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Letterstål, Anna
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Publications (10 of 35) Show all publications
Nilsson, O., Hultgren, R. & Letterstål, A. (2023). Experiences of participating in an eHealth intervention for patients with abdominal aortic aneurysm: A qualitative study. Journal of Vascular Nursing
Open this publication in new window or tab >>Experiences of participating in an eHealth intervention for patients with abdominal aortic aneurysm: A qualitative study
2023 (English)In: Journal of Vascular Nursing, ISSN 1062-0303, E-ISSN 1532-6578Article in journal (Refereed) Published
Abstract [en]

Aims: To explore patients’ experiences of an eHealth tool and tailored psychosocial support throughout the care trajectory of AAA repair. Design: A qualitative interview study.

Methods: Individual in-depth interviews were performed with twelve patients participating in an intervention study in conjunction with AAA surgery. Data were collected from March to December 2019. The interviews were analysed using qualitative content analysis with an inductive approach.

Results: The patients’ familiarity with and attitude to eHealth influenced their use of the eHealth tool. The interpersonal relationship with health care staff affected patients’ ability to submit themselves. The preoperative information, including the eHealth tool, may result in an overwhelming amount of information, causing anxiety and leading patients to refrain from information, partly due to the timing of the information. Psychosocial support offered continuity and reassurance, and enabled the patients to elaborate on existential matters.

Conclusion: The design of eHealth services in AAA care would benefit from a consideration of patients’ attitude to eHealth and familiarity with modern technology. To increase patients’ accessibility to health care services, their preference for technology use and type of contact should be verified and respected. Psychosocial support should be offered with continuity to alleviate patients’ emotional burden. Adjustment to patients’ mental state and learning needs may forestall anxiety. Impact: This study highlights factors that affect the acceptability of eHealth services in AAA patients. These findings can guide future design and implementation of mobile health interventions in surgical care.

Place, publisher, year, edition, pages
Elsevier Inc., 2023
Keywords
Mobile health, Nursing, Qualitative research, Surgical nursing, Vascular disease
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-63670 (URN)10.1016/j.jvn.2023.05.007 (DOI)001138134600001 ()37684088 (PubMedID)2-s2.0-85162120484 (Scopus ID)
Available from: 2023-06-28 Created: 2023-06-28 Last updated: 2024-01-17Bibliographically approved
Källestedt, M.-L. -., Asp, M., Letterstål, A. & Widarsson, M. (2023). When caring becomes an art - how clinical gaze are perceived to be developed. International Journal of Qualitative Studies on Health and Well-being, 18(1), Article ID 2156659.
Open this publication in new window or tab >>When caring becomes an art - how clinical gaze are perceived to be developed
2023 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 18, no 1, article id 2156659Article in journal (Refereed) Published
Abstract [en]

PURPOSE: This qualitative study describes nurses' experiences and perceptions of how they develop the clinical gaze. METHODS: This qualitative study used an inductive approach and content analysis to assess the experiences of newly graduated nurses, nurse managers, and nursing teachers. Nineteen interviews were conducted. To achieve credibility, the study followed the guidelines of the Consolidated Criteria for Reporting Qualitative research (COREQ). RESULTS: Two themes emerged: nurses' personal abilities and the learning culture. Learning culture was considered the foundation of the development of the clinical gaze. The clinical gaze was found to be developed in relationships with patients and when learning together with colleagues, in which the opportunities for reflection are central. To develop the clinical gaze, structures for learning activities, such as reflection, communication exercises, and simulation, are needed so that they become a natural part of daily work. This can also be achieved through supervision and skills training both at university and in a care context. CONCLUSIONS: Prerequisites for the development of the clinical gaze include physical presence with the patient combined with learning activities such as conscious reflection with others in a safe learning culture.

Place, publisher, year, edition, pages
NLM (Medline), 2023
Keywords
Clinical gaze, clinical skills, education, health care, learning, patient safety, professional competence, reflection, exercise, human, qualitative research, university, Humans, Universities
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:mdh:diva-61355 (URN)10.1080/17482631.2022.2156659 (DOI)000895411300001 ()36482509 (PubMedID)2-s2.0-85143567479 (Scopus ID)
Available from: 2022-12-21 Created: 2022-12-21 Last updated: 2023-05-17Bibliographically approved
Letterstål, A., Kallestedt, M. L., Widarsson, M. & Asp, M. (2022). Nursing Faculties' Perceptions of Integrating Theory and Practice to Develop Professional Competence. Journal of Nursing Education, 61(5), 236-241
Open this publication in new window or tab >>Nursing Faculties' Perceptions of Integrating Theory and Practice to Develop Professional Competence
2022 (English)In: Journal of Nursing Education, ISSN 0148-4834, E-ISSN 1938-2421, Vol. 61, no 5, p. 236-241Article in journal (Refereed) Published
Abstract [en]

Background: Nursing faculties??? perceptions influence nursing education. This article describes how nursing faculty perceive nursing students??? development of professional competence by integrating theory and practice, and by examining how this context influences this integration. Method: With a phenomenographic approach, interviews were conducted with nine participants and analyzed into qualitatively different categories of description. Results: The integration of theoretical and practical knowledge is perceived as a challenge or as naturally intertwined in the entire education, focusing mainly on individual prerequisites for learning. Perceptions of a common mission create coherence for students. Evident learning structures are needed, and there is a perceived discrepancy between nurses??? competence and expectations in health care. Conclusion: If the theory and practice gap could be perceived as a driving force for continuous learning, it could become an incentive for closer collaboration by creating structures for competence development that include individuals, teams, and organizations. [J Nurs Educ. 2022;61(5):236-241.]

Keywords
NURSES, CARE, GAP, PHENOMENOGRAPHY, PHILOSOPHY, SIMULATION
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-58621 (URN)10.3928/01484834-20220303-05 (DOI)000799036500003 ()35522761 (PubMedID)2-s2.0-85146782858 (Scopus ID)
Available from: 2022-06-08 Created: 2022-06-08 Last updated: 2023-04-12Bibliographically approved
Nilsson, O., Stenman, M., Letterstål, A. & Hultgren, R. (2021). A randomized clinical trial of an eHealth intervention on anxiety in patients undergoing abdominal aortic aneurysm surgery. British Journal of Surgery, 108(8), 917-924
Open this publication in new window or tab >>A randomized clinical trial of an eHealth intervention on anxiety in patients undergoing abdominal aortic aneurysm surgery
2021 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 108, no 8, p. 917-924Article in journal (Refereed) Published
Abstract [en]

Background: The potential benefit of eHealth interventions in patients with abdominal aortic aneurysm (AAA) is uncertain. The primary aim of this study was to investigate the effect of an eHealth intervention on anxiety in patients with AAA undergoing surgery. Methods: A single-centre randomized clinical trial of patients with AAA scheduled for surgical repair was undertaken. The intervention group received an eHealth tool and psychosocial support besides standard care. The control group received standard care. The analysis of treatment effects was performed as intention-to-treat and per protocol analysis. The primary outcome measure was anxiety mean score (Hospital Anxiety and Depression Scale Anxiety (HADS)-A). Secondary outcomes measures were HADS Depression and short-form 12-item health survey mean scores. Results: Some 120 participants were randomized. No effect on anxiety mean scores was found in the intention-to-treat analysis (-1.21 versus -0.54, P=0.330). Among those randomized to the intervention, only 30 of 60 participants used the eHealth tool (application (app) users). The app users were younger and had a higher educational level. A decrease in anxiety mean scores was noted in those who used the app in the per protocol analysis (-2.00 versus -0.54, P=0.028). The intervention group stated a lower physical-component health-related quality of life (HRQoL) (-4.32 versus -1.16, P=0.042) but mental-component HRQoL and depressive symptoms were unchanged. Conclusions: Delivery of an eHealth intervention in this RCT did not result in an improvement in anxiety scores in patients awaiting AAA surgery. Uptake of the eHealth tool was low, although it resulted in lower anxiety scores in those participants who actually used it.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2021
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-56116 (URN)10.1093/bjs/znab151 (DOI)000697377700029 ()34021309 (PubMedID)2-s2.0-85116172803 (Scopus ID)
Available from: 2021-10-07 Created: 2021-10-07 Last updated: 2022-10-21Bibliographically approved
Widarsson, M., Asp, M., Letterstål, A. & Södersved Kallestedt, M.-L. (2020). Newly graduated swedish nurses’ inadequacy in developing professional competence. Journal of Continuing Education in Nursing: Continuing Competence for the Future, 51(2), 65-74
Open this publication in new window or tab >>Newly graduated swedish nurses’ inadequacy in developing professional competence
2020 (English)In: Journal of Continuing Education in Nursing: Continuing Competence for the Future, ISSN 0022-0124, E-ISSN 1938-2472, Vol. 51, no 2, p. 65-74Article in journal (Refereed) Published
Abstract [en]

Background: The learning process for student and recently graduated nurses during their transition to professional nursing is stressful and challenging. The aim of this study was to describe recent graduates’ experiences of developing professional competence in their basic nursing program and during their first year. Method: A qualitative descriptive design with an inductive approach based on interviews with 11 nurses, with a qualitative content analysis. Results: Recently graduated nurses experience shortages and struggle to develop their professional competence. They find that reflection is a fundamental tool in the process of professional competence development. The competence gap is not between theoretical and practical knowledge, but rather between the university and health care organizations. Conclusion: Focusing on the intertwining of theoretical and practical knowledge can bridge the gap between these two organizations and create a foundation for lifelong learning of professional competence. Creating opportunities for reflection is central to the learning process. 

Place, publisher, year, edition, pages
Slack Incorporated, 2020
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-47025 (URN)10.3928/00220124-20200115-05 (DOI)000509472600005 ()31978244 (PubMedID)2-s2.0-85078252301 (Scopus ID)
Available from: 2020-02-13 Created: 2020-02-13 Last updated: 2022-10-21Bibliographically approved
Södersved Kallestedt, M.-L., Asp, M., Letterstål, A. & Widarsson, M. (2020). Perceptions of managers regarding prerequisites for the development of professional competence of newly graduated nurses: A qualitative study. Journal of Clinical Nursing, 29(23-24), 4784-4794
Open this publication in new window or tab >>Perceptions of managers regarding prerequisites for the development of professional competence of newly graduated nurses: A qualitative study
2020 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 29, no 23-24, p. 4784-4794Article in journal (Refereed) Published
Abstract [en]

Aim and objectives To describe perceptions of managers regarding prerequisites for professional competence development of newly graduated nurses following a 1-year residency programme. Background In general, managers are unsatisfied with the professional competence of newly graduated nurses. Therefore, they have been involved in residency programmes to support the nurses' transition from being nursing students to professional nurses. However, perceptions of managers regarding the professional competence development of nurses have been sparingly studied. Design/Methods Qualitative, descriptive study with a data-driven inductive approach with content analysis to obtain an understanding of the perceptions of nine managers through interviews. EQUATOR checklist COREQ is used (see FileS1). Results Three themes emerged: (a) the nurses' relationships with their teams and patients, (b) expectations regarding the development of practical skills and leadership skills and (c) prerequisites for continuing learning by supportive structures and a mutual responsibility between the manager and the nurse. Reflection was perceived by the managers as a cornerstone in the learning and development of professional competence. Learning theory was important, but learning practical clinical skills was essential for the nurses to develop competence and be able to perform their work, including being a leader of the team. Some structures discouraged continued learning in the development of professional competence, indicating a gap between the healthcare settings and the basic nursing programme. Conclusions There is a gap between the university and the healthcare settings in maintaining a structure for continued learning, which requires cooperation. This gap and tension can be a driving force for the learning process of competence development. Relationships with team members and patients are considered fundamental for developing professional competence. Relevance to clinical practice To overcome the gap between the university and the healthcare settings, the managers can facilitate nurses' continued learning by creating structures for reflection.

Place, publisher, year, edition, pages
WILEY, 2020
Keywords
clinical skills, education, health care, leadership, learning, patient safety, professional competence
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-52849 (URN)10.1111/jocn.15522 (DOI)000580560300001 ()33010078 (PubMedID)2-s2.0-85092933797 (Scopus ID)
Available from: 2020-12-16 Created: 2020-12-16 Last updated: 2022-10-21Bibliographically approved
Wamala, S., Letterstål, A., Stier, J. & von Heideken Wågert, P. (2020). Så motverkas ofrivillig ensamhet. Dagens Arena
Open this publication in new window or tab >>Så motverkas ofrivillig ensamhet
2020 (Swedish)In: Dagens ArenaArticle in journal (Other (popular science, discussion, etc.)) Published
Abstract [sv]

Ofrivillig ensamhet och social isolering är ett allvarligt folkhälsoproblem och bör hanteras med forskningsbaserade åtgärder. Det menar experter från Mälardalens högskola och ger konkreta förslag på vad som bör göras. 

National Category
Other Medical Sciences
Identifiers
urn:nbn:se:mdh:diva-52595 (URN)
Available from: 2020-11-12 Created: 2020-11-12 Last updated: 2022-10-21Bibliographically approved
Nilsson, O., Hultgren, R. & Letterstål, A. (2019). eHealth tool for patients with abdominal aortic aneurysm: development and initial evaluation. Scandinavian Journal of Caring Sciences, 34(2), 348-356
Open this publication in new window or tab >>eHealth tool for patients with abdominal aortic aneurysm: development and initial evaluation
2019 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 34, no 2, p. 348-356Article in journal (Refereed) Published
Abstract [en]

Rationale Abdominal aortic aneurysm (AAA) is a prevalent condition among elderly men and may require surgical repair. Recent technical advances offer new opportunities to provide patients and next of kin with tailored and individualised information. eHealth tools have proven useful in other patient cohorts, but there are currently no validated educational eHealth tools for patients with AAA. Aim Our aim was to develop and evaluate an eHealth tool for patients with abdominal aortic aneurysm using a participatory design process. Method Patients, healthcare professionals and a technical team were involved in the development of the eHealth tool. The tool was assessed for content and usability through questionnaires, validated instruments and focus group interviews. Readability was assessed using Flesch Reading Ease Score (FRE) and Flesch-Kincaid Grade Level (FKGL). Interview data were analysed using thematic content analysis. Results Factual content and illustrations were accurate and in line with current information routine. Readability assessments produced a mean FRE score of 42.2 (+/- 3,7) and mean FKGL of 10 (+/- 1), implying that the eHealth tool may be difficult to comprehend for certain users. However, participants in the focus group interviews found the tool to be understandable, relevant and easy to use. Conclusion The developed eHealth tool is acceptable, understandable and usable for the potential end-users. Further evaluation of the usability of the tool and effect on outcome in clinical care is warranted. This is the first educational eHealth tool for patients with AAA and has potential to contribute to improved communication and quality of care for AAA patients.

Keywords
abdominal aortic aneurysm, eHealth, focus group interviews, participatory design, patient education
National Category
Clinical Medicine
Identifiers
urn:nbn:se:mdh:diva-60308 (URN)10.1111/scs.12736 (DOI)000476028800001 ()2-s2.0-85069908677 (Scopus ID)
Funder
Magnus Bergvall Foundation
Available from: 2022-10-21 Created: 2022-10-21Bibliographically approved
Nilsson, O., Hultgren, R. & Letterstål, A. (2017). Perceived learning needs of patients with abdominal aortic aneurysm. Journal of Vascular Nursing, 35(1), 4-11
Open this publication in new window or tab >>Perceived learning needs of patients with abdominal aortic aneurysm
2017 (English)In: Journal of Vascular Nursing, ISSN 1062-0303, E-ISSN 1532-6578, Vol. 35, no 1, p. 4-11Article in journal (Refereed) Published
Abstract [en]

Background: Patients undergoing surgical treatment of abdominal aortic aneurysm (AAA) should receive adequate information about the disease, treatment options, and self-care. Patients' learning needs should be acknowledged. The aim was to describe the perceived learning needs in patients with AAA. A secondary aim was to explore their experience of methods for patient education. Methods: Three focus group interviews were conducted with 14 patients treated with open or endovascular repair of AAA. The interviews embraced initial diagnosis, surgical treatment, and follow-up from a learning perspective and were analyzed using qualitative content analysis. Results: Three categories and 10 subcategories emerged. The health care staff failed to meet the participants' individual learning needs. Participants relied on other pathways to obtain knowledge, such as the internet or anecdotal information from friends and family. Learning needs pertained to risks and complications with surgery, self-care, and rupture risk. The participants were reluctant to ask questions due to a stressful environment. They requested accessible written information, along with a professional contact person for coordination and support during the care pathway. Conclusions: Patients with AAA describe unmet learning needs in regard to risks and complications with the disease and surgical treatment but also disease management and lifestyle factors. Education material should be consistent, individualized and easily accessible for patients and next of kin. Additional psychosocial support is warranted. Adjusting information to patients' needs may improve patient satisfaction.

Keywords
QUALITY-OF-LIFE, ENDOVASCULAR REPAIR, DECISION-MAKING, OUTCOMES, CARE, PARTICIPATION, INFORMATION, TRIAL
National Category
Surgery
Identifiers
urn:nbn:se:mdh:diva-60306 (URN)10.1016/j.jvn.2016.08.003 (DOI)000402534700003 ()2-s2.0-85000415081 (Scopus ID)
Available from: 2022-10-21 Created: 2022-10-21 Last updated: 2022-10-21Bibliographically approved
Burström, L., Letterstål, A., Engström, M.-L. W., Berglund, A. & Enlund, M. (2014). The patient safety culture as perceived by staff at two different emergency departments before and after introducing a flow-oriented working model with team triage and lean principles: A repeated cross-sectional study. BMC Health Services Research, 14, Article ID 296.
Open this publication in new window or tab >>The patient safety culture as perceived by staff at two different emergency departments before and after introducing a flow-oriented working model with team triage and lean principles: A repeated cross-sectional study
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2014 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 14, article id 296Article in journal (Refereed) Published
Abstract [en]

Background: Patient safety is of the utmost importance in health care. The patient safety culture in an institution has great impact on patient safety. To enhance patient safety and to design strategies to reduce medical injuries, there is a current focus on measuring the patient safety culture. The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety. Methods: A repeated cross-sectional design, using the Hospital Survey On Patient Safety Culture questionnaire before and after a quality improvement project in two emergency departments at a county hospital and a university hospital. The questionnaire was developed to obtain a better understanding of the patient safety culture of an entire hospital or of specific departments. The Swedish version has 51 questions and 15 dimensions. Results: At the county hospital, a difference between baseline and follow-up was observed in three dimensions. For two of these dimensions, Team-work within hospital and Communication openness, a higher score was measured at the follow-up. At the university hospital, a higher score was measured at follow-up for the two dimensions Team-work across hospital units and Team-work within hospital. Conclusion: The result showed changes in the self-estimated patient safety culture, mainly regarding team-work and communication openness. Most of the improvements at follow-up were seen by physicians, and mainly at the county hospital.

Keywords
Patient safety, Patient safety culture, Patient safety climate, Quality improvement, Team-work
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:mdh:diva-60298 (URN)10.1186/1472-6963-14-296 (DOI)000339219600001 ()25005231 (PubMedID)2-s2.0-84903864717 (Scopus ID)
Available from: 2022-10-21 Created: 2022-10-21 Last updated: 2022-11-17Bibliographically approved
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