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  • 151.
    Koistinen, Susanne
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Vårdvetenskap. Örebro universitet.
    Olai, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Uppsala universitet.
    Ståhlnacke, Katri
    Folktandvårdens Folkhälsoenhet, Region Örebro län.
    Anna, Fält
    Klinisk epidemiologi och biostatistik, Institutionen för medicinska vetenskaper, Örebro universitet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Oral health and oral care in short-term care: prevalence, related factors, and coherence between older peoples and professionals assessments2019Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, nr 3, s. 712-722Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Oral health is important for well-being and overall health. Older peoples oral health is well described in the residential care context, but remains understudied in short-term care.

    Objective: The aim of this study was to describe oral health, daily oral care and related factors among older people in short-term care and to compare self-perceived oral health with professional assessment.

    Materials and methods: This cross-sectional study included 391 older people in 36 short-term units in 19 Swedish municipalities. Oral health was assessed professionally by clinical oral assessment and the Revised Oral Assessment Guide (ROAG). The older peoples’ perceptions of their own oral health were measured with a global question on self-perceived oral health. Self-care ability was assessed with Katz Index of Activities of Daily Living (Katz-ADL).

    Results: Mean age was 82.9 years, 19% of participants were totally edentulous, and 43% had ≥20 teeth. Almost 60% had coating or food debris on their teeth, but only 19% received help with daily oral care. Those who were dependent on help with self-care had around a sixfold higher risk of having oral problems. There was a low level of agreement between the clinical assessment based on ROAG and self-perceived oral health.

    Conclusion: Professionals’ assessments of oral health differed considerably from the older peoples own assessments. A higher risk of oral problems and more occurrence of coating or food debris or broken teeth were seen among those dependent on help with self-care (ADL). This study indicates that in order to improve older peoples oral health and oral care we need to provide person-centred oral care and to develop a close collaboration between nursing and dental staff.

    Fulltekst (pdf)
    Koistinen et al 2019
  • 152.
    Koistinen, Susanne
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Vårdvetenskap.
    Olai, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ståhlnacke, Katri
    Fält, Anna
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Munhälsa hos äldre personer inom korttidsvård bedömd ur två perspektiv, självupplevd och professionell2018Konferansepaper (Fagfellevurdert)
  • 153.
    Koistinen, Susanne
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Vårdvetenskap.
    Olai, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ståhlnacke, Katri
    Fält, Anna
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Munhälsa hos äldre personer inom korttidsvård, bedömd ur två perspektiv, självupplevd och professionell2018Konferansepaper (Fagfellevurdert)
  • 154.
    Koistinen, Susanne
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Vårdvetenskap.
    Olai, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ståhlnacke, Katri
    Fält, Anna
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Munhälsorelaterad livskvalitet hos äldre personer inom korttidsvård2018Konferansepaper (Fagfellevurdert)
  • 155.
    Koistinen, Susanne
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Vårdvetenskap.
    Olai, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ståhlnacke, Katri
    Fält, Anna
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Oral health among elderly people assessed from two perspectives: self-perceived and professional2018Konferansepaper (Fagfellevurdert)
  • 156.
    Koistinen, Susanne
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Vårdvetenskap.
    Olai, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ståhlnacke, Katri
    Fält, Anna
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Oral health and related quality of life among older people in short-term care2019Konferansepaper (Fagfellevurdert)
  • 157.
    Koistinen, Susanne
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Vårdvetenskap.
    Olai, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Uppsala University.
    Ståhlnacke, Katri
    Fält, Anna
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Oral health-related quality of life and associated factors among older people in short-term care.2020Inngår i: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 18, s. 163-172Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: It is well known that oral health status is associated with oral health-related quality of life (OHRQoL) in the general population. The aim of this study was to describe and analyze OHRQoL among older people in short-term care and its associated factors.

    MATERIALS AND METHODS: This cross-sectional study included 391 older people in 36 short-term care units. Data were collected via clinical oral assessments, questions about self-perceived oral and general health, Katz Index of Activities of Daily Living (Katz-ADL) and the Revised Oral Assessment Guide (ROAG). OHRQoL was measured using the Oral Health Impact Profile (OHIP-14). Multivariate logistic regression models were applied in the analysis.

    RESULTS: Poor OHRQoL was reported by 34% of the older people. Associated factors were swallowing problems according to ROAG; quite poor/poor self-perceived physical, psychological, and oral health; and being a woman.

    CONCLUSIONS: There is an association between OHRQoL and older people's self-perceived health according to the OHIP-14. This indicates the importance of early detection of oral health problems in frail older people and to assess both oral health and swallowing problems among older people in short-term care.

    Fulltekst (pdf)
    fulltext
  • 158.
    Koistinen, Susanne
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Umeå University.
    Ståhlnacke, Katri
    Olai, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Uppsala University.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Carlsson, Eva
    Older people's experiences of oral health and assisted daily oral care in short-term facilities.2021Inngår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 21, nr 1, artikkel-id 388Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Older people's oral health has improved, and many retain their natural teeth throughout their life. However, their daily oral care can be more difficult because of compromised general health and the reduced capacity for self-care that often comes with old age. More knowledge is needed about how older people view their oral health and oral care. The aim of this study was to describe how older people in short-term care experience their oral health and daily oral care.

    METHOD: A descriptive, qualitative study was performed through interviews with 14 older people (74-95 years) recruited from short-term care units in two Swedish regions. Data were analysed using inductive content analysis.

    RESULTS: The findings are described in one main category, three categories and nine sub-categories. The main category was Adapting to a changed oral condition while striving to retain independence. The first category, Wanting to manage daily oral care independently, contained three subcategories: Having always brushed my teeth without help, Being satisfied with my mouth and teeth, and Having to accept help if necessary. The second category, Acceptance of changes in oral condition, had three subcategories: Difficulty in chewing and swallowing, Difficulty with tooth brushing, and Not considering a dentist visit to be worth the cost. The third category, Barriers to receiving assistance from staff, had three subcategories: Staff lacking the time to help, Not wanting to be a burden, and Lack of confidence in staff's knowledge.

    CONCLUSIONS: The participants were generally satisfied with their oral health despite an expressed need for dental treatment. Daily oral care was something they wanted to manage themselves, and they had a strong desire to stay independent for as long as possible. Closer collaboration between dental and health care staff is necessary in order to implement clinical practice guidelines for oral health care and increase nursing staff's attention towards older peoples' oral health.

    Fulltekst (pdf)
    fulltext
  • 159.
    Källberg, Ann-Sofie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Falun Hospital and Centre for Clinical Research Dalarna, Falun.
    Berg, Lena M
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Skogli, Sara
    Falun Hospital, Falun.
    Bjurbo, Charlotte
    Uppsala University Hospital, Uppsala.
    Muntlin, Åsa
    Uppsala University Hospital, Uppsala.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Prevalence of frailty and associated factors in older adults seeking care at Swedish emergency departments2023Inngår i: BMC Geriatrics, E-ISSN 1471-2318, Vol. 23, nr 1, artikkel-id 798Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Internationally, prolonged length of stay for older adults in the emergency department (ED) is associated with increased risk of in-hospital adverse events. In Sweden patients 65 years and older account for 35% of emergency visits, and according to consensus from an international expert group, all persons over 70 should be screened for frailty. This is not routinely done in Swedish EDs, and therefore, knowledge about prevalence, characteristics and clinical outcomes associated with frailty is limited.

    AIM: To describe the prevalence of frailty and associated factors in older adults seeking care at Swedish EDs.

    METHODS: The study has a cross-sectional design. Data was collected at three hospital-based EDs, varying in level and size of setting, for one month. Patients age 70 and older presenting at the EDs and agreed to participate were screened for frailty using the FRail Elderly Support researcH group (FRESH) instrument. Data were analysed using descriptive statistics to assess the distribution of patient characteristics and clinical outcomes. Multivariate logistic regression was used to model the association between frailty and demographic characteristics, and Cox regression was used to model the association between frailty and clinical outcomes.

    RESULTS: A total of 3101 patients were eligible for inclusion; of these, 984 (32%) were included and screened for frailty. Of the final sample, 57.3% were assessed as frail. Characteristics significantly associated with frailty were living in a residential care facility, age (> 80 years), being a woman and arriving with emergency medical service (EMS). There was a significant association between frailty and admittance to in-hospital care.

    CONCLUSION: Our study shows a high prevalence of frailty in older people. Factors associated with frailty were living in a residential care facility, age ≥ 80 years, being a woman and arriving with EMS to the ED and being admitted to in-hospital care. Frailty screening should be incorporated in the triage system to identify frail patients who need tailored interventions. More studies using the FRESH instrument are needed to further confirm our findings and to develop the methods for screening for frailty in the ED.

    Fulltekst (pdf)
    fulltext
  • 160. Källberg, Ann-Sofie
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Medical errors in Swedish emergency departments: A national review2010Inngår i: European Society of Emergency Medicine, Stockholm, Sverige, 2010Konferansepaper (Annet vitenskapelig)
  • 161.
    Källberg, Ann-Sofie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Patient safety risks in the emergency department2016Konferansepaper (Fagfellevurdert)
  • 162.
    Källberg, Ann-Sofie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro universitet.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Physicians' and nurses' perceptions of patient safety risks in the emergency department2017Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 33, s. 14-19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 163. Källberg, Ann-Sofie
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Göransson, Katarina
    Karolinska Institutet, Stockholm, Sweden.
    Medical errors regarding emergency department care reported to national authorities in Sweden by care providers and patients2011Inngår i: Australasian emergency nursing journal, ISSN 1574-6267, Vol. 14, s. S18-S18Artikkel i tidsskrift (Fagfellevurdert)
  • 164.
    Källberg, Ann-Sofie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Brixey, Julie
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Contributing factors to errors in Swedish emergency departments2015Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, nr 2, s. 156-161Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The Emergency Department (ED) is a complex and dynamic environment, often resulting in a somewhat uncontrolled and unpredictable workload. Contributing factors to errors in health care and in the ED are largely related to communication breakdowns. Moreover, the ED work environment is predisposed to multitasking, overcrowding and interruptions. These factors are assumed to have a negative impact on patient safety. Reported errors from care providers are mainly related to diagnostic procedures in Swedish EDs. However, there is a lack of knowledge and national oversight regarding contributing factors. The aim of this study was therefore to describe contributing factors in regards to errors occurring in Swedish EDs. 

    Method: Descriptive design based on registry data from the Lex Maria database of the Swedish National Board of Health and Welfare. 

    Results: The results indicate that factors contributing to errors in Swedish EDs are multifactorial in nature. The most common contributing factor was human error followed by factors in the local ED environment and teamwork failure. 

    Conclusion: Factors contributing to ED errors were multifactorial and included both organizational and teamwork failure in which human error was implicated. To reduce errors, further research is needed to develop methods that disclose latent working conditions such as high workload and interruptions. Patient safety research needs to include understanding of human behaviour in complex organizational systems and the impact of working conditions on patient safety and quality of care.

  • 165.
    Källberg, Ann-Sofie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Göransson, Katarina
    Karolinska Institutet, Stockholm.
    Östergren, Jan
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Medical errors and complaints in emergency department care in Sweden as reported by care providers, health care staff and patients: a national review2013Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 20, nr 1, s. 33-38Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Despite an increase in research, there is still a lack of knowledge about patient safety in emergency departments (EDs) in many European countries. The aim of this study was therefore to describe the incidence and types of reported medical errors and complaints in ED care in Sweden.

    Methods: Data reported in 2009 were gathered from national authorities, including the National Board of Health and Welfare, the Medical Responsibility Board, the Patients Advisory Committees, and local incident-reporting systems. Data were analyzed by content analysis.

    Results: Among 428 cases reported by care providers to the National Board of Health and Welfare, 64 (15.0%) were related to ED care. As several cases contained more than one medical error, 92 errors were identified, out of which 39 (42.4%) were related to diagnostic procedures. Among the 4628 cases of complaints reported by patients to the Medical Responsibility Board, 306 (6.6%) were related to ED care. In total, 437 complaints regarding perceived medical errors were identified (several cases contained more than one error), with 189 (43.2%) pertaining to diagnostic procedures. A total of 1341 complaints about ED care were made by patients to the Patients Advisory Committees (n=21), of which 655 (48.8%) were related to care and treatment. There were 7434 medical errors reported to local incident-reporting systems at the EDs (n=45). Of these, 1450 (19.5%) referred to care and treatment.

    Conclusion: Medical errors and complaints at Swedish EDs, as reported by both patients and care providers, were related mainly to diagnostic procedures and treatments.

  • 166. Källberg, Ann-Sofie
    et al.
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Östergren, Jan
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Medical errors at Swedish emergency departments as reported by health care providers, personnel and patients2011Inngår i: The Conference on Advances in Health Care Science Research, Stockholm, Sweden, 2011Konferansepaper (Fagfellevurdert)
  • 167. Källberg, Ann-Sofie
    et al.
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Östergren, Jan
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Medical errors in emergency department care reported to national authorities in Sweden by care providers and patients2011Inngår i: College of Emergency Nursing Australasia International Conference, Adelaide, Australia, 2011Konferansepaper (Fagfellevurdert)
  • 168.
    Källberg, Ann-Sofie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Östergren, Jan
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Perceptions and management of patient safety risks in the emergency department2015Konferansepaper (Fagfellevurdert)
  • 169.
    Liedgren, Pernilla
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Elvhage, Gudrun
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Kullberg, Christian
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    The use of decision support systems in social work: a scoping study literature review2016Inngår i: Journal of Evidence-Informed Social Work, ISSN 2376-1407, E-ISSN 2376-1415, Vol. 13, nr 1, s. 1-20Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Decision support systems are known to be helpful for professionals in many medical professions. In social work, decision support systems have had modest use, accompanied by strong criticism from the profession but often by praise from political management. In this study the aim of the authors was to collect and report on the published evidence on decision support systems in social work. The conclusion of the authors is that a decision support system gives support to social workers in conducting a thorough investigation, but at the same time gives them the freedom to make autonomous decisions that might be the most helpful for and used by social workers. Their results also indicate that decision support systems focusing on atypical rather than typical cases are perceived as the most useful among experienced staff.

  • 170.
    Lindholm, Christina
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Sörensen Duppils, Gill
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Trycksårsprevention - en regional forskningssatsning2010Inngår i: Regionala forskningsrådets konferens, Örebro, 2010Konferansepaper (Fagfellevurdert)
  • 171.
    Naseer, Mahwish
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Agerholm, Janne
    Fastbom, Johan
    Schön, Pär
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Dahlberg, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Emergency department revisits among older adults: A prospective cohort study2019Konferansepaper (Fagfellevurdert)
  • 172.
    Naseer, Mahwish
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete. Karolinska Institutet; Stockholm University.
    Agerholm, Janne
    Fastbom, Johan
    Schön, Pär
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Dahlberg, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete. Karolinska Institutet; Stockholm University.
    Factors associated with emergency department revisits among older adults in two Swedish regions: A prospective cohort study2020Inngår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 86, artikkel-id 103960Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives

    To assess the association between baseline characteristics at an index ED visit and ED revisit within 30 days among adults aged ≥ 65 years in two Swedish regions.

    Methods

    This was a register-based prospective cohort study. The sample included (N=16 688; N=101 017) older adults who have had an index ED visit in 2014 at hospital based EDs in the regions of Dalarna and Stockholm, Sweden. Several registers were linked to obtain information on sociodemographic factors, living conditions, social care, polypharmacy and health care use. Multivariate logistic regression was used to analyse the data.

    Results

    Seventeen percent of the study sample in Dalarna and 20.1% in Stockholm revisited ED within 30 days after an index ED visit. In both regions, male gender, being in the last year of life, excessive polypharmacy (≥ 10 drugs), ≥11 primary care visits and ED care utilization were positively associated with ED revisits. In Stockholm, but not in Dalarna, low level of education, polypharmacy, and institutional care was also associated with ED revisits. In contrast, home help was associated with ED revisits in Dalarna but not in Stockholm.

    Conclusion

    These findings call for further in-depth examinations of variations within single countries. ED revisits among older adults are driven by need of care but also by the social and care situation.

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  • 173.
    Naseer, Mahwish
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Aging Research Center, Karolinska Institutet and Stockholm University.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Aging Research Center, Karolinska Institutet and Stockholm University.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Schön, Pär
    Calderón-Larrañaga, Amaia
    The role of social connections and support in the use of emergency care among older adults2023Inngår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 111, artikkel-id 105010Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Limited and inconsistent findings have been reported on the link between social connections and support and emergency department (ED) visits in older populations. Moreover, the adequacy of informal care for older adults has rarely been considered. This study explored the associations of social connections, social support, and informal care with ED visits in younger-old (<78 years) and oldest-old (≥78 years) adults. Methods: This is a prospective cohort study based on community-living adults ≥60 years old participating in the Swedish National Study on Aging and Care in Kungsholmen (N=3066 at wave 1, 2001-2004; N=1885 at wave 3, 2007-2010; N=1208 at wave 5, 2013-2016). Standardised indexes were developed to measure social connections, social support, and informal care. The outcome variable was hospital-based ED visits within 4 years of the SNAC-K interview. Associations between exposure variables and ED visits were assessed through negative binomial regressions using generalised estimating equations. Results: Medium (IRR 0.77; 95% CI 0.59–0.99) and high (IRR 0.77; 95% CI 0.56–0.99) levels of social support were negatively associated with ED visits compared to low levels of social support, but only in oldest-old adults. No statistically significant associations were observed between social connections and ED visits. Higher ED visit rates were seen in oldest-old adults with unmet informal care needs, even if the differences did not reach statistical significance. Conclusions: ED visits were associated with social support levels among adults aged ≥78 years. Public health interventions to mitigate situations of poor social support may improve health outcomes and reduce avoidable ED visits in oldest-old adults. © 2023

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  • 174.
    Naseer, Mahwish
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Schön, Pär
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Individual and contextual predictors of emergency department visits among community-living older adults: a register-based prospective cohort study2022Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 2, artikkel-id e055484Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To examine the extent to which contextual factors explain emergency department (ED) visits and ED revisits, additional to that explained by individual factors.

    DESIGN: A register-based prospective cohort study.

    SETTING: Swedish region of Dalarna.

    PARTICIPANTS: Participants were 16 543 community-living adults aged 80 or older who were residents of the Dalarna region of Sweden, excluding older adults who moved out of Dalarna or into residential care during the study period.

    OUTCOME MEASURES: Dependent variables were initial ED visit, and at least one ED revisit within 30 days of an initial ED visit.

    RESULTS: Approximately 36% of the participants visited the ED during the study period with 18.9% returning to the ED within 30 days. For both initial ED visits and ED revisits, the addition of contextual factors to models containing individual factors significantly improved model fit (p<0.001; p<0.022) and the amount of variance explained in the outcome. In the final models, initial ED visit was significantly associated with older age, number of chronic diseases, receipt of home help, number of primary care visits, proportion of 80+ in the population and shorter distance to the ED; while an ED revisit was significantly associated with greater use of social care, number of hospital admissions and disposition (discharged; admitted to hospital) at initial ED visit.

    CONCLUSION: Contextual factors explain variance in initial ED visit, additional to that explained by individual factors alone, which indicates inequitable access to ED care. These findings suggest considering local variations in contextual factors in order to improve health-related outcomes among older adults.

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  • 175. Nilsson, U.
    et al.
    Göras, C.
    Wallentin, F. Y.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro University.
    Unbeck, Maria
    Karolinska Institutet.
    The Swedish Safety Attitudes Questionnaire - Operating Room Version: Psychometric Properties in the Surgical Team2018Inngår i: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, nr 6, s. 935-945Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To validate the Swedish Safety Attitudes Questionnaire-operating room (SAQ-OR) version by re-evaluating its psychometric properties for the surgical team.

    Design: Cross-sectional questionnaire study.

    Methods: 541 surgical team members including perioperative nurses, physicians, and licensed practical nurses at three Swedish hospitals were included.

    Findings: For the total sample, the Cronbach's α for the six factors ranged from 0.51 to 0.76. Goodness-of-fit analyses indicated that the six-factor model was acceptable and the factor loadings were statistically significant. The test of the hypothesized relationships among the factors showed a correlation from 0.936 to 0.042.

    Conclusions: The refined Swedish version of the SAQ-OR is a reasonably reliable and acceptably valid instrument for the measurement of patient safety climate in the surgical team. However, the results related to the different analyses varied among the different professionals and further research, using larger samples, is needed to explore these differences, especially among the physicians.

  • 176. Odencrants, Sigrid
    et al.
    Ehnfors, Margareta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Nutritional status and body composition among persons with chronic obstructive pulmonary disease.2009Inngår i: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 1, nr 1, s. 60-70Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim. The aim of the study was to determine whether a relationship exists between nutritional status, assessed by three recommended instruments, and body composition for older persons with Chronic Obstructive Pulmonary Disease (COPD). Background. Commonly reported symptoms of COPD include impaired nutritional status. This is difficult to assess accurately, because currently recommended instruments for risk identification do not evaluate body composition reliably. Design. A descriptive and correlational study; data were collected in 2007. Method. Study participants were 47 women and 34 men with a mean age of 65 years and 48% with very severe COPD. Data collection included body mass index (BMI), waist–hip ratio (WHR), fat-free mass index (FFMI), lung functions and assessment of nutritional status by the mini nutritional assessment (MNA), the malnutrition universal screening tool (MUST) and a national disease-specific instrument (ENS). Results. Participants' BMIs ranged from 15·9 to 43·8. Out of 15 with very low FFMIs five were classified as overweight. One of those participants was identified as malnourished by the MNA, two were identified by the MUST as at high risk for malnutrition and none was identified by the ENS as in need of qualified help with nutrition. Six participants were assessed using each instrument as being in need of special attention for their nutritional status. Correlations between each of the instrument and FFMIs were significant at the 0·01 level for each instrument. Conclusion. A combination of methods gives richer information as single measurements may give misleading results. Assessment of nutritional status cannot rely only on instrument values; there is a need for an astute 'clinical eye' as well. Relevance to clinical practice. The methods are suitable for skilled professional use in clinical practice with people with COPD, but the short form of the MNA and the ENS should be used with caution

  • 177. Odencrants, Sigrid
    et al.
    Ehnfors, Margareta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Nutritional status and patient characteristics for hospitalized elderly patients with chronic obstructive pulmonary disease.2008Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, nr 13, s. 1771-1778Artikkel i tidsskrift (Fagfellevurdert)
  • 178.
    Olin, Karolina
    et al.
    Karolinska Institutet, Stockholm, Sweden; Tyks and Hospital District of Southwest Finland, Turku, Finland.
    Göras, Camilla
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Örebro University, Orebro, Sweden; Falu Hospital, Falun, Sweden.
    Nilsson, Ulrica
    Karolinska Institutet, Stockholm, Sweden.
    Unbeck, Maria
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Institutet, Stockholm, Sweden .
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Pukk-Härenstam, Karin
    Karolinska Institutet, Stockholm, Sweden; Karolinska Universitetssjukhuset, Stockholm, Sweden.
    Ekstedt, Mirjam
    Karolinska Institute, Stockholm, Sweden .
    Mapping registered nurse anaesthetists' intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study2022Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 1, artikkel-id e052283Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Safe anaesthesia care is a fundamental part of healthcare. In a previous study, registered nurse anaesthetists (RNAs) had the highest task frequency, with the largest amount of multitasking and interruptions among all professionals working in a surgical team. There is a lack of knowledge on how these factors are distributed during the intraoperative anaesthesia care process, and what implications they might have on safety and quality of care.

    OBJECTIVE: To map the RNAs' work as done in practice, including tasks, multitasking, interruptions and their causes, and interactions, during all phases of the intraoperative anaesthesia work process.

    METHODS: Structured observations of RNAs (n=8) conducted during 30 procedures lasting a total of 73 hours in an operating department at a county hospital in Sweden, using the Work Observation Method By Activity Timing tool.

    RESULTS: High task intensity and multitasking were revealed during preparation for anaesthesia induction (79 tasks/hour, 61.9% of task time spent multitasking), anaesthesia induction (98 tasks/hour, 50.7%) and preparation for anaesthesia maintenance (86 tasks/hour, 80.2%). Frequent interruptions took place during preoperative preparation (4.7 /hour), anaesthesia induction (6.2 /hour) and preparation for anaesthesia maintenance (4.3 /hour). The interruptions were most often related to medication care (n=54, 19.8%), equipment issues (n=40, 14.7%) or the procedure itself (n=39, 14.3%). RNAs' work was conducted mostly independently (58.4%), but RNAs interacted with multiple professionals in and outside the operating room during anaesthesia.

    CONCLUSION: The tasks, multitasking, interruptions and their causes, and interactions during different phases illustrated the RNAs' work as done, as part of a complex adaptive system. Management of safety in the most intense phases-preparing for anaesthesia induction, induction and preparing for anaesthesia maintenance-should be investigated further. The complexity and adaptivity of the nature of RNAs' work should be taken into consideration in future management, development, research and education.

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  • 179. Oredsson, Sven
    et al.
    Jonsson, Håkan
    Rognes, Jon
    Lind, Lars
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Asplund, Kjell
    Castrén, Maaret
    Farrohknia, Nasim
    A systematic review of triage-related interventions to improve patient flow in emergency departments2011Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 19, artikkel-id 43Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.

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  • 180.
    Palmcrantz, Susanne
    et al.
    Karolinska institutet.
    Tistad, Malin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Karolinska institutet.
    Eldh, Ann Catrine
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Holmqvist, Lotta Widén
    Karolinska institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Tomson, Göran
    Karolinska institutet.
    Olsson, Christina B
    Karolinska institutet; Stockholm läns landsting.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Assessing feasibility and acceptability of study procedures: getting ready for implementation of national stroke guidelines in out-patient health care2015Inngår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 15, artikkel-id 517Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Even though Swedish national guidelines for stroke care (SNGSC) have been accessible for nearly a decade access to stroke rehabilitation in out-patient health care vary considerably. In order to aid future interventions studies for implementation of SNGSC, this study assessed the feasibility and acceptability of study procedures including analysis of the context in out-patient health care settings.

    METHODS: The feasibility and acceptability of recruitment, observations and interviews with managers, staff and patients were assessed, as well as the feasibility of surveying health care records.

    RESULTS: To identify patients from the the hospitals was feasible but not from out-patient care where a need to relieve clinical staff of the recruitment process was identified. Assessing adherence to guidelines and standardized evaluations of patient outcomes through health care records was found to be feasible and suitable assessment tools to evaluate patient outcome were identified. Interviews were found to be a feasible and acceptable tool to survey the context of the health care setting.

    CONCLUSION: In this feasibility study a variety of qualitative and quantitative data collection procedures and measures were tested. The results indicate what can be used as a set of feasible and acceptable data collection procedures and suitable measures for studying implementation of stroke guidelines in an out-patient health care context.

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  • 181.
    Pellas, Ulrika
    et al.
    Region Dalarna.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Svedbo Engström, Maria
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Källberg, Ann-Sofie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Omvårdnadsrådets utlåtande gällande förhållandet mellan antal patienter per sjuksköterska och patientsäkerhet inom somatisk slutenvård med internmedicinsk inriktning: Rapport baserad på uttömmande litteratursökning, underlag för beslut i Region Dalarnas Kunskapsstyrningsgrupp-beredningsgrupp2023Rapport (Annet vitenskapelig)
  • 182. Persson, Lena
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Activities and interruptions in the emergency department: An observational study2010Inngår i: European Society of Emergency Medicine, Stockholm, Sverige, 2010Konferansepaper (Annet vitenskapelig)
  • 183.
    Rudman, Ann
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Institutet, Stockholm.
    Boström, A. -M
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Gustavsson, P.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    The use of the evidence-based practice process by experienced registered nurses to inform and transform clinical practice during the COVID-19 pandemic: A longitudinal national cohort study2024Inngår i: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 21, nr 1, s. 14-22Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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  • 184.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Boström, Anne-Marie
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gustavsson, Petter
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Registered nurses’ evidence-based practice revisited: A longitudinal study in mid-career.2020Inngår i: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 17, nr 5, s. 348-355Artikkel i tidsskrift (Fagfellevurdert)
    Fulltekst (pdf)
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  • 185.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Gustavsson, Petter
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Boström, Anne-Marie
    Wallin, Lars
    Registered nurses evidence based practice: A longitudinal study of the first five years after graduation2012Konferansepaper (Fagfellevurdert)
  • 186.
    Rudman, Ann
    et al.
    Karolinska Institutet.
    Gustavsson, Petter
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Boström, Anne-Marie
    Wallin, Lars
    Karolinska Instiutet.
    Registered nurses' evidence-based practice: a longitudinal study of the first five years after graduation2012Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 49, nr 12, s. 1494-1504Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

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

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

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

  • 187.
    Rudman, Ann
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Melander, Sara
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Lindström, Veronica
    Falk, Lotta
    Hörberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Rasoal, Dara
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Dahlgren, Anna
    Boström, Anne-Marie
    Gustavsson, Petter
    Dahl, Oili
    Sjuksköterskor i frontlinjen av COVID-19 pandemin: Vilka blev konsekvenserna? Teknisk rapport om enkät och datainsamling2022Rapport (Annet vitenskapelig)
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  • 188. Saranto, Kaija
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Throddsen, Asta
    The state of art of standardizing nursing language in European countries2008Inngår i: Medical Informatics in Europe, MIE2008, Göteborg, Sverige, 2008Konferansepaper (Fagfellevurdert)
  • 189. Thoroddsen, Asta
    et al.
    Ehnfors, Margareta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Content and completeness of care plans after implementation of standardized nursing terminologies and computerized records2011Inngår i: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 29, nr 10, s. 599-607Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The nursing process and standardized nursing terminologies are essential elements to structure nursing documentation in daily nursing information management. The aim of this study was to describe sustainability and whether and how standardized nursing terminologies, in handwritten versus preprinted versus computerized nursing care plans, changed the content and completeness of documented nursing care. Three audits of patient records were performed: a pretest (n = 291) before a yearlong implementation of standardized nursing terminologies in nursing care plans followed by two posttests: (1) 3 weeks after implementation of nursing terminologies (n = 299) and (2) 22 months after implementation of nursing terminologies and 8 months after implementation of a computerized system (n = 281) in a university hospital. Content and completeness of documented nursing care improved after implementation of standardized nursing terminologies. Documentation of nursing care plans, signs and symptoms, related factors, and nursing interventions increased, whereas mean number of nursing diagnoses per patient did not change between audits. Computerized nursing care plans had the biggest impact, with more variety of nursing diagnoses and increased documentation of signs and symptoms, related factors, and nursing interventions. The use of standardized nursing terminologies improved nursing content in the nursing care plans. Moreover, computerized nursing care plans, in comparison with handwritten and preprinted care plans, increased documentation completeness.

  • 190. Thoroddsen, Asta
    et al.
    Ehnfors, Margareta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Nursing specialty knowledge expressed by standardized nursing languages2010Inngår i: International Journal of Nursing Terminologies and Classifications, ISSN 2047-3087, E-ISSN 2047-3095, Vol. 21, nr 2, s. 69-79Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE.  To describe how nursing specialty knowledge is demonstrated in nursing records by use of standardized nursing languages.

    METHODS.  A cross-sectional review of nursing records (N = 265) in four specialties.

    FINDINGS.  The most common nursing diagnoses represented basic human needs of patients across specialties. The nursing diagnoses and related interventions represented specific knowledge in each specialty. Sixty-three nursing diagnoses (nine appeared in four specialties) and 168 nursing interventions were used (24 appeared in four specialties).

    CONCLUSIONS.  Findings suggest that standardized nursing languages are capable of distinguishing between specialties. Further studies with large data sets are needed to explore the relationships between nursing diagnoses and nursing interventions in order to make explicit the knowledge that nurses use in their nursing practice.

    PRACTICE IMPLICATIONS.  Nursing data in clinical practice must be stored and retrievable to support clinical decision making, advance nursing knowledge, and the unique perspective of nursing.

  • 191. Thoroddsen, Asta
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehnfors, Margareta
    Accuracy in the documentation of pressure ulcers in patient records2011Inngår i: 8th Biennial European Conference of the Association for Common European Nursing Diagnosis, Interventions and Outcomes, Funchal, Madeira Portugal, 2011Konferansepaper (Fagfellevurdert)
  • 192. Thoroddsen, Asta
    et al.
    Sigurjonsdottir, G
    Ehnfors, Margareta
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Accuracy, completeness and comprehensiveness of information on pressure ulcers recorded in the patient record2013Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, nr 1, s. 84-91Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim:  To describe the accuracy, completeness and comprehensiveness of information on pressure ulcers documented in patient records.

    Design and setting:  A cross-sectional descriptive study performed in 29 wards at a university hospital in Iceland. The study included skin assessment of patients and retrospective audits of records of patients identified with pressure ulcers.

    Participants:  A sample of 219 patients was inspected for signs of pressure ulcers on 1 day in 2008. Records of patients identified with pressure ulcers were audited (n = 45) retrospectively.

    Results:  The prevalence of pressure ulcers was 21%. Information in patient records lacked accuracy, completeness and comprehensiveness. Only 60% of the identified pressure ulcers were documented in the patient records. The lack of accuracy was most prevalent for stage I pressure ulcers.

    Conclusions:  The purpose of documentation to record, communicate and support the flow of information in the patient record was not met. The patient records lacked accuracy, completeness and comprehensiveness, which can jeopardise patient safety, continuity and quality of care. The information on pressure ulcers in patient records was found not to be a reliable source for the evaluation of quality in health care. To improve accuracy, completeness and comprehensiveness of data in the patient record, a systematic risk assessment for pressure ulcers and assessment and treatment of existing pressure ulcers based on evidence-based guidelines need to be implemented and recorded in clinical practice. Health information technology, including the electronic health record with decision support, has shown promising results to facilitate and improve documentation of pressure ulcers.

  • 193. Thorodssen, Asta
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Sermeus, Walter
    Saranto, Kaija
    A survey of nursing documentation, terminologies and standards in European countries2012Konferansepaper (Fagfellevurdert)
  • 194. Throddsen, Asta
    et al.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Saranto, Kaija
    Sermeus, Walter
    Models, standards and structures of nursing documentation in European countries2009Inngår i: Studies in Health Technology and Informatics. Connecting Health and Humans. Proceedings of NI2009 / [ed] Saranto, K; Flatley Brennan, P, Helsingfors, Finland, 2009, Vol. 146, s. 327-331Konferansepaper (Fagfellevurdert)
    Abstract [en]

    The use of standardized nursing languages varies between and even within different European countries. Standardization of a nursing language is a demanding process which requires substantial methodological and technological knowledge as well as cultural experience in terminology development work. A survey was carried out to describe the current state of art of the use of models, standards and structures in nursing documentation. A web-based questionnaire was targeted to members of the Association for Common European Nursing Diagnoses, Interventions and Outcomes (ACENDIO). Replies were received from 17 countries in Europe. Results show that the nursing process is the model most often used to structure nursing documentation in Europe. Many standardized nursing terminologies are used in Europe but general use in nursing is still lacking which makes access to nursing data an obstacle. In more than 60% of the institutions in the countries that replied were nursing data not stored and could therefore not be retrieved. These results should be a major concern to nurses in Europe. This relates to the lack of use of standards in use of nursing terminologies and information systems. Standardization activities in existing and evolving networks in Europe, as well as in other parts of the world, need to be enhanced. As a European platform, ACENDIO can play a role in these standardization activities and should develop its role accordingly.

  • 195.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet; Umeå universitet.
    Palmcrantz, Susanne
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet; Göteborgs universitet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro universitet.
    Olsson, Christina B.
    Tomson, Göran
    Lotta, Widén Holmqvist
    Gifford, Wendy
    Eldh, Ann Catrine
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Developing leadership in managers to facilitate the implementation of national guideline recommendations: a process evaluation of feasibility and usefulness2016Inngår i: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 5, nr 8, s. 477-486Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation.

    Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention.

    Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation.

    Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.

    Fulltekst (pdf)
    fulltext
  • 196.
    Unbeck, Maria
    et al.
    Karolinska Institutet.
    Förberg, Ulrika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institutet.
    Ygge, Britt-Marie
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Petzold, Max
    Johansson, Eva
    Peripheral venous catheter related complications are common among peadiatric and neonatal patients2015Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, nr 6, s. 566-574Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: The aims of this study were to describe the characteristics of peripheral venous catheters (PVCs), including dwell time and reasons for removal, and explore predictors for PVC-related complications. 

    Methods: We included PVCs in 2032 children - 484 neonatal and 1548 paediatric - from 12 inpatient units. Data were retrieved from the patient record system, and predictors for complications were explored using logistic regression analyses. 

    Results: Just over one-third (35.4%) of the PVCs were removed due to complications, in particular infiltration and occlusion (51.9 and 48.4/1000 PVC days, respectively). PVC survival time was shorter in neonatal than paediatric patients (4 versus 5days), and infiltration was more frequent in neonatal patients (92.8 versus 38.7/1000 PVC days). Infiltration was associated with younger age (odds ratio 0.97) for neonatal patients and with younger age (OR 0.96), insertion in the bend of the arm (OR 1.48) or ankle (OR2.81) for paediatric patients. Occlusion was, both for neonatal and paediatric patients, associated with longer dwell time (OR 1.32 and 1.22 respectively), insertion in the ankle (OR 5.00 and 3.51) or foot (OR 3.47 and 1.99). 

    Conclusion: PVC-related complications, particularly infiltration and occlusion, were more common in hospitalised children but decreased with the child's age.

  • 197.
    Wallin, Lars
    et al.
    University of Alberta.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Evidence-based nursing-views from the Swedish horizon2004Inngår i: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 1, nr 3, s. 158-160Artikkel i tidsskrift (Fagfellevurdert)
  • 198.
    Wallin, Lars
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Boström, A-M
    Newly graduated nurses’ use of research findings andthe application of the principles of evidence-based practice2013Inngår i: Nordic Conference on Implementation of Evidence-based Practice: Abstracts, 2013, s. 47-48Konferansepaper (Fagfellevurdert)
  • 199.
    Wallin, Lars
    et al.
    Karolinska Institutet.
    Gustavsson, Petter
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Rudman, Ann
    Karolinska Institutet.
    A modest start, but a steady rise in research use: A longitudinal study of nurses during the first five years in professional life2012Inngår i: Implementation Science, E-ISSN 1748-5908, Vol. 7, nr 19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Newly graduated nurses are faced with a challenging work environment that may impede theirability to provide evidence-based practice. However, little is known about the trajectory of registered nurses’ use ofresearch during the first years of professional life. Thus, the aim of the current study was to prospectively examinethe extent of nurses’ use of research during the first five years after undergraduate education and specifically assesschanges over time.Method: Survey data from a prospective cohort of 1,501 Swedish newly graduated nurses within the nationalLANE study (Longitudinal Analyses of Nursing Education and Entry in Worklife) were used to investigate perceiveduse of research over the first five years as a nurse. The dependent variables consisted of three single itemsassessing instrumental, conceptual, and persuasive research use, where the nurses rated their use on a five-pointscale, from ‘never’ (1) to ‘on almost every shift’ (5). These data were collected annually and analyzed bothdescriptively and by longitudinal growth curve analysis.Results: Instrumental use of research was most frequently reported, closely followed by conceptual use, withpersuasive use occurring to a considerably lower extent. The development over time showed a substantial generalupward trend, which was most apparent for conceptual use, increasing from a mean of 2.6 at year one to 3.6 atyear five (unstandardized slope +0.25). However, the descriptive findings indicated that the increase started onlyafter the second year. Instrumental use had a year one mean of 2.8 and a year five mean of 3.5 (unstandardizedslope +0.19), and persuasive use showed a year one mean of 1.7 and a year five mean of 2.0 (unstandardized slope+0.09).Conclusion: There was a clear trend of increasing research use by nurses during their first five years of practice.The level of the initial ratings also indicated the level of research use in subsequent years. However, it took morethan two years of professional development before this increase ‘kicked in.’ These findings support previousresearch claiming that newly graduated nurses go through a ‘transition shock,’ reducing their ability to useresearch findings in clinical work.

    Fulltekst (pdf)
    fulltext
  • 200.
    Wallin, Lars
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Gustavsson, Petter
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Rudman, Ann
    Karolinska Institutet.
    A modest start, but steady rise in research use: A longitudinal study of nurses during the first five years in professional life2012Konferansepaper (Fagfellevurdert)
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