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  • 1.
    Burström, Lena
    et al.
    Uppsala universitet, Anestesiologi och intensivvård, Sweden; Västmanlands County Hospital, Västerås, Sweden.
    Letterstål, Anna
    Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Solna, Sweden.
    Engström, Marie-Loise Walker
    Uppsala universitet, Sweden; Västmanlands County Hospital, Västerås, Sweden.
    Berglund, Anders
    Uppsala universitet, Anestesiologi och intensivvård, Sweden; Västmanlands County Hospital, Västerås, Sweden.
    Enlund, Mats
    Uppsala universitet, Anestesiologi och intensivvård, Sweden; Västmanlands County Hospital, Västerås, Sweden.
    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 study2014Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 14, artikel-id 296Artikel i tidskrift (Refereegranskat)
    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.

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  • 2.
    Ekelund, Ulf
    et al.
    Lund University, Sweden.
    Kurland, Lisa
    Karolinska Institutet, Sweden.
    Eklund, Fredrik
    Nhg Sweden, Stockholm, Sweden.
    Torkki, Paulus
    Aalto University, Finland.
    Letterstål, Anna
    Karolinska Institutet, Sweden.
    Lindmarker, Per
    Karolinska Institutet, Sweden.
    Castrén, Maaret
    Karolinska Institutet, Sweden.
    Benchmarking quality of care in six Swedish emergency departments: A basis for Answer, A National Swedish Emergency Registry2010Konferensbidrag (Övrigt vetenskapligt)
  • 3.
    Ekelund, Ulf
    et al.
    Emergency Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Kurland, Lisa
    Department of Clinical Sciences and Education and Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Eklund, Fredrik
    Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Torkki, Paulus
    HEMA-Institute, BIT Research Centre, Aalto University, Espoo, Finland.
    Letterstål, Anna
    Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Lindmarker, Per
    Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Castrén, Maaret
    Department of Clinical Sciences and Education and Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Patient throughput times and inflow patterns in Swedish emergency departments: A basis for ANSWER, A National SWedish Emergency Registry2011Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 19, artikel-id 37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Quality improvement initiatives in emergency medicine (EM) often suffer from a lack of benchmarking data on the quality of care. The objectives of this study were twofold: 1. To assess the feasibility of collecting benchmarking data from different Swedish emergency departments (EDs) and 2. To evaluate patient throughput times and inflow patterns.

    METHOD: We compared patient inflow patterns, total lengths of patient stay (LOS) and times to first physician at six Swedish university hospital EDs in 2009. Study data were retrieved from the hospitals' computerized information systems during single on-site visits to each participating hospital.

    RESULTS: All EDs provided throughput times and patient presentation data without significant problems. In all EDs, Monday was the busiest day and the fewest patients presented on Saturday. All EDs had a large increase in patient inflow before noon with a slow decline over the rest of the 24 h, and this peak and decline was especially pronounced in elderly patients. The average LOS was 4 h of which 2 h was spent waiting for the first physician. These throughput times showed a considerable diurnal variation in all EDs, with the longest times occurring 6-7 am and in the late afternoon.

    CONCLUSION: These results demonstrate the feasibility of collecting benchmarking data on quality of care targets within Swedish EM, and form the basis for ANSWER, A National SWedish Emergency Registry.

  • 4.
    Enander, Carin
    Stockholms läns landsting, Sweden.
    Letterstål, Anna
    Stockholms läns landsting, Sweden.
    Öhlén, Gunnar
    Stockholms läns landsting, Sweden.
    Fokusrapport: Triagearbete på akutmottagningen2007Rapport (Övrigt vetenskapligt)
  • 5.
    Källestedt, M. -LS.
    et al.
    Källestedt Clinical Skills Center, Region Västmanland, Västerås, Sweden.
    Asp, Margareta
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Letterstål, Anna
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Widarsson, Margareta
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    When caring becomes an art - how clinical gaze are perceived to be developed2023Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 18, nr 1, artikel-id 2156659Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Letterstål, Anna
    Karolinska universitetssjukhuset, Sweden.
    Akutklinikens förbättringsarbete samt SVAR - Svenska akutvårdsregistret2013Konferensbidrag (Övrigt vetenskapligt)
  • 7.
    Letterstål, Anna
    Karolinska universitetssjukhuset, Sweden.
    Implementering av SBAR2012Konferensbidrag (Övrigt vetenskapligt)
  • 8.
    Letterstål, Anna
    Karolinska universitetssjukhuset, Sweden.
    Införande av evidensbaserade vitalparametrar2007Konferensbidrag (Övrigt vetenskapligt)
  • 9.
    Letterstål, Anna
    Karolinska universitetssjukhuset, Sweden.
    Initial bedömning av patientens vitalparametrar - Ett patientsäkerhets- och kvalitetskostnadsprojekt på akutvårdsavdelning2008Konferensbidrag (Övrigt vetenskapligt)
  • 10.
    Letterstål, Anna
    Karolinska universitetssjukhuset, Sweden.
    Nya kvalitetsregister2008Konferensbidrag (Övrigt vetenskapligt)
  • 11.
    Letterstål, Anna
    Karolinska universitetssjukhuset, Sweden.
    Patientens upplevelse av information och vård2010Konferensbidrag (Refereegranskat)
  • 12.
    Letterstål, Anna
    Karolinska universitetssjukhuset, Sweden.
    Presentation av delarbeten i avhandling ”Risk attitude and patients’ experience with treatment of abdominal aortic aneurysm and severe claudication"2010Konferensbidrag (Refereegranskat)
  • 13.
    Letterstål, Anna
    Karolinska universitetssjukhuset, Sweden.
    Presentation av kvalitetsregister för Akutsjukvård2010Konferensbidrag (Övrigt vetenskapligt)
  • 14.
    Letterstål, Anna
    Karolinska universitetssjukhuset, Sweden.
    Presentation av SBU rapport – Livskvalitet hos patienter med perifer kärlsjukdom2008Konferensbidrag (Övrigt vetenskapligt)
  • 15.
    Letterstål, Anna
    Karolinska universitetssjukhuset, Sweden.
    Castrén, Maaret
    Karolinska institutet, Sweden; Södersjukhuset, Sweden.
    Säfwenberg, Urban
    Akademiska sjukhuset Uppsala, Sweden.
    Kurland, Lisa
    Karolinska institutet, Sweden; Södersjukhuset, Sweden.
    SVAR – Ett unikt svenskt akutvårdsregister2010Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, nr 43, s. 2659-2660Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Det nya kvalitets­registret för akutsjukvård, SVAR, har potential att bli en unik informationskälla för svensk akutsjukvård.

  • 16.
    Letterstål, Anna
    Karolinska universitetssjukhuset, Sweden.
    SVAR - Svenska akutvårdsregistret2012Konferensbidrag (Övrigt vetenskapligt)
  • 17.
    Letterstål, Anna
    et al.
    Institutionen för Molekylär medicin och kirurgi, Karolinska institutet, Sweden.
    Eldh, A.
    Karolinska institutet, Sweden.
    Olofsson, P.
    Karolinska institutet, Sweden.
    Forsberg, C.
    Karolinska Institutet, Sweden.
    Patientens erfarenhet av att genomgå öppen kirurgisk behandling av bukaortaaneurysm2009Konferensbidrag (Övrigt vetenskapligt)
  • 18.
    Letterstål, Anna
    et al.
    Karolinska institutet, Sweden.
    Eldh, A.
    Karolinska institutet, Sweden.
    Olofsson, P.
    Karolinska institutet, Sweden.
    Forsberg, C.
    Karolinska institutet, Sweden.
    Patients’ experience of going through open surgery for abdominal aortic aneurysm2009Konferensbidrag (Refereegranskat)
  • 19.
    Letterstål, Anna
    et al.
    Department of Molecular medicine and surgery, Karolinska Institutet, Sweden.
    Eldh, A.
    Karolinska Institutet, Sweden.
    Olofsson, P.
    Karolinska Institutet, Sweden.
    Forsberg, C.
    Karolinska Institutet, Sweden.
    Patients’ experience of open surgery for an abdominal aortic aneurysm2009Konferensbidrag (Övrigt vetenskapligt)
  • 20.
    Letterstål, Anna
    et al.
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna.
    Eldh, Ann Catrine
    Department of Neurobiology, Care Sciences and Society, The Division of Nursing, Karolinska Institutet, Huddinge ; School of Health and Medical Sciences, Örebro University, Örebro.
    Olofsson, Per
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna.
    Forsberg, Christina
    Department of Neurobiology, Care Sciences and Society, The Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
    Patients' experience of open repair of abdominal aortic aneurysm - preoperative information, hospital care and recovery2010Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr 21-22, s. 3112-3122Artikel i tidskrift (Refereegranskat)
  • 21.
    Letterstål, Anna
    et al.
    Section of Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Forsberg, Christina
    Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Olofsson, Pär
    Section of Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Wahlberg, Eric
    Section of Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Risk attitudes to treatment among patients with severe intermittent claudication2008Ingår i: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 47, nr 5, s. 988-994Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives

    To determine claudication patients' risk attitude to invasive treatment and whether this treatment is cost effective.

    Methods

    Quality of life and health state utility status of 50 consecutive patients with severe intermittent claudication was assessed and compared with ankle-brachial pressure index values (ABPI) and results from treadmill tests before and after endovascular or open revascularization. Health utility scores were then calculated and used in a cost-utility analysis.

    Results

    Before surgery, patients were assigned a utility score of 0.51 (EQ-5D index) for their disease, and the standard gamble (SG) and time trade-off (TTO) median scores were 0.88 and 0.70, respectively. Before treatment, a weak correlation (r = 0.43, P < .001) between having a high risk perception of treatment and patients' walking distance were observed, where patients able to walk short distances accepted a higher risk. After treatment, ABI (P = .003) and walking distance (P = .002) improved significantly as well the physical components of the quality of life instruments (P < .001). The surgical treatment generated an improvement in quality of life expressed in QALYs equivalent to 0.17. With an estimated survival of 5 years, it adds up to a value of 0.85, corresponding to a sum of 51,000 US$ gained.

    Conclusions

    Patients with severe intermittent claudication are risk-seeking when it comes to surgical treatment and their risk attitude is correlated to their walking ability and quality of life. The incremental QALYs gained by treatment are achieved at a reasonable cost and revascularization appears to be cost effective.

  • 22. Letterstål, Anna
    et al.
    Kallestedt, M L S
    Reg Vastmanland, Västerås, Sweden.
    Widarsson, Margareta
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Asp, Margareta
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Nursing Faculties' Perceptions of Integrating Theory and Practice to Develop Professional Competence2022Ingår i: Journal of Nursing Education, ISSN 0148-4834, E-ISSN 1938-2421, Vol. 61, nr 5, s. 236-241Artikel i tidskrift (Refereegranskat)
    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.]

  • 23.
    Letterstål, Anna
    et al.
    Karolinska universitetssjukhuset, Sweden.
    Larsson, F.
    Karolinska universitetssjukhuset, Sweden.
    Assessment of vital signs on admission to short time emergency wards improves patient safety and cost-effectiveness2007Konferensbidrag (Refereegranskat)
  • 24.
    Letterstål, Anna
    et al.
    Karolinska universitetssjukhuset, Sweden.
    Larsson, F.
    Karolinska universitetssjukhuset, Sweden.
    Bedömning av patienter som skrivs in på akutvårdsavdelning2006Konferensbidrag (Refereegranskat)
  • 25.
    Letterstål, Anna
    et al.
    Akutkliniken, Akutdivisionen, Karolinska Universitetssjukhuset, Sweden.
    Larsson, F.
    Akutkliniken, Akutdivisionen, Karolinska Universitetssjukhuset, Sweden.
    Bedömning av patienter som skrivs in på akutvårdsavdelning: Ett patientsäkerhets och kvalitetskostnadsprojekt2006Konferensbidrag (Refereegranskat)
  • 26.
    Letterstål, Anna
    et al.
    Karolinska Institutet, Sweden.
    Olofsson, P.
    Karolinska Institutet, Sweden.
    Forsberg, C.
    Karolinska Institutet, Sweden.
    Postoperative mobilization of patients with abdominal aortic aneurysm2004Konferensbidrag (Övrigt vetenskapligt)
  • 27.
    Letterstål, Anna
    et al.
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
    Olofsson, Pär
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
    Forsberg, Christina
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
    Risk attitude and preferences in person's hypothetically facing open repair of abdominal aortic aneurysm2012Ingår i: Journal of Vascular Nursing, ISSN 1062-0303, E-ISSN 1532-6578, Vol. 30, nr 4, s. 112-117Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to describe risk attitude and preference for treatment using a proxy measurement of a general population sample hypothetically facing treatment for open repair (OR) of abdominal aortic aneurysm (AAA). In a telephone interview, a standard gamble (SG) and a time trade-off (TTO) question were asked to elicit risk attitude and preference for treatment in a general population sample of 200 persons, stratified in four age groups. When facing the two questions of (1) either live a shorter life without an AAA compared to a longer life with an AAA (TTO) or (2) taking a risk of living with AAA compared to taking the risk with surgical treatment (SG), the oldest age group was neither willing to live a shorter life without AAA, nor willing to take a risk with surgical treatment to the same extent as the younger age groups: age 50-59 (TTO P = 0.03, SG P = < 0.001), age 60-69 (TTO P = 0.01, SG P = < 0.001), age 70-79 (TTO P = 0.02, SG P = 0.002). These results suggest that persons in the age groups over 80 years old in the general population sample are more inclined to go on living with an AAA without taking the immediate risk associated with OR as well as the postoperatively impaired health-related quality of life (HRQL). Preference for treatment in different age groups is important to consider during the decision-making process, especially for patients over 80 years old. Patient education about treatment options, specific risks as well as postoperative impairment of HRQL is necessary in this process. 

  • 28.
    Letterstål, Anna
    et al.
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Sandström, Veronica
    Karolinska Institute, Sweden; Quality ServiceExecutive, Quintiles OY, Espoo, Finland.
    Olofsson, Pär
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Forsberg, Christina
    Röda Korsets Högskola, Sweden.
    Postoperative mobilization of patients with abdominal aortic aneurysm2004Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 48, nr 6, s. 560-568Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim.  This paper reports on a study which aimed to evaluate the effects of structured written preoperative information on patients’ postoperative psychological and physical wellbeing after surgery for abdominal aortic aneurysm (AAA).

    Background.  The possible benefits of current booklets written by professionals on postoperative psychological and physical wellbeing in patients with AAA are unknown. Previous studies have shown that preoperative information has a favourable effect on both mood state and physical mobilization.

    Method.  Fifty-two patients admitted for elective repair of AAA were selected consecutively and randomized to receive only verbal (control group), or verbal and written information in booklet form (experimental group). The booklet contained procedural and sensory information about the disease and its treatment. Two questionnaires were used to establish whether the booklet had any effect on perceived health, psychological and physical wellbeing postoperatively.

    Results.  The two groups were similar regarding their perceived health but differed significantly regarding psychological wellbeing pre- and postoperatively. Patients in the experimental group were significantly sadder both pre- and postoperatively compared with those in the control group. Both groups were similar in postoperative physical wellbeing.

    Conclusion.  This group of patients often has asymptomatic disease, with a short interval between diagnosis and major surgery. When patients receive an information booklet during this period, this seems to cause more worries than anticipated. Hence, a more supportive educational programme might benefit this patient group, both pre- and postoperatively.

  • 29.
    Nilsson, O.
    et al.
    Karolinska Univ Hosp, Sweden..
    Stenman, M.
    Karolinska Univ Hosp, Sweden..
    Letterstål, Anna
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Univ Hosp, Sweden..
    Hultgren, R.
    Karolinska Univ Hosp, Sweden..
    A randomized clinical trial of an eHealth intervention on anxiety in patients undergoing abdominal aortic aneurysm surgery2021Ingår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 108, nr 8, s. 917-924Artikel i tidskrift (Refereegranskat)
    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.

  • 30.
    Nilsson, Olga
    et al.
    Department of Vascular Surgery Karolinska University Hospital, Sweden; Department of Molecular Medicine and Surgery Karolinska Institutet, Sweden.
    Hultgren, Rebecka
    Department of Vascular Surgery Karolinska University Hospital, Sweden; Karolinska Institute, Sweden.
    Letterstål, Anna
    Department of Medicine Karolinska Institutet, Sweden.
    eHealth tool for patients with abdominal aortic aneurysm: development and initial evaluation2019Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 34, nr 2, s. 348-356Artikel i tidskrift (Refereegranskat)
    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.

  • 31.
    Nilsson, Olga
    et al.
    Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden.
    Hultgren, Rebecka
    Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden.
    Letterstål, Anna
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Experiences of participating in an eHealth intervention for patients with abdominal aortic aneurysm: A qualitative study2023Ingår i: Journal of Vascular Nursing, ISSN 1062-0303, E-ISSN 1532-6578Artikel i tidskrift (Refereegranskat)
    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.

  • 32.
    Nilsson, Olga
    et al.
    Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Sweden.
    Hultgren, Rebecka
    Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Sweden.
    Letterstål, Anna
    Programme Office, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Perceived learning needs of patients with abdominal aortic aneurysm2017Ingår i: Journal of Vascular Nursing, ISSN 1062-0303, E-ISSN 1532-6578, Vol. 35, nr 1, s. 4-11Artikel i tidskrift (Refereegranskat)
    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.

  • 33.
    Södersved Kallestedt, Marie-Louise
    et al.
    Mälardalens universitet, Akademin för hälsa, vård och välfärd. Uppsala Univ, Sweden.
    Asp, Margareta
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Letterstål, Anna
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Inst, Dept Med Solna, Stockholm, Sweden..
    Widarsson, Margareta
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Perceptions of managers regarding prerequisites for the development of professional competence of newly graduated nurses: A qualitative study2020Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 29, nr 23-24, s. 4784-4794Artikel i tidskrift (Refereegranskat)
    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.

  • 34.
    Wamala, Sarah
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Letterstål, Anna
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Stier, Jonas
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    von Heideken Wågert, Petra
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Så motverkas ofrivillig ensamhet2020Ingår i: Dagens ArenaArtikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
    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. 

  • 35.
    Widarsson, Margareta
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Asp, Margareta
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Letterstål, Anna
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Institutet, Stockholm, Sweden.
    Södersved Kallestedt, Marie-Louise
    Mälardalens universitet, Akademin för hälsa, vård och välfärd. Uppsala University, Region Västmanland, Västerås, Sweden.
    Newly graduated swedish nurses’ inadequacy in developing professional competence2020Ingår i: Journal of Continuing Education in Nursing: Continuing Competence for the Future, ISSN 0022-0124, E-ISSN 1938-2472, Vol. 51, nr 2, s. 65-74Artikel i tidskrift (Refereegranskat)
    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. 

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