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  • 1.
    Brodin, Kerstin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Hellzén, Ove
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Häggström, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Intraoperative Care of the Conscious Patient from the Perspective of the Operating Theatre Nurse: A Grounded Theory2017In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 7, no 9, p. 1086-1099Article in journal (Refereed)
    Abstract [en]

    Introduction: Intraoperative care includes a unique knowledge of how to

    perform a safe and effective surgery procedure. Surgery performed under regional

    or local anaesthesia allows the patient to remain conscious during the

    procedure and is rather common in Swedish healthcare today. Aim: The aim

    was to obtain a deeper understanding of the main concerns of operating theatre

    nurses (OTN) when caring for conscious patients during the intraoperative

    phase. Methods: Interviews were conducted with 23 OTNs from five different

    hospitals in Sweden and analysed according to grounded theory. Findings:

    The main concern among the OTNs was to take the patient in consideration.

    The core category “achieve and maintain ethical treatment of patients”

    in the operating theatre (OT) was a strategy used throughout the intraoperative

    process. Ethical treatment was described as moral behaviour at

    different levels and included the team’s behaviour, respectful and individualised

    patientcare, and the working-morale of the professionals. Being vigilant

    and being flexible were the categories related to the core category. The OTNs

    constantly assessed where to pay most attention as they balanced between the

    needs of the patient, the team, and the surgery procedure. Conclusion: It is

    important that every patient is taken into consideration and that ethical principles

    are held to the highest standards in the OT. A familiar team can facilitate

    that. The complex skills that operating theatre nurses develop can be

    added to explain important competencies within the profession.

  • 2.
    Brodin, Kerstin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Hellzén, Ove
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Häggström, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Patients´ experiences of being conscious during surgery – an interview studyManuscript (preprint) (Other academic)
  • 3.
    Hallin, Karin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Bäckström, Britt
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Häggström, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    High-fidelity simulation: Assessment of student nurses' team achievements of clinical judgment2016In: Nurse Education in Practice, Vol. 19, p. 12-18Article in journal (Refereed)
    Abstract [en]

    Nursing educators have the challenge of preparing nursing students to handle complex patient care situations in real life, but much remains unknown about the ability to make clinical judgments. In this study, high-fidelity simulation (HFS) was used at a Swedish university to find answers about pre-licensure nursing students' success in clinical judgment in terms of team ability and relationships with theoretical achievements, and personal and scenario circumstances. The matrix Lasater Clinical Judgment Rubric (LCJR) was used to analyze and score the students' ability in teams to notice, interpret and respond to complex care situations. Overall, the results showed the student teams in their first meeting with HFS in a complex care situation achieved low clinical judgment points; most teams were in the stages of Beginning and Developing. For attaining high team achievements the majority of the students in the team should theoretically be "high performance". Being observers and having HFS experience before nursing education was significant too. However, age, health care experience, and assistant nurse degrees were of secondary importance. Further research at universities regionally, nationally, and internationally is needed.

  • 4.
    Hallin, Karin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Häggström, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Bäckström, Britt
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Correlations between Clinical Judgement and Learning Style Preferences of Nursing Students in the Simulation Room2016In: Global Journal of Health Science, ISSN 1916-9736, E-ISSN 1916-9744, Vol. 8, no 6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Health care educators account for variables affecting patient safety and are responsible for developing the highly complex process of education planning. Clinical judgement is a multidimensional process, which may be affected by learning styles. The aim was to explore three specific hypotheses to test correlations between nursing students’ team achievements in clinical judgement and emotional, sociological and physiological learning style preferences.

    METHODS: A descriptive cross-sectional study was conducted with Swedish university nursing students in 2012-2013. Convenience sampling was used with 60 teams with 173 nursing students in the final semester of a three-year Bachelor of Science in nursing programme. Data collection included questionnaires of personal characteristics, learning style preferences, determined by the Dunn and Dunn Productivity Environmental Preference Survey, and videotaped complex nursing simulation scenarios. Comparison with Lasater Clinical Judgement Rubric and Non-parametric analyses were performed.

    RESULTS: Three significant correlations were found between the team achievements and the students’ learning style preferences: significant negative correlation with ‘Structure’ and ‘Kinesthetic’ at the individual level, and positive correlation with the ‘Tactile’ variable. No significant correlations with students’ ‘Motivation’, ‘Persistence’, ‘Wish to learn alone’ and ‘Wish for an authoritative person present’ were seen.

    DISCUSSION & CONCLUSION: There were multiple complex interactions between the tested learning style preferences and the team achievements of clinical judgement in the simulation room, which provides important information for the becoming nurses. Several factors may have influenced the results that should be acknowledged when designing further research. We suggest conducting mixed methods to determine further relationships between team achievements, learning style preferences, cognitive learning outcomes and group processes.

  • 5.
    Hammarström, Lars
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Häggström, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Devik, Siri Andreassen
    Nord University, Namsos, Norway.
    Hellzén, Ove
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Controlling emotions - nurses’ lived experiences caring for patients in forensic psychiatry2019In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, article id 1682911Article in journal (Refereed)
    Abstract [en]

    Purpose: Nurses working in forensic psychiatry often encounter offenders who have a severe mental illness, which may cause ethical challenges and influence nurses’ daily work. This study was conducted to illuminate the meaning of nurses’ lived experiences of encounters with patients with mental illnesses in forensic inpatient care. Methods: This qualitative study employed narrative interviews with 13 nurses. Interviews were audiotaped and transcribed verbatim and analysed following a phenomenological-hermeneutic approach. Results: Four key themes were revealed: “Being frustrated” (subthemes included “Fighting resignation” and “Being disappointed”), “Protecting oneself” (subthemes included “To shy away,” “Being on your guard,” and “Being disclosed”), “Being open-minded” (subthemes included “Being confirmed,” “Developing trust,” and “Developing compassion”), and “Striving for control” (subthemes included “Sensing mutual vulnerability” and “Regulating oneself”). Further, working in forensic psychiatry challenged nurses’ identity as healthcare professionals because of being in a stressful context. Conclusions: Dealing with aggressive patients with severe mental illnesses threatens nurses’ professional identity. Nurses must attempt to empathize with patients’ experiences and respond accordingly. Utilizing strategies rooted in compassion such as self-reflection, emotional regulation, and distancing themselves when necessary may enable nurses to more effectively respond to patients’ needs. © 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

  • 6.
    Häggström, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Att organisera en trygg och sammanhållen vårdkedja mellan IVA och allmän vårdavdelning.: En grundad teori om organisation, vård och samarbete i förflyttningsprocessen2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [sv]

    Det övergripande syftet med avhandlingen var att generera en grundad teori om huvudproblemet i förflyttningsprocessen mellan intensivvårdsavdelningar (IVA) och allmänna vårdavdelningar, det vill säga den vård som ges; före, under och efter det att patienter förflyttats från intensivvård till allmän vårdavdelning. Avhandlingen består av 4 delstudier (I- IV) som ligger till grund för en slutlig övergripande teori. Datainsamling har skett med hjälp av fokusgruppsdiskussioner, individuella intervjuer, observationer samt en enkät. Data inhämtades från tre sjukhus och fyra IVA-avdelningar samt sex allmänna vårdavdelningar. Olika personalgrupper och närstående har varit i fokus beroende på delstudiens syfte. I de olika delstudierna har Grundad Teori (GT) (I, II, III) och mixed method (IV) använts som metod. De fyra delstudierna har slutligen syntetiseras till en övergripande Grundad Teori.

     

    Avhandlingen visar att samspelet kring IVA-patienters förflyttningar påverkas av sjukhusets organisations- och säkerhetskultur och hur vårdkedjan organiserats. Det som upplevdes vara huvudproblemet för de inblandade var att organisera en trygg och sammanhållen vårdkedja mellan IVA och allmän vårdavdelning. Detta inkluderade att på ett patientsäkert sätt överbrygga de olikheter och det glapp som fanns mellan vården och vårdkulturen på den personaltäta, högteknologiska intensivvårdsavdelningen jämfört med vården och den vårdkultur som återfanns på de allmänna vårdavdelningarna.   Resultatet i den övergripande teorin visade att ett centralt behov hos såväl personal som hos närstående, är att uppleva kontroll och delaktighet i förflyttningsprocessen (kärnkategori). Detta behov kunde tillgodoses genom att det fanns och delgavs rutiner och strategier för vården före, under och efter förflyttning, att upprätta ett kliniköverskridande samarbete, genom kompetens och kunskap, att resurser fanns och genom att ge en personcentrerad vård. Om personal och närstående upplevde egen kontroll och delaktighet i förflyttningsprocessen bidrog detta till att reducera oro och osäkerhet och till att underlätta samverkan och samordning mellan IVA och allmän vårdavdelning. När den egna kontrollen och delaktigheten däremot uteblev, ökade istället de negativa upplevelserna av ett stort glapp mellan IVA och de allmänna vårdavdelningarna och desto mer negativt framstod skillnaderna vara mellan de olika enheterna och istället uppstod ett revirtänkande och misstro mellan personalgrupperna på de inblandade avdelningarna. 

    Det fanns ett behov av ett gott samarbetsklimat samt en god organisations- och säkerhetskultur för en sammanhållen vårdkedja. Utöver detta påverkades också förflyttningprocessen av om avdelningen byggt upp en god lärandemiljö med fungerande teamwork och rutiner och strategier kring patientomflyttningar. För att kunna ge god vård genom vårdkedjan behövdes också resurser. Personalens intentioner var att ge god, personcentrerad vård genom hela processen men de fick oftast balansera dessa intentioner mot bristande resurser och de förutsättningar som gavs, i form av personalbrist, bristande vårdplatser och avsaknad av planering. Vårdkedjan mellan IVA och allmänna vårdavdelningar kräver en organisation och en kultur som främjar individers egen kontroll och delaktighet. Dessutom krävs det planering och strategier som främjar patientsäkerhet, samordning och kontinuitet samt en tydlig nedtrappningsfas av den högteknologiska vården. Resultatet visar vidare att sjuksköterskor och andra i vårdteamet kring den svårt sjuke patienten har en stor pedagogisk utmaning i att kvalitetssäkra informationsflödet och kunskapsöverföringen om vad som skall hända i processen för närstående och för patienter.

  • 7.
    Häggström, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    How can nurses facilitate patient’s transitions from intensive care?: A grounded theory of nursing2012In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 28, no 4, p. 224-233Article in journal (Refereed)
    Abstract [en]

    Objectives: Intensive care patients often experience feelings of powerlessness and vulnerabilitywhen being transferred from an intensive care unit to a general ward. The aim of this study wasto develop a grounded theory of nurses care for patients in the ICU transitional care process.Methods: Group interviews, individual interviews and participant observations were conductedwith nurses in two hospitals in Sweden and were analysed using grounded theory.Result: The substantive theory shows the process of nursing care activities — from the contextsof the ICU and the general ward. The main concern was to achieve a coordinated, strengthening,person-centered standard of care to facilitate patient transitions. The core category ‘‘beingperceptive and adjustable’’ was a strategy to individualise, that was related to the other categories;‘‘preparing for a change’’ and ‘‘promoting the recovery’’. However, the nurses wereforced to ‘‘balance between patient needs and the caregivers’ resources’’ and consequentlywere compromising their care.Conclusions: To facilitate an ICU-patient’s transition, individual care planning is needed. Itis also essential that the patients are adequately prepared for the change to facilitate thetransitional care. Knowledge about transitional needs, empowerment and patient-educationseems to be important issues for facilitating transitions.

  • 8.
    Häggström, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Important quality aspects in transfer process2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, no 2, p. 123-139Article in journal (Refereed)
    Abstract [en]

    Purpose: Admission to and transfer from an intensive care unit affects not only the patient but also his or her relatives. The authors aimed to investigate relatives' perceptions of quality of care during a patient's transfer process from an intensive care unit to a general ward. Design/methodology/approach: The study had a mixed method design that included quantitative data and answers to open questions. The participants were 65 relatives of patients who received care in an ICU. They were recruited from two hospitals in Sweden. Findings: A majority perceived the transfer process as important, but analysis also showed that the participants rated it as an area for improvements. The relatives wanted participation, personal insight and control, respectful encounters, proximity, reassurance, continuous quality, reconnection and feedback. The relatives' participation in the transfer process was perceived as inadequate by 61 per cent, and the support that was received after the ICU discharge was perceived as inadequate by 53 per cent. The patients' length of stay in the ICU affected the relatives' perceptions of the quality of care. Overall, the relatives seemed to desire that the transfer process includes a continuous care, a competent staff, available information throughout the transfer process and personal involvement in the care, both before and after the transfer from the ICU. Research limitations/implications: The conclusion of this study is that relatives' needs and seeking for a well-planned ICU transitional process organisation with continuous quality before and after transfer, informational strategies that encourage the relatives to be involved and an organisation with competence throughout the healthcare chain are vital for quality. Practical implications: The conclusion of this study is that relatives' needs and seeking for a well-planned ICU transitional process organisation with continuous quality before and after transfer, informational strategies that encourage the relatives to be involved and an organisation with competence throughout the healthcare chain are vital for quality. Originality/value: The findings have important implications for nursing and nursing management. A relative's perception of the quality of care before and after transfer from ICU may be a valuable source to evaluate the ICU transitional care.

  • 9.
    Häggström, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Struggle with a gap between intensive care units and general wards2009In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 4, no 3, p. 181-192Article in journal (Refereed)
    Abstract [en]

    Nursing critically ill patients includes planning and performing safe discharges from Intensive Care Units (ICU) to the general wards. The aim of this study was to obtain a deeper understanding of the main concern in the ICU transitional process-the care before, during, and after the transfer of ICU patients. Interviews were conducted with 35 Swedish nurses and analysed according to grounded theory. The main concern was the nurses' "struggling with a gap." The "gap" was caused by differences in the altered level of care and contributed to difficulties for nurses encountering an overlap during the transitional care. The categories: Sheltering, seeking organizational intertwining and striving for control are related to the core category and were used to generate a theory. The nurses sought improved collaboration, and employed patient-centred routines. They wanted access to necessary tools; they relayed or questioned their own competence and sought assurance of the patients' ability to be transferred. If the nurses felt a loss of control, lack of intertwining and lack of collaboration, they sheltered their patients and themselves. Intertwining was more difficult to perform, but actually even more important to do. With knowledge about ICU transitional care, collaboration, routines, and with an organization that provides an educational environment, the process could be improved.

  • 10.
    Häggström, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    To reduce technology prior discharge from intensive care –important but difficult?: A grounded theory2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 3, p. 506-515Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to provide a deeperunderstanding of the experience of intensive care staffregarding the reduction in the use of medical technologyprior to patients’ transfer from the ICU.Background: The goal of ICU transitional care, provided forintensive care patients before, during and after the transferfrom the ICU to another care unit, is to ensure minimaldisruption and optimal continuity of care for the patient.To smooth this transition, there is a need to prepare for aless technological environment and therefore also a needfor a gradual reduction in the use of monitoring equipment.Method: Group interviews and individual interviews, togetherwith participant observations, were conducted withICU staff in two hospitals in Sweden. The data wereanalysed using classic grounded theory.Results: The main concern was the ICU staff’s ambiguityregarding whether and how to reduce the use of medicaltechnology devices. Insecurity about weaning patientsfrom medical equipment combined with a lack of standardizedroutines made it difficult for staff to reduce thetechnical support. The core category describes how theambiguity was solved primarily by ’prioritizing control’.However, this often caused the ICU staff to use advancedtechnology while the patients were in the ICU until theward staff arrived, even if this should have been handledotherwise. Why and how the ICU staff used the strategy of’prioritizing control’ is further explained in the categories’being affected by cultural/contextual aspects’, ’searching forguidance and a shared understanding’ and ’weighing advantageswith more v s less technology’.Conclusion: It is important to consider ICU staff ambiguityconcerning the reduction in technology and to establishstrategies for a safe and structured transitional phase withstep-down procedures in which technology and monitoringis gradually reduced prior to transfer from ICU.

  • 11.
    Häggström, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Bergsman, Ann-Christin
    Region Gävleborg.
    Månsson, Ulrika
    Norrbotten County Council.
    Rising Holmström, Malin
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Learning to manage vasoactive drugs: A qualitative interview study with critical care nurses2017In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 39, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Objective: Being a nurse in an intensive care unit entails caring for seriously ill patients. Vasoactive drugs are one of the tools that are used to restore adequate circulation. Critical care nurses often manage and administer these potent drugs after medical advice from physicians.

    Aim: To describe the experiences of critical care nurses learning to manage vasoactive drugs, and to highlight the competence required to manage vasoactive drugs.

    Research methodology/setting: Twelve critical care nurses from three hospitals in Sweden were interviewed. Qualitative content analysis was applied.

    Results: The theme "becoming proficient requires accuracy, practice and precaution" illustrated how critical care nurses learn to manage vasoactive drugs. Learning included developing cognitive, psychomotor, and effective skills. Sources for knowledge refers to specialist education combined with practical exercises, collegial support, and accessible routine documents. The competence required to manage vasoactive drugs encompassed well-developed safety thinking that included being careful, in control, and communicating failures. Specific skills were required such as titrating doses, being able to analyse and evaluate the technological assessments, adapting to the situation, and staying calm.

    Conclusion: Learning to manage vasoactive drugs requires a supportive introduction for novices, collegial support, lifelong learning, and a culture of safety.

  • 12.
    Häggström, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Bäckström, Britt
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Organizing Safe Transitions from Intensive Care2014In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, no Article ID 175314Article in journal (Refereed)
    Abstract [en]

    Background. Organizing and performing patient transfers in the continuum of care is part of the work of nurses and other staff of a multiprofessional healthcare team. An understanding of discharge practices is needed in order to ultimate patients’ transfers from high technological intensive care units (ICU) to general wards. Aim. To describe, as experienced by intensive care and general ward staff, what strategies could be used when organizing patient’s care before, during, and after transfer from intensive care. Method. Interviews of 15 participants were conducted, audio-taped, transcribed verbatim, and analyzed using qualitative content analysis. Results. The results showed that the categories secure, encourage, and collaborate are strategies used in the three phases of the ICU transitional care process. The main category; a safe, interactive rehabilitation process, illustrated how all strategies were characterized by an intention to create and maintain safety during the process. A three-way interaction was described: between staff and patient/families, between team members and involved units, and between patient/family and environment. Discussion/Conclusions. The findings highlight that ICU transitional care implies critical care rehabilitation. Discharge procedures need to be safe and structured and involve collaboration, encouraging support, optimal timing, early mobilization, and a multidiscipline approach.

  • 13.
    Häggström, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Bäckström, Britt
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Vestling, Irene
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Hallin, Karin
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Segevall, Cecilia
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Overcoming reluctance towards High Fidelity Simulation: a mutual challenge for nursing students’ and faculty teachers2017In: Global Journal of Health Science, ISSN 1916-9736, E-ISSN 1916-9744, Vol. 9, no 7, p. 127-137, article id 1916-9744Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: One strategy to develop nursing students’ clinical judgment are the use of high-fidelity patient simulation (HFS). The aim of the study was twofold. Firstly, the aim of this study was to describe the nursing students’ experiences while participating in HFS, and secondly to describe faculty teachers’ reflections about nursing students’ need in HFS and the related teaching challenges.

    METHODData was collected in focus group discussions and individual interviews, analyzed using thematic qualitative content analysis.

    FINDINGSThe nursing students’ experienced HFS as being thrown into an uncertain, exposure situation. This were for some, reason for reluctance. The teachers challenge was motivating and coaching the students throughout a demanding teaching situation.

    DISCUSSION: Students’ ability to perform in HFS is influenced by self-perceived efficacy, own attitudes and responsibility for one’s learning, which are a challenge for the teachers.

    CONCLUSION: HFS methodology can be useful to identify gaps and strengths in students’ professional transition towards becoming registered nurses. Overcoming reluctance towards HFS is a mutual challenge for faculty teachers and nursing students. By entering the scenario with a positive mindset, nursing students can improve their ability to perform clinical judgments.

  • 14.
    Häggström, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Bäckström, Ingela
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Management and Mechanical Engineering.
    Ingelsson, Pernilla
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Management and Mechanical Engineering.
    Carina, Edling
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    How can patient transfers be improved by combining QM, Nursing and Health care sciences?2018In: Proceedings of the 21th QMOD Conference: Building a Culture for Quality, Innovation and Sustainability / [ed] Su Mi Park-Daahlgard, 2018Conference paper (Refereed)
    Abstract [en]

    Purpose - The purpose of this paper is to present the state of the art when it comes to QM and nursing science, focusing on patient transfers from Intensive Care Unit (ICU)  to general wards, using the TQM values:  ‘customer focus’, ‘leadership commitment’, ‘participation of everybody’, ‘continuous improvement’, ‘process focus’ and ‘base decisions on facts’ as an analytical framework.

    Methodology/approach Literature from the research fields of QM and nursing sciences was reviewed and analyzed with the TQM values as a framework.

    Findings – No articles were found concerning QM within the specific area of patient transfer from ICU to general wards but the results are a summary of QM research and nursing science sorted under the TQM values. A result is that interdisciplinary care can improve a culture of safety and it can decrease mortality rates, staff turnover and increase quality of care and patient satisfaction. This means that there is a need for working with the QM culture in the patient transfer from ICU to general wards.

    Practical implications – This review identified a large need for empirical research in the field of health care where CI methods needs to be described, for example what tool or method that was applied and how it was applied and how the implementation were conducted.

  • 15.
    Häggström, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Fjellner, Cajsa
    Region of Jämtland Härjedalen.
    Öhman, Marie
    Region of Jämtland Härjedalen.
    Rising Holmström, Malin
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Ward visits- one essential step in intensive care follow-up: An interview study with critical care nurses’ and ward nurses’2018In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 49, p. 21-27Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to describe critical care nurses’ and ward nurses’ perceptions of the benefits and challenges with a nurse-led follow-up service for intensive care-survivors at general wards. Background: Patients recently transferred from intensive care to the general ward are still vulnerable and require complex care. There are different models of intensive care follow-up services and some include ward visits after transfer from intensive care. Research methodology/design: This study had a qualitative design. Data from 13 semi-structured interviews with Swedish critical care nurses and ward nurses were analysed using qualitative content analysis. Findings: The findings consisted of one theme, namely, “Being a part of an intra-organisational collaboration for improved quality of care”, and four subthemes: “Provides additional care for the vulnerable patients, “Strengthens ward-based critical care”, “Requires coordination and information”, and “Creates an exchange of knowledge”. The nurse-led follow-up service detected signs of deterioration and led to better quality of care. However, shortage of time, lack of interaction, feedback and information about the function of the follow-up service led to problems. Conclusion: The findings indicate that ward visits should be included in the intensive care follow-up service. Furthermore, intra-organisational collaboration seems to be essential for intensive care survivors’ quality of care. 

  • 16.
    Häggström, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Rising Holmström, Malin
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Personcentrerad vård2018Conference paper (Other academic)
  • 17.
    Häggström, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Rising Holmström, Malin
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Jong, Mats
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Establishing Patient Safety in Intensive Care -A Grounded Theory.: Building Trust-Important for Patient Safety2017In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 07, no 10Article in journal (Refereed)
    Abstract [en]

    Background: The modern intensive care unit (ICU) is a complex and high-risk environment, and even small adverse events and changes may deteriorate the patient’s conditions and eventually cause harm. Many factors can potentially be associated within an increased amount of errors, leading to adverse events. Nurses, nurse managers, and other leaders all play important roles in establishing patient safety. Aim: This study aimed to obtain a deeper understanding of leaders’ and nurses’ main concerns in establishing patient safety in Swedish intensive care units. Method: A grounded theory methodology was used. Data from 15 interviews with leaders and nurses involved in critical care in Sweden were collected, analysed and constant compared. Findings: The main concern in establishing patient safety was promoting quality of care, work engagement, and staffs well-being in strained ICUs. The core category building trust explained how the leaders’ and nurses’ strove for quality of care and wished a healthy, safe work environment. This is further explained in the categories “Being an accessible and able leader”, “Creating knowledge and understanding”, and “Establishing collaborative practice”. Conclusion: Establishing patient safety in the ICU requires that staffs enjoy going to work, have good work relations, are committed and want to stay at the unit. A healthy, salutogenetic unit with a work environment marked by trust provides a better opportunity to establish patient safety, and various leaders have potential to achieve this.

  • 18.
    Häggström, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Sten, Lilly-Mari
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Management and Mechanical Engineering.
    Bäckström, Ingela
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Management and Mechanical Engineering.
    Ingelsson, Pernilla
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Management and Mechanical Engineering.
    How to improve the transfer process from intensive care to general wards - listening to the co-workers2019In: Leadership and strategies for Sustainable Quality and Innovation in the 4th Industrial Revolution. Lund, Lund, 2019Conference paper (Refereed)
    Abstract [en]

    Background - Many errors and threats to patient safety are caused by deficiencies in the organization, such as inadequate procedures, inadequate planning and lack of information or communication. A specific danger to patient safety is the various gaps in the continuity of care. An example of the gap is the transfer of patients from the high-tech intensive care environment to the less frequent personnel ward environment, a process called ICU transitional care. ICU-nurses, ward-nurses, physicians, and other healthcare professionals, may provide this care. The effects of a poorly coordinated discharge can lead to readmission to the ICU and avoidable deaths.This study is a part of a research project financed by The Kamprad Family Foundation, with a purpose to gain new knowledge about how efficiency and quality in patient transfers within healthcare care can be improved. The purpose will be achieved through cooperation between the two research subjects Quality Management and Nursing science.Purpose - The purpose of this paper was to gain knowledge about how to improve patient transfers from intensive care to the general ward, by describing the intensive care co-workers generated suggestions.Methodology/approach – Six interdisciplinary focus groups interviews were conducted with co-workers at two hospitals in Sweden. The interviews were taped, verbatim transcribed and analysed with a mixed method. The QM values: ‘customer focus’, ‘leadership commitment’, ‘participation of everybody’, ‘continuous improvement’, ‘process focus’ and ‘base decisions on facts’ were used as an analytic framework.Findings - The co-workers suggested that the process should be defined and structured. The analyses showed a total of 94 suggestions that mainly were focused at following areas; planning, information, and communication, interest in the transfer process, enough resources, standardize and create routines, learning, follow up and evaluate.Practical implications - ICU transitional care is multifaceted and needs a holistic, system thinking solution. The findings indicate that the process could be safer, and more efficient by implementing the co-worker generated suggestions. The suggestions can be used to improve patients’ transfers in many contexts in healthcare, not only ICU transitional care.

  • 19.
    Ingelsson, Pernilla
    et al.
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Management and Mechanical Engineering.
    Sten, Lilly-Mari
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Management and Mechanical Engineering.
    Bäckström, Ingela
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Management and Mechanical Engineering.
    Häggström, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Assessing Quality Management culture in order to develop ICU transitional care2019In: 22nd QMOD conference: Quality and Service Sciences ICQSS 2019 / [ed] Su Mi Dahlgaard-Park, 2019Conference paper (Refereed)
    Abstract [en]

    Purpose - The purpose of this paper is to present and analyse the result from using a questionnaire measuring the presence of a number of QM values, as well as the use of Appreciative Inquiry (AI) and the feeling of pride in a healthcare setting focusing on transitional care.

     

    Methodology/approach – Co-workers at two different hospital’s intensive care units answered a previously developed and tested questionnaire. A new factor was developed in order to measure customer focus in the healthcare context. The result was analysed using SPSS with the aim of finding areas to improve the patient transfer process from intensive care to general ward.

     

    Findings – The questionnaire can be used to create an understanding of the existing culture in an organization but it needs to be analysed qualitatively. The result from the examined organizations show a common culture in the two units even though they are located in different hospitals and cities. The result further shows some differences between professions but overall, the result points at a relatively high agreement to the QM values in the organization indicating the presence of a quality culture.    

     

    Practical implications – Using a QM value survey in the healthcare context could help developing the care from a different point of view then ordinary. It could help to shift focus from individual to group and system.

  • 20.
    Kristiansen, Lisbeth
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Häggström, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Hallin, Karin
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Andersson, Ingela
    Bäckström, Britt
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Svensk översättning, kvalitativ relevansvärdering och kvantitativ reliabilitetstestning av Lasater Clinical Judgment Rubric: Swedish translation, qualitative relevance evaluation and quantitative reliability test of Lasater Clinical Judgment Rubric 2015In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 35, no 2, p. 113-122Article in journal (Refereed)
    Abstract [en]

    Newly graduated nurses show lacking skills and competences regarding the ability to make appropriate clinical assessment of acute, complex care situations. There is also a lack of translated, qualitative relevance evaluated and reliability tested rubrics in the Swedish language. The purpose of this method article was to translate, conduct a relevance evaluation and reliability test of the identified Lasater Clinical Judgment Rubric (LCJR). In this article the Swedish translation LCJR (S) is presented. The results showed that the LCJR (S) was both  qualitatively relevant and quantitatively reliable. We claim that there are several advantages to systematic use LCJR (S) for assessment of nursing students' clinical judgment in laboratory simulation environments with acute patient situations

  • 21.
    Rising Holmström, Malin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Häggström, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Junehag, Lena
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Coyne, Imelda
    Trinity College Dublin.
    Söderberg, Siv
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    To integrate and manage diabetes in school: Youth's expereinces of living with Type 1 diabetes in relation to school- a qualitative study2017In: International Diabetes Nursing, ISSN 2057-3316, E-ISSN 2057-3324, Vol. 14, no 2-3Article in journal (Refereed)
    Abstract [en]

    In Sweden, each year approximately 700 children develop Type 1 diabetes. Living with the illness is a challenge for youth and requires adjustments to lifestyle, and to manage school. The aim was to describe youths’ experiences of living with Type 1 diabetes in relation to school. A qualitative research design was used and interviews were performed with eight girls and five boys with Type 1 diabetes. The interviews were subjected to qualitative content analysis. Three themes were identified: to be friends with the diabetes, striving for normality and receiving support from others. Results showed a need to increase the understanding of T1D and diabetic competence within the Swedish school system and knowledge of youths’ own experiences is vital in this work. Living with T1D was a struggle for normality, independency and the youth needed to be friends with diabetes to handle everyday self-management. Although there are demanding life and school circumstances, it eventually becomes possible for the youth to handle the illness and to integrate and manage diabetes in school.

  • 22.
    Rising Holmström, Malin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Häggström, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Söderberg, Siv
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Being Facilitators in a Challenging Context-school Personnel's Experiences of Caring for Youth with Diabetes Type 12018In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 43, p. e114-e119Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of the study was to describe school personnel's experiences of caring for youth with diabetes type 1.

    Design and Methods: A qualitative design was chosen for this study. Data were collected with individual interviews that were subjected to inductive qualitative content analysis. The sample consisted of 24 school personnel (teachers, principals and school nurses) from Swedish schools. All had experience with youth aged 6 to 18 years old with diabetes type 1.

    Results: School personnel experienced caring for youth with diabetes type 1 as “Being facilitators in a challenging context” and described establishing trusting relationships, finding strategies to support self-care, feeling uncertain and incapable in need of education, and dealing with unclear responsibility.

    Conclusions: School personnel (teachers, principals and school nurses) are key professionals supporting youth with diabetes type 1 and self-care in school. Lack of education and unclear responsibility created feelings of uncertainty and insecurity for school personnel and a need for mandatory education of school personnel regarding T1DM and self-care, including legislation was identified.

    Implications: Mandatory education should be provided for all school personnel regarding diabetes type 1, self-care and current legislation. A liason position in form of a nurse specialist should manage the education. 

  • 23.
    Rising Holmström, Malin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Häggström, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Söderberg, Siv
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Experiences from Parents to Children with Diabetes Type 1.2018In: JSM Health Education Primary Health Care, ISSN 2578-3777, Vol. 3, no 2, article id 1044Article in journal (Refereed)
    Abstract [en]

    Introduction: When a child is diagnosed with a long-term illness such as diabetes type 1(DT1) parents often find it stressful to give optimum support to the child and to manage the situation especially when the child is in school. Parents experience that the stress to manage life with Diabetes Type 1, means to constant monitor blood glucose, to assist with insulin injections, food intake and physical activity, in order to optimum disease management. Aim: To explore how parents’ of children with Diabetes Type 1 experienced their role as a parent. Material and method: A qualitative design was used and individual interviews were conducted with a purposive sample of 13 parents (10 mothers and 3 fathers) of children with Diabetes Type 1. The interviews were analyzes using qualitative content analysis. Results and conclusions: The analysis resulted in one theme A life change revealing new needs with four subthemes; Struggling with fear and searching for explanations, Learning to manage and getting control of a lifelong illness, Collaboration with school as an important support and Managing the illness influenced work and family finances. Parents in this study struggled for their children at all times, to be the child’s caregiver and to take care of the child’s life in the best possible way. They asked for flexible and continue diabetes education for themselves and for school staff efficient communication and cooperation between parents/families, healthcare and school.

  • 24.
    Rising Holmström, Malin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Junehag, Lena
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Velander, Sofie
    Lundberg, Susanna
    Ek, Bosse
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Häggström, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Nurses’ experiences of prehospital care encounters with children in pain2019In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 43, p. 23-28Article in journal (Refereed)
    Abstract [en]

    Background: Pain relief in children is a complex issue, partly an ethical dilemma and due to a lack of nursing competence. There are few studies regarding prehospital care encounters with children in pain. Aim: The aim of this study was to describe nurses’ experiences in prehospital care encounters with children in pain and the specific related challenges. Method: This study has a qualitative design. Eighteen Swedish nurses participated in three focus group interviews analysed using qualitative content analysis. Findings: The findings consist of a theme, “A challenge to shift focus and adjust to the child”, and three categories describing prehospital care encounters with children in pain: “Being receptive and focusing on care,” “Developing a trusting relationship,” and “Providing professional nursing care.” Caring for children in pain was stressful for the nurses. The nurses described how they had to shift focus and used different methods to build trust, such as playfulness, making eye contact, attracting curiosity, and using the parents to create trust. The also had to adjust to the child regarding dosages and materials. Conclusion: Nurses has to be practically, mentally, and theoretically prepared to care for children with prehospital pain. It is essential to evaluate the administration of adequate pain relief to children, and more evidence-based knowledge is necessary concerning the different modes of administering pain-relieving drugs to prehospital children. 

  • 25.
    Rising Holmström, Malin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Marie, Häggström
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Skolsköterskans rolltransformering till den nya hälsofrämjande positionen: (The transformation of the school nurse’s role towards the new health-promoting position)2015In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 35, no 4, p. 210-217Article in journal (Refereed)
    Abstract [en]

    Aim The aim of this study was to describe the role transformation of school nurses towards primary health promotion, and secondary preventive and health treatment work.Background According to the Swedish educational act, the school nurse profession has changed towards being mainly health promotion and secondary preventive and health treatment work.Method The study consisted of a qualitative study design with content analysis inspired by Elo and Kyngäs. Sixteen individual interviews were conducted with school nurses from across one county.Findings The role transformation towards a more health promotion was described by school nurses' statements. The process of the transformation differed among the school nurses. Three categories illuminated their work; professional approach, student-centred and collaboration.Conclusion The role transformation process required enhanced relation and communicational skills. Structured collegial supervision might support the process.

  • 26.
    Sten, Lilly-Mari
    et al.
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Management and Mechanical Engineering.
    Ingelsson, Pernilla
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Management and Mechanical Engineering.
    Bäckström, Ingela
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Management and Mechanical Engineering.
    Häggström, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    The development of a measurement instrument focusing on team collaboration in the patient transfer process from intensive care to the general ward2019Conference paper (Refereed)
    Abstract [en]

    Purpose - The purpose of this paper is to describe the development and testing of a questionnaire aiming to measure team collaboration in the patient transfer process from the ICU to the general ward. The purpose is also to analyze the results to see how the survey can help improve team collaboration within ICU transitional care.

     

    Methodology/approach – Twenty statements were developed from theory and intended to measure team collaboration within and between hospital units. These statements were added to an existing questionnaire measuring values from QM theory. The questionnaire was tested in two ICUs in two hospitals located in Sweden, and the results from the statements regarding team collaboration were analyzed with SPSS.

     

    Findings – The results indicate that there is an internal consistency reliability between the developed factors and statements measuring team collaboration within and between hospital units. The results from the survey also show that this measurement tool can be a basis for improving team collaboration in the studied context.

1 - 26 of 26
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