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  • 1.
    Andersson, Helene
    et al.
    Sophiahemmet University.
    Andreassen Gleissman, Sissel
    Sophiahemmet University.
    Lindholm, Christina
    Sophiahemmet University.
    Fossum, Bjöörn
    Sophiahemmet University.
    Experiences of nursing staff caring for patients with methicillin-resistant Staphylococcus aureus.2016In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 63, no 2, 233-241 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Methicillin-resistant Staphylococcus aureus is a resistant variant of S. aureus and can cause pneumonia, septicaemia and, in some cases, death. Caring for patients with antibiotic resistant bacteria is a challenge for healthcare personnel. There is a risk of spreading the bacteria among patients and of healthcare personnel being infected themselves.

    AIM: To describe nursing staffs' experiences of caring for patients with methicillin-resistant S. aureus in Sweden.

    METHOD: A descriptive qualitative approach was used and 15 nurses from different hospitals and care units, including emergency and geriatric wards and nursing homes in Stockholm, were interviewed. All nurses had been involved in the care of patients with methicillin-resistant S. aureus, but not on a regular basis. The interviews were analysed using qualitative content analysis.

    FINDINGS: Three themes emerged from the data: feeling ignorant, afraid and insecure, feeling competent and secure and feeling stressed and overworked. The more knowledge the nurses acquired about methicillin-resistant S. aureus, the more positive was their attitude to caring for these patients.

    DISCUSSION AND CONCLUSION: Caring for patients with methicillin-resistant S. aureus without adequate knowledge of how to protect oneself and other patients against transmission may provoke anxiety among personnel. Guidelines, memos and adequate information at the right time are of central importance. Healthcare personnel must feel safe in their role as caregivers. All patients have the right to have the same quality of care regardless of the diagnosis and a lack of knowledge influences the level of care given.

    IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study demonstrates the importance of education when caring for patients with infectious diseases. Hopefully, knowledge gained from our study can provide guidance for future health care when new diseases and infections occur.

  • 2.
    Andersson, Helene
    et al.
    Sophiahemmet University.
    Andreassen, Sissel
    Sophiahemmet University.
    Lindholm, Christina
    Sophiahemmet University.
    Fossum, Bjöörn
    Sophiahemmet University.
    Emotional reactions when caring for MRSA-positive patients: ignorance and fear versus knowledge and securityArticle in journal (Refereed)
  • 3.
    Andersson, Helene
    et al.
    Sophiahemmet University.
    Kalin, Mats
    Fossum, Bjöörn
    Sophiahemmet University.
    Lindholm, Christina
    Ortqvist, Ake
    Är MRSA-patienter olika smittsamma i olika län?2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 7, 412-3 p.Article in journal (Other academic)
  • 4.
    Andersson, Helene
    et al.
    Sophiahemmet University.
    Lindholm, Christina
    Fossum, Bjöörn
    Sophiahemmet University.
    MRSA - global threat and personal disaster: Patients' experiences2011In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 58, no 1, 47-53 p.Article in journal (Refereed)
    Abstract [en]

    ANDERSSON H., LINDHOLM C. & FOSSUM B. (2011) MRSA - global threat and personal disaster: patients' experiences. International Nursing Review58, 47-53 Aim:  To ascertain and describe the patients' knowledge, perceptions and experiences of being methicillin-resistant Staphylococcus aureus (MRSA) positive. Background:  Antibiotic resistant bacteria are a serious global threat. MRSA can cause wound infection, pneumonia, septicaemia and mortality. This qualitative study has focused on patients' experiences of living with MRSA. Methods:  Fifteen patients with MRSA-infected wounds were interviewed. All data were transcribed verbatim and analysed according to content analysis. Findings:  Information about the MRSA diagnosis often caused a shock-like reaction. Patients' perception of being MRSA positive was stigmatizing as plague or leprosy; they felt dirty and felt that they were a severe threat to their environment. Fears of infecting someone else and being rejected were commonly expressed. The key findings emerged as a theme: Being exposed to others' shortcomings and being a threat to others' health. Three categories were identified: understanding and emotional reactions, treatment by the healthcare professionals and consequences and expectations. Gaps in both patient and staff knowledge of MRSA led to unnecessary misunderstandings, causing fear, social isolation and suffering. Conclusions:  Living with MRSA can be extremely stressful for the patients. Knowledge and empathy from staff involved in their care is crucial to optimize patients' experiences. Staff education to meet patients' demand for information and prevent contamination is essential.

  • 5.
    Andersson, Helene
    et al.
    Sophiahemmet University.
    Lindholm, Christina
    Sophiahemmet University.
    Iversen, Aina
    Giske, Christian G
    Örtqvist, Åke
    Kalin, Mats
    Fossum, Bjöörn
    Sophiahemmet University.
    Prevalence of antibiotic-resistant bacteria in residents of nursing homes in a Swedish municipality: healthcare staff knowledge of and adherence to principles of basic infection prevention2012In: Scandinavian journal of infectious diseases, ISSN 1651-1980, Vol. 44, no 9, 641-649 p.Article in journal (Refereed)
    Abstract [en]

    Abstract Background: The aims of this study were to investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in residents living in Swedish nursing homes, and if carriage of resistant bacteria was related to antibiotic treatment, other risk factors, and/or staff's adherence to guidelines for infection control. Methods: Five hundred and sixty residents from 9 nursing homes on a total of 67 wards participated in the study and had microbiological cultures taken. Faecal samples were obtained from 495 residents (88.3%). ESBL-positive residents were followed for 2 y with repeated sampling. Two hundred and ninety-six staff members were interviewed and observed regarding familiarity with and adherence to infection control guidelines. Results: No resident was positive for MRSA or VRE. Fifteen of the residents were found to be ESBL-positive. Residents living on wards where ESBL-positive residents were identified had been treated more frequently with antibiotics (42%), compared to those on wards where no residents with ESBL were found (28%; p = 0.02). ESBL-positive Escherichia coli isolates from residents living in adjacent rooms were found to be closely genetically related when analysed by pulsed-field gel electrophoresis, indicating transmission between residents. Staff adherence to infection control guidelines sometimes revealed shortcomings, but no significant differences regarding compliance to the guidelines could be found. Conclusion: Carriage of resistant bacteria was uncommon and only ESBL-producing Enterobacteriaceae were identified in Swedish nursing homes. Usage of antibiotics was higher on wards where ESBL-positive residents were detected and there was an indication of transmission of ESBL between residents.

  • 6.
    Bergkvist, Karin
    et al.
    Sophiahemmet University.
    Fossum, Bjöörn
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Mattsson, J
    Larsen, J
    Patients' experiences of different care settings and a new life situation after allogeneic haematopoietic stem cell transplantation2017In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354Article in journal (Refereed)
    Abstract [en]

    Over the past 20 years, considerable healthcare resources have shifted from an inpatient to an outpatient setting. To be in an outpatient setting or at home after allogeneic haematopoietic stem cell transplantation (allo-HSCT) has been shown to be medically safe and beneficial to the patient. In this study we describe patients' experiences of different care settings (hospital or home) and a new life situation during the acute post-transplant phase after HSCT. Semi-structured interviews were conducted with 15 patients (six women and nine men) 29-120 days after HSCT. An inductive qualitative content analysis was performed to analyse the data. The analysis resulted in four categories: To be in a safe place, To have a supportive network, My way of taking control, and My uncertain return to normality. The findings showed that patients undergoing HSCT felt medically safe regardless of the care setting. The importance of a supportive network (i.e. the healthcare team, family and friends) was evident for all patients. Both emotional and problem-focused strategies were used to cope with an uncertain future. Being at home had some positive advantages, including freedom, having the potential for more physical activity, and being with family members. The study highlights some key areas thought to provide more personalised care after HSCT.

    The full text will be freely available from 2018-03-02 15:58
  • 7.
    Bergkvist, Karin
    et al.
    Sophiahemmet University.
    Fossum, Bjöörn
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Mattsson, Jonas
    Larsen, Joacim
    Patients' life situation during allogeneic hematopoietic stem cell transplantation - when care is given in different care settingsManuscript (preprint) (Other academic)
  • 8.
    Bergkvist, Karin
    et al.
    Sophiahemmet University.
    Larsen, J
    Johansson, Unn-Britt
    Sophiahemmet University.
    Mattsson, J
    Fossum, Bjöörn
    Sophiahemmet University.
    Family members' life situation and experiences of different caring organisations during allogeneic haematopoietic stem cells transplantation-A qualitative study.2016In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe family members' life situation and experiences of care in two different care settings, the patient's home or in hospital during the acute post-transplantation phase after allogeneic haematopoietic stem cell transplantation (HSCT). Data were collected through semi-structured interviews with 14 family members (seven women and seven men). An inductive qualitative content analysis was used to analyse the data. The majority of the family members' (n = 10) had experiences from home care. The findings show the family members' voice of the uncertainty in different ways, related with the unknown prognosis of the HSCT, presented as Being me being us in an uncertain time. The data are classified into; To meet a caring organisation, To be in different care settings, To be a family member and To have a caring relationship. Positive experiences such as freedom and security from home care were identified. The competence and support from the healthcare professionals was profound. Different strategies such as adjusting, having hope and live in the present used to balance to live in an uncertain time. The healthcare professionals need to identify psychosocial problems, and integrate the psychosocial support for the family to alleviate or decrease anxiety during HSCT, regardless of the care setting.

  • 9.
    Bergkvist, Karin
    et al.
    Sophiahemmet University.
    Larsen, Joacim
    Johansson, Unn-Britt
    Sophiahemmet University.
    Mattsson, Jonas
    Fossum, Bjöörn
    Sophiahemmet University.
    Being me and being us in an uncertain time: Family members' experiences during allogeneic hematopoietic stem cell transplantation when care is given in the patient's home or in hospitalManuscript (preprint) (Other academic)
  • 10.
    Bergkvist, Karin
    et al.
    Sophiahemmet University.
    Larsen, Joacim
    Johansson, Unn-Britt
    Sophiahemmet University.
    Mattsson, Jonas
    Fossum, Bjöörn
    Sophiahemmet University.
    Family members' experiences of different caring organizations during allogeneic hematopoietic stem cells transplantation - a qualitative study2016Conference paper (Other academic)
  • 11. Carnlöf, Carina
    et al.
    Insulander, Per
    Pettersson Holmér, Pia
    Jensen-Urstad, Mats
    Fossum, Bjöörn
    Sophiahemmet University.
    Health-related quality of life in patients with atrial fibrillation undergoing pulmonary vein isolation, before and after treatment2010In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 9, no 1, 45-9 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and many AF patients experience a significantly impaired health-related quality of life (HRQOL). AF is also associated with a high risk of stroke and death. Many pharmacologic treatments for AF are ineffective and may have adverse effects. New methods, such as pulmonary vein isolation (PVI), have been developed to treat AF. AIMS: The aim of this study was to investigate the HRQOL issues in severe symptomatic AF patients before and after pulmonary vein isolation. METHODS: Forty patients treated with PVI were included of which 36 concluded the study with the self-reported HRQOL questionnaires before and once after PVI. A standardized control group was used. RESULTS: Compared to the control group the HRQOL before PVI was significantly lower in all domains except for bodily pain. The preoperative scores were compared with the scores obtained at the follow-up. All subscales of the SF-36 significantly improved after the PVI except for bodily pain, which remained unaltered. CONCLUSION: HRQOL is improved in AF patients with severe symptoms after PVI intervention.

  • 12.
    Eulau, Louise
    et al.
    Sophiahemmet University.
    Sundman, Christina
    Scheja, Max
    Fossum, Bjöörn
    Assessing students' learning in student-dedicated treatment rooms during clinical nursing education2015In: Nursing and Health, ISSN 2332-2217, Vol. 3, no 1, 22-29 p.Article in journal (Refereed)
  • 13.
    Fossum, Bjöörn
    Sophiahemmet University.
    Kommunikation: samtal och bemötande i vården2013Collection (editor) (Other academic)
  • 14.
    Fossum, Bjöörn
    Sophiahemmet University.
    Kommunikation: samtal och bemötande i vården2007Collection (editor) (Other academic)
  • 15.
    Fossum, Bjöörn
    et al.
    Sophiahemmet University.
    Arborelius, Elisabeth
    Patient-centred communication: videotaped consultations2004In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 54, no 2, 163-9 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to analyse the way in which orthopaedic physicians manage consultations, and to identify those factors associated with patient-experienced satisfaction/dissatisfaction. This was explored both using a descriptive method and by analysing comments from patients. Consultations were videotaped; 18 physicians and 18 patients participated. Approximately 1 week after the consultation, the patient was shown the video recording and asked for his/her points of view and spontaneous reactions. Each time, the patient wished to say something, the video was stopped and the comments recorded. According to the patients' comments of the videotaped consultations four consultations were mainly positive, seven negative and seven neither completely positive nor completely negative. We analysed the positive and negative consultations using the Consultation Map (CM) method. The pattern in the positive consultations shows a greater flexibility. Statements regarding initial history and aetiology often move to and fro between other items, and the consultation as a whole was often characterised by this rapid change between items. The pattern in the negative consultations seems to indicate a slower motion; with longer time spent with few items and fewer items covered. The positive consultations were characterised by a greater prevalence of the items 'Sharing Understanding' and 'Involving the Patient in Management'. On the other hand, the negative consultations were characterised by more time spent with the items 'History of problems', and 'Patient Ideas'. This might be due to the patient having tried to express him/herself in order to present his/her views but the physician not following them up. In this study, the CM has been helpful in clarifying the difference between encounters experienced as satisfactory or dissatisfactory.

  • 16.
    Fossum, Bjöörn
    et al.
    Sophiahemmet University.
    Arborelius, Elisabeth
    Bremberg, Sven
    Evaluation of a counseling method for the prevention of child exposure to tobacco smoke: an example of client-centered communication2004In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 38, no 3, 295-301 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Environmental tobacco smoke (ETS) is an important risk factor. The aim of this study is to evaluate effects of the counseling method "Smoke-free children" that focuses on protection of infants. METHODS: The counseling method, "Smoke-free children", has been developed and implemented at Swedish child health centers. The counseling method's point of departure is based upon a client-centered approach. Saliva cotinine samples from the mothers were collected when the child was 1-4 weeks and 3 months of age. Interviews regarding mothers' smoking habits and self-reported maternal smoking were also carried out. RESULTS: Forty-one mothers participated in the study, 26 in the intervention group and 15 in the control group. Cotinine was collected from 22 subjects in the intervention and 8 in the control group. Before the intervention, the mean cotinine level was 185 ng/mL in the intervention group and 245 ng/mL in the control group. After the intervention, cotinine levels were reduced in the intervention group (165 ng/mL) and increased in the control group (346 ng/mL). Yet, after the intervention, the mothers themselves reported more smoking in the intervention group than in the control group. Only weak correlations were found between self-reported smoking and cotinine. CONCLUSIONS: The statistical analysis supports the view that a client-centered intervention, aimed at increasing self-efficacy, exerts a positive effect on maternal smoking in the prevention of infant exposure to ETS, when applied in a routine clinical setting.

  • 17.
    Fossum, Bjöörn
    et al.
    Sophiahemmet University.
    Arborelius, Elisabeth
    Theorell, Töres
    How physicians experience patient consultations at an orthopaedic out-patient clinic: a qualitative study2002In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 47, no 2, 127-35 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to describe physicians' experiences in their encounters with patients by allowing the physicians to observe and comment on their own video-recorded medical consultations. Eighteen orthopaedic surgeons took part in the study; they were informed that we were interested in studying what actually takes place during a consultation, the quality of communication between doctor and patient, and how the physicians themselves experience the consultation. Each time the physician wished to make a comment, the video film was stopped and the comments were taped on audiocassette. The results showed that when the physicians watched the video-recorded consultations they commented spontaneously on issues regarding, among others: (1) how they try to adapt their communication to the patient's situation; (2) the need to explain things to the patient; (3) perceptions of working under unfavourable conditions; (4) difficulties in helping certain patients.

  • 18. Guldbrandsson, Karin
    et al.
    Fossum, Bjöörn
    Sophiahemmet University.
    An exploration of the theoretical concepts policy windows and policy entrepreneurs at the Swedish public health arena2009In: Health Promotion International, ISSN 1460-2245, Vol. 24, no 4, 434-44 p.Article in journal (Refereed)
    Abstract [en]

    In John Kingdon's Policy Streams Approach policy formation is described as the result of the flow of three 'streams', the problem stream, the policy stream and the politics stream. When these streams couple, a policy window opens which facilitate policy change. Actors who promote specific solutions are labelled policy entrepreneurs. The aim of this study was to test the applicability of the Policy Streams Approach by verifying whether the theoretical concepts 'policy windows' and 'policy entrepreneurs' could be discernable in nine specified cases. Content analyses of interviews and documents related to child health promoting measures in three Swedish municipalities were performed and nine case studies were written. The policy processes preceding the municipal measures and described in the case studies were scrutinized in order to find statements related to the concepts policy windows and policy entrepreneurs. All conditions required to open a policy window were reported to be present in eight of the nine case studies, as was the most important resource of a policy entrepreneur, sheer persistence. This study shows that empirical examples of policy windows and policy entrepreneurs could be identified in child health promoting measures in Swedish municipalities. If policy makers could learn to predict the opening of policy windows, the planning of public health measures might be more straightforward. This also applies to policy makers' ability to detect actors possessing policy entrepreneur resources.

  • 19. Guldbrandsson, Karin
    et al.
    Fossum, Bjöörn
    Sophiahemmet University.
    Reply to the Letter to the Editor2010In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 25, no 1, 136- p.Article in journal (Other academic)
  • 20.
    Klarare, Anna
    et al.
    Sophiahemmet University.
    Hansson, Johan
    Fossum, Bjöörn
    Sophiahemmet University.
    Fürst, Carl Johan
    Lundh Hagelin, Carina
    Sophiahemmet University.
    Team type, team maturity and team effectiveness in specialized palliative home care: An exploratory questionnaire studyManuscript (preprint) (Other academic)
  • 21.
    Klarare, Anna
    et al.
    Sophiahemmet University.
    Lundh Hagelin, Carina
    Sophiahemmet University.
    Fürst, Carl Johan
    Fossum, Bjöörn
    Sophiahemmet University.
    Team interactions in specialized palliative care teams: a qualitative study2013In: Journal of Palliative Medicine, ISSN 1096-6218, E-ISSN 1557-7740, Vol. 16, no 9, 1062-9 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Teamwork is a standard of care in palliative care and that is emphasized by leading organizations. When interdisciplinary teams communicate their varied assessments, outcomes may be more than additive due to the synthesis of information. Interprofessionality does not guarantee multidimensionality in health care interventions, however, and that interprofessional teams promote collaboration may be questioned.

    AIM: The aim was to explore team interaction among team members in specialized palliative care teams.

    DESIGN: Semistructured interviews were conducted with health professionals working in specialized palliative home care teams. The interviews were analyzed by content analysis.

    SETTING/PARTICIPANTS: Participants were recruited from specialized palliative care units in Sweden. The 15 interviewees included 4 men and 11 women. Physcians, nurses, paramedical staff, and social workers were included.

    RESULTS: Organizational issues like resources and leadership have a great impact on delivery of care. Competence was mirrored in education, collaboration, approach, and support within the team; while communication was described as key to being a team, resolving conflict, and executing palliative care.

    CONCLUSION: Communication and communication patterns within the team create the feeling of being a team. Team climate and team performance are significantly impacted by knowledge and trust of competence in colleagues, with other professions, and by the available leadership. Proportions of different health professionals in the team have an impact on the focus and delivery of care. Interprofessional education giving clarity on one's own professional role and knowledge of other professions would most likely benefit patients and family caregivers.

  • 22.
    Klarare, Anna
    et al.
    Sophiahemmet University.
    Rasmussen, Birgit
    Fürst, Carl Johan
    Fossum, Bjöörn
    Sophiahemmet University.
    Lundh Hagelin, Carina
    Sophiahemmet University.
    Hansson, Johan
    Experiences of security and continuity of care: patients' and families' narratives about the work of specialized palliative home care teams2017In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 15, no 2, 181-189 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Those who are seriously ill and facing death are often li ing with physical, emotional, social, and spiritual suffering. Teamwork is considered to be necessary to holistically meet the diverse needs of patients in palliative care. Reviews of studies regarding palliative care team outcomes have concluded that teams provide benefits, especially regarding pain and symptom management. Much of the research concerning palliative care teams has been performed from the perspective of the service providers and has less often focused on patients' and families' experiences of care.

    OBJECTIVE: Our aim was to investigate how the team's work is manifested in care episodes narrated by patients and families in specialized palliative home care (SPHC).

    METHOD: A total of 13 interviews were conducted with patients and families receiving specialized home care. Six patients and seven family members were recruited through SPHC team leaders. Interviews were transcribed verbatim and the transcripts qualitatively analyzed into themes.

    RESULTS: Two themes were constructed through thematic analysis: (1) security ("They are always available," "I get the help I need quickly"); and (2) continuity of care ("They know me/us, our whole situation and they really care"). Of the 74 care episodes, 50 were descriptions of regularly scheduled visits, while 24 related to acute care visits and/or interventions.

    SIGNIFICANCE OF RESULTS: Patients' and family members' descriptions of the work of SPHC teams are conceptualized through experiences of security and continuity of care. Experiences of security are fostered through the 24/7 availability of the team, sensitivity and flexibility in meeting patients' and families' needs, and practical adjustments to enable care at home. Experiences of continuity of care are fostered through the team's collective approach, where the individual team member knows the patients and family members, including their whole situation, and cares about the little things in life as well as caring for the family unit.

  • 23.
    Klarare Ljungberg, Anna
    et al.
    Sophiahemmet University.
    Fossum, Bjöörn
    Sophiahemmet University.
    Fürst, Carl Johan
    Lundh Hagelin, Carina
    Sophiahemmet University.
    Translation and cultural adaptation of research instruments - guidelines and challenges: an example in FAMCARE-2 for use in Sweden2015In: Informatics for health & social care, ISSN 1753-8165, Vol. 40, no 1, 67-78 p.Article in journal (Refereed)
    Abstract [en]

    Background: Assessing and evaluating health care is important, and an abundance of instruments are developed in different languages. Translating existing, validated instruments is demanding and calls for adherence to protocol. Purpose: The purpose of this study was to translate and culturally adapt the FAMCARE-2 scale for use in Sweden. Methods: Traditional back-translation and the decentering stance were utilized and assessed. Experts in palliative care clinic and research were involved; the FAMCARE-2 instrument was discussed with family caregivers and content validity was assessed by experienced health professionals. Results: Significant discrepancies were not revealed by back-translation. Using the decentering stance gave reliable structure and opportunities for reflection throughout the translation process. Discussion: Translating an existing instrument into a second language requires interpretation and adaptation more than a naive translation. The back-translation process may be enhanced if the decentering stance is adopted.

  • 24.
    Lachmann, Hanna
    et al.
    Sophiahemmet University.
    Fossum, Bjöörn
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Karlgren, Klas
    Ponzer, Sari
    Promoting reflection by using contextual activity sampling: a study on students' interprofessional learning2014In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 28, no 5, 400-406 p.Article in journal (Refereed)
    Abstract [en]

    Abstract Students' engagement and reflection on learning activities are important during interprofessional clinical practice. The contextual activity sampling system (CASS) is a methodology designed for collecting data on experiences of ongoing activities by frequent distribution of questionnaires via mobile phones. The aim of this study was to investigate if the use of the CASS methodology affected students' experiences of their learning activities, readiness for interprofessional learning, academic emotions and experiences of interprofessional team collaboration. Student teams, consisting of 33 students in total from four different healthcare programs, were randomized into an intervention group that used CASS or into a control group that did not use CASS. Both quantitative (questionnaires) and qualitative (interviews) data were collected. The results showed that students in the intervention group rated teamwork and collaboration significantly higher after than before the course, which was not the case in the control group. On the other hand, the control group reported experiencing more stress than the intervention group. The qualitative data showed that CASS seemed to support reflection and also have a positive impact on students' experiences of ongoing learning activities and interprofessional collaboration. In conclusion, the CASS methodology provides support for students in their understanding of interprofessional teamwork.

  • 25.
    Lachmann, Hanna
    et al.
    Sophiahemmet University.
    Ponzer, Sari
    Johansson, Unn-Britt
    Sophiahemmet University.
    Karlgren, Klas
    Fossum, Bjöörn
    Sophiahemmet University.
    Students' experiences of collaboration during and after an interprofessional training ward course: a mixed methods study2013In: International Journal of Medical Education, ISSN 2042-6372, E-ISSN 2042-6372, Vol. 4, 170-179 p.Article in journal (Refereed)
    Abstract [en]

    Objectives: The objective of this study was to obtain a deeper understanding of how students experience and perceive interprofessional collaboration connected to their learning activities during and after an interprofessional clinical course.

    Methods:

    A sample of 15 healthcare students participating on a two-week interprofessional clinical course was used. A mixed method approach was used for data collection. The students’ perceptions were gathered several times a day via mobile phones by using the Contextual Activity Sampling System (CASS) and they were also interviewed after the course.

    Results:

    The data revealed an interesting discrepancy between the students’ learning experiences reported during the course compared to their perceptions after the course. The students were generally more critical during the course, i.e., they tended to report things that did not work well. In the post-course interviews, the students reported that difficulties had been solved during the course. The students emphasized also the importance of structure, interaction, and insights into one’s own and other professions’ tasks as a base for fruitful interprofessional collaboration. Further-more, they underlined the benefits of interprofessional team learning with opportunities to contribute to and to acquire new knowledge.

    Conclusions:

    The CASS methodology provides possibilities to identify students’ and student teams’ needs of support to reach the intended learning outcomes of a specific course. Our results might be useful when developing clinical education with a special focus on supporting students in their collaborative practices.

  • 26. Lager, Anton C J
    et al.
    Fossum, Bjöörn
    Sophiahemmet University.
    Rörvall, Göran
    Bremberg, Sven G
    Children's overweight and obesity: local and national monitoring using electronic health records2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 2, 201-5 p.Article in journal (Refereed)
    Abstract [en]

    AIM: To test the feasibility of a system for monitoring children's obesity and overweight based on data from electronic health records in the school health services. METHODS: Data on weight and height from electronic health records at school health services were collected for 10-year-olds in 2003-2004, 2004-2005 and 2005-2006. School health personnel extracted group-level data with a simple program installed on the computer containing the health records. Four Swedish municipalities were included in the study: Karlstad, Umeå, Västerås, and Ystad. RESULTS: The system achieved coverage of 92-96% of all children in 2005-2006. The overall prevalence rates were 4.2% (3.8-4.7%) obese and 22.0% (21.1-23.0%) overweight, including obesity. CONCLUSIONS: A system based on electronic health records from the school health services can successfully provide data. The system has practical, economical and ethical strengths.

  • 27. Lager, Anton
    et al.
    Fossum, Bjöörn
    Sophiahemmet University.
    Bremberg, Sven
    Övervikt bland barn: nytt system för nationell uppföljning2005Report (Other academic)
    Abstract [en]

    Rapporten visar att det är praktiskt genomförbart att basera ett nationellt uppföljningssystem av barns övervikt och fetma på statistiken från skolhälsovården. Fyra kommuner med datoriserade journalsystem lämnade uppgifter: Västerås, Umeå, Karlstad och Ystad. Övervikt och fetma är ett stort folkhälsoproblem och antalet barn och ungdomar med övervikt har fördubblas på femton år. För att värdera de samlade effekterna av förebyggande insatser är det angeläget att följa utvecklingen över tid.Uppgifter från skolhälsovården kan enkelt sammanställas för att följa utvecklingen i Sverige.

  • 28. Lager, Anton
    et al.
    Guldbrandsson, Karin
    Fossum, Bjöörn
    Sophiahemmet University.
    The chance of Sweden's public health targets making a difference2007In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 80, no 3, 413-21 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a trend in health policy towards more focus on determinants and societal interventions and less on individuals. The Swedish public health targets are in line with this trend. The value of public health targets lies in their ability to function as a tool in governing with targets. This paper examines the possibility of the Swedish targets functioning as such a tool. METHOD: Document analyses were performed to examine three prerequisites of governing with targets: (1) the influence of the administration in the target setting process, (2) the explicitness of targets and (3) the follow-up system. The material consisted of the documents from the committee drafting the targets, the written opinions on the drafts, and the governmental bill with the adopted public health targets. RESULTS: The administration influenced the target setting process. Further, the government invests in a follow-up system that makes indicators on health determinants visible. However, although there existed explicit targets earlier in the process, the final targets in the bill are not explicit enough. CONCLUSION: The Swedish public health targets are not explicit enough to function in governing with targets. The reasons for this were political rather than technical. This suggests that policy makers focusing health determinants should not put time and resources in technical target formulating. Instead they could make indicators visible, thereby drawing attention to trends that are political by nature.

  • 29. Larsson, Sam
    et al.
    Lilja, John
    Fossum, Bjöörn
    Sophiahemmet University.
    Vem får man vara i vårt samhälle?: en kort introduktion till rapporten Om transpersoners psykosociala situation och psykiska hälsa2008Report (Other academic)
  • 30. Larsson, Sam
    et al.
    Lilja, John
    Fossum, Bjöörn
    Sophiahemmet University.
    Vem får man vara i vårt samhälle?: om transpersoners psykosociala situation och psykiska hälsa2008Report (Other academic)
    Abstract [sv]

    Det här är den första svenska kunskapssammanställningen om transpersoners psykiska och psykosociala hälsa. Särskilt fokus ligger på grupperna manliga transvestiter och transsexuella – de grupper som det i nuläget finns mest forskning om. Några viktiga frågor som rapporten försöker ge svar på är: Vad syftar begreppet transperson på? Hur kan transpersoners livssituation beskrivas i relevanta avseenden,som bakgrund, utveckling, identitetsupplevelse, social situation och sociala relationer? Vilka psykiska eller psykosociala påfrestningar kan finnas för transpersoner i samhället kopplat till att de är just transpersoner? Hur kan transpersoner förstås kopplat till samhällets identitets- och genusnormer samt i relation till heteronormen? Hur kan transpersoner förstås i ett historiskt och kulturellt sammanhang? Hur beskriver transpersoner sin situation med egna ord? Vilka förslag till insatser skulle kunna förbättra den psykosociala hälsosituationen för transpersoner?Vi vet att psykisk ohälsa har samband med utanförskap och diskriminering – något som drabbar många transpersoner. Denna rapport är ett viktigt bidrag till hur vi alla ska kunna skapa ett samhälle som visar större förståelse och acceptans för skilda sätt att vara och leva. Kunskapsunderlaget är angelägen läsning för politiker och beslutsfattare. Det riktar sig också till studerande och personal inom skola och högskola samt olika kategorier av vårdpersonal som läkare, sjuksköterskor, psykologer, socionomer och socialpedagoger. Givetvis vänder sig rapporten också till en intresserad allmänhet.

  • 31. Lindberg, Annelie
    et al.
    Fossum, Bjöörn
    Sophiahemmet University.
    Karlen, Per
    Broström, Olle
    Oxelmark, Lena
    The Relationship between Complementary and Alternative Medicine and Disease Related Concerns in Patients with Inflammatory Bowel Disease: A Mixed Methods Approach.2016In: Quality in Primary Care, ISSN 1479-1072, E-ISSN 1479-1064, Vol. 24, no 6, 263-271 p.Article in journal (Refereed)
  • 32. Lindberg, Annelie
    et al.
    Fossum, Bjöörn
    Sophiahemmet University.
    Karlen, Per
    Oxelmark, Lena
    Experiences of complementary and alternative medicine in patients with inflammatory bowel disease - a qualitative study2014In: BMC complementary and alternative medicine, ISSN 1472-6882, Vol. 14, 407- p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of Complementary and Alternative Medicine (CAM) in Inflammatory Bowel Disease (IBD) is increasing. Although CAM often improves patients' well-being, it can also lead to side-effects and interactions with conventional medications. Research on patients with IBD in Sweden who have experiences of CAM is sparse. More studies are needed to enhance awareness of and improve communication about CAM. The aim of this study was to describe experiences of CAM in the healthcare context reported by patients with IBD.

    METHODS: Fifteen patients with IBD, eight with Crohn's disease (CD) and seven with ulcerative colitis (UC), were recruited. Semi-structured qualitative interviews were conducted and qualitative content analysis was performed.

    RESULTS: The analysis revealed the theme Knowledge and communication lead to participation in the area of CAM based on three categories; CAM use, Communication and Self-care. Patients with IBD wanted to be asked about CAM to be able to start a dialogue, as some perceived being treated in a disparaging manner and not taken seriously when raising the subject. Healthcare professionals (HCPs) need to be aware of this in order to meet and understand patient needs. Patients with IBD found it easier to communicate about CAM with the IBD nurses than physicians and dietary changes was one important CAM treatment.

    CONCLUSIONS: The finding that it was easier to discuss CAM with nurses than physicians emphasizes the important role of the IBD nurse in communication and monitoring patients' CAM use. Patients wanted to be asked about CAM to be able to start a dialogue, as some perceived not taken seriously when raising the subject. Furthermore, HCPs need to understand that many patients with IBD regard dietary changes as an important part of CAM treatment. Further research in these areas is needed.

  • 33. Lindholm, Christina
    et al.
    Andersson, Helene
    Sophiahemmet University.
    Fossum, Bjöörn
    Sophiahemmet University.
    Jörbeck, H
    Wounds scrutiny in a Swedish hospital: prevalence, nursing care and bacteriology, including MRSA2005In: Journal of Wound Care, ISSN 0969-0700, E-ISSN 2052-2916, Vol. 14, no 7, 313-9 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To identify all wounds, wound types and wound characteristics; to identify bacteria in all wounds, particularly MRSA, VRE and multi-resistant Gram-negative rods;. METHOD: All patients admitted to or visiting hospital clinics were examined. If the patient had a wound, a questionnaire was filled in by a nurse, and if the wound met the inclusion criteria swabs were taken. RESULTS: A total of 2172 patients were admitted to or visited the hospital; 408 (19%) had a total of 668 wounds. Of this number, 248 were cultured. Thirty-seven patients had pressure ulcers, 83 had leg and foot ulcers and 288 patients had other types of wounds. Nursing care varied according to wound type and ward. Fifty-eight different types of wound dressings were used. Cleansing was performed with saline in 58% of the wounds. The mean number of dressing changes was once daily. Wounds were painful in 37% of the cases, with a predominance of leg and foot ulcers (51%). Many patients did not receive analgesia. MRSA was identified in two patients. No VRE was identified, and there was a low prevalence of multi-resistance in Enterobacteriaceae and Pseudomonas aeruginosa. CONCLUSION: The study provided important information for future improvement of wound care in a university hospital. Fewer resistant bacteria, particularly MRSA, were identified than expected.

  • 34. Olofsson, Anne
    et al.
    Fossum, Bjöörn
    Sophiahemmet University.
    Perspectives on music therapy in adult cancer care: a hermeneutic study2009In: Oncology Nursing Forum, ISSN 1538-0688, Vol. 36, no 4, E223-31 p.Article in journal (Refereed)
    Abstract [en]

    PURPOSE/OBJECTIVES: To explore perspectives on music therapy as a nursing intervention in adult cancer care and to expand and integrate knowledge and understanding about music therapy as an adjunctive intervention in adult cancer nursing care. DATA SOURCES: Published nursing articles. DATA SYNTHESIS: Medical and nursing journals have reported on research related to music and its effect as a nursing intervention. However, this research often lacks a musical context (i.e., knowledge and understanding from a musical perspective). CONCLUSIONS: Music therapy is not a consistent concept. Perspectives on the meanings of music therapy vary according to knowledge and scientific orientation. The perspective may influence the character and methodology of the music therapy intervention as well as the understanding of its results. IMPLICATIONS FOR NURSING: To fully develop music therapy as an adjunct intervention in adult cancer care, interdisciplinary cooperation between nurses and music therapists should be supported on clinical and educational levels.

  • 35. Oxelmark, Lena
    et al.
    Lindberg, Annelie
    Löfberg, Robert
    Sternby, Berit
    Eriksson, Anders
    Almer, Sven
    Befrits, Ragnar
    Fossum, Bjöörn
    Sophiahemmet University.
    Karlén, Per
    Broström, Olle
    Tysk, Curt
    Use of complementary and alternative medicine in Swedish patients with inflammatory bowel disease: a controlled study.2016In: European Journal of Gastroenterology and Hepathology, ISSN 0954-691X, E-ISSN 1473-5687, Vol. 28, no 11, 1320-1328 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is an increasing interest in complementary and alternative medicine (CAM) in patients with chronic diseases, including those with inflammatory bowel disease (IBD). Patients may turn to CAM when conventional therapies are inadequate or associated with side effects for symptomatic relief or to regain control over their disease. The objectives were to explore CAM use and perceived effects in IBD patients in comparison with a control group.

    METHODS: A cross-sectional, multicenter, controlled study was carried out. IBD patients were invited from 12 IBD clinics in Sweden. Controls were selected randomly from a residence registry. A study-specific questionnaire was used for data collection.

    RESULTS: Overall, 48.3% of patients with IBD had used some kind of CAM during the past year compared with 53.5% in controls (P=0.025, adjusted for age, sex, geographic residence, and diet). The most frequently used CAM among IBD patients was massage (21.3%), versus controls (31.4%) (adjusted P=0.0003). The second most used CAM was natural products, 18.7% in IBD patients versus 22.3% of the controls (unadjusted P=0.018). In all, 83.1% of the patients experienced positive effects from CAM and 14.4% experienced negative effects.

    CONCLUSION: Overall, 48.3% of Swedish IBD patients used some kind of CAM and controls used CAM significantly more. Natural products were used by one-fifth of the patients and even more by controls. This is notable from a patient safety perspective considering the possible risks of interactions with conventional medication. In all, 40% of the patients reported adverse events from conventional medicine. Patients experienced predominantly positive effects from CAM, and so did controls.

  • 36. Rådestad, Monica
    et al.
    Lennquist Montán, Kristina
    Rüter, Anders
    Sophiahemmet University.
    Castrén, Maaret
    Svensson, Leif
    Gryth, Dan
    Fossum, Bjöörn
    Sophiahemmet University.
    Attitudes Towards and Experience of the Use of Triage Tags in Major Incidents: A Mixed Method Study2016In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 31, no 4, 376-85 p.Article in journal (Refereed)
    Abstract [en]

    Introduction Disaster triage is the allocation of limited medical resources in order to optimize patient outcome. There are several studies showing the poor use of triage tagging, but there are few studies that have investigated the reasons behind this. The aim of this study was to explore ambulance personnel attitude towards, and experiences of, practicing triage tagging during day-to-day management of trauma patients, as well as in major incidents (MIs).

    METHODS: A mixed method design was used. The first part of the study was in the form of a web-survey of attitudes answered by ambulance personnel. The question explored was: Is it likely that systems that are not used in everyday practice will be used during MIs? Two identical web-based surveys were conducted, before and after implementing a new strategy for triage tagging. This strategy consisted of a time-limited triage routine where ambulance services assigned triage category and applied triage tags in day-to-day trauma incidents in order to improve field triage. The second part comprised three focus group interviews (FGIs) in order to provide a deeper insight into the attitudes towards, and experience of, the use of triage tags. Data were analyzed using qualitative content analysis.

    RESULTS: The overall finding was the need for daily routine when failure in practice. Analysis of the web-survey revealed three changes: ambulance personnel were more prone to use tags in minor accidents, the sort scoring system was considered to be more valuable, but it also was more time consuming after the intervention. In the analysis of FGIs, four categories emerged that describe the construction of the overall category: perceived usability, daily routine, documentation, and need for organizational strategies.

    CONCLUSION: Triage is part of the foundation of ambulance skills, but even so, ambulance personnel seldom use this in routine practice. They fully understand the benefit of accurate triage decisions, and also that the use of a triage algorithm and color coded tags is intended to make it easier and more secure to perform triage. However, despite the knowledge and understanding of these benefits, sparse incidents and infrequent exercises lead to ambulance personnel's uncertainty concerning the use of triage tagging during a MI and will therefore, most likely, avoid using them. Rådestad M , Lennquist Montán K , Rüter A , Castrén M , Svensson L , Gryth D , Fossum B . Attitudes towards and experience of the use of triage tags in major incidents: a mixed method study. Prehosp Disaster Med. 2016;31(4):1-10.

  • 37. Simon, Michael
    et al.
    Griffiths, Peter
    Kottner, Jan
    Unbeck, Maria
    Sterner, Eila
    Sophiahemmet University.
    Elg, Mattias
    Fossum, Bjöörn
    Sophiahemmet University.
    Thor, Johan
    PukkHärenstam, Karin
    Beckstead, Jason W
    'Choose your tool wisely: U charts are more informative than run charts with or without tests of significance. A comment on Unbeck et al. (2014), Unbeck et al. (2013) and Kottner (2014)': Authors' response (Unbeck and colleagues)2015In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 52, no 1, 481-486 p.Article in journal (Other academic)
  • 38.
    Siouta, Eleni
    et al.
    Sophiahemmet University.
    Hellström Muhli, Ulla
    Fossum, Bjöörn
    Sophiahemmet University.
    Karlgren, Klas
    Cardiologists' experiences and perceptions of patient involvement and communication related to shared decision-making regarding atrial fibrillation treatment2017In: Communication & Medicine: An Interdisciplinary Journal of Healthcare, Ethics and Society, ISSN 1612-1783, E-ISSN 1613-3625, Vol. 14, no 1Article in journal (Refereed)
  • 39. Siouta, Eleni
    et al.
    Hellström Muhli, Ulla
    Fossum, Bjöörn
    Sophiahemmet University.
    Karlgren, Klas
    Cardiologists' experiences and perceptions of patient involvement and communication related to shared decision-making regarding atrial fibrillation treatmentManuscript (preprint) (Other academic)
  • 40.
    Siouta, Eleni
    et al.
    Sophiahemmet University.
    Hellström Muhli, Ulla
    Hedberg, Berith
    Broström, Anders
    Fossum, Bjöörn
    Sophiahemmet University.
    Karlgren, Klas
    Patients' experiences of communication and involvement in decision-making about atrial fibrillation treatment in consultations with nurses and physicians2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 3, 535-46 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Insights in consultations across patient interactions with physicians and nurses are of vital importance for strengthening the patients' involvement in the treatment decision-making process. The experience of involvement and communication in decision-making from the patients' perspective has been sparsely explored.

    OBJECTIVE: To examine how patients describe involvement in and communication about decision-making regarding treatment in consultations with nurses and physicians.

    METHOD: Twenty-two patients with atrial fibrillation (AF), aged 37-90 years, were interviewed directly after their consultations with nurses and physicians in outpatient AF clinics in six Swedish hospitals.

    RESULTS: In consultations with nurses, the patients felt involved when obtaining clarifications about AF as a disease and its treatment and when preparing for and building up confidence in decision-making. In consultations with physicians, the patients felt involved when they could cooperate in decision-making, when acquiring knowledge, and when they felt that they were being understood. One shared category was found in consultations with both nurses and physicians, and the patients felt involved when they had a sense of trust and felt secure during and between consultations.

    CONCLUSIONS: Patients with AF stated that they would need to acquire knowledge and build up confidence and ability in order to be effectively involved in the decision-making about treatment. Despite not being actively involved in decision-making, patients felt involved through experiencing supportive and confirming communication.

    PRACTICE IMPLICATIONS: Attention must be given to the relationship with the patient to create the conditions for patient involvement in the consultation. This can be achieved through supportive communication attempting to create a feeling of clarity and building confidence. This will support involvement in decision-making concerning AF treatment and feelings of being understood and of trust in physicians and/or nurses.

  • 41.
    Sormunen, Taina
    et al.
    Sophiahemmet University.
    Aanesen, Arthur
    Fossum, Bjöörn
    Sophiahemmet University.
    Karlgren, Klas
    Westerbotn, Margareta
    Sophiahemmet University.
    Infertility-related communication and coping strategies among women affected by primary or secondary infertility2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Infertility is a worldwide problem and is experienced as psychologically stressful. Communication about infertility varies depending on clinical aspects, personal relationships and culture. The aim of this study was to explore infertility-related communication and coping strategies among women affected by, primary or secondary fertility problems.

    METHODS: A quantitative cross-sectional study design was used. One hundred ninety-nine women affected by primary and secondary infertility were recruited from one fertility clinic in Stockholm. A structured self-administered questionnaire was used to collect data. The answers were compared across the two groups using the chi-squared test for independence.

    RESULTS: The majority of the women discussed infertility related subjects with intimate friends and/or relatives and did not discuss the results of examinations and tests with people outside of the family. There were significant differences between the two groups. Twice as many women with secondary infertility acknowledged that they never talk about the causes or results of the tests and examinations with other people, compared with women with primary infertility. Approximately 25 percent of the women with primary infertility used distraction techniques, such as turning to work, as a coping strategy compared to women with secondary infertility (10%). Some women did not discuss the inability to conceive and reasons why they were childless with their spouses. Twelve percent of the women reported that they left the room when the subjects of children were being discussed. Approximately 30 percent of the participants did not ask friends or relatives for advice and a few were not able to discuss how tests and treatments affected them emotionally.

    CONCLUSION: The present study indicates that a majority of infertile women discuss about infertility-related subjects with their spouses. However they are less likely to discuss the reason for infertility and results of tests and examinations with people outside the family.

    RELEVANCE TO THE CLINICAL PRACTICE: The result of the current study can be useful regarding interventions for women affected by primary or by secondary infertility. The healthcare staff must be alert and attentive in order to pay attention to these possible challenges. Identification of women at risk of developing emotional problems due to communication difficulties regarding infertility-related issues merits close attention. This article is protected by copyright. All rights reserved.

  • 42.
    Sterner, Eila
    et al.
    Sophiahemmet University.
    Fossum, Bjöörn
    Sophiahemmet University.
    Berg, Elisabeth
    Lindholm, Christina
    Sophiahemmet University.
    Stark, André
    Objective evaluation by reflectance spectrophotometry can be of clinical value for the verification of blanching/nonblanching erythema in the sacral area2014In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 11, no 4, 416-423 p.Article in journal (Refereed)
  • 43.
    Sterner, Eila
    et al.
    Sophiahemmet University.
    Lindholm, Christina
    Berg, E
    Stark, A
    Fossum, Bjöörn
    Sophiahemmet University.
    Category I pressure ulcers: how reliable is clinical assessment?2011In: Orthopedic Nursing, ISSN 0744-6020, E-ISSN 1542-538X, Vol. 30, no 3, 194-205 p.Article in journal (Refereed)
    Abstract [en]

    finger-press tests and visual observation alone were not reliable methods to discriminate between blanching and nonblanching erythema. Forty-seven percent of the patients had a risk score 20 or fewer (high risk for pressure ulcers). Forty-four patients (56%) had pressure ulcers at discharge.

  • 44.
    Sterner, Eila
    et al.
    Sophiahemmet University.
    Unbeck, M
    Lindholm, Christina
    Sophiahemmet University.
    Stark, A
    Gordon, M
    Fossum, Bjöörn
    Sophiahemmet University.
    Poor documentation of risk factors and prevention strategies for pressure ulcers in orthopedic inpatientsManuscript (preprint) (Other academic)
  • 45.
    Tyrrell, Marie
    et al.
    Sophiahemmet University.
    Hillerås, Pernilla
    Sophiahemmet University.
    Skovdahl, Kirsti
    Fossum, Bjöörn
    Sophiahemmet University.
    Voices of Spouses living with partners with behavioural and psycological symtoms related to dementia2016Conference paper (Other academic)
    Abstract [en]

    Background: Persons with dementia, whdo reside in their own homes, are often cared for by family members or friends. The presence of a family career is said to have a protective effect, postponing admissions to residential care. The majority of persons with dementia develop behavioural and personality changes during the disease trajectory. The quality of life for both the person with behavioural and psychological symptoms and their careers are affected, increasing both suffering and risk for hospitalisation. Family careers to persons with dementia have identified behavioural changes as more distressing than cognitive impairment leading to increased burden of care and admissions to residential care. Knowledge gaps exist regarding how family careers living with persons with dementia experience behavioural and psychological symptoms in a community setting.

    AIM: To describe spouses’ experiences of living with partners who have behavioural and psychological symptoms related to dementia. Methods:Semi-structured interviews were carried out with 14 spouses of partners with dementia. The interviews included the completion of the NPI (Neuropsychiatric Inventory, Cummings, 1994). Interview data was analysed using content analysis. Results:(Preliminary) Spouses identified that partners with dementia had on average five to eight co-existing NPI symptoms. Frequency, severity and distress varied. The behavioural and psychological symptoms highlighted were within three of four possible symptom domains; Behaviour, Psychosis and Mood. From the narrative data four main categories emerged; Support, Coping, Vulnerability and domestic violence AND Social isolation. Conclusions: A large proportion of persons with dementia reside in the  community. Support offered to persons with dementia and their families should have a person-centered approach meeting individual needs. A greater awareness is required regarding welfare and safety of persons with dementia and their partners in a community setting.

  • 46. Tyrrell, Marie
    et al.
    Hillerås, Pernilla
    Sophiahemmet University.
    Skovdahl, Kirsti
    Fossum, Bjöörn
    Sophiahemmet University.
    Religa, Dorota
    Voices of spouses living with partners with neuropsychiatric symptoms related to dementia2017In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, 1471301217693867Article in journal (Refereed)
    Abstract [en]

    Persons with dementia, who reside in their own homes, are often cared for by family members. The presence of a family career is said to have a protective effect, postponing admissions to residential care. The majority of persons with dementia develop behavioural and personality changes during the disease trajectory also known as neuropsychiatric symptoms. Quality of life for both the person with neuropsychiatric symptoms and their careers are affected, increasing suffering and risk for hospitalisation and admission to long-term residential care. Family careers to persons with dementia have identified behavioural changes as more distressing than cognitive impairment leading to increased burden of care and admissions to residential care. Knowledge gaps exist regarding how family careers living with persons with dementia experience neuropsychiatric symptoms in a community setting. The aim was to describe spouses' experiences of living with partners who have developed neuropsychiatric symptoms related to dementia in a community setting. Semi-structured interviews were carried out with 14 spouses of partners with dementia. The interviews included completion of the neuropsychiatric inventory. Interview data were analysed using a content analysis approach. The results showed that spouses identified in the neuropsychiatric inventory that partners with dementia had on average five to eight co-existing symptoms. Frequency, severity and distress varied. From the narrative data, the theme living on the edge lacking support and time for self, emerged. The findings of this study suggest that support offered to persons with dementia and their spouses should have a person-centred approach meeting individual needs. Safety and welfare of persons with dementia and their spouses residing in their own homes may be jeopardised in the presence of neuropsychiatric symptoms. A greater awareness is required in the community regarding the well-being of these persons.

  • 47. Unbeck, Maria
    et al.
    Sterner, Eila
    Sophiahemmet University.
    Elg, Mattias
    Fossum, Bjöörn
    Sophiahemmet University.
    Thor, Johan
    Pukk Härenstam, Karin
    Design, application and impact of quality improvement 'theme months' in orthopaedic nursing: a mixed method case study on pressure ulcer prevention2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 4, 527-35 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While there is growing awareness of quality problems in healthcare systems, it remains uncertain how best to accomplish and sustain improvement over time.

    OBJECTIVE: To report on the design and application of quality improvement theme months in orthopaedic nursing, and evaluate the impact on pressure ulcer as an example.

    DESIGN: Retrospective mixed method case study with time series diagrams.

    SETTING: An orthopaedic department at a Swedish university hospital.

    METHOD: The interventions were led by nursing teams and focused on one improvement theme at a time in two-month cycles, hence the term 'improvement theme months'. These included defined objectives, easy-to-use follow-up measurement, education, changes to daily routines, "reminder months" and data feedback. The study draws on retrospective record data regarding one of the theme topics, pressure ulcer risk assessment and prevalence, in 2281 orthopaedic admissions during January 2007-October 2010 through point prevalence measurement one-day per month. Data were analysed in time series diagrams and through comparison to annual point prevalence data from mandatory county council-wide measurements prior to, during and after interventions from 2003 to 2010. By using document analysis we reviewed concurrent initiatives at different levels in the healthcare organisation and related them to the improvement theme months and their impact.

    RESULTS: The 46 monthly point prevalence samples ranged from 28 to 66 admissions. Substantial improvements were found in risk assessment rates for pressure ulcers both in the longitudinal follow-up (p<0.001) and in the annual county council-wide measurements. A reduction in pressure ulcer rate was observed in the annual county council-wide measurements. In the longitudinal data, wider variation in the pressure ulcer rate was seen (p<0.067); however, there was a significant decrease in pressure ulcer rates during the final ten-month period in 2010, compared to the baseline period in 2007 (p=0.004). Improvements were moderate the first years and needed reinforcement to be maintained.

    CONCLUSIONS: The theme month design and the way it was applied in this case showed potential, contributing to reduced pressure ulcer prevalence, as a way to conduct quality improvement initiatives in nursing. For sustainable improvement, multi component interventions are needed with regular monitoring and reminder efforts.

  • 48. Unbeck, Maria
    et al.
    Sterner, Eila
    Sophiahemmet University.
    Elg, Mattias
    Fossum, Bjöörn
    Sophiahemmet University.
    Thor, Johan
    Pukk Härenstam, Karin
    'The value of Statistical Process Control in quality improvement contexts: Commentary on Unbeck et al. (2013)': Authors' response2014In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 51, no 2, 348-349 p.Article in journal (Other academic)
  • 49. Unbeck, Maria
    et al.
    Sterner, Eila
    Elg, Mattias
    Fossum, Bjöörn
    Sophiahemmet University.
    Thor, Johan
    PukkHärenstam, Karin
    Authors' response (Unbeck and colleagues)2015In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 52, no 1, 484-5; discussion 485 p.Article in journal (Other academic)
  • 50. Österlund Efraimsson, Eva
    et al.
    Fossum, Bjöörn
    Sophiahemmet University.
    Ehrenberg, Anna
    Larsson, Kjell
    Klang, Birgitta
    Use of motivational interviewing in smoking cessation at nurse-led chronic obstructive pulmonary disease clinics2012In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 68, no 4, 767-782 p.Article in journal (Refereed)
    Abstract [en]

    efraimsson e.ö., fossum b., ehrenberg a., larsson k. & klang b. (2011) Use of motivational interviewing in smoking cessation at nurse-led chronic obstructive pulmonary disease clinics. Journal of Advanced Nursing. ABSTRACT: Aim.  This paper is a report of a study to describe to what extent Registered Nurses, with a few days of education in motivational interviewing based communication, used motivational interviewing in smoking cessation communication at nurse-led chronic obstructive pulmonary disease clinics in primary health care. Background.  For smokers with chronic obstructive pulmonary disease the most crucial and evidence-based intervention is smoking cessation. Motivational interviewing is often used in healthcare to support patients to quit smoking. Method.  The study included two videotaped consultations, the first and third of three at the clinic, with each of 13 smokers. Data were collected from March 2006 to April 2007. The nurses' smoking cessation communication was analysed using the Motivational Interviewing Treatment Integrity scale. To get an impression of the consultation, five parameters were judged on a five-point Likert-scale, with five indicating best adherence to Motivational Interviewing. Results.  Evocation', 'collaboration', 'autonomy-support' and 'empathy' averaged between 1·31 and 2·23 whereas 'direction' scored five in all consultations. Of communication behaviours, giving information was the most frequently used, followed by 'closed questions', 'motivational interviewing non-adherent' and 'simple reflections'. 'Motivational interviewing adherent', 'open questions' and 'complex reflections' occurred rarely. There were no important individual or group-level differences in any of the ratings between the first and the third consultations. Conclusion.  In smoking cessation communication the nurses did not employ behaviours that are important in motivational interviewing.

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