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  • 151. Rudman, Ann
    et al.
    Gustavsson, Petter
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin 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)
  • 152. Rudman, Ann
    et al.
    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.

  • 153. 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)
  • 154. 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.

  • 155. 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.

  • 156. 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)
  • 157. 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.

  • 158. 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)
  • 159. 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.

  • 160.
    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.

  • 161. Unbeck, Maria
    et al.
    Förberg, Ulrika
    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.

  • 162.
    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)
  • 163.
    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)
  • 164.
    Wallin, Lars
    et al.
    Karolinska Institutet.
    Gustavsson, Petter
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Rudman, Ann
    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, 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.

  • 165.
    Wallin, Lars
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Gustavsson, Petter
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Rudman, Ann
    A modest start, but steady rise in research use: A longitudinal study of nurses during the first five years in professional life2012Konferansepaper (Fagfellevurdert)
  • 166. Westgård, Theresa
    et al.
    Ottenvall Hammar, Isabelle
    Holmgren, Eva
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Wisten, Aase
    Ekdahl, Anne W
    Dahlin-Ivanoff, Synneve
    Wilhelmson, Katarina
    Comprehensive geriatric assessment pilot of a randomized control study in a Swedish acute hospital: a feasibility study2018Inngår i: Pilot and Feasibility Studies, ISSN 2055-5784, Vol. 4, artikkel-id 41Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Comprehensive geriatric assessment (CGA) represent an important component of geriatric acute hospital care for frail older people, secured by a multidisciplinary team who addresses the multiple needs of physical health, functional ability, psychological state, cognition and social status. The primary objective of the pilot study was to determine feasibility for recruitment and retention rates. Secondary objectives were to establish proof of principle that CGA has the potential to increase patient safety.

    Methods: The CGA pilot took place at a University hospital in Western Sweden, from March to November 2016, with data analyses in March 2017. Participants were frail people aged 75 and older, who required an acute admission to hospital. Participants were recruited and randomized in the emergency room. The intervention group received CGA, a person-centered multidisciplinary team addressing health, participation, and safety. The control group received usual care. The main objective measured the recruitment procedure and retention rates. Secondary objectives were also collected regarding services received on the ward including discharge plan, care plan meeting and hospital risk assessments including risk for falls, nutrition, decubitus ulcers, and activities of daily living status.

    Result: Participants were recruited from the emergency department, over 32 weeks. Thirty participants were approached and 100% (30/30) were included and randomized, and 100% (30/30) met the inclusion criteria. Sixteen participants were included in the intervention and 14 participants were included in the control. At baseline, 100% (16/16) intervention and 100% (14/14) control completed the data collection. A positive propensity towards the secondary objectives for the intervention was also evidenced, as this group received more care assessments. There was an average difference between the intervention and control in occupational therapy assessment - 0.80 [95% CI 1.06, - 0.57], occupational therapy assistive devices - 0.73 [95% CI 1.00, - 0.47], discharge planning -0.21 [95% CI 0.43, 0.00] and care planning meeting 0.36 [95% CI-1.70, -0.02]. Controlling for documented risk assessments, the intervention had for falls - 0.94 [95% CI 1.08, - 0.08], nutrition - 0.87 [95% CI 1.06, - 0.67], decubitus ulcers - 0.94 [95% CI 1.08, - 0.80], and ADL status - 0.80 [95% CI 1.04, - 0.57].

    Conclusion: The CGA pilot was feasible and proof that the intervention increased safety justifies carrying forward to a large-scale study.

    Trial registration: Clinical Trials ID: NCT02773914. Registered 16 May 2016.

  • 167.
    Åberg, Anna Cristina
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala universitet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro universitet.
    Inpatient geriatric care in Sweden: Important factors from an inter-disciplinary team perspective2017Inngår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 172, s. 113-120Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this study was to describe factors of importance for the quality of inpatient geriatric care from an inter-disciplinary team perspective, an area that has not been previously studied to our knowledge. The study design was qualitative descriptive with data being collected from focus-group interviews with members of geriatric care teams. The data collection was conducted at a Swedish university hospital with 69 beds for geriatric care. It comprised five group interviews with a total of 32 staff members, including representatives of all the seven professions working with geriatric care. Data was analysed using qualitative content analysis and a thematic framework approach. Three main themes were identified as being perceived as characterising important factors essential for quality geriatric care:

    • Interactive assessment processes,
    • A holistic care approach, and
    • Proactive non-hierarchical interaction

    Aspects of time and goal-orientation were additionally running like common threads through these themes and informed them. Accessibility, open communication, and staff continuity were experienced as prerequisites for well-functioning teamwork. Including patients and relatives in care planning and implementation was seen as essential for good care, but was at risk due to budget cuts that imposed shortened hospital stays. To meet the care demands of the growing population of older frail people, more specialised team-based care according to the concept of Comprehensive Geriatric Assessment – which is possibly best provided by older-friendly hospitals – appears as a constructive solution for reaching high degrees of both staff and patient satisfaction in geriatric care. More research is needed in this area.

  • 168.
    Österlund Efraimsson, Eva
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Communication and self-management education at nurse-led COPD clinics in primary health care2010Inngår i: European Association for Communication in Health Care, Verona, 2010Konferansepaper (Fagfellevurdert)
    Abstract [en]

    The general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD. Designs: Observational, prospective observational and experimental designs were used. Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker. Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.

  • 169.
    Österlund Efraimsson, Eva
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Fossum, Björn
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm; Sophiahemmet University, Stockholm, Sweden.
    Larsson, Kjell
    National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden .
    Klang, Birgitta
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Red Cross University College of Nursing, Stockholm, Sweden .
    Olai, Lena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care2015Inngår i: European Clinical Respiratory Journal, ISSN 1399-3003, Vol. 2, artikkel-id 27915Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes.

    Objective: To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care.

    Methods: A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations.

    Results: Only to a small extent did nurses’ evoke patients’ reasons for change, stimulate collaboration, and support patients’ autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients’ communicationwasmainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation.

    Conclusion: The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking.

    Practice implications: To make patients more active, the nurses need more education and continuous training in motivational communication.

  • 170.
    Österlund Efraimsson, Eva
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Fossum, Bjöörn
    Larsson, Kjell
    Klang, Birgitta
    Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care2011Inngår i: International Primary Care respiratory Group (IPCRG), Amsterdam, 2011Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Aim: To examine smoking cessation communication between patients and registered nurses, with a few days of Motivational Interviewing (MI) based education, in consultations over time at nurse-led Chronic Obstructive Pulmonary Disease (COPD) clinics in primary health care (PHC). Method: The first and third of three consultations were videotaped, involving 13 smokers and six nurses. In these consultations smoking cessation communication was analyzed using the Motivational Interviewing Treatment Integrity (MITI) Scale and Client Language Assessment in Motivational Interviewing (CLAMI). Results: The nurses did, but only to a small extent, evoke patients’ reasons forchange, foster collaboration and support patients’ autonomy. In the registration of specific utterances; they provided a lot of information (42%), asked closed (21%) rather than open questions (3%) and made more simple (14%) than complex (2%) reflections. Most of the registration of the patients’ utterances in the communication were either toward or away from smoking cessation coded in the category Follow/Neutral (59%), followed by utterances in the categories of Reason for change 40%, Taking steps 1% and Commitment 0%. No significant differences could be observed in the results of MITI and CLAMI between the first and third consultations. Conclusion: Smoking cessation communication at nurse-led COPD clinics neither focused on the patients’ reasons for or against smoking nor motivated patients to express commitment to, or take steps towards, smoking cessation

  • 171.
    Österlund Efraimsson, Eva
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Fossum, Bjöörn
    Larsson, Kjell
    Klang, Birgitta
    Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care2011Inngår i: European Respiratory Society (ERS), Amsterdam, 2011Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Objective: To explore smoking cessation communication between patients and registered nurses in consultations over time at nurse-led Chronic Obstructive Pulmonary Disease (COPD) clinics in primary health care. Method: The first and third of three consultations were videotaped, involving 13 smokers and six nurses with a few days of Motivational Interviewing (MI) based education. In these consultations smoking cessation communication was analyzed using the Motivational Interviewing Treatment Integrity Scale (MITI) and Client Language Assessment in Motivational Interviewing (CLAMI). Results: The nurses did only to a small extent evoke patients’ reasons for change, foster collaboration and support patients’ autonomy. Nurses provided a lot of information (42%), asked closed (21%) rather than open (3%) questions and made more simple (14%) than complex (2%) reflections. Patients communication were mainly Follow/Neutral (59%), Reasons for and against smoking 40%, least common were Taking steps (1%) and Commitment (0%) toward smoking cessation. Conclusion: The nurses did not use professional smoking cessation communication and the patients did not talk about how to quit smoking. Practice Implications: To make the patients more active in their smoking cessation process at nurse-led COPD clinics in primary health care the nurses need continuous education and training in smoking cessation communication.

  • 172.
    Österlund Efraimsson, Eva
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Klang, Birgitta
    Fossum, Bjöörn
    Support in smoking cessation at nurse-led Chronic Obstructive Pulmonary disease clinics2010Inngår i: European Respiratory Society, Barcelona, 2010Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Aim: To describe to what extent registered nurses use Motivational Interviewing (MI) in smoking cessation communication over time at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care. Background: For smokers with COPD the most crucial and evidence-based intervention is smoking cessation. Method and Results: The study included two videotaped consultations, the first and third of three at the clinic, with each of 13 smokers. The nurses’ smoking cessation communication was analyzed using the Motivational Interviewing Treatment Integrity scale, a behavioral coding system that assesses the practitioners’ use of motivational interviewing. Nurses and patients talked for equal amounts of time in one third of the 26 consultations, whilst nurses talked for longer in the remaining two thirds. To capture an impression of the consultation, five parameters were judged on a five-point Likert-scale, with five as the top score. Evocation, collaboration, autonomy-support and empathy averaged between 1.31 and 2.23 whereas direction scored five in all consultations. Of communication behaviors, giving information was the most frequently used, followed by closed questions, MI non–adherent and simple reflections. MI Adherent, open questions and complex reflections occurred rarely. There were no significant individual or group-level differences in any of the ratings between the first and the third consultations. Conclusion: In smoking cessation communication the nurses had low scores on evocation, collaboration, autonomy-support, empathy and high scores on direction. They also supplied large amounts of information, posed closed questions and made simple reflections. Open questions and complex reflections occurred rarely.

  • 173.
    Österlund Efraimsson, Eva
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Fossum, Bjöörn
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Larsson, Kjell
    Klang, Birgitta
    Support in smoking cessation at nurse-led Chronic Obstructive Pulmonary Disease clinics2010Inngår i: 5th International Primary Care Respiratory Group World Conference, Toronto, Kanada, 2010Konferansepaper (Annet vitenskapelig)
  • 174.
    Österlund Efraimsson, Eva
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Fossum, Bjöörn
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Larsson, Kjell
    Klang, Birgitta
    Use of motivational interviewing in smoking cessation at nurse-led chronic obstructive pulmonary disease clinics2012Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 68, nr 4, s. 767-782Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim. This paper is a report of a study to describe to what extent Registered Nurses, with a few days of education in motivational interviewing based communication, used motivational interviewing in smoking cessation communication at nurse-led chronic obstructive pulmonary disease clinics in primary health care.

    Background. For smokers with chronic obstructive pulmonary disease the most crucial and evidence-based intervention is smoking cessation. Motivational interviewing is often used in healthcare to support patients to quit smoking.

    Method. The study included two videotaped consultations, the first and third of three at the clinic, with each of 13 smokers. Data were collected from March 2006 to April 2007. The nurses’ smoking cessation communication was analysed using the Motivational Interviewing Treatment Integrity scale. To get an impression of the consultation, five parameters were judged on a five-point Likert-scale, with five indicating best adherence to Motivational Interviewing.

    Results. Evocation’, ‘collaboration’, ‘autonomy-support’ and ‘empathy’ averaged between 1·31 and 2·23 whereas ‘direction’ scored five in all consultations. Of communication behaviours, giving information was the most frequently used, followed by ‘closed questions’, ‘motivational interviewing non–adherent’ and ‘simple reflections’. ‘Motivational interviewing adherent’, ‘open questions’ and ‘complex reflections’ occurred rarely. There were no important individual or group-level differences in any of the ratings between the first and the third consultations.

    Conclusion. In smoking cessation communication the nurses did not employ behaviours that are important in motivational interviewing.

  • 175.
    Österlund Efraimsson, Eva
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Fossum, Bjöörn
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Larsson, Kjell
    Klang Söderkvist, Birgitta
    Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics inprimary health care2012Konferansepaper (Fagfellevurdert)
  • 176.
    Österlund Efraimsson, Eva
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Fossum, Bjöörn
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Larsson, Kjell
    Klang Söderkvist, Birgitta
    Use of Motivational Interviewing in smoking cessation at nurse-led Chronic Obstructive Pulmonary Disease clinics2012Konferansepaper (Fagfellevurdert)
  • 177.
    Österlund Efraimsson, Eva
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Fossum, Bjöörn
    Larsson, Kjell
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Klang, Birgitta
    The content and structure of self management education at nurse-led COPD clinics in primary health care2008Inngår i: European Respiratory Society Annual Congress, Berlin, Tyskland, 2008Konferansepaper (Fagfellevurdert)
  • 178.
    Österlund Efraimsson, Eva
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Hillervik, Charlotte
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Effects of COPD self-care management education at a nurse-led primary health care clinic2007Inngår i: European Respiratory Society, ERS, Stockholm, 2007Konferansepaper (Fagfellevurdert)
  • 179.
    Österlund Efraimsson, Eva
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Klang, Birgitta
    Larsson, Kjell
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Fossum, Bjöörn
    Communication and self-management education at nurse-led COPD clinics in primary health care2009Inngår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 77, nr 2, s. 209-217Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. The aim of the study was to explore the structure, content in communication and self-management education in patients’ first consultations at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary healthcare.

    Method. Thirty consultations performed by seven registered nurses were videotaped; structure and content in the consultation was analyzed using Pendleton's Consultation Map. Nurses’ self-management education was assessed from the content of the conversation: whether important and relevant information and self-management education was given, and how investigations were performed.

    Results. Each consultation lasted for a mean time of 37.53 min. Communication about reasons for consultations concerned mainly medical and physical problems and to a certain extent patients’ perceptions. Teaching about self-management and smoking cessation was of an informative nature. Two consultations ended with shared understanding, and none of the patients received an individual treatment-plan.

  • 180.
    Österlund-Efraimsson, Eva
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Hillervik, Charlotte
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Hälsa och samhälle, Omvårdnad.
    Effects of COPD self-care management education at a nurse-led primary health care clinic2008Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, nr 2, s. 178-185Artikkel i tidsskrift (Fagfellevurdert)
1234 151 - 180 of 180
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