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  • 101. Fossum, Mariann
    et al.
    Ehnfors, Margareta
    Fruhling, Ann
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Implementing research-based clinical guidelines integrated in a computerized decision support system in elderly care facilities2012Konferansepaper (Fagfellevurdert)
  • 102. Fossum, Mariann
    et al.
    Ehnfors, Margareta
    Fruhling, Ann
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    The experience of using a computerized decision support system2012Inngår i: 2012 11th International Congress on Nursing InformaticsJune 23 - June 27, 2012, Montreal, Canada: Proceedings, Montreal, Kanada, 2012Konferansepaper (Fagfellevurdert)
  • 103.
    Fossum, Mariann
    et al.
    Centre for Caring Research, Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
    Opsal, Anne
    Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Nurses' sources of information to inform clinical practice: An integrative review to guide evidence-based practice2022Inngår i: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 19, nr 5, s. 372-379Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Evidence-based practice in nursing is challenging and relies on the sources of information used by nurses to inform clinical practice. An integrative review from 2008 revealed that nurses more frequently relied on information from colleagues than information from high-level sources such as systematic reviews and evidence-based clinical practice guidelines.

    AIMS: To describe the information sources used by registered nurses to inform their clinical practice.

    METHODS: An integrative review was conducted according to the PRISMA guidelines, based on empirical research studies published from January 2007 until June 2021. The included studies were appraised, following which the identified sources of information from quantitative studies were compiled and ranked. Finally, the qualitative text data were summarized into categories.

    RESULTS: Fifty-two studies from various countries were included. The majority of studies employed a quantitative design and used original instruments. Peers were ranked as the number one source of information to inform nurses' clinical practice. However, computers and reference materials are now ranked among the top four most used information sources.

    LINKING EVIDENCE TO ACTION: Improvement in computer and information searching skills, as well as the availability of computerized decision support tools, may contribute to nurses' frequent use of digital sources and reference material to inform clinical practice. This review shows that nurses' most frequently reported peer nurses as their source of information in clinical practice. Information sources such as computers and reference materials were ranked higher, and information from patients was ranked lower than in the 2008 review. Developing and standardizing instruments and ensuring high-quality study design is critical for further research on nurses' sources of information for clinical practice.

    Fulltekst (pdf)
    fulltext
  • 104. Fossum, Mariann
    et al.
    Terjesen, Solveig
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehnfors, Margareta
    Söderhamn, Olle
    Evaluation of the Norwegian version of the Mini Nutritional assessment (MNA®) among older nursing home patients2009Inngår i: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, nr 2, s. 50-52Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The Mini Nutritional Assessment (MNA®) is a well-known clinical scale that is often used for nutritional screening of older people in different settings recommended by several international clinical and scientific organizations. Aims: The aims of this article were: 1) to translate the MNA® from English to Norwegian and 2) to test the Norwegian version of the instrument for reliability and validity in a small sample of older nursing home patients. Methods: The English version of the MNA® was translated according to recommended procedures. A convenience sample of 26 older nursing home patients was screened with the MNA® by 10 registered nurses. Reliability and validity of the instrument were assessed. Results: Support for reliability and validity was shown in the study group. Conclusion: Positive support for sufficient quality of the Norwegian version of the MNA® was shown, but further testing of the instrument is needed.

  • 105.
    Fossum, Marianne
    et al.
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden b Center for Caring Research – Southern Norway ; Department of Health and Nursing Science, Faculty of Health and Sport .
    Ehnfors, Margareta
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Svensson, Elisabeth
    Swedish Business School, Örebro University, Örebro, Sweden.
    Hansen, Linda M.
    Center for Caring Research – Southern Norway, Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: An intervention study2013Inngår i: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 82, nr 10, s. 911-921Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. Nursing documentation is essential for facilitating the flow of information to guarantee continuity, quality and safety in care. High-quality nursing documentation is frequently lacking; the implementation of computerized decision support systems is expected to improve clinical practice and nursing documentation.

    Aim. The present study aimed at investigate the effects of a computerized decision support system and an educational program as intervention strategies for improved nursing documentation practice on pressure ulcers and malnutrition in nursing homes.

    Design, setting and participants. An intervention study with two intervention groups and one control group was used. Fifteen nursing homes in southern Norway were included. A convenience sample of electronic healthcare records from 46 units was included. Inclusion criteria were records with presence of pressure ulcers and/or malnutrition. The residents were assessed before and after an intervention of a computerized decision support system in the electronic healthcare records. Data were collected through a review of 150 records before (2007) and 141 records after the intervention (2009).

    Methods. The nurses in intervention group 1 were offered educational sessions and were trained to use the computerized decision support system, which they used for eight months in 2008 and 2009. The nurses in intervention group 2 were offered the same educational program but did not use the computerized decision support system. The nurses in the control group were not subject to any intervention. The resident records were examined for the completeness and comprehensiveness of the documentation of pressure ulcers and malnutrition with three data collection forms and the data were analyzed with non-parametric statistics.

    Results. The implementation of the computerized decision support system and the educational program resulted in a more complete and comprehensive documentation of pressure ulcer- and malnutrition-related nursing assessments and nursing interventions.

    Conclusion. This study provides evidence that the computerized decision support system and an educational program as implementation strategies had a positive influence on nursing documentation practice.

  • 106. Frivoll Johnsen, Kersti
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Fossum, Mariann
    Universitetet i Agder, Kristansand, Norge.
    Dokumentasjon av sykepleie i sykehjem: nn vurdering av innhold og kvalitet på sykepleiedokumentasjonen og vurdering av reliabiliteten til instrumentet N-Catch2014Inngår i: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 34, nr 2, s. 27-32Artikkel i tidsskrift (Fagfellevurdert)
  • 107.
    Förberg, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institutet, Stockholm.
    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 records2012Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, nr 9-10, s. 1339-1344Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 108.
    Förberg, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Johansson, Eva
    Ygge, Britt-Marie
    Wallin, Lars
    Karolinska Institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Accuracy in documentation of pheripheral venous catheters in paediatric care: An intervention study in electronic patient records2011Konferansepaper (Annet vitenskapelig)
  • 109.
    Förberg, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Unbeck, Maria
    Karolinska institutet.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Johansson, Eva
    Petzold, Max
    Ygge, Britt-Marie
    Karolinska institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care: a cluster randomised study2016Inngår i: Implementation Science, E-ISSN 1748-5908, Vol. 11, nr 1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention.

    METHODS: The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention.

    RESULTS: No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal.

    CONCLUSIONS: The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs.

    TRIAL REGISTRATION: Current Controlled Trials ISRCTN44819426.

    Fulltekst (pdf)
    fulltext
  • 110.
    Förberg, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Unbeck, Maria
    Karolinska institutet.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Johansson, Eva
    Karolinska institutet.
    Ygge, Britt-Marie
    Karolinska institutet.
    Petzold, Max
    Göteborgs universitet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Effects of electronic reminders on complications of peripheral venous catheters and nurses' adherence to guidelines in pediatric care: A cluster randomized study2014Konferansepaper (Fagfellevurdert)
  • 111.
    Förberg, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institutet.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Johansson, Eva
    Ygge, Britt-Marie
    Backheden, Magnus
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Relationship between work context and adherence to clinical practice guideline for peripheral venous catheters among registered nurses in paediatric care2014Inngår i: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 11, nr 4, s. 227-239Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: It is known that registered nurses' (RNs') work context is related to their use of research and that it can affect nurse and patient satisfaction, as well as the outcomes of care. However, little is known about the relationship between work context and nurses' adherence to clinical practice guidelines. The aim of this study was to describe RNs' adherence to a clinical practice guideline (CPG) on the management of peripheral venous catheters (PVCs), their perceptions of work context, and how nurses' work context and characteristics relate to guideline adherence. 

    Methods: This cross-sectional survey was conducted at a large pediatric university hospital in Sweden. Data were collected through a questionnaire on RNs' adherence to components of a CPG and by using the Alberta Context Tool to assess the nurses' perceptions of work context, including leadership, culture, feedback processes, and other organizational characteristics. 

    Results: Work context-in the form of structural and electronic resources, information sharing activities, and feedback processes-was in different ways associated with the adherence to the CPG components. The RNs' adherence on unit level varied: half the units demonstrated complete adherence on disinfection of hands, whereas a majority of the units reported less than 70% adherence on the use of disposable gloves and the daily inspection of a PVC site. 

    Linking Evidence to Action: Our findings indicate that components in one CPG might require diverse implementation strategies because they are linked to different contextual factors.

  • 112.
    Förberg, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ygge, Britt-Marie
    Johansson, Eva
    Wallin, Lars
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Accuracy in recording of intravenous catheters in paediatric care2009Inngår i: Conference on Advances in Health Care Science Research, Stockholm, 2009Konferansepaper (Fagfellevurdert)
  • 113. Garmo, A
    et al.
    Pettersson-Frank, B
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Treatment effects and satisfaction in diabetic patients changing from multiple daily insulin injections to CSII2004Inngår i: Practical Diabetes International , ISSN 1528-252X, Vol. 21, nr 1, s. 7-12Artikkel i tidsskrift (Fagfellevurdert)
  • 114.
    Gelin, Maria
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Center for Clinical Research Dalarna, Uppsala University, Falun.
    Gesar, Berit
    Center for Clinical Research Dalarna, Uppsala University, Falun; Uppsala University, Uppsala.
    Källberg, Ann-Sofie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Center for Clinical Research Dalarna, Uppsala University, Falun.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Gustavsson, Catharina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Center for Clinical Research Dalarna, Uppsala University, Falun; Uppsala University, Uppsala.
    Introducing a triage and Nurse on Call model in primary health care - a focus group study of health care staff's experiences2023Inngår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, nr 1, artikkel-id 1299Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: With the increased demand for health care services and with simultaneous staff shortages, new work models are needed in primary health care. In November 2015, a Swedish primary health care centre introduced a work model consisting of a structured patient sorting system with triage and Nurse on Call. The aim of this study was to describe the staff's experiences of introducing the triage and Nurse on Call model at the primary health care centre.

    METHODS: Five focus group discussions with staff (n = 39) were conducted 4 years after the introduction of the work model. Groups were divided by profession: medical secretaries, nursing assistants, physicians, primary health care nurses, and registered nurses. The transcribed text from the discussions was analysed using qualitative inductive content analysis.

    RESULTS: The analysis generated one overarching theme: The introduction of triage and Nurse on Call addresses changed preconditions in primary health care, but the work culture, organization, and acquisition of new knowledge are lagging behind. The overarching theme had five categories: (1) Changed preconditions in primary health care motivate new work models; (2) The triage and Nurse on Call model improves teamwork and may increase the quality of care; (3) Unclear purpose and vague leadership make introducing the work model difficult; (4) Difficulties to adopt the work model as it challenges professional autonomy; and (5) The triage and Nurse on Call model requires more knowledge and competence from nurses in primary health care.

    CONCLUSIONS: This study contributes with knowledge about implications of a new work model in primary health care from the perspective of health care staff. The work model using triage and Nurse on Call in primary health care was perceived by participants to increase availability and optimize the use of resources. However, before introduction of new work models, it is important to identify barriers to and facilitators for successful improvements in the local health care context. Additional education for the health care staff is important if the transition is to be successful. Complementary skills and teamwork, supported by a facilitator seems important to ensure a well-prepared workforce.

    Fulltekst (pdf)
    fulltext
  • 115. Gunningberg, L
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Accuracy and quality in the nursing documentation of pressure ulcers: A comparison of record content and patient examination2004Inngår i: Journal of Wound, Ostomy and Continence Nursing (WOCN), ISSN 1071-5754, E-ISSN 1528-3976, Vol. 31, nr 6, s. 328-335Artikkel i tidsskrift (Fagfellevurdert)
  • 116. Gunningberg, L
    et al.
    Fogelberg-Dahm, M
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Accuracy in the recording of pressure ulcers and prevention after implementing an electronic health record in hospital care2008Inngår i: Quality and Safety in Healthcare, ISSN 1475-3898, E-ISSN 1470-7934, Vol. 17, nr 4, s. 281-285Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To compare the accuracy in recording of pressure-ulcer prevalence and prevention before and after implementing an electronic health record (EHR) with templates for pressure-ulcer assessment. 

    Methods: All inpatients at the departments of surgery, medicine and geriatrics were inspected for the presence of pressure ulcers, according to the European Pressure Ulcer Advisory Panel -methodology, during 1 day in 2002 (n= 357) and repeated in 2006 (n= 343). The corresponding patient records were audited retrospectively for the presence of documentation on pressure ulcers. 

    Results: In 2002, the prevalence of pressure ulcers obtained by auditing paper-based patient records (n= 413) was 14.3%, compared with 33.3% in physical inspection (n= 357). The largest difference was seen in the geriatric department, where records revealed 22.9% pressure ulcers and skin inspection 59.3%. Four years later, after the implementation of the EHR, there were 20.7% recorded pressure ulcers and 30.0% found by physical examination of patients. The accuracy of the prevalence data had improved most in the geriatric department, where the EHR showed 48.1% and physical examination 43.2% pressure ulcers. Corresponding figures in the surgical department were 22.2% and 14.1%, and in the medical department 29.9% and 10.2%, respectively. The patients received pressure-reducing equipment to a higher degree (51.6%) than documented in the patient record (7.9%) in 2006. 

    Conclusions: The accuracy in pressure-ulcer recording improved in the EHR compared with the paper-based health record. However, there were still deficiencies, which mean that patient records did not serve as a valid source of information on pressure-ulcer prevalence and prevention.

  • 117. Gunningberg, Lena
    et al.
    Fogelberg-Dahm, Marie
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Are record data on pressure ulcers reliable? A comparison between paper based-records and electronic health records.2007Inngår i: 10 th EPUAP conference, Oxford, United Kingdom, 2007Konferansepaper (Fagfellevurdert)
  • 118. Gunningberg, Lena
    et al.
    Fogelberg-Dahm, Marie
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Improved quality and comprehensiveness in nursing documentation of pressure ulcers after implementing an electronic health record in hospital care2009Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, nr 11, s. 1557-1564Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims. One aim was to compare the quality and comprehensiveness in nursing documentation of pressure ulcers before and after implementation of an electronic health record in a hospital setting. Another aim was to investigate the use of preformulated templates for pressure ulcer recording in the electronic health record. Background. With the possibilities of the electronic health record to provide information and give accurate and reliable feedback to the healthcare organisation, it is of high priority to develop standardised documentation practices for various areas of care (e.g. such as pressure ulcer care). Design. A cross-sectional retrospective review of health records. Methods. Three departments in a Swedish university hospital participated. In 2002, there were 413 patients, including 59 paper-based records identified with notes on pressure ulcers and in 2006, 343 patients, including 71 electronic health records with pressure ulcer recording. Recorded data on pressure ulcers were retrospectively reviewed. Results. Significantly more patient records showed notes of pressure ulcer grade (p < 0·001), size (p = 0·004), risk assessment (p = 0·002), nursing history (p = 0·040), nursing diagnoses (p < 0·001), nursing goals (p < 0·001) and nursing outcomes (p = 0·016) in 2006 than in 2002. One third of the recordings used preformulated templates. Conclusions. Although there were significant improvements in pressure ulcer recording after the change to the electronic health record, several deficiencies remained. Due to the short time of our follow-up after implementation of the electronic health record, we suspect that the quality of recording will improve when nurses become more familiar with the new system. Relevance to clinical practice. Education related to the use of the electronic health record and evidence-based pressure ulcer prevention should be provided to the nurses. To facilitate documentation, the templates need to be refined to be more user-friendly.

  • 119. Göransson, K
    et al.
    Ehnfors, M
    M, Fonteyn
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Thinking strategies used by registered nurses during emergency department triage2008Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 61, nr 2, s. 163-172Artikkel i tidsskrift (Fagfellevurdert)
  • 120. Göransson, K
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehnfors, M
    A nurse's role in triage in a Swedish Emergency Department2004Inngår i: Emergency Nurses Association 2004 Scientific Assembly, San Diego, California, 2004Konferansepaper (Annet vitenskapelig)
  • 121. Göransson, K
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehnfors, M
    ED triage: Is there a link between nurses' personal characteristics and accuracy in triage decisions?2006Inngår i: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 14, s. 83-88Artikkel i tidsskrift (Fagfellevurdert)
  • 122. Göransson, K
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehnfors, M
    Triage in emergency departments: A national survey in Sweden2005Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, s. 1067-1074Artikkel i tidsskrift (Fagfellevurdert)
  • 123. Göransson, K
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehnfors, M
    Fonteyn, M
    The use of qualitative data analysis software (QDAS) to manage and support the analysis of Think Aloud (TA) data2006Inngår i: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, nr 122, s. 143-6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This methodological paper describes how qualitative data analysis software (QDAS) is being used to manage and support a three-step protocol analysis (PA) of think aloud (TA) data in a study examining emergency nurses' reasoning during triage. The authors believe that QDAS program QRS NVivo will greatly facilitate the PA and will allow them to identify and describe the information that triage nurses concentrate on during triage, and how they structure this information to make a triage decision. These findings could assist in designing and creating decision support systems to guide nurses' triaging. Additionally, details about how to use QRS NVivo for PA of TA data may assist and guide future informatics research using similar methodology are presented here. This innovative use of QDAS holds great promise for future nursing informatics research.

  • 124.
    Göransson, Katarina
    et al.
    Örebro University, Örebro, Sweden.
    Ehnfors, Margareta
    Fonteyn, Marsha E
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro University, Örebro, Sweden.
    Thinking strategies used by Registered Nurses during emergency department triage2008Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 61, nr 2, s. 163-172Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Title.  Thinking strategies used by Registered Nurses during emergency department triage Aim.  This paper is a report of a study to describe and compare thinking strategies and cognitive processing in the emergency department triage process by Registered Nurses with high and low triage accuracy. Background.  Sound clinical reasoning and accurate decision‐making are integral parts of modern nursing practice and are of vital importance during triage in emergency departments. Although studies have shown that individual and contextual factors influence the decisions of Registered Nurses in the triage process, others have failed to explain the relationship between triage accuracy and clinical experience. Furthermore, no study has shown the relationship between Registered Nurses’ thinking strategies and their triage accuracy. Method.  Using the ‘think aloud’ method, data were collected in 2004–2005 from 16 RNs working in Swedish emergency departments who had previously participated in a study examining triage accuracy. Content analysis of the data was performed. Findings.  The Registered Nurses used a variety of thinking strategies, ranging from searching for information, generating hypotheses to stating propositions. They structured the triage process in several ways, beginning by gathering data, generating hypotheses or allocating acuity ratings. Comparison of participants’ use of thinking strategies and the structure of the triage process based on their previous triage accuracy revealed only slight differences. Conclusion.  The wide range of thinking strategies used by Registered Nurses when performing triage indicates that triage decision‐making is complex. Further research is needed to ascertain which skills are most important in triage decision‐making.

  • 125.
    Göransson, Katarina
    et al.
    Örebro University, Örebro, Sweden.
    Ehrenberg, Anna
    Örebro University, Örebro, Sweden.
    Ehnfors, Margareta
    12. A Nurse's Role in Triage in a Swedish Emergency Department2004Inngår i: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966, Vol. 30, nr 5, s. 408-409Artikkel i tidsskrift (Fagfellevurdert)
  • 126.
    Göransson, Katarina
    et al.
    Örebro University, Örebro, Sweden.
    Ehrenberg, Anna
    Örebro University, Örebro, Sweden.
    Ehnfors, Margareta
    Örebro University, Örebro, Sweden.
    A national survey of emergency department triage in Sweden2003Inngår i: AMIA Annual Symposium Proceedings, E-ISSN 1942-597X, Vol. 2003, s. 851-851Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to identify the organisation of and knowledge about triage work in Swedish emergency departments (ED) as a first step to understanding what is necessary for decision support in ED triage systems in Sweden. A national survey using telephone interviews for data collection was used. Results showed great variety in how work regarding ED triage is organised and performed. The variety occurs in several areas including education, personnel performing triage, facilities available and scales used.

  • 127.
    Göransson, Katarina
    et al.
    Örebro University, Örebro, Sweden.
    Ehrenberg, Anna
    Örebro University, Örebro, Sweden.
    Ehnfors, Margareta
    Örebro University, Örebro, Sweden.
    Triage in emergency departments: national survey2005Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, nr 9, s. 1067-1074Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim.  This paper reports a study the aim of which was to describe how triage‐related work was organized and performed in Swedish emergency departments. Background.  Hospitals in many developed countries use some kind of system to prioritize the patients attending emergency departments. Triage is a commonly used term to refer to the process of sorting and prioritizing patients for care. How the triage procedure is organized and which personnel perform this type of work vary considerably throughout the world. In Sweden, few studies have explored this important issue. Method.  A national survey was conducted using telephone interviews, with nurse managers at each of the emergency departments. The sample represented 87% of emergency departments in Sweden. Results.  The findings clearly illustrate the organization of emergency department triage, focusing on personnel who perform triage, as well as the facilities, resources and procedures available for triage. However, the results indicate that work associated with such triage in Sweden is not organized in any consistent matter. In 81% of the emergency departments a clerk, Licensed Practical Nurse or Registered Nurse were assigned to assess patients not arriving by ambulance. There was also diversity in other areas, including requirements for staff to have particular qualifications and clinical experience for being allocated to triage work, as well as facilities for triage personnel assessing and prioritizing patients. The use of triage scales and acuity ratings also lacked uniformity and disparities were observed in both the design and use of triage scales. A little less than half (46%) of the emergency departments did not use any kind of triage scale to document patient acuity ratings. Conclusion.  In contrast to several other countries, this study shows that Swedish emergency departments do not adhere well to established standards and guidelines about triage in emergency care. Research on emergency department triage, especially in the areas of personnel performing triage, triage scales and standards and guidelines are recommended. Relevance to clinical practice.  The diversity among several aspects of nursing triage (e.g. use of less qualified personnel performing triage, the use of different triage scales) presented in the study points to a safety risk for the patients. It also shows the need of further education for the personnel in clinical practice as well as further research on triage in order to gain national consensus about this nursing task.

  • 128.
    Göransson, Katarina
    et al.
    Örebro University.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehnfors, Margareta
    Fonteyn, Marsha
    An effort to use qualitative data analysis software for analysing think aloud data2007Inngår i: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 76, nr Supplement 2, s. S270-S273Artikkel i tidsskrift (Fagfellevurdert)
  • 129.
    Göransson, Katarina
    et al.
    Örebro University, Örebro, Sweden.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro University, Örebro, Sweden.
    Ehnfors, Margareta
    Örebro University, Örebro, Sweden.
    Fonteyn, Marsha
    Dana-Farber Cancer Center, Boston, MA, USA .
    The use of qualitative data analysis software (QDAS) to manage and support the analysis of think aloud (TA) data2006Inngår i: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 122, s. 143-146Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This methodological paper describes how qualitative data analysis software (QDAS) is being used to manage and support a three-step protocol analysis (PA) of think aloud (TA) data in a study examining emergency nurses' reasoning during triage. The authors believe that QDAS program QRS NVivo will greatly facilitate the PA and will allow them to identify and describe the information that triage nurses concentrate on during triage, and how they structure this information to make a triage decision. These findings could assist in designing and creating decision support systems to guide nurses' triaging. Additionally, details about how to use QRS NVivo for PA of TA data may assist and guide future informatics research using similar methodology are presented here. This innovative use of QDAS holds great promise for future nursing informatics research.

    Fulltekst (pdf)
    fulltext
  • 130.
    Göransson, Katarina
    et al.
    Örebro university.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Marklund, Bertil
    Ehnfors, Margareta
    Accuracy and concordance of nurses in emergency department triage2005Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, nr 4, s. 432-438Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In the emergency department (ED) Registered Nurses (RNs) often perform triage, i.e. the sorting and prioritizing of patients. The allocation of acuity ratings is commonly based on a triage scale. To date, three reliable 5-level triage scales exist, of which the Canadian Triage and Acuity Scale (CTAS) is one. In Sweden, few studies on ED triage have been conducted and the organization of triage has been found to vary considerably with no common triage scale. The aim of this study was to investigate the accuracy and concordance of emergency nurses acuity ratings of patient scenarios in the ED setting. Totally, 423 RNs from 48 (62%) Swedish EDs each triaged 18 patient scenarios using the CTAS. Of the 7550 triage ratings, 57.6% were triaged in concordance with the expected outcome and no scenario was triaged into the same triage level by all RNs. Inter-rater agreement for all RNs was kappa = 0.46 (unweighted) and kappa = 0.71 (weighted). The fact that the kappa-values are only moderate to good and the low concordance between the RNs call for further studies, especially from a patient safety perspective.

  • 131.
    Göransson, Katarina
    et al.
    Örebro University, Örebro, Sweden.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro University, Örebro, Sweden.
    Marklund, Bertil
    Ehnfors, Margareta
    Emergency department triage: Is there a link between nurses’ personal characteristics and accuracy in triage decisions?2006Inngår i: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 14, nr 2, s. 83-88Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A common task of registered nurses is to perform emergency department triage, often using an especially designed triage scale in their assessment. However, little information is available about the factors that promote the quality of these decisions. This study investigated personal characteristics of registered nurses and the accuracy in their acuity ratings of patient scenarios. Using the Canadian Triage and Acuity Scale (CTAS), 423 registered nurses from 48 (62%) Swedish emergency departments individually triaged 18 patient scenarios. The registered nurses’ percentage of accurate acuity ratings was 58%, with a range from 22% to 89% accurate acuity ratings per registered nurse. In total, 60.3% of the registered nurses accurately triaged the scenarios in 50–69% of the cases. No relationship was found between personal characteristics of the registered nurses and their ability to triage. The lack of a relationship between personal characteristics of registered nurses and their ability to triage suggests that there might be intrapersonal characteristics, particularly the decision-making strategies used which can partly explain this dispersion. Future research that focuses on decision-making is likely to contribute in identifying and describing essential nursing characteristics for successful emergency department triage.

  • 132.
    Göras, Camilla
    et al.
    Falu Hospital; Center for Clinical Research, Falun.
    Nilsson, Ulrica
    Ekstedt, Mirjam
    Unbeck, Maria
    Karolinska Institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Managing complexity in the operating room: a group interview study.2020Inngår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 20, nr 1, artikkel-id 440Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Clinical work in the operating room (OR) is considered challenging as it is complex, dynamic, and often time- and resource-constrained. Important characteristics for successful management of complexity include adaptations and adaptive coordination when managing expected and unexpected events. However, there is a lack of explorative research addressing what makes things go well and how OR staff describe they do when responding to challenges and compensating for constraints. The aim of this study was therefore to explore how complexity is managed as expressed by operating room nurses, registered nurse anesthetists, and surgeons, and how these professionals adapt to create safe care in the OR.

    METHOD: Data for this qualitative explorative study were collected via group interviews with three professional groups of the OR-team, including operating room nurses, registered nurse anesthetists and operating and assisting surgeons in four group interview sessions, one for each profession except for ORNs for which two separate interviews were performed. The audio-taped transcripts were transcribed verbatim and analyzed by inductive qualitative content analysis.

    RESULTS: The findings revealed three generic categories covering ways of creating safe care in the OR: preconditions and resources, planning and preparing for the expected and unexpected, and adapting to the unexpected. In each generic category, one sub-category emerged that was common to all three professions: coordinating and reaffirming information, creating a plan for the patient and undergoing mental preparation, and prioritizing and solving upcoming problems, respectively.

    CONCLUSION: Creating safe care in the OR should be understood as a process of planning and preparing in order to manage challenging and complex work processes. OR staff need preconditions and resources such as having experience and coordinating and reaffirming information, to make sense of different situations. This requires a mental model, which is created through planning and preparing in different ways. Some situations are repetitive and easier to plan for but planning for the unexpected requires anticipation from experience. The main results strengthen that abilities described in the theory of resilience are used by OR staff as a strategy to manage complexity in the OR.

    Fulltekst (pdf)
    fulltext
  • 133. Göras, Camilla
    et al.
    Nilsson, Ulrica
    Unbeck, Maria
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Safety climate in Swedish operating rooms: A cross sectional survey2015Konferansepaper (Fagfellevurdert)
  • 134. Göras, Camilla
    et al.
    Nilsson, Ulrica
    Unbeck, Maria
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Safety climate in Swedish operating rooms: A cross sectional survey2015Konferansepaper (Annet vitenskapelig)
  • 135. Göras, Camilla
    et al.
    Olin, Karolina
    Unbeck, Maria
    Karolinska Institutet.
    Pukk-Härenstam, Karin
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Tessma, Mesfin Kassaye
    Nilsson, Ulrica
    Ekstedt, Mirjam
    Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study.2019Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 9, nr 5, artikkel-id e026410Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: The work context of the operating room (OR) is considered complex and dynamic with high cognitive demands. A multidimensional view of the complete preoperative and intraoperative work process of the surgical team in the OR has been sparsely described. The aim of this study was to describe the type and frequency of tasks, multitasking, interruptions and their causes during surgical procedures from a multidimensional perspective on the surgical team in the OR.

    DESIGN: Prospective observational study using the Work Observation Method By Activity Timing tool.

    SETTING: An OR department at a county hospital in Sweden.

    PARTICIPANTS: OR nurses (ORNs) (n=10), registered nurse anaesthetists (RNAs) (n=8) and surgeons (n=9).

    RESULTS: The type, frequency and time spent on specific tasks, multitasking and interruptions were measured. From a multidimensional view, the surgical team performed 64 tasks per hour. Communication represented almost half (45.7%) of all observed tasks. Concerning task time, direct care dominated the surgeons' and ORNs' intraoperative time, while in RNAs' work, it was intra-indirect care. In total, 48.2% of time was spent in multitasking and was most often observed in ORNs' and surgeons' work during communication. Interruptions occurred 3.0 per hour, and the largest proportion, 26.7%, was related to equipment. Interruptions were most commonly followed by professional communication.

    CONCLUSIONS: The surgical team constantly dealt with multitasking and interruptions, both with potential impact on workflow and patient safety. Interruptions were commonly followed by professional communication, which may reflect the interactions and constant adaptations in a complex adaptive system. Future research should focus on understanding the complexity within the system, on the design of different work processes and on how teams meet the challenges of a complex adaptive system.

    TRIAL REGISTRATION NUMBER: 2016/264.

    Fulltekst (pdf)
    fulltext
  • 136. Göras, Camilla
    et al.
    Unbeck, Maria
    Karolinska Institutet.
    Nilsson, Ulrica
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro universitet.
    Interprofessional team assessments of the patient safety climate in Swedish operating rooms: a cross-sectional survey2017Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 7, nr 9, artikkel-id e015607Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: A positive patient safety climate within teams has been associated with higher safety performance. The aim of this study was to describe and compare attitudes to patient safety among the various professionals in surgical teams in Swedish operating room (OR) departments. A further aim was to study nurse managers in the OR and medical directors' estimations of their staffs' attitudes to patient safety.

    METHODS: A cross-sectional survey with the Safety Attitudes Questionnaire (SAQ) was used to elicit estimations from surgical teams. To evoke estimations from nurse managers and medical directors about staff attitudes to patient safety, a short questionnaire, based on SAQ, was used. Three OR departments at three different hospitals in Sweden participated. All licensed practical nurses (n=124), perioperative nurses (n=233), physicians (n=184) and their respective manager (n=22) were invited to participate.

    RESULTS: Mean percentage positive scores for the six SAQ factors and the three professional groups varied, and most factors (safety climate, teamwork climate, stress recognition, working conditions and perceptions of management), except job satisfaction, were below 60%. Significantly lower mean values were found for perioperative nurses compared with physicians for perceptions of management (56.4 vs 61.4, p=0.013) and working conditions (63.7 vs 69.8, p=0.007). Nurse managers and medical directors' estimations of their staffs' ratings of the safety climate cohered fairly well.

    CONCLUSIONS: This study shows variations and some weak areas for patient safety climate in the studied ORs as reported by front-line staff and acknowledged by nurse managers and medical directors. This finding is a concern because a weak patient safety climate has been associated with poor patient outcomes. To raise awareness, managers need to support patient safety work in the OR.

    Fulltekst (pdf)
    fulltext
  • 137. Göras, Camilla
    et al.
    Wallentin, Fan Yang
    Nilsson, Ulrica
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Swedish translation and psychometric testing of the safety attitudes questionnaire (operating room version)2013Inngår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 13, artikkel-id 104Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Tens of millions of patients worldwide suffer from avoidable disabling injuries and death every year. Measuring the safety climate in health care is an important step in improving patient safety. The most commonly used instrument to measure safety climate is the Safety Attitudes Questionnaire (SAQ). The aim of the present study was to establish the validity and reliability of the translated version of the SAQ.

    Methods: The SAQ was translated and adapted to the Swedish context. The survey was then carried out with 374 respondents in the operating room (OR) setting. Data was received from three hospitals, a total of 237 responses. Cronbach's alpha and confirmatory factor analysis (CFA) was used to evaluate the reliability and validity of the instrument.

    Results: The Cronbach's alpha values for each of the factors of the SAQ ranged between 0.59 and 0.83. The CFA and its goodness-of-fit indices (SRMR 0.055, RMSEA 0.043, CFI 0.98) showed good model fit. Intercorrelations between the factors safety climate, teamwork climate, job satisfaction, perceptions of management, and working conditions showed moderate to high correlation with each other. The factor stress recognition had no significant correlation with teamwork climate, perception of management, or job satisfaction.

    Conclusions: Therefore, the Swedish translation and psychometric testing of the SAQ (OR version) has good construct validity. However, the reliability analysis suggested that some of the items need further refinement to establish sound internal consistency. As suggested by previous research, the SAQ is potentially a useful tool for evaluating safety climate. However, further psychometric testing is required with larger samples to establish the psychometric properties of the instrument for use in Sweden.

    Fulltekst (pdf)
    fulltext
  • 138. Göras, Camilla
    et al.
    Yang Wallentin, F
    Nilsson, U
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Swedish translation and testing of the Safety Attitudes Questionnaire (OR version)2013Konferansepaper (Fagfellevurdert)
  • 139. Harvey, Gill
    et al.
    Gifford, Wendy
    Cummings, Greta
    Kelly, Janet
    Kislov, Roman
    Kitson, Alison
    Pettersson, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wilson, Paul
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries2019Konferansepaper (Fagfellevurdert)
  • 140. Harvey, Gill
    et al.
    Gifford, Wendy
    Cummings, Greta
    Kelly, Janet
    Kislov, Roman
    Kitson, Alison
    Pettersson, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Göteborgs universitet; Karolinska institutet.
    Wilson, Paul
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries2019Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 90, s. 21-30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The approach and style of leaders is known to be an important factor influencing the translation of research evidence into nursing practice. However, questions remain as to what types of roles are most effective and the specific mechanisms through which influence is achieved.

    OBJECTIVES: The aim of the study was to enhance understanding of the mechanisms by which key nursing roles lead the implementation of evidence-based practice across different care settings and countries and the contextual factors that influence them.

    DESIGN: The study employed a qualitative descriptive approach.

    SETTINGS: Data collection was undertaken in acute care and primary/community health care settings in Australia, Canada, England and Sweden.

    PARTICIPANTS: 55 individuals representing different levels of the nursing leadership structure (executive to frontline), roles (managers and facilitators), sectors (acute and primary/community) and countries.

    METHODS: Individual semi-structured interviews were conducted with all participants exploring their roles and experiences of leading evidence-based practice. Data were analysed through a process of qualitative content analysis.

    RESULTS: Different countries had varying structural arrangements and roles to support evidence-based nursing practice. At a cross-country level, three main themes were identified relating to different mechanisms for enacting evidence-based practice, contextual influences at a policy, organisational and service delivery level and challenges of leading evidence-based practice.

    CONCLUSIONS: National policies around quality and performance shape priorities for evidence-based practice, which in turn influences the roles and mechanisms for implementation that are given prominence. There is a need to maintain a balance between the mechanisms of managing and monitoring performance and facilitating critical questioning and reflection in and on practice. This requires a careful blending of managerial and facilitative leadership. The findings have implications for theory, practice, education and research relating to implementation and evidence-based practice.

  • 141. Harvey, Gill
    et al.
    Kitson, Alison
    Cummings, Greta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gifford, Wendy
    Kelly, Janet
    Kislov, Roman
    Pettersson, Lena
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wilson, Paul
    Mobilising evidence to improve nursing practice: International perspectives on "what, who and how"2017Konferansepaper (Annet vitenskapelig)
  • 142. Häggblom, M
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Problem-based learning in clinical nursing education: Integrating theory and practice2003Rapport (Annet vitenskapelig)
  • 143. Idvall, E
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Nursing documentation of postoperative pain management2004Inngår i: 12th Biennial Conference of the Workgroup of European Nurse Researchers Conference, Lissabon, Portugal, 2004Konferansepaper (Annet vitenskapelig)
  • 144. Johnsen, K
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Fossum, M
    Assessing the nursing documentation using the measurement instrument N-catch2013Konferansepaper (Fagfellevurdert)
  • 145. Kislov, R.
    et al.
    Wilson, P.
    Cummings, G.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gifford, W.
    Kelly, J.
    Kitson, A.
    Pettersson, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institute; Sahlgrenska Academy.
    Harvey, G.
    From Research Evidence to “Evidence by Proxy”?: Organizational Enactment of Evidence-Based Health Care in Four High-Income Countries2019Inngår i: PAR. Public Administration Review, ISSN 0033-3352, E-ISSN 1540-6210, Vol. 79, nr 5, s. 684-698Artikkel i tidsskrift (Fagfellevurdert)
    Fulltekst (pdf)
    fulltext
  • 146. Kislov, Roman
    et al.
    Cummings, Greta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gifford, Wendy
    Harvey, Gill
    Kitson, Alison
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wilson, Paul
    From research evidence to "Evidence by proxy".: Organisational enactment of evidence-based healthcare2019Konferansepaper (Fagfellevurdert)
  • 147. Kislov, Roman
    et al.
    Cummings, Greta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gifford, Wendy
    Harvey, Gill
    Kitson, Alison
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wilson, Paul
    From research evidence to "evidence by proxy"?: Organisational enactment of evidence-based healthcare in four high-income countries2018Konferansepaper (Fagfellevurdert)
  • 148. Kislov, Roman
    et al.
    Cummings, Greta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gifford, Wendy
    Harvey, Gill
    Kitson, Alison
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wilson, Paul
    From research evidence to "research by proxy"?: Organisational enactment of evidence-based healthcare in four high-income countries2018Konferansepaper (Fagfellevurdert)
  • 149. Kislov, Roman
    et al.
    Wilson, Paul
    Cummings, Greta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gifford, Wendy
    Kelly, Janet
    Kitson, Alison
    Pettersson, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Harvey, Gill
    The chain of codified knowledge: Organisational enactment of evidence-based healthcare in four high-income countries.2020Inngår i: Transitions and boundaries in the coordination and reform of health services: Building knowledge, strategy and leadership. / [ed] Nugus, P., Rodriguez, C, Denis, J-L. & Chenevert, D., Cham, Switzerland: Palgrave Macmillan, 2020Kapittel i bok, del av antologi (Fagfellevurdert)
  • 150. Kitson, Alison L
    et al.
    Harvey, Gillian
    Gifford, Wendy
    Hunter, Sarah C
    Kelly, Janet
    Cummings, Greta G
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Kislov, Roman
    Pettersson, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. The Sahlgrenska Academy, University of Gothenburg.
    Wilson, Paul
    How nursing leaders promote evidence-based practice implementation at point-of-care: A four-country exploratory study.2021Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 77, nr 5, s. 2447-2457Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: To describe strategies nursing leaders use to promote evidence-based practice implementation at point-of-care using data from health systems in Australia, Canada, England and Sweden.

    DESIGN: A descriptive, exploratory case-study design based on individual interviews using deductive and inductive thematic analysis and interpretation.

    METHODS: Fifty-five nursing leaders from Australia, Canada, England and Sweden were recruited to participate in the study. Data were collected between September 2015 and April 2016.

    RESULTS: Nursing leaders both in formal managerial roles and enabling roles across four country jurisdictions used similar strategies to promote evidence-based practice implementation. Nursing leaders actively promote evidence-based practice implementation, work to influence evidence-based practice implementation processes and integrate evidence-based practice implementation into everyday policy and practices.

    CONCLUSION: The deliberative, conscious strategies nursing leaders used were consistent across country setting, context and clinical area. These strategies were based on a series of activities and interventions around promoting, influencing and integrating evidence-based practice implementation. We conjecture that these three key strategies may be linked to two overarching ways of demonstrating effective evidence-based practice implementation leadership. The two overarching modes are described as mediating and adapting modes, which reflect complex, dynamic, relationship-focused approaches nursing leaders take towards promoting evidence-based practice implementation.

    IMPACT: This study explored how nursing leaders promote evidence-based practice implementation. Acknowledging and respecting the complex work of nursing leaders in promoting evidence-based practice implementation through mediating and adapting modes of activity is necessary to improve patient outcomes and system effectiveness.

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