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  • 1. Bergström, Malin
    et al.
    Rudman, Ann
    Karolinska Institutet.
    Waldenström, Ulla
    Kieler, Helle
    Fear of childbirth in expectant fathers, subsequent childbirth experience and impact of antenatal education: subanalysis of results from a randomized controlled trial.2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 8, p. 967-73Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore if antenatal fear of childbirth in men affects their experience of the birth event and if this experience is associated with type of childbirth preparation.

    DESIGN: Data from a randomized controlled multicenter trial on antenatal education.

    SETTING: 15 antenatal clinics in Sweden between January 2006 and May 2007.

    SAMPLE: 762 men, of whom 83 (10.9%) suffered from fear of childbirth. Of these 83 men, 39 were randomized to psychoprophylaxis childbirth preparation where men were trained to coach their partners during labor and 44 to standard care antenatal preparation for childbirth and parenthood without such training.

    METHODS: Experience of childbirth was compared between men with and without fear of childbirth regardless of randomization, and between fearful men in the randomized groups. Analyses by logistic regression adjusted for sociodemographic variables.

    MAIN OUTCOME MEASURES: Self-reported data on experience of childbirth including an adapted version of the Wijma Delivery Experience Questionnaire (W-DEQ B).

    RESULTS: Men with antenatal fear of childbirth more often experienced childbirth as frightening than men without fear: adjusted odds ratio 4.68, 95% confidence interval 2.67-8.20. Men with antenatal fear in the psychoprophylaxis group rated childbirth as frightening less often than those in standard care: adjusted odds ratio 0.30, 95% confidence interval 0.10-0.95.

    CONCLUSIONS: Men who suffer from antenatal fear of childbirth are at higher risk of experiencing childbirth as frightening. Childbirth preparation including training as a coach may help fearful men to a more positive childbirth experience. Additional studies are needed to support this conclusion.

  • 2. Bostrom, Anne-Marie
    et al.
    Rudman, Ann
    Karolinska Institutet.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Gustavsson, Jens Petter
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Huddinge, Sweden.
    Factors associated with evidence-based practice among registered nurses in Sweden: a national cross-sectional study2013In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 13, article id 165Article in journal (Refereed)
    Abstract [en]

    Background: Evidence-based practice (EBP) is emphasized to increase the quality of care and patient safety. EBP is often described as a process consisting of distinct activities including, formulating questions, searching for information, compiling the appraised information, implementing evidence, and evaluating the resulting practice. To increase registered nurses' (RNs') practice of EBP, variables associated with such activities need to be explored. The aim of the study was to examine individual and organizational factors associated with EBP activities among RNs 2 years post graduation.

    Methods: A cross-sectional design based on a national sample of RNs was used. Data were collected in 2007 from a cohort of RNs, included in the Swedish Longitudinal Analyses of Nursing Education/Employment study. The sample consisted of 1256 RNs (response rate 76%). Of these 987 RNs worked in healthcare at the time of the data collection. Data was self-reported and collected through annual postal surveys. EBP activities were measured using six single items along with instruments measuring individual and work-related variables. Data were analyzed using logistic regression models.

    Results: Associated factors were identified for all six EBP activities. Capability beliefs regarding EBP was a significant factor for all six activities (OR = 2.6 - 7.3). Working in the care of older people was associated with a high extent of practicing four activities (OR = 1.7 - 2.2). Supportive leadership and high collective efficacy were associated with practicing three activities (OR = 1.4 - 2.0).

    Conclusions: To be successful in enhancing EBP among newly graduated RNs, strategies need to incorporate both individually and organizationally directed factors.

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  • 3. Bujacz, A.
    et al.
    Rudman, Ann
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet.
    Gustavsson, P.
    Dahlgren, A.
    Tucker, P.
    Psychosocial working conditions of shiftworking nurses: A long-term latent transition analysis2021In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 29, no 8, p. 2603-2610Article in journal (Refereed)
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  • 4. Dahlgren, Anna
    et al.
    Tucker, Philip
    Gustavsson, Petter
    Rudman, Ann
    Karolinska Institutet.
    Quick returns and night work as predictors of sleep quality, fatigue, work-family balance and satisfaction with work hours.2016In: Chronobiology International, ISSN 0742-0528, E-ISSN 1525-6073, Vol. 33, no 6, p. 759-67Article in journal (Refereed)
    Abstract [en]

    Quick returns (intervals of <11 h between the end of one shift and the start of the next) are associated with short sleeps and fatigue on the subsequent shift. Recent evidence suggests that shift workers regard quick returns as being more problematic than night work. The current study explored quick returns and night work in terms of their impact on sleep, unwinding, recovery, exhaustion, satisfaction with work hours and work-family interference. Data from the 2006 cohort of Swedish nursing students within the national Longitudinal Analysis of Nursing Education (LANE) study were analysed (N = 1459). Respondents completed a questionnaire prior to graduation (response rate 69.2%) and 3 years after graduation (65.9%). The analyses examined associations between frequency of quick returns and night work and measures taken in year three, while adjusting for confounding factors (in year three and prior graduation). Frequency of quick returns was a significant predictor of poor sleep quality, short sleeps, unwinding, exhaustion, satisfaction with work hours and work-to-family interference, with higher frequency predicting more negative outcomes. Quick returns did not predict recovery after rest days. Frequency of night work did not predict any of the outcomes. In conclusion, quick returns were an important determinant of sleep, recovery and wellbeing, whereas night work did not show such an association.

  • 5.
    Edlund, Klara
    et al.
    Sophiahemmet Univ, Dept Hlth Promot Sci, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Unit Intervent Res Worker Hlth, Stockholm, Sweden..
    Sundberg, Tobias
    Sophiahemmet Univ, Dept Hlth Promot Sci, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Unit Intervent Res Worker Hlth, Stockholm, Sweden..
    Johansson, Fred
    Sophiahemmet Univ, Dept Hlth Promot Sci, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Unit Intervent Res Worker Hlth, Stockholm, Sweden..
    Onell, Clara
    Sophiahemmet Univ, Dept Hlth Promot Sci, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Unit Intervent Res Worker Hlth, Stockholm, Sweden..
    Rudman, Ann
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Inst.
    Holm, Lena W.
    Sophiahemmet Univ, Dept Hlth Promot Sci, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Unit Intervent Res Worker Hlth, Stockholm, Sweden..
    Grotle, Margreth
    Oslo Metropolitan Univ, Dept Physiotherapy, Oslo, Norway..
    Jensen, Irene
    Karolinska Inst, Inst Environm Med, Unit Intervent Res Worker Hlth, Stockholm, Sweden..
    Cote, Pierre
    Oslo Univ Hosp, Commun & Res Unit Musculoskeletal Hlth Formi, Oslo, Norway.;Ontario Tech Univ, Fac Hlth Sci, Ctr Disabil Prevent & Rehabil, Oshawa, ON, Canada..
    Skillgate, Eva
    Sophiahemmet Univ, Dept Hlth Promot Sci, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Unit Intervent Res Worker Hlth, Stockholm, Sweden..
    Sustainable UNiversity Life (SUN ) study: protocol for a prospective cohort study of modifiable risk and prognostic factors for mental health problems and musculoskeletal pain among university students2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 4, article id e056489Article in journal (Refereed)
    Abstract [en]

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

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  • 6.
    Ehrenberg, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Gustavsson, Petter
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Boström, Anne-Marie
    Rudman, Ann
    Karolinska Institutet.
    New graduate nurses' developmental trajectories for capability beliefs concerning core competencies for healthcare professionals: A national cohort study on patient-centered care, teamwork and evidence-based practice.2016In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 13, no 6, p. 454-462Article in journal (Refereed)
    Abstract [en]

    Background:

    This study aimed to describe the developmental trajectories of registered nurses' capability beliefs during their first 3 years of practice. The focus was on three core competencies for health professionals-patient-centered care, teamwork, and evidence-based practice.

    Methods:

    A national cohort of registered nurses (n = 1,205) was recruited during their nursing education and subsequently surveyed yearly during the first 3 years of working life. The survey included 16 items on capability beliefs divided into three subscales for the assessment of patient-centered care, teamwork, and evidence-based practice, and the data were analyzed with linear latent growth modeling.

    Results:

    The nurses' capability beliefs for patient-centered care increased over the three first years of working life, their capability beliefs for evidence-based practice were stable over the 3 years, and their capability beliefs for teamwork showed a downward trend.

    Linking evidence to action:

    Through collaboration between nursing education and clinical practice, the transition to work life could be supported and competence development in newly graduated nurses could be enhanced to help them master the core competencies. Future research should focus on determining which factors impact the development of capability beliefs in new nurses and how these factors can be developed by testing interventions.

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  • 7.
    Ehrenberg, Anna
    et al.
    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.
    Gustavsson, Petter
    Karolinska institutet.
    Rudman, Ann
    Karolinska institutet.
    Boström, Anne-Marie
    Karolinska institutet.
    Registered nurses' application of the principles of evidnece-based practice the five years after graduation2014Conference paper (Refereed)
  • 8.
    Ericsson, Christoffer R
    et al.
    University of Helsinki, Helsinki, Finland; Arcada University of Applied Sciences, Helsinki, Finland.
    Lindström, Veronica
    Umeå University, Umeå, Sweden; Ambulance Service Umeå, Umeå, Sweden; Sophiahemmet University, Stockholm, Sweden.
    Rudman, Ann
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm, Sweden; .
    Nordquist, Hilla
    University of Helsinki, Helsinki, Finland; South-Eastern Finland University of Applied Sciences, Kotka, Finland; .
    Paramedics' perceptions of job demands and resources in Finnish emergency medical services: a qualitative study2022In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 1469Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Paramedics' fatigue is rising. Stress factors show increased risk for burnout, fatigue, leaving the profession, decreased performance and risk for patient safety. Meanwhile, paramedics' strong community of practice, autonomy and a sense of professional respect are important factors in forming psychological resilience. We aimed to explore Finnish paramedics' perceptions of job demands and resources.

    METHODS: Our study design was descriptive, inductive with a constructivist approach. Using reflexive thematic analysis, we analyse open-ended questions, from a web-based survey and essays written by Finnish paramedic masters-degree students. The study followed the SRQR checklist.

    RESULTS: We identified paramedics' job demands as stress from a high workload, environmental factors and emotional burden. Performance expectations and a sense of inadequacy were further noted, as well as an organizational culture of hardiness, presenting lack of support and sense of inequality. Paramedics' job resources were pressure management strategies, which were expressed as positive coping mechanisms, agency to affect workload and professional self-actualization, expressed as psychologically safe work community, professional pride and internal drive to professional development.

    CONCLUSIONS: Finnish paramedics exhibit resources and demands related to uncertainty and emotional burden as well as cultural hardiness and psychological safety in communities.

    PATIENT OR PUBLIC CONTRIBUTION: This study was done based on survey data collected and analysed by the authors. No patient or public contribution was utilized for this study.

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  • 9. Ericsson, Christoffer R
    et al.
    Nordquist, Hilla
    Lindström, Veronica
    Rudman, Ann
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Finnish paramedics' professional quality of life and associations with assignment experiences and defusing use - a cross-sectional study.2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 1789Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Paramedics experience traumatic events and social emergencies during assignments while also being subjected to verbal and physical threats. Consequently, they are at risk for burnout and secondary traumatic stress, factors inherent to professional quality of life. Defusing and peer-support potentially decrease such symptoms; however, perceived defusing needs and use are not always balanced. Our aim was to explore Finnish paramedics' professional quality of life, using the Professional Quality of Life Scale, with associations to EMS assignment experiences as well as formal and informal defusing need and use over a 12-month period.

    METHODS: A quantitative study of 257 Finnish paramedics using a cross-sectional design. Study outcomes were secondary traumatic stress (STS), compassion satisfaction (CS), and burnout (BO) scores using the modified 9-item Short Professional Quality of Life scale (ProQOL). Likert-type scales were used to collect participants' recollections of assignment experiences and defusing from a 12-month period. Associations were explored using Spearman's correlation coefficients.

    RESULTS: Short ProQOL score medians were STS 4.00 (IQR 3), BO 6.00 (IQR 3) and CS 13.00 (IQR 3). STS and BO correlated to experiences of social emergencies and traumatic events while BO correlated to experiences of threat situations (r = 0.206, p = .001). Paramedics perceived a need for defusing in general associated with STS (r = 0.178, p < .001) and participated in informal defusing. Participation in defusing of any form did not associate with ProQOL scores.

    CONCLUSIONS: Finnish paramedics' more frequent experiences of social emergencies, traumatic events, and paramedic-directed threat situations were associated with higher levels of STS and BO. STS was also associated with paramedics' increased need for defusing and use of informal peer defusing, although neither STS, BO or CS scores associated to any defusing form. Managing paramedics STS and BO, while fostering CS, could therefore be a future research focus.

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  • 10. Flinkman, M.
    et al.
    Coco, K.
    Rudman, Ann
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    Leino-Kilpi, H.
    Registered nurses' psychological capital: A scoping review2023In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172XArticle, review/survey (Refereed)
    Abstract [en]

    Aims: The aim was to examine the extent and scope of empirical research concerning registered nurses' psychological capital. Background: In a time of global nursing shortage, identifying variables that could positively contribute to the retention of the nursing workforce is essential. Prior research has shown that psychological capital correlates positively with employees' better performance and well-being. Design: A scoping review. Data sources: A systematic literature search was conducted in the following databases: PubMed, CINAHL, PsycINFO, Web of Science and Scopus covering the period from 1 January 2005 to 7 May 2023. Review methods: The JBI methodological guidance for scoping reviews was followed. The results were summarized narratively. Results: A total of 111 studies reported in 114 peer-reviewed articles were included. Studies were carried out across 20 countries, with the majority from China (45), Australia (nine), Pakistan (nine), Canada (eight), South Korea (eight) and the United States (eight). A positive correlation was found between registered nurses' psychological capital and desirable work-related outcomes, such as work engagement, commitment and retention intention. Conclusion: A comprehensive overview of research evidence suggests that psychological capital is associated with many positive work-related outcomes and might therefore be a valuable resource for reducing nurse turnover. © 2023 The Authors. International Journal of Nursing Practice published by John Wiley & Sons Australia, Ltd.

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  • 11.
    Flinkman, Mervi
    et al.
    University of Turku, Turku, Finland.
    Rudman, Ann
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    Pasanen, Miko
    University of Turku, Turku, Finland.
    Leino-Kilpi, Helena
    University of Turku, Turku, Finland.
    Psychological capital, grit and organizational justice as positive strengths and resources among registered nurses: A path analysis2023In: Nursing Open, E-ISSN 2054-1058, Vol. 10, no 8, p. 5314-5327Article in journal (Refereed)
    Abstract [en]

    AIM: To examine registered nurses' individual strengths (psychological capital and grit) and an organizational resource (organizational justice) as well as associated work-related outcomes. In a time of a global nursing shortage, there is an urgent need to identify strengths and resources that can have a positive impact on the health, well-being and retention of registered nurses.

    DESIGN: A cross-sectional survey.

    METHODS: A nationwide convenience sample of 514 registered nurses responded to a survey. Data were collected using a self-reported questionnaire between March and May 2018. Data were analysed using descriptive statistics and multivariate path analysis.

    RESULTS: Participants rated their psychological capital and grit moderately high. Grit and organizational justice were found to have significant direct effects on psychological capital. Furthermore, psychological capital had positive direct effects on engagement and the perception of well-conducted everyday nursing as well as negative direct effects on burnout, the stress of conscience and the intent to leave the profession.

    CONCLUSION: The results suggest that nurse leaders and managers could consider improving registered nurses' well-being with two complementary approaches. It might be useful to reinforce positive, individual strengths, such as psychological capital, and at the same time create more favourable nursing work environments, for example by strengthening organizational justice.

    IMPLICATIONS FOR THE PROFESSION: Psychological capital and grit are emerging concepts in nursing workforce research. Identifying registered nurses' positive strengths and resources is important for inventing interventions that enhance nurses' engagement and well-being as well as reduce turnover intentions.

    IMPACT: Nurse leaders and managers play crucial roles in managing and developing registered nurses' individual strengths and organizational resources. This has gained even more importance now as the COVID-19 pandemic could have a long-term negative impact on nurses' well-being.

    REPORTING METHOD: The study is reported following STROBE guidelines.

    PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

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  • 12.
    Forsman, Henrietta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Gustavsson, Petter
    Rudman, Ann
    Karolinska Institutet.
    Wallin, Lars
    Newly graduated nurses’ research use in clinical practice – a pattern-oriented approach2008In: Knowledge Translation 2008: Forum for the Future, Banff, Kanada, 2008Conference paper (Refereed)
  • 13.
    Forsman, Henrietta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rudman, Ann
    Karolinska Institutet.
    Gustavsson, Petter
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Low research use among newly graduated nurses: a threat to patient safety?2011In: Medicinska Riksstämman 2011, Stockholm, 2011Conference paper (Other academic)
    Abstract [sv]

    Background: The application of research-based knowledge in clinical practice has the potential to improve quality of care, effectiveness and safety. However, the gap between research and practice is well-known and has been addressed globally. Among the educational goals of nursing education are abilities of critical reflection and implementation of new knowledge into practice. Knowledge about the extent of newly graduated nurses’ research use (RU) in clinical practice and factors that can hinder or facilitate their RU is however scarce. Aim: The overall aim of the thesis presented here was to study nurses’ self-reported RU the first three years postgraduation, change in RU over time and associated factors. Further, the aim was to study nursing students’ RU intentions and whether intention and educational factors could predict RU behavior. Methods: Data derive from the LANE study, a national and longitudinal survey study comprising three cohorts of nursing students, subsequently nurses, graduating in 2002, 2004 and 2006. Outcome measures were instrumental, conceptual and persuasive RU (IRU, CRU and PRU) at one, two and three years postgraduation (Y1, Y2, Y3), as well as IRU intention in last term of undergraduate studies. Results: At all time points, IRU was reported as most prevalent, followed by CRU and finally PRU. About one third of the respondents reported IRU on half or more than half of the working shifts. Seven different RU profiles across the three kinds of RU were identifed. The two clusters representing overall low RU were predominating, representing about half or more of the samples. Low users tended to become even lower over time between Y1 and Y2. A number of individual, organizational and educational factors were found as significantly related to overall low RU at Y2. IRU intention in last term of undergraduate studies showed that 34% of the sample intended to use research to a larger extent and IRU intention predicted IRU behavior at Y1. In addition, intention acted as a mediating factor for the effects from a number of other educational factors on IRU behavior. Implications: The results constitute unique knowledge. Considering today’s demand for evidence-based nursing practice, the relatively low extent of RU is worrying and may impact patient safety. Multiple factors were associated with the extent of RU the first years postgraduation and results have implications both for undergraduate nursing education and the healthcare organization.

  • 14.
    Forsman, Henrietta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Gustavsson, Petter
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rudman, Ann
    Karolinska Institutet.
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Research use in clinical practice: extent and patterns among nurses one and three years postgraduation2009In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 6, p. 1195-1206Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 15.
    Forsman, Henrietta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Gustavsson, Petter
    Rudman, Ann
    Karolinska Institutet.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    A longitudinal study of nurses' research use the first two years post-graduation.2009In: The 2009 Knowledge Utilization Colloqium, Wales, 2009Conference paper (Refereed)
  • 16. Forsman, Henrietta
    et al.
    Gustavsson, Petter
    Rudman, Ann
    Karolinska Institutet.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wallin, Lars
    The complexity of research use – extent and patterns among nurses one and three years post-graduation2008In: 9th European Doctoral Conference in Nursing Science, Maastricht, The Netherlands, 2008Conference paper (Refereed)
  • 17.
    Forsman, Henrietta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rudman, Ann
    Karolinska Institutet.
    Gustavsson, Petter
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Nurses' research utilization two years after graduation: a national survey ofassociated individual, organizational, and educational factors2012In: Implementation Science, E-ISSN 1748-5908, Vol. 7, article id 46Article in journal (Refereed)
    Abstract [en]

    Background. Nurses' research utilization (RU) as part of evidence-based practice is strongly emphasized in today's nursing education and clinical practice. The primary aim of RU is to provide high-quality nursing care to patients. Data on newly graduated nurses' RU are scarce, but a predominance of low use has been reported in recent studies. Factors associated with nurses' RU have previously been identified among individual and organizational/contextual factors, but there is a lack of knowledge about how these factors, including educational ones, interact with each other and with RU, particularly in nurses during the first years after graduation. The purpose of this study was therefore to identify factors that predict the probability for low RU among registered nurses two years after graduation.

    Methods. Data were collected as part of the LANE study (Longitudinal Analysis of Nursing Education), a Swedish national survey of nursing students and registered nurses. Data on nurses' instrumental, conceptual, and persuasive RU were collected two years after graduation (2007, n = 845), together with data on work contextual factors. Data on individual and educational factors were collected in the first year (2002) and last term of education (2004). Guided by an analytic schedule, bivariate analyses, followed by logistic regression modeling, were applied.

    Results. Of the variables associated with RU in the bivariate analyses, six were found to be significantly related to low RU in the final logistic regression model: work in the psychiatric setting, role ambiguity, sufficient staffing, low work challenge, being male, and low student activity.

    Conclusions. A number of factors associated with nurses' low extent of RU two years postgraduation were found, most of them potentially modifiable. These findings illustrate the multitude of factors related to low RU extent and take their interrelationships into account. This knowledge might serve as useful input in planning future studies aiming to improve nurses', specifically newly graduated nurses', RU.

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  • 18.
    Forsman, Henrietta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rudman, Ann
    Karolinska Institutet.
    Gustavsson, Petter
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wallin, Lars
    Nurses’ use of research findings in clinical practice - a prospective study of the first two years post-graduation2009In: Conference on Advances in Health Care Science Research, Stockholm, 2009Conference paper (Other academic)
  • 19.
    Forsman, Henrietta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rudman, Ann
    Karolinska Institutet.
    Gustavsson, Petter
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Use of research by nurses during their first two years after graduating2010In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 66, no 4, p. 878-890Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 20.
    Forsman, Henrietta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet.
    Gustavsson, Petter
    Inst för klinisk neurovetenskap, Karolinska Institutet.
    Rudman, Ann
    Inst för klinisk neurovetenskap, Karolinska Institutet.
    Nursing students’ intentions to use research as a predictor of use one year post graduation: a prospective study2012In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 49, no 9, p. 1155-1164Article in journal (Refereed)
    Abstract [en]

    Background. Graduating nursing students are expected to have acquired the necessary skills to provide research-based care to patients. However, recent studies have shown that new graduate nurses report their extent of research use as relatively low. Because behavior intention is a well-known predictor of subsequent behavior, this gives reasons to further investigate graduating nursing students’ intentions to use research in clinical practice after undergraduate study.

    Objectives. To investigate graduating nursing students’ intentions to use research in clinical practice and, furthermore, to investigate whether intention in itself and as a mediating variable can predict subsequent research use behavior in clinical practice one year post graduation.

    Design. A follow-up study was performed of graduating nursing students in their final semester of undergraduate study (2006) and at one year post graduation (2008). Data were collected within the larger national survey LANE (Longitudinal Analysis of Nursing Education).

    Participants. A sample of 1319 respondents was prospectively followed.

    Methods. Graduating nursing students’ intentions to use research instrumentally were studied as a predictor of their subsequent instrumental research use one year post graduation. A statistical full mediation model was tested to evaluate the effects of intention and factors from undergraduate study on subsequent research use in daily care.

    Results. Thirty-four percent of the nursing students intended to use research on more than half or almost every working shift in their future clinical practice. Intention showed a direct effect on research use behavior. In addition, significant indirect effects on research use were shown for capability beliefs (regarding practicing the principles of evidence-based practice) and perceived support for research use (from campus and clinical education), where intention acted as a mediating factor for those effects.

    Conclusions. Students rated a modest level of intention to use research evidence. Intentions close to graduation acted as an essential predictor of subsequent research use behavior, both through a direct effect and as a mediating variable. These findings give support for designing future interventions aiming at influencing students’ intention to use research to improve subsequent behavior. Focusing on strengthening students’ capability beliefs and providing support for research use appear as promising target activities.

  • 21. Frögli, Elin
    et al.
    Rudman, Ann
    Karolinska Institutet.
    Lövgren, Malin
    Gustavsson, Petter
    Problems with task mastery, social acceptance, and role clarity explain nurses' symptoms of burnout during the first professional years: A longitudinal study.2019In: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 62, no 4, p. 573-584Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Symptoms of burnout among new professionals is a well-recognized problem but there is a lack of prevention programs. Effective interventions are based on an understanding of the processes that contribute to the development of a problem and suggest how it may be addressed.

    OBJECTIVE: Using the framework of organizational socialization, the objective of this study was to investigate if development of the socialization processes role clarity, social acceptance, and task mastery affects development of symptoms of burnout among new professionals and may specifically be targeted in transition-to-practice programs to prevent symptoms of burnout from occurring. We conducted this investigation by examining the relations between role clarity, social acceptance, task mastery, and symptoms of burnout the first year after professional entry, as well as the relations between changes in the socialization processes and changes in symptoms of burnout during the first three years following professional entry in a sample of new nurses.

    METHOD: Relationships between the socialization processes and symptoms of burnout were modeled using a linear latent growth model and data from a nationally representative sample of 1210 new registered nurses.

    RESULTS: Role clarity, social acceptance, and task mastery were related to symptoms of burnout cross-sectionally and longitudinally. Task mastery was the most important explanatory variable.

    CONCLUSIONS: The results suggest that an intervention designed to support the development of the socialization processes may be effective in preventing symptoms of burnout among new nurses. Interventions targeting role clarity, social acceptance, and task mastery during the first professional year may be expected to have effects during the following years as well, extending the value and importance of such interventions.

  • 22.
    Frögéli, Elin
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Annell, Stefan
    Department of Leadership and Command & Control, Swedish Defence University, Stockholm, Sweden.
    Rudman, Ann
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Inzunza, Miguel
    Police Education and Research Unit, Umeå University, Umeå, Sweden.
    Gustavsson, Petter
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    The Importance of Effective Organizational Socialization for Preventing Stress, Strain, and Early Career Burnout: An Intensive Longitudinal Study of New Professionals2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 12, article id 7356Article in journal (Refereed)
    Abstract [en]

    Burnout was originally conceptualized based on experiences of new professionals. Role clarity, task mastery, and social acceptance are recognized as key resources enabling new professionals' management of the challenges of the new profession. However, relations between these resources and stress, strain, and burnout have not yet been thoroughly investigated at professional entry. Increased understanding of these relations could have implications for strategies to prevent burnout. The aim of the study was to investigate within- and between-individual effects over the first months and relations to burnout at one-year post-entry. Data (n = 322) was collected weekly over the first 13 weeks and again 9 months later. Relationships were modelled using a multilevel regression model and correlation analysis. Results showed that on weeks when participants experienced higher role clarity, task mastery, and social acceptance, they reported significantly less stress, and that participants who experienced higher levels of the resources in general, reported significantly less strain. Levels of the resources at three months were related to symptoms of burnout at 12 months. The study findings provide support of the role of task mastery, role clarity, and social acceptance as resources buffering the impact of demands at professional entry on experiences of stress, strain, and burnout.

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  • 23. Frögéli, Elin
    et al.
    Djordjevic, Aleksandar
    Rudman, Ann
    Karolinska Institutet.
    Livheim, Fredrik
    Gustavsson, Petter
    A randomized controlled pilot trial of acceptance and commitment training (ACT) for preventing stress-related ill health among future nurses.2016In: Anxiety, Stress, and Coping, ISSN 1061-5806, E-ISSN 1477-2205, Vol. 29, no 2, p. 202-18Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Levels of stress and burnout increase during nursing education. This development has consequences for nursing students' health, learning, competence, and interest in quality issues in health care.

    DESIGN: In a randomized controlled pilot trial with a sample of 113 nursing students the effect of an intervention using techniques from acceptance and commitment training (ACT) to prevent the development of stress and burnout was evaluated.

    METHOD: The 6 × 2-hour program was compared to standard treatment (reflection seminars) post-intervention and at a three-month follow-up using longitudinal analysis of mean response profiles. Mechanisms of change were investigated using a baseline-post intervention two-mediator model.

    RESULTS: The intervention resulted in increased mindful awareness and decreased experiential avoidance, as well as decreased perceived stress and burnout. Levels of mindful awareness and perceived stress were sustained at follow-up. The proposed mechanisms of change were partly supported by the data.

    CONCLUSION: This study shows that techniques from ACT might have the potential to contribute to preventing the development of stress and burnout during nursing education. However, additional studies are needed to validate these results.

  • 24. Frögéli, Elin
    et al.
    Rudman, Ann
    Karolinska Institutet.
    Gustavsson, Petter
    The relationship between task mastery, role clarity, social acceptance, and stress: An intensive longitudinal study with a sample of newly registered nurses.2019In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 91, p. 60-69, article id S0020-7489(18)30282-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Transitioning into a new professional role is challenging. Unfortunately, little is currently known about how to reduce experiences of stress among new professionals. The socialization processes role clarity, task mastery, and social acceptance are assumed to reduce experiences of stress as they mediate new professionals' acquisition of knowledge, skills, attitudes, and behaviors. However, little prospective data is available on the actual effect of the processes on stress.

    OBJECTIVES: To prospectively investigate how the socialization processes relate to experiences of stress among new nurses during the first three months of professional working life. Specifically, to investigate development over time, as well as how episodes of increased or decreased levels of the socialization processes relate to concurrent levels of stress. The general purpose of this investigation was to examine the suitability of the socialization processes as targets of an intervention seeking to reduce stress among new professionals.

    DESIGN: An intensive longitudinal study with weekly data collections over three months.

    PARTICIPANTS: 264 newly graduated Swedish nurses who started their first job during the period of the study.

    METHODS: The participants were followed prospectively during 14 consecutive weeks after their professional entry. Data on stress (Stress and Energy Questionnaire), role clarity (General Questionnaire for Psychological and Social Factors at Work), task mastery, and social acceptance (Needs Satisfaction and Frustration Scale) were collected weekly using digital surveys (mean response rate 82.7%). Data was analyzed using a multilevel model for intensive longitudinal data.

    RESULTS: For the typical nurse, stress decreased by 0.13 units per month, role clarity and task mastery increased by 0.08 and 0.05 units, and social acceptance decreased by 0.08 units. In addition, the slopes of 95 percent of the new nurses varied within 1.18 (stress), 0.72 (role clarity), 0.44 (task mastery), and 0.86 (social acceptance) units of the typical nurse. Most importantly, when the new nurses experienced higher levels of task mastery, role clarity, and social acceptance, they experienced lower levels of stress (within-person parameter estimates: task mastery -0.40, p = .001; role clarity -0.34, p = .001; and social acceptance -0.33, p = .001).

    CONCLUSIONS: Supporting the development of the socialization processes could be one theoretically based strategy to reduce levels of stress among new nurses. As stress among new professionals is not unique to the nursing profession, and the processes are considered important mediators of new professionals' adaptation in general, the results from this study should likely be generalizable to other professions.

  • 25. Frögéli, Elin
    et al.
    Rudman, Ann
    Karolinska Institutet.
    Ljótsson, Brjánn
    Gustavsson, Petter
    Preventing Stress-Related Ill Health Among New Registered Nurses by Supporting Engagement in Proactive Behaviors: A Randomized Controlled Trial2020In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 17, no 3, p. 202-212Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: New registered nurses (RNs) are at risk of developing symptoms of stress-related ill health.

    OBJECTIVES: To evaluate the effect of a 3 × 3 hour group intervention aiming to prevent symptoms of stress-related ill health among new RNs by increasing engagement in proactive behaviors. The intervention involves discussions and models of newcomer experiences and stress and the behavior change techniques reinforcing approach behaviors, systematic exposure, and action planning.

    DESIGN: A randomized parallel group trial with an active control condition.

    PARTICIPANTS: The study sample consisted of 239 new RNs participating in a transition-to-practice program for new RNs in a large county in Sweden.

    METHODS: Participants were randomized to either the experimental intervention or a control intervention. Data on experiences of stress, avoidance of proactive behaviors, engagement in leisure activities, role clarity, task mastery, and social acceptance were collected before and after the intervention. Effects were evaluated using multilevel model analysis and regression analysis. Missing data were imputed using multiple imputation.

    RESULTS: The control group experienced a statistically significant increase in experiences of stress during the period of the study (t(194.13) = 1.98, p = .049), whereas the level in the experimental group remained stable. Greater adherence to the intervention predicted a greater effect on experiences of stress (β = -0.15, p = .039) and social acceptance (β = 0.16, p = .027).

    LINKING EVIDENCE TO ACTION: Transition-to-practice programs may benefit from adding an intervention that specifically addresses new RNs' experiences of stress to further support them as they adjust to their new professional role. However, replication studies with larger samples, more reliable measures, and longer periods of follow-up are needed.

  • 26. Frögéli, Elin
    et al.
    Rudman, Ann
    Karolinska Institutet.
    Ljótsson, Brjánn
    Gustavsson, Petter
    Preventing stress-related ill health among newly registered nurses by supporting engagement in proactive behaviors: development and feasibility testing of a behavior change intervention.2018In: Pilot and Feasibility Studies, E-ISSN 2055-5784, Vol. 4, article id 28Article in journal (Refereed)
    Abstract [en]

    Background: Transitioning into a new professional role is a stressful experience with consequences for mental and physical health, job satisfaction, organizational commitment, and turnover. New registered nurses seem to be at particular risk of developing stress-related ill health during their first years in the profession. Previous research indicates that engagement in proactive behaviors may reduce this risk.

    Methods: With the work presented in this paper, we aimed to test the feasibility of conducting an evaluation of the effect of a behavior change intervention to prevent stress-related ill health among new registered nurses by supporting their engagement in proactive behaviors. Feasibility objectives included recruitment, randomization, data collection and analysis, participation, acceptability, and deliverability.We tested the feasibility of evaluating the effect of the intervention as part of a transition-to-practice program for new registered nurses using a non-randomized design with one condition. The trial included a sample of 65 new registered nurses who had been working for 6 months or less.

    Results: The feasibility of conducting a full-scale effect evaluation was confirmed for recruitment, data collection and analysis, participation, and acceptability. It was not possible to randomize participants, but analyses of between-group differences revealed no selection bias. The time of the intervention will need to be extended to ensure the deliverability.

    Conclusion: With some adjustments in the study design, it is feasible to evaluate the effect of a behavior change intervention to support new registered nurses' engagement in proactive behaviors during their transition into the new profession as part of a transition-to-practice program for new nurses.

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  • 27. Gustavsson, J Petter
    et al.
    Hallsten, Lennart
    Rudman, Ann
    Karolinska Institutet.
    Early career burnout among nurses: modelling a hypothesized process using an item response approach.2010In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 47, no 7, p. 864-75Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cherniss's pioneering research on burnout, based on grounded theory, focused specifically on competence crisis among new graduates, and identified negative attitude changes as the core phenomenon in the progression from competence crisis into early career burnout. In this model, the two main burnout dimensions of exhaustion and dysfunctional coping are ordered sequentially; i.e., initial exhaustion develops, due to dysfunctional coping (cynicism and disengagement), into burnout.

    OBJECTIVE: To test the sequential-developmental model of burnout originally proposed by Cherniss, using a psychometric approach.

    DESIGN: A sample of 933 early-career nursing professionals, recruited from a Swedish population-based cohort (response rate 81%), were assessed three years after graduation, using items from a burnout inventory. Data were analysed using the Rasch measurement model.

    RESULTS: The psychometric tests showed that data adhere to a sequential-developmental model when examined using the one-parameter item response approach. When tested against external variables, the prevalence of low mood, low levels of job performance and health problems increased monotonically along this sequential-developmental model of early career burnout.

    CONCLUSION: Among early-career nursing professionals burnout may be operationalized as a one-dimensional sequential-developmental model. This model resembles the results found in the literature on transition and socialization, and the association between these psychometric results and studies on nursing students' transition and socialization into working life are discussed.

  • 28.
    Hörberg, Anna
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Gadolin, Christian
    Univ West.
    Nilsson, Maria Skyvell
    Univ West.
    Gustavsson, Petter
    Karolinska Inst.
    Rudman, Ann
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Inst.
    Experienced Nurses' Motivation, Intention to Leave, and Reasons for Turnover: A Qualitative Survey Study2023In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 2023, article id 2780839Article in journal (Refereed)
    Abstract [en]

    There is a global nurse shortage, and researchers have made great efforts in trying to unveil the reasons for turnover and how to increase retention. However, such research has had a tendency to study variables related to intention to leave (ITL) or turnover as isolated phenomena. Objective. To simultaneously explore what factors motivate experienced nurses in the workplace and the underlying reasons for strong ITL and high staff turnover within the profession. Design. An inductive qualitative content analysis was used based on data from open-ended survey questions. The data originated from the longitudinal analyses of nursing education/employment/entry (LANE) in work-life study. The qualitative data analyzed in this study were distributed in October 2017-January 2018, to all nurses in three cohorts corresponding to 11-, 13- and 15-year postgraduation. Of the 2,474 nurses answering the survey, 1,146 (46%) responded to one or more of the open-ended questions. Results. The result showed that what motivates experienced nurses, their intention to leave (ITL), and reasons for turnover could be described in the form of five broad categories, namely, organizational characteristics, work characteristics, relationships at work, work recognition, and health issues. There was rarely a one single reason described, rather several reasons needed to be experienced over time for nurses to stay motivated or leave the profession. Conclusions. There is no single reason that makes nurses leave the profession, nor is there one single reason that makes them motivated to stay. Retention and turnover are complex processes and need to be addressed as this, not as a single isolated phenomenon.

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  • 29. Jirwe, Maria
    et al.
    Rudman, Ann
    Karolinska Institutet.
    Why choose a career in nursing?2012In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 68, no 7, p. 1615-23Article in journal (Refereed)
    Abstract [en]

    AIM: This paper examines the prevalence of various career-choice motives given by nursing students in two national cohorts at the beginning and end of their education respectively and how these motives are interrelated and associated with perceived career-choice stress.

    BACKGROUND: Several international studies have identified various motives for choosing nursing. The degree to which motives are autonomous or controlled affects an individual's professional development and health. Earlier research on career choice has used small non-representative samples.

    DESIGN: Cross-sectional survey.

    METHODS: This was a study of all Swedish undergraduate nursing students in their first (n = 1697) or last (n = 1150) year. The data for this study were collected in 2002, forming the baseline of a prospective longitudinal study where data were collected annually between 2002-2010. Data analysis included descriptive statistics, exploratory factor analysis and multiple regression analysis.

    RESULTS: A model incorporating three factors explained 50-60% of the variance in motives for becoming a nurse. 'Genuine interest' was ranked highest, followed by 'practical reasons'. Only a small group of students gave nursing as 'default choice'. Fewer autonomous motives for choosing nursing were associated with perceived career-choice stress.

    CONCLUSION: We suggest that it is imperative for nurse educators to identify students who lack autonomy. Supporting students' autonomy is likely to improve educational outcome, enable professional socialization and decrease professional turnover. Future research on students' motivation in relation to educational outcome and professional turnover as well as quality of patient care is needed.

  • 30. Johansson, Fred
    et al.
    Côté, Pierre
    Hogg-Johnson, Sheilah
    Rudman, Ann
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    Holm, Lena W
    Grotle, Margreth
    Jensen, Irene
    Sundberg, Tobias
    Edlund, Klara
    Skillgate, Eva
    Depression, anxiety and stress among Swedish university students before and during six months of the COVID-19 pandemic: A cohort study.2021In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 49, no 7, p. 741-749, article id 14034948211015814Article in journal (Refereed)
    Abstract [en]

    AIMS: The COVID-19 pandemic has had a profound effect on societies and citizens worldwide, raising concerns about potential mental health impacts. We aimed to describe trajectories of depression, anxiety and stress symptoms during the COVID-19 outbreak compared to before the outbreak, and to determine if trajectories were modified by pre-pandemic loneliness, poor sleep quality and mental health problems.

    METHODS: We conducted a cohort study with 1836 Swedish university students entering the study before 13 March 2020, the onset of the pandemic, with follow-ups within three (FU1) and six months (FU2) of the outbreak. Generalized Estimating Equations were used to estimate mean differences in symptom levels over time-periods, and to estimate potential effect modifications.

    RESULTS: We found small differences in mean levels of the depression, anxiety and stress scale (DASS-21) over time. Compared to before the pandemic, depression increased by 0.25 points of 21 (95% CI: 0.04 to -0.45) at FU1 and decreased by 0.75/21 (95% CI:-0.97 to -0.53) at FU2. Anxiety decreased from baseline to FU1 by 0.09/21 (95% CI: -0.24 to -0.07) and by 0.77/21 (95% CI: -0.93 to -0.61) to FU2. Stress decreased from baseline to FU1 by 0.30/21 (95% CI: -0.52 to -0.09) and by 1.32/21 (95% CI: -1.55 to -1.09) to FU2. Students with pre-pandemic loneliness, poor sleep quality or pre-pandemic mental health problems did not have worse trajectories of mean mental health symptoms.

    CONCLUSIONS: Symptom levels were relatively stable during the first three months of the pandemic, while there was a slight decrease during the summer months, probably due to seasonality effects.

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  • 31.
    Johansson, Fred
    et al.
    Sophiahemmet University, Stockholm.
    Rozental, Alexander
    Uppsala University, Uppsala; Karolinska Institutet, Stockholm.
    Edlund, Klara
    Sophiahemmet University, Stockholm; Karolinska Institutet, Stockholm.
    Côté, Pierre
    Ontario Tech University, Oshawa, Ontario, Canada.
    Sundberg, Tobias
    Sophiahemmet University, Stockholm.
    Onell, Clara
    Sophiahemmet University, Stockholm.
    Rudman, Ann
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    Skillgate, Eva
    Sophiahemmet University, Stockholm; Karolinska Institutet, Stockholm.
    Associations Between Procrastination and Subsequent Health Outcomes Among University Students in Sweden.2023In: JAMA Network Open, E-ISSN 2574-3805, Vol. 6, no 1, article id e2249346Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: Procrastination is prevalent among university students and is hypothesized to lead to adverse health outcomes. Previous cross-sectional research suggests that procrastination is associated with mental and physical health outcomes, but longitudinal evidence is currently scarce.

    OBJECTIVE: To evaluate the association between procrastination and subsequent health outcomes among university students in Sweden.

    DESIGN, SETTING, AND PARTICIPANTS: This cohort study was based on the Sustainable University Life study, conducted between August 19, 2019, and December 15, 2021, in which university students recruited from 8 universities in the greater Stockholm area and Örebro were followed up at 5 time points over 1 year. The present study used data on 3525 students from 3 time points to assess whether procrastination was associated with worse health outcomes 9 months later.

    EXPOSURE: Self-reported procrastination, measured using 5 items from the Swedish version of the Pure Procrastination Scale rated on a Likert scale from 1 ("very rarely or does not represent me") to 5 ("very often or always represents me") and summed to give a total procrastination score ranging from 5 to 25.

    MAIN OUTCOMES AND MEASURES: Sixteen self-reported health outcomes were assessed at the 9-month follow-up. These included mental health problems (symptoms of depression, anxiety, and stress), disabling pain (neck and/or upper back, lower back, upper extremities, and lower extremities), unhealthy lifestyle behaviors (poor sleep quality, physical inactivity, tobacco use, cannabis use, alcohol use, and breakfast skipping), psychosocial health factors (loneliness and economic difficulties), and general health.

    RESULTS: The study included 3525 participants (2229 women [63%]; mean [SD] age, 24.8 [6.2] years), with a follow-up rate of 73% (n = 2587) 9 months later. The mean (SD) procrastination score at baseline was 12.9 (5.4). An increase of 1 SD in procrastination was associated with higher mean symptom levels of depression (β, 0.13; 95% CI, 0.09-0.17), anxiety (β, 0.08; 95% CI, 0.04-0.12), and stress (β, 0.11; 95% CI, 0.08-0.15), and having disabling pain in the upper extremities (risk ratio [RR], 1.27; 95% CI, 1.14-1.42), poor sleep quality (RR, 1.09, 95% CI, 1.05-1.14), physical inactivity (RR, 1.07; 95% CI, 1.04-1.11), loneliness (RR, 1.07; 95% CI, 1.02-1.12), and economic difficulties (RR, 1.15, 95% CI, 1.02-1.30) at the 9-month follow-up, after controlling for a large set of potential confounders.

    CONCLUSIONS AND RELEVANCE: This cohort study of Swedish university students suggests that procrastination is associated with subsequent mental health problems, disabling pain, unhealthy lifestyle behaviors, and worse psychosocial health factors. Considering that procrastination is prevalent among university students, these findings may be of importance to enhance the understanding of students' health.

  • 32. Kanstrup, Marie
    et al.
    Rudman, Ann
    Göransson, Katarina
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    Andersson, Emil
    Lauri, Klara Olofsdotter
    Rapoport, Emma
    Sunnergård, Linda
    Bragesjö, Maria
    Andersson, Erik
    Iyadurai, Lalitha
    Holmes, Emily A
    Reaching people soon after a traumatic event: an exploratory observational feasibility study of recruitment in the emergency department to deliver a brief behavioral intervention via smartphone to prevent intrusive memories of trauma.2021In: Pilot and feasibility studies, ISSN 2055-5784, Vol. 7, no 1, article id 184Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The current study explored how to recruit patients soon after a traumatic event, to deliver a novel intervention in a new emergency department in Sweden. This brief behavioral intervention aims to prevent intrusive memories and is delivered soon after trauma in the emergency department. In the UK, it has shown promising results. Traumatic events resulting in admission to the emergency department (e.g., road traffic accidents) may result in subsequent mental health problems such as post-traumatic stress disorder, where intrusive memories of the trauma constitute a core clinical feature. Early interventions that prevent intrusive memories after psychological trauma are lacking. Specific aims were to explore identification of eligible patients (aim 1), fitting in with emergency department staff routines to deliver the study protocol (aim 2), and using the patients' own smartphones to deliver intervention/control task (aim 3). Two changes to the previous study were (i) extending the trauma types included (ii) a new control condition, also by smartphone.

    METHODS: This is an explorative observational study. Data was both analyzed descriptively and using the Framework method.

    RESULTS: We identified several possible ways to recruit patients, and establish a sense of embeddedness in the Swedish emergency department context and a positive appreciation from staff. The study protocol was tested with 8 participants. Tasks both in the intervention and control condition were readily delivered via patients' own smartphones.

    CONCLUSION: Recruitment of patients and smartphone delivery of the intervention indicates initial feasibility. Researcher presence and administration of study procedures was successfully fitted to emergency department routines and well received by staff. Further pilot work is warranted, underscoring the importance of our collaboration between nursing and psychology.

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  • 33.
    Lövgren, Malin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet.
    Gustavsson, Petter
    Karolinska Institutet.
    Melin, Bo
    Karolinska Institutet.
    Rudman, Ann
    Karolinska Institutet.
    Neck/shoulder and back pain in new graduate nurses: a growth mixture modeling analysis2014In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 51, no 4, p. 625-639Article in journal (Refereed)
    Abstract [en]

    Background: Although it is well known that musculoskeletal disorders are common among registered nurses, little longitudinal research has been conducted to examine this problem from nursing education to working life.

    Objectives: The aim was to investigate the prevalence and incidence of neck/shoulder and back pain in nursing students in their final semester, and one and two years after graduation. Furthermore, to identify common trajectories of neck/shoulder and back pain, and explore sociodemographic and lifestyle-related factors, contextual factors and health outcome that might be characteristic of individuals in the various trajectories.

    Design: Longitudinal study following nursing students from their final year of studies, with follow-ups one and two years after graduation.

    Settings and participants: Nursing students who graduated from the 26 universities providing undergraduate nursing education in Sweden 2002 were invited to participate(N = 1700). Of those asked, 1153 gave their informed consent.

    Methods: The participants answered postal surveys at yearly intervals. Descriptive statistics were used to analyze prevalence and incidence of pain, and growth mixture modeling was applied to identify different homogeneous clusters of individuals following similar trajectories in pain development across time.

    Results: The prevalence of neck/shoulder and back pain remained constant over time(around 50% for neck/shoulder pain and just over 40% for back pain). Six different development trajectories for each symptom were found, reflecting patterns of stable pain levels or variation in levels over time: one symptom-free group, two decreasing pain groups, two increasing pain groups, and one chronic pain group. With few exceptions, the same factors (sex, children, chronic disease, working overtime, work absence, sickness presence, physical load, depression, self-rated health, sleep quality and muscular tension) were associated with neck/shoulder and back pain trajectories. Different types of physical load characterized new nurses with neck/shoulder pain and back pain respectively.

    Conclusions: The high prevalence of pain among nursing students and among new graduate nurses, suggests that it would be effective to implement preventive strategies already during nursing education, but they should also preferably continue after graduation. Many factors associated with pain in the neck/shoulder and back seem to be modifiable, and thereby constitute targets for preventive strategies.

  • 34. Pennbrant, Sandra
    et al.
    Nilsson, Maria Skyvell
    Öhlén, Joakim
    Rudman, Ann
    Karolinska Institutet.
    Mastering the professional role as a newly graduated registered nurse.2013In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 33, no 7, p. 739-45, article id S0260-6917(12)00394-2Article in journal (Refereed)
    Abstract [en]

    Professional development is a process starting during undergraduate education and continuing throughout working life. A new nurse's transition from school to work has been described as difficult. This study aims to develop a model describing the professional development of new nurses during their first years of work. To develop this model, constant comparative analyses were performed. The method was a qualitative study of survey data on 330 registered nurses. The results showed that mastering the professional role was the result of an ongoing process building on the nurse's experiences and interactions with the surrounding environment. The professional developmental process involves the following interrelated sub-processes: evaluating and re-evaluating educational experiences, developing professional self-efficacy and developing clinical competence. These sub-processes are influenced by the following factors: social values and norms, healthcare organization, management of new nurses, co-workers, patients and significant others and the nurse's own family and friends. These factors affect professional development directly, indirectly or as mediating influences and can lead to possible outcomes, as new nurses choose to remain in or leave the profession. The results underscore the importance of developing a professional nursing role within the new working context. To facilitate this professional development, new nurses need support from their nursing-school educators and their healthcare employers. The model described here will be the subject of further measurement and testing.

  • 35.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Arborelius, Lotta
    Dahlgren, Anna
    Finnes, Anna
    Gustavsson, Petter
    Consequences of early career nurse burnout: A prospective long-term follow-up on cognitive functions, depressive symptoms, and insomnia.2020In: eClinicalMedicine, E-ISSN 2589-5370, Vol. 27, article id 100565Article in journal (Refereed)
    Abstract [en]

    Background: Burnout is common among nurses and midwives. We examined whether an early career episode of burnout has long-term consequences on; a) cognitive functions, b) symptoms of depression, and/or c) insomnia for nurses a decade after graduation.

    Methods: Symptoms of burnout were investigated in an observational longitudinal study of three national cohorts of registered nurses (RNs). Nursing students were recruited from all 26 of Sweden's nursing programs. Burnout was subsequently measured through annual assessment over the first three years post graduation, with one long-term follow-up 11-15 years after graduation. A total of 2474 nurses (62%) consented to participate at follow-up. Burnout was measured using items from the Oldenburg Burnout Inventory, cognitive function by a study specific instrument, depressive symptoms by the Major Depression Inventory, and sleep problems using items from the Karolinska Sleep Questionnaire. We used logistic regression to identify factors associated with consequences of early career burnout, adjusting for concurrent levels at follow up.

    Findings: The prevalence of nurses reporting high levels of burnout symptoms at least one of the first three years of working life was 299 (12·3%). High levels of burnout symptoms in early working life were significantly related to more frequent symptoms of cognitive dysfunction, depression, and impaired sleep a decade later when taking current burnout levels into account. After controlling for both current symptoms of burnout and the other outcome variables, nurses with early career burnout still reported more frequent problems with cognitive functions and sleep but not depression.

    Interpretation: The results of this study show that the detrimental processes caused by overwhelming or chronic stress start early on in nurses' careers and thus preventive efforts should preferably be introduced early on (e.g. as part of nursing education and onboarding programs).

    Funding: AFA Insurance Grant [number 150284].

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  • 36.
    Rudman, Ann
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    Boström, A. -M
    Wallin, Lars
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Gustavsson, P.
    Ehrenberg, Anna
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    The use of the evidence-based practice process by experienced registered nurses to inform and transform clinical practice during the COVID-19 pandemic: A longitudinal national cohort study2024In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 21, no 1, p. 14-22Article in journal (Refereed)
    Abstract [en]

    Background: During the COVID-19 pandemic, many registered nurses (RNs) worked on the frontline caring for severely ill patients. They did so with limited knowledge of how to treat and prevent the disease. This extreme situation puts pressure on RNs to find evidence on which to base the care of their patients. Aims: To examine: (1) the extent to which evidence-based practice (EBP) process was applied by Swedish RN cohorts 15–19 years after graduation during the pandemic, (2) whether there was any change to their EBP process from pre-pandemic to late pandemic, (3) the relationship between RNs' use of the EBP process and the duration of exposure to work situations severely affected by the COVID-19 pandemic, and (4) whether level of education, position and care setting were associated with the extent of RNs' EBP process. Methods: In 2021, the level of EBP activities was investigated among 2237 RNs 15–19 years after graduation. The scale used to measure EBP consisted of six items of the EBP process. Unpaired t-tests or one-way analysis of variance (ANOVA) were used in the analysis. Results: RNs used the EBP process to a moderate extent to inform and transform their clinical practice. There was a minor but significant decrease in practicing the EBP process from pre-pandemic to late in the pandemic. RNs who were most affected by the pandemic scored higher on the scale than less-affected colleagues. RNs in nonclinical positions reported more EBP activities, as did RNs in management positions. RNs working in outpatient settings reported more EBP activities than their colleagues in hospitals. Linking Evidence to Action: It is imperative that RNs hone their skills in EBP if they are to be prepared for future healthcare crises. Healthcare providers have a duty to facilitate the development of EBP and, in this regard, RNs in clinical positions in hospitals need particular support. © 2023 The Authors. Worldviews on Evidence-based Nursing published by Wiley Periodicals LLC on behalf of Sigma Theta Tau International.

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  • 37.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Boström, Anne-Marie
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Gustavsson, Petter
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Registered nurses’ evidence-based practice revisited: A longitudinal study in mid-career.2020In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 17, no 5, p. 348-355Article in journal (Refereed)
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  • 38.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    El-Khouri, Bassam
    Waldenström, Ulla
    Evaluating multi-dimensional aspects of postnatal hospital care.2008In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 24, no 4, p. 425-41Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: to investigate women's experiences of postnatal hospital care in relation to four different aspects: (1) interpersonal care; (2) time spent on physical check-ups; (3) time spent on information and support; and (4) time spent on assistance with breast feeding. More specifically, we aimed to establish whether typical clusters of women could be identified, and if so, whether these clusters could be related to specific outcomes of care, to the way in which care is organised, and to the individual's psychological health and socio-demographic background.

    DESIGN: longitudinal population-based survey, including three questionnaires completed in early pregnancy, at 2 months and 1 year after birth.

    SETTING: all postnatal wards in Sweden.

    PARTICIPANTS: women (n=2338) recruited at their first booking visit at 593 antenatal clinics, who responded to questions relating to postnatal hospital care 2 months after birth.

    FINDINGS: eight cluster profiles defined by the four aspects of postnatal care were identified. About half of the women were found in clusters that were satisfied with most aspects of care, and half in clusters that were dissatisfied with one aspect or more. Only 32% were very satisfied with all four dimensions. Specific groups of women, such as first-time mothers, migrants, young mothers and those with a short length of stay, were dissatisfied with different assessments of postnatal care. Psychological health in early pregnancy was associated with high ratings of all aspects of care, whereas emergency caesarean section and instrumental vaginal delivery was associated with dissatisfaction with breast feeding support and time spent on health check-ups.

    KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: women's individual appraisal of specific aspects of hospital postnatal care could be grouped into response patterns that were shared by smaller or larger groups. These patterns were related to maternal characteristics, labour outcomes and the way in which care was organised. The multi-faceted approach used in this study provided details about who was dissatisfied with what, and showed that women are not necessarily either satisfied or dissatisfied with care in a general sense. In order to provide individualised care, the carer needs to be aware of these differences.

  • 39.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    El-Khouri, Bassam
    Waldenström, Ulla
    Women's satisfaction with intrapartum care - a pattern approach.2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 59, no 5, p. 474-87Article in journal (Refereed)
    Abstract [en]

    AIM: This paper is a report of a study to investigate women's satisfaction with intrapartum care along three distinct dimensions simultaneously (interpersonal care, information and involvement in decision-making and physical birth environment) and to describe the characteristics of women with different patterns of satisfaction.

    BACKGROUND: Patient satisfaction is an important outcome in the evaluation and development of healthcare services. Studies of satisfaction have often used single global ratings but such ratings may not capture the multidimensionality of care during childbirth.

    METHOD: A cluster analytic technique was used to establish a finite set of response patterns. Data were obtained from a longitudinal population-based Swedish survey including 2605 women who completed questionnaires in early pregnancy, and 2 months and 1 year after the birth. Data collection commenced in March 1999 and was completed in April 2002.

    RESULTS: Nine different clusters, or patterns of satisfaction/dissatisfaction, were found. Nearly half of the women (47%) were in clusters that were satisfied or very satisfied with at least one dimension of care, 20% in clusters that were fairly satisfied (average), and 33% in less than satisfied clusters. Fifteen per cent were mainly dissatisfied with the physical environment, 8% mainly with interpersonal care, 7% only with information and decision-making and 3% with all dimensions. Women in the different clusters differed statistically significantly in psychological health in early pregnancy, emotional reactions during labour and in labour outcomes, but not in background characteristics.

    CONCLUSION: Looking at different dimensions of care instead of a single global measure gave a richer, more diverse, and also a more negative picture of women's experiences of intrapartum care.

  • 40.
    Rudman, Ann
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    Frögéli, E.
    Skyvell Nilsson, M.
    Gaining acceptance, insight and ability to act: A process evaluation of a preventive stress intervention as part of a transition-to-practice programme for newly graduated nurses2024In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 80, no 2, p. 597-611Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate how NGNs perceived and applied an intervention for preventing stress-related ill health embedded in a transition-to-practice programme when entering their professional life. Design: A qualitative exploratory descriptive design was selected for this study to gain insights and perspectives on the adoption and utilization of the intervention. Methods: In this qualitative methodology process evaluation, semi-structured and audio-recorded interviews were conducted with a sample of 49 nurses. Data were collected between December 2016 and July 2017, and were sorted in NVivo 12 Plus, followed by thematic analysis. Results: The analysis resulted in three change processes stimulated by the intervention: (a) Building acceptance of being new; (b) Gaining insight into professional development and health and (c) Practical steps for skills development, healthy habits and better-organized work. In addition to the three themes, barriers that hindered the progression of the processes were also described. Each process influenced the development of the others by stimulating a deeper understanding, motivation to change and courage to act. Several barriers were identified, including the use of cognitively demanding intervention tools, fatigue, high work demands, inconvenient work hours and a hostile social climate on the ward. Conclusion: This process evaluation showed that newly graduated nurses used knowledge from the intervention and adopted new behaviours largely in accordance with how the intervention was intended to work. Impact: When entering a new profession, it is crucial to receive a well-thought-out, structured and targeted introduction to the new professional role, tasks and work group. Nurses stated that the intervention increased their understanding of the role as new nurses and their insight into how to develop skills that promoted better functioning and recovery. The intervention also stimulated the development of new health behaviour and some new learning strategies. © 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.

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  • 41.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Gustavsson, J Petter
    Burnout during nursing education predicts lower occupational preparedness and future clinical performance: a longitudinal study.2012In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 49, no 8, p. 988-1001Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Early-career burnout among nurses can influence health and professional development, as well as quality of care. However, the prospective occupational consequences of study burnout have not previously been investigated in a national sample using a longitudinal design.

    OBJECTIVES: To prospectively monitor study burnout for a national sample of nursing students during their years in higher education and at follow-up 1 year post graduation. Further, to relate the possible development of study burnout to prospective health and life outcomes, as well as student and occupational outcomes.

    DESIGN: A longitudinal cohort of Swedish nursing students (within the population-based LANE (Longitudinal Analysis of Nursing Education/Entry) study) from all sites of education in Sweden was surveyed annually. Data were collected at four points in time over 4 years: three times during higher education and 1 year post graduation.

    PARTICIPANTS: : A longitudinal sample of 1702 respondents was prospectively followed from late autumn 2002 to spring 2006.

    METHODS: Mean level changes of study burnout (as measured by the Oldenburg Burnout Inventory, i.e. the Exhaustion and Disengagement subscales) across time, as well as prospective effects of baseline study burnout and changes in study burnout levels, were estimated using Latent Growth Curve Modeling.

    RESULTS: An increase in study burnout (from 30% to 41%) across 3 years in higher education was found, and levels of both Exhaustion and Disengagement increased significantly across the years in education (p<0.001). Baseline levels, as well as development of study burnout, predicted lower levels of in-class learner engagement and occupational preparedness in the final year. At follow-up 1 year post graduation, earlier development of study burnout was related to lower mastery of occupational tasks, less research utilization in everyday clinical practice and higher turnover intentions.

    CONCLUSIONS: The results suggest that study burnout may have interfered with learning and psychological well-being. Aspects related to work skills and intention to leave the profession were also affected. Thus, burnout development during higher education may be an important concern, and effective preventive measures to counteract burnout development may be necessary already at the outset of nursing education.

  • 42.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Gustavsson, J Petter
    Early-career burnout among new graduate nurses: a prospective observational study of intra-individual change trajectories.2011In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, no 3, p. 292-306Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Newly qualified and inexperienced nurses are at particular risk of suffering emotional exhaustion and burnout in unsupportive practice environments. Despite new nurses' potential vulnerability, development of burnout after graduation has rarely been studied longitudinally and in relation to demographic and educational characteristics prior to working life entry, i.e. during education.

    OBJECTIVES: To identify and compare typical change trajectories (i.e. common patterns of intra-individual development) in burnout symptoms for new graduate nurses annually over a three-year period, during which there was reason to believe that this group was especially vulnerable.

    DESIGN: A prospective longitudinal and national cohort of 1153 nurses within the population-based LANE study (Longitudinal Analyses of Nursing Education), where new graduate nurses were assessed four times annually, i.e. in their final year of nursing education and three times post graduation (after 1, 2 and 3 years).

    PARTICIPANTS: A longitudinal sample of 997 respondents was prospectively followed.

    METHODS: Within-group changes in burnout levels were analysed using a repeated-measures analysis of variance, and cluster analytic techniques were used to identify typical trajectories of burnout.

    RESULTS: At group level, mean levels of burnout were rather stable across time. However, underlying these levels we identified eight change trajectories, explaining 74% of all individual variation; seven of them reflected significant changes across time. Almost every fifth nurse reported extremely high levels of burnout at some point during their first three years after graduation. Changes in burnout levels were accompanied by concurrent changes in depressive symptoms and intention to leave the profession. This study also showed that negative development of burnout was predicted by not feeling well prepared for a nursing job, lacking study interest, high levels of performance-based self-esteem and depressive mood in the final year of education.

    CONCLUSIONS: An investigation of burnout symptoms over time disclosed numerous development patterns, some of which were stable while others changed significantly. Hence, this study gave a more nuanced picture of burnout development among new graduate nurses, highlighted by eight different trajectories. Regarding the time frame, nearly every second new graduate showed a significant increase in levels of burnout during their second year post graduation.

  • 43.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Gustavsson, Petter
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Boström, Anne-Marie
    Wallin, Lars
    Registered nurses evidence based practice: A longitudinal study of the first five years after graduation2012Conference paper (Refereed)
  • 44.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Gustavsson, Petter
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Boström, Anne-Marie
    Wallin, Lars
    Karolinska Instiutet.
    Registered nurses' evidence-based practice: a longitudinal study of the first five years after graduation2012In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 49, no 12, p. 1494-1504Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The capacity to provide evidence-based practice is one of five core competencies that it is proposed all healthcare professions should possess to meet the needs of the 21st century healthcare system. New nurses are faced with a challenging work environment which, combined with shortcomings in undergraduate education and their limited clinical experience, may affect their evidence-based practice.

    OBJECTIVE: The aim of this study was to prospectively examine the extent of Swedish nurses' evidence-based practice during the first five years of professional life.

    DESIGN: An observational longitudinal study, with yearly data collections over the course of five years. SETTINGS: Data was collected in two national cohorts (named EX2004 and EX2006) of Swedish registered nurses. Nurses in EX2006 were followed yearly during the first three years after graduation and nurses in EX2004 yearly three to five years after graduation. They had completed a three year academic nursing program and mainly worked in in-patient care settings.

    PARTICIPANTS: Participants were recruited while studying at any of the 26 universities in Sweden. A total of 2107 (EX2006) and 2331 (EX2004) nursing students were eligible. 1207 and 1227 nurses were included in the current longitudinal samples. The nurses had a mean age of 31.2/33.9years old and a majority were female. The cohorts were representative of the general nursing population.

    METHODS: Data was self-reported and collected through annual postal surveys. Evidence-based practice was conceptualized as a process and measured with an instrument including six items. Data was analyzed using latent growth curve modeling.

    RESULTS: The extent of evidence-based practice was stable, between the two cohorts and over time. Individual differences existed and remained stable over time. However, the extent of practicing the different components of evidence-based practice on a monthly basis varied considerably, from 10% of the nurses (appraising research reports) to 80% (using information sources other than databases to search for knowledge).

    CONCLUSION: The extent of evidence-based practice remained unchanged during the first five years of professional life. It appears important to enhance both the contribution of undergraduate education and the contextual conditions in work life, in order to improve evidence-based practice among newly graduated nurses.

  • 45.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Gustavsson, Petter
    Hultell, Daniel
    A prospective study of nurses' intentions to leave the profession during their first five years of practice in Sweden.2014In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 51, no 4, p. 612-24, article id S0020-7489(13)00273-3Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nursing turnover continues to be a problem for healthcare organizations. Longitudinal research is needed in order to monitor the development of turnover intentions to leave the profession over time.

    OBJECTIVE: The objectives were: (1) to investigate the prevalence of new graduates' intentions to leave the nursing profession, (2) to prospectively monitor the development of intention to leave during the first five years of professional life, and (3) to study the impact of sex, age, occupational preparedness and burnout (i.e. exhaustion and disengagement) on the development of intention to leave the profession.

    DESIGN: Longitudinal observational study.

    PARTICIPANTS: Participants were recruited from first-year nursing students at any of the 26 universities in Sweden offering nursing education. Of the 2331 student nurses who were invited to participate in the study, 1702 (73%) gave informed consent and thus constituted the cohort. This cohort was prospectively followed yearly (three times during education and five times post graduation) from late autumn 2002 to spring 2010. Of the 1501 respondents who continued to participate after graduating, 1417 worked as nurses at the time of data collection and responded to the items regarding intention to leave the nursing profession during at least one wave of measurement; these constituted the sample of the present longitudinal study.

    METHODS: The outcome variable was intention to leave the nursing profession. This was measured using a scale of three items, covering thoughts of leaving the profession. The main predictor was burnout, and this was measured by the exhaustion and disengagement scale from the Oldenburg Burnout Inventory. Data were analysed using latent growth curve modelling.

    RESULTS: After five years, every fifth nurse strongly intended to leave the profession. The longitudinal analysis of change in intention to leave showed that levels increased during the first years of employment. High levels of burnout were related to an increase in intention to leave.

    CONCLUSION: It is important for organizations employing new graduates to pay attention to nurses who show early signs of burnout, and provide a resourceful work environment with a suitable workload, sufficient introduction, management support, satisfactory collaboration with colleagues, and role clarity.

  • 46.
    Rudman, Ann
    et al.
    Karolinska institutet, Stockholm.
    Hörberg, Anna
    Karolinska institutet, Stockholm.
    Dahlgren, Anna
    Gustavsson, Petter
    Hälsa ett decennium efter karriärstart: Långtidsuppföljning av LUST-studien. Vetenskaplig slutrapport till AFA Försäkring (d nr 150284).2020Report (Other academic)
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  • 47.
    Rudman, Ann Ingmarsdotter
    Institutionen för kvinnors och barns hälsa / Department of Women's and Children's Health, Karolinska Institutet.
    Women's evaluations of intrapartum and postpartum care2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to increase understanding of women s evaluations of intrapartum and postpartum care. Evaluations of specific aspects of care, general assessments of intrapartum and postpartum care, and predictors of not being satisfied were investigated, as well as negative experiences of postpartum care, as expressed in women s own words. The four papers included in this thesis are based on selected quantitative data (Papers I-III) and qualitative data (Paper IV) from a national prospective longitudinal study (the KUB study: Women s Experiences of Childbirth). During a period of three weeks, evenly spread over one year (in May and September 1999 and January 2000), women were recruited at their first booking visit at an antenatal clinic. In total, 593 (97%) antenatal clinics participated in the recruitment. According to the Swedish Medical Birth Register, 4600 women were eligible for study. Approximately 3000 Swedish-speaking women were surveyed at three time points: early pregnancy, two months and one year postpartum. The number of respondents to the first questionnaire was 3061, to the second 2762 and to the third 2563. To assess representativity, the background characteristics of the study sample were compared with the total Swedish birth cohort of women in 1999. When asked to give an overall assessment of their experiences at two months after the birth, 10% of new mothers were not satisfied with intrapartum care and 26% were not satisfied with postpartum care. A more detailed analysis, including specific questions related to different aspects of care (interpersonal care, information and decision-making, information and support, the physical environment, medical check-ups and breastfeeding support) revealed a larger percentage of dissatisfied mothers. By this method, 33% were not satisfied with intrapartum care when assessments on the different dimensions were taken into account simultaneously, and 47% were dissatisfied with postpartum care. These findings illustrate the complexity of care evaluations, and that single-item questions may underestimate negative experiences. When taking all aspects of intrapartum and postpartum care into account, those related to emotional dimensions of care seemed to influence women s assessments the most. Interactions with the caregiver and the interpersonal manner of the caregiver were particularly important. Further important factors were: having sufficient time for personal support, as well as information and involvement in care decisions. Findings indicate that women should be given the opportunity to talk through their birth experience postpartum and air their own questions and concerns. On the postpartum ward, lack of attention to the mother herself was identified as a problem. Dissatisfaction with time available for support and care, was not necessarily too short, but rather inappropriate or not tailored to individual needs. Similarly, the duration of the hospital stay was not seen as sensitive to individual needs. A lack of balanced breastfeeding information and support, with the absence of a tolerant and respectful attitude to mothers who experience difficulties, was reported. The physical environment, both during and after the birth, was associated with women s negative experiences of care. Smaller units and family-oriented wards, where the baby s father could stay overnight, were associated with a positive experience of postpartum care. Some maternal characteristics and health problems during pregnancy related to how care was experienced. Pregnant women who experienced many physical problems had an increased risk of a more negative assessment of both episodes of care, and the risk increased with the number or severity of symptoms. Women with higher depressive symptoms and lower sense of coherence were primarily dissatisfied with interpersonal care as well as information and decision-making during labour. The opposite was found in women who were very satisfied with postpartum care. The outcome of labour and birth, such as infant health, affected women s ratings of intrapartum care. A woman s feelings during labour also seemed to influence the way she rated intrapartum care retrospectively. Altogether 150 women gave written negative comments about postpartum care in response to an openended questionnaire. Problems described by women were: lack of opportunity to rest and recover, nonindividualised information and breastfeeding support, and inappropriate symptom management.

  • 48.
    Rudman, Ann
    et al.
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Melander, Sara
    Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Lindström, Veronica
    Falk, Lotta
    Hörberg, Anna
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Ehrenberg, Anna
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Wallin, Lars
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Rasoal, Dara
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Dahlgren, Anna
    Boström, Anne-Marie
    Gustavsson, Petter
    Dahl, Oili
    Sjuksköterskor i frontlinjen av COVID-19 pandemin: Vilka blev konsekvenserna? Teknisk rapport om enkät och datainsamling2022Report (Other academic)
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  • 49.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Omne-Pontén, Marianne
    Wallin, Lars
    Karolinska Institutet.
    Gustavsson, Petter J
    Monitoring the newly qualified nurses in Sweden: the Longitudinal Analysis of Nursing Education (LANE) study2010In: Human Resources for Health, E-ISSN 1478-4491, Vol. 8, p. 10-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Longitudinal Analysis of Nursing Education (LANE) study was initiated in 2002, with the aim of longitudinally examining a wide variety of individual and work-related variables related to psychological and physical health, as well as rates of employee and occupational turnover, and professional development among nursing students in the process of becoming registered nurses and entering working life. The aim of this paper is to present the LANE study, to estimate representativeness and analyse response rates over time, and also to describe common career pathways and life transitions during the first years of working life.

    METHODS: Three Swedish national cohorts of nursing students on university degree programmes were recruited to constitute the cohorts. Of 6138 students who were eligible for participation, a total of 4316 consented to participate and responded at baseline (response rate 70%). The cohorts will be followed prospectively for at least three years of their working life.

    RESULTS: Sociodemographic data in the cohorts were found to be close to population data, as point estimates only differed by 0-3% from population values. Response rates were found to decline somewhat across time, and this decrease was present in all analysed subgroups. During the first year after graduation, nearly all participants had qualified as nurses and had later also held nursing positions. The most common reason for not working was due to maternity leave. About 10% of the cohorts who graduated in 2002 and 2004 intended to leave the profession one year after graduating, and among those who graduated in 2006 the figure was almost twice as high. Intention to leave the profession was more common among young nurses. In the cohort who graduated in 2002, nearly every fifth registered nurse continued to further higher educational training within the health professions. Moreover, in this cohort, about 2% of the participants had left the nursing profession five years after graduating.

    CONCLUSION: Both high response rates and professional retention imply a potential for a thorough analysis of professional practice and occupational health.

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  • 50.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Waldenström, Ulla
    Critical views on postpartum care expressed by new mothers2007In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 7, article id 178Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Women's evaluation of hospital postpartum care has consistently been more negative than their assessment of other types of maternity care. The need to further explore what is wrong with postpartum care, in order to stimulate changes and improvements, has been stressed. The principal aim of this study was to describe women's negative experiences of hospital postpartum care, expressed in their own words. Characteristics of the women who spontaneously gave negative comments about postpartum care were compared with those who did not.

    METHODS: Data were taken from a population-based prospective longitudinal study of 2783 Swedish-speaking women surveyed at three time points: in early pregnancy, at two months, and at one year postpartum. At the end of the two follow-up questionnaires, women were asked to add any comment they wished. Content analysis of their statements was performed.

    RESULTS: Altogether 150 women gave negative comments about postpartum care, and this sample was largely representative of the total population-based cohort. The women gave a diverse and detailed description of their experiences, for instance about lack of opportunity to rest and recover, difficulty in getting individualised information and breastfeeding support, and appropriate symptom management. The different statements were summarised in six categories: organisation and environment, staff attitudes and behaviour, breastfeeding support, information, the role of the father and attention to the mother.

    CONCLUSION: The findings of this study underline the need to further discuss and specify the aims of postpartum care. The challenge of providing high-quality follow-up after childbirth is discussed in the light of a development characterised by a continuous reduction in the length of hospital stay, in combination with increasing public demands for information and individualised care.

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