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  • 1.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nilsson, Maria
    Umeå universitet.
    Holmner, Åsa
    Umeå universitet.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nurses’ perceptions of climate and environmental issues: a qualitative study2015In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 71, no 8, p. 1883-1891Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to explore nurses' perceptions of climate and environmental issues and examine how nurses perceive their role in contributing to the process of sustainable development. 

    Background: Climate change and its implications for human health represent an increasingly important issue for the healthcare sector. According to the International Council of Nurses Code of Ethics, nurses have a responsibility to be involved and support climate change mitigation and adaptation to protect human health. 

    Design: This is a descriptive, explorative qualitative study. 

    Methods: Nurses (n=18) were recruited from hospitals, primary care and emergency medical services; eight participated in semi-structured, in-depth individual interviews and 10 participated in two focus groups. Data were collected from April-October 2013 in Sweden; interviews were transcribed verbatim and analysed using content analysis. 

    Results: Two main themes were identified from the interviews: (i) an incongruence between climate and environmental issues and nurses' daily work; and (ii) public health work is regarded as a health co-benefit of climate change mitigation. While being green is not the primary task in a lifesaving, hectic and economically challenging context, nurses' perceived their profession as entailing responsibility, opportunities and a sense of individual commitment to influence the environment in a positive direction. 

    Conclusions: This study argues there is a need for increased awareness of issues and methods that are crucial for the healthcare sector to respond to climate change. Efforts to develop interventions should explore how nurses should be able to contribute to the healthcare sector's preparedness for and contributions to sustainable development.

  • 2.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    von Koch, Lena
    Sjöstrand, Christina
    Heylighen, Ann
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet; Chalmers.
    The physical environment and patients' activities and care. A comparative case study at three newly built stroke units2018In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 74Article in journal (Refereed)
    Abstract [en]

    AIM: To explore and compare the impact of the physical environment on patients' activities and care at three newly built stroke units.

    BACKGROUND: Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients' activities in relation to the design of the physical environment of stroke units are scarce.

    DESIGN: This work is a comparative descriptive case study.

    METHOD: Patients (N=55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioral mapping analyzed with descriptive statistics and field note taking analyzed with deductive content analysis. Data were collected from April 2013 - December 2015.

    RESULTS: The units differed in the patients' levels of physical activity, the proportion of the day that patients spent with health professionals and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single room design. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients' activities and care.

    CONCLUSIONS: Patients' activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment. 

  • 3.
    Blomberg, Helena
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Stier, Jonas
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Metaphorical expressions used in Swedish news media narratives to portray the shortage of nurses and their working conditions2015In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 2, p. 382-395Article in journal (Refereed)
  • 4.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet; Chalmers University of Technology.
    Nordin, Susanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet.
    Wijk, Helle
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    A systematic review of the psychometric properties of instruments for assessing the quality of the physical environment in healthcare2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 12, p. 2796-2816Article in journal (Refereed)
    Abstract [en]

    AIM: To identify instruments measuring the quality of the physical healthcare environment, describe their psychometric properties.

    BACKGROUND: The physical healthcare environment is regarded as a quality factor for healthcare. To facilitate evidence-based design there is a need for valid and usable instruments that can evaluate the design of the healthcare environment.

    DESIGN: Systematic psychometric review.

    DATA SOURCES: A systematic literature search in Medline, CINAHL, Psychinfo, Avery index and reference lists of eligible papers (1990-2016).

    REVIEW METHOD: COSMIN guidelines were used to evaluate psychometric data reported.

    RESULTS: Twenty-three instruments were included. Most of the instruments are intended for for healthcare environments related to the care of older people. Many of the instruments were old, lacked strong, contemporary theoretical foundations, varied in the extent to which they had been used in empirical studies and in the degree to which their validity and reliability had been evaluated.

    CONCLUSIONS: Although we found many instruments for measuring the quality of the physical healthcare environment, none met all of our criteria for robustness. Of the instruments, The Multiphasic environmental assessment procedure, The Professional environment assessment protocol and The therapeutic environment screening have been used and tested most frequently. The Perceived hospital quality indicators is user centred and combine aspects of the physical and social environment. The Sheffield care environment assessment matrix has potential as it is comprehensive developed using a theoretical framework that has the needs of older people at the centre. However, further psychometric and user-evaluation of the instrument is required. 

  • 5. Estabrooks, Carole A
    et al.
    Squires, Janet E
    Strandberg, Elisabeth
    Nilsson-Kajermo, Kerstin
    Scott, Shannon D
    Profetto-McGrath, Joanne
    Harley, Dwight
    Wallin, Lars
    Karolinska Institutet.
    Towards better measures of research utilization: a collaborative study in Canada and Sweden2011In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, no 8, p. 1705-18Article in journal (Refereed)
    Abstract [en]

    AIMS: This paper is a report of a study examining research utilization in nursing. The specific aims were to (1) clarify the construct of research utilization, and (2) identify observable indicators of research utilization.

    BACKGROUND: Robust measures of research utilization do not exist despite steadily increasing numbers of studies in the field. One reason for this is theoretical confusion surrounding the central concepts in the field.

    METHOD: A qualitative (focus group) design was used to explore the construct of research utilization in two countries: Canada and Sweden. A systematic and sequential (three phases) approach to expert sampling framed the study. Phase 1 consisted of initial construct clarification by the research team (2005). In Phase 2, a face-to-face meeting with a panel of international research utilization nursing experts was held (2005). Phase 3 consisted of a series of focus groups with nursing care (direct and non-direct) providers (2005-2007). Data were analysed using content analysis.

    FINDINGS: The nursing care providers did not commonly use the term 'research utilization'. Several examples of research utilization were provided; a majority of these examples related to instrumental research utilization and became increasingly concrete as one moved from non-direct to direct care participants. Participants identified several indicators of research utilization (instrumental and conceptual). From these indicators, a measurement schematic was derived.

    CONCLUSIONS: The construct of research utilization is multi-faceted. Several indicators of research utilization were identified, which can be used to augment existing or develop a new and improved measure that taps both instrumental and conceptual use.

  • 6. Ewertzon, Mats
    et al.
    Alvariza, Anette
    Winnberg, Elisabeth
    Leksell, Janeth
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Uppsala universitet.
    Andershed, Birgitta
    Goliath, Ida
    Momeni, Pardis
    Kneck, Åsa
    Skott, Maria
    Årestedt, Kristofer
    Adaptation and evaluation of the Family Involvement and Alienation questionnaire for use in the care of older people, psychiatric care, palliative care and diabetes care2018In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 74, no 8, p. 1839-1850Article in journal (Refereed)
    Abstract [en]

    AIM: To adapt the Family Involvement and Alienation Questionnaire for use in the care of older people, psychiatric care, palliative care and diabetes care and to evaluate its validity and reliability.

    BACKGROUND: Involvement in the professional care has proven to be important for family members. However, they have described feelings of alienation in relation to how they experienced the professionals' approach. To explore this issue, a broad instrument that can be used in different care contexts is needed.

    DESIGN: A psychometric evaluation study, with a cross-sectional design.

    METHOD: The content validity of the Family Involvement and Alienation Questionnaire was evaluated during 2014 by cognitive interviews with 15 family members to adults in different care contexts. Psychometric evaluation was then conducted (2015-2016). A sample of 325 family members participated, 103 of whom in a test-retest evaluation. Both parametric and non-parametric methods were used.

    RESULTS: The content validity revealed that the questionnaire was generally understood and considered to be relevant and retrievable by family members in the contexts of the care of older people, psychiatric care, palliative care and diabetes care. Furthermore, the Family Involvement and Alienation Questionnaire (Revised), demonstrated satisfactory psychometric properties in terms of data quality, homogeneity, unidimensionality (factor structure), internal consistency and test-retest reliability.

    CONCLUSION: The study provides evidence that the Family Involvement and Alienation Questionnaire (Revised) is reliable and valid for use in further research and in quality assessment in the contexts of the care of older people, psychiatric care, palliative care and diabetes care. 

  • 7.
    Florin, Jan
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Patients' and nurses' perceptions of nursing problems in an acute care setting2005In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 51, no 2, p. 140-149Article in journal (Refereed)
    Abstract [en]

    Aim. This paper reports a study to determine the degree of agreement or disagreement between nurses and patients in their perceptions of the presence, severity, and importance of nursing problems. 

    Background. Patient experiences, values and preferences are increasingly acknowledged as important factors underpinning healthcare decision-making. The ability to identify patient problems accurately is an important prerequisite for planning and implementing individualized high quality care. 

    Methods. A convenience sample of patients (n = 80) and Registered Nurses (n = 30) in an acute care setting responded to a 43-item questionnaire. 

    Findings. Nurses identified patients' problems with a sensitivity of 0.53 and a positive predictive value of 0.50. Patients identified several severe problems that were not identified by nurses, particularly problems with nutrition, sleep, pain, and emotions/spirituality. Nurses underestimated the severity in 47% of mutually-identified problems. An overall level of agreement of 44% was found on the importance of patient problems. Low levels of agreement on severity and importance were related more to individual differences than to systematic differences. 

    Conclusions. Nurses need to be more aware that patients and nurses often hold disparate views of the priorities in nursing care. To plan individualized nursing care effectively, nurses need to elicit and use individual patients' preferences more systematically in care planning.

  • 8.
    Florin, Jan
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ehrenberg, Anna
    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 Univ Hosp, Stockholm, Sweden; Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Gustavsson, Petter
    Karolinska Inst, Div Psychol, Dept Clin Neurosci, Stockholm, Sweden.
    Educational support for research utilization and capability beliefs of evidence-based practice skills: a national survey of senior nursing students2012In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 68, no 4, p. 888-897Article in journal (Refereed)
    Abstract [en]

    Aim. The aim of the study was to investigate Swedish university nursing students’ experience of educational support for research utilization and capability beliefs regarding evidence-based practice skills.

    Background. Nursing programmes are offered at 26 universities in Sweden and even though there are common regulations for nursing education at the national level, substantial variations are found in local curricula. Little is known about students’ capability beliefs regarding evidence-based practice skills, particularly in comparison across universities.

    Methods. A cross-sectional survey design using self-administered postal questionnaires was conducted in 2006. A total of 1440 students (from 26 different universities) participated, constituting 68% of the national population of nursing students in their 6th and final semester.

    Results. Campus education supported the students to a greater extent than clinical education in following the development of knowledge in an area of interest, using research findings, and acquiring knowledge on how to pursue changes in clinical practice. Perceived support during campus education varied between universities. Students reported high capability beliefs regarding evidence-based practice skills, but large differences were found between universities for: stating a searchable question, seeking out relevant knowledge and critically appraising and compiling best knowledge.

    Conclusion. The identified differences between universities concerning the students’ perceived support for research utilization and their capability beliefs regarding evidence-based practice skills have implications for curricula, pedagogical perspectives in nursing education and the potential to implement evidence-based practice in healthcare settings. Further studies are warranted to investigate students’ individual characteristics and organizational characteristics as determinants of research utilization support and capability beliefs regarding evidence-based practice skills.

  • 9.
    Forsman, Henrietta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Gustavsson, Petter
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rudman, Ann
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Research use in clinical practice: extent and patterns among nurses one and three years postgraduation2009In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 6, p. 1195-1206Article in journal (Refereed)
    Abstract [en]

    Aim.  This paper is a report of a study of nurses’ research use in clinical practice one and three years postgraduation in Sweden.

    Background.  Internationally, learning to critically appraise and use research is an educational objective within nursing training, with the aim of promoting research use in nursing practice. The extent to which these skills is acquired and used among relatively newly graduated nurses is largely unexplored, however.

    Method.  A descriptive study was conducted in 2006 using a national longitudinal survey of two nursing cohorts one (n = 1,365) and three (n = 933) years postgraduation. The self-reported extent of instrumental, conceptual and persuasive research use was measured. Data were analysed using both variable- and pattern-oriented approaches based on cluster analysis.

    Results.  Research use was reported to occur in about half or fewer of the working shifts. In both samples, seven clusters of nurses with different research use profiles were identified. Clusters representing overall low and very low users in all three types of research use were predominant both at one (45·6%) and three (51·6%) years postgraduation, whereas clusters of nurses reporting overall high research use were uncommon. The proportion of very low users was larger 3 years after graduation than 1 year after graduation.

    Conclusions.  The low extent of reported research use, raises the question of whether scientific perspectives included in nursing education are translated into clinical application. The pattern-oriented approach illustrates the complexity of research use and identification of typical research use profiles in specific contexts may have potential to guide interventions aimed at supporting evidence-based practice.

  • 10.
    Forsman, Henrietta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Jansson, Inger
    Leksell, Janeth
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Uppsala University.
    Lepp, Margret
    Sundin Andersson, Christina
    Engström, Maria
    Nilsson, Jan
    Clusters of competence: Relationship between self-reported professional competence and achievement on a national examination among graduating nursing students.2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed)
    Abstract [en]

    AIMS: To identify clusters based on graduating nursing students' self-reported professional competence and their achievement on a national examination. Furthermore, to describe and compare the identified clusters regarding sample characteristics, students' perceptions of overall quality of the nursing programme and students' general self-efficacy.

    DESIGN: A cross-sectional study combining survey data and results from a national examination.

    METHODS: Data were collected at two universities and one university college in Sweden in January 2017, including 179 students in the final term of the nursing programme. The study was based on the Nurse Professional Competence Scale, the General Self-Efficacy scale and results from the National Clinical Final Examination. A Two-Step Cluster Analysis was used to identify competence profiles, followed by comparative analyses between clusters.

    RESULTS: Three clusters were identified illustrating students' different competence profiles. Students in Cluster 1 and 2 passed the examination, but differed in their self-assessments of competence, rating themselves under and above the overall median value respectively. Students in Cluster 3 failed the examination but rated themselves at the overall median level or higher.

    CONCLUSION: The study illustrates how nursing students' self-assessed competence might differ from competency assessed by examination, which is challenging for nursing education. Self-evaluation is a key learning outcome and is, in the long run, essential to patient safety.

    IMPACT: The study has identified clusters of students where some overestimate and others underestimate their competence. Students who assessed their competence low but passed the exam assessed their general self-efficacy lower than other students. The findings illuminate the need for student-centered strategies in nursing education, including elements of self-assessment in relation to examination to make the students more aware of their clinical competence.

  • 11.
    Forsman, Henrietta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rudman, Ann
    Gustavsson, Petter
    Ehrenberg, Anna
    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.
    Use of research by nurses during their first two years after graduating2010In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 66, no 4, p. 878-890Article in journal (Refereed)
    Abstract [en]

    Aim. This paper reports on a study of research use among nurses two years after graduation, as well as changes over time in research use in relation to changes in working conditions. 

    Background. The demand for evidence-based practice is widely expressed, and newly graduated nurses should possess the skills to provide high-quality care based on the best knowledge available. The way in which nurses use research during the first few years after graduating is, however, largely unknown. 

    Method. As part of a national longitudinal survey, nurses reported their extent of instrumental, conceptual and persuasive research use in 2006 (n = 1365) and 2007 (n = 1256). Data were analysed cross-sectionally and prospectively, using variable- and pattern-oriented methods. 

    Results. Instrumental research was reported most frequently, on about half of the working shifts. Seven profiles of research use were found, showing structural stability over time when compared with results from year 1. Most typically, nurses maintained the same profile over time; moreover, low users tended to become even lower users. Two years after graduation, 54 center dot 9% reported overall low use. Changes in working conditions did not explain the decrease in research use. 

    Conclusion. The results support previous claims of a gap between research and clinical practice. The predominance of overall low users is alarming and requires further research, including investigation of individual and organizational factors, to study their impact on nurses' research use.

  • 12. Göransson, K
    et al.
    Ehnfors, M
    M, Fonteyn
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Thinking strategies used by registered nurses during emergency department triage2008In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 61, no 2, p. 163-172Article in journal (Refereed)
  • 13. Johansson, Unn-Britt
    et al.
    Kaila, Päivi
    Ahlner-Elmqvist, Marianne
    Leksell, Janeth
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Isoaho, Hannu
    Saarikoski, Mikko
    Clinical learning environment, supervision and nurse teacher evaluation scale: psychometric evaluation of the Swedish version2010In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 66, no 9, p. 2085-2093Article in journal (Refereed)
    Abstract [en]

    Aim. This article is a report of the development and psychometric testing of the Swedish version of the Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale. Background. To achieve quality assurance, collaboration between the healthcare and nursing systems is a pre-requisite. Therefore, it is important to develop a tool that can measure the quality of clinical education. The Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale is a previously validated instrument, currently used in several universities across Europe. The instrument has been suggested for use as part of quality assessment and evaluation of nursing education. Methods. The scale was translated into Swedish from the English version. Data were collected between March 2008 and May 2009 among nursing students from three university colleges, with 324 students completing the questionnaire. Exploratory factor analysis was performed on the 34-item scale to determine construct validity and Cronbach’s alpha was used to measure the internal consistency. Results. The five sub-dimensions identified in the original scale were replicated in the exploratory factor analysis. The five factors had explanation percentages of 60·2%, which is deemed sufficient. Cronbach’s alpha coefficient for the total scale was 0·95, and varied between 0·96 and 0·75 within the five sub-dimensions. Conclusion. The Swedish version of Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale has satisfactory psychometric properties and could be a useful quality instrument in nursing education. However, further investigation is required to develop and evaluate the questionnaire.

  • 14.
    Leksell, Janeth
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wibell, L
    Johansson, I
    Wikblad, K
    Power and self-perceived health in blind diabetic and nondiabetic individuals2001In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 34, no 4, p. 511-519Article in journal (Refereed)
  • 15. Meijers, Judith M M
    et al.
    Janssen, Maaike A P
    Cummings, Greta G
    Wallin, Lars
    Karolinska Institutet.
    Estabrooks, Carole A
    Y G Halfens, Ruud
    Assessing the relationships between contextual factors and research utilization in nursing: systematic literature review2006In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 55, no 5, p. 622-35Article in journal (Refereed)
    Abstract [en]

    AIM: This paper reports a systematic literature review examining relationships between contextual factors and research utilization in nursing, examining the strength of these relationships, and mapping the contextual factors to the Promoting Action on Research Implementation in Health Services model of research implementation.

    BACKGROUND: Healthcare organizations have long struggled with how to improve clinical care outcomes. Understanding which contextual factors enhance nursing research utilization may support organizations in creating environments that facilitate the uptake of evidence in nursing practice to improve these outcomes.

    METHODS: A search of five electronic bibliographic databases and a manual search of specific journals were conducted for studies that were published in English and examined contextual factors as independent variables and research utilization as the dependent variable from the perspective of nurses working in clinical practice. The studies were assessed for quality of design, sample, measurement and statistical analysis.

    RESULTS: Ten papers met the search criteria. Six contextual factors were identified as having a statistically significant relationship with research utilization, namely the role of the nurse, multi-faceted access to resources, organizational climate, multi-faceted support, time for research activities and provision of education. The contextual factors could successfully be mapped to the dimensions of context in the Promoting Action on Research Implementation in Health Services framework (context, culture, leadership), with the exception of evaluation.

    CONCLUSION: The strength of the relationship between the six contextual factors and research utilization by nurses is still largely unknown as (a) few studies were found of sufficient quality because of methodological limitations and (b) the results in reviewed studies were mixed. More robust methods in future work would yield a better understanding of the full impact of contextual factors on nurses' use of research.

  • 16.
    Nordin, Susanna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Wijk, Helle
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    The association between the physical environment and the well-being of older people in residential care facilities: a multilevel analysis2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 12, p. 2942-2952Article in journal (Refereed)
    Abstract [en]

    AIMS: To investigate the associations between the quality of the physical environment and the psychological and social well-being of older people living in residential care facilities.

    BACKGROUND: Many older people in care facilities have cognitive and physical frailties and are at risk of experiencing low levels of well-being. High quality physical environments can support older people as frailty increases and promote their well-being. Although the importance of the physical environment for residents' well-being is recognised, more research is needed.

    DESIGN: A cross-sectional survey of 20 care facilities from each of which 10 residents were sampled. As the individual resident data was nested in the facilities, a multilevel analysis was conducted.

    METHODS: Data were collected during 2013 and 2014. The care facilities were purposely sampled to ensure a high level of variation in their physical characteristics. Residents' demographic and health data were collected via medical records and interviews. Residents' well-being and perceived quality of care were assessed via questionnaires and interviews. Environmental quality was assessed with a structured observational instrument.

    RESULTS: Multilevel analysis indicated that cognitive support in the physical environment was associated with residents' social well-being, after controlling for independence and perceived care quality. However, no significant association was found between the physical environment and residents' psychological well-being.

    CONCLUSION: Our study demonstrates the role of the physical environment for enhancing the social well-being of frail older people. Professionals and practitioners involved in the design of care facilities have a responsibility to ensure that such facilities meet high quality specifications. 

  • 17.
    Udo, Camilla
    et al.
    Department of Health Sciences, Mid Sweden University, Östersund, Sweden, and Health Care Sciences Post Graduate School at Karolinska Institute, Stockholm, Sweden.
    Danielson, Ella
    Mittuniversitetet, Inst. för Hälsovetenskap; Sahlgrenska Akademien, Götebrogs universitet.
    Melin-Johansson, Christina
    Mittuniversitetet, Inst. för Hälsovetenskap.
    Existential issues among nurses in surgical care - a hermeneutical study of critical incidents2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 3, p. 569-577Article in journal (Refereed)
    Abstract [en]

    Aims.

    To report a qualitative study conducted to gain a deeper understanding of surgical nurses’ experiences of existential care situations.

    Background.

    Existential issues are common for all humans irrespective of culture or religion and constitute man’s ultimate concerns of life. Nurses often lack the strategies to deal with patients’ existential issues even if they are aware of them.

    Design.

    This is a qualitative study where critical incidents were collected and analysed hermeneutically.

    Methods.

    During June 2010, ten surgical nurses presented 41 critical incidents, which were collected for the study. The nurses were first asked to describe existential care incidents in writing, including their own emotions, thoughts, and reactions. After 1–2 weeks, individual interviews were conducted with the same nurses, in which they reflected on their written incidents. A hermeneutic analysis was used.

    Findings.

    The majority of incidents concerned nurses’ experiences of caring for patients’ dying of cancer. In the analysis, three themes were identified, emphasizing the impact of integration between nurses’ personal self and professional role in existential care situations: inner dialogues for meaningful caring, searching for the right path in caring, and barriers in accompanying patients beyond medical care.

    Conclusion.

    Findings are interpreted and discussed in the framework of Buber’s philosophy of the relationships I-Thou and I-It, emphasizing nurses’ different relationships with patients during the process of caring. Some nurses integrate their personal self into caring whereas others do not. The most important finding and new knowledge are that some nurses felt insecure and were caught somewhere in between I-Thou and I-It.

  • 18.
    Wallin, Lars
    et al.
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Boström, AM
    Wikblad, K
    Ewald, U
    Sustainability in changing clinical practice promotes evidence-based nursing care2003In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 41, no 5, p. 509-518Article in journal (Refereed)
  • 19.
    Österlund Efraimsson, Eva
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Fossum, Bjöörn
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Larsson, Kjell
    Klang, Birgitta
    Use of motivational interviewing in smoking cessation at nurse-led chronic obstructive pulmonary disease clinics2012In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 68, no 4, p. 767-782Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of a study to describe to what extent Registered Nurses, with a few days of education in motivational interviewing based communication, used motivational interviewing in smoking cessation communication at nurse-led chronic obstructive pulmonary disease clinics in primary health care.

    Background. For smokers with chronic obstructive pulmonary disease the most crucial and evidence-based intervention is smoking cessation. Motivational interviewing is often used in healthcare to support patients to quit smoking.

    Method. The study included two videotaped consultations, the first and third of three at the clinic, with each of 13 smokers. Data were collected from March 2006 to April 2007. The nurses’ smoking cessation communication was analysed using the Motivational Interviewing Treatment Integrity scale. To get an impression of the consultation, five parameters were judged on a five-point Likert-scale, with five indicating best adherence to Motivational Interviewing.

    Results. Evocation’, ‘collaboration’, ‘autonomy-support’ and ‘empathy’ averaged between 1·31 and 2·23 whereas ‘direction’ scored five in all consultations. Of communication behaviours, giving information was the most frequently used, followed by ‘closed questions’, ‘motivational interviewing non–adherent’ and ‘simple reflections’. ‘Motivational interviewing adherent’, ‘open questions’ and ‘complex reflections’ occurred rarely. There were no important individual or group-level differences in any of the ratings between the first and the third consultations.

    Conclusion. In smoking cessation communication the nurses did not employ behaviours that are important in motivational interviewing.

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