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Publications (10 of 18) Show all publications
Falk, A.-C. (2023). Barn med skallskada (3ed.). In: Inger Kristensson Hallström & Mariette Derwig (Ed.), Pediatrisk omvårdnad: (pp. 357-360). Stockholm: Liber
Open this publication in new window or tab >>Barn med skallskada
2023 (Swedish)In: Pediatrisk omvårdnad / [ed] Inger Kristensson Hallström & Mariette Derwig, Stockholm: Liber, 2023, 3, p. 357-360Chapter in book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Liber, 2023 Edition: 3
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-5117 (URN)9789147146017 (ISBN)
Available from: 2024-01-17 Created: 2024-01-17 Last updated: 2024-01-17Bibliographically approved
Nymark, C., Falk, A.-C., von Vogelsang, A.-C. & Göransson, K. E. (2023). Differences between registered nurses and nurse assistants around missed nursing care: An observational, comparative study. Scandinavian Journal of Caring Sciences, 37(4), 1028-1037
Open this publication in new window or tab >>Differences between registered nurses and nurse assistants around missed nursing care: An observational, comparative study
2023 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 37, no 4, p. 1028-1037Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: From a nursing perspective, tasks that are not carried out, and the consequences of this, have been studied for over a decade. The difference between Registered Nurses (RNs) and nurse assistants (NAs) regarding qualifications and work tasks, and the profound knowledge around RN-to-patient ratios, warrants investigating missed nursing care (MNC) for each group rather than as one (nursing staff).

AIM: To describe and compare RNs and NAs ratings of and reasons for MNC at in-hospital wards.

METHODS: A cross-sectional study with a comparative approach. RNs and NAs at in-hospital medical and surgical wards for adults were invited to answer the MISSCARE Survey-Swedish version, including questions on patient safety and quality of care.

RESULTS: A total of 205 RNs and 219 NAs answered the questionnaire. Quality of care and patient safety was rated as good by both RNs and NAs. Compared to NAs, RNs reported more MNC, for example, in the item 'Turning patient every 2 h' (p < 0.001), 'Ambulation three times per day or as ordered' (p = 0.018), and 'Mouth care' (p < 0.001). NAs reported more MNC in the items 'Medications administered within 30 min before or after scheduled time' (p = 0.005), and 'Patient medication requests acted on within 15 min' (p < 0.001). No significant differences were found between the samples concerning reasons for MNC.

CONCLUSION: This study demonstrated that RNs' and NAs' ratings of MNC to a large extent differed between the groups. RNs and NAs should be viewed as separate groups based on their different knowledge levels and roles when caring for patients. Thus, viewing all nursing staff as a homogenous group in MNC research may mask important differences between the groups. These differences are important to address when taking actions to reduce MNC in the clinical setting.

Keywords
Missed nursing care, Patient safety, Quality of care
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4914 (URN)10.1111/scs.13175 (DOI)37114356 (PubMedID)
Available from: 2023-05-25 Created: 2023-05-25 Last updated: 2023-12-21Bibliographically approved
Lindström, V. & Falk, A.-C. (2023). Emergency care nurses' self-reported clinical competence before and after postgraduate education: A cross-sectional study. International Emergency Nursing, 70, 101320, Article ID 101320.
Open this publication in new window or tab >>Emergency care nurses' self-reported clinical competence before and after postgraduate education: A cross-sectional study
2023 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 70, p. 101320-, article id 101320Article in journal (Refereed) Published
Abstract [en]

Changing prerequisites in healthcare leads to the increased complexity of nursing. Since there are no regulations on re-validation of competencies for emergency nurses in Sweden there is sparse knowledge on how nurses develop competencies after registration as nurses (RN).

AIM: To describe self-reported professional competence after postgraduate education among RNs in emergency care settings.

METHOD: A cross-sectional design and STROBE guidelines were used. The short version of the Nurse Professional Competence Scale was used for data collection and the data were collected before and after postgraduate education, descriptive and comparative statistic was used for analysis.

RESULTS: 62 (71%) students participated in the first data collection and an independent group of 31 (48%) students participated in the second data collection. The results showed generally good competencies before entering education and significantly improved competencies after education were found in areas of working independently and reviewing literature for evidence-based nursing Conclusion: The competencies were assessed as very good after education. Evaluating nurses' competencies supports educators in developing education to ensure the need for knowledge in emergency care. To ensure required competencies among emergency care nurses there is a need to regulate additional training and re-validation of emergency nurses' competencies.

Keywords
Advanced level education, Continuous professional development, Nurse professional competence scale, Nursing, Outcome
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4997 (URN)10.1016/j.ienj.2023.101320 (DOI)37515996 (PubMedID)
Available from: 2023-09-06 Created: 2023-09-06 Last updated: 2023-11-21Bibliographically approved
Falk, A.-C., Boström, A.-M., Nymark, C. & von Vogelsang, A.-C. (2023). Missed nursing care in relation to registered nurses' level of education and self-reported evidence-based practice. Worldviews on Evidence-Based Nursing, 20(6), 550-558
Open this publication in new window or tab >>Missed nursing care in relation to registered nurses' level of education and self-reported evidence-based practice
2023 (English)In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 20, no 6, p. 550-558Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patient safety is one of the cornerstones of high-quality healthcare systems. Evidence-based practice is one way to improve patient safety from the nursing perspective. Another aspect of care that directly influences patient safety is missed nursing care. However, research on possible associations between evidence-based practice and missed nursing care is lacking.

AIM: The aim of this study was to examine associations between registered nurses' educational level, the capability beliefs and use of evidence-based practice, and missed nursing care.

METHODS: This study had a cross-sectional design. A total of 228 registered nurses from adult inpatient wards at a university hospital participated. Data were collected with the MISSCARE Survey-Swedish version of Evidence-Based Practice Capabilities Beliefs Scale.

RESULTS: Most missed nursing care was reported within the subscales Basic Care and Planning. Nurses holding a higher educational level and being low evidence-based practice users reported significantly more missed nursing care. They also scored significantly higher on the Evidence-based Practice Capabilities Beliefs Scale. The analyses showed a limited explanation of the variance of missed nursing care and revealed that being a high user of evidence-based practice indicated less reported missed nursing care, while a higher educational level meant more reported missed nursing care.

LINKING EVIDENCE TO ACTION: Most missed nursing care was reported within the subscales Planning and Basic Care. Thus, nursing activities are deprioritized in comparison to medical activities. Nurses holding a higher education reported more missed nursing care, indicating that higher education entails deeper knowledge of the consequences when rationing nursing care. They also reported varied use of evidence-based practice, showing that higher education is not the only factor that matters. To decrease missed nursing care in clinical practice, and thereby increase the quality of care, educational level, use of evidence-based practice, and organizational factors must be considered.

Keywords
Adult health/adult care, Advanced practice/advanced, Education, Evidence-based practice, Missed nursing care, Nursing practice, Patient safety, Quantitative methodology
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-5036 (URN)10.1111/wvn.12681 (DOI)37735718 (PubMedID)
Available from: 2023-10-13 Created: 2023-10-13 Last updated: 2023-12-21Bibliographically approved
Falk, A.-C. (2023). Nurse staffing levels in critical care: The impact of patient characteristics. Nursing in Critical Care, 28(2), 281-287
Open this publication in new window or tab >>Nurse staffing levels in critical care: The impact of patient characteristics
2023 (English)In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 28, no 2, p. 281-287Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Intensive care is one of the most resource-intensive forms of care because seriously ill patients are cared for in units with high staffing levels. Studies show that the number of registered nurses (RNs) per patient and nurse education level affects patient outcome. However, there is a lack of studies that consider how nurses/patient ratio with an advanced educational level of specialized nurses in intensive care, affect the intensive care performed in different patient populations.

AIM: To investigate if differences in patient characteristics and nurse-patient ratio have an impact on the quality of care.

STUDY DESIGN: This is a retrospective observational study with a review of all patients >15 years receiving care at two general intensive care units with different nurse/patient ratio (unit A, 1:1 nurse/patient ratio and unit B, 0.5:1 nurse/patient ratio).

RESULTS: There was no significant difference in the initial severity of illness between the units. However, younger patients, male patients and patients requiring surgery entailed a higher workload and a longer intensive care unit (ICU) stay despite a 1:1 critical care nurse/patient ratio. A small difference, but not significant, with more unplanned re-intubations occurred at unit A compared with unit B.

CONCLUSION: The differences in the nurse/patient ratio did not reflect a difference in the severity of illness among admitted patients but might be explained by patient characteristics with different needs.

RELEVANCE TO CLINICAL PRACTICE: Health care managers should consider not only the number of nurses but also their educational level, specific competencies and skills mix and nursing-sensitive measures to provide high-quality ICU care in settings with different patient characteristics. Nursing-sensitive patient outcomes should be considered in relation to nurse/patient ratio, as important to measure to ensure a high quality of patient care in the ICU.

Keywords
Intensive care, Nurse-patient ratio, Nursing, Quality of care
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4582 (URN)10.1111/nicc.12826 (DOI)35896444 (PubMedID)
Available from: 2022-09-23 Created: 2022-09-23 Last updated: 2024-03-26Bibliographically approved
Falk, A.-C., Nymark, C., Göransson, K. E. & von Vogelsang, A.-C. (2022). Missed nursing care in the critical care unit, before and during the COVID-19 pandemic: A comparative cross-sectional study. Intensive & Critical Care Nursing, 72, Article ID 103276.
Open this publication in new window or tab >>Missed nursing care in the critical care unit, before and during the COVID-19 pandemic: A comparative cross-sectional study
2022 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 72, article id 103276Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Todescribe and evaluate reported missed nursing care in the critical care context during different phases of the COVID-19 pandemic in Sweden.

RESEARCH METHODOLOGY: A comparative cross-sectional design was used, comparing missed nursing care in three samples: before the COVID-19 pandemic in 2019, during the second wave of the pandemic in spring 2020, and during the third wave of the pandemic in fall 2021.

SETTING: The study was conducted at critical care units at a university hospital, Sweden.

MAIN OUTCOME MEASURES: The MISSCARE Survey-Swedish version was used to collect data along with two study-specific questions concerning perception of patient safety and quality of care.

RESULTS: Significantly more overtime hours and number of days absent due to illness were reported during the pandemic. The nurse/patient ratio was above the recommended level at all data collection time points. Most missed nursing care was reported in items concerning basic care. The most reported reasons for missed nursing care in all samples concerned inadequate staffing, urgent situations, and a rise in patient volume. Most nurses in all samples perceived the level of patient safety and quality of care as good, and the majority had no intention to leave their current position.

CONCLUSION: The pandemic had a great impact on the critical care workforce but few elements of missed nursing care were affected. To measure and use missed nursing care as a quality indicator could be valuable for nursing managers, to inform them and improve their ability to meet changes in patient needs with different workforce approaches in critical care settings.

Keywords
Critical care, Cross-sectional studies, Missed nursing care, Nursing, Quality of care, Workforce
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4522 (URN)10.1016/j.iccn.2022.103276 (DOI)35672210 (PubMedID)
Available from: 2022-06-22 Created: 2022-06-22 Last updated: 2023-01-03Bibliographically approved
Nymark, C., von Vogelsang, A.-C., Falk, A.-C. & Göransson, K. E. (2022). Patient safety, quality of care and missed nursing care at a cardiology department during the COVID-19 outbreak. Nursing Open, 9(1), 385-393
Open this publication in new window or tab >>Patient safety, quality of care and missed nursing care at a cardiology department during the COVID-19 outbreak
2022 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 9, no 1, p. 385-393Article in journal (Refereed) Published
Abstract [en]

AIM: To evaluate missed nursing care and patient safety during the first wave of the COVID-19 pandemic at in-patient cardiology wards.

DESIGN: A cross-sectional design with a comparative approach.

METHOD: Registered nurses and nurse assistants at a cardiology department were invited to answer the MISSCARE Survey-Swedish version, and questions on patient safety and quality of care during the COVID-19 pandemic. The data were compared with a reference sample.

RESULTS: A total of 43 registered nurses and nurse assistants in the COVID-19 sample and 59 in the reference sample participated. The COVID-19 sample reported significantly more overtime hours and more absence from work due to illness in comparison with the reference sample. The patient safety and quality of care were perceived significantly worse, 76.7% (N = 33) versus 94.7% (N = 54), and 85.7% (N = 36) versus 98.3% (N = 58, respectively. The COVID-19 sample reported more missed nursing care in wound care and in basic nursing.

Keywords
Cardiac nursing, Nursing assessment, Quality and safety, Quality of care, Questionnaire
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4217 (URN)10.1002/nop2.1076 (DOI)34569190 (PubMedID)
Available from: 2021-10-19 Created: 2021-10-19 Last updated: 2022-10-13Bibliographically approved
Falk, A.-C. & Lindström, V. (2022). Self-reported clinical competence before entering advanced level training in acute and prehospital emergency care among registered nurses in Sweden. International Emergency Nursing, 61, Article ID 101146.
Open this publication in new window or tab >>Self-reported clinical competence before entering advanced level training in acute and prehospital emergency care among registered nurses in Sweden
2022 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 61, article id 101146Article in journal (Refereed) Published
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4356 (URN)10.1016/j.ienj.2022.101146 (DOI)35203011 (PubMedID)
Available from: 2022-03-30 Created: 2022-03-30 Last updated: 2022-03-30Bibliographically approved
Slettmyr, A., Frank, C. & Falk, A.-C. (2022). The core of patient-participation in the Intensive Care Unit: The patient's views. Intensive & Critical Care Nursing, 8, Article ID 103119.
Open this publication in new window or tab >>The core of patient-participation in the Intensive Care Unit: The patient's views
2022 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 8, article id 103119Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Patient participation is an established concept in public welfare. However, reports of the phenomenon of patient participation during intensive care from the patient's point of view are scarce. Therefore, the aim of this study was to explore the meaning of patient participation in the intensive care unit from the patient's perspective.

RESEARCH DESIGN: A qualitative design was used for the purpose of the study with a purposive convenient sample of nine adult patients with memories from their intensive care stay.

METHOD: Data was collected through individual interviews and analysed using a phenomenological hermeneutical method.

FINDINGS: The results of our study show a variety of meanings and degrees of participation that continuously move on a sliding scale from acting as a captain to feelings of being on an isolated island. Patient participation varied due to individual cognitive abilities and individual preferences, and the caregiver's attention altered between the body and the person through the continuum of care.

CONCLUSION: Patient participation during ICU care is more than participation in decision-making processes or direct patient care decisions. An understanding of the concept participation from the individual patient is necessary to support person centred care and the patient's relatives play an important role in during the entire care process.

Keywords
Critical care, Nursing, Patient participation, Phenomenological hermeneutical, Qualitative
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4189 (URN)10.1016/j.iccn.2021.103119 (DOI)34391629 (PubMedID)
Available from: 2021-09-03 Created: 2021-09-03 Last updated: 2022-09-28Bibliographically approved
Singh, L., Kanstrup, M., Depa, K., Falk, A.-C., Lindström, V., Dahl, O., . . . Holmes, E. A. (2021). Digitalizing a brief intervention to reduce intrusive memories of psychological trauma for health care staff working during COVID-19: Exploratory pilot study with nurses. JMIR Formative Research, 5(5), Article ID e27473.
Open this publication in new window or tab >>Digitalizing a brief intervention to reduce intrusive memories of psychological trauma for health care staff working during COVID-19: Exploratory pilot study with nurses
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2021 (English)In: JMIR Formative Research, E-ISSN 2561-326X, Vol. 5, no 5, article id e27473Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The COVID-19 pandemic has accelerated the worldwide need for simple remotely delivered (digital) scalable interventions that can also be used preventatively to protect the mental health of health care staff exposed to psychologically traumatic events during their COVID-19-related work. We have developed a brief behavioral intervention that aims to reduce the number of intrusive memories of traumatic events but has only been delivered face-to-face so far. After digitalizing the intervention materials, the intervention was delivered digitally to target users (health care staff) for the first time. The adaption for staff's working context in a hospital setting used a co-design approach.

OBJECTIVE: The aims of this mixed method exploratory pilot study with health care staff who experienced working in the pandemic were to pilot the intervention that we have digitalized (for remote delivery and with remote support) and adapted for this target population (health care staff working clinically during a pandemic) to explore its ability to reduce the number of intrusive memories of traumatic events and improve related symptoms (eg, posttraumatic stress) and participant's perception of their functioning, and to explore the feasibility and acceptability of both the digitalized intervention and digitalized data collection.

METHODS: We worked closely with target users with lived experience of working clinically during the COVID-19 pandemic in a hospital context (registered nurses who experienced intrusive memories from traumatic events at work; N=3). We used a mixed method design and exploratory quantitative and qualitative analysis.

RESULTS: After completing the digitalized intervention once with remote researcher support (approximately 25 minutes) and a brief follow-up check-in, participants learned to use the intervention independently. All 3 participants reported zero intrusive memories during week 5 (primary outcome: 100% digital data capture). Prior to study inclusion, two or more intrusions in the week were reported preintervention (assessed retrospectively). There was a general pattern of symptom reduction and improvement in perceived functioning (eg, concentration) at follow-up. The digitalized intervention and data collection were perceived as feasible and rated as acceptable (eg, all 3 participants would recommend it to a colleague). Participants were positive toward the digital intervention as a useful tool that could readily be incorporated into work life and repeated in the face of ongoing or repeated trauma exposure.

CONCLUSIONS: The intervention when delivered remotely and adapted for this population during the pandemic was well received by participants. Since it could be tailored around work and daily life and used preventatively, the intervention may hold promise for health care staff pending future evaluations of efficacy. Limitations include the small sample size, lack of daily intrusion frequency data in the week before the intervention, and lack of a control condition. Following this co-design process in adapting and improving intervention delivery and evaluation, the next step is to investigate the efficacy of the digitalized intervention in a randomized controlled trial.

Keywords
COVID-19, co-design, cognitive science, digital intervention, health care staff, intrusive memories, mixed methods, person-based approach, pilot trial, prevention, psychological trauma, remote delivery
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4097 (URN)10.2196/27473 (DOI)33886490 (PubMedID)
Available from: 2021-06-07 Created: 2021-06-07 Last updated: 2022-04-28Bibliographically approved
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2246-7894

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