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Wallin, Lars
Publications (10 of 39) Show all publications
Kislov, R., Wilson, P., Cummings, G., Ehrenberg, A., Gifford, W., Kelly, J., . . . Harvey, G. (2019). From Research Evidence to “Evidence by Proxy”?: Organizational Enactment of Evidence-Based Health Care in Four High-Income Countries. PAR. Public Administration Review
Open this publication in new window or tab >>From Research Evidence to “Evidence by Proxy”?: Organizational Enactment of Evidence-Based Health Care in Four High-Income Countries
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2019 (English)In: PAR. Public Administration Review, ISSN 0033-3352, E-ISSN 1540-6210Article in journal (Refereed) Epub ahead of print
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30082 (URN)10.1111/puar.13056 (DOI)2-s2.0-85065200893 (Scopus ID)
Available from: 2019-05-21 Created: 2019-05-21 Last updated: 2019-05-21Bibliographically approved
Fritz, J., Wallin, L., Söderlund, A., Almqvist, L. & Sandborgh, M. (2019). Implementation of a behavioral medicine approach in physiotherapy: impact and sustainability. Disability and Rehabilitation
Open this publication in new window or tab >>Implementation of a behavioral medicine approach in physiotherapy: impact and sustainability
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2019 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose: To explore the effects on and sustainability of physiotherapists’ clinical behavior when using facilitation to support the implementation of a behavioral medicine approach in primary health care for patients with persistent musculoskeletal pain.

Methods: A quasi-experimental pre-/post-test trial was conducted. Fifteen physiotherapists were included in the experimental group, and nine in the control group. Based on social cognitive theory and the Promoting Action on Research Implementation in Health Services framework, facilitation with multifaceted implementation methods was used during a six-month period. Clinical behaviors were investigated with a study-specific questionnaire, structured observations, self-reports and patient records. Descriptive and non-parametric statistical methods were used for analyzing differences over time and effect size.

Results: A sustained increase in self-efficacy for applying the behavioral medicine approach was found. Clinical actions and verbal expressions changed significantly, and the effect size was large; however, changes were not sustained at follow-ups. The behavioral changes were mainly related to the goal setting, self-monitoring and functional behavioral analysis components. No changes in clinical behavior were found in the control group.

Conclusion: Tailored multifaceted facilitation can support the implementation of a behavioral medicine approach in physiotherapy in primary health care, but more comprehensive actions targeting sustainability are needed.Implications for rehabilitation Tailored multifaceted facilitation can support the implementation of an evidence based behavioral medicine approach in physiotherapy. Facilitation can be useful for increasing self-efficacy beliefs for using behavioral medicine approach in physiotherapist’s clinical practice. Further research is required to establish strategies that are effective in sustaining behavioral changes.

Keywords
clinical competence, evidence-based practice, musculoskeletal pain, physiotherapy, primary health care, self-efficacy
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29978 (URN)10.1080/09638288.2019.1596170 (DOI)000465891500001 ()30999779 (PubMedID)2-s2.0-85064690361 (Scopus ID)
Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-05-17Bibliographically approved
Harvey, G., Gifford, W., Cummings, G., Kelly, J., Kislov, R., Kitson, A., . . . Ehrenberg, A. (2019). Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries. International Journal of Nursing Studies, 90, 21-30
Open this publication in new window or tab >>Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries
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2019 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 90, p. 21-30Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The approach and style of leaders is known to be an important factor influencing the translation of research evidence into nursing practice. However, questions remain as to what types of roles are most effective and the specific mechanisms through which influence is achieved.

OBJECTIVES: The aim of the study was to enhance understanding of the mechanisms by which key nursing roles lead the implementation of evidence-based practice across different care settings and countries and the contextual factors that influence them.

DESIGN: The study employed a qualitative descriptive approach.

SETTINGS: Data collection was undertaken in acute care and primary/community health care settings in Australia, Canada, England and Sweden.

PARTICIPANTS: 55 individuals representing different levels of the nursing leadership structure (executive to frontline), roles (managers and facilitators), sectors (acute and primary/community) and countries.

METHODS: Individual semi-structured interviews were conducted with all participants exploring their roles and experiences of leading evidence-based practice. Data were analysed through a process of qualitative content analysis.

RESULTS: Different countries had varying structural arrangements and roles to support evidence-based nursing practice. At a cross-country level, three main themes were identified relating to different mechanisms for enacting evidence-based practice, contextual influences at a policy, organisational and service delivery level and challenges of leading evidence-based practice.

CONCLUSIONS: National policies around quality and performance shape priorities for evidence-based practice, which in turn influences the roles and mechanisms for implementation that are given prominence. There is a need to maintain a balance between the mechanisms of managing and monitoring performance and facilitating critical questioning and reflection in and on practice. This requires a careful blending of managerial and facilitative leadership. The findings have implications for theory, practice, education and research relating to implementation and evidence-based practice.

Keywords
Evidence-based practice, Facilitation, Facilitators, Implementation, Knowledge translation, Leadership, Managers
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29100 (URN)10.1016/j.ijnurstu.2018.09.017 (DOI)000461265700005 ()30551080 (PubMedID)2-s2.0-85058064165 (Scopus ID)
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-03-28Bibliographically approved
Barenfeld, E., Wallin, L. & Björk Brämberg, E. (2019). Moving from knowledge to action in partnership: A case study on program adaptation to support optimal aging in the context of migration. Journal of Applied Gerontology, 38(8), 1096-1120
Open this publication in new window or tab >>Moving from knowledge to action in partnership: A case study on program adaptation to support optimal aging in the context of migration
2019 (English)In: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523, Vol. 38, no 8, p. 1096-1120Article in journal (Refereed) Published
Abstract [en]

This case study explored how a researcher-community partnership contributed to program adaptations when implementing person-centered group-based health promotion services to older people who have migrated to Sweden. The study was conducted over 3 years and various data sources were used: focus groups, individual interviews, documents, and archive material. Findings from different data sources and partners' perspectives were triangulated to an overall case description using an iterative process. Adaptations were shaped through a dynamic process, negotiating toward suitable solutions that culminated in actions taken to adapt or inhibit adaptations. The negotiations were driven by the interplay within and between three reasons to adapt. The partners' opportunities to influence the negotiation process depended on establishing common ground to shape adaptations. Practical implications are provided on how to move from knowledge to action when implementing person-centered group-based health promotion to support optimal aging in the context of migration.

Keywords
emigrants and immigrants; health promotion; implementation; older adults; researcher–community partnership
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-25957 (URN)10.1177/0733464817727110 (DOI)000473175600002 ()28853322 (PubMedID)2-s2.0-85068233444 (Scopus ID)
Available from: 2017-09-04 Created: 2017-09-04 Last updated: 2019-07-22Bibliographically approved
Orton, M.-L., Andersson, Å., Wallin, L., Forsman, H. & Eldh, A. C. (2019). Nursing management matters for registered nurses with a PhD working in clinical practice. Journal of Nursing Management
Open this publication in new window or tab >>Nursing management matters for registered nurses with a PhD working in clinical practice
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2019 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIM: To investigate what registered nurses (RNs) with a PhD working in clinical practice experience in terms of their role, function and work context.

BACKGROUND: Previous studies have shown that RNs with a graduate degree contribute to better and safer care for patients. However, little is known about what further academic schooling of RNs, at PhD level, means for clinical practice.

METHOD: Qualitative design, with semi-structured interviews and inductive content analysis.

RESULTS: The main areas of responsibilities for RNs with a PhD working in clinical practice were related to practice development and implementation of research results. In their work, they experienced barriers to the full use of their competence; the expectations and prerequisites of the organization were not clearly defined, and they often lacked a mandate to create conditions for quality improvement of nursing care.

CONCLUSIONS: RNs with a PhD can contribute to evidence-based practice (EBP), clinical training as well as the development of clinical research. Their roles and responsibilities need to be clarified and for this, they need support from managers.

IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should partner with RNs with a PhD to support the EBP process and help structure nursing practice in more efficient ways. 

Keywords
clinical practice, content analysis, doctoral degree, nursing care, qualitative
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29316 (URN)10.1111/jonm.12750 (DOI)30656787 (PubMedID)2-s2.0-85066033400 (Scopus ID)
Available from: 2019-01-21 Created: 2019-01-21 Last updated: 2019-08-05Bibliographically approved
Svenningsson, I., Petersson, E.-L., Udo, C., Westman, J., Björkelund, C. & Wallin, L. (2019). Process evaluation of a cluster randomised intervention in Swedish primary care: using care managers in collaborative care to improve care quality for patients with depression.. BMC Family Practice, 20(1), Article ID 108.
Open this publication in new window or tab >>Process evaluation of a cluster randomised intervention in Swedish primary care: using care managers in collaborative care to improve care quality for patients with depression.
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2019 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 20, no 1, article id 108Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The collaborative care model with a care manager has previously generated beneficial results for patients with depression in terms of decreased burden of depression symptoms. A care manager function has been tested in Sweden in the PRIM-CARE RCT with successful results. The aim of the present study was to evaluate the process of implementing care managers in collaborative care for patients with depression in Swedish primary health care in the PRIM-CARE RCT.

METHODS: The study followed UK Medical Research Council guidance for process evaluation. Field notes from the implementation of the PRIM - CARE RCT were used, as well as data collected from five focus group discussions with General Practitioners (n = 29) and three focus group discussions with care managers (n = 11). Data were analysed with content analysis.

RESULTS: Training sessions, careful preparation and extensive initial support to the care manager and staff at the Primary Care Centres were important ingredients in the implementation. The close access to facilitators, the recurrent peer support meetings, and the weekly newsletter strengthened the care manager function.

CONCLUSIONS: A complex intervention adapted to the Swedish primary care context focusing on a care manager function for patients with depression could be performed through a stepwise implementation process. Financial support from the health care regions included in the study helped to reduce the impact of identified barriers. This process evaluation has revealed new and important knowledge for primary care development concerning infrastructure and organization building, knowledge sharing, and facilitating factors and barriers.

TRIAL REGISTRATION: NCT02378272 Care Manager - Coordinating Care for Person Centered Management of Depression in Primary Care (PRIM - CARE). Registered March 4 2015. Retrospectively registered.

Keywords
Accessibility, Care manager, Collaborative care, Continuity, Depression, Facilitator, Primary health care, Process evaluation
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30592 (URN)10.1186/s12875-019-0998-4 (DOI)000477585300002 ()31351444 (PubMedID)2-s2.0-85069940111 (Scopus ID)
Available from: 2019-08-06 Created: 2019-08-06 Last updated: 2019-08-12
Hälleberg Nyman, M., Forsman, H., Wallin, L., Ostaszkiewicz, J., Hommel, A. & Eldh, A. C. (2019). Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care: A process evaluation of an implementation intervention in the orthopaedic context. Journal of Evaluation In Clinical Practice, 25(2), 282-289
Open this publication in new window or tab >>Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care: A process evaluation of an implementation intervention in the orthopaedic context
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2019 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, no 2, p. 282-289Article in journal (Refereed) Published
Abstract [en]

RATIONALE, AIMS, AND OBJECTIVES:

The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery.

METHODS:

A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed.

RESULTS:

Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit.

CONCLUSION:

To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.

Keywords
evidence-based practice; implementation; incontinence; older people; orthopaedics; research utilization
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26873 (URN)10.1111/jep.12879 (DOI)000461883800015 ()29411463 (PubMedID)2-s2.0-85063088977 (Scopus ID)
Available from: 2017-12-20 Created: 2017-12-20 Last updated: 2019-04-04Bibliographically approved
Lind, S., Wallin, L., Furst, C. J. & Beck, I. (2019). The integrated palliative care outcome scale for patients with palliative care needs: Factors related to and experiences of the use in acute care settings. Palliative & Supportive Care
Open this publication in new window or tab >>The integrated palliative care outcome scale for patients with palliative care needs: Factors related to and experiences of the use in acute care settings
2019 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523Article in journal (Refereed) Epub ahead of print
Abstract [en]

ObjectiveImplementation of patient-reported outcome measures for patients with palliative care needs is characterized by both enablers and barriers. The ways in which healthcare professionals experience the use of assessment tools is important. Our aims were to explore factors contributing to or hindering patients with palliative care needs in assessing their symptoms with the Integrated Palliative Care Outcome Scale (IPOS) and to explore healthcare professionals' experiences of the use of IPOS in acute care settings.MethodData were collected as a part of the evaluation of the feasibility of an implementation strategy for introducing IPOS. Data from three participating acute care units were included. We used descriptive and analytical statistics; a qualitative content analysis was also performed.ResultA total of 309 patients were eligible to be offered assessment of symptoms with IPOS. Of these 69 (22%) had completed IPOS. A significant positive association was found between healthcare professionals' participation in training sessions and completed IPOS. The experiences of IPOS were split into two categories: "IPOS acting as a facilitator" and "barriers to the use of IPOS." The use of IPOS was described as contributing to person-centered care of patients with palliative care needs and inspiration to improved routines. Healthcare professionals' feelings of uncertainty about how to approach severely ill patients and their family members appear to have hindered their use of IPOS.Significance of resultsWe found an association between healthcare professionals' participation in training sessions and patients who completed IPOS, indicating the need for a high degree of attendance at the training to achieve successful implementation. The healthcare professionals expressed feelings of insecurity concerning the use of IPOS indicating a need for further education and clinical support in its use of IPOS. Nevertheless, use of IPOS was considered to contribute to improved care of patients with palliative care needs.

Keywords
Acute care settings, Implementation, Integrated palliative care, Mixed-method, Outcome scale, Palliative care
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29748 (URN)10.1017/S1478951518001104 (DOI)2-s2.0-85062676075 (Scopus ID)
Available from: 2019-03-25 Created: 2019-03-25 Last updated: 2019-03-25Bibliographically approved
Wikström, E., Dellenborg, L., Wallin, L., Gillespie, B. M. & Erichsen Andersson, A. (2019). The Safe Hands Study: Implementing aseptic techniques in the operating room: Facilitating mechanisms for contextual negotiation and collective action. American Journal of Infection Control, 47(3), 251-257
Open this publication in new window or tab >>The Safe Hands Study: Implementing aseptic techniques in the operating room: Facilitating mechanisms for contextual negotiation and collective action
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2019 (English)In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 47, no 3, p. 251-257Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Even though hand hygiene and aseptic techniques are essential to provide safe care in the operating room, several studies have found a lack of successful implementation. The aim of this study was to describe facilitative mechanisms supporting the implementation of hand hygiene and aseptic techniques.

METHODS: This study was set in a large operating room suite in a Swedish university hospital. The theory-driven implementation process was informed by the literature on organizational change and dialogue. Data were collected using interviews and participant observations and analyzed using a thematic approach. The normalization process theory served as a frame of interpretation during the analysis.

RESULTS: Three facilitating mechanisms were identified: (1) commitment through a sense of urgency, requiring extensive communication between the managers, operating room professionals, and facilitators in building commitment to change and putting the issues on the agenda; (2) dialogue for co-creation, increasing and sustaining commitment and resource mobilization; and (3) tailored management support, including helping managers to develop their leadership role, progressively involving staff, and retaining focus during the implementation process.

CONCLUSIONS: The facilitating mechanisms can be used in organizing implementation processes. Putting the emphasis on help and support to managers seems to be a crucial condition in complex implementation processes, from preparation of the change process to stabilization of the new practice.

Keywords
Aseptic technique, Co-creation, Complex intervention, Contextual restructuring, Hand hygiene, Implementation process
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28915 (URN)10.1016/j.ajic.2018.08.024 (DOI)000459766900005 ()30449454 (PubMedID)2-s2.0-85056694740 (Scopus ID)
Available from: 2018-11-23 Created: 2018-11-23 Last updated: 2019-03-14Bibliographically approved
Saarijärvi, M., Wallin, L., Moons, P., Gyllensten, H. & Bratt, E.-L. (2019). Transition program for adolescents with congenital heart disease in transition to adulthood: protocol for a mixed-method process evaluation study (the STEPSTONES project).. BMJ Open, 9(8), Article ID e028229.
Open this publication in new window or tab >>Transition program for adolescents with congenital heart disease in transition to adulthood: protocol for a mixed-method process evaluation study (the STEPSTONES project).
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 8, article id e028229Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Today, the majority of young persons living with chronic conditions in high-income countries survive into adulthood and will need life-long medical follow-up. Therefore, transition programmes have been developed to facilitate transfer to adult care, and to support self-management and independence during adulthood. The Swedish Transition Effects Project Supporting Teenagers with chrONic mEdical conditionS (STEPSTONES) project aims to evaluate the effectiveness of a person-centred transition programme for empowering adolescents with congenital heart disease in transition to adulthood. To understand how the transition programme causes change and how outcomes are created, process evaluation is imperative to assess implementation, context and mechanisms of impact. This protocol aims to describe the process evaluation of the STEPSTONES transition programme.

METHODS AND DESIGN: Medical Research Council guidance for process evaluation of complex interventions will be the guiding framework for this mixed-method study. The combination of qualitative and quantitative data will capture different aspects of programme delivery. The sample will consist of participants in the STEPSTONES randomised controlled trial (RCT), persons implementing the programme and healthcare professionals. Quantitative data will consist of protocols and routine monitoring documents from the RCT, data collected from patient registries and sociodemographic data to assess the implementation of the intervention. This data will be analysed with quantitative content analysis, along with descriptive and inferential statistics. Qualitative data will consist of participatory observations, logbooks and interviews with persons implementing the programme, participants and healthcare professionals. Analyses will be performed using qualitative content analysis to investigate mechanism of impact, context and delivery. Quantitative and qualitative data will be integrated in the final stage by using a triangulation protocol according to mixed-method guidelines.

ETHICS AND DISSEMINATION: The study is approved by the Regional Ethical Review Board in Gothenburg, Sweden. Results will be presented in open access, peer-reviewed journals and at international scientific conferences.

Keywords
adolescent, heart defect, implementation science, process evaluation, randomized controlled trial, transition to adult care
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30595 (URN)10.1136/bmjopen-2018-028229 (DOI)31377699 (PubMedID)
Available from: 2019-08-06 Created: 2019-08-06 Last updated: 2019-08-06Bibliographically approved
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