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  • 1.
    Hasselberg, Marie
    et al.
    Karolinska Institutet, Sweden.
    Kirsebom, Marie
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Bäckström, Josefin
    Uppsala University, Sweden.
    Berg, Hans-Yngve
    Karolinska Institutet, Sweden;Swedish Transport Agency, Sweden.
    Rissanen, Ritva
    Karolinska Institutet, Sweden.
    I did NOT feel like this at all before the accident: do men and women report different health and life consequences of a road traffic injury?2019Inngår i: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 25, nr 4, s. 307-312Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Worldwide, injuries represent one of the leading causes of mortality, and nearly one-quarter of all injuries are road traffic related. In many high-income countries, the burden of road traffic injuries (RTIs) has shifted from premature death to injury and disability with long-term consequences; therefore, it is important to assess the full burden of an RTI on individual lives.

    Objective To describe how men and women with minor and moderate injuries reported the consequences of an RTI on their health and lives.

    Methods The study was designed as an explorative qualitative study, in which the answers to an open-ended question concerning the life and health consequences following injury were analysed using systematic text condensation.

    Participants A total of 692 respondents with a minor or a moderate injury were included.

    Results The respondents reported the consequences of the crash on their health and lives according to four categories: physical consequences, psychological consequences, everyday life consequences and financial consequences. The results show that medically classified minor and moderate injuries have detrimental long-term health and life consequences. Although men and women report some similar consequences, there are substantial differences in their reported psychological and everyday life consequences following an injury. Women report travel anxiety and PTSD-like symptoms, being life altering for them compared with men, for whom these types of reports were missing.

    Conclusion These differences emphasise the importance of considering gender-specific physical and psychological consequences following an RTI.

  • 2.
    Kirsebom, Marie
    Uppsala University.
    Mind the gap: organizational factors related to transfers of older people between nursing homes and hospital care2015Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The overall aim of the present thesis was to study factors related to transfers of older people between nursing homes, emergency department and hospital care.

    The thesis was based on four studies and used three methods: focus group discussions, structured review of electronic healthcare records, semi-structured interviews with registered nurses and general practitioners.

    Study I: nursing home nurses found it difficult to decide whether older residents should be referred to hospital from the nursing home. Hospital registered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Study II: transfer rate to ED was 594 over 9 months among a total of 431 residents (M 1.37 each). 25% were caused by falls and/or injuries, 63% resulted in hospitalization (M 7.12 days). The transfer rate was 0.00-1.03 transfers/bed; it was higher for private for-profit providers than for public/private non-profit providers. Study III: nursing homes with high transfer rates had fewer updated advance care plans than did nursing homes with lower transfer rates. More nurses from nursing homes with low transfer rates had a specialist education and training in dementia care and had worked longer in eldercare. Study IV: general practitioners perceived registered nurses’ continuity, competence and collaboration with family members as important to quality of care in nursing homes; inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety.

    The findings indicate that organizational factors could explain differences in transfer rates between nursing homes. The studies highlight the importance of advance care planning together with residents and family members in facilitating future medical decisions. Registered nurses’ continuity and competence are perceived as crucial to quality of care. To meet increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care several changes should be made: Nursing homes should be equipped with suitable medical equipment and registered nurse staff should be matched accordingly; importantly, registered nurses and general practitioners should be able to access each other’s healthcare record systems.

  • 3.
    Kirsebom, Marie
    et al.
    Uppsala University.
    Hedström, Mariann
    Uppsala University.
    Pöder, Ulrika
    Uppsala University.
    Wadensten, Barbro
    Uppsala University.
    General practitioners' experiences as nursing home medical consultants2017Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, nr 1, s. 37-44Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE:

    To describe general practitioners' experiences of being the principal physician responsible for a nursing home.

    METHOD:

    Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation.

    RESULT:

    Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-life care. Registered Nurses' continuity and competence are perceived as crucial to the quality of care, but inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety.

    CONCLUSION:

    The study highlights the importance of advance care planning together with residents and family members in facilitating future decisions on medical treatment and end-of-life care. To meet the increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care, there would seem to be a need to increase Registered Nurses' staffing and acquire more advanced medical equipment, as well as to create better possibilities for Registered Nurses and general practitioners to access each other's healthcare record systems.

  • 4.
    Kirsebom, Marie
    et al.
    Uppsala University.
    Hedström, Mariann
    Uppsala University.
    Pöder, Ulrika
    Uppsala University.
    Wadensten, Barbro
    Uppsala University.
    Transfer of nursing home residents to emergency departments: organizational differences between nursing homes with high vs. low transfer rates2017Inngår i: Nursing Open, E-ISSN 2054-1058, Vol. 4, nr 1, s. 41-48Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To explore possible factors in the organization of nursing homes that could be related to differences in the rate of transfer of residents from nursing homes to emergency department.

    Design: Explorative.

    Method: In a single municipality, qualitative and quantitative data were collected from documents and through semi-structured interviews with 11 RNs from five nursing homes identified as having the highest vs. six identified as having the lowest transfer rates to emergency department. Data were analysed by non-parametric tests and basic content analysis.

    Results: All nursing homes in the highest transfer rate group and one in the lowest transfer rate group were run by private for-profit providers. Compared with the low group, the high group had fewer updated advance care plans and the RNs interviewed had less work experience in care of older people and less training in care of persons with dementia. There was no difference in nursing home size or staff/resident ratio. The RNs described similar possibilities to provide palliative care, medical equipment and perceived medical support from GPs.

  • 5.
    Kirsebom, Marie
    et al.
    Uppsala University.
    Hedström, Mariann
    Uppsala University.
    Wadensten, Barbro
    Uppsala University.
    Pöder, Ulrika
    Uppsala University.
    The frequency of and reasons for acute hospital transfers of older nursing home residents2013Inngår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 58, nr 1, s. 115-120Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of the study was to examine the frequency of and reason for transfer from nursing homes to the emergency department (ED), whether these transfers led to admission to a hospital ward, and whether the transfer rate differs as a function of type of nursing home provider and to identify the frequency of avoidable hospitalizations as defined by the Swedish Association of Local Authorities and Regions (SALAR). The design was retrospective, descriptive. Data were collected in a Swedish municipality where 30,000 inhabitants are 65 years or older. Structured reviews of the electronic healthcare records were performed. Included were residents living in a nursing home age 65+, with healthcare records including documented transfers to the ED during a 9-month period in 2010. The transfer rate to the ED was 594 among a total of 431 residents (M = 1.37 each). 63% resulted in hospitalization (M = 7.12 days). Nursing home's transfer rate differed between 0.00 and 1.03 transfers/ bed and was higher for the private for-profit providers than for public/private non-profit providers. One- fourth of the transfers were caused by falls and/or injuries, including fractures. The frequency of avoidable hospitalizations was 16% among the 375 hospitalizations. The proportion of transfers to the ED ranged widely between nursing homes. The reasons for this finding ought to be explored.

     

  • 6.
    Kirsebom, Marie
    et al.
    Uppsala University.
    Wadensten, Barbro
    Uppsala University.
    Hedström, Mariann
    Uppsala University.
    Communication and coordination during transition of older persons between nursing homes and hospital still in need of improvement2013Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, nr 4, s. 886-895Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim:

    To investigate registered hospital and nursing home nurses' experiencesof coordination and communication within and between care settings when olderpersons are transferred from nursing homes to hospital and vice versa.

    Background:

    It has previously been reported that transfers to hospital from nursing homes and discharge of patients from hospital are surrounded by communication difficulties. However, studies focusing on both hospital and nursing home registered nurses' experiences of communication and coordination within and between nursing homes and hospitals are uncommon.

    Design:

    A descriptive study design with a qualitative approach was used.

    Methods:

    In 2008, three focus group discussions were conducted with registered nurses from hospitals and nursing homes (n=20). Data were analysed using content analysis.

    Results:

    Nursing home registered nurses found it difficult to decide whether the older person should be referred to hospital from the nursing home. Hospitalregistered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Both hospital and nursinghome registered nurses suggested increased collaboration to understand each other's work situation better.

    Conclusion:

    Communication and coordination among hospital andnursing home registered nurses need to be furthered improved. Registered nurses'coordination and planning in the nursing home are extremely important to future elder care. We recommend that the medical care plan be regularly updated and meticulously followed, the aim being to reduce the risk of inappropriate medical treatment and nursingcare and unnecessary transfer and admission to hospital.

  • 7.
    Kneck, Åsa
    et al.
    Ersta Sköndal Bräcke University College, Sweden.
    Flink, Maria
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Karolinska Institutet, Sweden.
    Frykholm, Oscar
    Karolinska Institutet, Sweden.
    Kirsebom, Marie
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Karolinska Institutet, Sweden.
    The information flow in a healthcare organisation with integrated units2019Inngår i: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 19, nr 3, s. 1-10, artikkel-id 20Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Integrated care is believed to provide support to patients with multiple long-term and complex conditions. Transparency in information delivery is key for shared decision-making, and co-production of care. This study aimed to explore information pathways within an integrated healthcare and social care organisation and describe how information continuity was delivered for an older patient with complex care needs.

    Methods: An explorative single-case study conducted in a Swedish healthcare organization where municipality and the county council have integrated their services. One focus group discussion and six individual interviews were conducted.

    Results: Information flow to partners in care was obstructed, with compensatory double documentation, complementary information channels, and information loss. A heavy burden was on the patient and relatives to keep track of and communicate information between different caregivers. Patients were expected to be active partners in their own care, but were largely excluded from the information flow.

    Discussion: Even integration of care organisations does not imply that integrated care is delivered at the sharp end of practice. An integrated electronic health record is needed to improve accessibility of care information from within all the organisations, facilitating handovers between professionals and levels of care, and involving patients in the information flow.

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