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  • 1.
    Cacciatore, J.
    et al.
    Arizona State University.
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Rådestad, I.
    Sophiahemmet University College.
    Fatherhood and suffering: a qualitative exploration of Swedish men's experiences of care after the death of a baby2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 5, p. 664-670Article in journal (Refereed)
    Abstract [en]

    Background: This study was designed to evaluate fathers' experiences of stillbirth and psychosocial care.

    Methods: Data were collected between 27 March 2008 and 1 April 2010 via a questionnaire posted on the homepage of the Swedish National Infant Foundation. The responses to the following open-ended questions were analyzed using content analysis: "Are you grateful today for anything that health care professionals did in connection with the birth of your child?" and " Are you sad, hurt or angry today about something personnel did in connection with the birth of your baby?"

    Results: 113/131 (86%) fathers reported feelings of being grateful. Only 22/131 (16%) fathers reported feeling sad, hurt, or angry. Fathers expressed gratitude when health care professionals treated their newborn " with respect and without fear" , " with extraordinary reverence" , and when their fatherhood was validated by providers. They were also grateful when providers helped them to create memories of their baby. Fathers also reported feeling sad, hurt, or angry when providers were nonchalant and indifferent and when they perceived providers to be uncaring and disrespectful toward their baby.

    Conclusion: Bereaved fathers experience overall gratitude for person-centered psychosocial care in the aftermath of stillbirth, particularly when they feel validated as a grieving father and their child is acknowledged with reverence. Clinical implications: Health care professionals should support fathers by treating the baby who died with respect and dignity and by validating and acknowledging both his grief experiences and his fatherhood just as they would for a grieving mother.

  • 2.
    Eriksson, Henrik
    et al.
    Röda Korset Högskola.
    Salzmann-Erikson, Martin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Cyber nursing: Health 'experts' approaches in the post-modern era of virtual encounters2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 3, p. 335-344Article in journal (Refereed)
    Abstract [en]

    Background. The imperative to gather information online and to become an ‘expert’ by locating effective advice for oneself and others is a fairly new support phenomenon in relation to health advice. The creation of new positions for health ‘experts’ within the space of the Internet has been addressed as a cybernursing activity. A focused analysis of communication in health forums might give insight into the new roles that are available for healthexperts in cyberspace.

    Aim. The aim of this study is to describe approaches to being an ‘expert’ in lifestyle health choice forums on the Internet and to elaborate on the communicative performances that take place in the forums.

    Method. An archival and cross-sectional observational forum study was undertaken using principles for conducting ethnographic research online. 2640 pages of data from two health Internet forums were gathered and analyzed.

    Findings. The results reveal three distinctive types of experts that emerge in the forums: (1) those that build their expertise by creating a presence in the forum based on lengthy and frequent postings, (2) those who build a presence through reciprocal exchanges with individual posters with questions or concerns, and (3) those who build expertise around a “life long learning” perspective based on logic and reason.

    Discussion. The results suggest that experts not only co-exist in the forums, but more importantly they reinforce each others’ positions. This effect is central; alongside one another, the posts of the three types of experts we identify constitute a whole for those seeking the forum for advice and support. Users are provided with strong opinions and advice, support and Socratic reasoning, and a problem-oriented approach. The Internet is now an integral part of everyday living, not least of which among those who seek and offer support in cyberspace. As such, cyber nursing has become an important activity to monitor, and formal health care professionals and nursing researchers must stay abreast of developments.

  • 3.
    Forsman, Henrietta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet.
    Gustavsson, Petter
    Inst för klinisk neurovetenskap, Karolinska Institutet.
    Rudman, Ann
    Inst för klinisk neurovetenskap, Karolinska Institutet.
    Nursing students’ intentions to use research as a predictor of use one year post graduation: a prospective study2012In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 49, no 9, p. 1155-1164Article in journal (Refereed)
    Abstract [en]

    Background. Graduating nursing students are expected to have acquired the necessary skills to provide research-based care to patients. However, recent studies have shown that new graduate nurses report their extent of research use as relatively low. Because behavior intention is a well-known predictor of subsequent behavior, this gives reasons to further investigate graduating nursing students’ intentions to use research in clinical practice after undergraduate study.

    Objectives. To investigate graduating nursing students’ intentions to use research in clinical practice and, furthermore, to investigate whether intention in itself and as a mediating variable can predict subsequent research use behavior in clinical practice one year post graduation.

    Design. A follow-up study was performed of graduating nursing students in their final semester of undergraduate study (2006) and at one year post graduation (2008). Data were collected within the larger national survey LANE (Longitudinal Analysis of Nursing Education).

    Participants. A sample of 1319 respondents was prospectively followed.

    Methods. Graduating nursing students’ intentions to use research instrumentally were studied as a predictor of their subsequent instrumental research use one year post graduation. A statistical full mediation model was tested to evaluate the effects of intention and factors from undergraduate study on subsequent research use in daily care.

    Results. Thirty-four percent of the nursing students intended to use research on more than half or almost every working shift in their future clinical practice. Intention showed a direct effect on research use behavior. In addition, significant indirect effects on research use were shown for capability beliefs (regarding practicing the principles of evidence-based practice) and perceived support for research use (from campus and clinical education), where intention acted as a mediating factor for those effects.

    Conclusions. Students rated a modest level of intention to use research evidence. Intentions close to graduation acted as an essential predictor of subsequent research use behavior, both through a direct effect and as a mediating variable. These findings give support for designing future interventions aiming at influencing students’ intention to use research to improve subsequent behavior. Focusing on strengthening students’ capability beliefs and providing support for research use appear as promising target activities.

  • 4. Frögéli, Elin
    et al.
    Rudman, Ann
    Karolinska Institutet.
    Gustavsson, Petter
    The relationship between task mastery, role clarity, social acceptance, and stress: An intensive longitudinal study with a sample of newly registered nurses.2019In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 91, p. 60-69, article id S0020-7489(18)30282-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Transitioning into a new professional role is challenging. Unfortunately, little is currently known about how to reduce experiences of stress among new professionals. The socialization processes role clarity, task mastery, and social acceptance are assumed to reduce experiences of stress as they mediate new professionals' acquisition of knowledge, skills, attitudes, and behaviors. However, little prospective data is available on the actual effect of the processes on stress.

    OBJECTIVES: To prospectively investigate how the socialization processes relate to experiences of stress among new nurses during the first three months of professional working life. Specifically, to investigate development over time, as well as how episodes of increased or decreased levels of the socialization processes relate to concurrent levels of stress. The general purpose of this investigation was to examine the suitability of the socialization processes as targets of an intervention seeking to reduce stress among new professionals.

    DESIGN: An intensive longitudinal study with weekly data collections over three months.

    PARTICIPANTS: 264 newly graduated Swedish nurses who started their first job during the period of the study.

    METHODS: The participants were followed prospectively during 14 consecutive weeks after their professional entry. Data on stress (Stress and Energy Questionnaire), role clarity (General Questionnaire for Psychological and Social Factors at Work), task mastery, and social acceptance (Needs Satisfaction and Frustration Scale) were collected weekly using digital surveys (mean response rate 82.7%). Data was analyzed using a multilevel model for intensive longitudinal data.

    RESULTS: For the typical nurse, stress decreased by 0.13 units per month, role clarity and task mastery increased by 0.08 and 0.05 units, and social acceptance decreased by 0.08 units. In addition, the slopes of 95 percent of the new nurses varied within 1.18 (stress), 0.72 (role clarity), 0.44 (task mastery), and 0.86 (social acceptance) units of the typical nurse. Most importantly, when the new nurses experienced higher levels of task mastery, role clarity, and social acceptance, they experienced lower levels of stress (within-person parameter estimates: task mastery -0.40, p = .001; role clarity -0.34, p = .001; and social acceptance -0.33, p = .001).

    CONCLUSIONS: Supporting the development of the socialization processes could be one theoretically based strategy to reduce levels of stress among new nurses. As stress among new professionals is not unique to the nursing profession, and the processes are considered important mediators of new professionals' adaptation in general, the results from this study should likely be generalizable to other professions.

  • 5. Gustavsson, J Petter
    et al.
    Hallsten, Lennart
    Rudman, Ann
    Karolinska Institutet.
    Early career burnout among nurses: modelling a hypothesized process using an item response approach.2010In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 47, no 7, p. 864-75Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cherniss's pioneering research on burnout, based on grounded theory, focused specifically on competence crisis among new graduates, and identified negative attitude changes as the core phenomenon in the progression from competence crisis into early career burnout. In this model, the two main burnout dimensions of exhaustion and dysfunctional coping are ordered sequentially; i.e., initial exhaustion develops, due to dysfunctional coping (cynicism and disengagement), into burnout.

    OBJECTIVE: To test the sequential-developmental model of burnout originally proposed by Cherniss, using a psychometric approach.

    DESIGN: A sample of 933 early-career nursing professionals, recruited from a Swedish population-based cohort (response rate 81%), were assessed three years after graduation, using items from a burnout inventory. Data were analysed using the Rasch measurement model.

    RESULTS: The psychometric tests showed that data adhere to a sequential-developmental model when examined using the one-parameter item response approach. When tested against external variables, the prevalence of low mood, low levels of job performance and health problems increased monotonically along this sequential-developmental model of early career burnout.

    CONCLUSION: Among early-career nursing professionals burnout may be operationalized as a one-dimensional sequential-developmental model. This model resembles the results found in the literature on transition and socialization, and the association between these psychometric results and studies on nursing students' transition and socialization into working life are discussed.

  • 6. Harvey, Gill
    et al.
    Gifford, Wendy
    Cummings, Greta
    Kelly, Janet
    Kislov, Roman
    Kitson, Alison
    Pettersson, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Göteborgs universitet; Karolinska institutet.
    Wilson, Paul
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries2019In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 90, p. 21-30Article in journal (Refereed)
    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.

  • 7. Hommel, Ami
    et al.
    Magnéli, Martin
    Samuelsson, Bodil
    Schildmeijer, Kristina
    Sjöstrand, Desirée
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Unbeck, Maria
    Karolinska Institutet.
    Exploring the incidence and nature of nursing-sensitive orthopaedic adverse events: A multicenter cohort study using Global Trigger Tool.2020In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 102, article id 103473Article in journal (Refereed)
    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.

  • 8. Kelly-Pettersson, Paula
    et al.
    Samuelsson, Bodil
    Muren, Olle
    Unbeck, Maria
    Karolinska Institutet.
    Gordon, Max
    Stark, André
    Sköldenberg, Olof
    Waiting time to surgery is correlated with an increased risk of serious adverse events during hospital stay in patients with hip-fracture: A cohort study.2017In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 69, p. 91-97, article id S0020-7489(17)30031-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hip fractures are common in the elderly and are associated with a high adverse event and mortality rate. Time to surgery is one of the major modifiable risk factors influencing adverse outcomes in hip-fracture patients. National guidelines and recommendations have been introduced which advocate specific time frames in which surgery should be performed i.e. within 24-48h. These time constraints have been arbitrarily set without being modelled on the linear assumption i.e. that risk increases continually over time and not within specific cut-off times.

    OBJECTIVES: To investigate how waiting time to surgery influenced the risk of serious adverse events in hip-fracture patients during the hospital stay and to examine how the risk increased over time.

    DESIGN: An observational single cohort study Participants 576 patients (72.4% females, mean [SD] age 82 [10]) years, with a hip fracture were included in the cohort study.

    METHODS: The outcomes of the study were the occurrence of serious adverse events during hospital stay, length of stay and one-year mortality. A structured medical record review was carried out to identify outcomes and mortality data was obtained from the Swedish National Death Registry. Waiting time to surgery was used as the exposure variable and age, sex, type of fracture, comorbidities using the American Society of Anaesthesiologists classification score and the presence of cognitive dysfunction were identified as confounders. A logistic regression analysis was performed to identify risk factors influencing outcomes.

    RESULTS: A total of 119 patients (20.6%) suffered 397 (range 1-5) serious adverse events during hospital stay. Every 10h of waiting time to surgery increased the risk of serious adverse events by 12% (odds ratio 1.12 [95% confidence interval 1.02-1.23]). We found no optimal cut-off times for waiting time to surgery. For every 24h of waiting time, the length of stay from surgery was increased by 0.6days (95% CI 0.1-1.1). We found no correlation between waiting time to surgery and one-year mortality.

    CONCLUSIONS: A large proportion of patients suffered from at least one serious adverse event after hip-fracture surgery and there are no safe limits for waiting time to surgery for hip-fracture patients. As the risk increases with every hour of waiting time, patients with higher American Society of Anesthesiologists classification scores, males and those with subtrochanteric fractures should be prioritized for surgery.

  • 9.
    Klingberg-Allvin, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Van Tam, Vu
    Thu Nga, Nguyen
    Ransjö-Arvidson, Anna-Berit
    Johansson, Annika
    Ethics of justice and ethics of care. Values and attitudes among midwifery students on adolescent sexuality and abortion in Vietnam and their implications for midwifery education: a survey by questionnaire and interview2007In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 44, no 1, p. 37-46Article in journal (Refereed)
    Abstract [en]

    Adolescent’s sexuality and related reproductive health and rights problems are sensitive issues in Vietnam. Globalisation has had an impact on the lifestyles of young people, and rising numbers of abortion and STI/HIV risks among youth are posing major health concerns in the country. These problems need to be addressed. Midwives belong to a key category of health personnel in Vietnam, whose task it is to promote adolescents’ sexual and reproductive health and prevent reproductive ill health. It is important to understand future midwives’ perceptions and attitudes in order to improve their education and training programmes. Aim: The aim of this study was to investigate Vietnamese midwifery students’ values and attitudes towards adolescent sexuality, abortion and contraception and their views on professional preparation. Methods: A quantitative survey including 235 midwifery students from four different secondary medical colleges in northern Vietnam was carried out in 2003. A qualitative study addressing similar questions was performed and 18 midwifery students were individually interviewed. Findings: Findings revealed a general disapproval of adolescent pre-marital sexual relations and abortion – ‘an ethics of justice’ - but also an empathic attitude and willingness to support young women, who bear the consequences of unwanted pregnancies and social condemnation – ‘an ethics of care’. Gender-based imbalance in sexual relationships, limited knowledge about reproductive health issues among youth, and negative societal attitudes were concerns expressed by the students. The students saw their future tasks mainly related to childbearing and less to other reproductive health issues, such as abortion and prevention of STI/HIV. Conclusion: Midwifery education in Vietnam should encourage value-reflective thinking around gender inequality and ethical dilemmas, in order to prepare midwives to address adolescents’ reproductive health needs.

  • 10.
    Lövgren, Malin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet.
    Gustavsson, Petter
    Karolinska Institutet.
    Melin, Bo
    Karolinska Institutet.
    Rudman, Ann
    Karolinska Institutet.
    Neck/shoulder and back pain in new graduate nurses: a growth mixture modeling analysis2014In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 51, no 4, p. 625-639Article in journal (Refereed)
    Abstract [en]

    Background: Although it is well known that musculoskeletal disorders are common among registered nurses, little longitudinal research has been conducted to examine this problem from nursing education to working life.

    Objectives: The aim was to investigate the prevalence and incidence of neck/shoulder and back pain in nursing students in their final semester, and one and two years after graduation. Furthermore, to identify common trajectories of neck/shoulder and back pain, and explore sociodemographic and lifestyle-related factors, contextual factors and health outcome that might be characteristic of individuals in the various trajectories.

    Design: Longitudinal study following nursing students from their final year of studies, with follow-ups one and two years after graduation.

    Settings and participants: Nursing students who graduated from the 26 universities providing undergraduate nursing education in Sweden 2002 were invited to participate(N = 1700). Of those asked, 1153 gave their informed consent.

    Methods: The participants answered postal surveys at yearly intervals. Descriptive statistics were used to analyze prevalence and incidence of pain, and growth mixture modeling was applied to identify different homogeneous clusters of individuals following similar trajectories in pain development across time.

    Results: The prevalence of neck/shoulder and back pain remained constant over time(around 50% for neck/shoulder pain and just over 40% for back pain). Six different development trajectories for each symptom were found, reflecting patterns of stable pain levels or variation in levels over time: one symptom-free group, two decreasing pain groups, two increasing pain groups, and one chronic pain group. With few exceptions, the same factors (sex, children, chronic disease, working overtime, work absence, sickness presence, physical load, depression, self-rated health, sleep quality and muscular tension) were associated with neck/shoulder and back pain trajectories. Different types of physical load characterized new nurses with neck/shoulder pain and back pain respectively.

    Conclusions: The high prevalence of pain among nursing students and among new graduate nurses, suggests that it would be effective to implement preventive strategies already during nursing education, but they should also preferably continue after graduation. Many factors associated with pain in the neck/shoulder and back seem to be modifiable, and thereby constitute targets for preventive strategies.

  • 11.
    Nilsson, Lena
    et al.
    Linköping University, Linköping.
    Lindblad, Marléne
    Swedish Red Cross University, Stockholm.
    Johansson, Nathalie
    Dalarna University, School of Health and Welfare. Region Uppsala.
    Säfström, Lisa
    Dalarna University, School of Health and Welfare. Heby Home Health Care, Heby.
    Schildmeijer, Kristina
    Linnaeus University, Kalmar.
    Ekstedt, Mirjam
    Linnaeus University, Kalmar; Karolinska Institutet, Stockholm.
    Unbeck, Maria
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    Exploring nursing-sensitive events in home healthcare: A national multicenter cohort study using a trigger tool2023In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 138, article id 104434Article in journal (Refereed)
    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.

  • 12.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Gustavsson, J Petter
    Burnout during nursing education predicts lower occupational preparedness and future clinical performance: a longitudinal study.2012In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 49, no 8, p. 988-1001Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Early-career burnout among nurses can influence health and professional development, as well as quality of care. However, the prospective occupational consequences of study burnout have not previously been investigated in a national sample using a longitudinal design.

    OBJECTIVES: To prospectively monitor study burnout for a national sample of nursing students during their years in higher education and at follow-up 1 year post graduation. Further, to relate the possible development of study burnout to prospective health and life outcomes, as well as student and occupational outcomes.

    DESIGN: A longitudinal cohort of Swedish nursing students (within the population-based LANE (Longitudinal Analysis of Nursing Education/Entry) study) from all sites of education in Sweden was surveyed annually. Data were collected at four points in time over 4 years: three times during higher education and 1 year post graduation.

    PARTICIPANTS: : A longitudinal sample of 1702 respondents was prospectively followed from late autumn 2002 to spring 2006.

    METHODS: Mean level changes of study burnout (as measured by the Oldenburg Burnout Inventory, i.e. the Exhaustion and Disengagement subscales) across time, as well as prospective effects of baseline study burnout and changes in study burnout levels, were estimated using Latent Growth Curve Modeling.

    RESULTS: An increase in study burnout (from 30% to 41%) across 3 years in higher education was found, and levels of both Exhaustion and Disengagement increased significantly across the years in education (p<0.001). Baseline levels, as well as development of study burnout, predicted lower levels of in-class learner engagement and occupational preparedness in the final year. At follow-up 1 year post graduation, earlier development of study burnout was related to lower mastery of occupational tasks, less research utilization in everyday clinical practice and higher turnover intentions.

    CONCLUSIONS: The results suggest that study burnout may have interfered with learning and psychological well-being. Aspects related to work skills and intention to leave the profession were also affected. Thus, burnout development during higher education may be an important concern, and effective preventive measures to counteract burnout development may be necessary already at the outset of nursing education.

  • 13.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Gustavsson, J Petter
    Early-career burnout among new graduate nurses: a prospective observational study of intra-individual change trajectories.2011In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, no 3, p. 292-306Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Newly qualified and inexperienced nurses are at particular risk of suffering emotional exhaustion and burnout in unsupportive practice environments. Despite new nurses' potential vulnerability, development of burnout after graduation has rarely been studied longitudinally and in relation to demographic and educational characteristics prior to working life entry, i.e. during education.

    OBJECTIVES: To identify and compare typical change trajectories (i.e. common patterns of intra-individual development) in burnout symptoms for new graduate nurses annually over a three-year period, during which there was reason to believe that this group was especially vulnerable.

    DESIGN: A prospective longitudinal and national cohort of 1153 nurses within the population-based LANE study (Longitudinal Analyses of Nursing Education), where new graduate nurses were assessed four times annually, i.e. in their final year of nursing education and three times post graduation (after 1, 2 and 3 years).

    PARTICIPANTS: A longitudinal sample of 997 respondents was prospectively followed.

    METHODS: Within-group changes in burnout levels were analysed using a repeated-measures analysis of variance, and cluster analytic techniques were used to identify typical trajectories of burnout.

    RESULTS: At group level, mean levels of burnout were rather stable across time. However, underlying these levels we identified eight change trajectories, explaining 74% of all individual variation; seven of them reflected significant changes across time. Almost every fifth nurse reported extremely high levels of burnout at some point during their first three years after graduation. Changes in burnout levels were accompanied by concurrent changes in depressive symptoms and intention to leave the profession. This study also showed that negative development of burnout was predicted by not feeling well prepared for a nursing job, lacking study interest, high levels of performance-based self-esteem and depressive mood in the final year of education.

    CONCLUSIONS: An investigation of burnout symptoms over time disclosed numerous development patterns, some of which were stable while others changed significantly. Hence, this study gave a more nuanced picture of burnout development among new graduate nurses, highlighted by eight different trajectories. Regarding the time frame, nearly every second new graduate showed a significant increase in levels of burnout during their second year post graduation.

  • 14.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Gustavsson, Petter
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Boström, Anne-Marie
    Wallin, Lars
    Karolinska Instiutet.
    Registered nurses' evidence-based practice: a longitudinal study of the first five years after graduation2012In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 49, no 12, p. 1494-1504Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The capacity to provide evidence-based practice is one of five core competencies that it is proposed all healthcare professions should possess to meet the needs of the 21st century healthcare system. New nurses are faced with a challenging work environment which, combined with shortcomings in undergraduate education and their limited clinical experience, may affect their evidence-based practice.

    OBJECTIVE: The aim of this study was to prospectively examine the extent of Swedish nurses' evidence-based practice during the first five years of professional life.

    DESIGN: An observational longitudinal study, with yearly data collections over the course of five years. SETTINGS: Data was collected in two national cohorts (named EX2004 and EX2006) of Swedish registered nurses. Nurses in EX2006 were followed yearly during the first three years after graduation and nurses in EX2004 yearly three to five years after graduation. They had completed a three year academic nursing program and mainly worked in in-patient care settings.

    PARTICIPANTS: Participants were recruited while studying at any of the 26 universities in Sweden. A total of 2107 (EX2006) and 2331 (EX2004) nursing students were eligible. 1207 and 1227 nurses were included in the current longitudinal samples. The nurses had a mean age of 31.2/33.9years old and a majority were female. The cohorts were representative of the general nursing population.

    METHODS: Data was self-reported and collected through annual postal surveys. Evidence-based practice was conceptualized as a process and measured with an instrument including six items. Data was analyzed using latent growth curve modeling.

    RESULTS: The extent of evidence-based practice was stable, between the two cohorts and over time. Individual differences existed and remained stable over time. However, the extent of practicing the different components of evidence-based practice on a monthly basis varied considerably, from 10% of the nurses (appraising research reports) to 80% (using information sources other than databases to search for knowledge).

    CONCLUSION: The extent of evidence-based practice remained unchanged during the first five years of professional life. It appears important to enhance both the contribution of undergraduate education and the contextual conditions in work life, in order to improve evidence-based practice among newly graduated nurses.

  • 15.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Gustavsson, Petter
    Hultell, Daniel
    A prospective study of nurses' intentions to leave the profession during their first five years of practice in Sweden.2014In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 51, no 4, p. 612-24, article id S0020-7489(13)00273-3Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nursing turnover continues to be a problem for healthcare organizations. Longitudinal research is needed in order to monitor the development of turnover intentions to leave the profession over time.

    OBJECTIVE: The objectives were: (1) to investigate the prevalence of new graduates' intentions to leave the nursing profession, (2) to prospectively monitor the development of intention to leave during the first five years of professional life, and (3) to study the impact of sex, age, occupational preparedness and burnout (i.e. exhaustion and disengagement) on the development of intention to leave the profession.

    DESIGN: Longitudinal observational study.

    PARTICIPANTS: Participants were recruited from first-year nursing students at any of the 26 universities in Sweden offering nursing education. Of the 2331 student nurses who were invited to participate in the study, 1702 (73%) gave informed consent and thus constituted the cohort. This cohort was prospectively followed yearly (three times during education and five times post graduation) from late autumn 2002 to spring 2010. Of the 1501 respondents who continued to participate after graduating, 1417 worked as nurses at the time of data collection and responded to the items regarding intention to leave the nursing profession during at least one wave of measurement; these constituted the sample of the present longitudinal study.

    METHODS: The outcome variable was intention to leave the nursing profession. This was measured using a scale of three items, covering thoughts of leaving the profession. The main predictor was burnout, and this was measured by the exhaustion and disengagement scale from the Oldenburg Burnout Inventory. Data were analysed using latent growth curve modelling.

    RESULTS: After five years, every fifth nurse strongly intended to leave the profession. The longitudinal analysis of change in intention to leave showed that levels increased during the first years of employment. High levels of burnout were related to an increase in intention to leave.

    CONCLUSION: It is important for organizations employing new graduates to pay attention to nurses who show early signs of burnout, and provide a resourceful work environment with a suitable workload, sufficient introduction, management support, satisfactory collaboration with colleagues, and role clarity.

  • 16. Saar, Lili
    et al.
    Unbeck, Maria
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet.
    Bachnick, Stefanie
    Gehri, Beatrice
    Simon, Michael
    Exploring omissions in nursing care using retrospective chart review: An observational study.2021In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 122, article id 104009Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Omissions in nursing care can compromise patient safety. To date, this phenomenon has been investigated almost exclusively via nurse surveys. However, such surveys restrict the range of activities which can be assessed for omissions, and patient level analysis. As an alternative, retrospective chart review methodology has been used successfully in other research fields, but not yet for omitted nursing care.

    OBJECTIVES: To describe characteristics and frequency of omitted nursing care using a retrospective chart review methodology.

    DESIGN, SETTING AND PARTICIPANTS: Observational single center study in two German neurological inpatient units. A random sample of 100 patient admissions was used.

    METHODS: A structured chart review protocol to detect nursing omissions was developed and applied. The full range of expected nursing care activities were assessed regarding the importance of documenting them and whether they had been fully or partially omitted. Vital sign measurements were assessed regarding both the measurement target number and the number of measurements recorded.

    RESULTS: In total, 1885 activities-a mean of 19 per patient-were identified. Of the reviewed activities, 52% (n = 971) were fully or partially omitted. Patients experienced between one and 22 omitted nursing care activities during their hospital stay (8-84% of expected care activities). Ranging from 6% to 100% some activities were more commonly omitted than others during admission. The most frequently omitted nursing activity was giving emotional care (88%, n = 66); the least frequently omitted was teaching (10%, n = 29). Vital signs were recorded only 50% (n = 141) of the targeted number of times.

    CONCLUSIONS: Using a retrospective chart review protocol to identify omissions in nursing care allows the assessment of a broad range of nursing activities. Additionally, this is the first-time patient-level data on a broad range of activities have been analyzed. The newly developed chart review methodology can complement established survey methods and provide a new perspective on the phenomenon of omitted nursing care.

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  • 17.
    Unbeck, Maria
    et al.
    Karolinska Institutet.
    Sterner, Eila
    Elg, Mattias
    Fossum, Bjöörn
    Thor, Johan
    Pukk Härenstam, Karin
    Design, application and impact of quality improvement 'theme months' in orthopaedic nursing: a mixed method case study on pressure ulcer prevention.2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 4, p. 527-35, article id S0020-7489(13)00041-2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While there is growing awareness of quality problems in healthcare systems, it remains uncertain how best to accomplish and sustain improvement over time.

    OBJECTIVE: To report on the design and application of quality improvement theme months in orthopaedic nursing, and evaluate the impact on pressure ulcer as an example.

    DESIGN: Retrospective mixed method case study with time series diagrams.

    SETTING: An orthopaedic department at a Swedish university hospital.

    METHOD: The interventions were led by nursing teams and focused on one improvement theme at a time in two-month cycles, hence the term 'improvement theme months'. These included defined objectives, easy-to-use follow-up measurement, education, changes to daily routines, "reminder months" and data feedback. The study draws on retrospective record data regarding one of the theme topics, pressure ulcer risk assessment and prevalence, in 2281 orthopaedic admissions during January 2007-October 2010 through point prevalence measurement one-day per month. Data were analysed in time series diagrams and through comparison to annual point prevalence data from mandatory county council-wide measurements prior to, during and after interventions from 2003 to 2010. By using document analysis we reviewed concurrent initiatives at different levels in the healthcare organisation and related them to the improvement theme months and their impact.

    RESULTS: The 46 monthly point prevalence samples ranged from 28 to 66 admissions. Substantial improvements were found in risk assessment rates for pressure ulcers both in the longitudinal follow-up (p<0.001) and in the annual county council-wide measurements. A reduction in pressure ulcer rate was observed in the annual county council-wide measurements. In the longitudinal data, wider variation in the pressure ulcer rate was seen (p<0.067); however, there was a significant decrease in pressure ulcer rates during the final ten-month period in 2010, compared to the baseline period in 2007 (p=0.004). Improvements were moderate the first years and needed reinforcement to be maintained.

    CONCLUSIONS: The theme month design and the way it was applied in this case showed potential, contributing to reduced pressure ulcer prevalence, as a way to conduct quality improvement initiatives in nursing. For sustainable improvement, multi component interventions are needed with regular monitoring and reminder efforts.

  • 18.
    Unbeck, Maria
    et al.
    Karolinska Institutet.
    Sterner, Eila
    Elg, Mattias
    Fossum, Bjöörn
    Thor, Johan
    PukkHärenstam, Karin
    Authors' response (Unbeck and colleagues).2015In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 52, no 1, p. 484-5; discussion 485Article in journal (Refereed)
  • 19.
    Wallin, Lars
    Karolinska Institutet.
    Knowledge translation and implementation research in nursing2009In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 46, no 4, p. 576-87Article in journal (Refereed)
  • 20.
    Wallin, Lars
    et al.
    University of Alberta.
    Rudberg, Agneta
    Gunningberg, Lena
    Staff experiences in implementing guidelines for Kangaroo Mother Care: a qualitative study2005In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 42, no 1, p. 61-73Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate staff experiences in implementing guidelines for Kangaroo Mother Care in neonatal care. The study was part of a randomized controlled trial, the overall goal of which was to assess the impact of external facilitation. A total of eight focus group interviews were held at two intervention and two control units. The establishment of a change team to implement the guideline resulted in activities that impacted staff behaviour, which in turn was perceived to influence patients' well-being. The guideline and contextual factors, such as leadership and staff colleagues' attitudes, were of significant importance in that process. The study intervention-facilitation promoted implementation activities and was highly appreciated by the change teams. However, reviewing the development of events at one of the control units, the provided facilitation appeared to be no more effective than an improvement-focused organizational culture in which the nurse manager was actively involved in the change process. Overall, learning and behaviour change seemed to be a social phenomenon, something that greatly benefited from people's interaction with one another.

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