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  • 1. Abdullahi, A.
    et al.
    Kalid, Mohamed
    Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Kipchumba, E.
    Sulaiman, M.
    Supporting Micro-enterprise in Humanitarian Programming: Impact Evaluation of Business Grants versus Unconditional Cash Transfer2023In: Journal of African Economies, ISSN 0963-8024, E-ISSN 1464-3723, Vol. 32, no 4, p. 415-437Article in journal (Refereed)
    Abstract [en]

    Humanitarian programming in fragile economies often use unconditional cash transfers (UCTs) to offset food insecurity. However, there is an increasing focus on using cash transfers to boost household incomes beyond the short-term through micro-enterprise start-up and growth. This paper conducts a randomised control trial to measure the impact of three different sizes of business grants against UCT in Somalia. We find that giving the same amount of money as a lump sum business grant results in higher likelihood of business ownership and income compared with UCT in the short run (3-4 months after the transfers). However, the impacts are larger and persist 3 years later only for those who received larger amount of grants. The results indicate our 'medium'-sized grant being more cost-effective. © 2022 The Author(s).

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  • 2. Abshir, Juweria N L
    et al.
    Osman, Fatumo
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Somali National University, Mogadishu, Somalia; Uppsala University, Uppsala.
    Dahir, Gallad
    Somali National University, Mogadishu, Somalia.
    Dahlberg, Anton
    Uppsala University, Uppsala.
    Parental burnout among Somali mothers: Associations with mental health, perceived social support, and sociodemographic factors2023In: PLOS global public health, ISSN 2767-3375, Vol. 3, no 10, article id e0002501Article in journal (Refereed)
    Abstract [en]

    Parenthood can be defined by the contradiction that it is one of the most satisfying yet stressful experiences in life. Many parents experience stress during parenthood, and some to the extent that they display symptoms of parental burnout. Nevertheless, research on parental burnout is scant and many studies have only examined the condition in Western settings. The aim of this study was to examine parental burnout among Somali mothers in Mogadishu, Somalia, and its association with certain psychological, psychosocial, and sociodemographic factors. In this cross-sectional study, questionnaire data were collected through the measurements Parental Burnout Assessment and Patient Health Questionnaire 9, as well as through social and demographic questions. A total of 882 Somali mothers in Mogadishu participated. The analysis methods used were univariate, bivariate, and multiple linear regression analysis. The results revealed that the mean parental burnout score was low in the sample. Additionally, a significant association was found between higher levels of parental burnout and higher levels of depression, perceived lack of social support, being unmarried, having a low monthly household income, and when the youngest child was of school-age.

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  • 3.
    Adamek, Caisa
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Lissars, Julia
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Sjuksköterskors upplevelser av att vårda personer med demenssjukdom inom slutenvård: En litteraturstudie2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Dementia is an umbrella term for illnesses that cause cognitive impairment. A person centered approach is the foundation of caring for people with dementia. The relatives to admitted patients with dementia experience the care as generally good, but with room for improvement. Aim: This literature review aims to illustrate RNs experiences in caring for persons with dementia in an inpatient hospital setting. Method: This literature review was made with a methodology similar to ones used in systematic reviews. The search engines PubMed, CINAHL and APA PsycInfo were used and the chosen articles were checked for quality according to a template for qualitative research. The results were analyzed using Fribergs five steps for qualitative analysis. Results: A large number of RNs experienced challenges in the care of PwD. Organisational pressure and a lack of interprofessional co-operation led to an increase in the use of psychotropic drugs, as the stressful environment increased the rate of responsive behaviours in PwD. Distraction was common for RNs to use to counter responsive behaviours. RNs also used person centred communication to facilitate a good relationship. Conclusions: Experienced factors like lack of time and lack of knowledge was experienced as contributing to nurses having difficulties performing person centred care. This can resultin a reduced wellbeing for people with dementia when they are in need of care.

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  • 4.
    af Winklerfelt Hammarberg, Sandra
    et al.
    Karolinska Institutet, Stockholm, Academic Primary Health Care Centre, Region Stockholm, Stockholm.
    Björkelund, Cecilia
    Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Nejati, Shabnam
    Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Magnil, Maria
    Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Hange, Dominique
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg.
    Svenningsson, Irene
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg.
    Petersson, Eva‑Lisa
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg.
    Udo, Camilla
    Dalarna University, School of Health and Welfare, Social Work. Division of Health Care Science, Marie Cederschiöld University, Stockholm; Center for Clinical Research Dalarna, Uppsala University, Falun.
    Wallin, Lars
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Westman, Jeanette
    Karolinska Institutet, Stockholm; Academic Primary Health Care Centre, Region Stockholm, Stockholm; Uppsala University, Uppsala.
    Clinical effectiveness of care managers in collaborative primary health care for patients with depression: 12‑ and 24‑month follow‑up of a pragmatic cluster randomized controlled trial2022In: BMC Primary Care, E-ISSN 2731-4553, Vol. 23, no 1, article id 198Article in journal (Refereed)
    Abstract [en]

    Background: In previous studies, we investigated the effects of a care manager intervention for patients withdepression treated in primary health care. At 6 months, care management improved depressive symptoms, remission,return to work, and adherence to anti-depressive medication more than care as usual. The aim of this study wasto compare the long-term effectiveness of care management and usual care for primary care patients with depressionon depressive symptoms, remission, quality of life, self-efficacy, confidence in care, and quality of care 12 and24 months after the start of the intervention.Methods: Cluster randomized controlled trial that included 23 primary care centers (11 intervention, 12 control)in the regions of Västra Götaland and Dalarna, Sweden. Patients ≥18 years with newly diagnosed mild to moderatedepression (n = 376: 192 intervention, 184 control) were included. Patients at intervention centers co-developed astructured depression care plan with a care manager. Via 6 to 8 telephone contacts over 12 weeks, the care managerfollowed up symptoms and treatment, encouraged behavioral activation, provided education, and communicatedwith the patient’s general practitioner as needed. Patients at control centers received usual care. Adjusted mixedmodel repeated measure analysis was conducted on data gathered at 12 and 24 months on depressive symptomsand remission (MADRS-S); quality of life (EQ5D); and self-efficacy, confidence in care, and quality of care (study-specificquestionnaire).Results: The intervention group had less severe depressive symptoms than the control group at 12 (P = 0.02) butnot 24 months (P = 0.83). They reported higher quality of life at 12 (P = 0.01) but not 24 months (P = 0.88). Differencesin remission and self-efficacy were not significant, but patients in the intervention group were more confident that they could get information (53% vs 38%; P = 0.02) and professional emotional support (51% vs 40%; P = 0.05) from theprimary care center.Conclusions: Patients with depression who had a care manager maintained their 6-month improvements in symptomsat the 12- and 24-month follow-ups. Without a care manager, recovery could take up to 24 months. Patients withcare managers also had significantly more confidence in primary care and belief in future support than controls.

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  • 5.
    Ahlblom, Annika
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Latvakoski, Sabina
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Föräldrars upplevelse av spädbarns sömn vid en och sex månaders ålder: En kvantitativ studie2022Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The first year of life is critical for sleep development, and the quality of sleep affects both the physical and neurological development. The sleep of infants constitutes a common cause of worry among new parents, which can lead to modifications in recommended sleep arrangements to promote both parents’ and infants’ wellbeing. Aim: To investigate parents’ experience and description of preterm (<37 weeks of pregnancy) and full-term infants’ sleeping habits at one and six months of age. Method: This was a quantitative study with a longitudinal design consisting of 923 parents to 504 infants born during 2020/2021 who received care in either the maternity- or neonatal ward in Sweden. Data was collected from questionnaires and was analyzed using descriptive statistics, Mann-Whitney U test and Cohen’s d. Results: Fathers and parents with a low educational level experienced the infant’s sleep less problematic compared to mothers and parents with a high educational level at both one and six months of age. Over time there was no difference related to educational level. One moth post-partum, parents to preterm infants experienced that the sleeping habits were more of a problem compared to parents to full term infants. Parents to breastfed infants experienced the sleeping habits as more problematic at six months of age, and co-sleeping was common during the infants’ first month of life. Conclusions: Parents’ experience of infants’ sleeping habits is affected by various factors in the immediate home environment. Hence there is a need for individualized support and interventions for new parents regarding infants’ sleep environment.

  • 6.
    Ahrne, Malin
    et al.
    Karolinska Institutet, Stockholm.
    Byrskog, Ulrika
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Essén, Birgitta
    Uppsala University, Uppsala.
    Andersson, Ewa
    Karolinska Institutet, Stockholm.
    Small, Rhonda
    Karolinska Institutet, Stockholm; La Trobe University, Melbourne, Australia.
    Schytt, Erica
    Uppsala Univ, Ctr Clin Res Dalarna; Western Norway University of Applied Sciences, Bergen, Norway.
    Group antenatal care (gANC) for Somali-speaking women in Sweden - a process evaluation.2022In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 22, no 1, article id 721Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Language supported group antenatal care (gANC) for Somali-born women was implemented in a Swedish public ANC clinic. The women were offered seven 60-min sessions, facilitated by midwives and starting with a presentation of a selected topic, with an additional 15-min individual appointment before or after. The aim of this study was to assess the feasibility for participants and midwives of implementing The Hooyo ("mother" in Somali) gANC intervention, including implementation, mechanisms of impact and contextual factors.

    METHODS: A process evaluation was performed, using The Medical Research Council (MRC) guidelines for evaluating complex interventions as a framework. A range of qualitative and quantitative data sources were used including observations (n = 9), complementary, in-depth and key-informant interviews (women n = 6, midwives n = 4, interpreters and research assistants n = 3) and questionnaire data (women n = 44; midwives n = 8).

    RESULTS: Language-supported gANC offered more comprehensive ANC that seemed to correspond to existing needs of the participants and could address knowledge gaps related to pregnancy, birth and the Swedish health care system. The majority of women thought listening to other pregnant women was valuable (91%), felt comfortable in the group (98%) and supported by the other women (79%), and they said that gANC suited them (79%). The intervention seemed to enhance knowledge and cultural understanding among midwives, thus contributing to more women-centred care. The intervention was not successful at involving partners in ANC.

    CONCLUSIONS: The Hooyo gANC intervention was acceptable to the Somali women and to midwives, but did not lead to greater participation by fathers-to-be. The main mechanisms of impact were more comprehensive ANC and enhanced mutual cultural understanding. The position of women was strengthened in the groups, and the way in which the midwives expanded their understanding of the participants and their narratives was promising. To be feasible at a large scale, gANC might require further adaptations and the "othering" of women in risk groups should be avoided.

    TRIAL REGISTRATION: The study was registered in ClinicalTrials.gov (Identifier: NCT03879200).

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  • 7. Alvarez-Nieto, Carmen
    et al.
    Richardson, Janet
    Navarro-Peran, M. Angeles
    Tutticci, Naomi
    Huss, Norma
    Elf, Marie
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Anåker, Anna
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Aronsson, Jennie
    Baid, Heather
    Lopez-Medina, Isabel M.
    Nursing students' attitudes towards climate change and sustainability: A cross-sectional multisite study2022In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 108, article id 105185Article in journal (Refereed)
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  • 8. Amritzer, Maria A
    et al.
    Muntlin, Åsa
    Berg, Lena M
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Göransson, Katarina E
    Nursing staff ratio and skill mix in Swedish emergency departments: A national cross-sectional benchmark study.2021In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 29, no 8, p. 2594-2602Article in journal (Refereed)
    Abstract [en]

    AIM: To describe ratio and skill mix for nursing staff in Swedish emergency departments over a specific 24-hour period.

    BACKGROUND: The link between number of patients per nursing staff and missed nursing care is well described within the in-hospital setting, showing association with negative outcomes such as increased mortality. Potential association within the emergency department setting is still unexplored.

    METHOD: A national descriptive cross-sectional benchmark study.

    RESULTS: The majority (n=54; 89%) of Swedish emergency departments participated. The patients-per-registered nurse ratio varied between the shifts, from 0.3 patients to 8.8 patients (mean 3.2). The variation of patients per licensed practical nurse varied, from 1.5 to 23.5 patients (mean 5.0). The average skill mix was constant at around 60% registered nurses and 40% licensed practical nurses.

    CONCLUSION: The varying ratios for patient per registered nurse and licensed practical nurse in Swedish emergency departments is noteworthy. Furthermore, the patient flow and nursing staff numbers did not match one another, resulting in higher nursing staff ratios during the evening shift.

    IMPLICATIONS FOR NURSING MANAGEMENT: Findings can be used to improve rosters in relation to crowding, to manage the challenging recruitment and retention situation for nursing staff and to improve patient safety.

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  • 9. Amritzer, Maria
    et al.
    Göransson, Katarina
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Berg, Lena
    Nymark, Carolin
    A new perspective of missed nursing care – the emergency department context: a descriptive, cross-sectional study2023In: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966Article in journal (Refereed)
  • 10.
    Andersen, Randi Dovland
    et al.
    Department of Research Telemark Hospital Skien Norway; Research Center for Habilitation and Rehabilitation Services and Models (CHARM) Institute of Health and Society University of Oslo Oslo Norway.
    Genik, Lara
    Department of Psychology University of Guelph Guelph ON Canada.
    Alriksson-Schmidt, Ann I
    Department of Clinical Sciences Lund Skåne University Hospital Orthopedics Lund University Lund Sweden.
    Anderzen-Carlsson, Agneta
    University Health Care Research Center and Swedish Institute for Disability Research Faculty of Medicine and Health Örebro University Örebro Sweden.
    Burkitt, Chantel
    Gillette Children's Specialty Healthcare Saint Paul MN USA; Department of Educational Psychology University of Minnesota Minneapolis MN USA.
    Bruflot, Sindre K
    Telemark Chapter of the Norwegian Cerebral Palsy Association Skien Norway.
    Chambers, Christine T
    Departments of Psychology & Neuroscience and Pediatrics Dalhousie University Halifax NS Canada; Centre for Pediatric Pain Research IWK Health Centre Nova Scotia Canada.
    Jahnsen, Reidun B
    Research Center for Habilitation and Rehabilitation Services and Models (CHARM) Institute of Health and Society University of Oslo Oslo Norway; Department of Clinical Neurosciences for Children Oslo University Hospital Oslo Norway.
    Jeglinsky-Kankainen, Ira
    Department of Health and Welfare Arcada University of Applied Sciences Helsinki Finland.
    Wallin, Lars
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Pain burden in children with cerebral palsy (CPPain) survey: Study protocol2022In: Paediatric & neonatal pain, ISSN 2637-3807, Vol. 4, no 1, p. 11-21Article in journal (Refereed)
    Abstract [en]

    Pain is a significant health concern for children living with cerebral palsy (CP). There are no population-level or large-scale multi-national datasets using common measures characterizing pain experience and interference (ie, pain burden) and management practices for children with CP. The aim of the CPPain survey is to generate a comprehensive understanding of pain burden and current management of pain to change clinical practice in CP. The CPPain survey is a comprehensive cross-sectional study. Researchers plan to recruit approximately 1400 children with CP (primary participants) across several countries over 6-12 months using multimodal recruitment strategies. Data will be collected from parents or guardians of children with CP (0-17 years) and from children with CP (8-17 years) who are able to self-report. Siblings (12-17 years) will be invited to participate as controls. The CPPain survey consists of previously validated and study-specific questionnaires addressing demographic and diagnostic information, pain experience, pain management, pain interference, pain coping, activity and participation in everyday life, nutritional status, mental health, health-related quality of life, and the effect of the COVID-19 pandemic on pain and access to pain care. The survey will be distributed primarily online. Data will be analyzed using appropriate statistical methods for comparing groups. Stratification will be used to investigate subgroups, and analyses will be adjusted for appropriate sociodemographic variables. The Norwegian Regional Committee for Medical and Health Research Ethics and the Research Ethics Board at the University of Minnesota in USA have approved the study. Ethics approval in Canada, Sweden, and Finland is pending. In addition to dissemination through peer-reviewed journals and conferences, findings will be communicated through the CPPain Web site (www.sthf.no/cppain), Web sites directed toward users or clinicians, social media, special interest groups, stakeholder engagement activities, articles in user organization journals, and presentations in public media.

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  • 11. Andersson, ÅC.
    et al.
    Eksborg, S.
    Förberg, Ulrika
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Nydert, P.
    Lindemalm, S.
    Frequency of paediatric patients administered extemporaneous preparations at a Swedish university hospital: A registry-based study comparing two study-years, 10 years apart2023In: European journal of hospital pharmacy. Science and practice, ISSN 2047-9956, E-ISSN 2047-9964, article id ejhpharm-2023-003804Article in journal (Refereed)
    Abstract [en]

    Background: Lack of child-friendly dosage forms and strengths often leads to manipulation of medicines at hospital units or by caregivers in the home setting. One alternative to manipulating dosage forms is the use of extemporaneous preparations. In Sweden, these are produced according to good manufacturing practice by a few extemporaneous pharmacies. Objectives: To compare frequencies of patients administered extemporaneous preparations in two separate years, 10 years apart. Methods: This registry-based study describes and compares the frequency of extemporaneous oral preparations administered to paediatric patients in 2009 and 2019 at a Swedish university hospital. The study included 117 023 oral administrations (to 4905 patients) and 128 638 oral administrations (to 4718 patients) from 2009 and 2019, respectively. Results: The frequency of inpatients administered one or more extemporaneous preparations increased from 22% in 2009 to 40% in 2019 (p<0.0001). The increase was observed in all age groups. The use of some active pharmaceutical ingredients increased (eg, captopril, clonidine, hydrocortisone, melatonin and propranolol), and some active pharmaceutical ingredients decreased between the study years (eg, midazolam and sildenafil). Conclusions: The introduction of new authorised products has decreased the need for manipulation or extemporaneous preparations in some therapeutic groups. There remains, however, a pronounced lack of commercially available child-friendly dosage forms and suitable strengths enabling safe administration of medicines to children, indicated by the large percentage of patients receiving at least one extemporaneous preparation. © European Association of Hospital Pharmacists 2023. Re-use permitted under CC BY. Published by BMJ.

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  • 12. Andersson, Åsa C.
    et al.
    Eksborg, Staffan
    Förberg, Ulrika
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    Nydert, Per
    Lindemalm, Synnöve
    Manipulated Oral and Rectal Drugs in a Paediatric Swedish University Hospital, a Registry-Based Study Comparing Two Study-Years, Ten Years Apart2023In: Pharmaceuticals, E-ISSN 1424-8247, Vol. 16, no 1, article id 8Article in journal (Refereed)
    Abstract [en]

    This is a registry-based study with the aim of describing and comparing the frequency of manipulations of solid oral and rectal medicines in 2009 and 2019 at inpatient units and an emergency department in a paediatric hospital within a Swedish university hospital. All patients aged 1 month-18 years with oral or rectal administrations were included. In total, 140,791 oral and rectal administrations were included in 2009, and 167,945 oral and rectal administrations were included in 2019. The frequency of patients receiving at least one manipulated oral medicine decreased between the study years, both in inpatient units and in the emergency department (from 19% to 17%, p = 0.0029 and from 11% to 5%, p &lt; 0.0001, respectively). The frequency of patients receiving a manipulated rectal medicine also decreased between the study years, both in inpatient units and in the emergency department (from 22% to 10%, p &lt; 0.0001 and from 35% to 7% 2019, p &lt; 0.0001, respectively). The results show a decrease in the manipulation of both oral and rectal medicines to paediatric patients in 2019 compared to 2009. Even though this implies a safer practice, there is still a pronounced lack of child-friendly dosage forms and suitable strengths enabling the safe administration of medicines to sick children. 

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  • 13.
    Andersson, Åsa C
    et al.
    Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Lindemalm, Synnöve
    Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Onatli, Dilba
    Uppsala University, Uppsala.
    Chowdhury, Samia
    Uppsala University, Uppsala.
    Eksborg, Staffan
    Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Förberg, Ulrika
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    'Working outside the box'-an interview study regarding manipulation of medicines with registered nurses and pharmacists at a Swedish paediatric hospital2023In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 112, no 12, p. 2551-2559Article in journal (Refereed)
    Abstract [en]

    AIM: Studies on frequencies of manipulated medicines in paediatric care are common, but there is little knowledge of experiences of pharmacists and registered nurses in this area. The aim of this study was to explore registered nurses' and pharmacists' reasoning in the manipulation of medicines to paediatric inpatients.

    METHODS: Semistructured interviews with twelve registered nurses and seven pharmacists were performed at a Swedish paediatric university hospital. The interviews were transcribed verbatim and analysed using content analysis.

    RESULTS: Four major categories emerged from the analysis of the interviews: medicines management, knowledge, consulting others and organisation. Medicines management involved the process of drug handling, which is prescribing, reconstitution or manipulation and administration. Knowledge concerned both the knowledge base and how healthcare personnel seek information. Consulting others involved colleagues, registered nurses and pharmacists, between registered nurses, pharmacists and physicians and between registered nurses, pharmacists and caregivers. Organisation covered documentation, time and working environment.

    CONCLUSION: Both pharmacists and registered nurses stated that manipulation of medicines to paediatric patients was often necessary but felt unsafe due to lack of supporting guidelines. Pharmacists were natural members of the ward team, contributing with specific knowledge about medicines and formulations.

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  • 14.
    Anåker, Anna
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Fagerström, Lisbeth
    Åbo Akademi University, Vaasa, Finland; University of South-Eastern Norway, Drammen, Norway.
    Wangensteen, Sigrid
    Norwegian University of Science and Technology, Gjøvik, Norway.
    Andersen, Irene Aasen
    Høgskulen på Vestlandet, Institutt for helse- og omsorgsvitskap, Bergen, Norway.
    Henriksen, Jette
    VIA University College, Aarhus, Denmark.
    Svavarsdóttir, Margrét Hrönn
    University of Akureyri, Akureyri, Iceland.
    Thorsteinsson, Hrund Scheving
    University of Iceland, Reykjavik, Iceland.
    Strandell-Laine, Camilla
    Novia University of Applied Sciences, Turku, Finland; Lovisenberg Diaconal University College, Oslo, Norway.
    The Professional Nurse Self-Assessment Scale II - Translation and cultural adaptation for Nordic countries2024In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It is important to map the clinical competence of newly graduated nurses in Nordic countries. The use of a common Nordic instrument could provide insights into nurses' levels of self-assessed clinical competence and perceptions of their need for professional development.

    AIM: To translate and culturally adapt the original Norwegian version of the Professional Nurse Self-Assessment Scale II (PROFFNurse SAS II) into (1) Danish, (2) Finnish and (3) Icelandic versions.

    METHOD: The PROFFNurse SAS II was translated and cross-culturally adapted. This translation was inspired by the process used in the Guidelines for Cross-Cultural Adaptation.

    RESULT: The translation and cultural adaptation processes employed the required steps and provided specific details. In addition, practical issues encountered during the translation process while translating and adapting instruments that may influence future translations were revealed. This study found that having a professional bilingual/bicultural agency translator was partly problematic in the process of translation and found that it is important to adjust the translations to each country's specific words used in nursing.

    CONCLUSION: Translating the PROFFNurse SAS II instrument into all Nordic languages enables us to use the instrument from a Nordic perspective and across various countries. This is important when comparing self-awareness and reflecting on nurses' clinical competencies. Professional development is central to valuing and developing clinical competence and allowing for the discovery of gaps in clinical competence.

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  • 15.
    Anåker, Anna
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Morichetto, Hanna
    Liljewall Architects, Gothenburg, Sweden.
    Elf, Marie
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    The physical environment is essential, but what does the design and structure of stroke units look like?: A descriptive survey of inpatient stroke units in Sweden2023In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 37, no 2, p. 328-336Article in journal (Refereed)
    Abstract [en]

    Background: The design of the physical environment is a critical factor in patient care and is known to influence health, well-being, clinical efficiency, and health-related outcomes. To date, there has been no general review of the physical environment of modern Swedish stroke units.

    Aim: To explore the physical environment of inpatient stroke units in Sweden and describe the design and structure of these units. Methods: This was a cross-sectional study. Data were collected in Sweden from April to July 2021 via a survey questionnaire.

    Results: The layout of the stroke units varied broadly, such as the number of single-bed and multi-bed rooms. More than half the stroke units comprised spaces for rehabilitation and had an enriched environment in the form of communal areas with access to computers, games, books, newspapers, and meeting places. However, they offered sparse access to plants and/or scenery.

    Conclusions: Healthcare environments are an essential component of a sustainable community. From a sustainability perspective, healthcare facilities must be built with high architectural quality and from a long-term perspective. Research on the physical environment in healthcare should contribute to improved quality of care, which can be achieved through building healthcare facilities that support the performance of care and recovery. Therefore, mapping of areas of interest for further investigation is crucial.

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  • 16.
    Anåker, Anna
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Spante, Marianne
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Nursing students' perception of climate change and sustainability actions - A mismatched discourse: A qualitative, descriptive exploratory study.2021In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 105, article id 105028Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Climate change is described as the biggest global challenge for human health in the upcoming decade. Nurses play a central role in mitigating the effect of climate change on the healthcare sector and adapting to the phenomenon. Therefore, nursing students must be prepared for a new professional role keeping climate change in mind; consequently, it is important to study students' perceptions of climate change and sustainability.

    OBJECTIVES: To explore nursing students' perceptions of climate change and sustainability and examine how they perceive their role as nursing students in working towards a more sustainable development within the healthcare sector.

    DESIGN: It is a qualitative, descriptive exploratory study.

    SETTINGS: A nursing program at a university in central Sweden.

    PARTICIPANTS: Nursing students.

    METHODS: Individual in-depth interviews and one group interview were conducted for the study.

    RESULTS: The main findings revealed that students saw themselves living in a mismatched discourse. They perceived the future of humanity as gloomy but thought that sustainability is the society's joint obligation to achieve the right to a good life for all people equally.

    CONCLUSIONS: Nursing students perceived themselves as important actors in the work of climate change and sustainability. Thus, nursing education needs to integrate the impact of climate change on healthcare and promote sustainability into the curriculum for preparing students to take responsibility for sustainability in society.

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  • 17.
    Anåker, Anna
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    von Koch, Lena
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm.
    Eriksson, Gunilla
    Karolinska Institutet, Stockholm; Uppsala University, Uppsala.
    Sjöstrand, Christina
    Karolinska University Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Elf, Marie
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm; Chalmers University of Technology, Gothenburg.
    The physical environment and multi-professional teamwork in three newly built stroke units2022In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, no 7, p. 1098-1106Article in journal (Refereed)
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  • 18.
    Armuand, Gabriela
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Grandahl, Maria
    Uppsala University.
    Volgsten, Helena
    Uppsala University.
    Stern, Jenny
    Uppsala University; Sophiahemmet University, Stockholm.
    Characteristics of good contraceptive counselling - An interview study2024In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 39, article id 100948Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: One key component in preventing unplanned pregnancies is to provide effective contraceptive counselling. This study aimed to investigate what characterises good contraceptive counselling from the woman's perspective.

    METHODS: A qualitative study with a phenomenological approach. Twenty-four women aged 15-45 participated in semi-structured, individual, face-to-face interviews that lasted, on average, one hour. Data were analysed by latent content analysis.

    RESULTS: One overall theme emerged, person-centred contraceptive counselling - an interactive process, with three main categories: (i) a trustworthy healthcare provider, (ii) creating a liaison and (iii) the right time and place.

    CONCLUSIONS: The healthcare provider's attributes as well as what happened between the healthcare provider and the woman, and the surrounding context, had a bearing on the women's descriptions of good contraceptive counselling. The process of the counselling was described as more important than the actual outcome; thus, healthcare providers need to be aware that this seemingly straightforward consultation is rather multi-layered and has great health promoting potential.

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  • 19. Aronsson, Jennie
    et al.
    Anåker, Anna
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Richardson, Janet
    Sustainability in Clinical Practice: A Cross-National Comparative Study of Nursing Students in England and Sweden2022In: Journal of Nursing Education, ISSN 0148-4834, E-ISSN 1938-2421, Vol. 61, no 7, p. 390-393Article in journal (Refereed)
    Abstract [en]

    Background: Delivering health care negatively influ-ences the environment and contributes to climate change. This study examined how nursing students in England and Sweden can make changes in clinical practice to enhance environmental sustainability. Method: Third-year under-graduate nursing students at English and Swedish universities responded to open-ended questions on the Sustainability Attitudes in Nursing Survey. Data were analyzed using inductive content analysis. Results: Students in both countries identified lack of confidence as the main barrier to challenging unsustainable practice, followed by a resistance to change in practice. English students predominantly changed their own behavior or influenced the practice of others. Swedish students either changed their own behavior or their own attitudes to sustainability. Conclusion:There is a need to ensure students have confidence to act as change agents to enhance sustainable practice in the clinical environment.

  • 20. Aronsson, Jennie
    et al.
    Nichols, Andy
    Warwick, Paul
    Elf, Marie
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Awareness and attitudes towards sustainability and climate change amongst students and educators in nursing: A systematic integrative review protocol.2022In: Nursing Open, E-ISSN 2054-1058, Vol. 9, no 1, p. 839-844Article in journal (Refereed)
    Abstract [en]

    AIM: This review identifies and synthesizes literature related to the awareness of and attitudes towards sustainability and climate change from the perspective of nursing students and educators.

    DESIGN: A systematic integrative review.

    METHODS: The review will follow the five stages outlined by Whittemore and Knafl: problem identification, literature search, data evaluation, data analysis and presentation. The data analysis will be based on inductive content analysis developed by Elo and Kyngäs. Principles of the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) will also inform the review process.

    RESULTS: This review will offer insights about sustainability and climate change in relation to an important target population: the future nursing workforce and those educating its members. Findings might inform curriculum development, potentially contributing to a nursing profession that looks after the health of the planet and the health of the population inhabiting it.

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  • 21.
    Aronsson, Jennie
    et al.
    University of Plymouth, Plymouth, Devon, UK..
    Nichols, Andy
    University of Plymouth, Plymouth, Devon, UK..
    Warwick, Paul
    University of Plymouth, Plymouth, Devon, UK..
    Elf, Marie
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Nursing students' and educators' perspectives on sustainability and climate change: An integrative review2023In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed)
    Abstract [en]

    Aim: To identify and synthesize research on the awareness, attitudes and action related to sustainability and climate change from the perspective of nursing students and educators globally.

    Design: Integrative review.

    Methods: The review was guided by Whittemore and Knafl. Included studies were appraised using the Mixed Methods Appraisal Tool. A deductive content analysis based on Elo and Kyngäs' methodology was employed.

    Data Sources: CINAHL, MEDLINE, EMBASE, Web of Science, British Education Index, GreenFILE and Scopus were searched up to the 8th November 2022.

    Results: Thirty-two studies were included in the review. Two studies included nursing educators in their samples, the rest focused solely on students. Findings suggest that whilst some students were aware of sustainability issues and felt that nurses have a responsibility to mitigate climate change, others showed limited awareness and believed that nurses have more important priorities. A global interest was seen among students for increased curricular content related to sustainability and climate change. Waste management and education of others were suggested actions students can take; however, barriers included lack of confidence and limited power.

    Conclusion: There is a need for sustainability education within nursing curricula, accompanied by student support.

    Implications for the Profession: The review acts as a starting point to make sustainable healthcare and climate change mitigation integral aspects of nursing.

    Impact: Sustainability education within nursing curricula can positively impact on sustainable healthcare and climate change mitigation. More research is needed on the perspectives of nursing educators.

    Reporting Method: The review is reported according to the PRISMA guidelines.

    Patient or Public Contribution: No Patient or Public Contribution.

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  • 22.
    Arén, Cilmara
    et al.
    Dalarna University.
    Jaçelli, Armand
    Dalarna University.
    Gesar, Berit
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    From, Ingrid
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    The work-related stress experienced by registered nurses at municipal aged care facilities during the COVID-19 pandemic: a qualitative interview study.2022In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 21, no 1, article id 296Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Stress can originate from many different unsatisfying work situations. Registered nurses working in municipal care have experience of work-related stress in different ways.

    AIM: The purpose of this study was to describe the work-related stress experienced by registered nurses caring for older people at municipal aged care facilities.

    METHODS: Qualitative semi-structured interviews according to Polit and Beck were carried out in clinical work at six different municipal aged care facilities in Sweden. Twelve registered nurses participated in the study.

    RESULTS: The results outlined in one main central theme: Feelings of inadequacy and dissatisfaction contribute to work-related stress and three categories: Difficulty coping with work tasks, Insufficient support, Work-related stress affects private lives. Areas identified were lack of time, staff shortages, high number of patients, lack of communication and teamwork in the working group, showing that inadequacy and dissatisfaction can contribute to work-related stress. This can contribute to work-related stress, and it can be a result of problems in the organizational and social work environment.

    CONCLUSION: This study showed the everyday experiences of registered nurses' stress at work. The reasons that registered nurses experience a heavy workload were found to be similar in several municipal care facilities. Future interventions should consider the areas of stress found in this study to reduce the risk of further increasing the work-related stress experienced by registered nurses working in municipal aged care.

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  • 23. Baghdasaryan, Z.
    et al.
    Lampa, E.
    Osman, Fatumo
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Uppsala University.
    ‘Let us understand each other and work together in the child's best interest’ – Exploring the narratives of newly arrived refugee parents in Sweden2021In: International Journal of Intercultural Relations, ISSN 0147-1767, E-ISSN 1873-7552, Vol. 81, p. 226-235Article in journal (Refereed)
  • 24.
    Beck, Simon
    et al.
    Dalarna University, School of Health and Welfare.
    Lundblad, Lina
    Dalarna University, School of Health and Welfare.
    Göras, Camilla
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Eneslätt, Malin
    Implementing advance care planning in Swedish healthcare settings - a qualitative study of professionals' experiences2023In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 41, no 1, p. 23-32Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Advance care planning (ACP) is a process involving conversations about values and preferences regarding future care at the end-of-life. ACP has led to positive outcomes, both in relation to quality of life and with increased use of palliative care, less life-sustaining treatment and fewer hospital admissions. Sweden has yet to embrace the practice systematically, but scattered initiatives exist.

    AIM: To study implementation of a routine for ACP in NH settings in Sweden by exploring healthcare professionals' experiences of engaging in ACP following this implementation.

    METHODS: The study followed a qualitative inductive design with convenience and snowball sampling. Semi-structured group and individual interviews with registered healthcare professionals were analysed using qualitative content analysis.

    FINDINGS: Organisational support for sustainable ACP implementation was found to be essential. This included sufficient training, facilitation, collaboration and uniform work routines across providers and professionals. Engaging in ACP conversations following the implemented routine was found to be a process of preparing, being, talking, deciding and sharing.

    CONCLUSIONS: Successful implementation of ACP in NHs requires a carefully planned implementation strategy. ACP in NHs tend to be medically focused at the expense of residents' psychosocial care-planning needs. Widespread uptake of ACP in Sweden could be useful in the national effort to adopt more person-centred care in Swedish healthcare.

    KEY POINTS While advance care planning has been implemented in many other countries, Sweden lacks a national strategy on advance care planning and Swedish healthcare settings have yet to systematically implement this practice.  

    • This study is the first to report on professionals' experiences of engaging in sustainable advance care planning, following top-down implementation of the practice in one Swedish region.  

    • Successful implementation of advance care planning in nursing homes requires a system-level approach, and shortcomings of the implementation process are highlighted.

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  • 25.
    Bergström, Anna
    et al.
    Uppsala University, Uppsala; University College London, London, UK.
    Hoa, Dinh Phuong
    Vietnam National Children's Hospital, Hanoi, Vietnam; Hanoi University of Public Health, Hanoi, Vietnam.
    Nga, Nguyen Thu
    Vietnam National Children's Hospital, Hanoi, Vietnam.
    Hoa, Trieu
    Provincial Health Bureau, Cao Bang, Vietnam.
    Tu, Tran Thanh
    National Children's Hospital, Hanoi, Vietnam.
    Lien, Pham Thi Lan
    National Children's Hospital, Hanoi, Vietnam.
    Trang, Tran
    National Children's Hospital, Hanoi, Vietnam.
    Wallin, Lars
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Persson, Lars-Åke
    London School of Hygiene & Tropical Medicine, London, UK.
    Eriksson, Leif
    Uppsala University, Uppsala; .
    A facilitated social innovation: stakeholder groups using Plan-Do-Study-Act cycles for perinatal health across levels of the health system in Cao Bang province, Vietnam2023In: Implementation Science Communications, E-ISSN 2662-2211, Vol. 4, article id 24Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Universal coverage of evidence-based interventions for perinatal health, often part of evidence-based guidelines, could prevent most perinatal deaths, particularly if entire communities were engaged in the implementation. Social innovations may provide creative solutions to the implementation of evidence-based guidelines, but successful use of social innovations relies on the engagement of communities and health system actors. This proof-of-concept study aimed to assess whether an earlier successful social innovation for improved neonatal survival that employed regular facilitated Plan-Do-Study-Act meetings on the commune level was feasible and acceptable when implemented on multiple levels of the health system (52 health units) and resulted in actions with plausibly favourable effects on perinatal health and survival in Cao Bang province, northern Vietnam.

    METHODS: The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided the implementation and evaluation of the Perinatal Knowledge-Into-Practice (PeriKIP) project. Data collection included facilitators' diaries, health workers' knowledge on perinatal care, structured observations of antenatal care, focus group discussions with facilitators, their mentors and representatives of different actors of the initiated stakeholder groups and an individual interview with the Reproductive Health Centre director. Clinical experts assessed the relevance of the identified problems and actions taken based on facilitators' diaries. Descriptive statistics included proportions, means, and t-tests for the knowledge assessment and observations. Qualitative data were analysed by content analysis.

    RESULTS: The social innovation resulted in the identification of about 500 relevant problems. Also, 75% of planned actions to overcome prioritised problems were undertaken, results presented and a plan for new actions to achieve the group's goals to enhance perinatal health. The facilitators had significant roles, ensuring that the stakeholder groups were established based on principles of mutual respect. Overall, the knowledge of perinatal health and performance of antenatal care improved over the intervention period.

    CONCLUSIONS: The establishment of facilitated local stakeholder groups can remedy the need for tailored interventions and grassroots involvement in perinatal health and provide a scalable structure for focused efforts to reduce preventable deaths and promote health and well-being.

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  • 26.
    Bergsvind, Ulrica
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Larsson, Linda
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Mammors upplevelser av amningen de två första veckorna efter förlossningen: En kvalitativ intervjustudie2023Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: It is well known that breastfeeding during the infants first period of life has positive effects for both the mother and the child but is also important from a public health perspective. Despite well-documented benefits for both mother and baby, breastfeeding rates have decreased in Sweden. Promoting breastfeeding is among the most important things a country can do from a public health perspective. Aim: To describe mother´s experiences in the early breastfeeding in the transition between obstetric care and BVC. Method: The study was conducted as a qualitative interview study in which seven mothers participated. The material was analysed according to Graneheim and Lundman's qualitative content analysis. Results: In the results, three main categories emerged, emotional experiences, bodily experiences, and desired support. The mothers experienced mental fatigue and insecurity but also security in the early breastfeeding period. Factors such as recovery and pain in the body, breasts and nipples were factors experienced by the mothers. Better support directly at the birth was requested and a booked appointment to BVC before was desired. Conclusions: If the healthcare staff have good knowledge of breastfeeding and can meet the mothers and give them the support they need, the chances of a functioning breastfeeding increase.

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  • 27. Bernhardt, Julie
    et al.
    Lipson-Smith, Ruby
    Davis, Aaron
    White, Marcus
    Zeeman, Heidi
    Pitt, Natalie
    Shannon, Michelle
    Crotty, Maria
    Churilov, Leonid
    Elf, Marie
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Why hospital design matters: A narrative review of built environments research relevant to stroke care2022In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 17, no 4, article id 17474930211042485Article in journal (Refereed)
    Abstract [en]

    Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. How building design can best support healthcare services, staff, and patients is important to consider. In this narrative review we outline why the healthcare environment matters and describe areas of research focus and current built environment evidence that supports health care in general and stroke care in particular. Ward configuration, corridor design, and staff station placements can all impact care provision, staff and patient behaviour. Contrary to many new ward design approaches, single bed rooms are neither uniformly favoured, nor strongly evidence-based, for people with stroke. Green spaces are important both for staff (helping to reduce stress and errors), patients and relatives, although access to, and awareness of, these and other communal spaces is often poor. Built environment research specific to stroke is limited but increasing and we highlight emerging collaborative multi-stakeholder partnerships (Living Labs) contributing to this evidence base. We believe that involving engaged and informed clinicians in design and research will help shape better hospitals of the future.

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  • 28. Bjurling-Sjöberg, Petronella
    et al.
    Göras, Camilla
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Department of Anesthesia and Intensive Care Unit, Falun Hospital, Region Dalarna, Falun.
    Lohela-Karlsson, Malin
    Nordgren, Lena
    Källberg, Ann-Sofie
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Department of Emergency Medicine, Falun Hospital, Region Dalarna, Falun.
    Castegren, Markus
    Condén Mellgren, Emelie
    Holmberg, Mats
    Ekstedt, Mirjam
    Resilient performance in healthcare during the COVID-19 pandemic (ResCOV): study protocol for a multilevel grounded theory study on adaptations, working conditions, ethics and patient safety.2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 12, article id e051928Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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  • 29.
    Blixt, Jonna
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Bäck, Erika
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Sjuksköterskors omvårdnadsåtgärder för att förebygga hjärt- och kärlsjukdom: En litteraturöversikt2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Cardiovascular disease is a public health problem that leads to a reduced quality of life. The number of people who fall ill is increasing, and this leads to a high burden on the healthcare system and large costs for society. In health-promoting nursing work, nurses focus on health and well-being through lifestyle changes. Aim: The purpose of the literature review was to illuminate nurses nursing measures to prevent cardiovascular disease in patients. Method: A literature review carried out structured with elements of the methodology used in systematic literature reviews based on the results from 14 scientific articles obtained from PubMed and CINAHL. Results: The results present the main categories Physical activity, Diet and Patient education, which highlight nurses nursing measures to prevent cardiovascular disease. The subcategories describe methods and tools to promote preventive nursing measures and their effects. The subcategories also describe the role and efforts of nurses in the preventive work of cardiovascular disease. Conclusions: There are different types of nursing measures that nurses can perform to prevent cardiovascular disease. Nurses have a central role in the health promotion work, which means motivating, informing and following up on lifestyle changes. Nurses competence, communication, respect and relationship with patients increase patients adherence to a healthier lifestyle. This promotes the conditions for nurses to carry out nursing measures to prevent cardiovascular disease.

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  • 30.
    Bogren, Malin
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Jha, Paridhi
    Foundation for Research in Health Systems, Bangalore, Karnataka, India.
    Sharma, Bharati
    Indian Institute of Public Health Gandhinagar, Gujarat, India.
    Erlandsson, Kerstin
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Contextual factors influencing the implementation of midwifery-led care units in India2023In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 36, no 1, p. e134-e141Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Government of India has committed to educate 90,000 midwives functioning in midwifery-led care units (MLCUs) to care for women during labour and birth. There is a need to consider local circumstances in India, as there is no 'one size fits all' prescription for MLCUs.

    AIM: To explore contextual factors influencing the implementation of MLCUs across India.

    METHOD: Data were collected through six focus group interviews with 16 nurses, midwives, public health experts and physicians, representing six national and international organisations supporting the Indian Government in its midwifery initiative. Transcribed interviews were analysed using content analysis.

    FINDINGS: Four generic categories describe the contextual factors which influence the implementation of MLCUs in India: (i) Perceptions of the Nurse Practitioner in Midwifery and MLCUs and their acceptance, (ii) Reversing the medicalization of childbirth, (iii) Engagement with the community, and (iv) The need for legal frameworks and standards.

    CONCLUSION: Based on the identified contextual factors in this study, we recommend that in India and other similar contexts the following should be in place when designing and implementing MLCUs: legal frameworks to enable midwives to provide full scope of practice in line with the midwifery philosophy and informed by global standards; pre- and in-service training to optimize interdisciplinary teamwork and the knowledge and skills required for the implementation of the midwifery philosophy; midwifery leadership acknowledged as key to the planning and implementation of midwifery-led care at the MLCUs; and a demand among women created through effective midwifery-led care and advocacy messages.

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  • 31.
    Borg, Johan
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Alam, Moudud
    Dalarna University, School of Information and Engineering, Statistics.
    Boström, Anne-Marie
    Karolinska Institutet, Huddinge; Karolinska University Hospital, Stockholm; Stockholms Sjukhem, Stockholm.
    Marmstål Hammar, Lena
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Huddinge; Mälardalen University, Västerås.
    Experiences of Assistive Products and Home Care among Older Clients with and without Dementia in Sweden2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 19, article id 12350Article in journal (Refereed)
    Abstract [en]

    The purpose was to compare selection, use and outcomes of assistive products among older home care clients with and without dementia in Sweden, and to explore the relations between the use of assistive products and perceptions of home care, loneliness and safety. Self-reported data from 89,811 home care clients aged 65 years or more, of whom 8.9% had dementia, were analysed using regression models. Excluding spectacles, 88.2% of them used assistive products. Respondents without dementia were more likely to use at least one assistive product but less likely to use assistive products for remembering. Respondents with dementia participated less in the selection of assistive products, used less assistive products, and benefited less from them. Users of assistive products were more likely to be anxious and bothered by loneliness, to feel unsafe at home with home care, to experience that their opinions and wishes regarding assistance were disregarded by home care personnel, and to be treated worse by home care personnel. The findings raise concerns about whether the needs for assistive products among home care clients with dementia are adequately provided for. They also indicate a need to strengthen a person-centred approach to providing home care to users of assistive products.

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  • 32.
    Borneskog, Catrin
    et al.
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Engström, Gabriella
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Islam, Noor
    Dalarna University, Falun.
    Byrskog, Ulrika
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Pedersen, Christina
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Strömsöe, Anneli
    Dalarna University, School of Health and Welfare, Medical Science.
    Erlandsson, Kerstin
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    MSc student group,
    Public nursing institute in Bangladesh.
    Midwife Educators' perceptions of the efficacy of the Objective Structured clinical assessment of life-saving interventions - a qualitative interview study in Bangladesh2023In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, article id 100861Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Objective Structured Clinical Assessment (OSCA) is a way of evaluating students or clinicians in how they are carrying out their duties. The aim of this study was to examine how midwifery educators in Bangladesh perceived using OSCA as an assessment device in midwifery education for student performance in life-saving midwifery interventions.

    METHOD: Individual interviews were conducted with 47 academic midwives and clinical midwives using purposive sampling at 38 education institutions in Bangladesh. Content analysis inspired by Elo and Kyngas was used to analyze the data.

    RESULTS: The ability of students to perform effectively in the OSCA-evaluated simulation of life-saving skills was related to the educators' understanding of the concept of midwifery. The overarching main category of this study showed that for midwifery educators to be able to effectually teach professional, evidence-based midwifery, they need to be able to synthesize the delivery of practical and theoretical skills with pedagogical skills and knowledge. To implement the OSCA tool more effectively, midwifery educators need to understand the underpinning principles of midwifery values and philosophy including leadership, ownership, responsibility, and personal engagement.

    CONCLUSION: There is potential to improve the efficacy of using OSCA to deliver the teaching of life-saving skills. Team sessions with midwives and physicians aiming to practice teamwork and role divisions in life-saving interventions are recommended.

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  • 33.
    Boström, Rebecca
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Nilsson, Angelica
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Patienters erfarenheter av information i samband med utskrivning från slutenvården: En litteraturöversikt2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Clear deliver of information through the discharge process is important for the patient. Iti s also important with adapted and person-centered information about the patient treatment plan and the care provided during the period of time at the hospital. The nurse who is providing the information should ensure that the patient has understood the content of the information and the meaning of it. Good communication is necessary to increase patient participation and improve patient safety. Aim: The aim of this literature review was to highlight inpatients experiences of information associated with discharge from hospital. Method: A structured literature review has been made based on 18 scientific articles with elements of the methodology used in systematic reviews. The databases used were CINAHL and PubMed, the articles used were published between 2013 and 2022. Results: The result identified three categories that affected patients experiences of information associated with discharge from hospital: Meeting associated at discharge, lack of information and customized information. Conclusions: The literature review shows that patients experience lack of information when discharge from hospital. Meeting the patient's need for information and participation at discharge turns out to be a challenge for healthcare professionals. By working personcentered and focusing on the individual's needs as well as including and informing, participation increases in a patient-safe manner.

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  • 34.
    Broström Brandt, Karin
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Tryggvadóttir, Katrin
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Distriktssköterskors upplevelser och erfarenheter av att vara delaktiga i bedömningen av övergång till palliativ vård i livets slutskede: En intervjustudie i hemsjukvården2023Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Working as a district nurse in home care services implies independency and high responsibility. Home care service involves for instance giving palliative care for seriously ill patients in their homes. Palliative care focuses on alleviating the patient's suffering and promoting the quality of life. Decision-making about the transition to palliative care at the end of life relies on the doctor and end of life-discussions should be held with the patient and possibly next of kin. The district nurse should be able to identify changes in the patient's condition and make an assessment regarding the transition to palliative care at the end of life together with the doctor. Aim: The aim of this study was to describe experiences among district nurses’ regarding being involved in the assessment of transition to palliative care at the end of life for patients with home care services. Method: The study was conducted empirically as a qualitative interview study. Seven district nurses participated in the interviews and the material was analyzed according to Graneheim and Lundman's qualitative content analysis. Results: The result described three categories that affected the district nurse's experiences: personal factors, factors regarding the patient and next of kin as well as cooperation factors. Personal factors referred to one's own attitude towards the work assignment, what knowledge the district nurse had and how the burden of the responsibility was perceived. Factors regarding the patient and next of kin referred to the patient's own requests and how the patient's and next of kin's understanding of the disease affected the district nurse. Cooperation factors referred to the relationship between the district nurse and the patient, the cooperation with the doctor and the importance of end of life-discussions. Conclusions: The district nurse's cooperation with the doctor in the assessment of transition to palliative care at the end of life is of importance to be able to fulfill the patient's requests. Having experience-based knowledge and a good care relationship with the patient and next of kin contributes to the district nurses feeling confident when performing this work assignment.

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  • 35. Bujacz, A.
    et al.
    Rudman, Ann
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet.
    Gustavsson, P.
    Dahlgren, A.
    Tucker, P.
    Psychosocial working conditions of shiftworking nurses: A long-term latent transition analysis2021In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 29, no 8, p. 2603-2610Article in journal (Refereed)
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  • 36.
    Bäckar, Sara
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Vad vårdnadshavare uppfattar som viktigt i mötet med sjuksköterskor i samband med palliativ vård av deras barn: En litteraturöversikt2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The World Health Organization’s (2018) principles are the guidelines regarding pediatric palliative care that are applied in Sweden. Where palliative care for children should have a person centred focus, where the child is at the center and where the caregivers felt involved in all elements. Aim: To describe caregivers’ perception of what is important in the meeting with registered nurses in connection with palliative care of their child. Method: The method is a structured literature study with elements of the methodology used in systematic reviews. The databases used were PubMed and CINAHL. The work used an integrated analysis where articles are collected in an overview, where comparisons can then be made between articles based on different variables. Nine items were used. Results: The material resulted in three categories. Family Focus with the subcategories Individualized care and Seen as part of the team. Communication with the subcategories Information at the right time, Personalized communication and Straight and clear communication. Security with the subcategories Practical support and Emotional support. Conclusions: Caregivers’ desire for an individualized focus and a compassionately committed approach in the meeting with the nurse in a context where the medical aspect, often based on standardized care programs, constituted a large space. Communication was appreciated to be clear, straightforward, delicate and given at the right time.

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  • 37.
    Bäckström, Sara
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Edén, Malin
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Personcentrerat arbetssätt inom geriatrisk slutenvård - ur sjuksköterskeperspektiv: En intervjustudie2022Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Person-centered care (PCC) can be described as care that strives to make visible and meet the entire person's physical and mental needs. There is a lot of work going on to develop person-centered working methods to strengthen the patient's position. Many studies show that PCC is good for patients, but few studies describe perceptions of person-centered working methods from the perspective of healthcare professionals. Aim: To describe nurses' experience of working based on a person-centered working methods in a geriatric inpatient ward. Method: A qualitative study with a descriptive phenomenological approach was conducted. Ten clinically active nurses at a geriatric medicine ward, from a hospital in central Sweden, participated in the survey. Data were collected using a semi-structured interview guide and analyzed using Colaizzi's (1978) phenomenological analysis model. Results: The six themes identified were: A feeling of participation among all, A need for time set aside, A continuity in teamwork, The importance of leadership, Positive impact on the work environment, and The nurse's professional development was promoted. The informants expressed an increased degree of job satisfaction, a better psychosocial work environment and less stress in comparison to how they experienced their work situation before the work method was introduced. Conclusion: The result shows the conditions required to successfully establish and maintain a structured person-centered working method. Everyone involved in the elderly person's care need to collaborate and a person-centered approach needs to be multi-professional and team-based with a common goal picture and care philosophy.

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  • 38. Conte, Helen
    et al.
    Wihlborg, Jonas
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Lindström, Veronica
    Developing new possibilities for interprofessional learning- students’ experience of learning together in the ambulance service2022In: BMC Medical Education, E-ISSN 1472-6920, Vol. 22, no 1, article id 192Article in journal (Refereed)
    Abstract [en]

    Background: It is known that setting and context matters, and contextual factors influence interprofessional education (IPE). Activities developed in a new setting should therefore be evaluated to determine students’ experiences and learning. IPE in the ambulance service may present a new setting for interprofessional learning (IPL). Aim: The aim of this study was to explore undergraduate students’ experiences of collaboration and learning together during their clinical rotation in the ambulance service.Study design and method: A mixed convergent parallel design was used to describe nursing and medical students’ experiences of collaboration and learning together during their clinical rotation in the ambulance service during autumn 2019. Two group interviews with nursing students (n = 20; response rate 80%) were conducted and the medical students (n = 40; response rate 72.5%) answered a self-assessment questionnaire regarding their IPE. The groupdiscussions were analysed using an inductive thematic analysis and descriptive statistics were used to describe the medical students’ self-assessed experiences and competencies in interprofessional collaboration. Results: In the context of the ambulance service, some of the challenges included, the team vary daily, a context that can be unpredictable, and the team being required to make decisions in various situations with limited support. The context presented good opportunities to learn together, since they faced a broad variety of situations and had opportunities to follow patients through the chain of care. Conclusion: The students’ experiences show that the ambulance service offers possibilities for IPL. The ambulance service enhanced the students’ learning in an unfamiliar environment, encouraging them to develop collaborative learning strategies and situational leadership regardless of established hierarchical structures and stereotypes that are sometimes present in other parts of the health care service.

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  • 39. Crilly, Julia
    et al.
    Muntlin, Åsa
    Green, D
    Malyon, L
    Christofis, L
    Higgins, M
    Källberg, Ann-Sofie
    Dellner, S
    Myrelid, Å
    Djärv, T
    Göransson, Katarina
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Factors predictive of hospital admission for children via emergency departments in Australia and Sweden: an observational cross-sectional study.2023In: BMC Health Services Research, E-ISSN 1472-6963Article in journal (Refereed)
  • 40.
    Dahir, Gallad
    et al.
    Somali National University, Mogadishu, Somalia.
    Kulane, Asli
    Karolinska Institutet.
    Omar, Bakar
    Somali National University, Mogadishu, Somalia.
    Osman, Fatumo
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Somali National University, Mogadishu, Somalia.
    We have almost accepted child spacing. Let's wait on family planning and limiting children': Focus group discussions among young people with tertiary education in Somalia2023In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 35, article id 100828Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Somalia has high rates of maternal mortality, fertility and pregnancy among young women. Factors contributing to this situation are a lack of knowledge regarding sexual and reproductive health, early marriages, cultural norms and the unmet need for or use of contraceptives. This study aimed to explore the perceptions of family planning among young men and women with tertiary education in Mogadishu.

    METHODS: A purposeful and convenience strategy using snowballing was used to recruit participants. Four focus group discussions were held online with 26 young women and men aged 19-25 years old. All participants were studying at five different universities in Mogadishu, and only one participant was married. The data were analysed using thematic analysis.

    FINDINGS: The findings showed that participants objected to the concept of family planning but supported the concept of child spacing. They highlighted that people of their generation with tertiary education practise child spacing to combine careers with family life. Although all the participants knew of the benefits of child spacing, they had different opinions on whether modern contraceptive methods were an option for them. They were more comfortable with traditional contraceptive methods and believed that the quality of the modern contraceptive medicine available in the country was unreliable.

    CONCLUSION: Our findings suggest that it is crucial not only to include young people in family planning awareness initiatives and implementation but also to give them a voice to advocate family planning and start dialogues within their own communities.

  • 41.
    Danesh, Valerie
    et al.
    Center for Applied Health Research, Baylor Scott & White Health, Dallas, nited States.
    Sasangohar, Farzan
    A&M University, Houston, TX, United States.
    Källberg, Ann-Sofie
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Department of Emergency Medicine, Falun Hospital.
    Kean, Emily B.
    University of Cincinnati, Cincinnati, OH, United States.
    Brixey, Juliana J.
    The University of Texas Health Science Center, Houston, TX, United States.
    Johnson, Kimberly D.
    University of Cincinnati, Cincinnati, OH, United States.
    Systematic review of interruptions in the emergency department work environment2022In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 63, article id 101175Article in journal (Refereed)
    Abstract [en]

    Objective: The purpose of this systematic review is to describe the operationalization of interruptions measurement and to synthesize the evidence on the causes and consequences of interruptions in the emergency department (ED) work environment. Methods: This systematic review of studies explores the causes and consequences of interruptions in the ED. Of 2836 abstract/titles screened, 137 full-text articles were reviewed, and 44 articles met inclusion criteria of measuring ED interruptions. Results: All articles reported primary data collection, and most were cohort studies (n = 30, 68%). Conceptual or operational definitions of interruptions were included in 27 articles. Direct observation was the most common approach. In half of the studies, quantitative measures of interruptions in the ED were descriptive only, without measurements of interruptions’ consequences. Twenty-two studies evaluated consequences, including workload, delays, satisfaction, and errors. Overall, relationships between ED interruptions and their causes and consequences are primarily derived from direct observation within large academic hospitals using heterogeneous definitions. Collective strengths of interruptions research in the ED include structured methods of naturalistic observation and definitions of interruptions derived from concept analysis. Limitations are conflicting and complex evaluations of consequences attributed to interruptions, including the predominance of descriptive reports characterizing interruptions without direct measurements of consequences. Conclusions: The use of standardized definitions and measurements in interruptions research could contribute to measuring the impact and influence of interruptions on clinicians’ productivity and efficiency as well as patients’ outcomes, and thus provide a basis for intervention research. © 2022 Elsevier Ltd

  • 42.
    Dillner, Pernilla
    et al.
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm.
    Eggenschwiler, Luisa C
    University of Basel, Basel, Switzerland.
    Rutjes, Anne W S
    University of Modena and Reggio Emilia, Modena, Italy; University of Bern, Bern, Switzerland.
    Berg, Lena M
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    Musy, Sarah N
    University of Basel, Basel, Switzerland.
    Simon, Michael
    University of Basel, Basel, Switzerland.
    Moffa, Giusi
    University of Basel, Basel, Switzerland.
    Förberg, Ulrika
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    Unbeck, Maria
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    Incidence and characteristics of adverse events in paediatric inpatient care: a systematic review and meta-analysis2023In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, no 3, p. 133-149Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Adverse events (AEs) cause suffering for hospitalised children, a fragile patient group where the delivery of adequate timely care is of great importance.

    OBJECTIVE: To report the incidence and characteristics of AEs, in paediatric inpatient care, as detected with the Global Trigger Tool (GTT), the Trigger Tool (TT) or the Harvard Medical Practice Study (HMPS) method.

    METHOD: MEDLINE, Embase, Web of Science and Google Scholar were searched from inception to June 2021, without language restrictions. Studies using manual record review were included if paediatric data were reported separately. We excluded studies reporting: AEs for a specific disease/diagnosis/treatment/procedure, or deceased patients; study protocols with no AE outcomes; conference abstracts, editorials and systematic reviews; clinical incident reports as the primary data source; and studies focusing on specific AEs only. Methodological risk of bias was assessed using a tool based on the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Primary outcome was the percentage of admissions with ≥1 AEs. All statistical analyses were stratified by record review methodology (GTT/TT or HMPS) and by type of population. Meta-analyses, applying random-effects models, were carried out. The variability of the pooled estimates was characterised by 95% prediction intervals (PIs).

    RESULTS: We included 32 studies from 44 publications, conducted in 15 countries totalling 33 873 paediatric admissions. The total number of AEs identified was 8577. The most common types of AEs were nosocomial infections (range, 6.8%-59.6%) for the general care population and pulmonary-related (10.5%-36.7%) for intensive care. The reported incidence rates were highly heterogeneous. The PIs for the primary outcome were 3.8%-53.8% and 6.9%-91.6% for GTT/TT studies (general and intensive care population). The equivalent PI was 0.3%-33.7% for HMPS studies (general care). The PIs for preventable AEs were 7.4%-96.2% and 4.5%-98.9% for GTT/TT studies (general and intensive care population) and 10.4%-91.8% for HMPS studies (general care). The quality assessment indicated several methodological concerns regarding the included studies.

    CONCLUSION: The reported incidence of AEs is highly variable in paediatric inpatient care research, and it is not possible to estimate a reliable single rate. Poor reporting standards and methodological differences hinder the comparison of study results.

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  • 43.
    Dillner, Pernilla
    et al.
    Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Unbeck, Maria
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Danderyd Hospital, Karolinska Institutet, Stockholm.
    Norman, Mikael
    Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Nydert, Per
    Karolinska University Hospital, Astrid Lindgren's Children's Hospital, Stockholm.
    Härenstam, Karin Pukk
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Astrid Lindgren's Children's Hospital, Stockholm .
    Lindemalm, Synnöve
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Astrid Lindgren's Children's Hospital, Stockholm .
    Wackernagel, Dirk
    Karolinska Institutet, Stockholm; University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany.
    Förberg, Ulrika
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    Identifying neonatal adverse events in preterm and term infants using a Paediatric Trigger Tool2023In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 112, no 8, p. 1670-1682Article in journal (Refereed)
    Abstract [en]

    AIM: To explore the incidence and characteristics of inpatient neonatal adverse events in a Swedish setting.

    METHODS: A retrospective record review, using a trigger tool, performed by registered nurses and a neonatologist, at a University Hospital. The identified adverse events were categorised by, for example, preventability, severity and time of occurrence.

    RESULTS: A random selection of 150 admissions representing 3531 patient days were reviewed (mean [SD] birthweight 2620 [1120]g). Three hundred sixty adverse events were identified in 78(52.0%) infants and 305(84.7%) of these were assessed as being preventable. The overall adverse event rate was 240 per 100 admissions and 102.0 per 1000 patient days. Preterm infants had a higher rate than term infants (353 versus 79 per 100 admissions, p=0.001), however with regard to the length of stay, the rates were similar. Most adverse events were temporary and less severe (n=338/360, 93.9%) and the most common type involved harm to skin, tissue or blood vessels (n=163/360, 45.3%). Forty percent (n=145) of adverse events occurred within the first week of admission.

    CONCLUSION: Adverse events were common in neonatal care and many occurred during the first days of treatment. Characterisation of adverse events may provide focus areas for improvements in patient safety.

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  • 44. Durbeej, Natalie
    et al.
    McDiarmid, Serena
    Sarkadi, Anna
    Feldman, Inna
    Punamäki, Raija-Leena
    Kankaanpää, Reeta
    Andersen, Arnfinn
    Hilden, Per Kristian
    Verelst, An
    Derluyn, Ilse
    Osman, Fatumo
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Uppsala University.
    Correction to: Evaluation of a school-based intervention to promote mental health of refugee youth in Sweden (The RefugeesWellSchool Trial)2021In: Trials, E-ISSN 1745-6215, Vol. 22, no 1, article id 861Article in journal (Refereed)
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  • 45. Durbeej, Natalie
    et al.
    McDiarmid, Serena
    Sarkadi, Anna
    Feldman, Inna
    Punamäki, Raija-Leena
    Kankaanpää, Reeta
    Andersen, Arnfinn
    Hilden, Per Kristian
    Verelst, An
    Osman, Fatumo
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Uppsala University.
    Evaluation of a school-based intervention to promote mental health of refugee youth in Sweden (The RefugeesWellSchool Trial): study protocol for a cluster randomized controlled trial.2021In: Trials, E-ISSN 1745-6215, Vol. 22, no 1, article id 98Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sweden is home to a large and growing population of refugee youths who may be at risk of mental health problems such as post-traumatic stress disorder (PTSD). Thus, there is a need for interventions that address mental health problems in these populations. Schools have been identified as an ideal setting for delivering such interventions as they offer a non-stigmatizing space and are often central to young refugees' social networks. The RefugeesWellSchool trial in Sweden will investigate an intervention comprising two programmes: Teaching Recovery Techniques (TRT) and In-service Teacher Training (INSETT), delivered in a school setting, among refugee youth. TRT is a group-based programme for children and adolescents, informed by Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). INSETT is a multi-module course for teachers providing information on trauma and the refugee experience to build teachers' cultural competence and capacity for supporting refugee youths in schools.

    METHODS: This trial employs a cluster randomized-control design with two arms: (1) the intervention arm in which the TRT and INSETT programmes are offered (n = 350), (2) the wait-list control arm (n = 350) in which services are provided as usual until the TRT and INSETT programmes are offered approximately six months later. Data will be collected prior to the intervention, immediately following the intervention, and at three months post-intervention. Outcomes for the trial arms will be compared using linear mixed models or ANCOVA repeated measures as well as the Reliable Change Index (RCI).

    DISCUSSION: This study will provide knowledge about the effectiveness of an intervention comprising two programmes: a group-based programme for youth reporting symptoms of PTSD and a training course for teachers, in order to build their competence and ability to support refugee youths in schools.

    TRIAL REGISTRATION: ISRCTN, ISRCTN48178969 , Retrospectively registered 20/12/2019.

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  • 46. Edberg, Anna-Karin
    et al.
    Ehrenberg, AnnaDalarna University, School of Health and Welfare, Caring Science/Nursing.Wijk, HelleÖhlén, Joakim
    Omvårdnad på avancerad nivå: Kärnkompetenser inom sjuksköterskans specialistområden2021Collection (editor) (Other academic)
  • 47.
    Edlund, Klara
    et al.
    Sophiahemmet Univ, Dept Hlth Promot Sci, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Unit Intervent Res Worker Hlth, Stockholm, Sweden..
    Sundberg, Tobias
    Sophiahemmet Univ, Dept Hlth Promot Sci, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Unit Intervent Res Worker Hlth, Stockholm, Sweden..
    Johansson, Fred
    Sophiahemmet Univ, Dept Hlth Promot Sci, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Unit Intervent Res Worker Hlth, Stockholm, Sweden..
    Onell, Clara
    Sophiahemmet Univ, Dept Hlth Promot Sci, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Unit Intervent Res Worker Hlth, Stockholm, Sweden..
    Rudman, Ann
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Inst.
    Holm, Lena W.
    Sophiahemmet Univ, Dept Hlth Promot Sci, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Unit Intervent Res Worker Hlth, Stockholm, Sweden..
    Grotle, Margreth
    Oslo Metropolitan Univ, Dept Physiotherapy, Oslo, Norway..
    Jensen, Irene
    Karolinska Inst, Inst Environm Med, Unit Intervent Res Worker Hlth, Stockholm, Sweden..
    Cote, Pierre
    Oslo Univ Hosp, Commun & Res Unit Musculoskeletal Hlth Formi, Oslo, Norway.;Ontario Tech Univ, Fac Hlth Sci, Ctr Disabil Prevent & Rehabil, Oshawa, ON, Canada..
    Skillgate, Eva
    Sophiahemmet Univ, Dept Hlth Promot Sci, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Unit Intervent Res Worker Hlth, Stockholm, Sweden..
    Sustainable UNiversity Life (SUN ) study: protocol for a prospective cohort study of modifiable risk and prognostic factors for mental health problems and musculoskeletal pain among university students2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 4, article id e056489Article in journal (Refereed)
    Abstract [en]

    Introduction Mental health problems and musculoskeletal pain are common health problems among young adults including students. Little is known about the aetiology and prognosis of these problems in university students. We aim to determine the role of personal, sociodemographic, academic and environmental factors for risk and prognosis of symptoms of depression, anxiety and stress as well as musculoskeletal pain in university students. The constructs that will be studied are based on the biopsychosocial model and psychopathology associated with disabling pain. This model acknowledges illness to consist of interrelated mechanisms categorised into biological, psychological, environmental and social cues. Methods and analysis This cohort study aims to recruit around 5000 Swedish full-time students. Data will be collected using five online surveys during one academic year. A subgroup (n=1851) of the cohort, recruited before the COVID-19 pandemic, receive weekly text messages with three short questions assessing mood, worry and pain, sent through the web-based platform SMS-track . Statistical analyses will include Kaplan-Meier estimates, Cox regression analyses, multinomial logistic regression analyses and generalised estimating equations. We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up. Protocol amendments Due to opportunity and timing of the study, with relevance to the outbreak of the COVID-19 pandemic, this study further aims to address mental health problems, musculoskeletal pain and lifestyle in university students before and during the pandemic. Ethics and dissemination The Sustainable UNiversity Life study was approved by the Swedish ethics authority (2019-03276; 2020-01449). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications.

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  • 48. Edqvist, Malin
    et al.
    Dahlen, Hannah G.
    Haggsgard, Cecilia
    Tern, Helena
    Ängeby, Karin
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Ctr Clin Res & Educ, Karlstad, Region Varmland.
    Teleman, Pia
    Ajne, Gunilla
    Rubertsson, Christine
    The Effect of Two Midwives During the Second Stage of Labour to Reduce Severe Perineal Trauma (Oneplus): A Multicentre, Randomized Controlled Trial in Sweden2022In: Obstetrical and Gynecological Survey, ISSN 0029-7828, E-ISSN 1533-9866, Vol. 77, no 9, p. 513-515Article in journal (Refereed)
    Abstract [en]

    In many high-income countries, severe perinatal trauma (SPT), affecting the anal sphincter muscle complex, has been on the rise over the last decade. However, effective strategies to prevent SPT are scarce. In randomized controlled trials, only perineal warm compresses and massage have shown benefit. Other cohort studies have shown that prevention models involving several components can decrease the occurrence of SPT, including a stepped-wedge design that reduced SPT from 3.3% to 3.0%. In Scandinavia, a preventive strategy called collegial assistance has been used to help prevent SPT. This strategy involves 2 mid-wives who assist the woman in the second stage of labor, with the second midwife primarily focused on preventing SPT. The aim of this study was to compare the rate of SPT in pregnancies managed by collegial assistance versus a single midwife. This Oneplus study was a randomized, controlled, unmasked trial, conducted at 5 obstetric units in Sweden between December 10, 2018, and March 21, 2020. Included were adult women with uncomplicated singleton pregnancies at >37 weeks of gestation, who were carrying their first child or having their first vaginal birth after cesarean delivery. Excluded were women who had multiple pregnancies, had intrauterine fetal demise, were undergoing a planned cesarean section, or were at <37 weeks' gestation. Women were randomly assigned to either the intervention group with 2 midwives in attendance during active second stage labor or standard care with 1 midwife. All midwives were asked to document the preventive methods used in case report forms. A total of 3750 women were included in the final analysis-with 1879 women receiving collegial assistance and 1871 women receiving standard care. Of the women who gave birth spontaneously, 1546 were in the intervention group and 1513 in the standard care group. Severe perinatal trauma occurred less frequently in the intervention group than the standard care group (3.9% vs 5.7%; odds ratio, 0.68; 95% confidence interval, 0.49-0.97; P = 0.025). In the intervention group, 0.2% had fourth-degree tears compared with 0.5% in the standard care group. The median time for collegial assistance was 15 minutes (interquartile range, 10-20 minutes). The use of perineal warm compresses was similar in the intervention group and standard care group (86.4% vs 85.7%, respectively). No differences were observed in birth positions, manual perineal protection, neonatal outcomes, or secondary maternal outcomes. In conclusion, the attendance of a second midwife dedicated to preventing SPT during the second stage of labor significantly reduced the risk of injury.

  • 49.
    Edqvist, Malin
    et al.
    Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    Dahlen, Hannah G
    School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia.
    Häggsgård, Cecilia
    Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    Tern, Helena
    Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    Ängeby, Karin
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Teleman, Pia
    Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden.
    Ajne, Gunilla
    Division of Obstetrics and Gynaecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Women's Health and Health Professions, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Rubertsson, Christine
    Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    The effect of two midwives during the second stage of labour to reduce severe perineal trauma (Oneplus): a multicentre, randomised controlled trial in Sweden2022In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 399, no 10331, p. 1242-1253Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Severe perineal trauma (SPT) affecting the anal sphincter muscle complex is a serious complication following childbirth, associated with short-term and long-term maternal morbidity. Effective preventive strategies are still scarce. The aim of the Oneplus trial was to test the hypothesis that the presence of a second midwife during the second stage of labour, with the purpose of preventing SPT, would result in fewer injuries affecting the anal sphincter than if attended by one midwife.

    METHODS: In this multicentre, randomised, controlled parallel group, unmasked trial done at five obstetric units in Sweden, women were randomly assigned to be assisted by either one or two midwives in late second stage. Nulliparous women and women planning the first vaginal birth after caesarean section who were age 18-47 years were randomly assigned to an intervention when reaching the second stage of labour. Further inclusion criteria were gestational week 37+0, carrying a singleton live fetus in vertex presentation, and proficiency in either Swedish, English, Arabic, or Farsi. Exclusion criteria were a multiple pregnancy, intrauterine fetal demise, a planned caesarean section, or women who were less than 37 weeks pregnant. Randomisation to the intervention group of two midwives or standard care group of one midwife (1:1) was done using a computer-based program and treatment groups were allocated by use of sealed opaque envelopes. All women and midwives were aware of the group assignment, but the statistician from Clinical Studies Forum South, who did the analyses, was masked to group assignment. Midwives were instructed to implement existing prevention models and the second midwife was to assist on instruction of the primary midwife, when asked. Midwives were also instructed to complete case report forms detailing assistance techniques and perineal trauma prevention techniques. The primary outcome was the proportion of women who had SPT, for which odds ratios (ORs) and 95% CIs were calculated, and logistic regression was done to adjust for study site. All analyses were done according to intention to treat. The trial is registered with ClinicalTrials.gov, NCT0377096.

    FINDINGS: Between Dec 10, 2018, and March 21, 2020, 8866 women were assessed for eligibility, and 4264 met the inclusion criteria and agreed to participate. 3776 (88·5%) of 4264 women were randomly assigned to an intervention after reaching the second stage of labour. 1892 women were assigned to collegial assistance (two midwives) during the second stage of labour and 1884 women were assigned to standard care (one midwife). 13 women in each group did not meet the inclusion criteria and were excluded. After further exclusions, 1546 women spontaneously gave birth in the intervention group and 1513 in the standard care group. 1546 women in the intervention group and 1513 in the standard care group were included in the intention-to-treat analysis of the primary outcome. There was a significant reduction in SPT in the intervention group (3·9% [61 of 1546] vs 5·7% [86 of 1513]; adjusted OR 0·69 (0·49-0·97).

    INTERPRETATION: The presence of two midwives during the active second stage can reduce SPT in women giving birth for the first time.

  • 50.
    Egal, Jama Ali
    Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Women search for normality in birth: Solutions empowering resilience and reproductive agency while reducing adverse outcomes for Somaliland women2023Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis aimed to explore the causes of severe pregnancy outcomes and maternal deaths in Somaliland (studies I and II) and how these causes are influenced by the context of the wider health system (studies III and IV). 

    Methodology: Both quantitative and qualitative methodologies were used. A prospective cross-sectional design was used to collect data for studies I and II. Study II focused on maternal deaths using a mixed method design. Studies III and IV used individual interviews to explore the needs of women when choosing a place of birth and the role of traditional birth attendants (TBAs) in maternity services in Somaliland. 

    Analysis: Data were analysed using descriptive statistics and percentages. An inductive content analysis was used for study III, and a qualitative thematic analysis was used for study IV.

    Results: Study I showed that the maternal near-miss (MNM) ratio was 56 MNMs per 1,000 live births according to the Sub-Saharan Africa (SSA) criteria and 13 MNMs per 1,000 live births according to the WHO criteria. The mortality index was highest among women with medical complications. Study II highlighted that 89% of these women self-referred to the hospital and that only 25% were admitted to the intensive care unit. Poor risk awareness and inadequate interprofessional collaboration contributed to missed opportunities. Study III showed that the lack of reproductive agency involved in facility-based births makes home births a first choice, regardless of potential risks and medical needs. Study IV demonstrated that TBAs need to be better connected with health facilities and skilled birth attendants (SBAs) to reduce maternal and neonatal mortality and morbidities in Somaliland.

    Conclusion: Women search for normality in birth, and the midwifery profession could provide this normality by facilitating resilience and reproductive agency while reducing adverse outcomes of pregnancy, birth and the postpartum period. There is a need to improve the quality of maternal health services by implementing evidence-based obstetric interventions and continuous in-service training. The referral system needs to be strengthened by utilising TBAs as a community resource to support community maternal and child health centres.

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