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  • 1.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Design quality in a healthcare context – time to operationalize the concept2016Conference paper (Refereed)
    Abstract [en]

    We present a review of the concept of design quality in healthcare. The aim of review was to define the concept of design quality in order to be able to operationalize the concept for future research. In recent years, several studies have shown that the design of the physical environment affects the patient's health and wellbeing and how different models of care can be implemented, for example, person-centered care. Design quality in architecture has long been the subject for theoretical discussion. From the Roman architect Vitruvius to contemporary design quality following tangible and intangible properties such as utility, durability and beauty. In dictionaries, the general design quality is described as a standard for something when it is compared to other things; how good or bad something is to be of good / bad / the highest quality. Design quality can be described as a measure of a high standard, a plan or an intention of design in the way that it will work and look like. However, until recently, the meaning of design quality in healthcare has been vague and merely described as a subjective experience of the environment. In order to be useful the concept need to be connected to quality indicators of healthcare. In this presentation, we discuss the concept of design quality and its relation to evidence-based design i.e. design decisions based on the best available results from credible research and evaluation of completed building projects.

  • 2.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sustainability – a question for the leadership?2014Conference paper (Refereed)
    Abstract [en]

    Background The overall issue for the health sector during the coming century will be the climate change and its implication for human health. We argue that awareness of nurse’s experience and knowledge in climate and environmental issues is a crucial question for the health sector and their leadership in the process with a sustainable development.

    Aim The aim of this study was to explore nurse’s experience and knowledge of climate and environmental issues in relation to a health perspective and how nurses can contribute to the process of sustainable development.

    Method/design The study was conducted as an interview study with qualitative approach. Eight individual and two focus groups with registered nurses who represented hospitals, primary care and emergency medical services participated in the study and were analyzed with content analysis.

    Result One of the results that appeared in the study showed that there is a sense of responsibility to work on climate and environmental issues, but this is overshadowed by care task in daily work at the clinic.

    Conclusion The leadership has an enormously important role to integrate climate and environmental change issues in their daily work. The leadership needs to avoid that the question of sustainability becomes an imposition to be made after all other work. This study has shown the importance of knowledge concerning climate and environmental issues in the health sector and the importance of knowledge about a sustainable development within leadership.

  • 3.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sustainability in nursing: a concept analysis2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 381-389Article in journal (Refereed)
    Abstract [en]

    Aim. The aim of this study was to describe, explore and explain the concept of sustainability in nursing.

    Background. Although researchers in nursing and medicine have emphasised the issue of sustainability and health, the concept of sustainability in nursing is undefined and poorly researched. A need exists for theoretical and empirical studies of sustainability in nursing.

    Design. Concept analysis as developed by Walker and Avant.

    Method. Data were derived from dictionaries, international healthcare organisations and literature searches in the CINAHL and MEDLINE databases. Inclusive years for the search ranged from 1990 to 2012. A total of fourteen articles were found that referred to sustainability in nursing.

    Results. Sustainability in nursing involves six defining attributes: ecology, environment, future, globalism, holism and maintenance. Antecedents of sustainability require climate change, environmental impact and awareness, confidence in the future, responsibility and a willingness to change. Consequences of sustainability in nursing include education in the areas of ecology, environment and sustainable development as well as sustainability as a part of nursing academic programs and in the description of the academic subject of nursing. Sustainability should also be part of national and international healthcare organisations. The concept was clarified herein by giving it a definition.

    Conclusion. Sustainability in nursing was explored and found to contribute to sustainable development, with the ultimate goal of maintaining an environment that does not harm current and future generations' opportunities for good health. This concept analysis provides recommendations for the healthcare sector to incorporate sustainability and provides recommendations for future research.

  • 4.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Heylighen, Ann
    KU Leuven, Belgium.
    Nordin, Susanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Design quality in the context of healthcare environments: a scoping review2017In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 10, no 4, p. 136-150Article in journal (Refereed)
    Abstract [en]

    Objective:

    We explored the concept of design quality in relation to healthcare environments. In addition, we present a taxonomy that illustrates the wide range of terms used in connection with design quality in healthcare.

    Background:

    High-quality physical environments can promote health and well-being. Developments in healthcare technology and methodology put high demands on the design quality of care environments, coupled with increasing expectations and demands from patients and staff that care environments be person centered, welcoming, and accessible while also supporting privacy and security. In addition, there are demands that decisions about the design of healthcare architecture be based on the best available information from credible research and the evaluation of existing building projects.

    Method:

    The basic principles of Arksey and O’Malley’s model of scoping review design were used. Data were derived from literature searches in scientific databases. A total of 18 articles and books were found that referred to design quality in a healthcare context.

    Results:

    Design quality of physical healthcare environments involves three different themes: (i) environmental sustainability and ecological values, (ii) social and cultural interactions and values, and (iii) resilience of the engineering and building construction. Design quality was clarified herein with a definition.

    Conclusions:

    Awareness of what is considered design quality in relation to healthcare architecture could help to design healthcare environments based on evidence. To operationalize the concept, its definition must be clear and explicit and able to meet the complex needs of the stakeholders in a healthcare context, including patients, staff, and significant others.

  • 5.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nilsson, Maria
    Umeå universitet.
    Holmner, Åsa
    Umeå universitet.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nurses’ perceptions of climate and environmental issues: a qualitative study2015In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 71, no 8, p. 1883-1891Article in journal (Refereed)
    Abstract [en]

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

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

    Design: This is a descriptive, explorative qualitative study. 

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

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

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

  • 6.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    von Koch, Lena
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Designing Inclusive Architecture: Facilitators and Barriers of the Healthcare Environment for Rehabilitation at Stroke Units2016In: Designing Around People: CWUAAT 2016 / [ed] Pat Langdon, Jonathan Lazar, Ann Heylighen, Hua Dong, Springer London, 2016, p. 229-230Chapter in book (Refereed)
  • 7.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    von Koch, Lena
    Karolinska Institutet.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    “Det är ensamt”– patienternas upplevelse av den fysiska miljön på en nybyggd strokeenhet2018Conference paper (Refereed)
  • 8.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    von Koch, Lena
    Karolinska Institutet.
    Eriksson, Gunilla
    Karolinska Institutet.
    Sjöstrand, Christina
    Karolinska Institutet.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet.
    Multi-professional teamwork in stroke units –time to understand the impact of the built environment on the work of staff2018Conference paper (Refereed)
  • 9.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    von Koch, Lena
    Karolinska institutet.
    Heylighen, Ann
    Katholieke Universiteit Leuven, Leuven, Belgium.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet; Chalmers.
    "It's lonely": Patients' experiences of the physical environment at a newly built stroke unit2018In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The aim of this study was to explore patients' experiences of the physical environment at a newly built stroke unit.

    BACKGROUND:

    For a person who survives a stroke, life can change dramatically. The physical environment is essential for patients' health and well-being. To reduce infections, a majority of new healthcare facilities mainly have a single-room design. However, in the context of stroke care, knowledge of how patients experience the physical environment, particularly their experience of a single-room design, is scarce.

    METHOD:

    This study used a qualitative design. Patients ( n = 16) participated in semistructured individual interviews. Data were collected in December 2015 and February 2017 in Sweden; interviews were transcribed verbatim and analyzed using content analysis.

    RESULTS:

    Two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In single rooms, social support was absent and a sense of loneliness was expressed. Patients were positively distracted when they looked at nature or activities that went on outside their windows.

    CONCLUSIONS:

    The physical environment is significant for patients with stroke. This study highlights potential areas for architectural improvements in stroke units, primarily around designing communal areas with meeting places and providing opportunities to participate in the world outside the unit. A future challenge is to design stroke units that support both community and privacy. Exploring patients' experiences could be a starting point when designing new healthcare environments and inform evidence-based design.

  • 10.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    von Koch, Lena
    Sjöstrand, Christina
    Bernhardt, Julie
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet; Chalmers University of Technology.
    A comparative study of patients’ activities and interactions in a stroke unit before and after reconstruction – the significance of the built environment2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 7, article id e0177477Article in journal (Refereed)
    Abstract [en]

    Early mobilization and rehabilitation, multidisciplinary stroke expertise and comprehensive therapies are fundamental in a stroke unit. To achieve effective and safe stroke care, the physical environment in modern stroke units should facilitate the delivery of evidence-based care. Therefore, the purpose of this study was to explore patients’ activities and interactions in a stroke unit before the reconstruction of the physical environment, while in a temporary location and after reconstruction. This case study examined a stroke unit as an integrated whole. The data were collected using a behavioral mapping technique at three different time points: in the original unit, in the temporary unit and in the new unit. A total of 59 patients were included. The analysis included field notes from observations of the physical environment and examples from planning and design documents. The findings indicated that in the new unit, the patients spent more time in their rooms, were less active, and had fewer interactions with staff and family than the patients in the original unit. The reconstruction involved a change from a primarily multi-bed room design to single-room accommodations. In the new unit, the patients’ lounge was located in a far corner of the unit with a smaller entrance than the patients’ lounge in the old unit, which was located at the end of a corridor with a noticeable entrance. Changes in the design of the stroke unit may have influenced the patients’ activities and interactions. This study raises the question of how the physical environment should be designed in the future to facilitate the delivery of health care and improve outcomes for stroke patients. This research is based on a case study, and although the results should be interpreted with caution, we strongly recommend that environmental considerations be included in future stroke guidelines.

  • 11.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    von Koch, Lena
    Sjöstrand, Christina
    Heylighen, Ann
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet; Chalmers.
    The physical environment and patients' activities and care. A comparative case study at three newly built stroke units2018In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 74Article in journal (Refereed)
    Abstract [en]

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

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

    DESIGN: This work is a comparative descriptive case study.

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

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

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

  • 12. Charise, A
    et al.
    Witteman, H
    Whyte, S
    Sutton, E
    Massimi, M
    Stephens, L
    Bender, L
    Evans, J
    Logie, C
    Mirza, R
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Questioning context: a set of interdisciplinary questions for investigating contextual factors affecting health decision making2011In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 14, no 2, p. 115-132Article in journal (Refereed)
    Abstract [en]

    Objective: To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making.

    Background: Decision-making processes and outcomes may be shaped by a range of non-medical or ‘contextual’ factors particular to an individual including social, economic, political, geographical and institutional conditions. Research concerning contextual factors occurs across many disciplines and theoretical domains, but few conceptual tools have attempted to integrate and translate this wide-ranging research for health decision-making purposes.

    Methods: To formulate this tool we employed an iterative, collaborative process of scenario development and question generation. Five hypothetical health decision-making scenarios (preventative, screening, curative, supportive and palliative) were developed and used to generate a set of exploratory questions that aim to highlight potential contextual factors across a range of health decisions.

    Findings: We present an exploratory tool consisting of questions organized into four thematic domains – Bodies, Technologies, Place and Work (BTPW) – articulating wide-ranging contextual factors relevant to health decision making. The BTPW tool encompasses health-related scholarship and research from a range of disciplines pertinent to health decision making, and identifies concrete points of intersection between its four thematic domains. Examples of the practical application of the questions are also provided.

    Conclusions: These exploratory questions provide an interdisciplinary toolkit for identifying the complex contextual factors affecting decision making. The set of questions comprised by the BTPW tool may be applied wholly or partially in the context of clinical practice, policy development and health-related research.

  • 13.
    Eldh, Ann Catrine
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Olai, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Jönsson, Birgitta
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Denti, Leif
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Supporting first-line managers in implementing oral care guidelines in nursing homes – a pilot study2018In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, no 2, p. 87-95Article in journal (Refereed)
    Abstract [en]

    This study investigated first-line managers’ experience of and responses to a concise leadership intervention to facilitate the implementation of oral care clinical practice guidelines (CPGs) in nursing homes. Leadership is known to be an important element in knowledge implementation but little is known as to what supports managers to facilitate the process. By means of a process evaluation with mixed methods, the context and a three-month leadership program was explored, including activities during and in relation to the program, and the effects in terms of oral care CPG implementation plans. While the managers appreciated the intervention and considered improved oral care to be a priority, their implementation plans mainly focused the dissemination of an oral care checklist. The findings suggest that extended implementation interventions engaging both managers and clinical staff are needed, and that a concise intervention does not facilitate first-line managers to adopt behaviors known to facilitate knowledge implementation.

  • 14.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Att ligga steget före: Vikten av tidig planering för att säkra goda vårdmiljöer.2014In: Vårdmiljöns betydelse / [ed] Helle Wijk, Lund: Studentlitteratur AB, 2014, 1, , p. 368Chapter in book (Other (popular science, discussion, etc.))
  • 15.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Modeling of Care Processes. The use of Simulation Models for the Design of Health Care Environments.2006Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The necessity to improve the building design process is stressed in many studies. Communication in the early stages of the process is particularly important and it is suggested that this influences the quality of the whole process. In recent times, the construction sector has become more customer-oriented and is making use of the organisation and its main process as a basis for design decisions and as an important complement to construction issues. Participants in the building design process need tolls to indentify the requirements of the organisation for a building project. The overall aim of this thesis was to explore modelling and simulations (system dynamics) as at tool in facilitating collaboration between participants in the early stages in the design process for new health care environments. Two models were developed: a conceptual model for care planning and a simulation model of a stroke care process with a patient-centred focus. The thesis also investigated whether system dynamics with group modelling facilitates collaboration between participants in the design process. A case study approach was adopted to gain a detailed understanding of the activities during the group modelling project. Data was collected through literature, interviews and observations of the group modelling sessions. The results showed that group modelling with system dynamics facilitated the design work. The method allows the participants to visualise and understand the relationships between important factors in the stroke care process and brings system thinking into the stroke care process. The findings from the thesis have implications for managing the requirements of the buildings in the early stages of the design process.

  • 16.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    The Care planning process: A Case for System Dynamics2005In: 23th International System Dynamics Conferences, Boston, 2005Conference paper (Refereed)
    Abstract [en]

    Health care is a complex dynamic setting suitable for system dynamics analyses. The method has the potential to be an important quality improvement tool in the near future. However, it will be necessary to develop the models beyond the pure production model focus on the clinical care process from a patent perspective and in doing so it is inevitable that variables such as health, communication and care planning are involved. Consequently, useful and valid models for modern health care must involve variables that are unfairly designated as intangible. The present paper describes an exploratory system dynamics model of the care planning process. It draws on a range of studies and theories about the process. The paper discusses how it could be possible to incorporate and validate variables alongside the more traditional way.

  • 17.
    Elf, Marie
    et al.
    Chalmers Tekniska Högskola.
    Dougherty, Mark
    Dalarna University, School of Technology and Business Studies, Computer Engineering.
    The role for simulation in the design of new health care environments2003In: The 8th International Congress in Nursing Informatics - NI2003, Rio de Janeiro, Brazil, 2003Conference paper (Refereed)
  • 18.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Eldh, Ann Catrine
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Malmqvist, Inga
    Chalmers.
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    von Koch, Lena
    Karolinska institutet.
    Using of group-modeling in pre-design phase of new healthcare environments: stakeholders experiences2016In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 9, no 2, p. 69-81Article in journal (Refereed)
    Abstract [en]

    Background: Current research shows a relationship between healthcare architecture and patient-related outcomes. The planning and designing of new healthcare environments is a complex process; the needs of the various end-users of the environment must be considered, including the patients, the patients’ significant others, and the staff. The aim of this study was to explore the experiences of healthcare professionals participating in group modeling utilizing system dynamics in the pre-design phase of new healthcare environments. We engaged healthcare professionals in a series of workshops using system dynamics to discuss the planning of healthcare environments in the beginning of a construction, and then interviewed them about their experience.

    Methods: An explorative and qualitative design was used to describe participants’ experiences of participating in the group modeling projects. Participants (n=20) were recruited from a larger intervention study using group modeling and system dynamics in planning and designing projects. The interviews were analyzed by qualitative content analysis.

    Results: Two themes were formed, representing the experiences in the group modeling process: ‘Participation in the group modeling generated knowledge and was empowering’ and ‘Participation in the group modeling differed from what was expected and required the dedication of time and skills”.

    Conclusions: The method can support participants in design teams to focus more on their healthcare organization, their care activities and their aims rather than focusing on detailed layout solutions. This clarification is important when decisions about the design are discussed and prepared and will most likely lead to greater readiness for future building process.

  • 19.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Eldh, Ann Catrine
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    von Koch, Lena
    Karolinska Institutet.
    Using modeling as a co-design approach in the planning process of new care environments2016In: Nordic Conference in Nursing Research 2016: SSF, 2016Conference paper (Refereed)
    Abstract [en]

    Current research shows a relationship between healthcare architecture and patient-related Outcomes. The planning and designing of new healthcare environments is a complex process; the needs of the various end-users of the environment must be considered, including the patients, the patients’ significant others, and the staff. The aim of this study was to explore the experiences of healthcare professionals participating in group modelling utilizing system dynamics in the pre-design phase of new healthcare environments. We engaged healthcare professionals in a series of workshops using system dynamics to discuss the planning of healthcare environments in the beginning of a construction, and then interviewed them about their experience. An explorative and qualitative design was used to describe participants’ experiences of participating in the group modelling projects. Participants (n=20) were recruited from a larger intervention study using group modeling and system dynamics in planning and designing projects. The interviews were analysed by qualitative content analysis. Two themes were formed, representing the experiences in the group modeling process: ‘Partaking in the G-M created knowledge and empowerment’and ‘Partaking in the G-M was different from what was expected and required time and skills’. The method can support participants in design teams to focus more on their healthcare organization, their care activities and their aims rather than focusing on detailed layout solutions. This clarification is important when decisions about the design are discussed and prepared and will most likely lead to greater readiness for future building process.

  • 20.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Eriksson, Gunilla
    Johansson, Sverker
    von Koch, Lena
    Ytterberg, Charlotte
    Self-reported fatigue and associated factors six years after stroke2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 8, article id e0161942Article in journal (Refereed)
    Abstract [en]

    Several studies have found that fatigue is one of the most commonly reported symptoms after stroke and the most difficult to cope with. The present study aimed to investigate the presence and severity of self-reported fatigue six years after stroke onset and associated factors. The cohort "Life After Stroke Phase I" (n = 349 persons) was invited at six years to report fatigue (Fatigue Severity Scale 7-item version), perceived impact of stroke and global recovery after stroke (Stroke Impact Scale), anxiety and depression (Hospital Anxiety and Depression Scale), life satisfaction (Life Satisfaction Checklist) and participation in everyday social activities (Frenchay Activities Index). At six years 37% of the 102 participants in this cross-sectional study reported fatigue. The results showed that in nearly all SIS domains the odds for post-stroke fatigue were higher in persons with a higher perceived impact. Furthermore, the odds for post-stroke fatigue were higher in those who had experienced a moderate/severe stroke and had signs of depression and anxiety. Fatigue is still present in one-third of persons as long as six years after stroke onset and is perceived to hinder many aspects of functioning in everyday life. There is an urgent need to develop and evaluate interventions to reduce fatigue.

  • 21.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Flink, Maria
    Karolinska Institutet .
    Nilsson, Marie
    Karolinska Institutet .
    Tistad, Malin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    von Koch, Lena
    Karolinska Institutet .
    Ytterberg, Charlotte
    Karolinska Institutet .
    The case of value-based healthcare for people living with complex long-term conditions2017In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, no 1, p. 1-6, article id 24Article in journal (Refereed)
    Abstract [en]

    Background

    There is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the patient’s experience of her or his entire cycle of care, including the use of well-defined outcome measurements. Challenges arise when the approach is applied to health services for people living with long-term complex conditions that require support from various healthcare services. The aim of this work is to critically discuss the value-based approach and its implications for patients with long-term complex conditions. Two cases from clinical practice and research form the foundation for our reasoning, illustrating several challenges regarding value-based health services for people living with long-term complex conditions.

    Discussion

    Achieving value-based health services that provide the health outcomes that matter to patients and providing greater patient-centredness will place increased demands on the healthcare system. Patients and their informal caregivers must be included in the development and establishment of outcome measures. The outcome measures must be standardized to allow evaluation of specific conditions at an aggregated level, but they must also be sensitive enough to capture each patient’s individual needs and goals. Healthcare systems that strive to establish value-based services must collaborate beyond the organizational boundaries to create clear patient trajectories in order to avoid fragmentation.

    Summary

    The shift towards value-based health services has the potential to align healthcare-service delivery with patient-centred care if serious efforts to take the patient’s perspective into account are made. This is especially challenging in fragmented healthcare systems and for patients with long-term- and multi-setting-care needs.

  • 22.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Fröst, Peter
    Chalmers Tekniska Högskola.
    Lindahl, Göran
    Chalmers Tekniska Högskola.
    Wijk, Helle
    Shared-decision making in designing new healthcare environments: ready to take off for improved quality2015In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, article id 114Article in journal (Refereed)
    Abstract [en]

    Background

    Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments.

    Discussion

    This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed.

    Summary

    We suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users’ perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.

  • 23.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Granath, JÅ
    Sjödén, PO
    The Health Care Environment2003In: The International Postgraduate Research Conferences, Lisbon, 2003Conference paper (Other academic)
  • 24.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Holmström, Paul
    Göteborgs Universitet .
    Malmqvist, Inga
    Chalmers Tekniska Högskola .
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    von Koch, Lena
    Karolinska Institutet Institutionen för neurobiologi, vårdvetenskap och samhälle.
    Facilitating designing of a new dementia care environment through group modeling2012Conference paper (Refereed)
  • 25.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Holmström, Paul
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Models of Care processes – Implications for the Design of New Health Care Environments2004In: EuroFM Conferences, Copenhagen, 2004Conference paper (Other academic)
  • 26.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Jansson, Monika
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Neljesjö, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ossiannilsson, Ebba
    Lunds Universitet.
    Implementation of Open Educational Resources in a nursing programme: experiences and reflections2015In: Conference proceedings: The Online, Open and Flexible Higher Education Conference, 2015Conference paper (Refereed)
    Abstract [en]

    World leading organizations like the United Nations Educational, Scientific and Cultural Organization (UNESCO) and the Commonwealth of learning (COL) stress the pedagogical benefits for learners of using Open Educational resources (OER). The use of OER is also increasing in higher education, as well as the increased use by citizens in society. The situation of the OER impact is encouraging, but also mixed. There are two main hypotheses under investigation were (A) that OER improves student performance; and (B) that openly licensed material is used differently to other online material.

    In this paper, we describe the implementation process of using Open Educational Resources (OER) in the nursing programme at Dalarna University, Sweden. The project is called IMPOERS (Implementation of OERs) (Elf, et.al, 2014). The IMPOERs project will implement the use of OERs in a nursing programme at Dalarna University, Sweden. The University and its nursing programme have long engaged in e-learning, and the nursing programme has recently been awarded the European Association of Distance Teaching Universities (EADTU) E-xcellence Associates Quality Label (Ubachs 2009 Williams, Kear & Roswell 2012). The quality award was based on the creation of a roadmap for the continuous development of e-learning and the implementation of OER, as OER until that time was not very frequently used, and neither the awareness of its benefits (Santesson et al., 2012). Hence, the IMPOERs was launched with the overall aim introduce and implement OER as a pedagogical framework in the nursing programme. We also wanted to evaluate both the process and outcomes.

  • 27.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Jansson, Monika
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Neljesjö, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ossiannilsson, Ebba
    Vice President The Swedish Association for Distance Education/SVERD/SADE.
    Införandet av öppna lärresurser i sjuksköterskeprogrammet - erfarenheter och reflektioner: Demonstration2016Conference paper (Other academic)
    Abstract [sv]

    Detta projekt beskriver införandet av öppna lärresurser (OER) i sjuksköterskeprogrammet vid Högskolan Dalarna. Projektet kallas IMPOER. Sjuksköterskeprogrammet har en lång historia av att använda e-lärande och har tilldelats excellence kvalitetsackreditering av den europeiska sammanslutningen for distansundervisning inom högre utbildning (EADTU). Ackrediteringen innebar att skriva fram en plan for att kontinuerligt utveckla e-lärandet. Planen innehöll bl.a. ett mal om att satsa mer på OER. I detta projekt definieras OER som undervisnings-, inlärnings- eller forskningsmaterial som antingen ar helt fritt eller har slappts med en licens som tillåter fri användning, anpassning och distribution av material s.k.creative common license.

    SyfteSyftet med projektet var att införa OER och studera hur studenter och lärare upplevde användningen av OER och deras uppfattningar om hur ansatsen påverkade inlärningsprocessen.

    IMPOER projektetTrots att användningen av e-lärande ar etablerat i sjuksköterskeprogrammet sa ar användandet av OER inte speciellt utbrett. Kursen som valdes for IMPOER projektet var en preklinisk kurs i grundläggande omvårdnad, en kurs i andra terminen av programmet, som inkluderar både teoretiska och praktiska moment. Fokus i kursen ligger på patientens grundläggande omvårdnadsbehov, och studenterna övar på omvårdnadsaktiviteter såsom att stödja patienten med personlig hygien. Den kliniska undervisningen sker på ett kunskapscentrum, där studenterna har möjlighet att praktisera omvårdnad i en simulerad miljö med autentisk utrustning och material. I kursen ingår aven lärandemål som ar relaterade till den åldrande individen i samhället. Tidigare har inlärning skett genom imitation, vilket innebar att studenterna undervisas i tekniker och sedan imiterar pedagogen. Denna traditionella undervisningsmetod ar resurskrävande och ineffektiv. Vi ville med projektet omvända klassrummet och ge studenterna en möjlighet att bredda och fördjupa sin kunskap innan seminarier och examinationer.

     GenomförandetProjektet genomfördes i tre steg (1) systematisk sökning och granskning av OER som skulle kunna användas i kursen; (2) utveckling av läromedel (lärandemål, examinationsuppgifter, studieguide, videoproduktion); (3) stod till studenter och lärare att använda OER.

    Efter en genomgång av OER på nätet konstaterades att det fanns otillräckligt med OER som passade en svensk kontext. Projektledarna (MN, MJ) utvecklade därför in ett antal scenarier och spelade in instruktionsfilmer med stod av en medieproducent anställd vid Högskolans Dalarna. Under kursens gång uppmuntrades studenterna att använda OER och de inspelade filmerna for att förbereda sig for de praktiska examinationerna på kunskapscentrat. I en av uppgifterna ingick att skriva om individens åldrandeprocess med hjälp av OER.

    UtvärderingProjektet utvärderades med hjälp av semi-strukturerade intervjuer och analyserades med innehållsanalys. Resultaten visar att både studenter och lärare tyckte att det hade varit en positiv erfarenhet av att använda OER men de kände sig överväldigade av den mängd material som fanns och de var bekymrade över kvaliteten. Användningen av OER stimulerade ett kritiskt förhållningssätt. Både studenterna och lärare ansåg att ansatsen var ett stimulerande och bra satt att lära sig, och de uppskattade att det fanns OER som var fritt och lätt att komma at. Om användningen av OER skall utvecklas och bli hållbar behovs en förändring i attityder och praxis bland studenter och lärare.

  • 28.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Lindahl, Göran
    Chalmers Tekniska Högskola.
    Anåker, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    A study of relationships between content in documents from the health service operational plan and documents from the planning of new healthcare environments2018In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to investigate the content and quality of the governing documents created in the planning and design phase of new healthcare environments and in the related healthcare strategic and operational plans.

    Background: Quality deficits in buildings can often be traced back to the initial stages in the planning and design phase. Although, large investments have been made to improve the process of planning new healthcare environments and linking the requirements to health service strategies, healthcare organizations rarely relate their strategy goals to the built environment.

    Methods: A retrospective review of documents created in the planning and design stages of new healthcare environments and the operational plans of the target organizations was conducted.

    Results: The organizational operational plans did not contain any statements or information about the built environment or how a building could or should support the organization's goals. Important information was frequently absent from the documents governing the planning and design of buildings. The documents lacked information about what and how to follow-up and what to measure once a construction project had been completed. There were no references to evidence.

    Conclusions: Poor documentation might undermine the quality of the planning and design phase and ultimately the opportunity to create environments that support health outcomes. Therefore, more emphasis must be placed on the importance of documentation but above all to strengthen and clarify the relationship between the healthcare organization strategy to achieve an effective and efficient care process and the intention made in the planning and design process.

  • 29.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Chalmers tekniska högskola, KI.
    Lundberg Santesson, Inger
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Florin, Jan
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Yes we can do Quality in eLearning2013In: Proceedings : The Open and Flexible Higher Education Conference 2013: Hosted by the FIED and the UMPC in Paris, European Association of Distance Teaching Universities , 2013, p. 114-119Conference paper (Refereed)
    Abstract [en]

    Introduction: Dalarna University and the Nursing programme have performed eLearning for a long time and our feeling was that we are good in providing high quality eLearning. However, we wanted to benchmark the education against quality standards for a more objective quality assessment and thus as one of the first Nursing programme in Europe we performed an analysis of the education with support of European Association of Distance Education Universities (EADTU) system. Background and aim: Today, e-learning becomes more established in higher education providing new pedagogical possibilities and support for competence development. This has impacts on students’ and teachers’ roles and responsibility for learning, creation of learning content and activities and forms for interaction. However, it is necessary to assure the quality of eLearning environment and experience provided to the students. The aim of this paper is to describe a quality improvement process regarding eLearning of a Nursing Programme conducted in a blended learning environment. Methods: A systematic Benchmarking process with a bottom-up approach developed by EADTU was used to assess the quality of eLearning. Results: A need of strategies and work processes regarding management, development, implementation and evaluation of eLearning was identified as well as directions regarding teachers’ competence and continuing learning. The awareness of strengths and weaknesses in the nursing programme in relation to eLearning has provided incitement for a continuous quality work. Conclusions: It is essential to have knowledge about the quality of higher education concerning structures, processes and results. Benchmarking can function as a tool to initiate a process of heightened awareness and ongoing quality work. Benchmarking with a bottom-up approach could be a fruitful way of enforcing and maintaining high quality in higher education.

  • 30.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Malmqvist, Inga
    An audit of the content and quality in briefs for Swedish healthcare spaces2009In: Journal of Facilities Management, ISSN 1472-5967, E-ISSN 1741-0983, Vol. 7, no 3, p. 198-211Article in journal (Refereed)
    Abstract [en]

    Purpose: Initial briefs (programs) were examined in order to obtain an overview of current practice in documenting the briefing process for new health care buildings in Sweden. Methodology: An audit instrument was developed and used to examine briefs for the content and quality of information and to determine whether and to what extent the information was comprehensive and patient oriented. Findings: The results indicate that few strategic briefs make use of evidence to support their statements. Moreover, few briefs had an explicitly patient-focused goal for the project or measurable outcomes. Implication for practice: This new audit approach can be applied in various organisations and over time to improve the briefing process and create clearer goals and guidelines. Originality/value: The present study contributes with an audit of written briefs. The question of whether the use of briefing and a systematic brief make a significant contribution to the high quality of design solutions remains unanswered, as is also the case of whether the brief, in general, reflects the briefing process. Despite the recent focus on improving the quality of the briefing process, there is a lack of knowledge concerning the documentation resulting from the briefing process. Studies are needed that employ different approaches in order to accept or reject the assumption that the briefs are an accurate reflection of the briefing process.

  • 31.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Chalmers tekniska högskola, Karolinska Institutet.
    Malmqvist, Inga
    Chalmers University of Technology,, Architecture, Göteborg.
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    von Koch, Lena
    Karolinska Institutet Institutionen för neurobiologi, vårdvetenskap och samhälle.
    Designing patient-centered healthcare spaces2013Conference paper (Refereed)
    Abstract [en]

    The architecture can promote patients health. Accessibility, safety and care quality can be built into the design of healthcare environments. The current planning process has been criticized to be guided by technical solutions rather than the users’ needs and a lack of correspondence between the goal of the organization and the planning process. We used the system dynamics (SD) modeling method to facilitate the pre-planning process (before architectural design details are presented) of new healthcare environments. SD is an interactive computer-based method that is suitable for use with a group-modeling approach with a focus on learning, which is facilitated through the construction of simple models of the system that help the user to experiment with and study the behavior of these models. The aim of using SD was to strengthen the understanding of the healthcare organization and its care processes, enhance the integration of scientific knowledge related to care processes and architecture. A case study design was used in five different healthcare settings. The participants built the model in collaboration through a reflective and iterative process of learning about their organization/system to contribute to the planning process. The preliminary results show that we succeeded in turning the discussions toward the work and related care processes as a basis for further planning of the building.

  • 32.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Malmqvist, Inga
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    von Koch, Lena
    Designing sustainable healthcare environments2011In: 19th International Conference on Health Promoting Hospitals and Health Services, Turku, Finland, 2011Conference paper (Refereed)
  • 33.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Nordin, Susanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Von Koch, Lena
    Wijk, Helle
    Designing for person-centered care in older people’s residential facilities2011In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 23, no Suppl. 1, p. 270-Article in journal (Refereed)
  • 34.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Chalmers tekniska högskola, KI.
    Neljesjö, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Jansson, Monika
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ossiannilsson, Ebba
    Lunds Universitet .
    IMPOER - implementering av öppna lärresurser (OER) i sjuksköterskeprogrammet, Högskolan Dalarna2014In: NU2014, Umeå 8-10 oktober 2014: Abstracts, 2014, p. 149-149Conference paper (Other academic)
    Abstract [sv]

    Ett forskningsprojekt IMPOERS har startats för att följa en cohort sjuksköterskestudenter under implementering av OER. Detta är ett av de första mer systematiska projekten i Sverige om införande av OER. Några första preliminära resultat kommer att kunna presenteras vid NU2014, hösten 2014.

    Bakgrund

    Sjuksköterskeprogrammet på Högskolan Dalarna fick i januari 2013 utmärkelsen Excellent eLärande efter genomförd utvärdering av European Association of Distance Education Universities (EADTU). I samband med utmärkelsen vill man främja användning av Open Educational Resources (OER) för fördjupat lärande och för att studenterna härigenom ska kunna ta del av den främsta internationella forskningsfronten inom området och bli delaktiga i internationella nätverk. OER är lärresurser som är tillgängliga på internet och fritt kan användas, kopieras och spridas och i många fall även bearbetas. En öppen digital lärresurs har en angivelse, eller upphovsrättslicens, som visar under vilka villkor den får användas, kopieras, spridas och bearbetas. UNESCO är en av de drivande organisationerna bakom OER rörelsen för att tillhanda hålla fri och öppen utbildning för alla. På senare år har pedagogiska fördelar lyfts fram i användningen av OER och forskning har visat att OER kan vara en stark driv för individualiserat och öppet fritt lärande. Trots att användingen av OER ökar kraftigt inom högre utbildning, inte minst internationellt, så finns det få studier som har belyst både effekter av införande av OER och själva implementeringsprocessen.  

    Projektet syftar till att beskriva hur och på vilket sätt OER kan genomföras och användas inom en sjuksköterskeutbildning. OER kommer att implementeras och effekter och genomförandeprocessen kommer att studeras. Detta kommer att genomföras genom en blandad metod med hjälp av enkäter, dagböcker och intervjuer. Specifika frågor som vi vill besvara:

    Hur används OER?

    När används OER?

    Vilka OER används?

    Hur etableras professionella nätverk för studenterna genom användning av OER?

    På vilket sätt influeras kvaliteten i lärandet?

    Metod

    Vi kommer att implementera OER i en kurs inom programmet och följa dess effekter och processen att införa OER. Det kommer vi att göra genom mixad metod med hjälp av enkäter, dagboksanteckningar och intervjuer (narrativs).

  • 35.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet; Chalmers University of Technology.
    Nordin, Susanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet.
    Wijk, Helle
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    A systematic review of the psychometric properties of instruments for assessing the quality of the physical environment in healthcare2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 12, p. 2796-2816Article in journal (Refereed)
    Abstract [en]

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

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

    DESIGN: Systematic psychometric review.

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

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

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

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

  • 36.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nordin, Susanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wijk, Helle
    Göteborgs Universitet.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Development of an instrument measuring the quality of residential care facilities for older people2016In: The 23rd Nordic Congress of Gerontology, 19-22 June 2016, in Tampere, Finland, 2016Conference paper (Refereed)
    Abstract [en]

    Aims. To validate the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM). The instrument’s items measure environmental elements important for supporting the needs of older people, and conceptualized within eight domains.

    Methods. Item relevance was assessed by a group of experts and measured using content validity index (CVI). Test-retest and inter-rater reliability tests were performed.  The domain structure was assessed by the inter-rater agreement of a second group of experts, and measured using Fleiss kappa.

    Results. All items attained a CVI above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ = 0.903 and 0.869) and inter-rater reliability (κ = 0.851 and 0.832). Domain structure was good,  Fleiss’ kappa was 0.63 (range 0.45 to 0.75).   

    Conclusion. The S-SCEAM of 210 items and eight domains showed good content validity and construct validity. The instrument is suggested for use in measuring of the quality of the physical environment in residential care facilities for older persons.

  • 37.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Nordmark, Sofi
    Lyhagen, Johan
    Lindberg, Inger
    Finch, Tracy
    Åberg, Anna Cristina
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    The Swedish version of the Normalization Process Theory Measure S-NoMAD: translation, adaptation, and pilot testing2018In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13, no 1, article id 146Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The original British instrument the Normalization Process Theory Measure (NoMAD) is based on the four core constructs of the Normalization Process Theory: Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring. They represent ways of thinking about implementation and are focused on how interventions can become part of everyday practice.

    AIM: To translate and adapt the original NoMAD into the Swedish version S-NoMAD and to evaluate its psychometric properties based on a pilot test in a health care context including in-hospital, primary, and community care contexts.

    METHODS: A systematic approach with a four-step process was utilized, including forward and backward translation and expert reviews for the test and improvement of content validity of the S-NoMAD in different stages of development. The final S-NoMAD version was then used for process evaluation in a pilot study aimed at the implementation of a new working method for individualized care planning. The pilot was executed in two hospitals, four health care centres, and two municipalities in a region in northern Sweden. The S-NoMAD pilot results were analysed for validity using confirmatory factor analysis, i.e. a one-factor model fitted for each of the four constructs of the S-NoMAD. Cronbach's alpha was used to ascertain the internal consistency reliability.

    RESULTS: In the pilot, S-NoMAD data were collected from 144 individuals who were different health care professionals or managers. The initial factor analysis model showed good fit for two of the constructs (Coherence and Cognitive Participation) and unsatisfactory fit for the remaining two (Collective Action and Reflexive Monitoring) based on three items. Deleting those items from the model yielded a good fit and good internal consistency (alphas between 0.78 and 0.83). However, the estimation of correlations between the factors showed that the factor Reflexive Monitoring was highly correlated (around 0.9) with the factors Coherence and Collective Action.

    CONCLUSIONS: The results show initial satisfactory psychometric properties for the translation and first validation of the S-NoMAD. However, development of a highly valid and reliable instrument is an iterative process, requiring more extensive validation in various settings and populations. Thus, in order to establish the validity and reliability of the S-NoMAD, additional psychometric testing is needed.

  • 38.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Chalmers tekniska högskola, KI.
    Ossiannilsson, Ebba
    Lunds Universitet.
    Jansson, Monika
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Neljesjö, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    The IMPOERS - Implementation of OER in a nursing program2014In: Conference Abstracts: The Open and Flexible Higher Education Conference Hosted by AGH University of Science and Technology in Krakow, 23-24 October 2014, 2014Conference paper (Refereed)
  • 39.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ossiannilsson, Ebba
    Lunds Universitet.
    Neljesjö, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Jansson, Monika
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Implementation of open educational resources in a nursing programme: experiences and reflections2015In: Open learning, ISSN 0268-0513, E-ISSN 1469-9958, Vol. 30, no 3, p. 252-266Article in journal (Refereed)
    Abstract [en]

    The IMPOER project (implementation of open educational resources, OER) aimed to implement OER in a nursing programme at Dalarna University, Sweden. The university and its nursing programme have long engaged in e-learning, and the nursing programme has recently been awarded the European Association of Distance Teaching Universities E-xcellence Associates Quality Label. The quality award was based on the creation of a roadmap for the continuous development of e-learning and the implementation of OER. The results of the study illustrated that overall, the students and the educators were positive about using OER. They considered that this approach was a new way of learning, and they appreciated the fact that OER were free and easy to access. However, they felt overwhelmed by the amount of material that was available and they were concerned about quality. If the use of OER is to be sustainable, a change in attitudes and practices among students and teachers is likely needed regarding the use of resources on the web.

  • 40.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ossiannilsson, Ebba
    Örtlund, Olivia
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Neljesjö, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Jansson, Monika
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Teachers view of using Open Educational Recourses (OER) in a nursing programme2015In: NGL 2015, Next Generation Learning Conference, Book of Abstract, 2015Conference paper (Other academic)
  • 41.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Poutilova, M
    von Koch, L
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    Using system dynamics for collaborative design: a case study2007In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 7, no 123Article in journal (Refereed)
    Abstract [en]

    Background 

    In order to facilitate the collaborative design, system dynamics (SD) with a group modelling approach was used in the early stages of planning a new stroke unit. During six workshops a SD model was created in a multiprofessional group.

    Aim

    To explore to which extent and how the use of system dynamics contributed to the collaborative design process.

    Method

    A case study was conducted using several data sources.

    Results

    SD supported a collaborative design, by facilitating an explicit description of stroke care process, a dialogue and a joint understanding. The construction of the model obliged the group to conceptualise the stroke care and experimentation with the model gave the opportunity to reflect on care.

    Conclusion

    SD facilitated the collaborative design process and should be integrated in the early stages of the design process as a quality improvement tool.

  • 42.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Poutilova, Maria
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    A dynamic conceptual model of care planning2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 4, p. 530-538Article in journal (Refereed)
    Abstract [en]

    This article presents a conceptual model of the care planning process developed to identify the hypothetical links between structural, process and outcome factors important to the quality of the process. Based on existing literature, it was hypothesized that a thorough assessment of patients' health needs is an important prerequisite when making a rigorous diagnosis and preparing plans for various care interventions. Other important variables that are assumed to influence the quality of the process are the care culture and professional knowledge. The conceptual model was developed as a system dynamics causal loop diagram as a first essential step towards a computed model. System dynamics offers the potential to describe processes in a nonlinear, dynamic way and is suitable for exploring, comprehending, learning and communicating complex ideas about care processes.

  • 43.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Putilova, Maria
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    von Koch, Lena
    Developing a model of a stroke care process2009In: On-line journal of Nursing Informatics, ISSN 1089-9758, E-ISSN 1089-9758, Vol. 13, no 3, p. 3-34Article in journal (Refereed)
    Abstract [en]

    Aim. The paper presents the development and structure of a generic stroke care simulation model, used in designing of a stroke unit in Sweden. Background and rationale. Designing new health care spaces is a multifaceted process; requiring multi-professional (nurses, other healthcare professionals, building planners and architects) involvement. To secure that the patients’ interest are in focus the different stakeholders need to analyze and develop a common understanding of the care processes that are to take place in the new space. Modeling and simulation is one significant method, making it possible to depict the dynamic structure of the system and experiment with the model, asking “what – ifs” questions. Methods. System dynamics, a modeling method was used to develop the model. The iterative and group-modeling process included development of a quantified model (with a multi-professional design team, based on evidence from the literature, and a survey from stroke care experts), and validation of the model. Results. The dynamic care model developed included variables that are essential in modern care, such as patient-participation, care-planning, and teamwork. Conclusion. The presented generic model provides a framework for exploring, comprehending, and communicating complex ideas about stroke care.

  • 44.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Svedbo Engström, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wijk, Helle
    Sahlgrenska Akademin, Göteborgs Universitet .
    An assessment of briefs used for designing healthcare environments: a survey in Sweden2012In: Construction Management and Economics, ISSN 0144-6193, E-ISSN 1466-433X, Vol. 30, no 10, p. 835-844Article in journal (Refereed)
    Abstract [en]

    The brief is a central document in decision making during the early stages of the planning and construction (briefing/programming) of healthcare environments. Thus, the demand on the content and quality of these documents is high. This study aimed to assess the content and quality of initial briefs developed in Sweden to obtain an up-to-date picture of current practices of writing project statements in the early stages of designing healthcare environments. A study of 29 initial briefs was performed with a new instrument called the Content and Quality of Brief Instrument (CQB-I). The results showed that, in many cases, the documentation in the briefs was incomplete and that the information did not adequately address users’ needs. In addition, the briefs often did not include any measurable outcomes or explicitly evidence-based information. This study’s findings have implications for identifying areas for improvement in design teams’ documentation practices. Assessment can have a real impact on the quality of briefs and can raise awareness of the need to improve the briefing process itself. The present study is one of the first to assess the content and quality of briefs and provides a starting point for both practitioners and future researchers to explore the role of briefs in briefing process quality improvement.  

  • 45.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Svedbo Engström, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Sahlgrenska akademin.
    Wijk, Helle
    Development of the Content and Quality in Briefs Instrument (CQB-I)2012In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 5, no 3, p. 74-88Article in journal (Refereed)
    Abstract [en]

    Objective: The Content and quality of Briefs Instrument (CQB-I) was designed to develop a valid and reliable audit instrument to examine the content and quality of information in documents (briefs) created in the early stages of designing healthcare environments.

    Background: The importance of effective briefing has been emphasised in many research studies during the past two decades. However, there is no developed instrument for auditing the content and quality of the documents, which makes this paper interesting.

    Methods: The study had a methodological and developmental design based on an established methodology for instrument development and validation. The development process consisted of three main phases: item generation and scale construction, assessment of face and content validity, and finally, testing of the reliability. To obtain face and content validity, expert panels reviewed the CQB-I. Content validity was assessed by using the Content Validity Index (I-CVI=item level, S-CVI=scale level). The reliability was tested by test-retest and inter-rater reliability. Results: CQB-I was found to have good content validity (I-CVI =0.78 – 1.0 and S-CVI=0.98). Inter-rater reliability was acceptable (Spearman’s correlation = 0.62) and the stability was considered high for both raters (83% respectively 88%).

    Conclusions: The instrument can be used as a guide for the work process in the design team and contribute to the ongoing development of making the design process more user-oriented with the ultimate goal of healthcare environments designed for a patient-centered care.

  • 46.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wijk, Helle
    Sahlgrenska Akademin, Göteborgs Universitet .
    Kan man kvalitetssäkra lokalprogram?: En grupp lokalplanerare om användbarheten av ett granskningsinstrument av lokalprogram2012Conference paper (Refereed)
    Abstract [sv]

    I detta projekt har vi studerat en grupp lokalplanerares uppfattning av att använda ett nyutvecklat instrument (CQB-I - content and quality in briefs instrument) som syftar till att bedöma innehåll och kvalitet av lokalprogram för nya vårdmiljöer. Studien är en del i ett större projekt som avser att kvalitetssäkra tidiga och centrala skeden av planering av nya vårdmiljöer med fokus på styrdokument (lokalprogram, eng. briefs) som skapas i tidiga faser av planeringsprocessen. Instrumentet mäter huruvida det finns en tydlig målbeskrivning för projektet utifrån användarnas behov och de vårdaktiviteter som ska äga rum i den nya vårdmiljön. Vidare mäter instrumentet om det finns tydliga patientrelaterade resultatmått angivna och om informationen i dokumenten är personorienterad och kunskapsbaserad. Studien använde en mixad metod där relevansen av instrumentet skattades och en fokusgruppsintervju genomfördes. Studien visade att CQB-I uppfattades vara ett relevant instrument framförallt som en guide för lokalprogrammering men även för uppföljning av redan skrivna lokalprogram. Instrument kan bidra till att föra in forskningsresultat i lokalplanering och bidra till en dialog och samverkan i tidiga skeden genom att orientera processen mot användarnas behov, diskuterar och skriva ner klara resultatmått och därmed kvalitetssäkra processen.

  • 47.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Chalmers tekniska högskola, KI.
    Wijk, Helle
    Sahlgrenska Akademin, Göteborgs Universitet .
    Space planners' perception of an assessment instrument for briefs in the pre-design phase of new healthcare environments2014In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 8, no 1, p. 67-80Article in journal (Refereed)
    Abstract [en]

    Objectives: The main purpose of the study was to investigate the usability of a new developed instrument designed to assess the content and quality in programs for new healthcare environments (CQB-I). We studied the perception of using the instrument on a group of space-planners. The study is part of a larger project designed to assure the quality of early and main stages of the planning of new care environments with a focus on policy documents (programs or briefs), created in the early phases of the planning process. The instrument measures whether there is a clear mission statement for the project based on user needs and care activities that will take place in the new healthcare environment. Furthermore, the instrument measures if there are clear patient-related outcome measures specified and if the information in the documents is person-oriented and knowledge-based.

    Method: The study used a mixed method where the relevance and usability of the instrument was estimated and a focus group interview was conducted.

    Findings: The study showed that CQB-I perceived to be a relevant instrument primarily as a guide for programming, but also for monitoring the produced programs.  Instruments can help to bring research results into planning and contribute to dialogue and collaboration in the early stages by orienting process of user needs, discuss and write down clear performance indicators and related quality assurance process.

     

  • 48.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wikblad, Karin
    Satisfaction with information and quality of life in cancer patients undergoing chemotherapy. The role of individual differences in information preferences.2001In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 24, no 5, p. 351-356Article in journal (Other academic)
    Abstract [en]

    Earlier studies have shown that patients are dissatisfied with the information they receive from doctors and nurses. The purpose of this study was to analyze satisfaction with information and quality of life in patients with cancer undergoing chemotherapy, considering the patient's information preference. Data were collected during interviews with 30 consecutive patients undergoing chemotherapy for cancer. The subject of the interviews was the satisfaction of patients with the information they received, and additional measures used were the Miller Behavioral Styles Scale and EORTC-QLQ-30. The results showed that 21 of 30 patients were satisfied with the information they received from health care. Married patients or cohabitants were satisfied more often than single patients. No significant differences in quality of life could be found between satisfied and dissatisfied patients. Regarding information preferences, the dissatisfied patients reported more information-avoiding behavior than those who were satisfied. The results must be interpreted cautiously because of the study's limitations, but one clinical implication can be stated: There is value in being aware of patients' information-seeking/avoiding behavior before starting to inform them.

  • 49.
    Elizabeth Marcheschi, Elizabeth
    et al.
    Chalmers Tekniska Högskola, Göteborg.
    von Koch, Lena
    Karolinska Institutet .
    Hélène Pessah-Rasmussen, Hélène
    Lunds Universitet.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Development and test of a methodology for the investigation of stroke patients’ rehabilitation in home settings2017Conference paper (Refereed)
  • 50.
    Elke Miedema, Elke
    et al.
    Chalmers University of Technology, Architecture, Gothenburg, Sweden.
    Göran, Lindahl
    Chalmers University of Technology, Architecture, Gothenburg, Sweden,.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Health-promotive ambitions related to building design: The case of Angered Nearby Hospital2017In: ARCH17: 3rd international conference on architecture, research, care and health. Conference Proceedings / [ed] Nanet Mathiasen and Anne Kathrine Frandsen, 2017, p. 331-344Conference paper (Refereed)
    Abstract [en]

    The potential of the built environment to mediate effects on patient and caregiver physical, cognitive and social health continues to be advocated. Evidence indicates that well-designed physical settings play an important role in making healthcare facilities safer and more healing for patients, and better working places for staff. Collaboration between researchers from varied disciplines is now adding to our understanding of the range of impacts on patient health and well-being. For instance, health architecture and interior designers are involving users of healthcare built environments in the design process using inclusive design or patient-centred care frameworks. Neuroscience researchers are exploring relationships between the environment and recovery from brain injury, often using a model of enriched environments. An overview of the range of theoretical frameworks used in empirical research to test built environment attributes is now warranted. In this paper, we present a mapping of the field showing the use of theories in built environment research. This would enable better selection of theoretical frameworks in order to evaluate the effect of specific design solutions on patient and care-giver health. Today, there are no comprehensive summaries of theories and conceptual frameworks applied in studies of healthcare architecture that could serve as a guide to future research. The aim of this scop- 378 ing review was to (i) identify theories and frameworks used in research of the physical environment in health care, (ii) describe their core constructs, assumptions, scientific utility, (iii) assess their applicability and feasibility for use in research. The basic principles of Arksey and O’Malley’s model of scoping review design were used to identify the theories and frameworks. 15 theories/frameworks were included and described in terms of general characteristics (purpose, country and year of development, discipline), core construct and applicability and feasibility.

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