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  • 201. 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, E-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.

    Fulltekst (pdf)
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  • 202. Wilhelmson, Katarina
    et al.
    Hammar, Isabelle Andersson
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Niklasson, Johan
    Eckerblad, Jeanette
    Ekerstad, Niklas
    Westgård, Theresa
    Holmgren, Eva
    Åberg, N David
    Ivanoff, Synneve Dahlin
    Comprehensive Geriatric Assessment for Frail Older People in Swedish Acute Care Settings (CGA-Swed): A Randomised Controlled Study2020Inngår i: Geriatrics (Basel, Switzerland), ISSN 2308-3417, Vol. 5, nr 1, artikkel-id E5Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of the study is to evaluate the effects of the Comprehensive Geriatric Assessment (CGA) for frail older people in Swedish acute hospital settings - the CGA-Swed study. In this study protocol, we present the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants. The study is a randomised controlled trial with an intervention group receiving the CGA and a control group receiving medical assessment without the CGA. Follow-ups were conducted after 1, 6 and 12 months, with dependence in activities of daily living (ADL) as the primary outcome measure. The study group consisted of frail older people (75 years and older) in need of acute medical hospital care. The study design, randomisation and process evaluation carried out were intended to ensure the quality of the study. Baseline data show that the randomisation was successful and that the sample included frail older people with high dependence in ADL and with a high comorbidity. The CGA contributed to early recognition of frail older people's needs and ensured a care plan and follow-up. This study is expected to show positive effects on frail older people's dependence in ADL, life satisfaction and satisfaction with health and social care.

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  • 203.
    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.

    Fulltekst (pdf)
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  • 204.
    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.

  • 205.
    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.

    Fulltekst (pdf)
    fulltext
  • 206.
    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

  • 207.
    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.

  • 208.
    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.

  • 209.
    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)
  • 210.
    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.

  • 211.
    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)
  • 212.
    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)
  • 213.
    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)
  • 214.
    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)
  • 215.
    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.

  • 216.
    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)
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