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  • 1.
    Abrahamsen Grøndahl, Vigdis
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Karlsson, Ingela
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hall-Lord, Marie-Louise
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Appelgren, Jari
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Economics and Statistics.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Quality of care from patients' perspective: impact of the combination of person-related and external objective care conditions2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17/18, p. 2540-2551Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To describe patients' perceptions of quality of care and to explore combinations of person-related and external objective care conditions as potential predictors of these perceptions. Background. Several studies have examined various single factors of person-related and external objective care conditions in relation to quality of care. None of these has included the effect of over-occupancy on patients' perception of quality of care. Furthermore, little is known about how combinations of different factors are related to each other and to the perception of quality of care using multivariate analysis. Design. A cross-sectional design. Method. A total of 528 patients (83·7%) from 12 medical, surgical or medical-surgical wards in five hospitals in Norway participated. Perceptions of quality of care and person-related conditions were measured with the 'Quality from Patient's Perspective' instrument. Data on external objective care conditions was collected from ward statistics provided by head nurses. Multivariate general linear modelling was used ( p < 0·05). Results. The combination of person-related and external objective care conditions revealed five factors that predict patients' perception of quality of care. Three of these are person-related conditions: sex, age and self-reported psychological well-being and two of them are external objective care conditions: RNs (headcount) on the wards and frequency of over-occupancy. These five factors explained 55% of the model. Patients rated the quality of care high. Conclusions. Sex, age, psychological well-being, frequency of over-occupancy and the number of RNs are important factors that must be emphasised if patients are to perceive the quality of care as high. Relevance to clinical practice. Head nurses and healthcare authorities must continually prepare the wards for over-occupancy and they must consider the number of RNs working on the wards.

  • 2.
    Ahlqvist, Margary
    et al.
    Division of Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Bogren, Agneta
    Department of Nursing in Gastroenterology and Endochrinology, Karolinska University Hospital, Stockholm, Sweden.
    Hagman, Sari
    Department of Nursing in Gastroenterology and Endochrinology, Karolinska University Hospital, Stockholm, Sweden.
    Nazar, Isabel
    Department of Nursing in Gastroenterology and Endochrinology, Karolinska University Hospital, Stockholm, Sweden.
    Nilsson, Katarina
    Department of Nursing in Gastroenterology and Endochrinology, Karolinska University Hospital, Stockholm, Sweden.
    Nordin, Karin
    Division of Clinical Pharmacology, Human Pharmacological Unit, Karolinska University Hospital, Stockholm, Sweden.
    Sunde Valfridsson, Berit
    Intensive Care Unit, Karolinska University Hospital, Stockholm, Sweden.
    Söderlund, Mona
    Lecturer, Ersta Sko¨ ndal University College, Stockholm, Sweden.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Handling of peripheral intravenous cannulae: effects of evidence-based clinical guidelines2006In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 15, no 11, p. 1354-1361Article in journal (Refereed)
    Abstract [en]

    Aim. This study aimed at evaluating the outcome of implemented evidence-based clinical guidelines by means of surveying the frequency of thrombophlebitis, nurses’ care, handling and documentation of peripheral intravenous cannulae. Background. Peripheral intravenous cannulae are frequently used for vascular access and, thereby, the patients will be exposed to local and systemic infectious complications. Evidence-based knowledge of how to prevent these complications and how to care for patients with peripheral intravenous cannula is therefore of great importance. Deficient care, handling and documentation of peripheral intravenous cannulae have previously been reported. Design. A cross-sectional survey was conducted by a group of nurses at three wards at a university hospital before and after the implementation of the evidence-based guidelines. Method. A structured observation protocol was used to review the frequency of thrombophlebitis, the nurses’ care, handling and the documentation of peripheral intravenous cannulae in the patient's record. Results. A total of 107 and 99 cannulae respectively were observed before and after the implementation of the guidelines. The frequency of peripheral intravenous cannulae without signs of thrombophlebitis increased by 21% ( P < 0·01) and the use of cannula size 0·8 mm increased by 22% ( P < 0·001). Nurses’ documentation of peripheral intravenous cannula improved significantly ( P < 0·001). Conclusion. We conclude that implementation of the guidelines resulted in significant improvements by means of decreased frequency of signs of thrombophlebitis, increased application of smaller cannula size (0·8 mm), as well as of the nurses’ documentation in the patient's record. Relevance to clinical practice. Further efforts to ameliorate care and handling of peripheral intravenous cannulae are needed. This can be done by means of increasing nurses’ knowledge and recurrent quality reviews. Well-informed patients can also be more involved in the care than is common today.

  • 3.
    Andersson, Ewa K.
    et al.
    Blekinge Inst Technol, Dept Hlth, SE-37179 Karlskrona, Sweden.;Lund Univ, Dept Hlth Sci, Lund, Sweden..
    Sjostrom-Strand, Annica
    Lund Univ, Dept Hlth Sci, Lund, Sweden..
    Willman, Ania
    Blekinge Inst Technol, Dept Hlth, SE-37179 Karlskrona, Sweden.;Malmo Univ, Dept Care Sci, Malmo, Sweden..
    Borglin, Gunilla
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Malmo Univ, Dept Care Sci, Nursing, Malmo, Sweden. .
    Registered nurses views of caring in coronary care - a deductive and inductive content analysis2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 23-24, p. 3481-3493Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To extend nurses' descriptions of how they understood caring, as reflected in the findings of an earlier study (i.e. the hierarchical outcome space) and to gain additional understandings and perspectives of nurses' views of caring in relation to a coronary care patient case. Background. Scientific literature from the 1970s-1990s contains descriptions of caring in nursing. In contrast, the contemporary literature on this topic - particularly in the context of coronary care - is very sparse, and the few studies that do contain descriptions rarely do so from the perspective of nurses. Design. Qualitative descriptive study. Methods. Twenty-one nurses were interviewed using the stimulated recall interview technique. The data were analysed using deductive and inductive qualitative content analysis. Results. The results of the iterative and integrated content analysis showed that the data mainly reproduced the content of the hierarchical outcome space describing how nurses could understand caring; however, in the outcome space, the relationship broke up (i.e. flipped). The nurses' views of caring could now also be understood as: person-centredness 'lurking' in the shadows; limited 'potential' for safeguarding patients' best interests; counselling as virtually the 'only' nursing intervention; and caring preceded by the 'almighty' context. Their views offered alternative and, at times, contrasting perspectives of caring, thereby adding to our understanding of it. Conclusion. Caring was described as operating somewhere between the nurses caring values and the contextual conditions in which caring occurred. This challenged their ability to sustain caring in accordance with their values and the patients' preferences. Relevance to clinical practice. To ensure that the essentials of caring are met at all times, nurses need to plan and deliver caring in a systematic way. The use of systematic structures in caring, as the nursing process, can help nurses to work in a person-centred way, while sustaining their professional values.

  • 4.
    Anderzen-Carlsson, Agneta
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Örebro universitet.
    Gillå, Cristina
    Central Child Health Unit, County Council of Varmland, Karlstad, Sweden.
    Lind, Maria
    Central Child Health Unit, Orebro County Region, Orebro, Sweden.
    Almqvist, Kjerstin
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013).
    Lindgren Fändriks, Anna
    Central Child Health Unit, County Council of Varmland, Karlstad, Sweden.
    Källström, Åsa
    School of Law, Psychology and Socialwork, Orebro University, Orebro, Sweden.
    Child healthcare nurses' experiences of asking new mothers about intimate partner violence2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 13-14, p. 2752-2762Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To investigate child healthcare nurses' experiences of asking mothers of 8-month-old children about intimate partner violence using a two-step questionnaire. Background: Exposure to intimate partner violence is detrimental to women and to their children, and its early detection is vital. Child health care is a promising setting for detecting intimate partner violence. Design: The overall project had a quasi-experimental design and was employed in 2015 at 12 child healthcare centres in Sweden. The project aimed to test a two-step method for talking about intimate partner violence with mothers (n = 198) at the child healthcare centre. In this article, we disclose the experiences of the intervention from the perspective of the nurses (n = 13) who were educated and involved in the intervention. Methods: Data were collected by semi-structured interviews, analysed by thematic analysis. Results: Five categories emerged: using the two-step questionnaire method, asking about IPV as an important issue, being comfortable in the professional role and with asking about IPV, the importance of time and place in asking about IPV and spillover effects. Conclusions: Asking mothers visiting the child health clinic about their experiences of intimate partner violence was seen as an important task. Using a questionnaire could facilitate asking, but the questionnaire must be short and easy to use. Furthermore, the time and place for initiating a talk about this sensitive topic must be carefully chosen. Relevance to clinical practice: The Violence in Families questionnaire was regarded as a useful tool and could thus be implemented in practice. However, it is important to offer education to the nurses prior to implementing a routine of asking about intimate partner violence in the child healthcare setting.

  • 5.
    Athlin, Elsy
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Idwall, Ewa
    Linköping university.
    Jernfält, Margareth
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Johansson, Inger
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Factors of importance to the development of pressure ulcers in the care trajectory: Perceptions of hospital and community care nurses2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 15-16, p. 2252-2258Article in journal (Refereed)
    Abstract [en]

    AIM:

    The study aimed at describing contributing factors for the progression or regression of pressure ulcers in the care trajectory as they were understood by nurses working in hospitals or community care.

    BACKGROUND:

    The development of pressure ulcers is considered to be connected with early prevention and awareness among nurses and some studies have indicated that the care trajectory may be a weak point.

    DESIGN:

    The study was carried out with a qualitative design.

    METHOD:

    Fifteen nurses from two Swedish hospitals and 15 nurses from community care were interviewed during 2005. Qualitative content analysis was used to make an understanding of patterns possible.

    FINDINGS:

    Three main categories arose, showing that pressure ulcers were considered to be affected in the care trajectory by factors related to the individual patient, to the healthcare personnel and to the healthcare structure. Hospital and community care nurses mostly had corresponding perceptions of these factors.

    CONCLUSION:

    The study both confirmed previous findings and added new knowledge about factors that may affect pressure ulcer in the trajectory of care. The informants' views of nurses' responsibilities and their attitudes towards the care of pressure ulcers could, along with their views on the organisation of care, increase the understanding of the occurrence of pressure ulcers. The need for development and clarification of the organisation and responsibility of pressure ulcer care in the care trajectory was stressed. Relevance to clinical practice. The study highlighted attitudes and values among registered nurses, as well as to how to preserve their commitment and increase their knowledge concerning prevention of pressure ulcers.

  • 6.
    Bjuresäter, Kaisa
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Larsson, Maria
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Athlin, Elsy
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Struggling in an inescapable life situation: being a close relative of a person dependent on home enteral tube feeding2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 7-8, p. 1051-1059Article in journal (Refereed)
    Abstract [en]

    Aim. To explore what it means to be a close relative of a person dependent on home enteral tube feeding (HETF) and how they can manage this situation. Background. Previous studies have shown that the situation of close relatives in home care in general can be burdensome and difficult. Research is scarce about experiences of close relatives when patients are treated with HETF. Design. A qualitative design was used, in accordance with grounded theory ( GT). Methods. Twelve close relatives were interviewed twice, using open- ended questions. Five were relatives of patients supported by home care services or advanced home care teams. Using the GT method, sampling, data collection and data analysis were carried out simultaneously. Results. One core category, ` Struggling in an inescapable life situation' and eight categories were found. The situation led to involuntary changes in the lives of the close relatives, something they could do little about. Their lives had become completely upturned and restricted by the HETF. Togetherness and pleasure was lost and they felt lonely. The relatives faced a new role of being informal caregivers and they had to adjust their daily life accordingly. They felt forced to take on a heavy responsibility for which they lacked support. The close relatives struggled to manage and to make the best of their new situation. Conclusions. This study highlighted the demands and vulnerability which is embedded in the role of being a close relative of a patient with HETF. It also pointed out their need for comprehensive support from the health care system.

  • 7.
    Bjuresäter, Kaisa
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Larsson, Maria
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Athlin, Elsy
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Cooperation in the care for patients with home enteral tube feeding throughout the care trajectory: nurses' perspectives2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 22, p. 3021-3029Article in journal (Refereed)
  • 8.
    Blomberg, Karin
    et al.
    School of Health and Medical Sciences, Örebro University.
    Bisholt, Birgitta
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Kullén Engström, Agneta
    School of Health, University of Borås.
    Ohlsson, Ulla
    School of Health and Medical Sciences, Örebro University.
    Sundler Johansson, Annelie
    School of Life Sciences, University of Skövde.
    Gustafsson, Margareta
    School of Health and Medical Sciences, Örebro University.
    Swedish nursing students’ experience of stress during clinical practice in relation to clinical setting characteristics and the organisation of the clinical education2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 15/16, p. 2264-2271Article in journal (Refereed)
    Abstract [en]

    Aims and objectives

    To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education.

    Background

    Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference.

    Design

    A cross-sectional study with evaluative design.

    Methods

    Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included.

    Results

    Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis.

    Conclusions

    The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation.

    Relevance to clinical practice

    It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support.

  • 9.
    Bååth, Carina
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hall-Lord, Mari-Louise
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Idvall, Ewa
    Institutionen för medicin och hälsa, Linköpings universitet.
    Wiberg-Hedman, Katarina
    Landstinget i Värmland.
    Wilde Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Interrater reliability using Modified Norton Scale, Pressure Ulcer Card, Short Form- Mini Nutritional Assessment by registered and enrolled nurses in clinical practice2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 5, p. 618-626Article in journal (Other academic)
    Abstract [en]

    Aim.  Examine the interrater reliability between and among registered and enrolled nurses using Modified Norton Scale, Pressure Ulcer Card and Short Form-Mini Nutritional Assessment.

    Background.  In Sweden, registered nurses and enrolled nurses usually co-operate in patient care. National guidelines emphasize that reliable and valid assessment tools should be used. Interrater reliability for regular use of assessment tools is seldom studied.

    Design cross-sectional.  Registered nurses and enrolled nurses made 228 assessments of patients’ skin, risk for pressure ulcer and malnutrition, in patients with hip fracture and patients who had suffered a stroke.

    Results.  The interrater reliability of the Modified Norton Score total score was very good among registered nurses, good among enrolled nurses and between both groups. There was good, moderate and fair agreement on the subscales. Interrater reliability of Short Form Mini-Nutritional Assesment screening score was very good between both groups, good among registered nurses and moderate among enrolled nurses. There was good and moderate agreement on the items. There was good, moderate and fair agreement between and among registered nurses and enrolled nurses when using the Pressure Ulcer Card.

    Conclusion.  The Modified Norton Scale and Short Form Mini-Nutritional Assessment were reasonably understandable and easy to utilize in clinical care. Therefore, it seems possible for nurses to accomplish assessment using these tools. The agreement level was low for most skin sites except sacrum when nurses assessed patients’ skin with the Pressure Ulcer Card.

    Relevance to clinical practice.  The utilize of reliable and valid assessment tools is important in clinical practice. The tools could be used as an aid to the clinical judgement and therefore identify patients at risk for pressure ulcers and malnutrition. Pressure ulcer grading is a difficult skill that requires training and time to develop.

  • 10.
    Caspari, Synnove
    et al.
    Oslo Metropolitan University, Norway.
    Raholm, Maj-Britt
    Sogn Fjordane University College.
    Saeteren, Berit
    Oslo Metropolitan University, Norway.
    Rehnsfeldt, Arne
    Stord Haugesund University College, Norway.
    Lillesto, Britt
    Nord University, Norway.
    Lohne, Vibeke
    Oslo Metropolitan University, Norway.
    Slettebo, Ashild
    University Agder, Norway.
    Heggestad, Anne Kari T.
    Oslo Metropolitan University, Norway.
    Hoy, Bente
    VIA University College, Denmark.
    Lindwall, Lillemor
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Naden, Dagfinn
    Oslo Metropolitan University.
    Tension between freedom and dependence: A challenge for residents who live in nursing homes2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 21-22, p. 4119-4127Article in journal (Refereed)
    Abstract [en]

    Aims and objectives To present results from interviews of older people living in nursing homes, on how they experience freedom. Background We know that freedom is an existential human matter, and research shows that freedom remains important throughout life. Freedom is also important for older people, but further research is needed to determine how these people experience their freedom. The background for this article was a Scandinavian study that occurred in nursing homes; the purpose of the study was to gain knowledge about whether the residents felt that their dignity was maintained and respected. Design The design was hermeneutic, with qualitative research interviews. MethodTwenty-eight residents living in nursing homes in Denmark, Sweden and Norway were interviewed. Collecting tools used were an interview guide and also a tape recorder. Researchers in the three countries performed the interviews. The data were transcribed and analysed on three levels of hermeneutic interpretation. Results To have their freedom was emphasised as very important according to their experience of having their dignity taken care of. The following main themes emerged: (a) Autonomy or paternalism; (b) Inner and outer freedom; and (c) Dependence as an extra burden. ConclusionsResidents in a nursing home may experience the feeling of having lost their freedom. This conclusion has implications for healthcare professionals and researchers, as it is important for residents in nursing homes to feel that they still have their freedom. Relevance to clinical practiceIn clinical practice, it is important and valuable for the staff to consider how they can help older people feel that they still have their freedom.

  • 11.
    Granrud, M. D.
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.
    Anderzen-Carlsson, Agneta
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Örebro universitet.
    Bisholt, Birgitta
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Steffenak, A. K. M.
    Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.
    Public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools: A phenomenographic study2019In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 15-16, p. 2899-2910Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To describe the variation in public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools in Norway. Background: Mental health problems among adolescents account for a large portion of the global burden of disease and affect 10%–20% of adolescents worldwide. Public health nurses in school health services play an important role in disease prevention and promotion of physical and mental health. In order to serve adolescents with regard to mental health problems, public health nurses are dependent on collaboration with other professionals in schools. Design: Qualitative interviews were conducted with 18 public health nurses working in the school health services. Method: A phenomenographic approach was used for interviewing and for analysing the qualitative interviews. This study is presented in line with COREQ's checklist. Result: The analysis resulted in three descriptive categories based on eight identified conceptions. The categories are as follows: “The formal structure has an impact on interprofessional collaboration”; “The public health nurse is an important, but not always self-evident, partner in interprofessional collaboration”; and “The primary players are the teachers in collaboration.”. Conclusion: The public health nurses describe that they had limited impact on collaboration and were dependent on both the school principal and the teachers for achieving good collaboration. Teachers have the power to decide whether to collaborate with the public health nurse, and public health nurses regard teachers as the most important collaborative partners. The public health nurses need to make themselves and their competence visible. Relevance to clinical practice: The findings demonstrated that public health nurses are important collaborators, but are not always included in interprofessional collaboration. This knowledge is essential to strengthen public health nurses' roles and presence in schools, which could most certainly benefit adolescents with mental health problems in secondary school.

  • 12.
    Helgesen, Ann K
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Larsson, Maria
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Athlin, Elsy
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    How do relatives of persons with dementia experience their role in the patient participation process in special care units?2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 11/12, p. 1672-1681Article in journal (Refereed)
    Abstract [en]

    Aims and objective To explore the role of relatives in the patient participation process for persons with dementia living in special care units in Norwegian nursing homes, with focus on everyday life. Background Studies exploring the experience of relatives of persons with dementia as to their role in the patient participation process are limited. Design The study had an explorative grounded theory design. Method Data collection was carried out by interviews with twelve close relatives. Simultaneously, data analysis was performed with open, axial and selective coding. Results The relatives' role in the patient participation process was experienced as transitions between different roles to secure the resident's well-being, which was understood as the resident's comfort and dignity. This was the ultimate goal for their participation. The categories 'being a visitor', 'being a spokesperson', 'being a guardian' and 'being a link to the outside world' described the different roles. Different situations and conditions triggered different roles, and the relatives' trust in the personnel was a crucial factor. Conclusions The study has highlighted the great importance of relatives' role in the patient participation process, to secure the well-being of residents living in special care units. Our findings stress the uttermost need for a high degree of competence, interest and commitment among the personnel together with a well functioning, collaborative and cooperative relationship between the personnel and the relatives of persons with dementia. The study raises several important questions that emphasise that more research is needed. Relevance to clinical practice Relatives need to be seen and treated as a resource in the patient participation process in dementia care. More attention should be paid to initiating better cooperation between the personnel and the relatives, as this may have a positive impact both on the residents' and the relatives' well-being.

  • 13.
    Henoch, Ingela
    et al.
    Gothenburg University.
    Lovgren, Malin
    Dalarna University.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Tishelman, Carol
    Karolinska institutet, Sweden.
    Perception of quality of care: Comparison of the views of patients' with lung cancer and their family members2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 3-4, p. 585-594Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To explore potential differences within dyads of patients with lung cancer and family members judgment of different aspects of quality of care and relationships between quality of care and personal and health-related characteristics. Background. High quality of care is important for acceptable quality of life in patients in palliative care. If patients are unable to participate in quality of care assessments or decision-making, family members might often act as proxies, despite the complicated nature of their own situation. Design. Cross-sectional survey design. Method. A patient and family member version of the abbreviated questionnaire Quality from Patients' Perspective, with additional items about perceived health and opinions about care, was mailed to members of the Swedish lung cancer Patient Organisation. Wilcoxon's signed rank test was used to identify potential differences within 51 patient-family member dyads' quality of care ratings. Relationships between Quality from Patients' Perspective dimensions and demographic and healthrelated variables were examined with Spearman's correlations. Results. Patient-family member dyads had high levels of agreement in ratings of perceived reality of quality of care. Family members generally rated the subjective importance of individual items higher than did the patient in the dyad, with significant difference in the dimension ` socio-cultural approach'. Older patients were found to rate the physical-technical conditions higher than younger patients, in relation to perceived reality but not subjective importance. Women family members were found to rate the subjective importance of medical-technical competence, identity-oriented approach and socio-cultural approach significantly higher than men did. Conclusions. Patients with lung cancer and their family members agree in ratings of the perceived reality, but they differ more in ratings of the subjective importance of quality of care. When patients are unable to communicate their preferences, family members' opinions could be used as proxies concerning concrete aspects of quality of care. Concerning more subjective aspects, family members' ratings should be interpreted with precaution, as it could diverge from patients' own opinion. Relevance to clinical practice. The perceptions of the importance of different aspects of quality of care were less related to health status than were judgments of quality of care received. This might suggest that the care patients received fulfilled neither the patients' nor family members' expectations, which is an important message to healthcare professionals and which would demand further exploration.

  • 14.
    Henricson, Maria
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Berglund, Anna-Lena
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Määttä, Sylvia
    University College of Borås, School of Health Science.
    Ekman, Rolf
    Neurochemical Laboratory, Göteborg University, Sahlgrenska University Hospital.
    Segesten, Kerstin
    University College of Borås, School of Health Science.
    The outcome of tactile touch on oxytocin in intensive care patients: a randomized controlled trial2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 19, p. 2624-2633Article in journal (Refereed)
    Abstract [en]

    Aim. To explore the effects of five-day tactile touch intervention on oxytocin in intensive care patients. The hypotheses were that tactile touch increases the levels of oxytocin after intervention and over a six-day period. Background. Research on both humans and animals shows a correlation between touch and increased levels of oxytocin which inspired us to measure the levels of oxytocin in arterial blood to obtain information about the physiological effect of tactile touch. Design. Randomised controlled trial. Method. Forty-four patients from two general intensive care units, were randomly assigned to either tactile touch ( n = 21) or standard treatment – an hour of rest ( n = 23). Arterial blood was drawn for measurement of oxytocin, before and after both treatments. Results. No significant mean changes in oxytocin levels were found from day 1 to day 6 in the intervention group (mean −3·0 pM, SD 16·8). In the control group, there was a significant ( p = 0·01) decrease in oxytocin levels from day 1 to day 6, mean 26·4 pM (SD 74·1). There were no significant differences in changes between day 1 and day 6 when comparing the intervention group and control group, mean 23·4 pM (95% CI −20·2–67·0). Conclusion. Our hypothesis that tactile touch increases the levels of oxytocin in patients at intensive care units was not confirmed. An interesting observation was the decrease levels of oxytocin over the six-day period in the control group, which was not observed in the intervention group. Relevance to clinical practice. Tactile touch seemed to reduce the activity of the sympathetic nervous system. Further and larger studies are needed in intensive care units to confirm/evaluate tactile touch as a complementary caring act for critically ill patients.

  • 15.
    Hommel, Ami
    et al.
    Skåne University Hospital.
    Gunningberg, Lena
    Uppsala university.
    Idvall, Ewa
    Malmö University.
    Bååth, Carina
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Landstinget i Värmland.
    Successful factors to prevent pressure ulcers - an interview study.2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 1-2, p. 182-189Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore successful factors to prevent pressure ulcers in hospital settings.

    BACKGROUND: Pressure ulcer prevalence has been recognised as a quality indicator for both patient safety and quality of care in hospital and community settings. Most pressure ulcer can be prevented if effective measures are implemented and evaluated. The Swedish Association of Local Authorities and Regions initiated nationwide pressure ulcer prevalence studies in 2011. In 2014, after four years of measurement, the prevalence was still unacceptably high on a national level. The mean prevalence of pressure ulcer in the spring of 2014 was 14% in hospital settings with a range from 2·7-36·4%.

    DESIGN: Qualitative semistructured interviews were conducted.

    METHODS: A qualitative content analysis, in addition to Promoting Action on Research Implementation in Health Services frameworks, was used in the analysis of the data text. Individual interviews and focus groups were used to create opportunities for both individual responses and group interactions. The study was conducted at six hospitals during the fall of 2014.

    RESULTS: Three main categories were identified as successful factors to prevent pressure ulcer in hospitals: creating a good organisation, maintaining persistent awareness and realising the benefits for patients.

    CONCLUSION: The goal for all healthcare personnel must be delivering high-quality, sustainable care to patients. Prevention of pressure ulcer is crucial in this work. It seems to be easier for small hospitals (with a low number of units/beds) to develop and sustain an effective organisation in prevention work.

    RELEVANCE TO CLINICAL PRACTICE: The nurse managers' attitude and engagement are crucial to enable the personnel to work actively with pressure ulcer prevention. Strategies are proposed to advance clinical leadership, knowledge, skills and abilities for the crucial implementation of pressure ulcer prevention.

  • 16.
    Hov, Reidun
    et al.
    Karlstad University, Faculty of Social and Life Sciences.
    Hedelin, Birgitta
    Karlstad University, Faculty of Social and Life Sciences.
    Athlin, Elsy
    Karlstad University, Faculty of Social and Life Sciences.
    Being an intensive care nurse related to questions of withholding or withdrawing curative treatment2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 1, p. 203-211Article in journal (Refereed)
  • 17.
    Larsson, Maria
    et al.
    Karlstad University, Faculty of Social and Life Sciences.
    Hedelin, Birgitta
    Karlstad University, Faculty of Social and Life Sciences.
    Athlin, Elsy
    Karlstad University, Faculty of Social and Life Sciences.
    Lived experiences of eating problems for patients with head and neck cancer during radiotherapy2003In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 4, p. 562-570Article in journal (Refereed)
  • 18.
    Lovlien, Mona
    et al.
    Norwegian Univ Technol & Sci, POB 121, NO-2802 Gjovik, Norway..
    Mundal, Liv
    Oslo Univ Hosp HF, Oslo, Norway..
    Hall-Lord, Marie Louise
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Norwegian Univ Technol & Sci, POB 121, NO-2802 Gjovik, Norway.;Karlstad Univ, Karlstad, Sweden..
    Health-related quality of life, sense of coherence and leisure-time physical activity in women after an acute myocardial infarction2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 7-8, p. 975-982Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesTo examine the relationship between leisure-time physical activity, health-related quality of life and sense of coherence in women after an acute myocardial infarction, and further to investigate whether these aspects were associated with age. BackgroundPhysical activity and health-related quality of life are vital aspects for patients after an acute myocardial infarction. DesignCross-sectional. MethodAll eligible women diagnosed with acute myocardial infarction received a postal questionnaire two to three months after hospital discharge, and 142 women were included. To measure health-related quality of life and sense of coherence, The MacNew Heart disease questionnaire and the Sense of coherence-13 scale was used. ResultsRespondents reporting at least one type of physical activity had significantly higher health-related quality of life as compared to respondents reporting no kind of physical activity. Respondents reporting physical activity for at least 30minutes twice a week had significantly higher health-related quality of life scores than respondents being active less than twice a week. A weak association was found between physical activity level and sense of coherence. Reduction in physical activity after the acute myocardial infarction was associated with reduced health-related quality of life and sense of coherence. Sense of coherence was significantly associated with age, as respondents 75years and older had significantly higher scores than respondents younger than 75years. ConclusionsPhysical activity, even at a low level, is significantly associated with increased health-related quality of life and to some extent to sense of coherence. Relevance to clinical practiceTailoring women after an acute myocardial infarction about lifestyle changes must include knowledge about the benefits of leisure-time physical activity, and that even a small amount of activity is associated with a better health-related quality of life. The utmost important assignment is to motivate the women for regular physical activity in their leisure-time. Older women need special attention.

  • 19.
    Madsen, Ulla Riis
    et al.
    Slagelse Hospital, Danmark.
    Hommel, Ami
    Lunds universitet.
    Berthelsen, Connie Bottcher
    Aarhus Universitet, Danmark.
    Bååth, Carina
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Systematic review describing the effect of early mobilisation after dysvascular major lower limb amputations2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 21-22, p. 3286-3297Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To assess the effect of early mobilisation of patients after dysvascular lower limb amputation and to compare the effectiveness of different mobilisation regimens. Background. Patients who have undergone dysvascular major lower limb amputations are at high risk of postoperative complications, which include loss of basic functions, and early mobilisation interventions might prevent these complications. Design. Systematic review. Methods. Systematic searches were performed on PubMed (including MEDLINE), CINAHL and EMBASE databases to identify studies investigating the effects of (early) mobilisation interventions in dysvascular lower limb-amputated patients. Data collection and quality assessment were performed using the Cochrane Effective Practice and Organization of Care Review Group data collection checklist and the Cochrane Handbook for Systematic Reviews of Interventions, respectively. Results. Five studies were included in the review: four pre- to post-case studies and one randomised controlled study. However, none of these studies were of high quality. Four studies investigated early mobilisation promoted by immediate postoperative prosthesis. One study investigated whether reorganizing care increases mobilisation and thereby functional outcome. Conclusions. This systematic review reveals a lack of evidence to determine whether early mobilisation interventions are beneficial to this vulnerable patient group. Nevertheless, ambulation from the first postoperative day with temporary prosthesis is possible among the heterogeneous population of dysvascular lower limb-amputated patients if the necessary interdisciplinary team is dedicated to the task. Relevance to clinical practice. Mobilisation is a fundamental care task often missed for several reasons. Moreover, mobilisation of the newly amputated patient is complex, and knowledge of effective strategies to promote postoperative mobilisation in this vulnerable population is desired. Nurses are urged to take responsibility for this fundamental care task and to engage the necessary collaborative interdisciplinary team to develop, implement and evaluate ambitious early mobilisation interventions.

  • 20.
    Moen, Øyfrid
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Avdelningen for helse, omsorg og sykepleie, Högskolen i Gjövik.
    Hall-Lord, Marie-Louise
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Hedelin, Birgitta
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Living in a family with a child with attention deficit hyperactivity disorder: a phenomenographic study2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, no 21-22, p. 3166-3176Article in journal (Refereed)
    Abstract [en]

    This study contributes to knowledge of the parents, siblings and children with attention deficit hyperactivity disorder experiences of everyday life with a child with attention deficit hyperactivity disorder. All family members need support before their problems become too severe.

    Attention deficit hyperactivity disorder is a highly prevalent, clinically heterogeneous disorder characterised by behavioural symptoms of inattention, hyperactivity and impulsivity that creates impairments for the child and affects the family life. The impairments vary with age and context, and the same symptoms do not necessarily have the same effects in different contexts and persons.

    The findings include two descriptive categories ‘safeguarding a functioning family’ and ‘fighting for acceptance and inclusion’. To create a stable and structured family life to avoid conflicts within the family and manage their daily life were crucial. The child with attention deficit hyperactivity disorder and their parents developed special skills and strategies to live with attention deficit hyperactivity disorder in the family sphere and the social context. To apply for help before the problems in the family become too severe and to share responsibility with professionals, who have competence, to meet the families in their worries were stressed. The striving in the family strengthened the companionship in the families, and they conceived growth.

  • 21.
    Nordström, Gun
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Boström, A
    Nilsson Kajermo, K
    Wallin, L
    Registred nurses´use of research findings in the care of older people2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 10, p. 1430-1441Article in journal (Refereed)
  • 22.
    Odencrants, Sigrid
    et al.
    Örebro universitet.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Assessment of nutritional status and meal-related situations among patients with chronic obstructive pulmonary disease in Primary health care - obese patients; a challenge for the future.2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 7-8, p. 977-985Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe nutritional status, meal related situations, food habits and food preferences of patients with chronic obstructive pulmonary disease (COPD) in a Primary health care (PHC) setting.

    BACKGROUND: To date, guidelines have mainly focused on underweight patients with COPD, as a low body mass index (BMI) is a risk factor for mortality. However, in recent years there has been an increase in the number of overweight patients with COPD, and therefore nutritional management must be developed to cover problems related to both under and overweight.

    DESIGN: Descriptive.

    METHODS: One hundred and three patients from PHC centres representing COPD stages 2 and 3 were included. The Mini Nutritional Assessment (MNA) was used to collect nutritional status data while semi-structured interviews provided information on food and meal related situations.

    RESULTS: Mean age was 69 (± 5)years and 45% were women. Among all patients mean BMI was 27 and 14% had a BMI ≤ 21 kg/m(2) . More women (31%) than men (26%) had a BMI ≥ 30 kg/m(2) . According to the MNA screening score, 86% of the patients were assessed as normal or not at risk of malnutrition. The total MNA assessment score revealed that 10 patients were at risk of malnutrition or malnourishment. Problems with meal related situations were mostly associated with eating, and only a small number reported difficulties with shopping or preparing food.

    CONCLUSIONS: In PHC, more patients with COPD were obese than malnourished and their self-reported nutritional status was not always accurate.

    RELEVANCE TO CLINICAL PRACTICE: It is challenging to identify the patient's nutritional status, individualize nutritional care and educate obese patients with COPD at PHC centres. It is necessary to develop screening instruments to assess the risk of both obesity and malnutrition.

  • 23.
    Olsson, Cecilia
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Athlin, Elsy
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Larsson, Maria
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Sexuality is not a priority when disease and treatment side effects are severe: conceptions of patients with malignant blood diseases2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, p. 3503-3512Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES:

    To describe how patients with malignant blood diseases conceive the influence of chemo- or chemoimmunotherapy on sexuality, and their need of support related to this issue.

    BACKGROUND:

    Sexuality is often negatively affected in cancer patients with sex-specific diagnoses. For patients with malignant blood diseases, the research is limited with regard to the effect on sexuality. Knowledge about their need for support related to sexuality is also needed as nurses are found to often avoid this area of their responsibility.

  • 24.
    Räty, Lena
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Patient' perceptions of living with epilepsy: A phenomenographic study2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 13/14, p. 1993-2002Article in journal (Refereed)
  • 25.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences.
    Hall-Lord, Marie-Louise
    Karlstad University, Faculty of Social and Life Sciences.
    Axelsson, Ove
    Udén, Giggi
    Wilde Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences.
    Midwifery care: development of an instrument to measure quality based on the World Health Organization’s classification of care in normal birth2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 1, p. 75-83Article in journal (Refereed)
  • 26.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hall-Lord, Marie-Louise
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Women’s perception of intrapartal care  in relation to WHO’s recommendations2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Journal of Clinical Nursing, Vol. 17, no 22, p. 2993-3003Article in journal (Refereed)
    Abstract [en]

    Background. The aim of intrapartal care in normal birth is to achieve a healthy mother and child using the least possible number of interventions that is compatible with safety. Aim. The aims of this study were to elucidate women’s perception of intrapartal care and women’s perceptions of normal birth. Methods. A questionnaire developed from the WHO’s recommendations for care in normal birth was answered by 138 (response rate 66·0% Swedish women. The women were asked to evaluate items in two ways: their perceived reality of care received and the subjective importance of each item. Results. Most women reported receiving care in the category (A) practices that are good and should be encouraged. However, women to a minor degree reported assessment for physical health, enquiring about support needs and pain assessment on admission. Many women received electronic foetal monitoring, repeated vaginal examinations, oxytocin augmentation and suturing after birth which fall under the category (B) practices that are harmful, (C) insufficient evidence exists and (D) practices frequently used inappropriately. The women who reported ‘Yes’ for perceived reality also reported high subjective importance for those items regardless of category A–D. Eighty-four per cent of the women perceived that they had a normal delivery. Conclusion. The result suggests that women have great trust that the care midwives give them is the best care. Midwives, therefore, have an ethical responsibility to keep themselves informed about the best evidence-based care and to implement critical reviewing of their practice as part of continuing professional development. The women’s perceptions of a normal birth allows for a wide range of interventions. Relevance for clinical practice. The result emphasises the importance of midwives’ knowledge of evidence-based care and how to implement this into practice. Further research should include elucidation of the meaning of normal childbirth to childbearing women.

  • 27.
    Solveig, Struksnes
    et al.
    Gjovik Univ Coll, Gjovik, Norway..
    Margareta, Bachrach-Lindstrom
    Linkoping Univ, Linkoping, Sweden..
    Hall Lord, Marie-Louise
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences. Karlstad University, Division for Health and Caring Sciences. Karlstad Univ, Karlstad, Sweden..
    Randi, Slaasletten
    Gjovik Univ Coll, Gjovik, Norway..
    Inger, Johansson
    Gjovik Univ Coll, Gjovik, Norway..
    The nursing staff's experiences and reactions when older people with dementia fall in nursing homes2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no Suppl., p. 26-Article in journal (Other academic)
  • 28.
    Steffenak, Anne Kjersti Myhrene
    et al.
    Hedmark Univ Coll, Fac Publ Hlth, N-2418 Elverum, Norway..
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Hartz, Ingeborg
    Hedmark Univ Coll, Fac Publ Hlth, N-2418 Elverum, Norway..
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Public health nurses' perception of their roles in relation to psychotropic drug use by adolescents: a phenomenographic study2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 7-8, p. 970-979Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesThe purpose of the paper was to describe the perceptions of public health nurses' roles in relation to psychotropic drug use by adolescents. BackgroundMental health problems among adolescents are documented with studies indicating an increased use of psychotropic drugs. In Norway, care for such adolescents may fall naturally into the remit of public health nurses. DesignA phenomenographic approach was used to analyse the data. MethodA qualitative interview study was made of 20 Norwegian public health nurses, strategically chosen using phenomenographic methodology. ResultsThe public health nurses described three categories: discovering public health nurses who become aware of psychotropic drug use in the health dialogue with adolescents and choose to either act or not act in relation to psychotropic drug use. Those public health nurses who take action are cooperating public health nurses, who cooperate with adolescents, their families, schools and others. If cooperation has been established, supporting public health nurses teach and support the adolescent in relation to psychotropic drug use. ConclusionThe public health nurses who do not act can hinder or delay further treatment. Public health nurses need to acquire knowledge about psychotropic drugs, to fulfil their role in nursing mental health problems among adolescents and the increasing use of psychotropic drugs. Relevance to clinical practiceThe results demonstrated that public health nurses, working in health centres and schools, have the responsibility and the opportunity to identify young people struggling with mental health problems and psychotropic drug use as well as teach and support significant others, e.g. parents and siblings. Intervention studies are needed with regard to health promotion programmes aimed at fortifying young people's mental health.

  • 29.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Unosson, M
    No gender differences in fatigue and functional limitations due to fatigue among patients with chronic obstructive pulmonary disease2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 9/10, p. 1303-1310Article in journal (Refereed)
  • 30.
    Wallengren, Catarina
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Segersten, Kerstin
    School of Health and Sciences, University College of Borås / Department of Health Studies, University of Stavanger.
    Friberg, Febe
    School of Health and Sciences, University of Borås.
    Relative´s information needs and the characteristics of their search for information - in the words of relatives of stroke survivors2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 19/20, p. 2888-2896Article in journal (Refereed)
  • 31.
    Wangensteen, Sigrid
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Johansson, Inger
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    The first year as a nurse: an experience of growth and development2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, no 17, p. 1877-1885Article in journal (Refereed)
  • 32.
    Wangensteen, Sigrid
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Johansson, Inger S.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Björkström, Monica E.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Research utilisation and critical thinking among newly graduated nurses: Predictors for research use. A quantitative cross-sectional study2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17/18, p. 2436-2447Article in journal (Refereed)
    Abstract [en]

    AIM:The aim was to describe research utilisation among newly graduated nurses and to explore critical thinking dispositions and other individual and contextual factors as possible predictors for research use.

    BACKGROUND:Nurses are expected to be research users, and variations in research utilisation are explained by individual and contextual factors. To our knowledge, critical thinking dispositions have not earlier been explored as predictors for research use.

    DESIGN:A cross-sectional design was chosen.

    METHODS:Data collection was carried out from October 2006 to April 2007 using the Research Utilization Questionnaire (RUQ) and the California Critical Thinking Disposition Inventory (CCTDI). The response rate was 33% (n =617). Pearson's chi-square test and regression analyses were used for statistical calculations.

    RESULTS:The respondents reported a positive attitude towards research, but only 24% (n = 148) were defined as research users. A significantly higher proportion of research users reported high critical thinking scores. Critical thinking explained 20% of the variance in attitude towards research and 11% of the variance in research use. Availability and support to implement research findings was the second strongest predictor for research use.

    CONCLUSIONS:Critical thinking, a significant predictor for attitude towards research and for the use of research, should be recognised and strengthened in nursing education and clinical practice. Contextual factors seem to be important for newly graduated nurses' use of research.

    RELEVANCE TO CLINICAL PRACTICE:Nurse leaders play an important role in nurturing newly graduated nurses' critical thinking and assisting them in transferring their positive attitude towards research into research use. Nurse educators play a significant role in supporting, challenging and supervising nursing students to be critical thinkers and strong believers in research utilisation.

  • 33.
    Wentzel Persenius, Mona
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hall-Lord, Marie-Louise
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Bååth, Carina
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Assessment and documentation of patients' nutritional status: perceptions of registered nurses and their chief nurses2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 16, p. 2125-2136Article in journal (Refereed)
    Abstract [en]

    To study, within municipal care and county council care, (1) chief nurses' and registered nurses' perceptions of patient nutritional status assessment and nutritional assessment/screening tools, (2) registered nurses' perceptions of documentation in relation to nutrition and advantages and disadvantages with a documentation model.

    BACKGROUND:

    Chief nurses and registered nurses have a responsibility to identify malnourished patients and those at risk of malnutrition.

    DESIGN AND METHODS:

    In this descriptive study, 15 chief nurses in municipal care and 27 chief nurses in county council care were interviewed by telephone via a semi-structured interview guide. One hundred and thirty-one registered nurses (response rate 72%) from 14 municipalities and 28 hospital wards responded to the questionnaire, all in one county.

    RESULTS:

    According to the majority of chief nurses and registered nurses, only certain patients were assessed, on admission and/or during the stay. Nutritional assessment/screening tools and nutritional guidelines were seldom used. Most of the registered nurses documented nausea/vomiting, ability to eat and drink, diarrhoea and difficulties in chewing and swallowing, while energy intake and body mass index were rarely documented. However, the majority documented their judgement about the patient's nutritional condition. The registered nurses perceived the VIPS model (Swedish nursing documentation model) as a guideline as well as a model obstructing the information exchange. Differences were found between nurses (chief nurses/registered nurses) in municipal care and county council care, but not between registered nurses and their chief nurses.

    CONCLUSIONS:

    All patients are not nutritionally assessed and important nutritional parameters are not documented. Nutritionally compromised patients may remain unidentified and not properly cared for.

    RELEVANCE TO CLINICAL PRACTICE:

    Assessment and documentation of the patients' nutritional status should be routinely performed in a more structured way in both municipal care and county council care. There is a need for increased nutritional nursing knowledge.

  • 34.
    Wilde-Larsson, Bodil
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Larsson, G
    Kvist, L
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Womens' opinions on intrapartal care: development of a theory-based questionnaire2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 11/12, p. 1748-1760Article in journal (Refereed)
    Abstract [en]

    Aim. To develop a patient questionnaire specific to intrapartal care, based on the theoretical foundation of the generalinstrument Quality from the Patients Perspective (QPP).Background. Existing general patient questionnaires do not take intrapartal care aspects fully into account, and availableintrapartal-specific patient questionnaires tend to have a weak theoretical foundation.Design. A cross-sectional, nationwide study carried out during a two-week period in 2007 at Swedish maternity units.Method. An intrapartal-specific QPP-questionnaire (QPP-I) was developed by combining a selection of 22 items from the shortand long versions of the QPP with 10 newly constructed items. Responses were obtained from 739 women (63% response rate).The dimensionality of the QPP-I was assessed using structural equation modelling (a nested factor model). Non-parametricstatistics were used for subgroup comparisons.Results. A nested model with a general factor including all 32 items and 10 subordinate factors was developed. Most scales hadacceptable reliability coefficients (0Æ730Æ93), and a meaningful pattern of subgroup differences was obtained.Conclusions. The QPP-I is theory based and has its roots in a patient perspective. It was developed using a nationwide sample ofSwedish women receiving intrapartal care, and an advanced statistical method was used. The outcome of this initial empiricaltrial was promising but needs to be tested in different countries and cultures.Relevance to clinical practice. By combining womens responses on perceived reality and subjective importance ascribed to thevarious aspects of care measured, the QPP-I offers the care provider better guidelines on which elements to focus qualityimprovement work on, than would be the case if only a rank order of perceived reality ratings was available

  • 35.
    Wilde-Larsson, Bodil
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Starrin, Bengt
    Karlstad University, Faculty of Social and Life Sciences, Department of Social Studies.
    Larsson, G
    Birthgiving Women´s feelings and perceptions of quality of intrapartal care: a nationwide Swedish cross-sectional study2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 7-8, p. 1168-1177Article in journal (Refereed)
    Abstract [en]

    Aim. The aim was to explore the relationships between the feelings of women who give birth and several birth-related care conditions, the womens' socio-demographic background, personality and perceptions of the quality of intrapartum care. Background. Childbirth is a highly significant emotional event for women and it is an explicit goal that each woman should have a positive childbirth experience. Design. The nationwide study is cross-sectional and was conducted at Swedish maternity units over two months in 2007. Methods. The study group consisted of 739 women (63% response rate). A dimensionality analysis of six emotion items was performed using structural equation modelling (SEM). Non-parametric tests and generalised linear mixed effects model analyses were used to study relationships and to make subgroup comparisons. Results. In the SEM analysis, a positive and a negative feeling factor were identified. Strong associations between the feeling factors and the womens' perceptions of the quality of care were found, particularly in regard to the so-called identity-oriented approach of the midwives and other health professionals. In addition, a higher intensity of negative feelings was associated with a personality pattern characterised by extraversion, emotional instability and lower degree of conscientiousness, a lower level of education and having had delivery through Caesarean section. Conclusions. The positive and negative feelings of women who give birth strongly covary with the women's perception of the quality of their intrapartum care. This pertains in particular to information issues, the midwives showing commitment, empathy and respect, being present during labour and allowing the women to actively participate as much as they want to. Relevance to clinical practice. Subgroup differences indicate that midwives should pay increased attention to childbearing women who have primary school education only, a lower emotional stability and/or deliver through Caesarean section.

  • 36.
    Zakrisson, Ann-Britt
    et al.
    Univ Orebro, Fac Hlth & Med, Univ Healthcare Res Ctr, SE-70182 Orebro, Sweden.;Univ Orebro, Ctr Assessment Med Technol, SE-70182 Orebro, Sweden..
    Hiyoshi, Ayako
    Univ Orebro, Fac Hlth & Med, Clin Epidemiol & Biostat, SE-70182 Orebro, Sweden..
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Cty Council Varmland, Primary Care Res Unit, Karlstad, Sweden..
    A three-year follow-up of a nurse-led multidisciplinary pulmonary rehabilitation programme in primary health care: a quasi-experimental study2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 7-8, p. 962-971Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesTo investigate the effects of a nurse-led multidisciplinary pulmonary rehabilitation programme conducted in primary health care on functional capacity, quality of life and exacerbation frequency over threeyears among patients with Chronic Obstructive Pulmonary Disease. BackgroundAlthough Chronic Obstructive Pulmonary Disease is a chronic respiratory disease, it has been established that pulmonary rehabilitation has positive effects on patients' everyday functioning. However, the duration of these functional improvements, especially when the rehabilitation programmes are provided in primary health care settings, remains to be established. DesignA quasi-experimental design. MethodPrimary health care patients with Chronic Obstructive Pulmonary Disease (GOLD stages II and III) were included; 49 in the intervention group and 54 in the control group. The intervention comprised a six-week pulmonary rehabilitation programme. Functional capacity was assessed using a six-minute walking test and quality of life by the Clinical COPD Questionnaire at baseline, after oneyear and threeyears. Exacerbation frequency was calculated from oneyear before to threeyears after the programme. ResultsNo significant differences between the groups were observed in the six-minute walking-test or the Clinical COPD Questionnaire after oneyear and threeyears. On average, there were significant improvements in the six-minute walking-test and the Clinical COPD Questionnaire from baseline to the one-year follow-up. Exacerbation frequency tended to decrease in the intervention group and increase in the control group (interaction test was p=0091) but increased again in both groups after threeyears. ConclusionThere was no evidence of the benefit of the nurse-led multidisciplinary pulmonary rehabilitation programme, although the exacerbation frequency tended to decrease in the intervention group after oneyear. There is a need for support and coaching at regular follow-ups in primary health care. Relevance to clinical practiceThere is a need to support and coach patients with Chronic Obstructive Pulmonary Disease in primary health care by means of regular follow-ups.

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