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  • 1.
    Ingvarsson, Emelie
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Schildmeijer, Kristina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Hagerman, Heidi
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Lindberg, Catharina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    "Being the main character but not always involved in one's own care transition" - a qualitative descriptive study of older adults' experiences of being discharged from in-patient care to home2024Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, nr 1, artikel-id 571Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The growing number of older adults with chronic diseases challenges already strained healthcare systems. Fragmented systems make transitions between healthcare settings demanding, posing risks during transitions from in-patient care to home. Despite efforts to make healthcare person-centered during care transitions, previous research indicates that these ambitions are not yet achieved. Therefore, there is a need to examine whether recent initiatives have positively influenced older adults' experiences of transitions from in-patient care to home. This study aimed to describe older adults' experiences of being discharged from in-patient care to home.Methods This study had a qualitative descriptive design. Individual interviews were conducted in January-June 2022 with 17 older Swedish adults with chronic diseases and needing coordinated care transitions from in-patient care to home. Data were analyzed using inductive qualitative content analysis.Results The findings indicate that despite being the supposed main character, the older adult is not always involved in the planning and decision-making of their own care transition, often having poor insight and involvement in, and impact on, these aspects. This leads to an experience of mismatch between actual needs and the expectations of planned support after discharge.Conclusions The study reveals a notable disparity between the assumed central role of older adults in care transitions and their insight and involvement in planning and decision-making.

  • 2.
    Hedqvist, Ann-Therese
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Region Kalmar County, Sweden.
    Praetorius, Gesa
    Swedish National Road and Transport Research Institute, Sweden;University of South-Eastern Norway, Norway.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Karolinska Institutet, Sweden.
    Lindberg, Catharina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Entangled in complexity: An ethnographic study of organizational adaptability and safe care transitions for patients with complex care needs2024Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim of this study was to visualize vulnerabilities and explore the dynamics of inter-professional collaboration and organizational adaptability in the context of care transitions for patients with complex care needs.

    Design: An ethnographic design using multiple convergent data collection techniques.

    Methods: Data collection involved document review, participant observations and interviews with healthcare and social care professionals (HSCPs). Narrative analysis was employed to construct two illustrative patient scenarios, which were then examined using the Functional Resonance Analysis Method (FRAM). Thematic analysis was subsequently applied to synthesize the findings.

    Results: Inconsistencies in timing and precision during care transitions pose risks for patients with complex care needs as they force healthcare systems to prioritize structural constraints over individualized care, especially during unforeseen events outside regular hours. Such systemic inflexibility can compromise patient safety, increase the workload for HSCPs and strain resources. Organizational adaptability is crucial to managing the inherent variability of patient needs. Our proposed ‘safe care transition pathway’ addresses these issues, providing proactive strategies such as sharing knowledge and increasing patient participation, and strengthening the capacity of professionals to meet dynamic care needs, promoting safer care transitions.

    Conclusion: To promote patient safety in care transitions, strategies must go beyond inter-professional collaboration, incorporating adaptability and flexible resource planning. The implementation of standardized safe care transition pathways, coupled with the active participation of patients and families, is crucial. These measures aim to create a resilient, person-centred approach that may effectively manage the complexities in care transitions.

    Implications: The recommendations of this study span the spectrum from policy-level changes aimed at strategic resource allocation and fostering inter-professional collaboration to practical measures like effective communication, information technology  integration, patient participation and family involvement. Together, the recommendations offer a holistic approach to enhance care transitions and, ultimately, patient outcomes.

  • 3. Ingvarsson, Emelie
    et al.
    Schildmeijer, Kristina
    Hagerman, Heidi
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Lindberg, Catharina
    Older adults’ experiences of coordinated care transitions when being discharged from in-patient care to home.2024Konferensbidrag (Refereegranskat)
  • 4.
    Backåberg, Sofia
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Univ Calgary, Canada.
    Östh, Katarina Eriksson
    Region Kronoberg, Sweden.
    Kimming, Anna
    Region Kronoberg, Sweden.
    Frykberg, Gunilla E.
    Uppsala University, Sweden.
    Sustainable human movements - a threshold concept with potential to open up new perspectives in physiotherapy2024Ingår i: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is a call to action for physiotherapists worldwide to contribute to the transition towards 'sustainable health'. In this paper, we build upon the current definition of 'sustainable health' and also on 'sustainable physical activity' to introduce and theoretically substantiate the concept of sustainable human movements, and suggest a definition thereof. Sustainable human movements will be described as a threshold concept with three aligned critical concepts; (i) movement control, including forces as causes of emerging movements, (ii) movement quality, referring to how movements are performed in terms of optimisation, and (iii) physical literacy, including motivation, confidence and physical competence. A deep understanding of these concepts, combined with a collaboration and learning approach applied together with the patient, is proposed to enable a sustainable human movement approach to permeate physiotherapy theory and practice. To facilitate this, a generic and easily accessible tool has recently been developed. It combines support for structured observational movement analysis and pedagogical support for creating a mutual and extended understanding of a patient's lived experience. This encourages the patient to become actively involved and take responsibility for promoting his/her 'sustainable health'. The aims of this paper are to a) suggest a theoretical framework for and definition of the concept sustainable human movements, and b) introduce a clinical tool that ultimately aims at promoting sustainable movements and health.

  • 5.
    Nilsson, Lena
    et al.
    Linköping University, Sweden.
    Lindblad, Marléne
    Swedish Red Cross University, Sweden.
    Johansson, Nathalie
    Dalarna University, Sweden;Region Uppsala, Sweden.
    Säfström, Lisa
    Dalarna University, Sweden.
    Schildmeijer, Kristina
    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). Region Uppsala, Sweden.
    Unbeck, Maria
    Dalarna University, Sweden;Danderyd Hospital, Sweden.
    Exploring nursing-sensitive events in home healthcare: A national multicenter cohort study using a trigger tool2023Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 138, artikel-id 104434Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The provision of home healthcare is increasing in response to the growing aging population with the need for chronic disease management in their homes. Safety work differs from hospital care. The incidence of adverse events in home healthcare is sparsely studied but is estimated to occur in-one third of patients, and most are deemed preventable. Although nursing care is crucial for risk assessment and preventive work in the home environment, the role of registered nurses in the prevention of no-harm incidents and adverse events has not received sufficient scientific attention.

    OBJECTIVES: To explore nursing-sensitive events in patients receiving home healthcare.

    DESIGN, SETTING AND PARTICIPANTS: A Swedish national multicenter study based on a structured record review of 600 randomly chosen healthcare records from 10 organizations in different regions of the country.

    METHODS: Ten trained teams, each including physician(s) and registered nurses, undertook a review based on the Global Trigger Tool method. The review covered a maximum of 90 days from admission to home healthcare. First, each record was screened for the presence of 38 predefined triggers. In the second step, every potential event was assessed according to preventability, types of events, severity, time of occurrence, consequences of the event, and potential contributing causes.

    RESULTS: In total, 699 events were identified in the study. Of these, 495 (74.0%) were classified as nursing-sensitive (227 no-harm incidents and 268 adverse events) and affected 267 (44.5%) patients, with a mean of 1.9 events per patient. The majority (n = 367, 73.1%) were considered preventable. The most prominent types of nursing-sensitive event were falls (n = 138, 27.9%), pressure ulcers (n = 62, 12.5%), healthcare-associated infections (n = 58, 11.7%) and medication management (n = 50, 10.1%). Concerning severity, 45.9% were classified as no-harm incidents and another 36.6% resulted in temporary harm that required extra healthcare resources: 226 hospital days, 66 physician visits in outpatient care, and 99 in home healthcare. All severity types occurred from day 1, except death, which included only one patient. The most frequent contributing factors were deficiencies in nursing care, treatment & diagnosis, with the subgroups nursing care, observation, treatment & follow-up, followed by deficiencies in the organization.

    CONCLUSIONS: Nursing-sensitive events in home healthcare are common, often preventable, and occur from the start of the care period. This study contributes to increased knowledge of patient safety shortcomings and points to the important role that registered nurses play in patient safety work.

  • 6.
    Hybinette, Karl
    et al.
    Karolinska institutet, Sweden;Karolinska University Hospital, Sweden.
    Praetorius, Gesa
    Swedish National Road and Transport Research Institute, Sweden;University of South-Eastern Norway, Norway.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Pukk Härenstam, Karin
    Karolinska Institute, Sweden;Karolinska University Hospital, Sweden.
    Exploring patient flow management through a lens of cognitive systems engineering2023Ingår i: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 66, nr 12, s. 2106-2120Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Hospitals work to provide quality, safety, and availability to patients with a wide variety of care needs, which makes efficient prioritisation and resource utilisation essential. Anticipation of each patients' trajectory, while monitoring available resources across the hospital, are major challenges for patient flow management. This study focuses on how hospital patient flow management is realised in situ with the help of concepts from cognitive systems engineering. Five semi-structured interviews with high level managers and shadowing observations of seven full work-shifts with management teams were conducted, to explore how patient flow is coordinated and communicated across the hospital. The data has been analysed using qualitative content analysis. The results describe patient flow management using an adapted Extended Control Model (ECOM) and reveal how authority and information might be better placed closer to clinical work for increased efficiency of patient flow.

    Practitioner summary: This study describes how a large tertiary paediatric hospital's patient flow management functions. The results offer a new understanding of how patient flow management is communicated and coordinated across organisational levels of the hospital and how authority and information might be better placed closer to clinical work for increased efficiency.

  • 7.
    Hedqvist, Ann-Therese
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Hagerman, Heidi
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Lindberg, Catharina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Svensson, Ann
    University West, Sweden.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    In pursuit of integrated care: Interprofessional collaboration in transitional care for older people with complex care needs2023Ingår i: Presented at the Nordic Conference in Nursing Research, Reykjavik, Iceland, October 2-4, 2023, 2023Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background:

    Contemporary healthcare systems are based on a reductionist, biomedical paradigm maladapted to meet the needs of an aging population with multimorbidity. Integrated care and interprofessional collaboration are suggested to connect the different parts of healthcare. However, how this can be realised is less understood.

    The aim of the study was to develop a deeper understanding of how interprofessional collaboration across care providers in transitional care is conducted to achieve integrated care for older people with complex care needs.

    Method:

    Using constructivist grounded theory, observations and interviews were conducted with healthcare and social care professionals (n=86) from a multidisciplinary and cross-stakeholder perspective in a region in Sweden.

    Results:

    Interprofessional collaboration in transitional care emerges as a continuum of "Moving from fragmentation to coupling and integration through collaborative efforts". On the lowest level of integration, professionals are working in organisational “silos” that are difficult to cross, as each specialist's expert knowledge is necessary for the vulnerable patient´s wellbeing. Patients´ perception of seamless care is facilitated by the mutual sharing of patient data across organizations through integrated information systems. The highest level of integration is consolidated as the interprofessional team collaborates on a pronounced common ground with a shared mental map of the goals of care, constructing unity for the older person and their family.

    Conclusion:

    To achieve seamless transitional care for older people with complex care needs, clear boundaries and liability areas are necessary, and actors in interprofessional teams are required to assume responsibility across conceivable gaps across organizations.

  • 8.
    Hagerman, Heidi
    et al.
    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).
    Municipal top-level managers' experiences of how to create safe and secure care for older adults with complex care needs in Sweden.2023Ingår i: Presented at Nordic Conference in Nursing Research, 2 – 4 October 2023,  Reykjavik, Iceland, 2023Konferensbidrag (Refereegranskat)
  • 9.
    Niklasson, Joakim
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Fagerström, Cecilia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Region Kalmar County, Sweden.
    Bergman, Patrick
    Linnéuniversitetet, Fakulteten för samhällsvetenskap (FSV), Institutionen för idrottsvetenskap (ID). Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för medicin och optometri (MEO).
    Lindberg, Terese
    Blekinge Institute of Technology, Sweden.
    Backåberg, Sofia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). University of Calgary, Canada.
    The meaning of sedentary behavior among older adults: a phenomenological hermeneutic study.2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 1134Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: A sedentary lifestyle has implications for health and well-being. For healthy ageing, it is recommended to interrupt prolonged sitting; however, little is known about the meaning of sedentary behavior among older adults. The aim of this study was to understand the meaning of sedentary behavior among older adults with initial support from community care.

    METHODS: A phenomenological hermeneutics approach was used, and individual interviews were conducted with sixteen older adults aged 70 to 97 years, by phone and face to face. The older adults lived in ordinary housing in southern Sweden and received initial support from community care.

    RESULTS: The interviews yielded three key themes: Being sedentary is an unnatural part of life, having an ageing body means unwanted frailty, and having a sedentary lifestyle is based on conscious choices.

    CONCLUSION: Being sedentary means having a lack of physical activity and social interactions, resulting in wanting to be more physically active than sometimes possible. Clinical practitioners should bear in mind that becoming more sedentary is inevitable with an ageing body, but that older adults may have an innate desire to be as physically active as possible. A lifelong exposure to physical activity, the possibility of well-being found in sedentary activities and the impact of social networks should not be overlooked when creating clinical interventions to break unhealthy sedentary behavior among older adults. To increase the understanding of sedentary behavior among older adults, future research could focus on the impact of physical impairment on sedentary behavior and the relationship between sedentary behavior and physical activity throughout life.

  • 10.
    Svensson, Ingrid
    et al.
    Karolinska institutet, Sweden.
    von Knorring, Mia
    Karolinska institutet, Sweden.
    Hagerman, Heidi
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Fagerström, Cecilia
    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). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Smeds Alenius, Lisa
    Karolinska institutet, Sweden.
    Unfolding alignment - How top management work to align demand and capacity: an ethnographic study of resilience in a Swedish healthcare region.2023Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, nr 1, artikel-id 321Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Resilient healthcare organizations maintain critical functions and high-quality care under varying conditions. While previous research has focused on the activities of frontline healthcare professionals working at the "sharp end" of care, less attention has been paid to managers at the top management level. More knowledge is needed to fully understand how the managers align demand and capacity at the "blunt end" of care. Therefore, this study aimed to explore how top managers work to align demand and capacity in a healthcare region in Sweden.

    METHODS: Observations of management team meetings, interviews, and conversations were conducted with top managers responsible for healthcare in one of Sweden's 21 regions. Data collection used an ethnographic approach. Data were analyzed using qualitative reflexive thematic analysis.

    RESULTS: The data showed how alignment work was done through active reflection that built on past experiences and on structures built into the organization at the same time as taking future potential outcomes and consequences into account. In addition to collaborative, preventive, supportive, and contextualizing work, which was conducted in the present, a general approach permeated the organization, which enabled connecting actions, i.e., different forms of alignment work, occurring at different points in time, and connecting different types of knowledge across organizational borders and stakeholders.

    CONCLUSION: This study explored how top managers work to align demand and capacity in a healthcare region in Sweden. It was shown how four categories of work; collaborative, preventive, supportive and contextualization work, together with a general approach; focusing on opportunities, building on a stable past and taking a reflective stance, constitute alignment in practice. More; the alignment work was done in the here and now, with both the past and future in mind. The ability to take action to benefit the whole is a possibility and a responsibility for top management. In the region studied, this was done by aligning demands with capacity based on past experiences and focusing on the available opportunities to connect knowledge needed within and across organizational borders.

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  • 11.
    Bratt, Anna S.
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för psykologi (PSY).
    Johansson, Maude
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för psykologi (PSY).
    Holmberg, Mats
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Uppsala University, Sweden;Mälardalen University, Sweden.
    Fagerström, Cecilia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Region Kalmar County, Sweden.
    Elmqvist, Carina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Region Kronoberg, Sweden.
    Rusner, Marie
    Region Västra Götaland, Sweden;University of Gothenburg, Sweden.
    Kaldo, Viktor
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för psykologi (PSY). Karolinska Institutet, Sweden;Region Stockholm, Sweden.
    An internet-based compassion course for healthcare professionals: Rationale and protocol for a randomised controlled trial2022Ingår i: Internet Interventions, ISSN 2214-7829, Vol. 28, artikel-id 100463Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Severe stress is one of the most common causes of sick leave in Sweden. Previous research hasshown that compassion interventions for healthcare professionals can decrease work-related stress through theintroduction of self-care, self-awareness, and emotion regulation abilities when experiencing difficult situations.Internet-based stress management interventions have hitherto shown promising results in reducing stress.However, further research is needed to examine the effectiveness of internet-based compassion interventions forhealthcare professionals.Objective: In the present study protocol, a randomised controlled trial is described, aiming to examine the effectsof an internet-based compassion course for healthcare professionals on work-related stress and stress ofconscience.Method: Healthcare professionals will be offered an internet-based stress management course of five modulesacross a period of five weeks. The design is a randomised controlled study consisting of three groups enrolled inone of the following: a compassion course (n = 120), a cognitive behavioural stress management course (n =120), or placed on a waitlist followed by either the compassion course or the cognitive behavioural stressmanagement course (n = 36). We hypothesise that the internet-based compassion course would reduce theparticipants’ stress of conscience to a greater degree compared to the other two groups. The secondary hypothesisis that the compassion course would increase the participants’ professional quality of life (i.e., higher jobsatisfaction and lower empathy fatigue) and self-compassion. In addition, the internet-based compassion courseis expected to reduce the participants’ work-related stress and sick leave rates to the same degree (non-inferiority)as the cognitive behavioural stress management course and to a higher degree when compared to thewaitlist condition. The primary outcome measure is the Stress of Conscience Questionnaire (SCQ) and the secondaryoutcome measures are the Professional Quality of Life Scale (PROQOL), the Work-related StressCopenhagen Psychosocial Questionnaire (COPSOQ), and the Self-compassion Scale (SCS). Assessments will beperformed at baseline, four weekly assessments during treatment, post-treatment (5 weeks), and follow-ups at 10weeks, 15 weeks, and 6 months. The repeated measures data will be analysed using a generalised estimatingequation for repeated measurements to examine whether changes over time differ between the groups andwhether the improvements persist over time.Discussion: The clinical trial is expected to provide novel data on the effects of compassion interventions and addto the existing knowledge of internet-based interventions for stress management in healthcare professionals.

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  • 12.
    Adelsjö, Igor
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Nilsson, Lina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för medicin och optometri (MEO).
    Hellström, Amanda
    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). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Karolinska Institutet, Sweden.
    Lehnbom, Elin C.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). UiT The Arctic University of Norway, Norway.
    Communication about medication management during patient–physician consultations in primary care: a participant observation study2022Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 11, artikel-id e062148Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To explore communication about medication management during annual consultations in primary care. Design: passive participant observations of primary care consultations.

    Setting Two primary care centres in southern Sweden.

    Participants Consultations between 18 patients (over the age of 60 years) with chronic diseases and 10 general practitioners (GPs) were observed, audio-recorded, transcribed and analysed using content analysis.

    Results Four categories emerged: communication barriers, striving for a shared understanding of medication management, evaluation of the current medication treatment and the plan ahead and behavioural changes in relation to medication management. Misunderstandings in communication, failure to report changes in the medication treatment and use of generic substitutes complicated mutual understanding and agreement on continued treatment. The need for behavioural changes to reduce the need for medication treatment was recognised but should be explored further.

    Conclusion Several pitfalls, including miscommunication and inaccurate medication lists, for safe medication management were identified. The purpose of annual consultations should be clarified, individual treatment plans could be used more actively during primary care consultations and efforts are needed to improve verbal communication and information continuity.No data are available.

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  • 13.
    Ekstedt, Mirjam
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Karolinska Institutet, Sweden.
    Kirsebom, Marie
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Lindqvist, Gunilla
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Kneck, Åsa
    Ersta Sköndal Bräcke University College, Sweden.
    Frykholm, Oscar
    Karolinska Institutet, Sweden.
    Flink, Maria
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Wannheden, Carolina
    Karolinska Institutet, Sweden.
    Design and Development of an eHealth Service for Collaborative Self-Management among Older Adults with Chronic Diseases: A Theory-Driven User-Centered Approach2022Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 1, artikel-id 391Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The increasing prevalence of chronic conditions and multimorbidity poses great challenges to healthcare systems. As patients' engagement in self-managing their chronic conditions becomes increasingly important, eHealth interventions are a promising resource for the provision of adequate and timely support. However, there is inconclusive evidence about how to design eHealth services to meet the complex needs of patients. This study applied an evidence-based and theory-informed user-centered design approach in three phases to identify the needs of older adults and healthcare professionals in the collaborative management of multimorbidity (phase 1), develop an eHealth service to address these needs (phase 2), and test the feasibility and acceptance of the eHealth service in a clinical setting (phase 3). Twenty-two user needs were identified and a web-based application-ePATH (electronic Patient Activation in Treatment at Home)-with separate user interfaces for patients and healthcare professionals was developed. The feasibility study with two nurses and five patients led to a redesign and highlighted the importance of adequately addressing not only varying user needs but also the complex nature of healthcare organizations when implementing new services and processes in chronic care management.

  • 14.
    Hedqvist, Ann-Therese
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Region Kalmar County, Sweden.
    Ingvarsson, Emelie
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Lindberg, Catharina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Hagerman, Heidi
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Svensson, Ann
    University West, Sweden.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Interlacing the threads of seamless care: Interprofessional collaboration in care transitions for older people with complex care needs2022Ingår i: International Journal of Integrated Care, Ubiquity Press, 2022, Vol. 22, s. 360-360Konferensbidrag (Refereegranskat)
    Abstract [en]

    Introduction: Current healthcare systems are not optimally designed to meet the needs of aging populations. With shorter hospital stays, fewer hospital beds, and fragmentation of the healthcare system, older people with complex care needs are recognised as particularly vulnerable. This development further increases the demands on older people and their family to assume responsibility of own health, and to navigate through the healthcare system, knowing of when and where to seek help. In care transitions, an interprofessional collaboration across care providers is considered as a path to deliver seamless care. Still, it seems hard to achieve.

    Aim and Method: The aim of the study is to explore interprofessional collaboration in care transitions from inpatient care to home healthcare for older people with complex care needs.

    Care transitions involve a variety of healthcare teams across stakeholder boundaries. Hence, to study this extensive process, an explorative qualitative methodology was chosen, using Constructivist Grounded Theory. The sampling approach was guided by the continuous analysis of the collected data, utilizing a theoretical sampling. Fifty-nine multidisciplinary healthcare and social care professionals (HSCP) from different stakeholders were recruited. Document analysis, participatory observations and semi-structured interviews were conducted and analysed according to Charmaz.

    Results: Collaborating for a comprehensive care of older people with complex care needs emerges as interlacing the different threads of care to construct seamless care. Organizational gaps and legislations divide the HSCP as they strive to perform safe care within system boundaries, limited by interdependencies and communication organized in silos. Care is integrated as HSCP assumes accountability by going above and beyond their responsibility, constructing unity for the older person and their family. Seamless care is facilitated when information systems are integrated and by mutual sharing of patient data across organizations. To achieve seamless care for older people with complex care needs, HSCP need to adapt the delivery of care to the older person’s needs and resources instead of performing care as per organizational boundaries and conditions. Further, the autonomy of older people and their families need to be strengthened, including them as partners in the collaboration and coordination of care.

    Conclusions: Care efforts for older people with complex care needs are visualized as threads that together create a comprehensive care. To weave the threads together, a collaborative effort is required, strengthening the autonomy of the older person and their family, supported by integrated information systems that coordinate the care seamlessly.

    Implications and limitations: This study contributes to the understanding of interprofessional collaboration in care transitions of older people with complex care needs. Key strengths include the rich data and multidisciplinary perspective on providing integrated care. Limitations concern the absence of patient, family and informal caregivers’ involvement which should be included in further studies.

  • 15.
    Olin, Karolina
    et al.
    Karolinska Institutet, Sweden;Adm Ctr Tyks & Hosp Dist Southwest Finla, Finland.
    Göras, Camilla
    Örebro University, Sweden;Center for Clinical Research Dalarna, Sweden;Falun Central Hospital, Sweden.
    Nilsson, Ulrica
    Karolinska Institutet, Sweden.
    Unbeck, Maria
    Karolinska Institutet, Sweden;Dalarna University, Sweden.
    Ehrenberg, Anna
    Dalarna University, Sweden.
    Pukk-Härenstam, Karin
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Karolinska Institutet, Sweden.
    Mapping registered nurse anaesthetists' intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study2022Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 1, artikel-id e052283Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Safe anaesthesia care is a fundamental part of healthcare. In a previous study, registered nurse anaesthetists (RNAs) had the highest task frequency, with the largest amount of multitasking and interruptions among all professionals working in a surgical team. There is a lack of knowledge on how these factors are distributed during the intraoperative anaesthesia care process, and what implications they might have on safety and quality of care.

    Objective To map the RNAs' work as done in practice, including tasks, multitasking, interruptions and their causes, and interactions, during all phases of the intraoperative anaesthesia work process.

    Methods Structured observations of RNAs (n=8) conducted during 30 procedures lasting a total of 73 hours in an operating department at a county hospital in Sweden, using the Work Observation Method By Activity Timing tool.

    Results High task intensity and multitasking were revealed during preparation for anaesthesia induction (79 tasks/hour, 61.9% of task time spent multitasking), anaesthesia induction (98 tasks/hour, 50.7%) and preparation for anaesthesia maintenance (86 tasks/hour, 80.2%). Frequent interruptions took place during preoperative preparation (4.7 /hour), anaesthesia induction (6.2 /hour) and preparation for anaesthesia maintenance (4.3 /hour). The interruptions were most often related to medication care (n=54, 19.8%), equipment issues (n=40, 14.7%) or the procedure itself (n=39, 14.3%). RNAs' work was conducted mostly independently (58.4%), but RNAs interacted with multiple professionals in and outside the operating room during anaesthesia.

    Conclusion The tasks, multitasking, interruptions and their causes, and interactions during different phases illustrated the RNAs' work as done, as part of a complex adaptive system. Management of safety in the most intense phases-preparing for anaesthesia induction, induction and preparing for anaesthesia maintenance-should be investigated further. The complexity and adaptivity of the nature of RNAs' work should be taken into consideration in future management, development, research and education.

  • 16.
    Lytsy, Per
    et al.
    Swedish Agency for Health Technology Assessment and Assessment of Social Services, Sweden;Karolinska Institutet, Sweden.
    Engström, Sven
    Region Jönköping County, Sweden.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Engström, Ingemar
    Örebro University, Sweden.
    Hansson, Lars
    Lund University, Sweden.
    Ali, Lilas
    University of Gothenburg, Sweden.
    Fredriksson, Maja Kärrman
    Swedish Agency for Health Technology Assessment and Assessment of Social Services, Sweden.
    Liliemark, Jan
    Swedish Agency for Health Technology Assessment and Assessment of Social Services, Sweden.
    Berg, Jenny
    Swedish Agency for Health Technology Assessment and Assessment of Social Services, Sweden.
    Outcomes associated with higher relational continuity in the treatment of persons with asthma or chronic obstructive pulmonary disease: A systematic review2022Ingår i: eClinicalMedicine, E-ISSN 2589-5370, Vol. 49, artikel-id 101492Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background

    Asthma and chronic obstructive pulmonary disease (COPD) are chronic conditions where relational continuity of care, as in regularly meeting the same health care provider, creates opportunities for monitoring and adjustment of treatment based on an individual's changing needs, potentially affecting quality of delivered care. The aim of this systematic review was to investigate the effects of relational continuity in the treatment of persons with asthma or COPD.

    Methods

    Eleven databases (CINAHL, Medline, PsycINFO, Scopus, Embase, Cochrane Library, Database of Systematic Review of Effects, DARE, Epistemonikos, NICE Evidence Search, KSR Evidence and AHRQ) were searched between January 1, 2000, and February 1 - 4, 2021, for controlled and observational studies about relational continuity and health outcomes for persons with asthma and/or COPD. Inclusion criteria were studies investigating an index or aspect relevant to relational continuity between a health professional/team of health professionals and patients. After screening, and assessment of study relevance and quality by at least two independent reviewers, studies with acceptable risk of bias were included and summary data was extracted from the publications. Main outcomes were mortality, morbidity (including health care utilization) and cost measures. Syntheses without metanalyses were performed due to considerable study heterogeneity. The certainty of the summarized result was assessed using GRADE (the Grading of Recommendations Assessment, Development and Evaluation). PROSPERO study registration number: CRD42020196518.

    Findings

    We identified 2824 unique references and included 15 studies (14 observational and 1 randomized controlled trial) in the review, from which results were derived for six outcomes. For persons with asthma or COPD we found that higher compared to lower relational continuity of care prevents premature mortality (low certainty; 2 studies, 111 545 participants), lowers risk of emergency department visits (low certainty, 5 studies, 362 305 participates) and risk of hospitalization (moderate certainty, 9 studies, 525 716 participants), and lowers health care costs (low certainty; 4 studies, 390 682 participants). Results regarding treatment adherence (1 study, 971 participants) and patient perceptions (3 studies, 2026 participants) were assessed as having very low certainty.

    Interpretation

    Low to moderate certainty evidence suggests that higher versus lower relational continuity of care for persons with asthma or COPD prevents premature mortality, lowers risks of unplanned health care utilization and reduces health care costs. The results may be of value when planning care for individuals and for policymakers in organizing health care and developing guidelines for treatment and follow-up routines.

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  • 17.
    Strandberg, Susanna
    et al.
    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). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Hagerman, Heidi
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Hellström, Amanda
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Patients' and healthcare professionals' experiences regarding patient safety when using telemonitoring of chronic diseases at home2022Ingår i: International Journal of Integrated Care, E-ISSN 1568-4156, Vol. 22, nr S3, s. 359-359Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Chronic diseases and multi-morbidity are increasing worldwide and the complexity of disease management is putting new demands on safe and secure healthcare. eHealth technology such as telemonitoring (TM) for people with chronic diseases living at home can provide opportunities to improve self-care management through the support of healthcare professionals (HCPs). However, when using TM, patients and HCPs need to feel safe in handling the technology. Since the implementation of TM increases rapidly into healthcare settings, we need to better understand whether and how TM usage affects the experience of safety among patients and HCPs.

    Aim and Method: To provide a deeper understanding of patients' and HCPs' experiences regarding patient safety when using telemonitoring of chronic diseases at home. The study had a descriptive design with a qualitative approach. Between March and May 2020, semi-structured interviews were conducted with 20 patients and 9 HCPs (nurses and physicians) working in a region in southern Sweden. Inductive content analysis guided by Graneheim and Lundman was used to analyse the interview text in Nvivo.

    Highlights: Our findings show that TM increased the feeling of shared responsibility and engaged both patients and HCPs. TM can increase the safety awareness of both patients and HCPs and enable them to create care together when monitoring the patients' disease from home. The regular measurements and close contact with HCPs increased the sense of availability to healthcare and enhanced for patients to understand their own health values, provided with insights into their own health and increased engagement in self-care. However, if the telehealth devices were used incorrectly, patient safety risks could emerge. Low health and/or digital literacy may jeopardize the benefits of TM. If the patients do not understand their own health values, they may not understand when to act if their values are deteriorating.

    Conclusions: This study suggests that TM has potential to enhance patient safety at home through patient's activation in own health and interaction with engaged HCP. It is important to focus on the patients' individual needs, preconditions, and health status to avoid risks and to use the full potential of the service.

    Implications for applicability/transferability, sustainability, and limitations: The key strength is that both HCPs and patients were involved, enabling several divergent perspectives to be included. One limitation is that the HCPs chose which patients to include, which might have biased the recruitment and limited transferability to groups with lower digital literacy than the included patients.

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  • 18.
    Fagerström, Cecilia
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Region Kalmar County, Sweden.
    Wickström, Hanna
    Lund University, Sweden;Blekinge Wound Healing Centre, Sweden.
    Tuvesson, Hanna
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Linnéuniversitetet, Kunskapsmiljöer Linné, Digitala transformationer.
    Still engaged – healthcare staff’s engagement when introducing a new eHealth solution for wound management: a qualitative study2022Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, nr 1, artikel-id 103Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    eHealth solutions have often been considered favourable for improved effectiveness and quality in healthcare services for wound management. Staff engagement related to organisational changes is a key factor for successful development and implementation of a new eHealth solution, like a digital decision support systems (DDSS). It is essential to understand the engagement process in terms of sustainability, wellbeing in staff and efficiency in a long-term perspective. The aim of this study was to describe healthcare staff’s engagement during a 6-month test of an eHealth solution (DDSS) for wound management.

    Methods

    A qualitative design, including interviews conducted with healthcare staff working with wound management within primary, community and specialist care (n = 11) on two occasions: at the introduction of the solution and after 6 months, when the test period was over. Data were interpreted with qualitative content analysis.

    Results

    Healthcare staff’s descriptions from a 6-month test of an eHealth solution for wound management can be summarised as Engaging through meaning, but draining. The analysis revealed a result with three subcategories: Having a shared interest is stimulating, Good but not perfect and Exciting, but sometimes exhausting. The staff described their engagement as sustained through feelings of meaningfulness when using the eHealth solution, but limited by feelings of exhaustion due to heavy workload and lack of support and understanding from others.

    Conclusions

    The results indicate that the healthcare staff who tested the eHealth solution described themselves as individuals who easily become engaged when an idea and efforts felt meaningful. The staff needed resources to nourish engagement in their new role when implementing eHealth in the clinical everyday work of wound management. Allocating time and support are important to consider when planning for sustainable implementation of eHealth solutions in healthcare organisations.

  • 19.
    Backåberg, Sofia
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Djukanovic, Ingrid
    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). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Hagerman, Heidi
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Lindberg, Catharina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Schildmeijer, Kristina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Tidöavtalet hotar den sömlösa vården av äldre2022Ingår i: Sydsvenskan, ISSN 1652-814X, nr 2022-11-09Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Rätt till fast läkarkontakt kan absolut vara bra, speciellt för diagnostik, bedömning och medicinsk behandling. Men det räcker inte, skriver forskare och lärare vid Linnéuniversitetet.

  • 20.
    Kaltenbrunner, Monica
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Hagerman, Heidi
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Utvärdering av boendeprocessen inom Kalmar kommun2022Rapport (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Genom bland annat omställningen till Nära vård men även utifrån en strävan att höja kvalitén inom vård- och omsorgsverksamheten har ett behov av att omstrukturera arbetsprocesser vid vård- och omsorgsboenden i Kalmar kommun uppstått. Utifrån det behovet skapades boendeprocessen som introducerades till medarbetare i verksamheterna hösten 2021 och därefter infördes praktiskt i verksamheterna i början av 2022.

    Vid organisationsförändringar är det viktigt att få kännedom om hur medarbetare och chefer uppfattat och tar till sig förändringen. Vissa individer är snabba att ta till sig av nya förändringar medan andra behöver mer tid. Genom att utvärdera införandet av boendeprocessen kan insatser kring införandet anpassas till medarbetarnas och verksamheternas behov. 

    Deltagare i utvärderingen var chefer och medarbetare (sjuksköterskor, undersköterskor, vårdbiträden, arbetsterapeuter och biståndsbedömare) vid 13 vård- och omsorgsboenden samt 8 nattenheter som arbetar med boendeprocessen i Kalmar kommun. Vid utvärderingen av införandet av boendeprocessen användes enkäten ”Implementation process assessment tool” (IPAT). Chefer och medarbetare fick besvara enkäten under första delen av 2022. Svarsfrekvens uppgick till 49% (234 deltagare). 

    Resultaten visar att verksamheterna befinner sig i början av införandet av boendeprocessen. De allra flesta chefer och medarbetare är motiverade till, och engagerade i, att föra in boendeprocessen i sin verksamhet. Många deltagarna skattade att de tror att de kan bidra till att införa boendeprocessen samt uppger att de har stöd i processen. Det framkom också att många tror att boendeprocessen kan gynna både sin egen arbetsmiljö och att den kan vara gynnsam för omsorgstagarna.  

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  • 21.
    Hedqvist, Ann-Therese
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Praetorius, Gesa
    Linnéuniversitetet, Fakulteten för teknik (FTK), Sjöfartshögskolan (SJÖ).
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Vulnerable patients in a complex system depend on interprofessional team adaptation at hospital discharge2022Ingår i: International Society For Quality In Health Care (ISQua) 38th International Conference, Brisbane, Australia, October 17-20, 2022, 2022Konferensbidrag (Refereegranskat)
    Abstract [en]

    Objectives: The highly differentiated and specialized healthcare systems are not optimally designed to provide patients with chronic conditions in need of treatment from multi-professional teams with a smooth and seamless care trajectory. Care transitions, especially hospital discharge, tend to be critical for patients' safety and health outcomes. Interprofessional team collaboration across care providers is crucial for efficient and safe care transitions, depending on dynamic and adaptive teams in the unavoidable uncertainty characterizing today's healthcare systems. 

    This study explores adaptation and maladaptations in horizontal team collaboration in care transitions of vulnerable patients with complex care needs at discharge from hospital to their private homes.

    Methods: The study was conducted in a southern region in Sweden using an ethnographic methodology with participatory observations, document review and interviews. A total of 77 professionals from hospital and primary care participated. A purposive sampling strategy was utilized to capture the interprofessional team collaboration across organizations in the patient's care transition from hospital to home. The comprehensive data was then applied to two patient cases and analysed with the Functional Resonance Analysis Method.

    Results: Successful team adaptations as well as maladaptations are revealed as homecare team and patients attempt to manage the uncontrolled conditions in the home after discharge. Maladaptations occur as the organizational capacity is insufficient to meet the needs of the patients in their home environment. The demands challenge the resources of the patient, his or her family, and the homecare team must anticipate and adapt to the unexpected to maintain patient safety. Whether the team adaptations of preparing discharge were successful or not will be revealed through adaptive outcomes or adverse events. 

    Information sharing emerges as a central prerequisite for successful team collaboration in care transitions. Flawed or insufficient access to information affected the team performance by hindering anticipating and planning for the care at home. In exacerbations of the chronic illness, information access and communication are needed to obtain a holistic view and respond to the altered care needs. For the team to adapt to the new demands, each team member require a clear understanding of their own as well as other team member’s roles and responsibilities. Ambiguity or imprecision could lead to uncertainty of who does what and where lines are drawn between organizations. 

    By interprofessional collaboration during the discharge planning, a shared understanding of treatment and care needed at home is distributed to the team as a collective cognitive mind. Through a shared mental model, the team may anticipate and prepare for the patient's arrival home. When the team collaboration failed or communication was insufficient, gaps appeared, which pressed the need for further adaptations. Successful adaptations could bridge the gaps, maintaining safe and secure care for the patient, while maladaptations posed a risk of patient harm or re-hospitalisation.

    Conclusion: To maintain patient safety in transitional care from hospital to home, adaptations to the variability of the system are not to be stifled. Instead, the system needs to allow for flexibility, promoting availability of all resources needed since these are hard to predict. Responding to unexpected events and variations requires allocated resources in the first few days of homecoming, allowing for flexibility and thus increasing patient safety.

  • 22.
    Ekstedt, Mirjam
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Karolinska Institutet, Sweden.
    Schildmeijer, Kristina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Backåberg, Sofia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). University of Calgary, Canada.
    Ljungholm, Linda
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Fagerström, Cecilia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    ‘We just have to make it work’: a qualitative study on assistant nurses’ experiences of patient safety performance in home care services using forum play scenarios2022Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 5, artikel-id e057261Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Safety is essential to support independent living among the rising number of people with long-term healthcare and social care needs. Safety performance in home care leans heavily on the capacity of unlicensed staff to respond to problems and changes in the older patients’ functioning and health. The aim of this study is to explore assistant nurses’ adaptive responses to everyday work to ensure safe care in the home care context.

    Design A qualitative approach using the drama-based learning and reflection technique forum play with subsequent group interviews. The audio-recorded interviews were transcribed and analysed with thematic analysis.

    Setting Home care services organisations providing care to older people in their private homes in two municipalities in southern Sweden.Participants Purposeful sampling of 24 assistant nurses and three managers from municipal home care services and a local geriatric hospital clinic.

    Results Home care workers’ adaptive responses to provide safe home care were driven by an ambition to ‘make it work in the best interests of the person’ by adjusting to and accommodating care recipient needs and making autonomous decisions that expanded the room for manoeuvrability, while weighing risks of a trade-off between care standards and the benefits for the community-dwelling older people’s independent living. Adaptations to ensure information transfer and knowledge acquisition across disciplines and borders required reciprocity.

    Conclusions Safety performance in home care service is dependent on the staff closest to the older people, who deal with safety risks and ethical dilemmas on a day-to-day basis and their access to information, competence, and resources that fit the demands. A proactive leadership characterised by mutual trust and adequate support for decision making is suggested. Managers and decision-makers across healthcare and social care need to consider how they can develop interprofessional collaborations and adaptive routines supporting safety from a broader perspective.

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  • 23.
    Ljungholm, Linda
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Edin-Liljegren, Anette
    Umeå University, Sweden;Region Västerbotten, Sweden.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Karolinska Institutet, Sweden.
    Klinga, Charlotte
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Karolinska Institutet, Sweden;Region Stockholm, Sweden.
    What is needed for continuity of care and how can we achieve it?: - Perceptions among multiprofessionals on the chronic care trajectory2022Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, nr 1, artikel-id 686Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Continuity of care (CoC) implies delivery of services in a coherent, logical and timely fashion. Continuity is conceptualized as multidimensional, encompassing three specific domains - relational, management and informational continuity - with emphasis placed on their interrelations, i.e., how they affect and are affected by each other. This study sought to investigate professionals' perceptions of the prerequisites of CoC within and between organizations and how CoC can be realized for people with complex care needs. Methods This study had a qualitative design using individual, paired and focus group interviews with a purposeful sample of professionals involved in the chain of care for patients with chronic conditions across healthcare and social care services from three different geographical areas in Sweden, covering both urban and rural areas. Transcripts from interviews with 34 informants were analysed using conventional content analysis. Results CoC was found to be dependent on professional and cross-disciplinary cooperation at the micro, meso and macro system levels. Continuity is dependent on long-term and person-centred relationships (micro level), dynamic stability in organizational structures (meso level) and joint responsibility for cohesive care and enabling of uniform solutions for knowledge and information exchange (macro level). Conclusions Achieving CoC that creates coherent and long-term person-centred care requires knowledge- and information-sharing that transcends disciplinary and organizational boundaries. Collaborative accountability is needed both horizontally and vertically across micro, meso and macro system levels, rather than a focus on personal responsibility and relationships at the micro level.

  • 24.
    Ljungholm, Linda
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Klinga, Charlotte
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Karolinska Institutet, Sweden.
    Edin-Liljegren, Anette
    Karolinska Institutet, Sweden;Umeå University, Sweden.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Karolinska Institutet, Sweden.
    What matters in care continuity on the chronic care trajectory for patients and family carers?—A conceptual model2022Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 31, nr 9-10, s. 1327-1338Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Abstract Aims and Objectives

    To describe essential aspects of care continuity from the perspectives of persons with complex care needs and their family carers.

    Background

    Continuity of care is an important aspect of quality, safety and efficiency. For people with multiple chronic diseases and complex care needs, care must be experienced as connected and coherent, and consistent with medical and individual needs. The more complex the need for care, the greater the need for continuity across different competencies, services and roles.

    Design

    A constructivist grounded theory approach was applied.

    Methods

    Sixteen patients with one or more chronic diseases needing both health care and social care, living in their private homes, and twelve family carers, were recruited. Semi-structured interviews were conducted and analysed with constructivist grounded theory. The COREQ checklist was followed.

    Results

    A conceptual model of care continuity was constructed, consisting of five categories that were interconnected through the core category: time and space. Patients' and family carers' experiences of care continuity were closely related to timely personalised care delivery, where access to tailored information, regardless of who was performing a care task, was essential for mutual understanding. This required clarity in responsibilities and roles, interprofessional collaboration and achieving a trusting relationship between each link in the chain of care, over time and space. To achieve care continuity, all the identified categories were important, as they worked in synergy, not in isolation.

    Conclusion

    Care continuity for people with complex care needs and family carers is experienced as multidimensional, with several essential aspects that work in synergy, but varies over time and depends on each person's own resources and situational and contextual circumstances.

    Relevance to clinical practice

    The findings promote understanding of patients' and family carers' experiences of care continuity and may guide the delivery of care to people with complex care needs.

  • 25.
    Hybinette, Karl
    et al.
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Härenstam, Karin Pukk
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Karolinska Institutet, Sweden.
    A First-line management team’s strategies for sustaining resilience in a specialised intensive care unit—a qualitative observational study2021Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 11, nr 3, artikel-id e040358Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives

    Acute care units manage high risk patients at the edge of scientifically established treatments and organisational constraints while aiming to balance reliability to standards with the needs of situational adaptation (resilience). First-line managers are central in coordinating clinical care. Any systemic brittleness will be evident only in retrospect through, for example, care quality measures and accident statistics. This challenges us to understand what successful managerial strategies for adaptation are and how they could be improved. The managerial work of balancing reliability and adaptation is only partially understood. This study aims to explore and describe how system resilience is enhanced by naturally occurring coordination performed in situ by a management team under variable circumstances.

    Design

    An explorative observational study of a tertiary neonatal intensive care unit (NICU) in Sweden. One year of broad preparatory work followed by focused shadowing observations of coordination analysed through inductive–deductive content analysis from a perspective of resilience engineering.

    Participants

    A team of managers (ie, clinical coordinators, head nurses, senior medical doctors).

    Results

    The results describe a functional relationship between operational stress and a progression of adjustments in the actual situation, expressed through recurring patterns of adaptation. Managers focused on maintaining coherence in escalating problematic situations by facilitating teamwork through goalsetting, problem-solving and circumventing the technical systems’ limitations.

    Conclusions

    Coordination supports a coherent goal setting by increased team collaboration and is supported by team members’ abilities to predict the behaviour of each other. Our findings suggest that in design of future research or training for coordination, the focus of assessment and reflection on adaptive managerial responses may lie on situations where the system was ‘stretched’ or ‘needed reorganisation’ and that learning should be about whether the actions were able to achieve short-term goals while preserving the long-term goals.

  • 26.
    Fu, Yu
    et al.
    Blekinge Institute of Technology, Sweden.
    Hu, Yan
    Blekinge Institute of Technology, Sweden.
    Sundstedt, Veronica
    Blekinge Institute of Technology, Sweden.
    Fagerström, Cecilia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    A Survey of Possibilities and Challenges with AR/VR/MR and Gamification Usage in Healthcare2021Ingår i: Proceedings of the 14th International Joint Conference on Biomedical Engineering Systems and Technologies - HEALTHINF / [ed] Pesquita, C;Fred, A;Gamboa, H, SciTePress, 2021, Vol. 5, s. 733-740Konferensbidrag (Refereegranskat)
    Abstract [en]

    Software and applications of augmented reality (AR), virtual reality (VR), and mixed reality (MR) technology combined with game/gamification techniques in healthcare have increasingly been studied in academia. However, there is a need to explore the usage, challenges and opportunities of AR/VR/MR game/gamification software/applications in the healthcare system. To explore this, we present an online survey conducted in the healthcare-relevant system (including hospital-based system, homecare-based system, institute and university, and industry). Based on the answers, we found examples of digital games and AR/VR/MR applications used in healthcare, as well as some general information (name and feature, purpose, target user, and use occasion), usage situation, and user experience. This presented survey is beneficial for both researchers and developers in computer science and medical science. It can familiarise them with existing products and their current use, advantages and potential issues of AR/VR/MR and game applications in healthcare. In future work, the survey would be extended to obtain other user experiences and feedback of AR/VR/MR techniques and game/gamification technology applied to healthcare, as well as to study how to overcome the challenges, and develop the opportunities further.

  • 27.
    Backåberg, Sofia
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Brunt, David
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Rask, Mikael
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Gummesson, Christina
    Lund University, Sweden.
    Experiences of using a video-based learning model during a long-term process of movement awareness and learning – a hermeneutical study2021Ingår i: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 23, nr 1, s. 41-47Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To explore the long-term learning process in movement awareness development supported by a video-based learning model.

    Participants: Eleven undergraduate nursing students.

    Method: The students participated in learning sessions comprising video modelling, video feedback and reflective enquiry with a focus on inter-personal interaction. Each student participated in three individual video sessions during a four-month period. Three individual interviews were carried out, the last one 12–18 months after the final session. Visual, verbal and written material were collected from the video sessions, individual interviews and diaries, and interpreted within a hermeneutical approach.

    Results: The learning process was described in three themes: motivation for change, exploring alternative perspectives and movement changes through challenges.

    Conclusions: The video-based learning model implies a challenging experience on a personal level that supports motivation and a deep approach to learning. It adds a powerful base for reflection, which encourages student-centred active learning. The facilitator’s reflective approach is essential to allow the student to explore her/his own movement, in contrast to delivering instructions. The learning model may be valuable in the physiotherapist’s clinical work in facilitating patients’ movement awareness in the process of movement improvements.

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  • 28.
    Carlqvist, Catharina
    et al.
    Karlstad University, Sweden.
    Hagerman, Heidi
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Fellesson, Markus
    Karlstad University, Sweden.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Hellström, Amanda
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Health care professionals' experiences of how an eHealth application can function as a value-creating resource - a qualitative interview study2021Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, nr 1, artikel-id 1203Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The number of patients with one or more chronic conditions is increasing globally. One strategy to achieve more sustainable care for these patients is by implementing use of home-based eHealth applications. Such services support patients to take on a more active role as value-creating co-producers of their own care, in collaboration with health care professionals. Health care professionals have a key role in the value creation process, but little is known about value formation within eHealth interactions, especially from their perspective. Therefore, this study aimed to provide a deeper understanding of how an eHealth application can function as a value-creating resource from the perspective of health care professionals. Methods: Semi-structured interviews were conducted with thirteen health care professionals (nurses, physicians and first-line managers). Qualitative content analysis was used to analyze the interviews. Results: The findings indicate that value formation processes are strongly influenced by the organizational preconditions and by the usability and functionality of technology. The experiences of the health care professionals indicated that value was conceptualized in dimensions of meaningfulness, building of relationships, building safety and feelings of trust. Although these dimensions were mainly expressed in a positive way, such as perceived improvement of medical care, accessibility and continuity, they also had a negative side that caused value destruction. This was primarily due to patient difficulties in using the application or making measurements. Subsequent efforts at value recovery resulted in value creation, but were often time-consuming for the professionals. Conclusions: This study contributes by extending conceptualizations of value to the role of health care professionals and by highlighting technology as sometimes facilitating and sometimes hampering value formation processes. The findings indicate that the eHealth application was a value-creating resource, facilitating proactive communication and supporting patients’ engagement and control over their self-care. However, for the application to become a more valuable resource in practice and counteract inequity in care, it needs to be further developed to be adapted to the needs and preconditions of patients. © 2021, The Author(s)

  • 29.
    Fagerström, Cecilia
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Region Kalmar County, Sweden.
    Welmer, Anna-Karin
    Karolinska Institutet, Sweden.
    Elmståhl, Sölve
    Lund University, Sweden.
    Tuvesson, Hanna
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Life weariness, suicidal thoughts and mortality: a sixteen-year longitudinal study among men and women older than 60 years2021Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 21, artikel-id 1359Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundSuicide in old age is a significant contributor to mortality. However, the extent to which life weariness and suicidal thoughts impact on mortality in a long-term perspective is unknown. The aim of this study was to investigate the effect of life weariness and suicidal thoughts on long-term survival (16 years) in an older Swedish population, controlling for demographic and social network factors and depression. A further aim was to investigate differences in sex and age interactions in relation to mortality among individuals with and without life weariness and suicidal thoughts.

    MethodsA longitudinal cohort study on a national, representative sample of individuals aged 60+ years was conducted within the Swedish National Study of Aging and Care study. The sample included 7213 individuals, who provided information about life weariness and suicidal thoughts through an item derived from the Montgomery-Åsberg Depression Rating Scale. Data were analysed with multivariate Cox proportional hazards models, adjusted for potential confounders.

    ResultsAt baseline, 12.5% of the participants (14.6% of females and 9.5% of males) reported life weariness and suicidal thoughts. During the 16-year follow-up, a mean survival time was 11.5 years (standard deviation (SD) 5.6), and 3804 individuals died (59.5% females and 40.5% males). Individuals with life weariness and suicidal thoughts had half the survival rate compared with those without such thoughts (24.5% vs. 50.6%), with a mean survival time of 8.4 years (SD 5.7) versus 12.0 years (SD 5.4). The multi-adjusted hazard ratio of mortality for those reporting life weariness and suicidal thoughts was 1.44 (95% confidence interval, 1.30–1.59), with the population attributable risk at 11.1%. In the models, being male or female 80+ years showed the highest multi-adjusted hazard ratio of long-term mortality (ref. female 60–69 years).

    ConclusionsThe findings suggested that life weariness and suicidal thoughts were risk factors for long-term mortality, when controlled for sex and age interactions that were found to strongly predict long-term mortality. These findings have practical implications in prevention of mortality, emphasising the importance of screening, identifying, and intercepting older men and women with signs of life weariness and suicidal thoughts.

  • 30.
    Hellström, Amanda
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Hagerman, Heidi
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Strandberg, Susanna
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Nordheim, Espen
    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). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Monitorering i hemmet: Framtidens sjukvård2021Rapport (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Digitalisering av hälso- och sjukvårdstjänster ökar, och som ett led i detta har hemmonitorering testats i en förstudie, för att senare om möjligt kunna implementeras i större skala. Hemmonitoreringen har i detta fall inneburit att patienter rapporterat in vitalparametrar samt utförd egenvård till en sjuksköterska, som mottagit och registrerat värdena. Sjuksköterskan och patienten har haft en kontinuerlig kontakt så att värden och justeringar i behandling har kunnat kommuniceras, diskuterats och följas upp. Totalt erbjöds 65 patienter med diabetes, hypertoni eller hjärtsvikt, kopplade till fem olika vårdenheter, att delta i studien. Patienterna genomförde hemmonitoreringen under 6 månader. Syftet med denna rapport var att undersöka hur hemmonitorering genom telemedicin påverkar patienternas situation i hemmet, sjukdomskontroll och vårdkonsumtion samt funktionalitet och användbarhet av hemmonitorering ur patient- och personalperspektiv.

    Resultatet visar de flesta av patienterna och vårdgivarna ansåg hemmonitoreringen som något positivt. Men för att dra bästa nytta av monitoreringen behövs avsatta personalresurser för att handha inkommande data och kommunikation med patienter kopplade till systemet, samt att patienterna har en god grundförståelse för sin sjuklighet. Tekniska aspekter som förmåga att kunna hantera rapporteringsterminal och medicinsk utrustning medförde inga större problem för patienterna i studien, och många ansåg systemet lätt att lära sig, lätt att integrera i dagliga rutiner samt att det inte tog så mycket tid i anspråk. Hemmonitorering tycks lämpa sig för många olika patientgrupper, men vid utbyggnad av användandet kan det vara hjälpfullt att göra detta genom samskapande processer med patienter, anhöriga och involverad vårdpersonal, så att innehåll och utformning matchar de behov som finns för patientgruppen.

    I föreliggande rapport har inga aspekter gällande cybersäkerhet undersökts, men detta kan vara en aspekt att ta hänsyn till då känslig information delas trådlöst mellan patient och vårdgivare.

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  • 31.
    Wennerberg, Camilla
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Region Kalmar County, Sweden.
    Schildmeijer, Kristina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Hellström, Amanda
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Karolinska Institutet, Sweden.
    Patient Experiences of Self-Care Management after Radical Prostatectomy2021Ingår i: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 50, artikel-id 101894Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Prostate cancer is the most common cancer form in Sweden and side effects of the leading treatment, radical prostatectomy, include urinary leakage and erectile dysfunction. Patients are recommended to perform self-care to reduce side effects, but their experiences of performing self-care management after radical prostatectomy are largely unexplored. The aim of this study was to deepen the understanding about patient experiences of support for managing self-care during the first six months after radical prostatectomy.

    Methods: Eighteen patients were consecutively recruited six months after surgery and individual interviews were conducted. The study had a descriptive qualitative approach and inductive content analysis was used. Results: Patients described self-care management during the first half-year after surgery as a progression with growth in self-management skills through interconnected phases, from initially striving to get a grasp of the situation and find supportive relationships, to getting grounded in the new situation and taking command of the situation. At six months after surgery, patients had reached a point where they needed to maneuver feelings about long-term consequences.

    Conclusions: Standardized routines ensure a certain level of care, but are sparsely adjustable to patients & rsquo; progression in self-care management. For sustained self-care behaviors, tailored and interactive support is required from multiple disciplines and peers, in order for a patient to get grounded in and take command of the situation.

  • 32.
    Gustafsson, Ingrid
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Rask, Mikael
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Schildmeijer, Kristina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Elmqvist, Carina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Region Kronoberg, Sweden.
    Patients experience of warmth and coldness in connection with surgery – a phenomenological study2021Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 16, nr 1, artikel-id 1858540Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The aim was to describe patients' lived experience of warmth and coldness in connection with surgery.

    Methods: A reflective lifeworld research (RLR) approach founded on phenomenology and the methodological principles of openness, flexibility, and bridling were used. The data consisted of 16 in-depth interviews with patients from four hospitals in Sweden.

    Results: Warmth and coldness in connection with surgery means an expectation to maintain one ' s daily life temperature comfort. When patients' needs of temperature comfort is fulfilled it give a sense of well-being and calmness. Despite the body is covered there are feelings of vulnerability. When patients have the ability to change their own temperature comfort, they feel independent.

    Conclusion: The individual feeling of temperature comfort could be affected or changed to discomfort during the perioperative context, and an intervention is required to avoid suffering due to the care. An ability to independently influence one ' s own temperature comfort can strengthen the patient, whereas the opposite entails suffering in silence. The phenomenon is also related to feelings of confidence about receiving the best care as well as being exposed and vulnerable. When the patient ' s need of comfortable temperature is met then feelings of security and sense of well-being emerged.

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  • 33.
    Bjurling‐Sjöberg, Petronella
    et al.
    Uppsala University, Sweden;Region Sörmland, Sweden.
    Göras, Camilla
    Region Dalarna, Sweden;Dalarna University, Sweden.
    Lohela-Karlsson, Malin
    Uppsala University, Sweden;Region Västmanland, Sweden.
    Nordgren, Lena
    Uppsala University, Sweden;Region Sörmland, Sweden.
    Källberg, Ann-Sofie
    Dalarna University, Sweden;Region Dalarna, Sweden.
    Castegren, Markus
    Uppsala University, Sweden;Region Sörmland, Sweden;Karolinska Institutet, Sweden.
    Condén Mellgren, Emelie
    Uppsala University, Sweden;Region Västmanland, Sweden.
    Holmberg, Mats
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Uppsala University, Sweden;Region Sörmland, Sweden.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Karolinska Institutet, Sweden.
    Resilient performance in healthcare during the COVID-19 pandemic (ResCOV): study protocol for a multilevel grounded theory study on adaptations, working conditions, ethics and patient safety2021Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 11, nr 12, artikel-id e051928Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction

    Since early 2020, the COVID-19 pandemic has challenged societies and revealed the built-in fragility and dependencies in complex adaptive systems, such as healthcare. The pandemic has placed healthcare providers and systems under unprecedented amounts of strain with potential consequences that have not yet been fully elucidated. This multilevel project aims to explore resilient performance with the purpose of improving the understanding of how healthcare has adapted during the pandemic’s rampage, the processes involved and the consequences on working conditions, ethics and patient safety.

    Methods

    An emerging explorative multilevel design based on grounded theory methodology is applied. Open and theoretical sampling is performed. Empirical data are gathered over time from written narratives and qualitative interviews with staff with different positions in healthcare organisations in two Swedish regions. The participants’ first-person stories are complemented with data from the healthcare organisations’ internal documents and national and international official documents.

    Analysis

    Experiences and expressions of resilient performance at different system levels and times, existing influencing risk and success factors at the microlevels, mesolevels and macrolevels and inter-relationships and consequences in different healthcare contexts, are explored using constant comparative analysis. Finally, the data are complemented with the current literature to develop a substantive theory of resilient performance during the pandemic.

    Ethics and dissemination

    This project is ethically approved and recognises the ongoing strain on the healthcare system when gathering data. The ongoing pandemic provides unique possibilities to study system-wide adaptive capacity across different system levels and times, which can create an important basis for designing interventions focusing on preparedness to manage current and future challenges in healthcare. Feedback is provided to the settings to enable pressing improvements. The findings will also be disseminated through scientific journals and conferences.

  • 34.
    Brandberg, Carina
    et al.
    Karolinska Institutet, Sweden.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Karolinska Institutet, Sweden.
    Flink, Maria
    Karolinska Institutet, Sweden.
    Self-management challenges following hospital discharge for patients with multimorbidity: a longitudinal qualitative study of a motivational interviewing intervention2021Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 11, nr 7, artikel-id e046896Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives

    The aim of this study was to describe challenges in self-management activities among people with multimorbidity during a 4-week post-discharge period.

    Design

    This is a longitudinal qualitative study using data from a randomised controlled trial (RCT) of motivational interviewing (MI) sessions.

    Setting

    The RCT was conducted at six wards in two hospitals—one university hospital and one general hospital in Stockholm, Sweden, during 2016–2018.

    Participants

    Sixteen participants from the intervention group, diagnosed with heart failure or chronic obstructive pulmonary disease and at least one other chronic condition, were purposively selected for this study.

    Interventions

    Each participant had four or five post-discharge MI sessions with a trained social worker during a period of approximately 4 weeks. The sessions were recorded digitally and analysed using content analysis. Altogether, 70 recorded sessions were analysed.

    Results

    Self-management after hospital discharge was a dynamic process with several shifting features that evolved gradually over time. Patients with multimorbidity experienced two major challenges with self-management in the first 4 weeks following hospital discharge: ‘Managing a system-centred care’ and ‘Handling the burden of living with multiple illnesses at home post-discharge’.

    Conclusions

    Self-management for patients with multimorbidity in the first post-discharge period does not equate to a fixed set of tasks, but varies over the post-discharge period. Self-management challenges include not only the burden of the disease itself, but also that of navigating and understanding the healthcare system. Hence, self-management support post-discharge involves both aiding patients with care coordination and meeting their gradually shifting disease-related needs.

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  • 35.
    Hefni, Mohammed E.
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för kemi och biomedicin (KOB). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Mansoura Univ, Egypt.
    Bergström, Maria
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för kemi och biomedicin (KOB). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Lennqvist, Torbjörn
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för biologi och miljö (BOM).
    Fagerström, Cecilia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Witthöft, Cornelia M.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för kemi och biomedicin (KOB). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Simultaneous quantification of trimethylamine N-oxide, trimethylamine, choline, betaine, creatinine, and propionyl-, acetyl-, and L-carnitine in clinical and food samples using HILIC-LC-MS2021Ingår i: Analytical and Bioanalytical Chemistry, ISSN 1618-2642, E-ISSN 1618-2650, Vol. 413, s. 5349-5360Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Trimethylamine-N-oxide (TMAO), a microbiome-derived metabolite from the metabolism of choline, betaine, and carnitines, is associated to adverse cardiovascular outcomes. A method suitable for routine quantification of TMAO and its precursors (trimethylamine (TMA), choline, betaine, creatinine, and propionyl-, acetyl-, and l-carnitine) in clinical and food samples has been developed based on LC-MS. TMA was successfully derivatized using iodoacetonitrile, and no cross-reactions with TMAO or the other methylamines were detected. Extraction from clinical samples (plasma and urine) was performed after protein precipitation using acetonitrile:methanol. For food samples (meatballs and eggs), water extraction was shown to be sufficient, but acid hydrolysis was required to release bound choline before extraction. Baseline separation of the methylamines was achieved using a neutral HILIC column and a mobile phase consisting of 25 mmol/L ammonium formate in water:ACN (30:70). Quantification was performed by MS using external calibration and isotopic labelled internal standards. The assay proved suitable for both clinical and food samples and was linear from approximate to 0.1 up to 200 mu mol/L for all methylamines except for TMA and TMAO, which were linear up to 100 mu mol/L. Recoveries were 91-107% in clinical samples and 76-98% in food samples. The interday (n=8, four duplicate analysis) CVs were below 9% for all metabolites in clinical and food samples. The method was applied successfully to determine the methylamine concentrations in plasma and urine from the subjects participating in an intervention trial (n=10) to determine the effect of animal food ingestion on methylamine concentrations.

  • 36.
    Lincke, Alisa
    et al.
    Linnéuniversitetet, Fakulteten för teknik (FTK), Institutionen för datavetenskap och medieteknik (DM).
    Fagerström, Cecilia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Region Kalmar County, Sweden.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Karolinska Institutet, Sweden.
    Löwe, Welf
    Linnéuniversitetet, Fakulteten för teknik (FTK), Institutionen för datavetenskap och medieteknik (DM).
    Backåberg, Sofia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Skeleton avatar technology as a way to measure physical activity in healthy older adults2021Ingår i: Informatics in Medicine Unlocked, ISSN 2352-9148, Vol. 24, artikel-id 100609Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Nowadays, self-reported assessments (SA) and accelerometer-based assessments (AC) are commonly used methods to measure daily life physical activity (PA) in older adults. SA is simple, cost-effective, and can be used in large epidemiological studies, but its reliability and validity have been questioned. Accelerometer measurement has proven valid to provide accurate and reliable measurement of everyday life physical activities regarding frequency, duration, and intensity in older populations, but is expensive and requires a long-time measurement. Here is, furthermore, a lack of well-defined and reliable accelerometer cut-off points to measure PA among older adults. Therefore, there is a need to develop a simple and reliable method to complement/replace self-assessment methods of daily life physical activity and facilitate the future development of cut-off points to measure daily life physical activities among older adults. In this study, we explore how skeleton avatar technology (SAT) can be used to measure PA among older adults.

    Objectives

    1. To explore the association between accelerometer data and self-reported assessment data of daily life physical activities in older adults, and 2. To explore how the SAT of a standardized functional (balance) test can be used to measure daily life physical activity among older adults.

    Method

    The correlation analysis was used to explore the association between response variables, and deep neural networks were used to predict the response variables (AC and SA outcomes).

    Results

    The results indicate that there is a moderate (r = 0.31) significant (p = 0.029) correlation between AC of PA and SA of PA. The functional balance test assessed with SAT was able to predict AC with 3.89% Mean Absolute Error (MAE), and SA with 11.07% MAE.

    Conclusion

    Overall, these results indicate that one functional balance test measured with SAT can be used to predict PA outcomes measured with accelerometer devices. SAT can predict PA outcomes better than SA outcomes within the same population. More research is needed to explore the ability of SAT predicting PA among older adults with various functional abilities, and how SAT can be developed using 2D recordings, such as mobile phone recordings, to predict PA efficiently.

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  • 37.
    Engström, Maria
    et al.
    University of Gävle, Sweden;Uppsala University, Sweden;Lishui University, China.
    Högberg, Hans
    University of Gävle, Sweden.
    Strömberg, Annika
    University of Gävle, Sweden.
    Hagerman, Heidi
    University of Gävle, Sweden.
    Skytt, Bernice
    University of Gävle, Sweden;Uppsala University, Sweden.
    Staff Working Life and Older Persons' Satisfaction With Care: A Multilevel, Correlational Design2021Ingår i: Journal of Nursing Care Quality, ISSN 1057-3631, E-ISSN 1550-5065, Vol. 36, nr 1, s. E7-E13Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: 

    The importance of staff working life for staff well-being has been demonstrated in several studies; less research has focused on staff working life and older persons' satisfaction with care.

    Purpose: 

    The study aim was to study relationships between 1) staff assessments of their structural conditions/empowerment in elderly care, psychological empowerment, and job satisfaction and (2) older persons' satisfaction with care.

    Methods: 

    A multilevel, cross-sectional, and correlational design was applied using questionnaire data on working life (1021 staff members) and unit-level data (40 elderly care units) on older persons' satisfaction with care.

    Results: 

    Statistically significant relationships were found between all 3 working life variables and older persons' satisfaction with care. Furthermore, the results revealed an indirect/mediating effect of job satisfaction between structural empowerment and satisfaction with care, but not for psychological empowerment.

    Conclusions: 

    Staff structural empowerment, psychological empowerment, and job satisfaction are linked to older persons' satisfaction with care.

  • 38.
    Wranker, Lena Sandin
    et al.
    Lund University, Sweden;University of Gothenburg, Sweden.
    Elmstahl, Solve
    Lund University, Sweden.
    Fagerström, Cecilia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Region Blekinge, Sweden.
    The Health of Older Family Caregivers - A 6-Year Follow-up2021Ingår i: Journal of gerontological social work, ISSN 0163-4372, E-ISSN 1540-4048, Vol. 64, nr 2, s. 190-207Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It is unclear whether caregiving has an impact on the physical, mental and functional health of older caregivers. This study aimed to describe physical, mental and functional health in relation to family caregiving in old age (60+) over a six-year period. The study comprised 2,294 randomly selected individuals (60-96 years) from the Swedish National Study on Aging and Care, who answered the question on whether they were caregivers and who were followed up six years later. The prevalence of family caregivers was 13.1% and the incidence was 12.4%. Four tracks (T) were identified; T1) Family caregiver both at baseline and follow-up (n = 74), T2) Family caregiver at baseline but not at follow-up (n = 226), T3) non-caregiver at baseline but family caregiver at follow-up (n = 218), T4) non-caregiver both at baseline and follow-up (1,776). Only non-caregivers (T4) reported a decline in mental health, p < .036. Worries about health increased significantly in T2 and T4. The prevalence of caregivers was 13.1% with a high turnover. There are differences between family caregivers and non-caregivers in deterioration in physical and mental health as well as physical function over a six-year period.

  • 39.
    Fagerström, Cecilia
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Region Blekinge, Sweden.
    Elmståhl, Sölve
    Lund University, Sweden.
    Wranker, Lena Sandin
    Lund University, Sweden.
    Analyzing the situation of older family caregivers with a focus on health-related quality of life and pain: a cross-sectional cohort study2020Ingår i: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 18, nr 1, s. 1-10, artikel-id 79Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background For a significant proportion of the older population, increasing age is associated with health problems and worsening health. Older family caregivers are largely responsible for care of next-of-kin living at home, which impacts their own physical and mental health both positively and negatively. However, evidence is insufficient regarding the health situation of older caregivers. The aim of this study was to investigate health-related quality of life (HRQoL) and pain, and their associations, among caregivers aged >= 60 years. Methods The participants (n = 3444) were recruited from the Swedish National Study on Aging and Care-Blekinge and Good Aging in Skane during 2001-2004. Participants aged >= 60 years were selected randomly and underwent cognitive tests, with demographic information obtained through questionnaires. The response rate was 60%. A predefined research protocol was used. HRQoL was measured with the Short-Form Health Survey, dimension mental health. Logistic regression models were used to investigate the associations between HRQoL and pain as well as control factors. Results Family caregiving was reported by 395 (11.5%) of the participants, and 56.7% of the caregivers reported pain. Family caregivers reported lower pain intensity on the Visual Analogue Scale and were younger, on median, than non-caregivers. Irrespective of caregiver status, pain was associated with mental HRQoL. Concerns about personal health and financial status had the strongest associations with mental HRQOL in both groups, but the levels were higher among caregivers. Conclusion Pain was one factor associated with low HRQoL regardless of family caregiver status and remained important when controlling for factors related to advanced age. This finding remained among family caregivers, though they reported lower pain intensity. Factors other than pain were shown to be important to mental HRQoL and should also be taken into consideration when discussing actions for family caregivers to maintain and improve health and HRQoL.

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  • 40.
    Nilsen, Per
    et al.
    Linköping University, Sweden.
    Seing, Ida
    Linköping University, Sweden.
    Ericsson, Carin
    Linköping University, Sweden;Region Östergötland, Sweden.
    Birken, Sarah A.
    University of North Carolina at Chapel Hill, USA.
    Schildmeijer, Kristina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses2020Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 20, nr 1, s. 1-8, artikel-id 147Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Health care organizations are constantly changing as a result of technological advancements, ageing populations, changing disease patterns, new discoveries for the treatment of diseases and political reforms and policy initiatives. Changes can be challenging because they contradict humans’ basic need for a stable environment. The present study poses the question: what characterizes successful organizational changes in health care? The aim was to investigate the characteristics of changes of relevance for the work of health care professionals that they deemed successful.

    Methods

    The study was based on semi-structured interviews with 30 health care professionals: 11 physicians, 12 registered nurses and seven assistant nurses employed in the Swedish health care system. An inductive approach was applied using questions based on the existing literature on organizational change and change responses. The questions concerned the interviewees’ experiences and perceptions of any changes that they considered to have affected their work, regardless of whether these changes were “objectively” large or small changes. The interviewees’ responses were analysed using directed content analysis.

    Results

    The analysis yielded three categories concerning characteristics of successful changes: having the opportunity to influence the change; being prepared for the change; valuing the change. The interviewees emphasized the importance of having the opportunity to influence the organizational changes that are implemented. Changes that were initiated by the professionals themselves were considered the easiest and were rarely resisted. Changes that were clearly communicated to allow for preparation increased the chances for success. The interviewees did not support organizational changes that were perceived to be implemented unexpectedly and/or without prior communication. They conveyed that it was important for them to understand the need for and benefits of organizational changes. They particularly valued and perceived as successful organizational changes with a patient focus, with clear benefits to patients.

    Conclusions

    Organizational changes in health care are more likely to succeed when health care professionals have the opportunity to influence the change, feel prepared for the change and recognize the value of the change, including perceiving the benefit of the change for patients.

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  • 41.
    Karlsson, Jonas
    et al.
    University of Borås, Sweden.
    Eriksson, Thomas
    University of Borås, Sweden.
    Lindahl, Berit
    University of Borås, Sweden.
    Schildmeijer, Kristina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Fridh, Isabell
    University of Borås, Sweden;Sahlgrenska university hospital, Sweden.
    Critical care nurses' lived experiences of interhospital intensive care unit-to-unit transfers: A phenomenological hermeneutical study2020Ingår i: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 61, s. 1-7, artikel-id 102923Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To explore critical care nurses' lived experiences of transferring intensive care patients between hospitals. Methods: A phenomenological hermeneutic approach using data generated through individual inter-views with 11 critical care registered nurses. Setting: Two general intensive care units in Sweden. Findings: Five themes were identified: it depends on me; your care makes a difference; being exposed; depending on interprofessional relationships; and sensing professional growth. These themes were synthesised into a comprehensive understanding showing how transferring intensive care patients between hospitals meant being on an ambivalent journey together with the patient but also on a journey within yourself in your own development and growth, where you, as a nurse, constantly are torn between contradictory feelings and experiences. Conclusion: Interhospital intensive care unit-to-unit transfers can be a challenging task for critical care nurses but also an important opportunity for professional growth. During the transfer, nurses become responsible for the patient, their colleagues and the entire transfer process. In a time of an increasing number of interhospital intensive care unit-to-unit transfers, this study illuminates the risk for missed nursing care, showing that the critical care nurse has an important role in protecting the patient from harm and safeguarding dignified care. (C) 2020 Elsevier Ltd. All rights reserved.

  • 42.
    Backåberg, Sofia
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). University of Calgary, Canada.
    Hellström, Amanda
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Fagerström, Cecilia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Region Kalmar County, Sweden.
    Halling, Anders
    Lund University, Sweden.
    Lincke, Alisa
    Linnéuniversitetet, Fakulteten för teknik (FTK), Institutionen för datavetenskap och medieteknik (DM).
    Löwe, Welf
    Linnéuniversitetet, Fakulteten för teknik (FTK), Institutionen för datavetenskap och medieteknik (DM).
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Karolinska Institutet, Sweden.
    Evaluation of the Skeleton Avatar Technique for Assessment of Mobility and Balance Among Older Adults2020Ingår i: Frontiers of Computer Science, ISSN 2095-2228, E-ISSN 2095-2236, Vol. 2, artikel-id 601271Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Mobility and balance is essential for older adults’ well-being an independence and the ability tomaintain physically active. Early identification of functionalimpairmentmay enable early risk-of-fall assessments and preventivemeasures.  There is a need to find new solutions to assess functional ability in easy, efficient, and accurateways, which can be clinically used frequently and repetitively. Therefore, we need to understand how functional tests and expert assessments (EAs) correlate with new techniques.

    Objective: To explore whether the skeleton avatar technique (SAT) can predict the results of functional tests (FTs) of mobility and balance: Timed Up and Go (TUG), the 30-s chair stand test (30sCST), the 4-stage balance test (4SBT), and EA scoring of movement quality.

    Methods: Fifty-four older adults (+65 years) were recruited through pensioners’ associations. The test procedure contained three standardized FTs: TUG, 30sCST, and 4SBT. The test performances were recorded using a three-dimensional SAT camera. EA scoring was performed based on the video recordings of the 30sCST. Functional ability scores were aggregated from balance and mobility scores. Probability theory-based statistical analyses were used on the data to aggregate sets of individual variables into scores, with correlation analysis used to assess the dependency between variables and between scores. Machine learning techniques were used to assess the appropriateness of easily observable variables/scores as predictors of the other variables included.

    Results: The results indicate that SAT data of the fourth 4SBT stage could be used to predict the aggregated results of all stages of 4SBT (with 7.82% mean absolute error), the results of the 30sCST (11.0%), the TUG test (8.03%), and the EA of the sit-to-stand movement (8.79%). There is a moderate (significant) correlation between the 30sCST and the 4SBT (0.31, p = 0.03), but not between the EA and the 30sCST.

    Conclusion: SAT can predict the results of the 4SBT, the 30sCST (moderate accuracy), and the TUG test and might add important qualitative information to the assessment of movement performance in active older adults. SAT might in the future provide the means for a simple, easy, and accessible assessment of functional ability among older adults.

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  • 43.
    Hommel, Ami
    et al.
    Malmö University, Sweden;Skåne University Hospital, Sweden.
    Magneli, Martin
    Karolinska Institutet, Sweden;Danderyd Hospital, Sweden.
    Samuelsson, Bodil
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Schildmeijer, Kristina
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Sjöstrand, Desiree
    Region Skåne, Sweden.
    Göransson, Katarina E.
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Unbeck, Maria
    Karolinska University Hospital, Sweden;Karolinska Institutet, Sweden.
    Exploring the incidence and nature of nursing-sensitive orthopaedic adverse events: A multicenter cohort study using Global Trigger Tool2020Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 102, s. 1-9, artikel-id 103473Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: For decades, patient safety has been recognized as a critical global healthcare issue. However, there is a gap of knowledge of all types of adverse events sensitive to nursing care within hospitals in general and within orthopaedic care specifically. Objectives: The aim of this study is to explore the incidence and nature of nursing-sensitive adverse events following elective or acute hip arthroplasty at a national level. Design: A retrospective multicenter cohort study. Outcome variables: Nursing-sensitive adverse events, preventability, severity and length of stay. Methods: All patients, 18 years or older, who had undergone an elective (degenerative joint disease) or acute (fractures) hemi or total hip arthroplasty surgery at 24 hospitals were eligible for inclusion. Retrospective reviews of weighted samples of 1998 randomly selected patient records were carried out using the Swedish version of the Global Trigger Tool. The patients were followed for readmissions up to 90 days postoperatively throughout the whole country regardless of index hospital. Results: A total of 1150 nursing-sensitive adverse events were identified in 728 (36.4%) of patient records, and 943 (82.0%) of the adverse events were judged preventable in the study cohort. The adjusted cumulative incidence regarding nursing-sensitive adverse events for the study population was 18.8%. The most common nursing-sensitive adverse event types were different kinds of healthcare-associated infections (40.9%) and pressure ulcers (16.5%). Significantly higher proportions of nursing-sensitive adverse events were found among female patients compared to male, p < 0.001, and patients with acute admissions compared to elective patients, p < 0.001. Almost half (48.5%) of the adverse events were temporary and of a less severe nature. On the other hand, 592 adverse events were estimated to have contributed to 3351 extra hospital days. Conclusions: This study shows the magnitude of nursing-sensitive adverse events. We found that nursing-sensitive adverse events were common, in most cases deemed preventable and were associated with different kinds of adverse events and levels of severity in orthopaedic care. Registered nurses play a vital role within the interdisciplinary team as they are the largest group of healthcare professionals, work 24/7 and spend much time at the bedside with patients. Therefore, nursing leadership at all hospital levels must assume responsibility for patient safety and authorize bedside registered nurses to deliver high-quality and sustainable care to patients. (C) 2019 The Authors. Published by Elsevier Ltd.

  • 44.
    Wickström, Hanna
    et al.
    Lund University, Sweden;Blekinge Wound Healing Centre, Sweden.
    Tuvesson, Hanna
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Linnéuniversitetet, Kunskapsmiljöer Linné, Digitala transformationer.
    Öien, Rut
    Blekinge Centre of Competence, Sweden.
    Midlöv, Patrik
    Lund University, Sweden.
    Fagerström, Cecilia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa.
    Health care staff's experiences of engagement when introducing a digital decision support system for wound management: qualitative study2020Ingår i: JMIR Human Factors, E-ISSN 2292-9495, Vol. 7, nr 4, s. 1-10, artikel-id e23188Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: eHealth solutions such as digital decision support systems (DDSSs) have the potential to assist collaborationbetween health care staff to improve matters for specific patient groups. Patients with hard-to-heal ulcers have long healing timesbecause of a lack of guidelines for structured diagnosis, treatment, and follow-up. Multidisciplinary collaboration in woundmanagement teams is essential. A DDSS could offer a way of aiding improvement within wound management. The introductionof eHealth solutions into health care is complicated, and the engagement of the staff seems crucial. Factors influencing andaffecting engagement need to be understood and considered for the introduction of a DDSS to succeed.

    Objective: This study aims to describe health care staff’s experiences of engagement and barriers to and influencers of engagementwhen introducing a DDSS for wound management.

    Methods: This study uses a qualitative approach. Interviews were conducted with 11 health care staff within primary (n=4),community (n=6), and specialist (n=1) care during the start-up of the introduction of a DDSS for wound management. Theinterviews focused on the staff’s experiences of engagement. Content analysis by Burnard was used in the data analysis process.

    Results: A total of 4 categories emerged describing the participants’ experiences of engagement: a personal liaison, a professionalcommitment, an extended togetherness, and an awareness and understanding of the circumstances.

    Conclusions: This study identifies barriers to and influencers of engagement, reinforcing that staff experience engagementthrough feeling a personal liaison and a professional commitment to make things better for their patients. In addition, engagementis nourished by sharing with coworkers and by active support and understanding from leadership.

  • 45.
    Lindblad, Marléne
    et al.
    KTH Royal Institute of Technology, Sweden;Ersta Sköndal Bräcke University College, Sweden.
    Unbeck, Maria
    Karolinska institutet, Sweden;Karolinska University Hospital, Sweden.
    Nilsson, Lena
    Linköping University, Sweden.
    Schildmeijer, Kristina
    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). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Karolinska institutet, Sweden.
    Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology2020Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 20, nr 1, s. 1-11, artikel-id 289Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Patient safety in home healthcare is largely unexplored. No-harm incidents may give valuable information about risk areas and system failures as a source for proactive patient safety work. We hypothesized that it would be feasible to retrospectively identify no-harm incidents and thus aimed to explore the cumulative incidence, preventability, types, and potential contributing causes of no-harm incidents that affected adult patients admitted to home healthcare.

    Methods

    A structured retrospective record review using a trigger tool designed for home healthcare. A random sample of 600 home healthcare records from ten different organizations across Sweden was reviewed.

    Results

    In the study, 40,735 days were reviewed. In all, 313 no-harm incidents affected 177 (29.5%) patients; of these, 198 (63.2%) no-harm incidents, in 127 (21.2%) patients, were considered preventable. The most common no-harm incident types were “fall without harm,” “deficiencies in medication management,” and “moderate pain.” The type “deficiencies in medication management” was deemed to have a preventability rate twice as high as those of “fall without harm” and “moderate pain.” The most common potential contributing cause was “deficiencies in nursing care and treatment, i.e., delayed, erroneous, omitted or incomplete treatment or care.”

    Conclusion

    This study suggests that it is feasible to identify no-harm incidents and potential contributing causes such as omission of care using record review with a trigger tool adapted to the context. No-harm incidents and potential contributing causes are valuable sources of knowledge for improving patient safety, as they highlight system failures and indicate risks before an adverse event reach the patient.

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  • 46.
    Backåberg, Sofia
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Observational Movement Analysis Association in Sweden, Sweden.
    Kimming, Anna
    Observational Movement Analysis Association in Sweden, Sweden.
    Peter, Kraft
    Spetsamossens Fysioterapi, Sweden.
    Christina, Reifeldt
    Hjälpmedelcenter Sverige, Sweden.
    IRAF - Instrument for Movement Analysis of Person Transfer and Mobility in Daily Living2020Rapport (Övrigt vetenskapligt)
    Abstract [en]

    IRAF is an instrument developed to support education, communication and assessment within the field of safe and gentle person transfers. IRAF encompasses both the level of independence and the qualitative aspects of the movement performance to clarify the individual’s need of support in daily life transfers to guide how to provide safe and adequate support, i.e., in what way, how much and in what stage of the transfer. Additionally, the aim is to create a common language for person transfers among patients, healthcare providers, family care givers, and teachers within different contexts, such as hospitals, rehabilitation centres, home care and educational institutions. The IRAF is today a paper-based instrument and is currently under development in a digital format.

    The purpose of IRAF is to provide structure for and facilitate the analysis and assessment of an individual’s mobility in physical activities in daily living to enhance understanding and communication of an individual’s level of independence(LI) and the quality of movement performance (MP). 

     

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    IRAF - Instrument for Movement Analysis of Person Transfer and Mobility in Daily Living
  • 47.
    Göras, Camilla
    et al.
    Dalarna University, Sweden;Falun Central Hospital, Sweden.
    Nilsson, Ulrica
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Karolinska Institutet, Sweden.
    Unbeck, Maria
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Ehrenberg, Anna
    Dalarna University, Sweden.
    Managing complexity in the operating room: a group interview study2020Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 20, nr 1, s. 1-12, artikel-id 440Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Clinical work in the operating room (OR) is considered challenging as it is complex, dynamic, and often time- and resource-constrained. Important characteristics for successful management of complexity include adaptations and adaptive coordination when managing expected and unexpected events. However, there is a lack of explorative research addressing what makes things go well and how OR staff describe they do when responding to challenges and compensating for constraints. The aim of this study was therefore to explore how complexity is managed as expressed by operating room nurses, registered nurse anesthetists, and surgeons, and how these professionals adapt to create safe care in the OR. Method Data for this qualitative explorative study were collected via group interviews with three professional groups of the OR-team, including operating room nurses, registered nurse anesthetists and operating and assisting surgeons in four group interview sessions, one for each profession except for ORNs for which two separate interviews were performed. The audio-taped transcripts were transcribed verbatim and analyzed by inductive qualitative content analysis. Results The findings revealed three generic categories covering ways of creating safe care in the OR: preconditions and resources, planning and preparing for the expected and unexpected, and adapting to the unexpected. In each generic category, one sub-category emerged that was common to all three professions: coordinating and reaffirming information, creating a plan for the patient and undergoing mental preparation, and prioritizing and solving upcoming problems, respectively. Conclusion Creating safe care in the OR should be understood as a process of planning and preparing in order to manage challenging and complex work processes. OR staff need preconditions and resources such as having experience and coordinating and reaffirming information, to make sense of different situations. This requires a mental model, which is created through planning and preparing in different ways. Some situations are repetitive and easier to plan for but planning for the unexpected requires anticipation from experience. The main results strengthen that abilities described in the theory of resilience are used by OR staff as a strategy to manage complexity in the OR.

  • 48.
    Tuvesson, Hanna
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Linnéuniversitetet, Kunskapsmiljöer Linné, Digitala transformationer.
    Eriksén, Sara
    Blekinge Institute of Technology, Sweden.
    Fagerström, Cecilia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Linnéuniversitetet, Kunskapsmiljöer Linné, Hållbar hälsa. Region Blekinge, Sweden.
    mHealth and engagement concerning persons with somatic health conditions:: Integrative literature review2020Ingår i: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 8, nr 7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Chronic somatic health conditions are a global public health challenge. Being engaged in one's own health management for such conditions is important, and mobile health (mHealth) solutions are often suggested as key to promoting engagement. Objective: The aim of this study was to review, critically appraise, and synthesize the available research regarding engagement through mHealth for persons with chronic somatic health conditions. Methods: An integrative literature review was conducted. The PubMed, CINAHL, and Inspec databases were used for literature searches. Quality assessment was done with the guidance of Critical Appraisal Skills Programme (CASP) checklists. We used a self-designed study protocol comprising 4 engagement aspects-cognitive, behavioral and emotional, interactional, and the usage of mHealth-as part of the synthesis and analysis. Results: A total of 44 articles met the inclusion criteria and were included in the analysis. mHealth usage was the most commonly occurring engagement aspect, behavioral and emotional aspects the second, cognitive aspects the third, and interactional aspects of engagement the least common aspect in the included articles. The results showed that there is a mix of enablers and barriers to engagement in relation to the 4 engagement aspects. The perceived meaningfulness and need for the solution and its content were important to create and maintain engagement. When perceived as meaningful, suitable, and usable, mHealth can support knowledge gain and learning, facilitate emotional and behavioral aspects such as a sense of confidence, and improve interactions and communications with