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  • 1.
    Johansson-Pajala, Rose-Marie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Conditions for the Successful Implementation of Computer-Aided Drug Monitoring from Registered Nurses' Perspective: A Case Site Analysis2019In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 37, no 4, p. 196-202Article in journal (Refereed)
    Abstract [en]

    This research addressed the introduction of a computerized decision support system for drug monitoring to be used by registered nurses in nursing homes. The system was introduced, and its effects were evaluated over the period of 1 year; however, at the end of 1 year, the implementation was not successful in all the participating settings. The aim of this study was to identify the conditions needed for the successful implementation of a computerized decision support system from the registered nurses' perspective. Two case sites were purposively selected based on the implementation's success in one nursing home, but not in the other. Focus group discussions were performed, one in each setting, with eight registered nurses. An inductive thematic analysis was conducted. The findings revealed six themes illustrating the registered nurses' views about the conditions needed: need to see benefits, have the time and take the time, curb administrative hassle, collaboration at all levels, stated responsibility, and requirements set from managerial positions. The most outstanding findings, when compared with the previous implementations of nursing informatics, involved collaboration and the view of drug monitoring responsibility in relation to themselves and the physicians.

  • 2.
    Johansson-Pajala, Rose-Marie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Pharmacovigilance in municipal elderly care: From a nursing perspective2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Medication management constitutes a large part of registered nurses' (RNs) daily work in municipal elderly care. They are responsible for monitoring multimorbid older persons with extensive treatments, and they often work alone, without daily access to physicians. RNs’ drug monitoring is, in this thesis, based on the concept of pharmacovigilance. Pharmacovigilance is about the science and the activities that aim to improve patient care and safety in drug use, that is, to detect, assess, understand and prevent drug-related problems.

    The overall aim was to explore conditions for pharmacovigilance from a nursing perspective, focusing on implications of RNs’ competence and use of a computerized decision support system (CDSS). Both quantitative and qualitative research methods were used, including a questionnaire (I), focus group discussions (II), individual interviews (III) and an intervention study (IV). In total 216 RNs and 54 older persons participated from 13 special accommodations, located in three different regions.

    RNs who had completed further training in pharmacovigilance rated their medication competence higher than those who had not. However, there was no difference between groups in the number of pharmacovigilant activities they performed in clinical practice (I). The RNs appeared to act as “vigilant intermediaries” in drug treatment. They depended on the nursing staff's observations of drug-related problems. The RNs continuously controlled the work of staff and physicians, and attempted to compensate for shortcomings in competence, accessibility and continuity (II). RNs’ use of a CDSS was found to affect drug monitoring, including aspects of time, responsibility, standardization of the work, as well as access to knowledge and opportunities for evidence-based care (III). The CDSS detected significantly more drug-related problems when conducting medication reviews, than the RNs did. Nevertheless, this did not result in any significant improvement in the quality of drug use in the follow up, three and six months later (IV).

    This thesis contributes to the recognition of pharmacovigilance from a nursing perspective. Increased medication competence seems to be insufficient to generate pharmacovigilant activities. RNs depend on other health care professionals and organizational conditions in order to perform their work. A CDSS has the potential to support RNs, both in structured medication reviews and in daily clinical practice. Inter-professional collaboration is crucial, with or without a CDSS, and the entire team needs to be aware of and take responsibility. Other important conditions is the existence of well-functioning communication channels, competence across the team, and established procedures based on current guidelines.

  • 3.
    Johansson-Pajala, Rose-Marie
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Gustafsson, Lena-Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Jorsäter Blomgren, Kerstin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Fastbom, Johan
    Stockholm University, Stockholm.
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Nurses' use of computerised decision support systems affects drug monitoring in nursing homes2017In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 25, no 1, p. 56-64Article in journal (Refereed)
    Abstract [en]

    Aim: To describe variations in nurses' perceptions of using a computerised decision support system (CDSS) in drug monitoring. Background: There is an increasing focus on incorporating informatics into registered nurses' (RNs) clinical practice. Insight into RNs’ perceptions of using a CDSS in drug monitoring can provide a basis for further development of safer practices in drug management. Method: A qualitative interview study of 16 RNs. Data were analysed using a phenomenographic approach. Results: The RNs perceived a variety of aspects of using a CDSS indrug monitoring. Aspects of ‘time’ were evident, as was giving a ‘standardisation’ to the clinical work. There were perceptions of effects of obtained knowledge and ‘evidence’ and the division of ‘responsibilities’ between RNs and physicians of using the CDSS. Conclusion: The RNs perceived a CDSS as supportive in drug monitoring, in terms of promoting standardised routines, team-collaboration and providing possibilities for evidence-based clinical practice. Implications: Implementing a CDSS seems to be one feasible strategy to improve RNs’ preconditions for safe drug management. Nurse managers’ engagement and support in this process are vital for a successful result.

  • 4.
    Johansson-Pajala, Rose-Marie
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Jorsäter Blomgren, Kerstin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bastholm-Rahmner, P.
    Karolinska Institutet, Stockholm.
    Fastbom, J.
    Karolinska Institutet, Stockholm.
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. City University London, United Kingdom.
    Nurses in municipal care of the elderly act as pharmacovigilant intermediaries: A qualitative study of medication management2016In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 34, no 1, p. 37-45Article in journal (Refereed)
    Abstract [en]

    Objective: To explore registered nurses experience of medication management in municipal care of the elderly in Sweden, with a focus on their pharmacovigilant activities. Design: A qualitative approach using focus-group discussions was chosen in order to provide in-depth information. Data were analysed by qualitative content analysis. Setting: Five focus groups in five different long-term care settings in two regions in Sweden. Subject: A total of 21 registered nurses (RNs), four men and 17 women, aged 27-65 years, with 4-34 years of nursing experience. Results: The findings reveal that RNs in municipal long-term care settings can be regarded as "vigilant intermediaries" in the patients drug treatments. They continuously control the work of staff and physicians and mediate between them, and also compensate for existing shortcomings, both organizational and in the work of health care professionals. RNs depend on other health care professionals to be able to monitor drug treatments and ensure medication safety. They assume expanded responsibilities, sometimes exceeding their formal competence, and try to cover for deficiencies in competence, experience, accessibility, and responsibility-taking. Conclusion: The RNs play a central but also complex role as "vigilant intermediaries" in the medication monitoring process, including the issue of responsibility. Improving RNs possibility to monitor their patients drug treatments would enable them to prevent adverse drug events in their daily practice. New strategies are justified to facilitate RNs pharmacovigilant activities. Key points This study contributes to the understanding of registered nurses (RNs) role in medication management in municipal care of the elderly (i.e. detecting, assessing, and preventing adverse drug events or any drug-related problems).RNs can be considered to be "vigilant intermediaries" in elderly patients drug treatments, working at a distance from staff, physicians, and patients. RNs occasionally take on responsibilities that exceed their formal competence, with the patients best interests in mind. In order to prevent adverse drug events in municipal care of the elderly, new strategies are justified to facilitate RNs pharmacovigilant activities. 

  • 5.
    Johansson-Pajala, Rose-Marie
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Jorsäter Blomgren, Kerstin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Registered nurses’ use of computerised decision support in medication reviews: Implications in Swedish nursing homes2018In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 31, no 6, p. 531-544Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to explore the implications of registered nurses’ (RNs) use of a computerized decision support system (CDSS) in medication reviews. Design/methodology/approach: The paper employs a quasi-experimental, one-group pre-test/post-test design with three- and six-month follow-ups subsequent to the introduction of a CDSS. In total, 11 RNs initiated and prepared a total of 54 medication reviews. The outcome measures were the number of drug-related problems (DRPs) as reported by the CDSS and the RNs, respectively, the RNs’ views on the CDSS, and changes in the quality of drug treatment. Findings: The CDSS significantly indicated more DRPs than the RNs did, such as potential adverse drug reactions (ADRs). The RNs detected additional problems, outside the scope of the CDSS, such as lack of adherence. They considered the CDSS beneficial and wanted to continue using it. Only minor changes were found in the quality of drug treatments, with no significant changes in the drug-specific quality indicators (e.g. inappropriate drugs). However, the use of renally excreted drugs in reduced renal function decreased. Practical implications: The RNs’ use of a CDSS in medication reviews is of value in detecting potential ADRs and interactions. Yet, in order to have an impact on outcomes in the quality of drug treatment, further measures are needed. These may involve development of inter-professional collaboration, such as established procedures for the implementation of medication reviews, including the use of CDSS. Originality/value: This is, to the best of the authors’ knowledge, the first study to explore the implications of medication reviews, initiated and prepared by RNs who use a CDSS. The paper adds further insight into the RNs’ role in relation to quality of drug treatments.

  • 6.
    Johansson-Pajala, Rose-Marie
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Jorsäter-Blomgren, Kerstin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Implications of computer-supported medication reviews in Swedish nursing homes, led by nursesManuscript (preprint) (Other academic)
  • 7.
    Johansson-Pajala, Rose-Marie
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Thommes, K.
    Paderborn University, Paderborn, Germany.
    Hoppe, J. A.
    Paderborn University, Paderborn, Germany.
    Tuisku, O.
    Lappeenranta University of Technology, Lahti, Finland.
    Hennala, L.
    Lappeenranta University of Technology, Lahti, Finland.
    Pekkarinen, S.
    Lappeenranta University of Technology, Lahti, Finland.
    Melkas, H.
    Lappeenranta University of Technology, Lahti, Finland.
    Gustafsson, Christine
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Improved Knowledge Changes the Mindset: Older Adults’ Perceptions of Care Robots2019In: Lecture Notes in Computer Science, vol. 11592, Springer Verlag , 2019, p. 212-227Conference paper (Refereed)
    Abstract [en]

    This paper explores Finnish, German and Swedish older adults’ perceptions of a future welfare service with increased use of welfare technologies, specifically care robots. The issues are the rapid digitalization and development of health and welfare technology, which presently is mainly technology driven (not need or user driven), and the demographic challenge. The aim of the study was to explore older adults’ perception of the future use of welfare technology or care robots. A qualitative approach with focus group discussions was employed, followed by thematic analysis. The results are presented in four overall themes: the impact on daily life for older adults and professional caregivers, codes of practice and terms of use, dissemination of information and knowledge, and conditions for successful implementation. There were significant differences in the informants’ attitudes toward and knowledge about care robots. However, the informants’ attitudes appeared to change during the focus groups and in general, became more positive. Authentic needs, which care robots could support, refer to independence, safety and security, and the ability to manage or ease daily life or working life. The results suggest that older adults, after receiving relevant information, were open to the idea of being supported by care robots in their daily lives. 

  • 8.
    Martin, Lene
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Johansson-Pajala, Rose-Marie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Jorsäter Blomgren, Kerstin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Fastbom, Johan
    Karolinska Institutet, Sweden.
    Nurses' self-reported medication competence in relation to their pharmacovigilant activities in clinical practice2015In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, no 1, p. 145-152Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives

    Adverse drug reactions (ADRs) represent a major health problem and previous studies show that nurses can have an active role in promoting medication safety. The aim of this study was to describe and evaluate nurses' self-reported competence and pharmacovigilant activities in clinical practice and also to explore the impact of age, education, workplace and nursing experience on these matters.

    Methods

    This cross-sectional study was based on a questionnaire covering areas related to nurses' medication competence, including knowledge, assessment and information retrieval, and pharmacovigilant activities within these areas, for example, the detection and assessment of ADRs. A 45-item questionnaire was 2013 sent out to 296 nurses in different settings and counties in Sweden. They were selected on the basis of having applied to a university course including pharmacovigilance during 2008–2011. One hundred twenty-four had participated in the courses (exposed) and 172 had applied to the courses but not participated (unexposed).

    Results

    Completed questionnaires were obtained from 75 exposed (60%) and 93 unexposed (54%) nurses. Overall nurses rated themselves high in medication competence but low in pharmacovigilant activities. Significant (P ≤ 0.001) differences between groups were observed regarding medication competence. The exposure of completed dedicated courses in pharmacovigilance was the strongest factor for self-reported medication competence when adjusted for age, other education, workplace and experience. No significant differences between the groups were found regarding the number of pharmacovigilant activities during the 6 months prior to answering the questionnaire.

    Conclusion

    Dedicated university courses improved nurses' self-reported competence in pharmacovigilance but did not increase the number of related activities. Education per se seems to be not sufficient to generate pharmacovigilant activities among nurses.

  • 9.
    Zander, Viktoria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Johansson-Pajala, Rose-Marie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Gustafsson, Christine
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Methods to evaluate perspectives of safety, independence, activity, and participation in older persons using welfare technology. A systematic review2019In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115Article in journal (Refereed)
    Abstract [en]

    Purpose: To conduct a systematic review of existing methods to evaluate the individual aspects of welfare technology from the perspectives of independence, safety, activity, and participation. Furthermore, the study aimed to describe outcomes that have been the focus of previous research to evaluate individual aspects of welfare technology in older persons living in ordinary housing. Materials and methods: A systematic literature review in PubMed, CINAHL Plus, PsycINFO, Scopus, and Web of Science. Studies selected were those that explored the use of assistive and welfare technology devices from older persons’ perspectives, and which considered the concepts of independence, safety, activity and participation, and quality of life. Results: A broad spectrum of instruments was applied in the studies. For independence, three questionnaires were used in the identified studies. For safety, one instrument was used in two versions. To study activity and participation as well as quality of life, several scales were used. Additionally, several studies included qualitative approaches for evaluation, such as interviews, or posed one or more questions regarding the effects of welfare technology. Conclusions: The integration of digital assistive and welfare technology should be based on the needs of older persons, and those needs must be assessed using reliable and relevant instruments. The heterogeneity of the target group, i.e., older persons, together with the fact that assessments must give consideration to identifying goals, obstacles, and risks as well as users’ preferences, implies a person-centred approach.

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