. To increase effectiveness of the role, a differentiated strategy which involves activities at both individual, group and organizational levels is needed.

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