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  • 1.
    Ahlqvist, Margary
    et al.
    Karolinska Inst, Dept Clin Sci, Div Surg, Stockholm, Sweden..
    Berglund, Britta
    Karolinska Inst, Dept Clin Sci, Div Surg, Stockholm, Sweden..
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Klang, Birgitta
    Karolinska Inst, Care Sci & Soc, Div Nursing, Dept Neurobiol, Stockholm, Sweden..
    Johansson, Eva
    Karolinska Inst, Care Sci & Soc, Div Nursing, Dept Neurobiol, Stockholm, Sweden..
    Satisfactory reliability among nursing students using the instrument PVC ASSESS to evaluate management of peripheral venous catheters2014In: Journal of Vascular Access, ISSN 1129-7298, E-ISSN 1724-6032, Vol. 15, no 2, p. 128-134Article in journal (Refereed)
    Abstract [en]

    Purpose: Nursing students should be given opportunities to participate in clinical audits during their education. However, audit tools are seldom tested for reliability among nursing students. The aim of this study was to present reliability among nursing students using the instrument PVC assess to assess management of peripheral venous catheters (PVCs) and PVC-related signs of thrombophlebitis. Methods: PVC assess was used to assess 67 inserted PVCs in 60 patients at ten wards at a university hospital. One group of nursing students (n= 4) assessed PVCs at the bedside (inter-rater reliability) and photographs of these PVCs were taken. Another group of students (n= 3) assessed the PVCs in the photographs after 4 weeks (test-retest reliability). To determine reliability, proportion of agreement [P(A)] and Cohen's kappa coefficient (k) were calculated. Results: For bedside assessment of PVCs, P(A) ranged from good to excellent (0.80-1.0) in 55% of the 26 PVC assess items that were tested. P(A) was poor (< 0.70) for two items: "adherence of inner dressing to the skin" and " PVC location." In 81% of the items, k was between moderate and almost perfect: moderate (n= 5), substantial (n= 3), almost perfect (n= 5). For edema at insertion site and two items on PVC dressing, k was fair (0.21-0.40). Regarding test-retest reliability, P(A) varied between good and excellent (0.81-1) in 85%-95% of the items, and the k ranged between moderate and almost perfect (0.41-1) in 90%-95%. Conclusions: PVC assess demonstrated satisfactory reliability among nursing students. However, students need training in how to use the instrument before assessing PVCs.

  • 2.
    Ahlqvist, Margary
    et al.
    Karolinska Univ Hosp Huddinge, Karolinska Inst, Div Surg, Dept Clin Sci Intervent & Technol, SE-14186 Stockholm, Sweden..
    Berglund, Britta
    Karolinska Univ Hosp Huddinge, Karolinska Inst, Div Surg, Dept Clin Sci Intervent & Technol, SE-14186 Stockholm, Sweden..
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Klang, Birgitta
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Wiren, Mikael
    Karolinska Univ Hosp Huddinge, Karolinska Inst, Div Surg, Dept Clin Sci Intervent & Technol, SE-14186 Stockholm, Sweden..
    Johansson, Eva
    Karolinska Univ Hosp Solna, Red Cross Univ Coll, Stockholm, Sweden.;Karolinska Univ Hosp Solna, Karolinska Inst, Dept Med, Div Hematol, Stockholm, Sweden..
    A new reliable tool (PVC assess) for assessment of peripheral venous catheters2010In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 6, p. 1108-1115Article in journal (Refereed)
    Abstract [en]

    Rationale and aims To evaluate the extensive use of peripheral venous catheters (PVCs), including catheter-related complications, a reliable tool for PVC assessment is needed. The aim of this study was to develop such a tool to evaluate PVCs in relation to management, documentation and signs and symptoms of thrombophlebitis (TH), as well as to determine its inter-rater and test-retest reliability. Method The tool development included confirmation of content and face validity. Two groups of registered nurses used the new tool (PVC assess) to assess PVC management and signs of TH independently. Group A (n = 3) assessed 26 items in 67 PVCs bedside (inter-rater reliability). Group B (n = 3) assessed photographs (67 PVCs, 21 items) of the same PVCs as those in Group A with a 4-week interval (test-retest reliability). Proportion of agreement P(A) and Cohen's kappa were calculated to evaluate inter-rater and test-retest reliability. Results Among nurses assessing PVCs at bedside, the P(A) was good to excellent (0.80-1) in 96% of the items in PVC assess. In 80% of the items kappa was substantial to almost perfect (0.61-1). TH sign erythema fell into the fair range (kappa = 0.40). In test-retest reliability analysis the P(A) was within the good and excellent range (0.80-1.0) and kappa varied from moderate to almost perfect (0.41-1.0) in 95% of the items. One item 'outer dressing is clean' was in fair range (0.21-0.40). Conclusions The PVC assess instrument shows satisfactory inter-rater and test-retest reliability. Reliability tests on reviewing documentation remain to be performed.

  • 3.
    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.

  • 4. Ahlstedt, S.
    et al.
    Marklund, B.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Allergy-like conditions and quality of life in adolescents with emphasis on adverse reaction to food2004Conference paper (Refereed)
  • 5. Barthelsson, C
    et al.
    Anderberg, B
    Björwell, C
    Ramel, S
    Gisecke, K
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Outpatient vesus inpatient laparoscopic cholecystectomy2008In: J Eval Clin Pract. 2008;14:577-84Article in journal (Refereed)
  • 6. Barthelsson, C
    et al.
    Anderberg, B
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Postoperative recovery from different perspectives2007Conference paper (Refereed)
  • 7. Barthelsson, C
    et al.
    Lützén, K
    Anderberg, B
    Bringman, S
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Patients´ experiences of laparoscopic fundoplication in day surgery2003In: J Amb Surg. 2003;10:101-107Article in journal (Refereed)
  • 8. Barthelsson, C
    et al.
    Lützén, K
    Anderberg, B
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Patients´experiences of laparoscopic cholecystectomy2003In: J Clin Nurse. 2003;12:253-529Article in journal (Refereed)
  • 9.
    Barthelsson, Cajsa
    et al.
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Norberg, Åke
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm.
    Sense of coherence and other predictors or pain and health following laparoscopic cholecystectomy2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 1, p. 143-150Article in journal (Refereed)
    Abstract [en]

    Pain is the most common symptom following laparoscopic cholecystectomy (LC) and might delay discharge from hospital after day surgery. A patient’s ability to manage stressful situations can be assessed by the sense of coherence (SOC) and has been proposed to predict health. The aim of this study was to investigate predictors of average pain the first postoperative week after LC, and predictors of changes in perceived health, with special reference to individual coping resources measured by the Sense of Coherence Scale. Furthermore, a test–re-test was performed on SOC to evaluate the stability in the context of LC surgery.  Method:  Seventy-three patients completed questionnaires about SOC, health status, pain, anxiety, symptom occurrence and symptom distress preoperatively, postoperative day 1–7 and after 1 and 6 months following LC. Results: By multiple regression, 23% of the variability in pain intensity could be explained by the variables age, SOC and education. Age was the strongest predictor. Further, 19% of the change in health between day 7 and 1 month could be explained by the two variables symptom distress the first postoperative day and SOC. The test–re-test of SOC had a correlation coefficient (r) of 0.55. Forty-six patients (63%) remained within ± 10% of their preoperative SOC score at 6 months, 11 patients (15%) decreased and 16 patients (22%) increased their SOC values.  Conclusion: SOC was found to be a significant but weak predictor of pain intensity the first week after LC. Furthermore, patients scoring low SOC values experienced a delay in their health improvement. SOC was more unstable over time than previously suggested. Further, interventional studies are needed to clarify if SOC might be a clinically useful measure to identify vulnerable patients undergoing LC surgery.

  • 10.
    Barthelsson, S
    et al.
    Karolinska institutet.
    Norberg, Å
    Karolinska institutet.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Longitudinal changes in health and symptoms following laparoscopic cholecystectomy2009In: Ambulatory Surgery, ISSN 0966-6532, E-ISSN 1873-2097, Vol. 15, no 4, p. 87-92Article in journal (Refereed)
  • 11. Berglund, B.
    et al.
    Mattiasson, A-C
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Acceptance of disability and sense of coherence in individuals with Ehlers-Danlos syndrome2003In: J Clin Nurs 2003;12:770-777Article in journal (Refereed)
  • 12. Berglund, B
    et al.
    Mattiasson, A-C
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Foot pain and disability in individuals with Ehlers-Danlors syndrome (EDS). Impact of daily life activities2005In: Disability and Rehabilitation. 2005;27(4):164-169Article in journal (Refereed)
  • 13. Berglund, B
    et al.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Symptoms and functional health status of individuals with Ehlers Danlos syndrome2001In: J Clin Rheumatol. 2001;7(5)308-314Article in journal (Refereed)
  • 14. Berglund, B
    et al.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    The use of the modified Norton Scale in nursing-home patients1995In: Scand J Caring Sci 1995;9:165-169Article in journal (Refereed)
  • 15. Berglund, B
    et al.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Lützén, K
    Living a restricted life with Ehlers-Danlos Syndrom (EDS)2000In: Int J Nurs Stud 2000; 37:111-118Article in journal (Refereed)
  • 16. Bjuresäter, K
    et al.
    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.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Feeding methods, side effects and health related quality of life in patients with home enteral tube feeding2008Conference paper (Refereed)
  • 17.
    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.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Patients Living with Home Enteral Tube Feeding: Side effects, health-related quality of life and nutritional care2014In: Clinical Nursing Studies, ISSN 2324-7940, Vol. 2, no 3, p. 64-75Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to examine patients’ perceptions of side effects, health-related quality of life (HRQL), generalhealth, and nutritional care among patients receiving home enteral tube feeding (HETF) at two occasions after dischargefrom hospital. Three questionnaires, one study-specific, the Short Form 12 (SF-12) and the Health Index (HI), were sent topatients with HETF (n=62) twice, two weeks after discharge from hospital and two months later. Forty patients respondedtwo weeks after discharge and out of these 29 patients also responded after two months. Data were collected in centralSweden from March 2006 to January 2010. Side effects were common at both points of data collection (70% of thepatients after two weeks and 72% after two month). Patients using bolus feeding reported significantly fewer side effectsthan patients using intermittent feeding. HRQL and HI scores for the total group were low at both points of data collection.The bolus feeding group reported significantly higher physical HRQL and emotional HI than the intermittent feedinggroup did. Most patients were satisfied with the information and support they received from the health care team. Thisstudy has revealed that patients treated with HETF experienced side effects limiting their daily life to a great extent.Differences in HRQL related to feeding methods were found. Individualized support and regular controls are needed inorder to meet patient needs. Bolus feeding may be a suitable feeding method to improve well-being.

  • 18.
    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: from nurses' perspectives2008In: Journal of Clinical Nursing (2008) 17, 3021-3029Article in journal (Refereed)
  • 19.
    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)
  • 20. Björvell, B
    et al.
    Aly A, A
    Langius, A
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Indicators of changes in weight and eating behaviour in severely obese patients, treated in a nursing behavioral program1994In: Internat J Obesity 1994;18:521-525Article in journal (Refereed)
  • 21.
    Bood, Sven-Åke
    et al.
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology.
    Sundequist, U.
    Kjellgren, Anette
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Norlander, Torsten
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology.
    Effects of flotation-REST (Restricted Environmental Stimulation Technique) on stress related muscle pain: What makes the difference in therapy, attention-placebo or the relaxation response?2005In: Pain Research and Management, 10, 201-209Article in journal (Refereed)
  • 22.
    Bood, Sven-Åke
    et al.
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology.
    Sundequist, U.
    Kjellgren, Anette
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology.
    Norlander, Torsten
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology.
    Nordström, L.
    Nordenström, K.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Eliciting the relaxation response with the help of flotation-REST (Restricted Environmental Stimulation Technique) in patients with stress-related ailments2006In: Internation journal of Stress Manage. 2006;13:154-175Article in journal (Refereed)
  • 23.
    Bood, Sven-Åke
    et al.
    Karlstad University, Faculty of Economic Sciences, Communication and IT.
    Sundequist, Ulf
    Karlstad University, Faculty of Economic Sciences, Communication and IT.
    Kjellgren, Anette
    Karlstad University, Faculty of Economic Sciences, Communication and IT.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences.
    Norlander, Torsten
    Karlstad University, Faculty of Economic Sciences, Communication and IT.
    Effects of Flotation REST (Restricted Environmental Stimulation Technique) on Stress Related Muscle Pain: Are 33 flotation sessions more effective as compared to 12 sessions?2007In: Social behavior and personality, ISSN 0301-2212, E-ISSN 1179-6391, Vol. 35, no 2, p. 143-155Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to investigate whether or not 33 flotation sessions were more effective for stress-related ailments than 12 sessions. Participants were 37 patients, 29 women and 8 men, all diagnosed as having stress-related pain of a muscle tension type. The patients were randomized to one of two conditions: 12 flotation-REST treatments or 33 flotation-REST treatments. Analyses for subjective pain typically indicated that 12 sessions were enough to get considerable improvements and no further improvements were noticed after 33 sessions. A similar pattern was observed concerning the stress-related psychological variables: experienced stress, anxiety, depression, negative affectivity, dispositional optimism, and sleep quality. For blood pressure no effects were observed after 12 sessions, but there was a significant lower level for diastolic blood pressure after 33 sessions. The present study highlighted the importance of finding suitable complementary treatments in order to make further progress after the initial 12 sessions.

  • 24. Borglund, E
    et al.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Nyman, CR
    Classification of peristomal skin changes in patients with urostomy1988In: J Am Acad Dermatol 1988;19:623-628Article in journal (Refereed)
  • 25. Boström, A-M
    et al.
    Wallin, L
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Evidence-based practice and determinants of research use in elderly care in Sweden2007In: J Eval Clin Practice 2007;13:665-73Article in journal (Refereed)
  • 26. Boström, A-M
    et al.
    Wallin, L
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Research use in the care of older people. A survey among healthcare staff2006In: Int J Older People Care 2006;1:131-140Article in journal (Refereed)
  • 27.
    Boström, Anne-Marie
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet.
    Nilsson Kajermo, Kerstin
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet and Clinical Research Utilization (CRU), Karolinska University Hospital.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wallin, Lars
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet and Clinical Research Utilization (CRU), Karolinska University Hospital.
    Barriers to research utilization and research use among registered nurses working in the care of older people. Does the BARRIERS Scale discriminate between research users and non-research uses on perception of barriers?2008In: Implementation Science, E-ISSN 1748-5908, Vol. 3, no 24Article in journal (Refereed)
    Abstract [en]

    BackgroundOne strategy to enhance research use and change current practice is to identify barriers and then implement tailored interventions to reduce these barriers. In nursing, the BARRIERS scale has been frequently used to identify nurses' perceptions of barriers to research utilization. However, this scale has not been applied to care of older people, and only one study has investigated how identified barriers link to research utilization. Therefore, the purpose of this study was twofold: to describe RNs' perceptions of barriers to and facilitators of research utilization and to examine the validity of the BARRIERS scale in relation to research use.

    MethodsA cross-sectional survey design was used and registered nurses (RNs) working in the care of older people participated (response rate 67%, n = 140/210). Two questionnaires, the BARRIERS scale and the Research Utilization Questionnaire (RUQ), were used. Data were analyzed using descriptive and bivariate inferential statistics.

    ResultsCharacteristics of the organization and the presentation of research findings were rated as the most prominent barriers. The three items most frequently reported as barriers were: the nurse is isolated from knowledgeable colleagues with whom to discuss the research (89%); the facilities are inadequate for implementation (88%); and, the relevant literature is not compiled in one place (81%). Surveyed RNs suggested more support from unit managers and better availability of user-friendly reports in Swedish to enhance research use.

    The RNs reported a modest use of research. A weak but significant correlation was found between the Research Use index in RUQ and the Presentation subscale in the BARRIERS scale (r = -0.289, p < 0.01), suggesting that the RNs reporting more research use were less likely to perceive presentation of research as a barrier. Dividing the sample into research users (n = 29) and non-research users (n = 105), the research users rated significantly lower on the subscales Presentation, Nurse and Research in the BARRIERS scale.

    ConclusionThe BARRIERS scale revealed differences in the perception of barriers between research users and non-research users. Thus, methodologically the scale appears useful in identifying some types of barriers to research utilization but not organizational barriers. The identified barriers, however, are general and wide-ranging, making it difficult to design useful specific interventions.

  • 28.
    Boström, Anne-Marie
    et al.
    Karolinska institutet.
    Nordström, GunKarlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).Wilde-Larsson, BodilKarlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Kvalitetsarbete för bättre och säkrare vård2017Collection (editor) (Refereed)
  • 29.
    Boström, Ann-Marie
    et al.
    Karolinska institutet.
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Andvändning av forskningsresultat i vården2017In: Kvalitetsarbete för bättre och säkrare vård / [ed] Ann-Marie Boström, Gun Nordström, Bodil Wilde Larsson, Lund: Studentlitteratur AB, 2017, 2, p. 195-218Chapter in book (Refereed)
  • 30. Eek, A-C
    et al.
    Lindgren, M
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Kvalitetsindikationer för patienter med eller med risk för trycksår2007Chapter in book (Refereed)
  • 31. Eriksson, L
    et al.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Berglund, T
    Sandström, E
    The health related quality of life in a Swedish sample of HIV-infected persons2000In: J Adv Nurs. 2000;32(5):1213-1219Article in journal (Refereed)
  • 32. Eriksson, LE
    et al.
    Bratt, G
    Sandström, E
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    The two-year impact of first generation protease inhibitor based antiretroviral therapy (PI-art) on health-related quality of life2005In: Health Qual Life Outcomes. 2005;3(1):32Article in journal (Refereed)
  • 33.
    Finbråten, Hanne Søberg
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Guttersrud, Ö
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Högskolan i Hedmark.
    Pettersen, K.S.
    Trollvik, A
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Validating the functional, communicative and critical health literacy scale using rasch modeling and confirmatory factor analysis2018In: Journal of Nursing Measurement, ISSN 1061-3749, E-ISSN 1945-7049, no 2, p. 341-363Article in journal (Refereed)
    Abstract [en]

    Background and Purpose: The functional, communicative, and critical health literacy (FCCHL) scale is widely used for assessing health literacy (HL) in people with chronic diseases, such as type 2 diabetes (T2DM). Despite related subscales, researchers continue to apply a consecutive modeling approach, treating the three subscales as independent. This article studies the psychometric characteristics of the FCCHL by applying multidimensional modeling approaches.

    Methods: Rasch modeling and confirmatory factor analyses were applied to responses (paper-and-pencil) from 386 adults with T2DM.

    Results: Using a six-point rating scale and a three-dimensional Rasch model, this study found that a 12-item version of the FCCHL reduced within-item bias and improved subscale reliability indexes.

    Conclusion: This study suggests a parsimonious 12-item version of the FCCHL. The data fit a three-dimensional Rasch model best.

  • 34.
    Finbråten, Hanne Søberg
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Pettersen, Kjell Sverre
    Oslo and Akershus University College of Applied Sciences, NOR.
    Wilde Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Trollvik, Anne
    Inland Norway University of Applied Sciences, NOR.
    Guttersrud, Øystein
    Oslo University.
    Validating the European Health Literacy Survey Questionnaire in people with type 2 diabetes: Latent trait analyses applying multidimensional Rasch modelling and confirmatory factor analysis2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 11, p. 2730-2744Article in journal (Refereed)
    Abstract [en]

    AIM: To validate the European Health Literacy Survey Questionnaire (HLS-EU-Q47) in people with type 2 diabetes mellitus.

    BACKGROUND: The HLS-EU-Q47 latent variable is outlined in a framework with four cognitive domains integrated in three health domains, implying 12 theoretically defined subscales. Valid and reliable health literacy measurers are crucial to effectively adapt health communication and education to individuals and groups of patients.

    DESIGN: Cross-sectional study applying confirmatory latent trait analyses.

    METHODS: Using a paper-and-pencil self-administered approach, 388 adults responded in March 2015. The data were analysed using the Rasch methodology and confirmatory factor analysis.

    RESULTS: Response violation and trait violation (multidimensionality) of local independence were identified. Fitting the 'multidimensional random coefficients multinomial logit' model, 1-, 3- and 12-dimensional Rasch models were applied and compared. Poor model fit and differential item functioning were present in some items and several subscales suffered from poor targeting and low reliability. Despite multidimensionality in the data, we did not observe any unordered response categories.

    CONCLUSION: Interpreting the domains as distinct but related latent dimensions, the data fit a 12-dimensional Rasch model and a 12-factor confirmatory factor model best. Therefore, the analyses did not support the estimation of one overall 'health literacy score'. To support the plausibility of claims based on the HLS-EU score(s), we suggest: removing the health care aspect to reduce the magnitude of multidimensionality; rejecting redundant items to confine response dependency; adding 'harder' items and applying a six-point rating scale to improve subscale targeting and reliability; and revising items to improve model fit. This article is protected by copyright. All rights reserved.

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    Finbråten 2017
  • 35.
    Finbråten, Hanne Søberg
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Høgskolen i Hedmark, Norge.
    Pettersen, Kjell Sverre
    Høgskolen i Oslo og Akershus, Norge.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Trollvik, Anne
    Høgskolen i Hedmark, Norge.
    Guttersrud, Øystein
    Universitetet i Oslo, Norge.
    Validating the Norwegian translation of the HLS-EUQ472014Conference paper (Refereed)
  • 36.
    Finbråten, Hanne Søberg
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Inland Norway University of Applied Sciences.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Inland Norway University of Applied Sciences, Norway.
    Nordström, Gun
    Inland Norway University of Applied Sciences, Norway.
    Pettersen, Kjell Sverre
    Oslo Metropolitan Universitet, Norway.
    Trollvik, Anne
    Inland Norway University, Norway.
    Guttersrud, Öystein
    University of Oslo, Norway.
    Establishing the HLS-Q12 short version of the European Health Literacy Survey Questionnaire: Latent trait analyses using Rasch modelling and confirmatory factor modelling2018In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 18, no 506Article in journal (Other academic)
    Abstract [en]

    The European Health Literacy Survey Questionnaire (HLS-EU-Q47) is widely used in assessing health literacy (HL). There has been some controversy whether the comprehensive HLS-EU-Q47 data, reflecting a conceptual model of four cognitive domains across three health domains (i.e. 12 subscales), fit unidimensional Rasch models. Still, the HLS-EU-Q47 raw score is commonly interpreted as a sufficient statistic. Combining Rasch modelling and confirmatory factor analysis, we reduced the 47 item scale to a parsimonious 12 item scale that meets the assumptions and requirements of objective measurement while offering a clinically feasible HL screening tool. This paper aims at (1) evaluating the psychometric properties of the HLS-EU-Q47 and associated short versions in a large Norwegian sample, and (2) establishing a short version (HLS-Q12) with sufficient psychometric properties.MethodsUsing computer-assisted telephone interviews during November 2014, data were collected from 900 randomly sampled individuals aged 16 and over. The data were analysed using the partial credit parameterization of the unidimensional polytomous Rasch model (PRM) and the 'between-item' multidimensional PRM, and by using one-factorial and multi-factorial confirmatory factor analysis (CFA) with categorical variables.ResultsUsing likelihood-ratio tests to compare data-model fit for nested models, we found that the observed HLS-EU-Q47 data were more likely under a 12-dimensional Rasch model than under a three- or a one-dimensional Rasch model. Several of the 12 theoretically defined subscales suffered from low reliability owing to few items. Excluding poorly discriminating items, items displaying differential item functioning and redundant items violating the assumption of local independency, a parsimonious 12-item HLS-Q12 scale is suggested. The HLS-Q12 displayed acceptable fit to the unidimensional Rasch model and achieved acceptable goodness-of-fit indexes using CFA.ConclusionsUnlike the HLS-EU-Q47 data, the parsimonious 12-item version (HLS-Q12) meets the assumptions and the requirements of objective measurement while offering clinically feasible screening without applying advanced psychometric methods on site. To avoid invalid measures of HL using the HLS-EU-Q47, we suggest using the HLS-Q12. Valid measures are particularly important in studies aiming to explain the variance in the latent trait HL, and explore the relation between HL and health outcomes with the purpose of informing policy makers.

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    Søberg_Finbråten_et_al_2018
  • 37.
    Finbråten, Hanne Søberg
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013).
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Pettersen, Kjell Sverre
    Høgskolen i Oslo og Akershus, Norge.
    Trollvik, Anne
    Høgskolen i Hedmark, Norge.
    Guttersrud, Øystein
    Universitetet i Oslo.
    Validating data from health literacy instruments applying modern test theory2014Conference paper (Refereed)
  • 38. Folin, A.
    et al.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Accidental blood contact during orthopedic surgical procedures1997In: Infect Control Hosp Epidemiol 1997;18:244-246Article in journal (Refereed)
  • 39. Folin, A
    et al.
    Nyberg, B
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Reducing blood exposures during orthopedic surgical procedures2000In: AORN 2000; 71:573-582Article in journal (Refereed)
  • 40. Frisk, U
    et al.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Patients´and nurses´perception of patients´sleep in an intensive care unit2003In: Intensive and Critical Care Nursing. 2003;19:342-349Article in journal (Refereed)
  • 41.
    From, Ingrid
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Nordström, Gun
    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.
    Johansson, Inger
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Caregivers in older peoples' care: Perception of quality, working conditions, competence and personal health2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 3, p. 704-714Article in journal (Refereed)
  • 42.
    From, Ingrid
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Dalarna University.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Hedmark University College, Norway.
    Johansson, Inger
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Gjövik University College, Norway.
    Formal caregivers' perceptions of quality of care for older people: predicting factors2015In: BMC Research Notes, E-ISSN 1756-0500, Vol. 8, no 623Article in journal (Refereed)
    Abstract [en]

    Background

    Despite the growing number of studies concerning quality of care for older people, there is a lack of studies depicting factors associated with good quality of care from the formal caregivers’ perspective. The aim was to describe formal caregivers’ perceptions of quality of care for older people in the community and explore factors associated with these perceptions. In total, 70 nursing assistants, 163 enrolled nurses and 198 registered nurses from 14 communities in central Sweden participated in the study. They filled out the following questionnaires: a modified version of Quality from the Patient’s Perspective, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items regarding education and competence, Health Index and Sense of coherence questionnaire. The overall response rate was 57 % (n = 431).

    Results

    In the perceived reality of quality of care respondents assessed the highest mean value in the dimension medical-technical competence and physical technical conditions and lower values in the dimensions; identity-oriented approach, socio-cultural atmosphere and in the context specific dimension. The caregivers estimated their competence and health rather high, had lower average values in sense of coherence and organizational climate and low values in stress of conscience.

    Conclusions

    The PR of quality of care were estimated higher among NA/ENs compared to RNs. Occupation, organizational climate and stress of conscience were factors associated with quality of care that explained 42 % of the variance. Competence, general health and sense of coherence were not significantly associated to quality of care. The mentioned factors explaining quality of care might be intertwined and showed that formal caregivers’ working conditions are of great importance for quality of care.

  • 43. Gardulf, A
    et al.
    Bergman, U
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Computerize drug handling! Scrutinity of drug prescriptions at four emergency hospitals show big shortages2005In: Läkartidningen. 2005;102(22):1732-1737 (In Swedish)Article in journal (Refereed)
  • 44. Gardulf, A
    et al.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Correctly written drug prescriptions important for the nurses´drug handling but reviews of in-patients drug prescriptions demonstrated errors1998In: Vård i Norden 1998;18:4-8Article in journal (Refereed)
  • 45. Gardulf, A
    et al.
    Orton, M-L
    Eriksson, M-L
    Undén, M
    Arnetz, B
    , Nilsson-Kajermo
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Factors of importance for work satisfaction among nurses in a university hospital in Sweden2008In: Scand J Caring Sci. 2008;22:151-60Article in journal (Refereed)
  • 46. Gardulf, A
    et al.
    Söderström, I-L
    Eriksson, L E
    Orton, M-L
    Arnetz, B
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Why do Swedish nurses want to quit their jobs?2005In: Journal of Nursing ManagementArticle in journal (Refereed)
  • 47.
    Gardulf, Ann
    et al.
    Karolinska Institutet ;The Japanese Red Cross Institute,JPN.
    Florin, Jan
    Dalarna University ; Karolinska Institutet,.
    Carlsson, Marianne
    University of Gävle ; Uppsala University.
    Leksell, Janeth
    Dalarna University ; Uppsala University.
    Lepp, Margret
    University of Gothenburg ;Østfold University College, NOR ; Griffith University, AUS.
    Lindholm, Christina
    Sophiahemmet University.
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Norway University of Applied Sciencies, NOR.
    Theander, Kersti
    Region Värmland.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Norway University of Applied Sciencies, NOR.
    Nilsson, Jan
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). The Japanese Red Cross Institute for Humanitarian Studies, JPN ; Sophiahemmet University.
    The Nurse Professional Competence (NPC) Scale: A tool that can be used in national and international assessments of nursing education programmes2019In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 39, no 3, p. 137-142Article in journal (Refereed)
  • 48.
    Gardulf, Ann
    et al.
    Karolinska Univ Hosp, Karolinska Inst, Dept Lab Med, Div Clin Immunol,Unit Clin Nursing Res & Clin Res, SE-14186 Stockholm, Sweden.;Japanese Red Cross Inst Humanitarian Studies, Tokyo, Japan..
    Nilsson, Jan
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Japanese Red Cross Inst Humanitarian Studies, Tokyo, Japan..
    Florin, Jan
    Dalama Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    Leksell, Janeth
    Dalama Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.;Uppsala Univ, Dept Med Sci Clin Diabetol & Metab, Uppsala, Sweden..
    Lepp, Margret
    Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, Gothenburg, Sweden.;Ostfold Univ Coll, Holden, Norway..
    Lindholm, Christina
    Sophiahemmet Univ, Stockholm, Sweden..
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Hedmark University College, Hedmark, Norway.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Hedmark Univ Coll, Hedmark, Norway..
    Carlsson, Marianne
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden.;Univ Gavle, Fac Hlth & Occupat Studies, Gavle, Sweden..
    Johansson, Eva
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Dept Nursing, Stockholm, Sweden..
    The Nurse Professional Competence (NPC) Scale: Self-reported competence among nursing students on the point of graduation2016In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 36, p. 165-171Article in journal (Refereed)
    Abstract [en]

    Background: International organisations, e.g. WHO, stress the importance of competent registered nurses (RN) for the safety and quality of healthcare systems. Low competence among RNs has been shown to increase the morbidity and mortality of inpatients. Objectives: To investigate self-reported competence among nursing students on the point of graduation (NSPGs), using the Nurse Professional Competence (NPC) Scale, and to relate the findings to background factors. Methods and participants; The NPC Scale consists of 88 items within eight competence areas (CAs) and two overarching themes. Questions about socio-economic background and perceived overall quality of the degree programme were added. In total, 1086 NSPGs (mean age, 28.1[20-56] years, 87.3% women) from 11 universities/university colleges participated. Results: NSPGs reported significantly higher scores for Theme I "Patient-Related Nursing" than for Theme II "Organisation and Development of Nursing Care". Younger NSPGs (20-27 years) reported significantly higher scores for the CAs "Medical and Technical Care" and "Documentation and Information Technology". Female NSPGs scored significantly higher for "Value-Based Nursing". Those who had taken the nursing care programme at upper secondary school before the Bachelor of Science in Nursing (BSN) programme scored significantly higher on "Nursing Care", "Medical and Technical Care", "Teaching/Learning and Support", "Legislation in Nursing and Safety Planning" and on Theme I. Working extra paid hours in healthcare alongside the BSN programme contributed to significantly higher self-reported scores for four CAs and both themes. Clinical courses within the BSN programme contributed to perceived competence to a significantly higher degree than theoretical courses (932% vs 875% of NSPGs). Summary and conclusion: Mean scores reported by NSPGs were highest for the four CAs connected with patient-related nursing and lowest for CAs relating to organisation and development of nursing care. We conclude that the NPC Scale can be used to identify and measure aspects of self-reported competence among NSPGs. (C) 2015 Elsevier Ltd. All rights reserved.

  • 49.
    German Millberg, Lena
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Berg, Linda
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademin, Göteborgs universitet.
    Björk Brämberg, Elisabeth
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademin, Göteborgs universitet.
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Öhlén, Joakim
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademin, Göteborgs universitet. Palliativt Forskningscentrum, Ersta Sköndal högskola och Ersta sjukhus, Stockholm..
    Academic learning for specialist nurses: a Grounded Theory study2014In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 14, no 6, p. 714-721Article in journal (Other academic)
    Abstract [en]

    The aim was to explore the major concerns of specialist nurses pertaining to academic learning during their education and initial professional career. Specialist nursing education changed in tandem with the European educational reform in 2007. At the same time, greater demands were made on the healthcare services to provide evidence-based and safe patient-care. These changes have influenced specialist nursing programmes and consequently the profession. Grounded Theory guided the study. Data were collected by means of a questionnaire with open-ended questions distributed at the end of specialist nursing programmes in 2009 and 2010. Five universities were included. Further, individual, pair and group interviews were used to collect data from 12 specialist nurses, 5-14 months after graduation. A major concern for specialist nurses was that academic learning should be "meaningful" for their professional future. The specialist nurses' "meaningful academic learning process" was characterised by an ambivalence of partly believing in and partly being hesitant about the significance of academic learning and partly receiving but also lacking support. Specialist nurses were influenced by factors in two areas: curriculum and healthcare context. They felt that the outcome of contribution to professional confidence was critical in making academic learning meaningful.

  • 50. Gunnarsson, N.
    et al.
    Marklund, B.
    Ahlstedt, S.
    Borell, L.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Allergy-like conditions and health-care contacts among children with exclusion diets at school2005In: Scand J Caring Sci. 2005;19:1-7Article in journal (Refereed)
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