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  • 1. Berg, Lena
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    The presence of emergency department crowding at a Swedish University hospital.: A longitudinal study using two crowding indicators as measures.2018Konferansepaper (Fagfellevurdert)
  • 2.
    Berg, Lena M
    et al.
    Karolinska institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Östergren, Jan
    Discacciati, Andrea
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Associations between crowding and ten-day mortality among patients allocated lower triage acuity levels without need of acute hospital care on departure from the emergency department2019Inngår i: Annals of Emergency Medicine, ISSN 0196-0644, E-ISSN 1097-6760, Vol. 74, nr 3, s. 345-356Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY OBJECTIVE: We describe the association between emergency department (ED) crowding and 10-day mortality for patients triaged to lower acuity levels at ED arrival and without need of acute hospital care on ED departure.

    METHODS: This was a registry study based on ED visits with all patients aged 18 years or older, with triage acuity levels 3 to 5, and without need of acute hospital care on ED departure during 2009 to 2016 (n=705,699). The sample was divided into patients surviving (n=705,076) or dying (n=623) within 10 days. Variables concerning patient characteristics and measures of ED crowding (mean length of stay and ED occupancy ratio) were extracted from the hospital's electronic health records. ED length of stay per ED visit was estimated by the average length of stay for all patients who presented to the ED during the same day and shift and with the same acuity level. The 10-day mortality after ED discharge was used as the outcome measure. Multivariable logistic regression analyses were conducted.

    RESULTS: The 10-day mortality rate was 0.09% (n=623). The event group had larger proportions of patients aged 80 years or older (51.4% versus 7.7%) and triaged with acuity level 3 (63.3% versus 35.6%), and greater comorbidity (age-combined Charlson comorbidity index median interquartile range 6 versus 0). We observed an increased 10-day mortality for patients with a mean ED length of stay greater than or equal to 8 hours versus less than 2 hours (adjusted odds ratio 5.86; 95% confidence interval [CI] 2.15 to 15.94) and for elevated ED occupancy ratio. Adjusted odds ratios for ED occupancy ratio quartiles 2, 3, and 4 versus quartile 1 were 1.48 (95% CI 1.14 to 1.92), 1.63 (95% CI 1.24 to 2.14), and 1.53 (95% CI 1.15 to 2.03), respectively.

    CONCLUSION: Patients assigned to lower triage acuity levels when arriving to the ED and without need of acute hospital care on departure from the ED had higher 10-day mortality when the mean ED length of stay exceeded 8 hours and when ED occupancy ratio increased.

  • 3.
    Berg, Lena M
    et al.
    Karolinska Institutet; Karolinska University Hospital.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Significant changes in emergency department length of stay and case mix over eight years at a large Swedish University Hospital2019Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 43, s. 50-55Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Describe the longitudinal development of crowding and patient/emergency department (ED) characteristics at a Swedish University Hospital.

    METHODS: A retrospective longitudinal registry study based on all ED visits with adult patients during 2009-2016 (N = 1,063,806). Patient characteristics and measures of ED crowding (ED occupancy ratio, length-of-stay [LOS], patients/clinician's ratios) were extracted from the hospital's electronic health record. Non-parametric analyses were conducted.

    RESULTS: The proportion of unstable patients (triage level 1-2) increased while the proportion of admitted patients decreased. All crowding variables were stable, except for LOS, which increased by 9 min/visit/year (95% CI: 8.8-9.1). LOS for visits by patients ≥ 80 years increased more compared to those 18-79 (248 min vs. 190 min, p < 0.001). Unstable patients increased their median LOS compared to stable patients (triage level 3-5). LOS for discharged patients increased with an average of 7.7 min/year (95% CI: 7.5-7.9) compared to 15.5 min/year (95% CI: 15.2-15.8) for those being admitted.

    CONCLUSION: Fewer admissions, despite an increase of unstable patients, is likely related to lack of in-hospital beds and contributes to ED crowding. The increase in median ED LOS, especially for patients in the subgroups unstable, ≥80 years and admitted to in-hospital care reflects this problem.

  • 4.
    Berg, Lena M
    et al.
    Karolinska University Hospital.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Djärv, Therese
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Reasons for interrupting colleagues during emergency department work: a qualitative study2016Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 29, nr SI, s. 21-26Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Emergency department team members frequently need to interact with each other, a circumstance causing multiple interruptions. However, information is lacking about the motives underlying these interruptions and this study aimed to explore clinicians' reasons to interrupt colleagues during emergency department work.

    METHOD: Semi-structured interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. The interviews were analyzed inductively using content analysis.

    RESULTS: The working conditions to some extent sustained the clinicians' need to interrupt, for example different routines. Another reason to interrupt was to improve the initiator's work process, such as when the initiators perceived that the interruption had high clinical relevance. The third reason concerns the desire to influence the work process of colleagues in order to prevent mistakes and provide information for the person being interrupted to improve patient care.

    CONCLUSION: The three identified categories for why emergency department clinicians interrupt their colleagues were related to working conditions and a wish to improve/influence the work processes for both initiators and recipients. Several of the reasons given for interrupting colleagues were done in order to improve patient care. Interruptions perceived as negative to the recipient were mostly related to the working conditions.

  • 5.
    Ehrenberg, Anna
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Berg, Lena
    Källberg, Ann-Sofie
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Östergren, Jan
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Hur uppfattar personal på akutmottagningar avbrott i arbetet?2013Konferansepaper (Fagfellevurdert)
  • 6.
    Florin, Jan
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Bååth, Carina
    Karlstad Universitet.
    Gunningberg, Lena
    Uppsala universitet.
    Mårtensson, Gunilla
    Högskolan i Gävle.
    Attitudes towards pressure ulcer prevention: A psychometric evaluation of the Swedish version of the APuP-instrument2016Inngår i: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 13, nr 5, s. 655-662Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The primary aim was to conduct a psychometric evaluation of the Attitude towards Pressure ulcer Prevention (APuP) instrument in a Swedish context. A further aim was to describe and compare attitudes towards pressure ulcer prevention between registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs). In total, 415 RNs, ANs and SNs responded to the questionnaire. In addition to descriptive and comparative statistics, confirmatory factor analyses were performed. Because of a lack of support for the instrument structure, further explorative and consecutive confirmatory tests were conducted. Overall, positive attitudes towards pressure ulcer prevention were identified for all three groups, but SNs reported lower attitude scores on three items and a higher score on one item compared to RNs and ANs. The findings indicated no support in this Swedish sample for the previously reported five-factor model of APuP. Further explorative and confirmative factor analyses indicated that a four-factor model was most interpretable: (i) Priority (five items), (ii) Competence (three items), (iii) Importance (three items) and (iv) Responsibility (two items). The five-factor solution could not be confirmed. Further research is recommended to develop a valid and reliable tool to assess nurses' attitudes towards pressure ulcer prevention working across different settings on an international level.

  • 7.
    Florin, Jan
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Graaf, Tyra E O
    Sjöberg, Arne
    Planering och dokumentation av vård och omsorg av äldre2017Bok (Annet (populærvitenskap, debatt, mm))
  • 8.
    Florin, Jan
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Strandberg, Elisabeth
    Jansson, Inger
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Björvell, Catrin
    A comparison between the ICNP and the ICF for expressing nursing content in the electronic health record.2021Inngår i: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 154, artikkel-id 104544Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The use of standardised terminologies for electronic health records (EHRs) is important and a sufficient coverage of all aspects of health care is increasingly being developed worldwide. The International Classification of Functioning, Disabilities and Health (ICF) is suggested as a unifying terminology suitable in a multi-professional EHR, but the level of representation of nursing content is unclear.

    OBJECTIVES: The aim was to describe lexical and semantic accordance in relation to comprehensiveness and granularity of concepts between the International Classification of Nursing Practise (ICNP) and the ICF.

    METHODS: 806 pre-coordinated concepts for diagnoses and outcomes in the ICNP terminology were manually mapped to 1516 concepts on level 4-6 in the ICF.

    RESULTS: Several dimensions of nursing diagnoses and outcomes in the ICNP were missing in the ICF. 60% of the concepts for diagnosis and outcome in the ICNP could not be stated using the ICF while another 31% could only be matched either as a subordinate or as a superordinate concept.

    CONCLUSIONS: The lexical and semantic accordance in relation to comprehensiveness and granularity between concepts in the ICNP and ICF was rather low. A large proportion of concepts for diagnoses and outcomes in the ICNP could not be satisfactorily stated using the ICF. Standardised terminologies rooted in a nursing tradition (e.g., the ICNP) is needed for communication and documentation in health care to represent the patient's health situation as well as professional diagnostic decisions and evaluations in nursing.

    Fulltekst (pdf)
    fulltext
  • 9.
    Florin, Jan
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Sävenstedt, Stefan
    Digital omvårdnad2021Inngår i: Omvårdnad på avancerad nivå: Känrkompetenser in om sjuksköterskans specialistområden / [ed] Anna-Karin Edberg, Anna Ehrenberg, Helle Wijk, Joakim Öhlén, Lund: Studentlitteratur AB, 2021, 2, s. 525-556Kapittel i bok, del av antologi (Annet (populærvitenskap, debatt, mm))
  • 10.
    Florin, Jan
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Sävenstedt, Stefan
    Digital vård2021Inngår i: Omvårdnad på avancerad nivå: Kärnkompetenser inom sjuksköterskans specialistområden / [ed] Anna-Karin Edberg, Anna Ehrenberg, Helle Wijk, Joakim Öhlén, Lund: Studentlitteratur AB, 2021, 2:1, s. 497-523Kapittel i bok, del av antologi (Annet (populærvitenskap, debatt, mm))
  • 11.
    Konradsen, Hanne
    et al.
    Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Gastroenterology, Herlev and Gentofte University Hospital, Herlev, Denmark.
    Lundberg, Veronica
    Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden.
    Florin, Jan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden.
    Boström, Anne-Marie
    Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden; Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden.
    Prevalence of constipation and use of laxatives, and association with risk factors among older patients during hospitalization: a cross sectional study2022Inngår i: BMC Gastroenterology, E-ISSN 1471-230X, Vol. 22, nr 1, artikkel-id 110Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Many older patients experience constipation as a bothersome symptom with a negative impact on quality of life. During hospitalization, the focus is often on the reason for admission with the risk that other health problems are not prioritized. The aim of the study was to describe the prevalence of constipation and use of laxatives among older hospitalized patients and to investigate the associations with demographic factors, risk assessments and prescribed medications.

    METHODS: A descriptive retrospective cross-sectional study design was used. This study enrolled patients aged 65 years or older admitted to a geriatric department. Data from electronic health records regarding constipation, demographics, risk assessments, medical diagnoses, prescribed medications and length of stay were extracted. Constipation was assessed using ICD- 10 diagnosis, documented signs and symptoms of constipation, and prescribed laxatives. Data was analyzed using descriptive and comparative analyses, including logistic regression.

    RESULTS: In total, 6% of the patients had an ICD-10 diagnosis of constipation, 65% had signs and symptoms of constipation, and 60% had been prescribed laxatives. Only 5% of the patients had constipation documented according to ICD-10, signs and symptoms, and prescribed laxatives. Signs and symptoms of constipation were associated with prescribed opioids (OR = 2.254) and longer length of stay (OR = 1.063). Being prescribed laxatives was associated with longer length of stay (OR = 1.109), prescribed opioids (OR = 2.154), and older age (OR = 1.030).

    CONCLUSIONS: The prevalence of constipation varies depending on the methods used to identify the condition. There was a discrepancy between the documentation of constipation in relation to sign and symptoms, ICD-10 diagnosis and prescribed laxatives. The documentation of constipation was not consistent for the three methods of assessment.

    Fulltekst (pdf)
    fulltext
  • 12.
    Källberg, Ann-Sofie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Patient safety risks in the emergency department2016Konferansepaper (Fagfellevurdert)
  • 13.
    Källberg, Ann-Sofie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro universitet.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Physicians' and nurses' perceptions of patient safety risks in the emergency department2017Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 33, s. 14-19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The emergency department has been described as a high-risk area for errors. It is also known that working conditions such as a high workload and shortage off staff in the healthcare field are common factors that negatively affect patient safety. A limited amount of research has been conducted with regard to patient safety in Swedish emergency departments. Additionally, there is a lack of knowledge about clinicians' perceptions of patient safety risks. Therefore, the purpose of this study was to describe emergency department clinicians' experiences with regard to patient safety risks.

    METHOD: Semi-structured interviews were conducted with 10 physicians and 10 registered nurses from two emergency departments. Interviews were analysed by inductive content analysis.

    RESULTS: The experiences reflect the complexities involved in the daily operation of a professional practice, and the perception of risks due to a high workload, lack of control, communication and organizational failures.

    CONCLUSION: The results reflect a complex system in which high workload was perceived as a risk for patient safety and that, in a combination with other risks, was thought to further jeopardize patient safety. Emergency department staff should be involved in the development of patient safety procedures in order to increase knowledge regarding risk factors as well as identify strategies which can facilitate the maintenance of patient safety during periods in which the workload is high.

  • 14. Källberg, Ann-Sofie
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Göransson, Katarina
    Karolinska Institutet, Stockholm, Sweden.
    Medical errors regarding emergency department care reported to national authorities in Sweden by care providers and patients2011Inngår i: Australasian emergency nursing journal, ISSN 1574-6267, Vol. 14, s. S18-S18Artikkel i tidsskrift (Fagfellevurdert)
  • 15.
    Lundberg Santesson, Inger
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Rudholm Feldreich, Tobias
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Svedbo Engström, Maria
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Olovsson, Sofia
    Högskolan Dalarna, Ej akademianställd.
    Benchmarking of the Nursing Program at Dalarna University2012Rapport (Annet vitenskapelig)
    Abstract [en]

    Quality review

    This report presents the result from a Benchmarking-project within the Nursing Program at Dalarna University 2012. Local team members are Jan Florin, Marie Elf, Tobias R Feldreich, Maria S Engström and Sofia Olovsson. Responsible for the project and a member of the Local team/Manager of the nursing Program; Inger L Santesson

    Fulltekst (pdf)
    fulltext
  • 16. Nilsson, Jan
    et al.
    Engström, Maria
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gardulf, Ann
    Carlsson, Marianne
    A short version of the nurse professional competence scale for measuring nurses' self-reported competence2018Inngår i: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 71, s. 233-239Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The Nurse Professional Competence (NPC) Scale with 88-items has been used to measure self-reported competence among nursing students and registered nurses in many national and international nursing research projects. However, a shorter version of the scale with maintained quality has been requested to further enhance its usability.

    OBJECTIVES: To develop and evaluate the construct validity and internal consistency of a shorter version of the NPC Scale.

    DESIGN: A developmental and methodological design.

    PARTICIPANTS AND SETTINGS: The study was based on a sample of 1810 nursing students at the point of graduation from 12 universities in Sweden.

    METHODS: The number of items in the original NPC Scale was reduced using several established research steps and then evaluated for data quality and construct validity using principal component analysis and confirmatory factor analysis. Reliability was measured as internal consistency using Cronbach's alpha.

    RESULTS: The extensive process of reducing the number of items resulted in a version with 35 items. Principal component analysis resulted in six factors explaining 53.6% of the variance: "Nursing Care", "Value-based Nursing Care", "Medical and Technical Care", "Care Pedagogics", "Documentation and Administration of Nursing Care", and "Development, Leadership, and Organization of Nursing Care". All factors showed Cronbach's alpha values of >0.70. The confirmative factor analysis goodness-of-fit indexes were for root mean square error of approximation 0.05 and for comparative fit index 0.89.

    CONCLUSIONS: The NPC Scale Short Form (NPC Scale-SF) 35-items revealed promising results with a six-factor structure explaining 53.6% of the total variance. This 35-item scale can be an asset when used alone and together with other instruments it can provide the possibility of more complex analyses of self-reported competence among nursing students and registered nurses.

    Fulltekst (pdf)
    fulltext
  • 17. Wiitavaara, Birgitta
    et al.
    Florin, Jan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska University Hospital, Stockholm.
    Content and psychometric evaluations of questionnaires for assessing physical function in people with arm-shoulder-hand disorders. A systematic review of the literature.2022Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 44, nr 24, s. 7575-7586Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The aim was to investigate how structured assessment of physical function can be performed in people with musculoskeletal disorders in arm-shoulder-hand. Specifically, we aimed to determine: • Which questionnaires are available for structured assessment of physical function in people with musculoskeletal disorders in arm-shoulder-hand? • What aspects of physical function do those questionnaires measure? • What are the psychometric properties of the questionnaires?

    MATERIALS AND METHODS: By means of a systematic review, questionnaires and psychometric tests of those were identified. ICF was used to categorise the content of the questionnaires, and the COSMIN checklist was used to assess the psychometric evaluations.

    RESULTS: Nine questionnaires were identified. Most items focused on activities rather than functions. Commonly, a couple of psychometric measurements had been tested, most often reported being adequate. Only one questionnaire had been tested for all aspects. Variation in scope and insufficient reports regarding validity and reliability make comparisons and decisions on use difficult both in clinical practice and for research purposes.

    CONCLUSIONS: The level of psychometric evaluation differs, and often only a few aspects of validity and reliability have been tested. The questionnaires address activity issues to a higher extent than function.IMPLICATIONS FOR REHABILITATIONThis review investigates the content and quality of nine ASH questionnaires.The questionnaires addressed activity issues to a higher extent than function.The level of psychometric testing of the questionnaires differed.DASH, Quick-DASH, and SPADI were the questionnaires that were most often evaluated with various psychometric tests, and with adequate results.

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