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  • 1. Boström, Anne-Marie
    et al.
    Kajermo, Kerstin Nilsson
    Nordström, Gun
    Wallin, Lars
    Karolinska Institutet.
    Registered nurses' use of research findings in the care of older people2009Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, nr 10, s. 1430-41Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: To describe registered nurses' reported use of research in the care of older people and to examine associations between research use and factors related to the elements: the communication channels, the adopter and the social system.

    BACKGROUND: Research use among registered nurses working in hospital settings has been reported in many studies. Few studies, however, have explored the use of research among registered nurses working in the care of older people.

    DESIGN: A cross-sectional survey.

    METHODS: In eight municipalities, all registered nurses (n = 210) working in older people care were invited to participate (response rate 67%). The Research Utilisation Questionnaire was adopted. Questions concerning the work organisation and research-related resources were sent to the Community Chief Nurse at each municipality. Descriptive statistics and logistic regression were applied.

    RESULTS: The registered nurses reported a relatively low use of research findings in daily practice, despite reporting a positive attitude to research. The registered nurses reported lack of access to research reports at the work place and that they had little support from unit managers and colleagues. Registered nurses working in municipalities with access to research-related resources reported more use of research than registered nurses without resources. The factors 'Access to research findings at work place', 'Positive attitudes to research' and 'Nursing programme at university level' were significantly associated with research use.

    CONCLUSIONS: There is a great potential to increase registered nurses' use of research findings in the care of older people. Factors which were linked to the communication channels and the adopter were associated with research use.

    RELEVANCE TO CLINICAL PRACTICE: Strategies to enhance research use should focus on access to and adequate training in using information sources, increased knowledge on research methodology and nursing science and a supportive organisation.

  • 2. Boström, Anne-Marie
    et al.
    Wallin, Lars
    Karolinska Institutet.
    Estabrooks, Carole A
    Kajermo, Kerstin Nilsson
    Commentary on Brown CE, Ecoff L, Kim SC, Wickline MA, Rose B, Klimpel K and Glaser D (2010) Multi-institutional study of barriers to research utilisation and evidence-based practice among hospital nurses. Journal of Clinical Nursing 19, 1944-1951.2012Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, nr 19-20, s. 2995-6Artikkel i tidsskrift (Fagfellevurdert)
  • 3. Carlsson, E
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehnfors, M
    Long term experiences of living with eating difficulties after stroke2004Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, s. 825-834Artikkel i tidsskrift (Fagfellevurdert)
  • 4. Carlsson, Eva
    et al.
    Ehnfors, Margareta
    Eldh, Ann Catrine
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet, Örebro university.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Accuracy and continuity in discharge information for patients wtih eating difficulties after stroke2012Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, nr 2, s. 21-31Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims. To describe the accuracy and continuity of discharge information for patients with eating difficulties after stroke. Design. Prospective, descriptive. 

    Methods. The study investigated a sample of 15 triads, each including one patient with stroke along with his patient record and discharge summary and two nursing staff in the municipal care to whom the patient was discharged. Data were collected by observations of patients' eating, record audits and interviews with nurses. Data were analysed using content analysis and descriptive statistics. 

    Results. Accuracy of recorded information on patients' eating difficulties and informational continuity were poor, as was accuracy in the transferred information according to nursing staff's perceptions. All patients were at risk of undernutrition and in too poor a state to receive rehabilitation. Nevertheless, patients' eating difficulties were described in a vague and unspecific language in the patient records. Co-ordinated care planning and management continuity related to eating difficulties were largely lacking in the documentation. Despite their important role in caring for patients with eating difficulties, little information on eating difficulties seemed to reach licensed practical nurses in the municipalities. 

    Conclusions. Comprehensiveness in the documentation of eating difficulties and accuracy of transferred information were poor based on record audits and as perceived by the municipal nursing staff. Although all patients were at risk of undernutrition, had multiple eating difficulties and were in too poor a state for rehabilitation, explicit care plans for nutritional problems were lacking. Relevance to clinical practice. Lack of accuracy and continuity in discharge information on eating difficulties may increase risk of undernutrition and related complications for patients in continuous stroke care. Therefore, the discharge process must be based on comprehensive and accurate documentation.

  • 5.
    Ehrenberg, Anna
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehnfors, M
    Ekman, I
    Older patients with chronic heart failure in home care. A record review of nurses’ assessments and interventions.2004Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, nr 1, s. 90-96Artikkel i tidsskrift (Fagfellevurdert)
  • 6.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Predictors of patient participation in clinical decision-making in nursing care.2008Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, s. 2935-2944Artikkel i tidsskrift (Fagfellevurdert)
  • 7.
    Florin, Jan
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehnfors, Margareta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Clinical decision making: predictors of patient participation in nursing care2008Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, nr 21, s. 2935-2944Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim. To investigate predictors of patients' preferences for participation in clinical decision-making in inpatient nursing care. 

    Background. Patient participation in decision-making in nursing care is regarded as a prerequisite for good clinical practice regarding the person's autonomy and integrity. 

    Design. A cross-sectional survey of 428 persons, newly discharged from inpatient care. Methods. The survey was conducted using the Control Preference Scale. Multiple logistic regression analysis was used for testing the association of patient characteristics with preferences for participation. 

    Results. Patients, in general, preferred adopting a passive role. However, predictors for adopting an active participatory role were the patient's gender (odds ratio = 1.8), education (odds ratio = 2.2), living condition (odds ratio = 1.8) and occupational status (odds ratio = 2.0). A probability of 53% was estimated, which female senior citizens with at least a high school degree and who lived alone would prefer an active role in clinical decision-making. At the same time, a working cohabiting male with less than a high school degree had a probability of 8% for active participation in clinical decision-making in nursing care. 

    Conclusions. Patient preferences for participation differed considerably and are best elicited by assessment of the individual patient. Relevance to clinical practice. The nurses have a professional responsibility to act in such a way that patients can participate and make decisions according to their own values from an informed position. Access to knowledge of patients' basic assumptions and preferences for participation is of great value for nurses in the care process. There is a need for nurses to use structured methods and tools for eliciting individual patient preferences regarding participation in clinical decision-making.

  • 8.
    Florin, Jan
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Patient participation in clinical decision making in nursing: a comparative study of nurses and patients’ perceptions2006Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 15, nr 12, s. 1498-1508Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims and objectives. The aim of this study was to compare the degree of concordance between patients and Registered Nurses' perceptions of the patients' preferences for participation in clinical decision-making in nursing care. A further aim was to compare patients' experienced participation with their preferred participatory role. 

    Background. Patient participation in clinical decision-making is valuable and has an effect on quality of care. However, there is limited knowledge about patient preferences for participation and how nurses perceive their patients' preferences. 

    Methods. A comparative design was adopted with a convenient sample of 80 nurse-patient dyads. A modified version of the Control Preference Scale was used in conjunction with a questionnaire developed to elicit the experienced participation of the patient. 

    Results. A majority of the Registered Nurses perceived that their patients preferred a higher degree of participation in decision-making than did the patients. Differences in patient preferences were found in relation to age and social status but not to gender. Patients often experienced having a different role than what was initially preferred, e.g. a more passive role concerning needs related to communication, breathing and pain and a more active role related to activity and emotions/roles. 

    Conclusions. Registered Nurses are not always aware of their patients' perspective and tend to overestimate patients' willingness to assume an active role. Registered Nurses do not successfully involve patients in clinical decision-making in nursing care according to their own perceptions and not even to the patients' more moderate preferences of participation. 

    Relevance to clinical practice. A thorough assessment of the individual's preferences for participation in decision-making seems to be the most appropriate approach to ascertain patient's involvement to the preferred level of participation. The categorization of patients as preferring a passive role, collaborative role or active role is seen as valuable information for Registered Nurses to tailor nursing care.

  • 9. Forberg, Ulrika
    et al.
    Johansson, Eva
    Ygge, Britt-Marie
    Wallin, Lars
    Karolinska Institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Accuracy in documentation of peripheral venous catheters in paediatric care: an intervention study in electronic patient records2012Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, nr 9-10, s. 1339-1344Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims. The aim of this study is to compare the accuracy and completeness in the recording of peripheral venous catheters before and after implementing a template in the electronic patient record in paediatric care.

    Background. As a basis for quality improvement and research purposes and to ensure patient safety, accurate clinical data need to be easily accessible in patient records. Several studies have concluded that the relation between performed care and what is documented in patient records is poor.

    Design. Before and after study.

    Method. The study took place at a large paediatric university hospital in Sweden. Inclusion criteria were patients who were admitted to one of the included wards, had one or several peripheral venous catheters and were available at the ward at the time for data collection. Data were collected by observations and record audits before and then four and 10 months after the introduction of a template for recording peripheral venous catheters in a structured and standardised way.

    Results. A significant increase in peripheral venous catheters with complete recording was observed after as compared with before the intervention. The percentage of peripheral venous catheters with recording of any kind was relatively stable (85-93%). The overall recording of peripheral venous catheters insertion did not improve, but there was an increase in the recording of side and size after the intervention. One of the 22 complications observed before the intervention was documented and none of the complications (n = 17 and n = 9) after.

    Conclusion. The electronic patient record did not provide accurate data on peripheral venous catheters in paediatric care neither before nor after the intervention. Relevance to clinical practice. Further efforts to increase the documentation of catheter-related complications are needed. Integrated decision support systems in electronic patient records that remind nurses to inspect peripheral venous catheters regularly could be one solution.

  • 10. Fossum, Mariann
    et al.
    Alexander, Greg L
    Göransson, Katarina
    Ehnfors, Margareta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Registered nurses’ thinking strategies about malnutrition and pressure ulcer in nursing homes: a scenario-based think aloud study2011Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, nr 17-18, s. 2425-2435Artikkel i tidsskrift (Fagfellevurdert)
  • 11. Gunningberg, Lena
    et al.
    Fogelberg-Dahm, Marie
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Improved quality and comprehensiveness in nursing documentation of pressure ulcers after implementing an electronic health record in hospital care2009Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, nr 11, s. 1557-1564Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims. One aim was to compare the quality and comprehensiveness in nursing documentation of pressure ulcers before and after implementation of an electronic health record in a hospital setting. Another aim was to investigate the use of preformulated templates for pressure ulcer recording in the electronic health record. Background. With the possibilities of the electronic health record to provide information and give accurate and reliable feedback to the healthcare organisation, it is of high priority to develop standardised documentation practices for various areas of care (e.g. such as pressure ulcer care). Design. A cross-sectional retrospective review of health records. Methods. Three departments in a Swedish university hospital participated. In 2002, there were 413 patients, including 59 paper-based records identified with notes on pressure ulcers and in 2006, 343 patients, including 71 electronic health records with pressure ulcer recording. Recorded data on pressure ulcers were retrospectively reviewed. Results. Significantly more patient records showed notes of pressure ulcer grade (p < 0·001), size (p = 0·004), risk assessment (p = 0·002), nursing history (p = 0·040), nursing diagnoses (p < 0·001), nursing goals (p < 0·001) and nursing outcomes (p = 0·016) in 2006 than in 2002. One third of the recordings used preformulated templates. Conclusions. Although there were significant improvements in pressure ulcer recording after the change to the electronic health record, several deficiencies remained. Due to the short time of our follow-up after implementation of the electronic health record, we suspect that the quality of recording will improve when nurses become more familiar with the new system. Relevance to clinical practice. Education related to the use of the electronic health record and evidence-based pressure ulcer prevention should be provided to the nurses. To facilitate documentation, the templates need to be refined to be more user-friendly.

  • 12. Göransson, K
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehnfors, M
    Triage in emergency departments: A national survey in Sweden2005Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, s. 1067-1074Artikkel i tidsskrift (Fagfellevurdert)
  • 13. Hagren, B.
    et al.
    Petterson, I.
    Lützen, Kim
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Clyne, N.
    Maintenance hemodialysis: patients´ experiences of their life situation2005Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, nr 3, s. 294-300Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Aim. The aim of this study was to examine how patients suffering from CKD on maintenance haemodialysis experience their life situation. The focus was on how treatment encroaches on time and space and how patients experience care. The rationale was that this knowledge is necessary to provide professional support that takes into consideration a person's whole life situation. Background. The experiences of patients with chronic kidney disease (CKD) undergoing maintenance haemodialysis have been studied in many quantitative studies, which translate patients' subjective experiences into objectively quantifiable data. However, there are few qualitative studies examining the experiences of these patients' life situation and expressing their experiences within the context of a nursing and caregiver's perspective. Method. Data were collected by interviews with 41 patients between the ages of 29 and 86 years who participated in the study. A content analysis was used to identify common themes that describe the patients' experiences of their life situation. Results. Three main themes were identified, 'not finding space for living', 'feelings evoked in the care situation' and, 'attempting to manage restricted life'. The first theme 'not finding space for living' consisted of two sub-themes: 'struggling with time-consuming care' and 'feeling that life is restricted'. The second theme 'feelings evoked in the care situation' consisted of two sub-themes: 'sense of emotional distance' and 'feeling vulnerable'. Conclusions. The patients in this study indirectly expressed an existential struggle, indicating that encroachment of time and space were important existential dimensions of CKD. The findings indicated that caregivers were not always aware of this inducing a sense of emotional distance and a sense of vulnerability in the patients. Relevance to clinical practice. Caregivers in dialysis units have to consider haemodialysis patients' experience of a sense of emotional distance in their relationship to caregivers. Nurses and doctors need to create routines within nursing practice to overcome this.

  • 14.
    Hrisanfow, Elisabet
    et al.
    Family Medicine Research Centre, Örebro University, Örebro.
    Hägglund, Doris
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease2013Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, nr 1-2, s. 97-105Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims and objectives. The aim of this study was to investigate the impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease in primary health care.

    Background. Existing information on the impact of cough and urinary incontinence on quality of life in patients with chronic obstructive pulmonary disease is scant.

    Design. A questionnaire survey.

    Method. The study included 391 women and 337 men, aged 5075 years, with chronic obstructive pulmonary disease. A self-administered questionnaire consisted of CCQ and SF-12 questionnaires. A response rate of 66% was obtained. Most patients had been diagnosed with moderate (Stage II) chronic obstructive pulmonary disease.

    Results. Women and men with urinary incontinence showed a significantly higher presence of symptomatic cough and phlegm production than did women and men without incontinence. Women with incontinence had a significantly higher burden of CCQ symptoms, functional and mental state than did women without incontinence. Concerning quality-of-life scores, women with incontinence had lower physical state scores (37.6 +/- 10.4 vs. 41.4 +/- 9.9; p < 0.001) and mental state scores (44.3 +/- 10.2 vs. 47.1 +/- 10.5; p < 0.007) than did women without incontinence. Men with incontinence had a significantly higher burden of CCQ symptoms and mental state than did men without incontinence. When examining the quality-of-life scores, men with incontinence had lower mental state scores than did men without incontinence (46.0 +/- 9.7 vs. 49.8 +/- 9.7; p < 0.001).

    Conclusion. The present results indicate that cough and urinary incontinence lead to poor quality of life in women and men with chronic obstructive pulmonary disease.

    Relevance to clinical practice. In the context of primary health care, appropriate questions concerning urinary incontinence and quality of life should be included in care plans for women and men living with chronic obstructive pulmonary disease.

  • 15.
    Hrisanfow, Elisabeth
    et al.
    Örebro universitet, Hälsoakademin.
    Hägglund, Doris
    Örebro universitet, Hälsoakademin.
    The prevalence of urinary incontinence among women and med with chronic obstructive pulmonary disease in Sweden2011Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, nr 13-14, s. 1895-1905Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim.  The aims of the present study were to investigate the prevalence, characteristics and status of urinary incontinence among women and men with chronic obstructive pulmonary disease in primary health care.

    Background.  Information on the prevalence of urinary incontinence in women and men with chronic obstructive pulmonary disease is scant. Such knowledge may be important to the development of care for patients with chronic obstructive pulmonary disease.

    Design.  A questionnaire survey.

    Method.  The study included 391 women and 337 men, aged 50–75 years, with chronic obstructive pulmonary disease. A self-administered, evidence-based questionnaire for incontinence was used. A response rate of 66% was obtained, of which 89·3% had spirometry-confirmed chronic obstructive pulmonary disease, and most patients had been diagnosed with moderate (Stage II) chronic obstructive pulmonary disease.

    Results.  The prevalence of urinary incontinence in women and men with chronic obstructive pulmonary disease was 49·6 and 30·3%, respectively. Women and men with urinary incontinence had a significantly higher body mass index than did women and men without urinary incontinence. The most common type of incontinence in women was stress incontinence (52·4%) and in men postmicturition dribbling (66·3%). Women with urinary incontinence had a higher presence of a symptomatic cough than did women without urinary incontinence (p < 0·001). On the whole, incontinence affected women more than men concerning experienced bothersomeness of incontinence (p < 0·001). More women than men with urinary incontinence refrained from activities (p < 0·021) and had sought help for incontinence (p < 0·012).

    Conclusion.  The present results indicate that urinary incontinence content should be included in care plans for patients living with chronic obstructive pulmonary disease. In addition, the results imply that nurses and physicians working in primary health care should ask patients with chronic obstructive pulmonary disease about urinary incontinence and then offer appropriate assessment and management of it.

  • 16.
    Hägglund, Doris
    Örebro universitet, Hälsoakademin.
    A systematic literature review of incontinence care for persons with dementia: the research evidence2010Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr 3-4, s. 303-312Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Backgroud. Urinary/faecal incontinence in persons with dementia is a potentially treatable condition. However, which type of incontinence care is most appropriate for persons with dementia remains undecided. Aim. The aim of this study was to perform a systematic review of literature on incontinence care in persons with dementia focusing on assessment/management and prevention. Design. A systematic search of the literature. Method. The search was performed in the CINAHL, PubMed and Cochrane Library databases. Results. Of the 48 papers analysed, two were systematic literature reviews of management of urinary incontinence including persons with dementia. These reviews showed that the best-documented effect of toilet assistance for urinary incontinence in elderly persons with/without dementia had prompted voiding. However, prompted voiding in persons with dementia raises ethical concerns related to the person's integrity and autonomy. Timed voiding in combination with additional interventions like incontinence aids, staff training on the technique of transferring participants from bed to commode and pharmacological treatment decreased the number of urinary incontinence episodes in older persons with/without dementia. There is good scientific evidence that prevention of urinary incontinence in elders with/without dementia decreases incontinence or maintains continence. However, the evidence is insufficient to describe the state of knowledge of faecal incontinence. Conclusions. Toilet assistance, including timed voiding in combination with additional interventions and prompted voiding, are the available evidence-based interventions; however, nursing incontinence care is an experience-based endeavour for persons with dementia. Relevance to clinical practice. There is a lack of evidence-based nursing interventions related to incontinence care for persons with dementia. More research is needed to show whether experience-based incontinence care is effective and which activities are most appropriate for persons with dementia. However, the practice of effective nursing will only be realised by using several sources of evidence, namely research, clinical experience and patient experience.

  • 17. Hälleberg Nyman, M
    et al.
    Forsman, Henrietta
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ostaszkiewicz, J
    Hommel, A
    Eldh, Ann Catrine
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institutet.
    Urinary incontinence and its management in patients aged 65 and older in orthopaedic care: what nursing and rehabilitation staff know and do2017Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, nr 21-22, s. 3345-3353Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS AND OBJECTIVES:

    To describe what nursing and rehabilitation staff know and do with regards to urinary incontinence and risk of urinary incontinence in patients 65 years or older undergoing hip surgery.

    BACKGROUND:

    Urinary incontinence is a common but often neglected issue for older people. Despite the existence of evidence-based guidelines on how to assess, manage and prevent UI, there are indications that these guidelines are not applied in hospital care.

    DESIGN:

    A qualitative study with descriptive design was conducted in two orthopaedic units.

    METHODS:

    46 interviews and 36 observations of care were conducted from January to October 2014 and analysed with qualitative content analysis.

    RESULTS:

    Enrolled nurses performed most of the care related to bladder function, with focus on urinary catheterisation and preventing urinary tract infection and urinary retention. Registered nurses' role in urinary matters mainly comprised documentation, while the rehabilitation staff focused on making it possible for the patient to be independent in toileting. The nursing staff considered urinary incontinence a common condition for older people and that it was convenient for the patients to have an indwelling catheter or incontinence pad/pant, although they acknowledged some of the risks associated with these procedures.

    CONCLUSIONS:

    Urinary incontinence is not a priority in orthopaedic care, and urinary incontinence guidelines are not applied. Further, attitudes and actions are mainly characterised by a lack of urinary incontinence knowledge and the nursing and rehabilitation staff do not take a team approach to preventing and managing UI.

    RELEVANCE TO CLINICAL PRACTICE:

    An increased focus on knowledge on urinary incontinence and evidence-based guidelines is needed. To secure evidence-based practice, the team of nursing and rehabilitation staff and managers must be aligned and work actively together, also including the patient in the team.

  • 18. Ingela, Henoch
    et al.
    Lövgren, Malin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wilde-Larsson, Bodil
    Tishelman, Carol
    Perception of quality of care: comparison of the opinions of patients’ with lung cancer and their family members2012Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, nr 3-4, s. 585-594Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims and objectives. To explore potential differences within dyads of patients’ with lung cancer and family members’ judgment of different aspects of quality of care and relationships between quality of care and personal and health-related characteristics.

    Background. High quality of care is important for acceptable quality of life in patients in palliative care. If patients are unable to participate in quality of care assessments or decision-making, family members might often act as proxies, despite the complicated nature of their own situation.

    Design. Cross-sectional survey design. Method. A patient and family member version of the abbreviated questionnaire Quality from Patients’ Perspective, with additional items about perceived health and opinions about care, was mailed to members of the Swedish lung cancer Patient Organisation. Wilcoxon’s signed rank test was used to identify potential differences within 51 patient–family member dyads’ quality of care ratings. Relationships between Quality from Patients’ Perspective dimensions and demographic and health-related variables were examined with Spearman’s correlations.

    Results. Patient–family member dyads had high levels of agreement in ratings of perceived reality of quality of care. Family members generally rated the subjective importance of individual items higher than did the patient in the dyad, with significant difference in the dimension ‘socio-cultural approach’. Older patients were found to rate the physical–technical conditions higher than younger patients, in relation to perceived reality but not subjective importance. Women family members were found to rate the subjective importance of medical–technical competence, identity-oriented approach and socio-cultural approach significantly higher than men did.

    Conclusions. Patients with lung cancer and their family members agree in ratings of the perceived reality, but they differ more in ratings of the subjective importance of quality of care. When patients are unable to communicate their preferences, family members’ opinions could be used as proxies concerning concrete aspects of quality of care. Concerning more subjective aspects, family members’ ratings should be interpreted with precaution, as it could diverge from patients’ own opinion. Relevance to clinical practice. The perceptions of the importance of different aspects of quality of care were less related to health status than were judgments of quality of care received. This might suggest that the care patients received fulfilled neither the patients’ nor family members’ expectations, which is an important message to healthcare professionals and which would demand further exploration.

  • 19.
    Letterstål, Anna
    et al.
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna.
    Eldh, Ann Catrine
    Department of Neurobiology, Care Sciences and Society, The Division of Nursing, Karolinska Institutet, Huddinge ; School of Health and Medical Sciences, Örebro University, Örebro.
    Olofsson, Per
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna.
    Forsberg, Christina
    Department of Neurobiology, Care Sciences and Society, The Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
    Patients' experience of open repair of abdominal aortic aneurysm - preoperative information, hospital care and recovery2010Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr 21-22, s. 3112-3122Artikkel i tidsskrift (Fagfellevurdert)
  • 20.
    Marmstål Hammar, Lena
    et al.
    Mälardalens högskola.
    Emami, Azita
    Seattle Univ, Coll Nursing.
    Götell, Eva
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Engström, Gabriella
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    The impact of caregivers' singing on expressions of emotion and resistance during morning care situations in persons with dementia: an intervention in dementia care2011Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, nr 7-8, s. 969-978Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim was to describe expressions of emotions and resistiveness to care among persons with dementia (PWD), during morning care situations without and with music therapeutic caregiving (MTC). BACKGROUND: Effective caregiving is dependent on the interpersonal relationship between nurse and patient. PWD suffer from major cognitive impairment, making interaction with others problematic. Such patients often react with problematic behaviours such as resistance and anger towards the care activity and the caregiver. Earlier research suggests that MTC - when caregivers sing for or together with PWD during caregiving - can reduce resistance and evoke positive emotions in PWD. DESIGN: This was an intervention study whereby MTC was implemented during morning care situations while PWD were being cared for. METHOD: The study included ten, 66-92-year-old men and women with severe dementia living in a nursing home in Sweden. Video observations of eight weekly sessions, consisting of four recordings of usual morning care and four recordings of morning care with MTC, provided data. The resistiveness to care scale and the observed emotion rating scale were used for analysis. RESULTS: Pull away was the most common resistant behaviour under both conditions. The PWDs' expressions of resistant behaviour, such as pull away, grab object and adduction, were significantly reduced under the intervention situation. Positively expressed emotions, specifically pleasure and general alertness, significantly increased under the MTC intervention compared with the 'usual' morning care sessions. CONCLUSIONS: MTC can be an effective nursing intervention to provide PWD a more pleasant experience of morning care situations as it decreases resistant behaviour and increases positive emotions. RELEVANCE TO CLINICAL PRACTICE: MTC offers a potential non-pharmacologic treatment that can be used in caring for PWD.

  • 21. Odencrants, Sigrid
    et al.
    Ehnfors, Margareta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Nutritional status and patient characteristics for hospitalized elderly patients with chronic obstructive pulmonary disease.2008Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, nr 13, s. 1771-1778Artikkel i tidsskrift (Fagfellevurdert)
  • 22.
    Svanberg, Anncarin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Uppsala Univ, Fac Med, Inst Med Sci, Uppsala, Sweden.
    Öhrn, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Vårdvetenskap med inriktning mot munhälsa.
    Birgegård, Gunnar
    Uppsala Univ, Fac Med, Inst Med Sci, Uppsala, Sweden.
    Oral cryotherapy reduces mucositis and improves nutrition: a randomised controlled trial2010Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr 15-16, s. 2146-2151Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim and objective. To investigate if oral cryotherapy during myeloablative therapy may influence frequency and severity of mucositis, nutritional status and infection rate after bone marrow transplantation.

    Background. Patients treated with intensive myeloablative treatment before bone marrow transplantation are all at risk to develop mucositis. Oral mucositis causes severe pain and oral dysfunction, which can contribute to local and systemic infections and bleeding; it may even interrupt cancer therapy. Oral mucositis also decreases the oral food intake, which increases the risk for malnutrition and infection. Reduced food intake, loss of fat and muscles, alterations in energy and substrate metabolism leads to malnutrition.

    Design. A randomised controlled trial with a random assignment to experimental or control group.

    Method. A stratified randomisation was used with regard to the type of transplantation. Mucositis was measured on WHO mucositis scale. Number of days of total parenteral nutrition, infection rate, weight, albumin levels and days at hospital was compared. Results. There were significantly fewer patients in the experimental group with mucositis grade 3–4 than in the control group and significantly lower number of days in the hospital (allogeneic patients). Less total parenteral nutrition was needed in the experimental group in both settings, and the S-albumin level was significantly better preserved. No significant difference could be found with regard to infection rate.

    Conclusion. Oral cryotherapy reduced mucositis, number of hospital days, the need for total parenteral nutrition and resulted in a better nutritional status.

    Relevance to clinical practice. Nurses caring for patients treated with myeloablative therapy should place high priority to prevent oral mucositis and hereby reduce its side effects.

  • 23.
    Swall, Anna
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Sophiahemmet Högskola.
    Ebbeskog, Britt
    Lundh Hagelin, Carina
    Sophiahemmet Högskola.
    Fagerberg, Ingegerd
    'Bringing respite in the burden of illness' - dog handlers experience of visiting older persons with dementia together with a therapy dog2016Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, nr 15-16, s. 2223-2231Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS AND OBJECTIVES:

    To illuminate meanings of the lived experiences of dog handlers' when visiting older persons with dementia with their therapy dog.

    BACKGROUND:

    Studies indicate that care of persons with dementia should focus on a person-centred approach with the person's interests in the centre. Animal-assisted therapy using a therapy dog in the care of persons with dementia has been shown to increase well-being and decrease problematic behaviours associated with the illness.

    DESIGN:

    A qualitative lifeworld approach was adopted for this study.

    METHODS:

    Data were collected from open-ended interviews with nine dog handlers, and the analysis conducted using the phenomenological hermeneutical method.

    RESULTS:

    The structural analysis resulted in one theme, 'Respite from the burden of illness for persons with dementia'.

    CONCLUSIONS:

    Visiting a person with dementia can be seen as an act of caring, providing temporary respite from their illness, and creating a special relationship between handler and patient. A therapy dog visit can represent a moment of communion between the handler and the person with dementia.

    IMPLICATION FOR CLINICAL PRACTICE:

    Dog handlers use their skills and knowledge to promote a situation that reduces symptoms of illness and encourages healthier behaviour. The results of this study may be of interest to researchers, clinical practitioners, caregivers and dog handlers who care for persons with dementia using therapy dog teams on prescription as an alternative method to minimise behavioural and psychological symptoms of dementia.

  • 24.
    Sörensen Duppils, Gill
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Wikblad, K.
    Behavioural changes before and during the prodromal phase of delirium2004Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, nr 5, s. 609-16Artikkel i tidsskrift (Fagfellevurdert)
  • 25.
    Sörensen Duppils, Gill
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Wikblad, Karin
    Acute confusional states after admission to hospital1998Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 7, nr 2, s. 195-196Artikkel i tidsskrift (Fagfellevurdert)
  • 26.
    Sörensen Duppils, Gill
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wikblad, Karin
    Patients' experience of being delirious2007Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, nr 5, s. 810-818Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim was to describe patients" experiences of being delirious.

    Background. Delirium is a serious psychiatric disorder that is frequently reported from hospital care settings, particularly among older patients undergoing hip surgery. It involves disturbances of consciousness and changes in cognition, a state which develops over a short period of time and tends to fluctuate during the course of the day. It is a certified fact that delirium is poorly diagnosed and recognized although the state often is described as terrifying. To be able to give professional care, it is of the utmost importance to know more about patients" experience of delirium.

    Method. Included in the interviews were patients who had undergone hip-related surgery and during the hospital stay experienced delirium. Fifteen patients participated in the interviews. Of these, six had experienced episodes of nightly delirium (sundown syndrome) and nine experienced delirium during at least one day. The interviews were analysed by qualitative content analysis.

    Results. The entry of delirium was experienced as a sudden change of reality that, in some cases, could be connected to basic unfulfilled physiological needs. The delirium experiences were like dramatic scenes that gave rise to strong emotional feelings of fear, panic and anger. The experiences were also characterized by opposite pairs; they took place in the hospital but at the same time somewhere else; it was like dreaming but still being awake. The exit from the delirium was associated with disparate feelings.

    Relevance to clinical practice. It is necessary to understand patients" thoughts and experiences during the delirious phase to be able to give professional care, both during the delirium phase and after the recovery.

  • 27.
    Widarsson, M.
    et al.
    Uppsala University, Uppsala, Sweden.
    Engström, G.
    Florida Atlantic University, United States.
    Tydén, T.
    Uppsala University, Uppsala, Sweden.
    Lundberg, P.
    Uppsala University, Uppsala, Sweden.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    'Paddling upstream': Fathers' involvement during pregnancy as described by expectant fathers and mothers2015Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, nr 7-8, s. 1059-1068Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims and objectives: To describe the perspectives of expectant mothers and fathers on fathers' involvement during pregnancy. Background: Becoming a father is a major life event and paternal involvement during pregnancy has a positive influence on the family. However, research into both expectant mothers' and fathers' perspectives on fathers' involvement during pregnancy is relatively scarce. Design: A descriptive qualitative study was used. Methods: Thirty expectant parents (20 women and 10 men) were interviewed either as part of one of four focus groups or in an individual interview. Qualitative content analysis was performed on the interview transcripts. Results: A theme of 'Paddling upstream' emerged as an expression of the latent content of the interviews concerning perspectives on fathers' involvement. Five sub-themes described the manifest content: trying to participate, trying to be understanding, trying to learn, trying to be a calming influence and trying to find a balanced life. Expectant parents suggested several ways to improve fathers' involvement and to meet parents' need for shared involvement. Conclusion: Expectant mothers and fathers wanted the father to be more involved in the pregnancy. Although fathers attempted different strategies, they did not always perceive what was expected of them and encountered many barriers as they tried to navigate through this unique experience. The best support for the father was the mother. Expectant parents wanted their healthcare to include the father more thoroughly and to focus on the whole family. Relevance to clinical practice: Prenatal care professionals can overcome barriers that prevent paternal involvement. Although fathers are not able to engage in the pregnancy on the same level as the mother, we suggest that their specific needs also be recognised through an increased awareness of gender norms in healthcare.

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