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Yuwanich, N., Akhavan, S., Nantsupawat, W., Martin, L., Elfström, M. & Sandborgh, M. (2018). Development and psychometric properties of the stressor scale for emergency nurses. International Emergency Nursing, 39, 77-88
Open this publication in new window or tab >>Development and psychometric properties of the stressor scale for emergency nurses
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2018 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 39, p. 77-88Article in journal (Refereed) Published
Abstract [en]

Introduction: Emergency department nurses are exposed to specific stressors and report higher stress levels than nurses in other hospital departments. This study aimed to develop and test the psychometric properties of a questionnaire-based instrument for identifying stressors for emergency department nurses. Methods: The instrument's content and face validities were examined by five experts and nurses in emergency nursing field. The test-retest reliability was examined on 30 emergency department nurses. The construct validity, including an exploratory and a confirmatory factor analysis, was tested on 405 emergency department nurses. Cronbach's alpha values and intra-class coefficients were calculated. Results: The instrument's content and face validities were satisfactory. The exploratory factor analysis provided a five-factor solution, whereas the confirmatory factor analysis provided a final four-factor solution with 25 items distributed among the factors Life and death situations, Patients' and families' actions and reactions, Technical and formal support, and Conflicts. The Cronbach's alpha values ranged from 0.89 to 0.93 per factor, and the intra-class correlation coefficient was 0.89, indicating good homogeneity and stability. Conclusions: The instrument's content, face, and construct validities were satisfactory, and the internal consistency and test-retest reliability were good. This instrument can be useful in the management of emergency departments.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2018
Keywords
Emergency room nursing, Instrument development, Occupational stress, Questionnaire, Validation
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-40256 (URN)10.1016/j.ienj.2018.01.005 (DOI)000436593800012 ()29409734 (PubMedID)2-s2.0-85041302081 (Scopus ID)
Available from: 2018-07-19 Created: 2018-07-19 Last updated: 2019-11-12
Norfjord Van Zyl, M., Akhavan, S., Tillgren, P. & Asp, M. (2018). Experiences and perceptions about undergoing mammographic screening: a qualitative study involving women from a county in Sweden. International Journal of Qualitative Studies on Health and Well-being, 13(1), Article ID 1521256.
Open this publication in new window or tab >>Experiences and perceptions about undergoing mammographic screening: a qualitative study involving women from a county in Sweden
2018 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 13, no 1, article id 1521256Article in journal (Refereed) Published
Abstract [en]

Purpose:An organized population-based mammographic screening programme aims for an early detection of potential breast abnormalities so that treatment can commence. Continuous participation and a high attendance rate are vital for an effective programme. It is important to understand the underlying reasons for participation in mammographic screening, should there be factors that are amendable within reason and could be adjusted. Therefore, the invited women are valuable sources of information. This study aimed at describing the experiences and perceptions about mammographic screening of women from three municipalities in a Swedish county.Method:Six semi-structured focus-group discussions, each with four to five participants, were held. Content analysis was then conducted.Results:The screening procedure, such as staff professionalism, was covered. Other people's opinions and the woman's own understanding affected the women's decisions on whether or not to undergo the procedure. Structural conditions, such as travel time and financial issues, were sources of concern. However, the offer to perform mammographic screening was perceived with gratitude.Conclusions:Structural conditions, risk and time perceptions, the screening procedure, attitudes towards undergoing it and appreciation of its benefit may influence the women's continuous willingness to be screened, which in turn may affect public and individual health.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2018
Keywords
Experiences, focus groups, mammographic screening, participation, perceptions, public health, qualitative study
National Category
Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-41008 (URN)10.1080/17482631.2018.1521256 (DOI)000444566400001 ()30215571 (PubMedID)2-s2.0-85053259288 (Scopus ID)
Available from: 2018-09-27 Created: 2018-09-27 Last updated: 2019-11-15
Yuwanich, N., Sandmark, H. & Akhavan, S. (2016). Emergency department nurses' experiences of occupational stress: A qualitative study from a public hospital in Bangkok, Thailand. Work: A journal of Prevention, Assesment and rehabilitation, 53(4), 885-897
Open this publication in new window or tab >>Emergency department nurses' experiences of occupational stress: A qualitative study from a public hospital in Bangkok, Thailand
2016 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 53, no 4, p. 885-897Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Occupational stress has been a health-related issue among nurses for many decades. Emergency department nurses are frequently confronted with occupational stress in their workplace; in particular, they encounter stressful situations and unpredictable events. These encounters could make them feel more stressed than nurses in other departments. Research considering occupational stress from the perspective of Thai emergency department nurses is limited. OBJECTIVE: This study aimed to explore nurses' perceptions of occupational stress in an emergency department. METHODS: A qualitative approach was used to gain an understanding of nurses' experiences and perceptions regarding stress in their workplace. Semi-structured interviews were used for data collection. Twenty-one emergency department nurses working in a public hospital in Thailand were interviewed, and the data were analyzed using content analysis. RESULTS: The findings comprised three themes: (1) perceived stress, (2) consequences of stress, and (3) stress management. CONCLUSIONS: The results of this study can be used by hospital management to help them adopt effective strategies, such as support programs involving co-workers/supervisors, to decrease occupational stress among emergency department nurses. Future research that explores each of the themes found in this study could offer a more comprehensive understanding of nurses' occupational stress in the emergency department.

Keywords
nursing profession, Stressor, workplace, content analysis, coworker, doctor patient relation, emergency ward, hospital management, human, human experiment, job stress, nurse, occupation, perception, public hospital, qualitative research, semi structured interview, stress management, Thailand
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-31585 (URN)10.3233/WOR-152181 (DOI)000376475300019 ()26519019 (PubMedID)2-s2.0-84965002444 (Scopus ID)
Available from: 2016-05-13 Created: 2016-05-13 Last updated: 2019-06-18Bibliographically approved
Akhavan, S., Tillgren, P., Aytar, O., Bogg, L. & Söderlund, A. (2016). Practice and Policy in Promoting Health and Equity –experiences from a national project in primary health care in Sweden. In: : . Paper presented at 22nd IUHPE World Conference on Health Promotion, CURITIBA, BRAZIL.
Open this publication in new window or tab >>Practice and Policy in Promoting Health and Equity –experiences from a national project in primary health care in Sweden
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2016 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Introduction: The Swedish Health Care Law requires the health system to provide good care on equal terms to all. However, several reports from different governmental agencies have revealed that health care is uneven in quality, lacking in accessibility, and not offered on equal terms to all people. Recent public health reports show that inequalities in health in the population have increased. To provide health care on equal terms has become a challenge for health care.

In order to apply methods for developing practice and policy in promoting health and equity the Swedish Association of Local Authorities and Regions developed and implemented a national project entitled Care on Equal Terms. The project began in 2011 and was completed in 2014 at seven Primary Health Care Units (PHCUs) in five regions. The aim of this study was to evaluate the outcomes of this project.

Methods: Based on a program theoretical approach an evaluation design was developed which included process, results and economical evaluation. In the data collection and analysis mixed methods were applied.

Results: According to the process evaluation, seven different strategies were applied in the process to develop primary health care on equal terms. One of the key observations was that in order to achieve health on more equal terms, health care needs to be provided on unequal terms, i. e. more needs to be done to reach those who need more assistance to access health services. Health promotion was one of the applied strategies and it was the most common strategy at some of the health care centers with the aim of developing patients' knowledge, awareness and understanding about health, care and self-care. The results evaluation showed that the PHCUs staff identified structural and organizational factors in health care as important factors for developing health promotion and equity in access. The health economic evaluation showed that the costs for implementing the activities for an improved equity were limited. Yet the majority of the PHCUs thought that the detailed regulation of their financing and reporting requirements were a limitation in their work for improved equity. Four of five county councils have recently introduced a primary care provider payment system (ACG) which may not be supportive of efforts to improve equity in access.

Conclusions: It is possible to develop and maintain practices that can contribute to more equitable care and increase health care personnel’s awareness about practice and policy in promoting health and equity.

National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-30887 (URN)
Conference
22nd IUHPE World Conference on Health Promotion, CURITIBA, BRAZIL
Available from: 2016-01-29 Created: 2016-01-29 Last updated: 2016-12-22Bibliographically approved
Akhavan, S. & Tillgren, P. (2015). Client/patient perceptions of achieving equity in primary health care: a mixed methods study. International Journal for Equity in Health, 14(1), 1-12, Article ID 196.
Open this publication in new window or tab >>Client/patient perceptions of achieving equity in primary health care: a mixed methods study
2015 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 14, no 1, p. 1-12, article id 196Article in journal (Refereed) Published
Abstract [en]

Abstract Introduction: To provide health care on equal terms has become a challenge for the health system. As the front line in health services, primary care has a key role to play in developing equitable health care, responsive to the needs of different population groups. Reducing inequalities in care has been a central and recurring theme in Swedish health reforms. The aim of this study is to describe and assess client/patient experiences and perceptions of care in four primary health care units (PHCUs) involved in Sweden's national Care on Equal Terms project. Methods: Mixed Method Research (MMR) was chosen to describe and assess client/patient experiences and perceptions of health care with regard to equity. There was a focus group discussion, and individual interviews with 21 clients/patients and three representatives of patient associations. Data from the Swedish National Patient Survey (NPS), conducted in 2011 and followed up in 2013, were also used. Results: The interview data were divided into two main categories and three subcategories. The first category "Perception of equitable health care" had two subcategories, namely "Health care providers' perceptions" and "Fairness and participation". The second category "To achieve more equitable health care" had four subcategories: "Encounter", "Access", "Interpreters and bilingual/diverse health care providers" and "Time pressure and continuity". Results from the NPS showed that two of the PHCUs improved in some aspects of patient perceived quality of care (PPQC) while two were not so successful. Conclusions: Clients/patients perceived health care providers' perceptions of their ethnic origin and mental health status as important for equitable health care. Discriminatory perceptions may lead to those in need of care refraining from seeking it. More equitable care means longer consultations, better accessibility in terms of longer opening hours, and ways of communicating other than just via voice mail. It also involves continuity in care and access to an interpreter if needed. Employing bilingual/diverse kinds of health providers is a way of providing more equitable primary health care.

Keywords
adolescent, adult, Article, attitude assessment, equitable health care, female, health care, health care access, health care quality, health personnel attitude, health survey, human, language ability, major clinical study, male, patient attitude, patient information, patient participation, primary health care, priority journal, Sweden
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-28712 (URN)10.1186/s12939-015-0196-5 (DOI)000359827900001 ()26265148 (PubMedID)2-s2.0-84938925502 (Scopus ID)
Available from: 2015-08-21 Created: 2015-08-21 Last updated: 2019-06-18Bibliographically approved
Akhavan, S. (2015). Patienters uppfattning om Vård på lika villkor. Socialmedicinsk Tidskrift, 92(2), 189-199
Open this publication in new window or tab >>Patienters uppfattning om Vård på lika villkor
2015 (Swedish)In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 92, no 2, p. 189-199Article in journal (Refereed) Published
Abstract [sv]

Att ta reda på patienternas uppfattningar om vård och de välfärdstjänster som samhället erbjuder är viktig för att kunna kvalitetsutveckla vården. Syftet med denna studie var att undersöka patienternas perspektiv om jämlikhet i vård samt deras idéer om metoder för att utveckla en mer jämlik vård. För att nå syftet används kvalitativ metod i form av intervjuer med patienter och representanter för patientföreningar. Resultatet visar att patienter anser att läkarkontinuitet, tid vid besök, tillgänglighet, kommunikation och bemötande kan utvecklas och blir bättre för att en mer jämlik vård ska uppnås. 

Abstract [en]

To find out the patients’ perceptions of the care and welfare services is important in order to develop the quality of care. The purpose of this study was to investigate the patients’ perspectives on care on equal terms and on their ideas about methods for a more equitable care. To achieve the purpose, qualitative methods were used in form of conducting interviews with patients’ and representatives of patient organizations. The results show that patients’ perceive that in order to achieve a more equitable care continuity, time during consultations, availability, communication and encounter should evolve and become better.

National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-30884 (URN)
Available from: 2016-01-29 Created: 2016-01-29 Last updated: 2017-11-30Bibliographically approved
Akhavan, S. (2015). Promoting Equity in Primary Health Care. Primary Health Care, 5(216)
Open this publication in new window or tab >>Promoting Equity in Primary Health Care
2015 (English)In: Primary Health Care, ISSN 2167-1079, Vol. 5, no 216Article in journal, Editorial material (Refereed) Published
Abstract [en]

Equity in access to primary health care services is a central objective of the Swedish health care system. Yet, several reports have illustrated that disparities still exist in the primary health sector, and have increased since the beginning of the 1990s. This commentary analyzes and explains the reasons for continuing inequality in access to and utilization of primary health care services in a welfare system. Social and structural factors, communication, macro-sociological aspects and health care providers’ attitudes and perceptions are discussed as substantial contributors to inequality in access to and utilization of primary health care services. In conclusion, some intervention strategies for promoting more equitable primary health care are suggested.

National Category
Other Medical Sciences Health Sciences
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-30869 (URN)10.4172/2167-1079.1000216 (DOI)
Available from: 2016-01-28 Created: 2016-01-28 Last updated: 2016-02-08Bibliographically approved
Akhavan, S., Aytar, O., Bogg, L., Söderlund, A. & Tillgren, P. (2015). Temaledare: Vård på lika villkor – Vad kan vi lära av Lärandeprojektet?. Socialmedicinsk Tidskrift, 92(2), 103-106
Open this publication in new window or tab >>Temaledare: Vård på lika villkor – Vad kan vi lära av Lärandeprojektet?
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2015 (Swedish)In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 92, no 2, p. 103-106Article in journal (Other academic) Published
Place, publisher, year, edition, pages
Stockholm: , 2015
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy Social Work Physiotherapy
Research subject
Care Sciences; Social Work
Identifiers
urn:nbn:se:mdh:diva-29360 (URN)
Projects
Lärandeprojektet - Vård på lika villkor
Available from: 2015-10-16 Created: 2015-10-16 Last updated: 2017-12-01Bibliographically approved
Akhavan, S. (2015). Vad sker med personalens inställning till Vård på lika villkor när verksamheterna deltar i Lärandeprojektet?. Socialmedicinsk Tidskrift, 92(2), 176-188
Open this publication in new window or tab >>Vad sker med personalens inställning till Vård på lika villkor när verksamheterna deltar i Lärandeprojektet?
2015 (Swedish)In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 92, no 2, p. 176-188Article in journal (Refereed) Published
Abstract [en]

Equity in health and providing care on equal terms is one of the most important aspects of a welfare society. Several reports indicate that the health care services are not equal. The purpose of this study was to study health care providers’ perceptions on equitable care and their ideas about methods to achieve a more equitable care. An web survey was sent to health care providers whose unit were involved in the project "Care on equal terms" before and after the project period. The results show that health care providers perceived that the factors that influence clients’/ patients’ access to care on equal terms consists of: structural / organizational factors in the health care organization or in the society and clients’/ patients’ social situation.

Abstract [sv]

Jämlikhet i hälsa och att erbjuda vård på lika villkor är en av de viktigaste aspekterna för ett välfärdssamhälle. Flera rapporter visar att hälso- och sjukvården inte är jämlik. Syftet med denna studie var att studera vårdpersonalens synpunkter på jämlik vård samt om deras tankar om metoder för att uppnå en mer jämlik vård. En webbenkät skickades till all personal före och efter projekttiden i de verksamheter som deltog i Lärande projektet. Resultatet visar att vårdpersonalen anser att de faktorer som påverkar brukares/patienters tillgång till vård på lika villkor består av: Strukturella/organisatoriska faktorer inom vården (t.ex. brist på läkare), eller i samhället (t.ex. bostadsområde) och patienternas/brukarnas sociala situation (t.ex. utbildning).

Place, publisher, year, edition, pages
Stockholm: , 2015
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-30882 (URN)
Available from: 2016-01-29 Created: 2016-01-29 Last updated: 2017-11-30Bibliographically approved
Akhavan, S., Aytar, O., Bogg, L., Söderlund, A. & Tillgren, P. (2014). Blev det ett genombrott?: Utvärdering av det nationella lärandeprojektet – Vård på lika villkor. Eskilstuna/ Västerås: Akademin för hälsa, vård och välfärd, Mälardalens högskola
Open this publication in new window or tab >>Blev det ett genombrott?: Utvärdering av det nationella lärandeprojektet – Vård på lika villkor
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2014 (Swedish)Report (Other academic)
Abstract [sv]

Sjukvården i Sverige är i dag inte jämlik, har brister i tillgänglighet och erbjuds inte på likvärdiga villkor trots Hälso- och sjukvårdslagens mål om en god hälsa och en vård på lika villkor för hela befolkningen.

För att bryta den pågående trenden och öka jämlikheten gjordes en överenskommelse mellan regeringen och SKL om lärandeprojektet Vård på lika villkor (under åren 2011–2014). Syftet med projektets har varit att inom socioekonomiskt resurssvaga bostadsområden öka jämlikheten i första linjens vård. Detta genom att testa, utveckla och identifiera effektiva arbetssätt och metoder vid sju primärvårdsverksamheter från fem landsting i Sverige.

Mälardalens högskola, Akademin för hälsa, vård och välfärd, fick av SKL i uppdrag att svara för forskarstöd och att genomföra en utvärdering av de metoder och arbetssätt som utvecklades och testades i lärandeprojektet.

Resultatet från den genomförda utvärderingen som belyser den genomförda processen, mål- och resultat samt hälsoekonomiska aspekter beskrivs närmare i denna rapport.

Place, publisher, year, edition, pages
Eskilstuna/ Västerås: Akademin för hälsa, vård och välfärd, Mälardalens högskola, 2014. p. 144
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Care Sciences within Health and Welfare
Identifiers
urn:nbn:se:mdh:diva-25409 (URN)978-91-7485-152-6 (ISBN)
Projects
Lärandeprojektet - Vård på lika villkor
Funder
Swedish Association of Local Authorities and Regions
Available from: 2014-06-26 Created: 2014-06-26 Last updated: 2014-07-03Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-9059-599X

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