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Harder, M., Höglander, J., Appelgren Engström, H., Holmström, I. & Blomberg, H. (2024). An integrative review of communication in a professional-parental relationship provided in child health services: An authoritarian or guiding approach. Patient Education and Counseling, 118, Article ID 108029.
Open this publication in new window or tab >>An integrative review of communication in a professional-parental relationship provided in child health services: An authoritarian or guiding approach
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2024 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 118, article id 108029Article in journal (Refereed) Published
Abstract [en]

Objectives

Early parental support, provided by nurses within child health services, aims to strengthen parents in their parenthood. The aim of this integrative review is to describe communication in parental support in encounters between child health nurses and parents in child health services.

Methods

An integrative review was conducted. The databases Cinahl+ , MedLine, Psych Info, and Scopus were searched, 312 articles were screened, and 16 articles were found to be eligible.

Results

The studies included qualitative and quantitative methods, using interviews, focus group interviews, and observations. The findings show an overarching theme: The significance of mutuality in communication in a professional-parental relationship, further described in the following categories, 1) Authoritarian approach: a controlling manner, a neglecting manner, and a teaching manner; 2. Guiding approach: a counselling manner and a compliant manner.

Conclusions

The communication between nurses and parents can be understood as having several layers; the organisational context, the professional skills, knowledge, and experiences, and parents’ knowledge, expectations, and needs. There is a lack of studies of authentic communication between nurses and parents; thus, future research is warranted.

Practice implications:

The authoritarian and guiding approaches in parental support show the required skills a nurse is expected to have, but sufficient organizational prerequisites are also crucial.

Keywords
Child health nurses, Child health services, Communication, Integrative review, Support
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-64635 (URN)10.1016/j.pec.2023.108029 (DOI)001103455500001 ()2-s2.0-85175006552 (Scopus ID)
Available from: 2023-10-31 Created: 2023-10-31 Last updated: 2023-12-07Bibliographically approved
Elvén, M., Holmström, I. K., Carlestav, M. & Edelbring, S. (2023). A tension between surrendering and being involved: An interview study on person-centeredness in clinical reasoning in the acute stroke setting. Patient Education and Counseling, 112, Article ID 107718.
Open this publication in new window or tab >>A tension between surrendering and being involved: An interview study on person-centeredness in clinical reasoning in the acute stroke setting
2023 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 112, article id 107718Article in journal (Refereed) Published
Abstract [en]

Objective: To explore how stroke survivors experience and prefer to participate in clinical reasoning processes in the acute phase of stroke care. Methods: An explorative qualitative design was used. Individual interviews were conducted with 11 stroke survivors in the acute phase of care and analyzed using reflexive thematic analysis. Results: The analysis identified five themes: What's going on with me?; Being a recipient of care and treatment; The need to be supported to participate; To be seen and strengthened; and Collaboration and joint understanding. Conclusion: Stroke survivors experience many attributes of person-centeredness in the acute phase of care but, according to their stories, their participation in clinical reasoning can be further supported. The tension between surrendering and the desire to be more actively involved in the care needs to be considered to facilitate participation in clinical reasoning. Practice Implications: Stroke survivors’ participation in clinical reasoning in the acute phase can be facilitated by health professionals noticing signs prompting a shift towards increased willingness to participate. Furthermore, health professionals need to take an active role, sharing their expertise and inviting the stroke survivors to share their perspective. The findings can contribute to further develop person-centered care in acute settings. 

Place, publisher, year, edition, pages
Elsevier Ireland Ltd, 2023
Keywords
Clinical reasoning, Decision-making, Participation, Person-centered care, Stroke care
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-62270 (URN)10.1016/j.pec.2023.107718 (DOI)000973282800001 ()37001485 (PubMedID)2-s2.0-85151854497 (Scopus ID)
Available from: 2023-04-19 Created: 2023-04-19 Last updated: 2023-05-24Bibliographically approved
Mattebo, M., Holmström, I., Höglund, A. T. & Fredriksson, M. (2023). Guideline documents on caesarean section on maternal request in Sweden: varying usability with a restrictive approach. BMC Health Services Research, 23(1), Article ID 1117.
Open this publication in new window or tab >>Guideline documents on caesarean section on maternal request in Sweden: varying usability with a restrictive approach
2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 1117Article in journal (Refereed) Published
Abstract [en]

Background: Globally, studies illustrate different approaches among health care professionals to decision making about caesarean section (CS) and that attitudes regarding the extent to which a CS on maternal request (CSMR) can be granted vary significantly, both between professionals and countries. Absence of proper regulatory frameworks is one potential explanation for high CSMR rates in some countries, but overall, it is unclear how recommendations and guidelines on CSMR relate to CSMR rates. In Sweden, CSMR rates are low by international comparison, but statistics show that the extent to which maternity clinics perform CSMR vary among Sweden’s 21 self-governing regions. These regions are responsible for funding and delivery of healthcare, while national guidelines provide guidance for the professions throughout the country; however, they are not mandatory. To further understand considerations for CSMR requests and existing practice variations, the aim was to analyse guideline documents on CSMR at all local maternity clinics in Sweden. Methods: All 43 maternity clinics in Sweden were contacted and asked for any guideline documents regarding CSMR. All clinics replied, enabling a total investigation. We used a combined deductive and inductive design, using the framework method for the analysis of qualitative data in multi-disciplinary health research. Results: Overall, 32 maternity clinics reported guideline documents and 11 denied having any. Among those reporting no guideline documents, one referred to using national guideline document. Based on the Framework method, four theme categories were identified: CSMR is treated as a matter of fear of birth (FOB); How important factors are weighted in the decision-making is unclear; Birth contracts are offered in some regions; and The post-partum care is related to FOB rather than CSMR. Conclusion: In order to offer women who request CS equal and just care, there is a pressing need to either implement current national guideline document at all maternity clinics or rewrite the guideline documents to enable clinics to adopt a structured approach. The emphasis must be placed on exploring the reasons behind the request and providing unbiased information and support. Our results contribute to the ongoing discussion about CSMR and lay a foundation for further research in which professionals, as well as stakeholders and both women planning pregnancy and pregnant women, can give their views on this issue. 

Place, publisher, year, edition, pages
BioMed Central Ltd, 2023
Keywords
Caesarean section on maternal request, CSMR, Guidelines, Reproductive autonomy, The framework method
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:mdh:diva-64643 (URN)10.1186/s12913-023-10077-7 (DOI)001095836500004 ()37853465 (PubMedID)2-s2.0-85174457929 (Scopus ID)
Available from: 2023-11-01 Created: 2023-11-01 Last updated: 2023-11-29Bibliographically approved
Höglander, J., Holmström, I., Gustafsson, T., Lindberg, E., Söderholm, H. M., Hedén, L., . . . Sundler, A. J. (2023). Implementing A person-centred CommunicaTION (ACTION) educational intervention for in-home nursing assistants – a study protocol. BMC Geriatrics, 23(1), Article ID 112.
Open this publication in new window or tab >>Implementing A person-centred CommunicaTION (ACTION) educational intervention for in-home nursing assistants – a study protocol
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2023 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 23, no 1, article id 112Article in journal (Refereed) Published
Abstract [en]

Background: In this study, the focus is on how to support the competence development needed for nursing assistants in home care. Home care services for older persons can be challenging concerning the nature of the interpersonal interaction and communication needed to care for and respond to the diverse needs of older people who seek to live well in our communities. This implies a need to offer more person-centred care (PCC) to older persons. However, there is a lack of knowledge on how to develop such competence. We, therefore, developed A Person-centred CommunicaTION (ACTION) programme, which is a web-based educational intervention aimed at supporting competence development for nursing assistants. The research objective is to evaluate the ACTION programme with respect to participants’ responses to and the effect of the intervention. Methods: A multicentre case–control study with pre- and post-assessments was designed. The ACTION programme will be implemented at home care units, in two different geographic areas in Sweden. A total of 300 nursing assistants will be recruited: 150 for the intervention group and 150 for the control group. We will evaluate the impact measures and the process. Pre- and post-assessments will be performed with data collected via a) audio recordings of communication, b) a questionnaire on self-efficacy communication skills, PCC, empathy and job satisfaction, c) user data, evaluation forms, field notes and observations, and d) interviews. The data will be analysed with descriptive and analytic statistics and/or qualitative methods for meanings. Discussion: This study has the potential to contribute to the evidence supporting competence development required to offer person-centred and quality home care to older persons and to meet upcoming needs for flexible and easily accessible competence development. Trial registration: ISRCTN64890826. Registered 10 January 2022, https://www.isrctn.com/ISRCTN64890826

Place, publisher, year, edition, pages
BioMed Central Ltd, 2023
Keywords
Competence development, Education intervention, Home care, Nursing assistants, Older persons, Person-centred communication, Study protocol, aged, article, audio recording, case control study, communication skill, controlled study, education, empathy, female, human, human experiment, interview, job satisfaction, male, multicenter study, nursing assistant, qualitative analysis, questionnaire, self concept, Sweden, interpersonal communication, very elderly, Aged, 80 and over, Case-Control Studies, Communication, Home Care Services, Humans
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-62033 (URN)10.1186/s12877-023-03831-3 (DOI)000940262500001 ()36841761 (PubMedID)2-s2.0-85148998872 (Scopus ID)
Available from: 2023-03-08 Created: 2023-03-08 Last updated: 2023-03-30Bibliographically approved
Wahlström, E., Golsäter, M., Holmström, I., Larm, P. & Harder, M. (2023). In search of factors related to migration affecting children's health - an analysis of documents guiding health visits within the Swedish school health services. Archives of Public Health, 81(1), Article ID 103.
Open this publication in new window or tab >>In search of factors related to migration affecting children's health - an analysis of documents guiding health visits within the Swedish school health services
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2023 (English)In: Archives of Public Health, ISSN 0778-7367, E-ISSN 2049-3258, Vol. 81, no 1, article id 103Article in journal (Refereed) Published
Abstract [en]

Background: Migration affects the health of children worldwide. Therefore, school nurses who encounter these children as part of their everyday practice need support from guidelines on how to promote the health of children who have migrated or whose parents have migrated. Yet knowledge regarding such content in guidelines of school nursing practice is sparse. Therefore, this study aims to investigate how municipal and regional guidelines and health questionnaires used in health visits in the Swedish school health services include factors related to migration that affect children's health.

Methods: A document analysis of municipal and regional guidelines and health questionnaires guiding school nurses' practice in health visits was conducted during the autumn of 2020. In total, 687 guidelines and health questionnaires were analyzed using deductive content analysis.

Results: The results show that municipal and regional guidelines and health questionnaires used in health visits in the Swedish school health services include content on many factors related to migration that affect children's health. Yet the content was limited, and none was found on factors related to discrimination based on ethnicity or origin.

Conclusion: Guidance related to promoting the health of children who have migrated or whose parents have migrated should include all factors affecting these children's health. Therefore, to strengthen school nurses' evidence-based practice, guideline development might be needed, although guidelines and health questionnaires exist and include content on many factors related to migration affecting the health of children in order to provide equitable healthcare for all children, regardless of country of origin.

Place, publisher, year, edition, pages
BMC, 2023
Keywords
Guidelines, Children, Migration, Health disparities, Health determinants, School nursing, Document analysis, Evidence-based practice
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-63664 (URN)10.1186/s13690-023-01125-z (DOI)001006088800001 ()37312228 (PubMedID)2-s2.0-85161851681 (Scopus ID)
Available from: 2023-06-28 Created: 2023-06-28 Last updated: 2023-06-28Bibliographically approved
Höglander, J., Holmström, I., Lövenmark [Åberg] [Engström], A., van Dulmen, S., Eide, H. & Sundler, A. (2023). Nurse-patient communication: An integrative review for future direction in nursing research.. Patient Education and Counseling, 109, 69-69
Open this publication in new window or tab >>Nurse-patient communication: An integrative review for future direction in nursing research.
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2023 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 109, p. 69-69Article in journal (Refereed) Published
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-64498 (URN)10.1016/j.pec.2022.10.163 (DOI)001040817800151 ()
Available from: 2023-10-11 Created: 2023-10-11 Last updated: 2023-10-11Bibliographically approved
Edelbring, S., Elvén, M., Holmström, I. K. & Prenkert, M. (2023). Person-Centeredness in Clinical Reasoning of Interprofessional Stroke Teams. Patient Education and Counseling, 109, 70-70
Open this publication in new window or tab >>Person-Centeredness in Clinical Reasoning of Interprofessional Stroke Teams
2023 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 109, p. 70-70Article in journal, Meeting abstract (Refereed) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-64496 (URN)10.1016/j.pec.2022.10.166 (DOI)001040817800154 ()
Available from: 2023-10-11 Created: 2023-10-11 Last updated: 2023-10-11Bibliographically approved
Höglander, J., Holmström, I. K., Lövenmark [Åberg] [Engström], A., Van Dulmen, S., Eide, H. & Sundler, A. J. (2023). Registered nurse-patient communication research: An integrative review for future directions in nursing research. Journal of Advanced Nursing
Open this publication in new window or tab >>Registered nurse-patient communication research: An integrative review for future directions in nursing research
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2023 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article, review/survey (Refereed) Published
Abstract [en]

AimTo explore communication research in nursing by investigating the theoretical approaches, methods, content and perspectives in research on real-time registered nurse (RN)-patient communication. DesignAn integrative review of real-time communication between RNs and patients. Data SourcesEmpirical research papers were searched in PubMed, CINAHL Plus and Medline. The results from the database searches were supplemented with results from manual searches in reference lists. Review MethodsA total of 1369 articles published between January 1996 and December 2021 were screened, which resulted in the inclusion of 52 articles. ResultsThe integration of various theories, such as nursing or communication theories, is weak in most of the included studies. RN-patient communication appears to influence relationship building. Even when nurses strive to meet patients' needs, they often focus primarily on nursing routines and physical care. The topic of the communication varies depending on the situation and different communication styles are used. When a patient-centred approach is adopted, the interpersonal communication becomes quite symmetrical, with complementary roles of nurses and patients. Within a more asymmetric communication context, nurses dominate communication, choose topics and function as instructors. How the nurses communicated subsequently influenced the patients' communication styles and strategies. ConclusionCommunication is multifaceted, contains different strategies and is important for building trust and facilitating patient-centred care. The importance of RNs' communication for interaction and relationship-building seems to be well established within research, but few studies focused on patients' communication with RNs. ImpactThis integrative review gives an overview of the width and depth of observational studies on RN-patient communication research. The variety of studies indicates that this area is a less well-grounded field of research. Future research is warranted to support nurses in their communication, especially regarding the exploration of patients' communication and desired communication skills in nurse-patient interactions. Patient or Public ContributionNo patient or public contribution was included in this integrative review.

Place, publisher, year, edition, pages
WILEY, 2023
Keywords
communication, integrative review, interaction, patient, registered nurse
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-61418 (URN)10.1111/jan.15548 (DOI)000899674900001 ()36534429 (PubMedID)2-s2.0-85144256181 (Scopus ID)
Available from: 2023-01-04 Created: 2023-01-04 Last updated: 2024-01-09Bibliographically approved
Skogevall, S., Eklund, J. H., Kaminsky, E. & Holmström, I. K. (2023). Review of frequent callers to telephone health services. Patient Education and Counseling, 109, 94-94
Open this publication in new window or tab >>Review of frequent callers to telephone health services
2023 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 109, p. 94-94Article in journal, Meeting abstract (Refereed) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-64497 (URN)10.1016/j.pec.2022.10.220 (DOI)001040817800208 ()
Available from: 2023-10-11 Created: 2023-10-11 Last updated: 2023-10-11Bibliographically approved
Sundler, A. J., Hedén, L., Holmström, I., van Dulmen, S., Bergman, K., Östensson, S. & Östman, M. (2023). The patient’s first point of contact (PINPOINT) – protocol of a prospective multicenter study of communication and decision-making during patient assessments by primary care registered nurses. BMC Primary Care, 24(1), Article ID 249.
Open this publication in new window or tab >>The patient’s first point of contact (PINPOINT) – protocol of a prospective multicenter study of communication and decision-making during patient assessments by primary care registered nurses
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2023 (English)In: BMC Primary Care, ISSN 2731-4553, Vol. 24, no 1, article id 249Article in journal (Refereed) Published
Abstract [en]

Background: A major challenge for primary care is to set priorities and balance demands with available resources. The registered nurses in this study are practice nurses working in primary care offices, playing a large role in initial assessments. The overall objective of this research is to investigate practices of communication and decision-making during nurses’ initial assessment of patients’ health problems in primary care, examine working mechanisms in good practices and develop feasible solutions. Methods: Project PINPOINT aims for a prospective multicenter study using various methods for data collection and analysis. A purposive sample of 150 patient‒nurse consultations, including 30 nurses and 150 patients, will be recruited at primary care centers in three different geographic areas of southwest Sweden. The study will report on outcomes of communication practices in relation to patient-reported expectations and experiences, communication processes and patient involvement, assessment and decision-making, related priorities and value conflicts with data from patient questionnaires, audio-recorded real-time communication, and reflective interviews with nurses. Discussion: This research will contribute to the knowledge needed for the guidance of first-line decision-making processes to best meet patient and public health needs. This knowledge is necessary for the development of assessments and decisions to be better aligned to patients and to set priorities. Insights from this research can empower patients and service providers and help understand and enhance feasible person-centered communication strategies tailored to patients’ level of health literacy. More specifically, this research will contribute to knowledge that can strengthen nurses’ communication, assessments, and clinical decision-making in primary care. In the long term, this will contribute to how the competencies of practice nurses and other professionals are organized and carried out to make the best use of the resources within primary care. Trial registration: ClinicalTrials.gov Identifier: NCT06067672. 

Place, publisher, year, edition, pages
BioMed Central Ltd, 2023
Keywords
Communication, Decision-making, Nurse, Nurse-patient interaction, Primary care, Study protocol, Health Literacy, Humans, Multicenter Studies as Topic, Nurse-Patient Relations, Nurses, Primary Health Care, Prospective Studies, article, clinical decision making, consultation, decision making, human, interpersonal communication, interview, multicenter study, patient assessment, patient participation, primary medical care, purposive sample, questionnaire, registered nurse, Sweden, multicenter study (topic), nurse patient relationship, prospective study
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-65022 (URN)10.1186/s12875-023-02208-0 (DOI)001122635700004 ()38031004 (PubMedID)2-s2.0-85178183187 (Scopus ID)
Available from: 2023-12-13 Created: 2023-12-13 Last updated: 2024-01-17Bibliographically approved
Projects
Developing gendercompetence in Swedish telenursing [2009-05853_VR]; Uppsala University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4302-5529

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