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  • 1. Barenfeld, Emmelie
    et al.
    Gustafsson, Susanne
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet; Göteborgs universitet.
    Dahlin-Ivanoff, Synneve
    Supporting decision-making by a health promotion programme: experiences of persons ageing in the context of migration.2017Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 12, nr 1, 1337459Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study is part of the Promoting Aging Migrants' Capabilities programme that applied person-centred group meetings and one individual home visit to prolong independence in daily activities among people ≥70 years who had migrated to Sweden from Finland or the Western Balkan region. With the purpose to understand programme outcomes, the study aimed to explore the participants' everyday experiences of using health-promoting messages exchanged during the programme. Using a grounded theory approach, 12 persons aged 70-83 years were interviewed six months to one year after their participation in the programme. The participants experienced how using health-promoting messages was a dynamic process of how to make decisions on taking action to satisfy health-related needs of oneself or others immediately or deferring action. Five sub-processes were also identified: gaining inner strength, meeting challenges in available resources, being attentive to what is worth knowing, approaching health risks, and identifying opportunities to advocate for others. The results suggest that the programme could develop personal skills to support older people who have migrated to overcome health-related challenges. They further demonstrate the importance of supporting their health literacy before personal resources hinder action, and call for research on programmes to overcome environmental barriers to health.

  • 2. Barenfeld, Emmelie
    et al.
    Gustafsson, Susanne
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Dahlin-Ivanoff, Synneve
    Understanding the "black box" of a health-promotion program: keys to enable health among older persons aging in the context of migration2015Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 10, 29013Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Although the need to make health services more accessible to persons who have migrated has been identified, knowledge about health-promotion programs (HPPs) from the perspective of older persons born abroad is lacking. This study explores the design experiences and content implemented in an adapted version of a group-based HPP developed in a researcher-community partnership. Fourteen persons aged 70-83 years or older who had migrated to Sweden from Finland or the Balkan Peninsula were included. A grounded theory approach guided the data collection and analysis. The findings showed how participants and personnel jointly helped raise awareness. The participants experienced three key processes that could open doors to awareness: enabling community, providing opportunities to understand and be understood, and confirming human values and abilities. Depending on how the HPP content and design are being shaped by the group, the key processes could both inhibit or encourage opening doors to awareness. Therefore, this study provides key insights into how to enable health by deepening the understanding of how the exchange of health-promoting messages is experienced to be facilitated or hindered. This study adds to the scientific knowledge base of how the design and content of HPP may support and recognize the capabilities of persons aging in the context of migration.

  • 3. Barenfeld, Emmelie
    et al.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Björk Brämberg, Elisabeth
    Moving from knowledge to action in partnership: A csae study on program adaptation to support optimal aging in the context of migration2017Ingår i: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This case study explored how a researcher-community partnership contributed to program adaptations when implementing person-centered group-based health promotion services to older people who have migrated to Sweden. The study was conducted over 3 years and various data sources were used: focus groups, individual interviews, documents, and archive material. Findings from different data sources and partners' perspectives were triangulated to an overall case description using an iterative process. Adaptations were shaped through a dynamic process, negotiating toward suitable solutions that culminated in actions taken to adapt or inhibit adaptations. The negotiations were driven by the interplay within and between three reasons to adapt. The partners' opportunities to influence the negotiation process depended on establishing common ground to shape adaptations. Practical implications are provided on how to move from knowledge to action when implementing person-centered group-based health promotion to support optimal aging in the context of migration.

  • 4. Bergström, Anna
    et al.
    Peterson, Stefan
    Namusoko, Sarah
    Waiswa, Peter
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Knowledge translation in Uganda: a qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework2012Ingår i: Implementation science, ISSN 1748-5908, Vol. 7, 117Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this 'know-do' gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the subelements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting.

    METHODS: This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data.

    RESULTS: The sub-elements of organizational context in the PARIHS framework--i.e., receptive context, culture, leadership, and evaluation--also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT.

    CONCLUSIONS: In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings--resources, community involvement, and commitment and informal payment--should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate subelement of the PARIHS framework as a whole.

  • 5. Bergström, Anna
    et al.
    Skeen, Sarah
    Duc, Duong M.
    Blandon, Elmer Zelaya
    Estabrooks, Carole
    Gustavsson, Petter
    Hoa, Dinh Thi Phuong
    Kallestål, Carina
    Malqvist, Mats
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institutet.
    Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings2015Ingår i: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 10, 120Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose.

    Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries.

    Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge.

    Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

  • 6. Bergström, Eva-Britt
    et al.
    Wallin, Lars
    Karolinska Institutet.
    Thomson, Gill
    Flacking, Renée
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Postpartum depression in mothers of infants cared for in a Neonatal Intensive Care Unit: Incidence and associated factors2012Ingår i: Journal of Neonatal Nursing, ISSN 1355-1841, Vol. 18, nr 4, 143-51 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This longitudinal cohort study investigated the incidence of postpartum depression (PPD) among mothers of infants cared for in two Neonatal Intensive Care Units (NICU) and factors related to PPD onset. 123 mothers were posted the Edinburgh Post-Natal Depression Scale (EPDS) and a questionnaire to record infant and maternal data at 1 month, and a repeat EPDS scale at 4 months post-discharge. PPD incidence was 15% at 1 month, 14% at 4 months, and varied by NICU (23% vs. 8%). Pre-pregnancy and/or antenatal depression was significantly associated with the incidence of PPD. Mothers who experienced PPD at 1 month had an almost eight fold risk of experiencing PPD at 4 months. Women who were not offered counselling during their infant’s stay on the NICU had a 60% increased risk for PPD onset. The findings highlight the need for routine pre-natal screening and targeted support for mothers with infants admitted to NICU.

  • 7. Bostrom, Anne-Marie
    et al.
    Rudman, Ann
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gustavsson, Jens Petter
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. 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 study2013Ingår i: BMC Health Services Research, ISSN 1472-6963, Vol. 13, 165Artikel i tidskrift (Refereegranskat)
    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.

  • 8. Boström, Anne-Marie
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Gustavsson, Petter
    Wallin, Lars
    Registered nurses' application of evidence based practice - A national survey2010Ingår i: The 2010 Knowledge Utilization Colloquium, Halifax, Kanada, 2010Konferensbidrag (Refereegranskat)
  • 9. Boström, Anne-Marie
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gustavsson, Petter
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institutet.
    Registered nurses' application of evidence based practice: a national survey2009Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, nr 6, 1159-1163 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Evidence-based practice (EBP) is a worldwide approach to improving health care. There is, however, a shortage of studies examining whether or not newly graduated health care professionals are actually applying EBP in their daily work.

    Objectives. To examine the application of EBP in clinical practice by registered nurses (RNs) 2 years post graduation and to explore whether the application of EBP differed with regard to the clinical settings where RNs were working.

    Method. A cross-sectional design using a national sample. Data were collected in 2007 from 987 RNs (response rate 76%). Six items measuring respondents' self-reported extent of applying EBP were used.

    Results. Of the 987 RNs, 19% formulated questions and performed searches in data bases, 56% used other information sources, 31% appraised the literature, 30% participated in practice development and 34% participated in evaluating clinical practice. A greater proportion of the RNs working in elder care applied EBP compared with the RNs working in hospitals, psychiatric care and primary care.

    Conclusions. The RNs applied the components of EBP to a rather low extent 2 years post graduation despite EBP being an important objective in Swedish health care and educational programmes since the 1990s. These findings support other studies reporting the implementation of EBP in organizations as a complex and often slow process. The differences in the RNs extent of applying EBP in relation to their workplace indicate that contextual factors and the role of the RN in the organization are of importance for getting EBP into practice.

  • 10. Boström, Anne-Marie
    et al.
    Kajermo, Kerstin Nilsson
    Nordström, Gun
    Wallin, Lars
    Karolinska Institutet.
    Barriers to research utilization and research use among registered nurses working in the care of older people: does the BARRIERS scale discriminate between research users and non-research users on perceptions of barriers?2008Ingår i: Implementation science : IS, ISSN 1748-5908, Vol. 3, 24- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: One strategy to enhance research use and change current practice is to identify barriers and then implement tailored interventions to reduce these barriers. In nursing, the BARRIERS scale has been frequently used to identify nurses' perceptions of barriers to research utilization. However, this scale has not been applied to care of older people, and only one study has investigated how identified barriers link to research utilization. Therefore, the purpose of this study was twofold: to describe RNs' perceptions of barriers to and facilitators of research utilization and to examine the validity of the BARRIERS scale in relation to research use.

    METHODS: A cross-sectional survey design was used and registered nurses (RNs) working in the care of older people participated (response rate 67%, n = 140/210). Two questionnaires, the BARRIERS scale and the Research Utilization Questionnaire (RUQ), were used. Data were analyzed using descriptive and bivariate inferential statistics.

    RESULTS: Characteristics of the organization and the presentation of research findings were rated as the most prominent barriers. The three items most frequently reported as barriers were: the nurse is isolated from knowledgeable colleagues with whom to discuss the research (89%); the facilities are inadequate for implementation (88%); and, the relevant literature is not compiled in one place (81%). Surveyed RNs suggested more support from unit managers and better availability of user-friendly reports in Swedish to enhance research use.The RNs reported a modest use of research. A weak but significant correlation was found between the Research Use index in RUQ and the Presentation subscale in the BARRIERS scale (r = -0.289, p < 0.01), suggesting that the RNs reporting more research use were less likely to perceive presentation of research as a barrier. Dividing the sample into research users (n = 29) and non-research users (n = 105), the research users rated significantly lower on the subscales Presentation, Nurse and Research in the BARRIERS scale.

    CONCLUSION: The BARRIERS scale revealed differences in the perception of barriers between research users and non-research users. Thus, methodologically the scale appears useful in identifying some types of barriers to research utilization but not organizational barriers. The identified barriers, however, are general and wide-ranging, making it difficult to design useful specific interventions.

  • 11. Boström, Anne-Marie
    et al.
    Kajermo, Kerstin Nilsson
    Nordström, Gun
    Wallin, Lars
    Karolinska Institutet.
    Registered nurses' use of research findings in the care of older people2009Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, nr 10, 1430-41 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

    DESIGN: A cross-sectional survey.

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

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

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

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

  • 12. Boström, Anne-Marie
    et al.
    Wallin, Lars
    Karolinska Institutet.
    Estabrooks, Carole A
    Kajermo, Kerstin Nilsson
    Commentary on Brown CE, Ecoff L, Kim SC, Wickline MA, Rose B, Klimpel K and Glaser D (2010) Multi-institutional study of barriers to research utilisation and evidence-based practice among hospital nurses. Journal of Clinical Nursing 19, 1944-1951.2012Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, nr 19-20, 2995-6 s.Artikel i tidskrift (Refereegranskat)
  • 13. Boström, Anne-Marie
    et al.
    Wallin, Lars
    Karolinska Institutet.
    Nordström, Gun
    Evidence-based practice and determinants of research use in elderly care in Sweden2007Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 13, nr 4, 665-73 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    RATIONALE AND OBJECTIVE: Evidence-based practice is a strategic ingredient in today's health care. Despite extensive efforts to produce and disseminate clinical guidelines, research uptake is still a difficult task. In Sweden, elderly care (EC) has shifted from hospital care to community-based care, and the major nursing-staff group in EC has no university education. These and other factors make implementation of evidence-based care particularly challenging in EC settings. The purpose of this study was to identify determinants of research utilization in EC.

    METHOD: Two questionnaires that cover research utilization and organizational climate were mailed to all staff (n = 132) working in seven EC units. The response rate was 67%.

    RESULTS: Of all respondents, 28% reported that they used research findings in daily practice (the RU group). Remaining respondents constituted the non-RU group. Significant differences existed between the RU group and the non-RU group as per six individual and six organizational factors. Using logistic regression models, four factors were significantly related to research utilization, namely: attitudes toward research (OR = 5.52, P = 0.004); seeking research that is related to clinical practice (OR = 5.56, P = 0.019); support from unit manager (OR = 4.03, P = 0.044) and access to research findings at work place (OR = 6.65, P = 0.005).

    CONCLUSIONS: Individual and organizational factors were associated with the use of research in EC. Despite distinguishing conditions in EC settings, identified factors reflect well-known determinants of research use that, as in many other health care contexts, should be considered in the endeavours of evidence-based practice.

  • 14. Boström, Anne-Marie
    et al.
    Wallin, Lars
    Karolinska Institutet.
    Nordström, Gun
    Research use in the care of older people: a survey among healthcare staff2006Ingår i: International Journal of Older People Nursing, ISSN 1748-3735, Vol. 1, nr 3, 131-40 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background.  Sweden has one of the largest proportions of older people in the world. To manage the healthcare needs of an aging population, there has been an alteration from hospital care to community-based care. In these settings, the majority of staff is enrolled nurses (EN) and nurse aides (NA) without university education. Aim and design.  The overall aim of this cross-sectional survey was to explore staff perceptions of factors related to research utilization in the care of older people. Method.  Questionnaires covering research utilization and demographics were sent to all staff (n = 132) working in seven units in older people care. The response rate was 67% (n = 89). The respondents consisted of ENs/NAs (n = 63), Registered Nurses (RN) and rehabilitation professionals (RP) as physiotherapists and occupational therapists (RN/RP n = 26). Results.  Most of staff reported positive attitudes towards research. The RNs/RPs stated more often than the ENs/NAs that they wanted to base their practice on research (81% vs. 25%; P = 0.001). The RNs/RPs also reported a greater extent of research use in daily practice (54% vs. 17%; P = 0.001). Support from colleagues (77% vs. 22%; P < 0.001) and unit managers (73% vs. 10%; P < 0.001) for implementing research findings was also more frequently reported by the RNs/RPs compared with the ENs/NAs. The majority of the ENs/NAs stated Do not know on many items concerning attitudes towards research, support for research utilization and actual use of research. Conclusions.  Despite overall positive attitudes towards research, the majority of staff did not use research findings in daily practice. This was particularly valid for the EN/NA group. Relevance to clinical practice.  There is an urgent need for managers and others in the care of older people to develop strategies for implementing evidence-based practice that involves the EN/NA group.

  • 15. Cummings, Greta G
    et al.
    Estabrooks, Carole A
    Midodzi, William K
    Wallin, Lars
    Karolinska Institutet.
    Hayduk, Leslie
    Influence of organizational characteristics and context on research utilization2007Ingår i: Nursing Research, ISSN 0029-6562, E-ISSN 1538-9847, Vol. 56, nr 4 Suppl, 24-39 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Despite three decades of empirical investigation into research utilization and a renewed emphasis on evidence-based medicine and evidence-based practice in the past decade, understanding of factors influencing research uptake in nursing remains limited. There is, however, increased awareness that organizational influences are important.

    OBJECTIVES: To develop and test a theoretical model of organizational influences that predict research utilization by nurses and to assess the influence of varying degrees of context, based on the Promoting Action on Research Implementation in Health Services (PARIHS) framework, on research utilization and other variables.

    METHODS: The study sample was drawn from a census of registered nurses working in acute care hospitals in Alberta, Canada, accessed through their professional licensing body (n = 6,526 nurses; 52.8% response rate). Three variables that measured PARIHS dimensions of context (culture, leadership, and evaluation) were used to sort cases into one of four mutually exclusive data sets that reflected less positive to more positive context. Then, a theoretical model of hospital- and unit-level influences on research utilization was developed and tested, using structural equation modeling, and 300 cases were randomly selected from each of the four data sets.

    RESULTS: Model test results were as follows--low context: chi2= 124.5, df = 80, p <. 001; partially low: chi2= 144.2, p <. 001, df = 80; partially high: chi2= 157.3, df = 80, p <. 001; and partially low: chi2= 146.0, df = 80, p <. 001. Hospital characteristics that positively influenced research utilization by nurses were staff development, opportunity for nurse-to-nurse collaboration, and staffing and support services. Increased emotional exhaustion led to less reported research utilization and higher rates of patient and nurse adverse events. Nurses working in contexts with more positive culture, leadership, and evaluation also reported significantly more research utilization, staff development, and lower rates of patient and staff adverse events than did nurses working in less positive contexts (i.e., those that lacked positive culture, leadership, or evaluation).

    CONCLUSION: The findings highlight the combined importance of culture, leadership, and evaluation to increase research utilization and improve patient safety. The findings may serve to strengthen the PARIHS framework and to suggest that, although it is not fully developed, the framework is an appropriate guide to implement research into practice.

  • 16. Duc, Duong M
    et al.
    Bergström, Anna
    Eriksson, Leif
    Selling, Katarina
    Thi Thu Ha, Bui
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Response process and test-retest reliability of the Context Assessment for Community Health tool in Vietnam2016Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, 31572Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The recently developed Context Assessment for Community Health (COACH) tool aims to measure aspects of the local healthcare context perceived to influence knowledge translation in low- and middle-income countries. The tool measures eight dimensions (organizational resources, community engagement, monitoring services for action, sources of knowledge, commitment to work, work culture, leadership, and informal payment) through 49 items.

    OBJECTIVE: The study aimed to explore the understanding and stability of the COACH tool among health providers in Vietnam.

    DESIGNS: To investigate the response process, think-aloud interviews were undertaken with five community health workers, six nurses and midwives, and five physicians. Identified problems were classified according to Conrad and Blair's taxonomy and grouped according to an estimation of the magnitude of the problem's effect on the response data. Further, the stability of the tool was examined using a test-retest survey among 77 respondents. The reliability was analyzed for items (intraclass correlation coefficient (ICC) and percent agreement) and dimensions (ICC and Bland-Altman plots).

    RESULTS: In general, the think-aloud interviews revealed that the COACH tool was perceived as clear, well organized, and easy to answer. Most items were understood as intended. However, seven prominent problems in the items were identified and the content of three dimensions was perceived to be of a sensitive nature. In the test-retest survey, two-thirds of the items and seven of eight dimensions were found to have an ICC agreement ranging from moderate to substantial (0.5-0.7), demonstrating that the instrument has an acceptable level of stability.

    CONCLUSIONS: This study provides evidence that the Vietnamese translation of the COACH tool is generally perceived to be clear and easy to understand and has acceptable stability. There is, however, a need to rephrase and add generic examples to clarify some items and to further review items with low ICC.

  • 17. Duong, Duc M.
    et al.
    Bergström, Anna
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Bui, Ha T. T.
    Eriksson, Leif
    Eldh, Ann Catrine
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Exploring the influence of context in a community-based facilitation intervention focusing on neonatal health and survival in Vietnam: a qualitative study2015Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, nr 15, 814Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    In the Neonatal health – Knowledge into Practice (NeoKIP) trial in Vietnam, local stakeholder groups, supported by trained laywomen acting as facilitators, promoted knowledge translation (KT) resulting in decreased neonatal mortality. In general, as well as in the community-based NeoKIP trial, there is a need to further understand how context influences KT interventions in low- and middle-income countries (LMICs). Thus, the objective of this study was to explore the influence of context on the facilitation process in the NeoKIP intervention.

    Methods

    A secondary content analysis was performed on 16 Focus Group Discussions with facilitators and participants of the stakeholder groups, applying an inductive approach to the content on context through naïve understanding and structured analysis.

    Results

    The three main-categories of context found to influence the facilitation process in the NeoKIP intervention were: (1) Support and collaboration of local authorities and other communal stakeholders; (2) Incentives to, and motivation of, participants; and (3) Low health care coverage and utilization. In particular, the role of local authorities in a KT intervention was recognized as important. Also, while project participants expected financial incentives, non-financial benefits such as individual learning were considered to balance the lack of reimbursement in the NeoKIP intervention. Further, project participants recognized the need to acknowledge the needs of disadvantaged groups.

    Conclusions

    This study provides insight for further understanding of the influence of contextual aspects to improve effects of a KT intervention in Vietnam. We suggest that future KT interventions should apply strategies to improve local authorities’ engagement, to identify and communicate non-financial incentives, and to make disadvantaged groups a priority. Further studies to evaluate the contextual aspects in KT interventions in LMICs are also needed.

  • 18.
    Ehrenberg, Anna
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Edberg, Anna-KarinFriberg, FebeWallin, LarsHögskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.Wijk, Helle
    Omvårdnad på avancerad nivå: Kärnkompetenser inom sjuksköterskans specialistområden2013Samlingsverk (redaktörskap) (Övrigt vetenskapligt)
  • 19.
    Ehrenberg, Anna
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Friberg, Febe
    Wallin, Lars
    Wijk, Helle
    Öhlén, Joakim
    Omvårdnadens grunder: En specialutgåva för sjuksköterskor2010Bok (Övrigt vetenskapligt)
  • 20.
    Ehrenberg, Anna
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Förberg, Ulrika
    Karolinska institutet.
    Unbeck, Maria
    Karolinska institutet.
    Johansson, Eva
    Karolinska institutet.
    Ygge, Britt-Marie
    Karolinska institutet.
    Petzold, Max
    Göteborgs universitet.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Electronic reminders as an implementation strategy for the uptake of clinical practice guidelines for peripheral venous catheters in pediatric care: A cluster randomized study2014Ingår i: Welcome to KU 14, The 14th annual Knowledge Utilization (KU), June 25-27 2014, at the Quality Spa and Resort Dalecarlia in Tällberg, Sweden., 2014Konferensbidrag (Refereegranskat)
  • 21.
    Ehrenberg, Anna
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gustavsson, Petter
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Boström, Anne-Marie
    Rudman, Ann
    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.2016Ingår i: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 13, nr 6, 454-462 s.Artikel i tidskrift (Refereegranskat)
    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.

  • 22.
    Ehrenberg, Anna
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wallin, LarsHögskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Omvårdnadens grunder: Ansvar och utveckling2014Samlingsverk (redaktörskap) (Övrig (populärvetenskap, debatt, mm))
  • 23.
    Ehrenberg, Anna
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Forsman, Henrietta
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Nyexaminerade sjuksköterskors användning av forskningsresultat och tillämpning av evidensbaserad vård2013Ingår i: Verksamhetsförlagd utbildning i högskolans vårdutbildningar – Att stödja lärande den 13-14 november 2013 i Skövde: Sammanfattningar av föredrag, 2013Konferensbidrag (Övrig (populärvetenskap, debatt, mm))
  • 24.
    Ehrenberg, Anna
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Wallin, LarsHögskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.Friberg, FebeEdberg, Anna-KarinWijk, HelleÖhlén, Joakim
    Omvårdnadens grunder: Ansvar och utveckling2009Bok (Övrigt vetenskapligt)
  • 25.
    Ehrenberg, Anna
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    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 graduation2014Konferensbidrag (Refereegranskat)
  • 26.
    Eldh, Ann Catrine
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Almost, Joan
    DeCorby-Watson, Kara
    Gifford, Wendy
    University of Ottawa.
    Harvey, Gill
    University of Adelaide.
    Hasson, Henna
    Karolinska Institutet.
    Kenny, Deborah
    Moodie, S
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Yost, J
    Clinical interventions, implementation interventions, and the potential greyness in between - a discussion paper2017Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, nr 1, 16Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is increasing awareness that regardless of the proven value of clinical interventions, the use of effective strategies to implement such interventions into clinical practice is necessary to ensure that patients receive the benefits. However, there is often confusion between what is the clinical intervention and what is the implementation intervention. This may be caused by a lack of conceptual clarity between 'intervention' and 'implementation', yet at other times by ambiguity in application. We suggest that both the scientific and the clinical communities would benefit from greater clarity; therefore, in this paper, we address the concepts of intervention and implementation, primarily as in clinical interventions and implementation interventions, and explore the grey area in between. Discussion: To begin, we consider the similarities, differences and potential greyness between clinical interventions and implementation interventions through an overview of concepts. This is illustrated with reference to two examples of clinical interventions and implementation intervention studies, including the potential ambiguity in between. We then discuss strategies to explore the hybridity of clinical-implementation intervention studies, including the role of theories, frameworks, models, and reporting guidelines that can be applied to help clarify the clinical and implementation intervention, respectively. Conclusion: Semantics provide opportunities for improved precision in depicting what is 'intervention' and what is 'implementation' in health care research. Further, attention to study design, the use of theory, and adoption of reporting guidelines can assist in distinguishing between the clinical intervention and the implementation intervention. However, certain aspects may remain unclear in analyses of hybrid studies of clinical and implementation interventions. Recognizing this potential greyness can inform further discourse.

  • 27.
    Eldh, Ann Catrine
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Squires, J.A.
    Estabrooks, C.E.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Translating and testing the Alberta Context Tool for use among nurses in Swedish elder care2013Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, 68Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. There is emerging evidence that context is important for successful transfer of research knowledge into health care practice. The Alberta Context Tool (ACT) is a Canadian developed research-based instrument that assesses 10 modifiable concepts of organizational context considered important for health care professionals’ use of evidence. Swedish and Canadian health care have similarities in terms of organisational and professional aspects, suggesting that the ACT could be used for measuring context in Sweden. This paper reports on the translation of the ACT to Swedish and a testing of preliminary aspects of its validity, acceptability and reliability in Swedish elder care.

    Methods. The ACT was translated into Swedish and back-translated into English before being pilot tested in ten elder care facilities for response processes validity, acceptability and reliability (Cronbach’s alpha). Subsequently, further modification was performed.

    Results. In the pilot test, the nurses found the questions easy to respond to (52%) and relevant (65%), yet the questions’ clarity were mainly considered ‘neither clear nor unclear’ (52%). Missing data varied between 0 (0%) and 19 (12%) per item, the most common being 1 missing case per item (15 items). Internal consistency (Cronbach’s Alpha > .70) was reached for 5 out of 8 contextual concepts. Translation and back translation identified 21 linguistic- and semantic related issues and 3 context related deviations, resolved by developers and translators.

    Conclusion. Modifying an instrument is a detailed process, requiring time and consideration of the linguistic and semantic aspects of the instrument, and understanding of the context where the instrument was developed and where it is to be applied. A team, including the instrument’s developers, translators, and researchers is necessary to ensure a valid translation. This study suggests preliminary validity, reliability and acceptability evidence for the ACT when used with nurses in Swedish elder care.

  • 28.
    Eldh, Ann Catrine
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Uppsala universitet.
    Fredriksson, Mio
    Uppsala universitet.
    Halford, Christina
    Uppsala universitet.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Dahlström, Tobias
    Uppsala universitet.
    Vengberg, Sofie
    Uppsala universitet.
    Winblad, Ulrika
    Uppsala universitet.
    Facilitators and barriers to applying a national quality registry for quality improvement in stroke care2014Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, 354Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden.

    METHODS: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis.

    RESULTS: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data.

    CONCLUSION: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.

  • 29.
    Eldh, Ann Catrine
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Uppsala universitet.
    Fredriksson, Mio
    Uppsala universitet.
    Vengberg, Sofie
    Uppsala universitet.
    Halford, Christina
    Uppsala universitet.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Dahlström, Tobias
    Uppsala universitet.
    Winblad, Ulrika
    Uppsala universitet.
    Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden2015Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, nr 1, 519Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study.

    METHODS: We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR).

    RESULTS: In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care.

    CONCLUSIONS: If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process.

  • 30.
    Eldh, Ann Catrine
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Hälleberg-Nyman, M.
    Örebro universitet.
    Forsman, Henrietta
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Hommel, A.
    Lunds universitet.
    Rycroft-Malone, J.
    Bangor University.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Onset prevention of incontinence in orthopaedic nursing and rehabilitation: a multifaceted undertaking2015Konferensbidrag (Refereegranskat)
  • 31.
    Eldh, Ann Catrine
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Tollne, AM
    Karolinska Institutet.
    Förberg, U
    Karolinska Institutet.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    What registered nurses do and do not in the management of pediatric peripheral venous catheters and guidelines: unpacking the outcomes of computer reminders2016Ingår i: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 13, nr 3, 207-215 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Clinical practical guidelines (CPGs) may enhance evidence-based practice, but require implementation. Computer reminders have previously shown various effects in supporting implementation; in a concomitant study, we found no effect on complications in peripheral venous catheters (PVCs) or registered nurses' (RNs) adherence to a CPG in pediatric care. Yet, there is a need to determine how reminders operate in particular contexts.

    Aim: To depict if, in what context, and how computer reminders regarding evidence-based management of PVC in pediatric care are applied according to RNs' actions and experience.

    Methods: Qualitative data from nonparticipant observations and interviews with 18 RNs in four intervention units at a pediatric hospital were analyzed with content analysis.

    Findings: Attention given to the computer reminders varied; the RNs noticed them in units where there was an agreement about the management and recording of PVCs, but not elsewhere. Rather, computer reminders did not facilitate adherence to the PVC-CPG where the CPG was not acknowledged from the start. RNs who knew how to manage PVCs had peer support and received additional reminders, which suggested that the computer reminders added to the significance of PVCs in pediatric care.

    Linking evidence to action: While the computer reminders alone did not support CPG implementation, they further increased the attention to PVCs in contexts where there was a readiness to change along with a supportive culture. We suggest further studies tailoring implementation strategies to include electronic means if there is a beneficial context.

  • 32.
    Eldh, Ann Catrine
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    How single is ‘single’: some pragmatic reflections on single versus multifaceted interventions to facilitate implementation2015Ingår i: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 4, nr 10, 699-701 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An earlier overview of systematic reviews and a subsequent editorial on single-component versus multifaceted interventions to promote knowledge translation (KT) highlight complex issues in implementation science. In this supplemented commentary, further aspects are in focus; we propose examples from (KT) studies probing the issue of single interventions. A main point is that defining what is a single and what is a multifaceted intervention can be ambiguous, depending on how the intervention is conceived. Further, we suggest additional perspectives in terms of strategies to facilitate implementation. More specifically, we argue for a need to depict not only what activities are done in implementation interventions, but to unpack functions in particular contexts, in order to support the progress of implementation science.

  • 33.
    Eldh, Ann Catrine
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Uppsala universitet.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Fredriksson, Mio
    Uppsala universitet.
    Vengberg, Sofie
    Uppsala universitet.
    Winblad, Ulrika
    Uppsala universitet.
    Halford, Christina
    Uppsala universitet.
    Dahlström, Tobias
    Uppsala universitet.
    Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 11, e011562Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement.

    Methods: Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression.

    Results: A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R2=0.76) with ‘Colleagues’ call for local results’ (p=<0.001), ‘Management Request of Registry data’ (p=<0.001), and it was said to be ‘Simple to explain the results to colleagues’ (p=0.02). Using stepwise regression, ‘Colleagues’ call for local results’ was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results.

    Conclusions: While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.

  • 34.
    Eriksson, Leif
    et al.
    Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
    Duc, Duong M
    Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden, Hanoi School of Public Health, Ba Dinh, Hanoi, Vietnam.
    Eldh, Ann Catrine
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden, .
    Thanh, Vu Pham N
    Public Health & Environment Department, Institute of Sociology, 01 Lieu Giai, Ba Dinh, Hanoi, Vietnam.
    Huy, Tran Q
    Department of Medical Services Administration, Ministry of Health, Nursing office, 138A Giang Vo, Ba Dinh, Hanoi, Vietnam.
    Målqvist, Mats
    Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Lessons learned from stakeholders in a facilitation intervention targeting neonatal health in Quang Ninh province, Vietnam2013Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 13, 234Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In northern Vietnam the Neonatal health - Knowledge Into Practice (NeoKIP, Current Controlled Trials ISRCTN44599712) trial has evaluated facilitation as a knowledge translation intervention to improve neonatal survival. The results demonstrated that intervention sites, each having an assigned group including local stakeholders supported by a facilitator, lowered the neonatal mortality rate by 50% during the last intervention year compared with control sites. This process evaluation was conducted to identify and describe mechanisms of the NeoKIP intervention based on experiences of facilitators and intervention group members.

    METHODS: Four focus group discussions (FGDs) were conducted with all facilitators at different occasions and 12 FGDs with 6 intervention groups at 2 occasions. Fifteen FGDs were audio recorded, transcribed verbatim, translated into English, and analysed using thematic analysis.

    RESULTS: Four themes and 17 sub-themes emerged from the 3 FGDs with facilitators, and 5 themes and 18 sub-themes were identified from the 12 FGDs with the intervention groups mirroring the process of, and the barriers to, the intervention. Facilitators and intervention group members concurred that having groups representing various organisations was beneficial. Facilitators were considered important in assembling the groups. The facilitators functioned best if coming from the same geographical area as the groups and if they were able to come to terms with the chair of the groups. However, the facilitators' lack of health knowledge was regarded as a deficit for assisting the groups' assignments. FGD participants experienced the NeoKIP intervention to have impact on the knowledge and behaviour of both intervention group members and the general public, however, they found that the intervention was a slow and time-consuming process. Perceived facilitation barriers were lack of money, inadequate support, and the function of the intervention groups.

    CONCLUSIONS: This qualitative process evaluation contributes to explain the improved neonatal survival and why this occurred after a latent period in the NeoKIP project. The used knowledge translation intervention, where facilitators supported multi-stakeholder coalitions with the mandate to impact upon attitudes and behaviour in the communes, has low costs and potential for being scaled-up within existing healthcare systems.

  • 35. Eriksson, Leif
    et al.
    Huy, Tran Q
    Duc, Duong M
    Ekholm Selling, Katarina
    Hoa, Dinh P
    Thuy, Nguyen T
    Nga, Nguyen T
    Persson, Lars-Åke
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam2016Ingår i: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 17, 23Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention.

    METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models.

    RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46).

    CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

  • 36. Eriksson, Leif
    et al.
    Nga, Nguyen Thu
    Hoa, Dinh P
    Persson, Lars-Åke
    Ewald, Uwe
    Wallin, Lars
    Karolinska Instituet.
    Newborn care and knowledge translation: perceptions among primary healthcare staff in northern Vietnam2011Ingår i: Implementation science, ISSN 1748-5908, Vol. 6, nr 29Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Nearly four million neonatal deaths occur annually in the world despite existing evidence-based knowledge with the potential to prevent many of these deaths. Effective knowledge translation (KT) could help to bridge this know-do gap in global health. The aim of this study was to explore aspects of KT at the primary healthcare level in a northern province in Vietnam.

    METHODS: Six focus-group discussions were conducted with primary healthcare staff members who provided neonatal care in districts that represented three types of geographical areas existing in the province (urban, rural, and mountainous). Recordings were transcribed verbatim, translated into English, and analyzed using content analysis.

    RESULTS: We identified three main categories of importance for KT. Healthcare staff used several channels for acquisition and management of knowledge (1), but none appeared to work well. Participants preferred formal training to reading guideline documents, and they expressed interest in interacting with colleagues at higher levels, which rarely happened. In some geographical areas, traditional medicine (2) seemed to compete with evidence-based practices, whereas in other areas it was a complement. Lack of resources, low frequency of deliveries and, poorly paid staff were observed barriers to keeping skills at an adequate level in the healthcare context (3).

    CONCLUSIONS: This study indicates that primary healthcare staff work in a context that to some extent enables them to translate knowledge into practice. However, the established and structured healthcare system in Vietnam does constitute a base where such processes could be expected to work more effectively. To accelerate the development, thorough considerations over the current situation and carefully targeted actions are required.

  • 37. Eriksson, Leif
    et al.
    Nga, Nguyen Thu
    Målqvist, Mats
    Persson, Lars-Ake
    Ewald, Uwe
    Wallin, Lars
    Uppsala universitet, Karolinska Institutet.
    Evidence-based practice in neonatal health: knowledge among primary health care staff in northern Viet Nam2009Ingår i: Human Resources for Health, ISSN 1478-4491, Vol. 7, 36- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: An estimated four million deaths occur each year among children in the neonatal period. Current evidence-based interventions could prevent a large proportion of these deaths. However, health care workers involved in neonatal care need to have knowledge regarding such practices before being able to put them into action.The aim of this survey was to assess the knowledge of primary health care practitioners regarding basic, evidence-based procedures in neonatal care in a Vietnamese province. A further aim was to investigate whether differences in level of knowledge were linked to certain characteristics of community health centres, such as access to national guidelines in reproductive health care, number of assisted deliveries and geographical location.

    METHODS: This cross-sectional survey was completed within a baseline study preparing for an intervention study on knowledge translation (Implementing knowledge into practice for improved neonatal survival: a community-based trial in Quang Ninh province, Viet Nam, the NeoKIP project, ISRCTN44599712). Sixteen multiple-choice questions from five basic areas of evidence-based practice in neonatal care were distributed to 155 community health centres in 12 districts in a Vietnamese province, reaching 412 primary health care workers.

    RESULTS: All health care workers approached for the survey responded. Overall, they achieved 60% of the maximum score of the questionnaire. Staff level of knowledge on evidence-based practice was linked to the geographical location of the CHC, but not to access to the national guidelines or the number of deliveries at the community level. Two separated geographical areas were identified with differences in staff level of knowledge and concurrent differences in neonatal survival, antenatal care and postnatal home visits.

    CONCLUSION: We have identified a complex pattern of associations between knowledge, geography, demographic factors and neonatal outcomes. Primary health care staff knowledge regarding neonatal health is scarce. This is a factor that is possible to influence and should be considered in future efforts for improving the neonatal health situation in Viet Nam.

  • 38. Estabrooks, CA
    et al.
    Midodzi, WK
    Cummings, G
    Wallin, Lars
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Knowledge utilization and policy implementation (KUPI): An integrated CIHR funded research program2004Ingår i: Margaret Scott Wright Research Day, University of Alberta, Canada, 2004Konferensbidrag (Refereegranskat)
  • 39. Estabrooks, CA
    et al.
    Wallin, Lars
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Milner, M
    Measuring knowledge utilization in health care2004Ingår i: Sigma Theta tau International. Evidence-Based Nursing: Strategies for Improving Practice, Dublin, Ireland, 2004Konferensbidrag (Refereegranskat)
  • 40. Estabrooks, CA
    et al.
    Wallin, Lars
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Milner, M
    Measuring knowledge utilization in health care2003Ingår i: International Journal of Policy Analysis & Evaluation, Vol. 1, nr 1, 3-36 s.Artikel i tidskrift (Refereegranskat)
  • 41. Estabrooks, Carole A
    et al.
    Derksen, Linda
    Winther, Connie
    Lavis, John N
    Scott, Shannon D
    Wallin, Lars
    Karolinska Institutet.
    Profetto-McGrath, Joanne
    The intellectual structure and substance of the knowledge utilization field: a longitudinal author co-citation analysis, 1945 to 20042008Ingår i: Implementation science : IS, ISSN 1748-5908, Vol. 3, 49- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: It has been argued that science and society are in the midst of a far-reaching renegotiation of the social contract between science and society, with society becoming a far more active partner in the creation of knowledge. On the one hand, new forms of knowledge production are emerging, and on the other, both science and society are experiencing a rapid acceleration in new forms of knowledge utilization. Concomitantly since the Second World War, the science underpinning the knowledge utilization field has had exponential growth. Few in-depth examinations of this field exist, and no comprehensive analyses have used bibliometric methods.

    METHODS: Using bibliometric analysis, specifically first author co-citation analysis, our group undertook a domain analysis of the knowledge utilization field, tracing its historical development between 1945 and 2004. Our purposes were to map the historical development of knowledge utilization as a field, and to identify the changing intellectual structure of its scientific domains. We analyzed more than 5,000 articles using citation data drawn from the Web of Science. Search terms were combinations of knowledge, research, evidence, guidelines, ideas, science, innovation, technology, information theory and use, utilization, and uptake.

    RESULTS: We provide an overview of the intellectual structure and how it changed over six decades. The field does not become large enough to represent with a co-citation map until the mid-1960s. Our findings demonstrate vigorous growth from the mid-1960s through 2004, as well as the emergence of specialized domains reflecting distinct collectives of intellectual activity and thought. Until the mid-1980s, the major domains were focused on innovation diffusion, technology transfer, and knowledge utilization. Beginning slowly in the mid-1980s and then growing rapidly, a fourth scientific domain, evidence-based medicine, emerged. The field is dominated in all decades by one individual, Everett Rogers, and by one paradigm, innovation diffusion.

    CONCLUSION: We conclude that the received view that social science disciplines are in a state where no accepted set of principles or theories guide research (i.e., that they are pre-paradigmatic) could not be supported for this field. Second, we document the emergence of a new domain within the knowledge utilization field, evidence-based medicine. Third, we conclude that Everett Rogers was the dominant figure in the field and, until the emergence of evidence-based medicine, his representation of the general diffusion model was the dominant paradigm in the field.

  • 42. Estabrooks, Carole A
    et al.
    Midodzi, William K
    Cummings, Greta G
    Wallin, Lars
    Karolinska Institutet.
    Predicting research use in nursing organizations: a multilevel analysis2007Ingår i: Nursing Research, ISSN 0029-6562, E-ISSN 1538-9847, Vol. 56, nr 4 Suppl, 7-23 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: No empirical literature was found that explained how organizational context (operationalized as a composite of leadership, culture, and evaluation) influences research utilization. Similarly, no work was found on the interaction of individuals and contextual factors, or the relative importance or contribution of forces at different organizational levels to either such proposed interactions or, ultimately, to research utilization.

    OBJECTIVE: To determine independent factors that predict research utilization among nurses, taking into account influences at individual nurse, specialty, and hospital levels.

    DESIGN: Cross-sectional survey data for 4,421 registered nurses in Alberta, Canada were used in a series of multilevel (three levels) modeling analyses to predict research utilization.

    METHODS: A multilevel model was developed in MLwiN version 2.0 and used to: (a) estimate simultaneous effects of several predictors and (b) quantify the amount of explained variance in research utilization that could be apportioned to individual, specialty, and hospital levels.

    FINDINGS: There was significant variation in research utilization (p <.05). Factors (remaining in the final model at statistically significant levels) found to predict more research utilization at the three levels of analysis were as follows. At the individual nurse level (Level 1): time spent on the Internet and lower levels of emotional exhaustion. At the specialty level (Level 2): facilitation, nurse-to-nurse collaboration, a higher context (i.e., of nursing culture, leadership, and evaluation), and perceived ability to control policy. At the hospital level (Level 3): only hospital size was significant in the final model. The total variance in research utilization was 1.04, and the intraclass correlations (the percent contribution by contextual factors) were 4% (variance = 0.04, p <.01) at the hospital level and 8% (variance = 0.09, p <.05) at the specialty level. The contribution attributable to individual factors alone was 87% (variance = 0.91, p <.01).

    CONCLUSIONS: Variation in research utilization was explained mainly by differences in individual characteristics, with specialty- and organizational-level factors contributing relatively little by comparison. Among hospital-level factors, hospital size was the only significant determinant of research utilization. Although organizational determinants explained less variance in the model, they were still statistically significant when analyzed alone. These findings suggest that investigations into mechanisms that influence research utilization must address influences at multiple levels of the organization. Such investigations will require careful attention to both methodological and interpretative challenges present when dealing with multiple units of analysis.

  • 43. Estabrooks, Carole A
    et al.
    Squires, Janet E
    Strandberg, Elisabeth
    Nilsson-Kajermo, Kerstin
    Scott, Shannon D
    Profetto-McGrath, Joanne
    Harley, Dwight
    Wallin, Lars
    Karolinska Institutet.
    Towards better measures of research utilization: a collaborative study in Canada and Sweden2011Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, nr 8, 1705-18 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: This paper is a report of a study examining research utilization in nursing. The specific aims were to (1) clarify the construct of research utilization, and (2) identify observable indicators of research utilization.

    BACKGROUND: Robust measures of research utilization do not exist despite steadily increasing numbers of studies in the field. One reason for this is theoretical confusion surrounding the central concepts in the field.

    METHOD: A qualitative (focus group) design was used to explore the construct of research utilization in two countries: Canada and Sweden. A systematic and sequential (three phases) approach to expert sampling framed the study. Phase 1 consisted of initial construct clarification by the research team (2005). In Phase 2, a face-to-face meeting with a panel of international research utilization nursing experts was held (2005). Phase 3 consisted of a series of focus groups with nursing care (direct and non-direct) providers (2005-2007). Data were analysed using content analysis.

    FINDINGS: The nursing care providers did not commonly use the term 'research utilization'. Several examples of research utilization were provided; a majority of these examples related to instrumental research utilization and became increasingly concrete as one moved from non-direct to direct care participants. Participants identified several indicators of research utilization (instrumental and conceptual). From these indicators, a measurement schematic was derived.

    CONCLUSIONS: The construct of research utilization is multi-faceted. Several indicators of research utilization were identified, which can be used to augment existing or develop a new and improved measure that taps both instrumental and conceptual use.

  • 44.
    Flacking, Renée
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ewald, Uwe
    Wallin, Lars
    Karolinska Institutet.
    Positive effect of Kangaroo Mother Care on long-term breastfeeding in very preterm infants2011Ingår i: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 40, nr 2, 190-197 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate the use of Kangaroo Mother Care (KMC) and its association with breastfeeding at 1 to 6 months of corrected age in mothers of very preterm (VPT) and preterm (PT) infants.

    Design: Prospective longitudinal study. Setting: Neonatal Intensive Care Units in four counties in Sweden. Participants: The study included 103 VPT (<32 gestational weeks) and 197 PT (32-36 gestational weeks) singleton infants and their mothers.

    Methods: Data on KMC, measured in duration of skin-to-skin contact/day during all days admitted to a neonatal unit, were collected using self-reports from the parents. Data on breastfeeding were obtained by telephone interviews.

    Results: VPT dyads that breastfed at 1, 2, 5, and 6 months had spent more time in KMC per day than those not breastfeeding at these times. A trend toward significance was noted at 3 and 4 months. In the PT dyads no statistically significant differences were found in the amount of KMC per day between those dyads that breastfed and those that did not.

    Conclusions: This study shows the importance of KMC during hospital stay for breastfeeding duration in VPT dyads. Hence, KMC has empowering effects on the process of breastfeeding, especially in those dyads with the smallest and most vulnerable infants.

  • 45.
    Flacking, Renée
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Hedberg Nyqvist, K
    Ewald, U
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Long-term duration of breastfeeding in Swedish low birth weight infants2003Ingår i: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 19, nr 2, 157-165 s.Artikel i tidskrift (Refereegranskat)
  • 46.
    Flacking, Renée
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, UK ; Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Thomson, Gill
    University of Central Lancashire.
    Ekenberg, Linda
    Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, UK.
    Löwegren, Linda
    Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, UK.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Influence of NICU co-care facilities and skin-to-skin contact on maternal stress in mothers of preterm infants2013Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, Vol. 4, nr 3, 107-112 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate the influence of co-care facilities and amount of skin-to-skin contact during Neonatal Intensive Care Unit (NICU) stay on maternal stress in mothers of preterm infants at two months corrected age.

    Methods:  A prospective cohort study that involved 300 mothers of pre-term infants was conducted in four NICUs (two with co-care facilities and two with non co-care) in Sweden. Data on duration of skin-to-skin contact per day for all days admitted to the NICU were collected using self-reports. Maternal stress was measured by the Swedish Parental Stress Questionnaire (SPSQ) at two months of infant’s corrected age.

    Results: Mothers whose infants were cared for in a NICU with co-care facilities reported significantly lower levels of stress in the dimension of ‘incompetence’ compared to mothers whose infants had been cared for in non co-care NICUs.  The amount of skin-to- skin experienced during the neonatal stay was not significantly associated with levels of maternal stress at two months corrected age.

    Conclusion:  The finding that mothers who do not experience co-care facilities experience greater levels of stress in relation to feelings of incompetence is of concern. Improvements to NICU environments are needed to ensure that mother-infant dyads are not separated.

  • 47.
    Florin, Jan
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Univ Hosp, Stockholm, Sweden; Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Gustavsson, Petter
    Karolinska Inst, Div Psychol, Dept Clin Neurosci, Stockholm, Sweden.
    Educational support for research utilization and capability beliefs of evidence-based practice skills: a national survey of senior nursing students2012Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 68, nr 4, 888-897 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim. The aim of the study was to investigate Swedish university nursing students’ experience of educational support for research utilization and capability beliefs regarding evidence-based practice skills.

    Background. Nursing programmes are offered at 26 universities in Sweden and even though there are common regulations for nursing education at the national level, substantial variations are found in local curricula. Little is known about students’ capability beliefs regarding evidence-based practice skills, particularly in comparison across universities.

    Methods. A cross-sectional survey design using self-administered postal questionnaires was conducted in 2006. A total of 1440 students (from 26 different universities) participated, constituting 68% of the national population of nursing students in their 6th and final semester.

    Results. Campus education supported the students to a greater extent than clinical education in following the development of knowledge in an area of interest, using research findings, and acquiring knowledge on how to pursue changes in clinical practice. Perceived support during campus education varied between universities. Students reported high capability beliefs regarding evidence-based practice skills, but large differences were found between universities for: stating a searchable question, seeking out relevant knowledge and critically appraising and compiling best knowledge.

    Conclusion. The identified differences between universities concerning the students’ perceived support for research utilization and their capability beliefs regarding evidence-based practice skills have implications for curricula, pedagogical perspectives in nursing education and the potential to implement evidence-based practice in healthcare settings. Further studies are warranted to investigate students’ individual characteristics and organizational characteristics as determinants of research utilization support and capability beliefs regarding evidence-based practice skills.

  • 48. Forberg, Ulrika
    et al.
    Johansson, Eva
    Ygge, Britt-Marie
    Wallin, Lars
    Karolinska Institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Accuracy in documentation of peripheral venous catheters in paediatric care: an intervention study in electronic patient records2012Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, nr 9-10, 1339-1344 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

    Design. Before and after study.

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

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

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

  • 49.
    Forsman, Henrietta
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Rudman, Ann
    Gustavsson, Petter
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Low research use among newly graduated nurses: a threat to patient safety?2011Ingår i: Medicinska Riksstämman 2011, Stockholm, 2011Konferensbidrag (Övrigt vetenskapligt)
    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.

  • 50. Forsman, Henrietta
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Gustavsson, Petter
    Research use in nursing practice and its association to educational, individual and work contextual factors2007Ingår i: 7th Conference on Advances in health Care Science Research, Stockholm, 2007Konferensbidrag (Refereegranskat)
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