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  • 1.
    Ahlstedt, C.
    et al.
    Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
    Eriksson Lindvall, C.
    Department of Business Studies Uppsala University, Uppsala, Sweden.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
    Muntlin Athlin, Å.
    Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
    What makes registered nurses remain in work?: An ethnographic study2019In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 89, p. 32-38Article in journal (Refereed)
    Abstract [en]

    Background: Registered nurses’ work-related stress, dissatisfaction and burnout are some of the problems in the healthcare and that negatively affect healthcare quality and patient care. A prerequisite for sustained high quality at work is that the registered nurses are motivated. High motivation has been proved to lead to better working results. The theory of inner work life describes the dynamic interplay between a person's perceptions, emotions and motivation and the three key factors for a good working life: nourishment, progress and catalysts. Objectives: The aim of the study was to explore registered nurses’ workday events in relation to inner work life theory, to better understand what influences registered nurses to remain in work. Design: A qualitative explorative study with an ethnographic approach. Methods: Participant observation over four months; in total 56 h with 479 events and 58 informal interviews during observation; all registered nurses employed at the unit (n = 10) were included. In addition, individual interviews were conducted after the observation period (n = 9). The dataset was analysed using thematic analysis and in the final step of the analysis the categories were reflected in relation to the three key factors in theory of inner work life. Results: Nourishment in a registered nurse context describes the work motivation created by the interpersonal support between colleagues. It was important to registered nurses that physicians and colleagues respected and trusted their knowledge in the daily work, and that they felt comfortable asking questions and supporting each other. Progress in the context of registered nurses’ work motivation was the feeling of moving forward with a mix of small wins and the perception of solving more complex challenges in daily work. It was also fundamental to the registered nurses’ development through new knowledge and learning during daily work. Catalysts, actions that directly facilitate the work, were highlighted as the possibility to work independently along with the opportunity to work together with other registered nurses. Conclusion: This study has a number of implications for future work and research on creating an attractive workplace for registered nurses. Working independently, with colleagues from the same profession, integrated with learning, visible progress, and receiving feedback from the work itself, contribute to work motivation. 

  • 2.
    Ahlstedt, Carina
    et al.
    Uppsala University, Dept of Public health & Caring Sciences, Sweden.
    Eriksson Lindvall, Carin
    Uppsala University, Dept of Business Studies, Sweden.
    Holmström, Inger
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala University, Dept of Public health & Caring Sciences, Sweden.
    Muntlin, Åsa
    Uppsala University, Dept of Public Health & Caring Sciences, and Dept of Medical Sciences, Sweden.
    Flourishing at work: Nurses' motivation through daily communication - an ethnographic approach2020In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 22, no 4, p. 1169-1176Article in journal (Refereed)
    Abstract [en]

    Shortage and turnover of registered nurses are worldwide challenges, and work motivation is one factor in retaining staff in the healthcare sector. The aim of this study was to explore registered nurses' motivation expressed in daily communication, using the basic needs in self‐determination theory as a framework. A secondary analysis of ethnographic data, collected through participant observations, informal interviews during observations, and individual interviews, was used. A total sample of all registered nurses employed at a hospital unit in Sweden (n = 10) participated. The data were analyzed thematically through the lens of the basic needs in self‐determination theory: autonomy, competence, and relatedness. Self‐regulation of learning, the possibilities to discuss work‐related challenges with colleagues, and having registered nurses lead dialogues with physicians were factors connected to autonomy. Having a registered nurse and physician solve problems together was a factor connected to competence. A sense of belonging and security in a permissive climate between registered nurses was connected to relatedness. This paper has implications for increased awareness of the three basic motivational needs, which could be used in the development of attractive workplaces.

  • 3.
    Arving, Cecilia
    et al.
    Uppsala University.
    Holmström, Inger
    Uppsala University.
    Creating a new profession in cancer nursing?: Experiences of working as a psychosocial nurse in cancer care2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 19-20, p. 2939-2947Article in journal (Refereed)
    Abstract [en]

    AIMS: To describe the nature of being a psychosocial nurse in cancer care.

    BACKGROUND: Psychosocial nurses in cancer care are a new profession in cancer nursing in Sweden, with potential to offer unique support to patients regarding somatic and psychological needs. This new profession is hitherto unexplored.

    DESIGN: A qualitative inductive interview approach was used.

    METHODS: A strategic sample of five nurses working as psychosocial nurses in cancer care in Sweden was interviewed. A thematic stepwise analysis was performed.

    RESULTS: The analysis revealed the twofold experience of being a psychosocial nurse in cancer care. The nurses felt as if they had two professions: nurse and therapist. They used skills from both professions to help the person, who had cancer and a psychosocial problem. It was stimulating to be able to combine the knowledge and practices of two professions. It was also difficult because they felt an uncertainty about what their roles and responsibilities really were.

    CONCLUSIONS: This new profession seems to need role descriptions and formal education so that psychosocial nurses receive respect and appreciation in their new and relatively unknown work in cancer care. RELEVANCE TO CLINICAL PRACTICES: The adjustment to the cancer disease and treatment side effects can be difficult for the patients and their families, which has highlighted the need for psychosocial support. To meet this need the health care system has to provide such support. Nurses are available and can be successfully educated to handle psychosocial problems among cancer patients. A new profession among nurses is emerging, which the present study aimed at describing. The present findings have potential to make healthcare professionals grasp what the core of psychosocial cancer nursing is, as well as its potential and pitfalls.

  • 4.
    Bastholm Rahmner, Pia
    et al.
    Karolinska Institutet, Stockholm, Sweden .
    Andersén-Karlsson, E
    South Stockholm General Hospital, Stockholm, Sweden.
    Arnhjort, T
    South Stockholm General Hospital, Stockholm, Sweden.
    Eliasson, M
    Stockholm County Council, Sweden.
    Gustafsson, L-L
    Stockholm County Council, Sweden.
    Jacobsson, L
    Ovesjö, M-L
    Stockholm County Council, Sweden.
    Rosenqvist, Urban
    University of Uppsala, Uppsala, Sweden.
    Sjöviker, S
    Karolinska Institutet, Stockholm, Sweden .
    Tomson, G
    Karolinska Institutet, Stockholm, Sweden.
    Holmström, Inger
    University of Uppsala, Uppsala, Sweden.
    Physicians perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system2004In: International journal of health care quality assurance incorporating leadership in helath services, ISSN 1366-0756, E-ISSN 2051-3135, Vol. 17, no 4, p. 173-179Article in journal (Refereed)
    Abstract [en]

    Seeks to identify physicians' perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system. Details a descriptive, qualitative study, with semi-structured individual interviews of 21 physicians in the Accident and Emergency Department of South Stockholm General Hospital. Identifies four descriptive categories for possibilities and obstacles. Concludes that gaining access to patient drug history enables physicians to carry out work in a professional way – a need the computerised prescription support system was not developed for and thus cannot fulfil. Alerts and producer-independent drug information are valuable in reducing workload. However, technical prerequisites form the base for a successful implementation. Time must be given to adapt to new ways of working.

  • 5.
    Bastholm Rahmner, Pia
    et al.
    Stockholm Cty Council.
    Gustafsson, Lars L.
    Stockholm Cty Council.
    Holmström, Inger
    Örebro universitet, Hälsoakademin.
    Rosenqvist, Urban
    Hlth Serv Res, Dept Publ Hlth & Caring Sci, Uppsala.
    Tomson, Göran
    Karolinska Inst.
    Whose job is it anyway?: Swedish general practitioners' perception of their responsibility for the patient's drug list2010In: Annals of Family Medicine, ISSN 1544-1709, E-ISSN 1544-1717, Vol. 8, no 1, p. 40-46Article in journal (Refereed)
    Abstract [en]

    PURPOSE Information about the patient's current drug list is a prerequisite for safe drug prescribing. The aim of this study was to explore general practitioners' (GPs) understandings of who is responsible for the patient's drug list so that drugs prescribed by different physicians do not interact negatively or even cause harm. The study also sought to clarify how this responsibility was managed. METHODS We conducted a descriptive qualitative study among 20 Swedish physicians. We recruited the informants purposively and captured their view on responsibility by semistructured interviews. Data were analyzed using a phenomenographic approach. RESULTS We found variation in understandings about who is responsible for the patient's drug list and, in particular, how the GPs use different strategies to manage this responsibility. Five categories emerged: (1) imposed responsibility, (2) responsible for own prescriptions, (3) responsible for all drugs, (4) different but shared responsibility, and (5) patient responsible for transferring drug information. The relation between categories is illustrated in an outcome space, which displays how the GPs reason in relation to managing drug lists. CONCLUSIONS The understanding of the GP's responsibility for the patient's drug list varied, which may be a threat to safe patient care. We propose that GPs are made aware of variations in understanding responsibility so that health care quality can be improved.

  • 6.
    Bastholm Rahmner, Pia
    et al.
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Gustafsson, Lars L.
    Karolinska University Hospital,.
    Larsson, Jan
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Rosenqvist, Urban
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Tomson, Göran
    Karolinska Institutet.
    Holmström, Inger
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Variations in understanding the drug-prescribing process: a qualitative study among Swedish GPs2009In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 26, no 2, p. 121-127Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A majority of doctor-patient meetings result in the patient getting a prescription. This underlines the need for a high-quality prescription process. While studies have been made on single therapeutic drug groups, a complete study of the physicians' general thought process that comprises the prescription of all drugs still remains to be made. OBJECTIVE: To identify variations in ways of understanding drug prescribing among GPs. METHODS: A descriptive qualitative study was conducted with 20 Swedish physicians. Informants were recruited purposively and their understandings about prescribing were studied in semi-structured interviews. Data were analysed using a phenomenographic approach. RESULTS: Five categories were identified as follows: (A) GP prescribed safe, reliable and well-documented drugs for obvious complaints; (B) GP sought to convince the patient of the most effective drug treatment; (C) GP chose the best drug treatment taking into consideration the patient's entire life situation; (D) GP used clinical judgement and close follow-up to minimize unnecessary drug prescribing and (E) GP prescribed drugs which are cheap for society and environmentally friendly. The categories are interrelated, but have different foci: the biomedical, the patient and the society. Each GP had more than one view but none included all five. The findings also indicate that complexity increases when a drug is prescribed for primary or secondary prevention. CONCLUSIONS: GPs understand prescribing differently despite similar external circumstances. The most significant factor to influence prescribing behaviour was the physician's patient relation approach. GPs may need to reflect on difficulties they face while prescribing to enhance their understandings.

  • 7.
    Bastholm Rahmner, Pia
    et al.
    Stockholm County Council.
    Tomson, Göran
    Karolinska Institutet.
    Rosenqvist, Urban
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Gustafsson, Lars L
    Karolinska Institutet.
    Holmström, Inger
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    "Limit work to here and now": A focus group study on how emergency physicians view their work in relation to patients' drug treatment2008In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 3, no 3, p. 155-164Article in journal (Refereed)
    Abstract [en]

    Patients come to the emergency department (ED) with complex medication and some patients present symptoms of adverse drug effects. Drug treatment is a complex process for physicians to handle. The aim of this study was to explore how a group of ED physicians view their work in relation to patients’ drug treatment. Three semi-structured focus group discussions with 12 physicians in an ED in Sweden were conducted and analysed thematically. The core theme was ‘‘limit work to here and now’’. Three descriptive themes were identified in relation to the main theme; (1) focussing to cope with work; (2) decision making on limited patient-specific information; and (3) actively seeking learning moments. The findings show that the physicians actively seek learning moments in work. Signing their own notes in the computerized medical record is a way of getting feedback on the treatment they have initiated and it was seen as a large part of their clinical education. If we want to support the physicians with new technology for safer drug treatment, such as a computerized drug prescribing support system, the support system should be adapted to the different learning styles and needs.

  • 8.
    Björkman, A.
    et al.
    University of Gavle, Gävle, Sweden.
    Engström, M.
    University of Gavle, Gävle, Sweden.
    Winblad, U.
    Uppsala University, Uppsala, Sweden.
    Holmström, Inger
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala University, Uppsala, Sweden.
    Malpractice claimed calls within the Swedish Healthcare Direct: a descriptive – comparative case study2021In: BMC Nursing, E-ISSN 1472-6955, Vol. 20, no 1, article id 21Article in journal (Refereed)
    Abstract [en]

    Background: Medical errors are reported as a malpractice claim, and it is of uttermost importance to learn from the errors to enhance patient safety. The Swedish national telephone helpline SHD is staffed by registered nurses; its aim is to provide qualified healthcare advice for all residents of Sweden; it handles normally about 5 million calls annually. The ongoing Covid-19 pandemic have increased call volume with approximate 30%. The aim of the present study was twofold: to describe all malpractice claims and healthcare providers’ reported measures regarding calls to Swedish Healthcare Direct (SHD) during the period January 2011–December 2018 and to compare these findings with results from a previous study covering the period January 2003–December 2010. Methods: The study used a descriptive, retrospective and comparative design. A total sample of all reported malpractice claims regarding calls to SHD (n = 35) made during the period 2011–2018 was retrieved. Data were analysed and compared with all reported medical errors during the period 2003–2010 (n = 33). Results: Telephone nurses’ failure to follow the computerized decision support system (CDSS) (n = 18) was identified as the main reason for error during the period 2011–2018, while failure to listen to the caller (n = 12) was the main reason during the period 2003–2010. Staff education (n = 21) and listening to one’s own calls (n = 16) were the most common measures taken within the organization during the period 2011–2018, compared to discussion in work groups (n = 13) during the period 2003–2010. Conclusion: The proportion of malpractice claims in relation to all patient contacts to SHD is still very low; it seems that only the most severe patient injuries are reported. The fact that telephone nurses’ failure to follow the CDSS is the most common reason for error is notable, as SHD and healthcare organizations stress the importance of using the CDSS to enhance patient safety. The healthcare organizations seem to have adopted a more systematic approach to handling malpractice claims regarding calls, e.g., allowing telephone nurses to listen to their own calls instead of having discussions in work groups in response to events. This enables nurses to understand the latent factors contributing to error and provides a learning opportunity.

  • 9.
    Björkman, Ingeborg
    et al.
    University of Uppsala, Uppsala, Sweden.
    Bernsten, Cecilia
    University of Uppsala, Uppsala, Sweden.
    Schmidt, Ingrid
    Apoteket AB, Stockholm, Sweden.
    Holmström, Inger
    University of Uppsala, Uppsala, Sweden.
    The role of drug and therapeutics committees: Perceptions of chairs and information officers2005In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, Vol. 18, no 4, p. 235-248Article in journal (Refereed)
    Abstract [en]

    Purpose – Improved quality and safety in drug use is a public health goal of major importance. In Sweden, local drug and therapeutics committees (DTCs) have adopted the task of working for safe and rational drug use. This study aimed to explore how chairs conceived the role of the DTCs, to explore how information officers conceived their own role, and to determine whether the respondents included patients in their answers. Design/methodology/approach – Data were collected using questionnaires and the answers were analysed according to phenomenographic method to identify conceptions. “Patient awareness” was studied by content analysis. Findings – In both groups the prescribers were the focus of attention, and only a few respondents mentioned patients. A variation of four conceptions was found among chairs and three among information officers. It would be beneficial if DTCs used this knowledge in their development. Originality/value – The importance of “patient awareness” within DTCs must be further explored.

  • 10.
    Carlsson, L.
    et al.
    Uppsala Univ., Sweden.
    Lännerström, L.
    Uppsala Univ., Sweden.
    Wallman, T.
    Uppsala Univ., Sweden.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    General practitioners' perceptions of working with the certification of sickness absences following changes in the Swedish social security system: A qualitative focus-group study2015In: BMC Family Practice, E-ISSN 1471-2296, Vol. 16, no 1, article id 21Article in journal (Refereed)
    Abstract [en]

    Background: Many physicians in Sweden, as well as in other countries, find the matter of certification of sickness absence (COSA) particularly burdensome. The issuing of COSAs has also been perceived as a work-environment problem among physicians. Among general practitioners (GPs) are the highest proportion of physicians in Sweden who experience difficulties with COSA. Swedish authorities have created several initiatives, by changing the social security system, to improve the rehabilitation of people who are ill and decrease the number of days of sick leave used. The aim of this study was to describe how GPs in Sweden perceive their work with COSA after these changes. Methods: A descriptive design with a qualitative, inductive focus-group discussion (FGD) approach was used. Results: Four categories emerged from the analysis of FGDs with GPs in Sweden: 1) Physicians' difficulties in their professional role; 2) Collaboration with other professionals facilitates the COSA; 3) Physicians' approach in relation to the patient; 4) An easier COSA process. Conclusions: Swedish GPs still perceived COSA to be a burdensome task. However, system changes in recent years have facilitated work related to COSA. Cooperation with other professionals on COSA was perceived positively.

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  • 11.
    Coyne, I.
    et al.
    School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderbäck, Maja
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Centeredness in Healthcare: A Concept Synthesis of Family-centered Care, Person-centered Care and Child-centered Care2018In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 42, p. 45-56Article in journal (Refereed)
    Abstract [en]

    Background: Increasingly within healthcare, different kind of ‘centeredness’ are used to denote the focus of care which can create confusion for practitioners. Methods: A concept analysis was undertaken to identify the antecedents, attributes and relationship between family-, person-, and child-centered care. PubMed and CINAHL were searched from 2012 to 2017 and thirty-five papers were reviewed. Results: Both person- and child-centered care are focused on individuals, a symmetric relationship and the tailoring of care to individual needs while family- centered care is focused on the family as a unit of which the child is included. Person-centered care focuses on an adult person with autonomy, while the focus in child-centered care is the individual child as an own actor with rights but still close to a family. Conclusion: It appears at a conceptual level that the concepts of centeredness contain both similarities and differences. Finding ways to structure nursing and focus the care that respects a person's dignity and humanity is essential in healthcare and should be a major goal of health policy and health systems worldwide. Implications: The identification of the antecedents and attributes embedded in the concepts may help raise professionals’ awareness of the different foci and how this will influence one's practice. There is a need to recognize strengths and weaknesses of the centeredness in different settings and environments. Furthermore, it is important to know which approach to apply within different situations so that quality care is enabled for every person, child and family.

  • 12.
    Danielsson, Lena
    et al.
    Vastmanlands Sjukhus, Reg Vastmanland, Vasteras, Sweden..
    Lundstrom, Marie-Louise
    Vastmanlands Sjukhus, Reg Vastmanland, Vasteras, Sweden..
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kerstis, Birgitta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Anaesthetizing children-From a nurse anaesthetist's perspective-A qualitative study2018In: Nursing Open, E-ISSN 2054-1058, Vol. 5, no 3, p. 393-399Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to describe nurse anaesthetists' experiences of encountering and caring for children in connection to anaesthesia. Design: Qualitative design. Methods: Sixteen written narratives based on eight nurse anaesthetists' experiences of meeting children was analysed using qualitative content analysis. Results: The overarching theme was: "anaesthetizing children is a complex caring situation, including interactions with the child and parents as well as ensuring patient safety, affected by the perioperative team and organizational prerequisites". The nurses stated that in their interaction with the family, their goal was to ensure that children and parents felt secure and calm. "Striving to work in confidence" underlined the team and organizational influences. Encountering children involves more than knowledge about technical equipment, procedures and drugs. Knowledge about children's development and fears and parents' needs are essential for an optimal caring situation. Organizations need to realize that extra time, skills and resources are needed to safely anaesthetize children.

  • 13.
    Danielsson, Lena
    et al.
    Region Västmanland, Sweden.
    Lundström, Louisa
    Region Västmanland, Sweden.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala universitet.
    Kerstis, Birgitta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Anaesthetizing children from a nurse anaethetist's perspective2019In: Barnveckan, Örebro, 2019Conference paper (Refereed)
  • 14.
    Edelbring, Samuel
    et al.
    Orebro Univ, Orebro, Sweden .
    Elvén, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Prenkert, Malin
    Orebro Univ, Orebro, Sweden .
    Person-Centeredness in Clinical Reasoning of Interprofessional Stroke Teams2023In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 109, p. 70-70Article in journal (Refereed)
  • 15.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Carlestav, M.
    Department of Neurology and Rehabilitation Medicine, Örebro University Hospital, Örebro, Sweden.
    Edelbring, S.
    School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    A tension between surrendering and being involved: An interview study on person-centeredness in clinical reasoning in the acute stroke setting2023In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 112, article id 107718Article in journal (Refereed)
    Abstract [en]

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

  • 16.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Prenkert, Malin
    Örebro University, Sweden.
    Edelbring, Samuel
    Örebro University, Sweden.
    Person-Centeredness in Clinical Reasoning of Interprofessional Stroke Teams2022In: ICCH2022. International Conference on communication in Healthcare 2022. Abtract book., 2022, p. 125-126Conference paper (Refereed)
    Abstract [en]

    Background: Although person-centered care is prioritized in healthcare, challenges remain before such care is integrated in everyday communication and practice. One way to strengthen person-centered care is that health professionals’ clinical reasoning (i.e., assessment and management) is pervaded by patient participation and individualized to patient needs. Interprofessional team meetings, focusing on goals and management planning, is an opportunity to improve person-centeredness. However, there is a lack of understanding of how person-centeredness is created in the clinical reasoning of teams. This study aims to explore how clinical reasoning is performed from a person-centered perspective in team meetings with patients with stroke and next of kin.

    Methods: Explorative qualitative design employing a thematic analysis of audio recorded communication at three team meetings. In total, three patients, two next of kin, and 15 professionals representing eight health professions, participated in the meetings.

    Findings: Four themes and eight subthemes were established: a) Emphasizing the patient’s resources; b) Struggling to find a common understanding, including subthemes: Unite the person’s narrative, the relative’s view, and the expertise of the interprofessional team, missed opportunities to clarify patient needs and wishes, and active listening and receptiveness; c) Balancing the patient’s goals and professionals’ goals, including subthemes: Shared goals, the professionals’ view of appropriate goals, and the professionals’ assessment governs achievement of goals; d) Ambiguity in decisions about the management plan, including subthemes: Initiating shared decision making and lack of clarity and consensus.

    Discussion: This study reveals how the patient, next of kin and team contribute to shared understanding of the patient’s problem. Goals were guided by the patient’s and professionals’ expertise. To improve person- centeredness in clinical reasoning, the team need to further put the patient’s personal goals and perception of goal-achievement in the forefront as well as improve communication skills to catch patient needs and facilitate shared decisions.

  • 17.
    Elvén, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden..
    Prenkert, Malin
    Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden..
    Holmström, Inger
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..
    Edelbring, Samuel
    Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden..
    Reasoning about reasoning - using recall to unveil clinical reasoning in stroke rehabilitation teams2024In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    PurposeThe study objective was to investigate how health care providers in stroke teams reason about their clinical reasoning process in collaboration with the patient and next of kin.Materials and methodsAn explorative qualitative design using stimulated recall was employed. Audio-recordings from three rehabilitation dialogs were used as prompts in interviews with the involved staff about their clinical reasoning. A thematic analysis approach was employed.ResultsA main finding was the apparent friction between profession-centered and person-centered clinical reasoning, which was salient in the data. Five themes were identified: the importance of different perspectives for a rich picture and well-informed decisions; shared understanding in analysis and decision-making - good intentions but difficult to achieve; the health care providers' expertise directs the dialog; the context's impact on the rehabilitation dialog; and insights about missed opportunities to grasp the patient perspective and arrive at decisions.ConclusionsInterprofessional stroke teams consider clinical reasoning as a process valuing patient and next of kin perspectives; however, their professional expertise risks preventing individual needs from surfacing. There is a discrepancy between professionals' intentions for person-centeredness and how clinical reasoning plays out. Stimulated recall can unveil person-centered practice and enhance professionals' awareness of their clinical reasoning. The findings provide insights into the clinical reasoning process of interprofessional stroke teams, which can increase awareness and support the development of competencies among health care providers.To increase patient participation in the clinical reasoning process, stroke teams are recommended to clarify the function of goals and the decision-making process in management.Stimulated recall is recommended as a reflective activity in the work of stroke teams to develop awareness and skills in clinical reasoning performed in collaboration between health care providers and patients.

  • 18.
    Ernesäter, A.
    et al.
    Faculty of Health and Occupational Studies, Caring Science University of Gavle, Sweden;Department of Public Health and Caring Sciences, Uppsala University, Health Services Research Uppsala, Sweden .
    Engström, M.
    Faculty of Health and Occupational Studies, Caring Science University of Gavle, Sweden;Department of Public Health and Caring Sciences, Uppsala University, Health Services Research Uppsala, Sweden .
    Winblad, U.
    Department of Public Health and Caring Sciences, Uppsala University, Health Services Research Uppsala, Sweden .
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Department of Public Health and Caring Sciences, Uppsala University, Health Services Research Uppsala, Sweden .
    A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish Healthcare Direct: A case-control study2014In: BMJ Open, E-ISSN 2044-6055, Vol. 4, no 10, article id e005961Article in journal (Refereed)
    Abstract [en]

    Objectives: The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. Setting: In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. Participants: A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. Results: Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. Conclusions: The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems.

  • 19.
    Ernesäter, Annica
    et al.
    Uppsala University, Uppsala, Sweden .
    Engström, Maria
    Uppsala University, Uppsala, Sweden .
    Holmström, Inger
    Uppsala University, Uppsala, Sweden .
    Winblad, Ulrika
    Uppsala University, Uppsala, Sweden .
    Incident reporting in nurse-led national telephone triage in Sweden: the reported errors reveal a pattern that needs to be broken2010In: Journal of telemedicine and telecare, ISSN 1758-1109, Vol. 16, no 5, p. 243-247Article in journal (Refereed)
    Abstract [en]

    We conducted a retrospective study of incident reports concerning the national, nurse-led telephone triage system in Sweden. The Swedish Health Care Direct organization (SHD) is staffed by registered nurses who act as telenurses and triage the callers' need for care, using a computerized decision support system. Data were collected during 2007 from all county councils that participated in the SHD and were analysed using content analysis. Incident reports were then compared concerning differences in reported categories and who reported the errors. The 426 incident reports included 452 errors. Of the analysed incident reports, 41% concerned accessibility problems, 25% incorrect assessment, 15% routines/guidelines, 13% technical problems and 6% information and communication. The most frequent outgoing incident reports (i.e. sent from SHD to other health-care providers) concerned accessibility problems and the most frequently incoming reports (i.e. sent to SHD from other health-care providers) concerned incorrect assessment. There was a significant difference (P < 0.001) between outgoing and incoming reports regarding the main category. Telenurses have limited possibilities for referring the caller to their primary health-care provider or specialist, which may cause them to over-triage or under-triage the callers' need for care. This over-triage or under-triage may in turn cause other health-care providers to report incorrect assessment to SHD. The implications for practice are that poor accessibility is a matter that should be addressed and that the reasons for incorrect assessment should be explored.

  • 20.
    Ernesäter, Annica
    et al.
    Högskolan i Gävle, Sweden.
    Engström, Maria
    Högskolan i Gävle, Sweden.
    Winblad, Ulrika
    Uppsala Universitet, Sweden.
    Ramqvist, Michael
    Linköpings universitet, Sweden.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala Universitet, Sweden.
    Telephone nurses' communication and response to callers' concern - a mixed method study2016In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, ISSN 0897-1897, Vol. 29, p. 116-121Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of this study was to describe telephone nurses' and callers' communication, investigate relationships within the dyad and explore telephone nurses' direct response to callers' expressions of concern 

    Background: Telephone nurses assessing callers' need of care is a rapidly growing service. Callers with expectations regarding level of care are challenging. 

    Method: RIAS and content analysis was performed on a criterion sampling of calls (N = 25) made by callers who received a recommendation from telephone nurses of a lower level of care than expected. 

    Results: Telephone nurses mainly ask close-ended questions, while open-ended questions are sparsely used. Relationships between callers' expressions of Concern and telephone nurses responding with Disapproval were found. Telephone nurses mainly responded to concern with close-ended medical questions while exploration of callers' reason for concern was sparse.

    Conclusion: Telephone nurses' reluctance to use open-ended questions and to follow up on callers' understanding might be a threat to concordance, and a potential threat to patient safety. 

  • 21.
    Ernesäter, Annica
    et al.
    Högskolan i Gävle, Ämnesavdelningen för vårdvetenskap.
    Holmström, Inger
    Folkhälso- och vårdvetenskap Uppsala Universitet.
    Engström, Maria
    Högskolan i Gävle, Ämnesavdelningen för vårdvetenskap.
    Computerized decision support systems in telenursing: how it is perceived by telenurses2009In: Med-e-Tel 2009: proceedings, 2009, p. 409-410Conference paper (Refereed)
    Abstract [en]

    Telephone advice nursing (telenursing) is an expanding service in many Western countries and in recent year’s centralization of telenursing services has occurred in some countries. Telenursing is a complex and knowledge intensive health service were registered nurses (RN’s) individually triage callers need for further care, give self care advice or refer the caller to appropriate care giver. These telenurses have numerous patient encounters every day, regarding all ages of callers and questions presented to the telenurses addresses a broad variation of medical conditions.  

    Telenursing has shown to be appreciated by the population as well as cost efficient.

     In an attempt to ensure quality and safety within telenursing the use of computerized decision support systems (CDSS) increased since CDSS enables uniformity and consistency of advices given to callers.   

    Traditionally, telenurses have relied on clinical knowledge, collegial support and books when triaging callers and few studies describe how telenurses perceive CDSS in their daily work.

    Eight telenurses from three different telephone advice call centres, all using CDSS took part in semi-structured interviews in 2006. Data were analysed using qualitative content analysis.

    The aim of the study was to describe telenurses experiences of working with CDSS. Telenurses described that the CDSS had both positive and negative influences of their work. They described that the CDSS simplified their work, complemented their knowledge and gave them a sense of security. They also described how the CDSS contributed to quality improvement of telenursing. The negative aspects of the CDSS were described as being inhibited by the system. Telenurses described how they perceived the system as partly incomplete and controlling and that they sometimes disagreed with the measures presented by the system.

    These advantages and disadvantages perceived within the system can be connected to the concepts of usability: user-worthiness and user-friendliness. Software should be easy to learn, contain few errors and be easy to orient in, to enhance usability. Hence usability could be further improved in the present system.

    There might be a risk that the CDSS will mechanize and undermine the communication between callers and telenurses. It is important, in order to increase the telenurses’ professional competence and the feeling of tele-presence that callers not only are given a correct estimation of their conditions but also a sense of security and confirmation. Otherwise callers may seek emergency care solely because of insecurity and anxiety.

  • 22.
    Ernesäter, Annica
    et al.
    Högskolan i Gävle, Ämnesavdelningen för vårdvetenskap.
    Holmström, Inger
    Folkhälso- och vårdvetenskap Uppsala Universitet.
    Engström, Maria
    Högskolan i Gävle, Ämnesavdelningen för vårdvetenskap.
    Telenurses’ experiences of working with computerized decisionsupport: supporting, inhibiting and quality improving2009In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 5, p. 1074-1083Article in journal (Refereed)
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  • 23.
    Ernesäter, Annica
    et al.
    Uppsala University.
    Winblad, Ulrika
    Uppsala University.
    Engström, Maria
    Uppsala University.
    Holmström, Inger K.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Malpractice claims regarding calls to Swedish telephone advice nursing: what went wrong and why?2012In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 18, no 7, p. 379-383Article in journal (Refereed)
    Abstract [en]

    We analysed the characteristics of all malpractice claims arising out of telephone calls to Swedish Healthcare Direct (SHD) during 2003-2010 (n = 33). The National Board of Health and Welfare's (NBHW) investigations describing the causes of the malpractice claims and the healthcare providers' reported measures were analysed using Qualitative Content Analysis. The original telephone calls themselves, which had been recorded, were analysed using the Roter Interaction Analysis System (RIAS). Among the 33 cases, 13 patients died and 12 were admitted to intensive care. Failure to listen to the caller (n = 12) was the most common reason for malpractice claims, and work-group discussion (n = 13) was the most common measure taken to prevent future re-occurrence. Male patients (n = 19) were in the majority, and females (n = 24) were the most common callers. The most common symptoms were abdominal (n = 11) and chest pain (n = 6). Telenurses followed up on caller understanding in six calls, and mainly used closed-ended questions. Despite the severity of these malpractice claims, the measures taken mainly addressed active failure, rather than the latent conditions. Third-party communication should be regarded as a risk. When callers make repeated contacts, telenurses need to re-evaluate their need for care.

  • 24.
    Ewertsson, Mona
    et al.
    Univ Örebro, Örebro, Sweden.
    Allvin, Renee
    Univ Örebro, Örebro, Sweden.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Blomberg, Karin
    Univ Örebro, Örebro, Sweden.
    Walking the bridge: Nursing students' learning in clinical skill laboratories2015In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 15, no 4, p. 277-283Article in journal (Refereed)
    Abstract [en]

    Despite an increasing focus on simulation as a learning strategy in nursing education, there is limited evidence on the transfer of simulated skills into clinical practice. Therefore it's important to increase knowledge of how clinical skills laboratories (CSL) can optimize students' learning for development of professional knowledge and skills, necessary for quality nursing practice and for patient safety. Thus, the aim was to describe nursing students' experiences of learning in the CSL as a preparation for their clinical practice. Interviews with 16 students were analysed with content analysis. An overall theme was identified walking the bridge in which the CSL formed a bridge between the university and clinical settings, allowing students to integrate theory and practice and develop a reflective stance. The theme was based on categories: conditions for learning, strategies for learning, tension between learning in the skills laboratory and clinical settings, and development of professional and personal competence. The CSL prepared the students for clinical practice, but a negative tension between learning in CSL and clinical settings was experienced. However, this tension may create reflection. This provides a new perspective that can be used as a pedagogical approach to create opportunities for students to develop their critical thinking.

  • 25.
    Ewertsson, Mona
    et al.
    Univ Orebro, Sweden.
    Gustafsson, Margareta
    Univ Orebro, Sweden.
    Blomberg, Karin
    Univ Orebro, Sweden.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden.
    Allvin, Renee
    Univ Orebro, Sweden.
    Use of technical skills and medical devices among new registered nurses: A questionnaire study2015In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 35, no 12, p. 1169-1174Article in journal (Refereed)
    Abstract [en]

    Background: One comprehensive part of nursing practice is performing technical skills and handling of medical equipment. This might be challenging for new registered nurses (RNs) to do in patient-safe way. Objectives: The aim of this study was to describe and compare the extent to which new RNs perform various technical skills and handle medical devices in different settings, and to investigate their possibility for continued learning in this respect. A further aim was to describe their perceptions of incident reporting related to technical skills and medical devices. Design: A cross-sectional study with descriptive and comparative design. Participants: RNs who recently graduated from a nursing programme at three Swedish universities and had worked as a RN for up to 1 year were included in the study (n = 113, response rate 57%). Method: Data were collected by means of a postal questionnaire. Results: Half of the RNs reported that they performed several of the listed tasks every day or every week, regardless of workplace. These tasks were most frequently performed in surgical departments. The majority of the participants (76%) stated a need of continued practical training. However, less than half of them (48%) had access to a training environment. Several participants (43%) had been involved in incidents related to technical skills or medical devices, which were not always reported. Nearly a third of the participants (31%) did not use the existing guidelines when performing technical skills, and reflection on performance was uncommon. Conclusions: This study highlights the importance of shared responsibilities between nurse educators and health care employers to provide learning opportunities for new RNs in technical skills, to maintain patient safety. To increase the safety culture where nursing students and new RNs understand the importance of using evidence-based guidelines and taking a reflective approach in the performance of technical tasks is needed.

  • 26.
    Fredriksson, Mio
    et al.
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Hlth Serv Res, Box 564, S-75122 Uppsala, Sweden..
    Holmström, Inger
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala Univ, Dept Publ Hlth & Caring Sci, Hlth Serv Res, Box 564, S-75122 Uppsala, Sweden..
    Höglund, Anna T.
    Uppsala Univ, Ctr Res Eth & Bioeth, Dept Publ Hlth & Caring Sci, Box 564, S-75122 Uppsala, Sweden..
    Fleron, Emma
    Akad Sjukhuset, Akutmottagningen Gynekol, S-75185 Uppsala, Sweden..
    Mattebo, Magdalena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Caesarean section on maternal request: a qualitative study of conflicts related to shared decision-making and person-centred care in Sweden2024In: Reproductive Health, E-ISSN 1742-4755, Vol. 21, no 1, article id 97Article in journal (Refereed)
    Abstract [en]

    BackgroundToday, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals' perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making.MethodsA qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription.ResultsIn the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman's current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman's sense of security (an uncomplicated decision-making process).ConclusionsThe complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals' reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context. Person-centered care is today a widespread approach, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). This study examines Swedish health professionals' views on CSMR. Interviews with 12 health professionals reveal conflicts between CSMR and key aspects of person-centered care, in particular shared decision-making. While professionals acknowledge women's autonomy, they question CSMR without medical need. Concerns include for example treatment quality and patient safety, and avoiding treatments that harm others. The Swedish context, balancing collective solutions with individualized care, complicates decision-making. Unlike countries with more private healthcare, where CSMR support might be higher, Swedish health professionals emphasize shared decision-making despite viewing the mode of delivery as primarily a professional decision. This study sheds light on the challenges in integrating CSMR into person-centered care frameworks.

  • 27.
    Hafskjold, L.
    et al.
    University College of Southeast Norway, Drammen, Norway.
    Eide, T.
    University College of Southeast Norway, Drammen, Norway.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sundling, V.
    University College of Southeast Norway, Kongsberg, Norway .
    van Dulmen, S.
    University College of Southeast Norway, Drammen, Norway .
    Eide, H.
    University College of Southeast Norway, Drammen, Norway .
    Older persons’ worries expressed during home care visits: Exploring the content of cues and concerns identified by the Verona coding definitions of emotional sequences2016In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, no 12, p. 1955-1963Article in journal (Refereed)
    Abstract [en]

    Objective Little is known about how older persons in home care express their concerns. Emotional cues and concerns can be identified by the Verona coding definitions of emotional sequences (VR-CoDES), but the method gives no insight into what causes the distress and the emotions involved. The aims of this study are to explore (1) older persons’ worries and (2) the content of these expressions. Methods An observational exploratory two-step approach was used to investigate audiotaped recordings from 38 Norwegian home care visits with older persons and nurse assistants. First, 206 cues and concerns were identified using VR-CoDES. Second, the content and context of these expressions were analysed inductively. Results Four main categories emerged: worries about relationships with others, worries about health care-related issues, worries about aging and bodily impairment, and life narratives and value issues, with several subcategories showing the causes of worry and emotions involved. Conclusion The two-step approach provides an in-depth knowledge of older persons’ worries, causes of worries, and their related emotions. Practice implications The subcategories described in a language close to the experience can be useful in practice development and communication training for students and health care providers.

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  • 28.
    Hafskjold, L.
    et al.
    Buskerud and Vestfold University College, Drammen, Norway.
    Sundler, Annelie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sundling, V.
    Buskerud and Vestfold University College, Drammen, Norway.
    Van Dulmen, S.
    Buskerud and Vestfold University College, Drammen, Norway.
    Eide, H.
    Buskerud and Vestfold University College, Drammen, Norway.
    A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol2015In: BMJ Open, E-ISSN 2044-6055, Vol. 5, no 4, article id e007864Article in journal (Refereed)
    Abstract [en]

    Introduction: This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of the COMHOME study is to generate knowledge on person-centred communication with older people (>65 years) in home healthcare services, radiographic and optometric practice. Methods and analysis: This study will explore the communication between care providers and older persons in home care services. Home healthcare visits will be audiorecorded (n=500) in Norway, the Netherlands and Sweden. Analyses will be performed with the Verona Coding Definitions for Emotional Sequences (VR-CoDES), the Roter Interaction Analysis System (RIAS) and qualitative methods. The content of the communication, communicative challenging situations as well as empathy, power distance, decision-making, preservation of dignity and respect will be explored. In Norway, an additional 100 encounters, 50 in optometric practice (video recorded) and 50 in radiographic practice (audiorecorded), will be analysed. Furthermore, healthcare providers' self-reported communication skills, empathy, mindfulness and emotional intelligence in relation to observed person-centred communication skills will be assessed using well-established standardised instruments. Ethics and dissemination: Depending on national legislation, approval of either the central ethical committees (eg, nation or university), the national data protection officials or the local ethical committees (eg, units of home healthcare) was obtained. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. The research findings will add knowledge to improve services provided to this vulnerable group of patients. Additionally, the findings will underpin a training programme for healthcare students and care providers focusing on communication with older people. 

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  • 29.
    Hakimnia, Roya
    et al.
    Uppsala universitet, Sweden.
    Carlsson, Marianne
    Uppsala universitet, Sweden.
    Höglund, Anna
    Uppsala universitet, Sweden.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala University, Sweden.
    Doing gender in the context of telenursing: Analyses of authentic calls to a telenursing site in Sweden2015In: Clinical Nursing Studies, ISSN 2324-7940, E-ISSN 2324-7959, ISSN 2324-7940, Vol. 3, no 2, p. 24-30Article in journal (Refereed)
    Abstract [en]

    Introduction: Aim: The aim of the present study was to analyze authentic health calls to a telenursing site in Sweden regardingreasons for calling and outcome of the calls with focus on a gender perspective. Background: Telephone advice nursing isan expanding service in many Western countries. In Sweden, all regions are now connected to a national telenursing service.Healthcare in Sweden is stipulated by law to be equitable. This includes the teleursing service, which is a new actor in Swedishhealthcare system, and which often is a citizen’s first contact with healthcare.

    Methods: The study had a descriptive and comparative design. 800 authentic calls to SHD were analysed regarding reasons forcalling, and outcome of the calls.

    Results: The results showed that men, and especially fathers, received more referrals to general practitioners than women. Themost common caller was a woman fluent in Swedish (64%), and the least likely caller was a man non-fluent in Swedish (3%).All in all, 70% of the callers were women. When the calls concerned children, 78% of the callers were female. In total, 9% ofthe calls were made by a man calling for another person. Callers were predominately young (mean age 29 years for women and33 for men).

    Conclusions: It is important that telenursing does not become a “feminine” activity, only suitable for young callers fluent inSwedish. Given the telenurses’ gatekeeping role, there is a risk that differences on this first level of health care can be reproducedthroughout the whole healthcare system. In striving for more equitable telenursing services, future research might investigate ifcampaigns encouraging men to call, and more frequent use of translators could enhance access to telenursing services.

  • 30.
    Hakimnia, Roya
    et al.
    Uppsala universitet, Sweden.
    Holmström, Inger K.
    Uppsala universitet, Sweden.
    Carlsson, Marianne
    Uppsala universitet, Sweden.
    Höglund, Anna T
    Uppsala universitet, Sweden.
    Exploring the communication between telenurse and caller – A critical discourse analysis.2014In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, ISSN 1748-2623,, Vol. 24, no 9, article id 24255Article in journal (Refereed)
    Abstract [en]

    Background: Telenursing is an expanding service in most Western societies. Sweden is a front-line country, with all of its 21 counties connected to Swedish Healthcare Direct (SHD) 1177. The intention of the service is twofold: to make health care more efficient, while also making it more accessible and safe for patients. Previous research has shown, however, that the service is not used equitably. Gender, age, socio-economic, and ethnicity differences have been reported as determining factors for the use of the service and the advice given.

    Aim: The aim of the study was to explore the communication between telenurses and callers in authentic calls to SHD 1177.

    Methodology: A qualitative method, using critical discourse analysis (CDA), was chosen. The approach was deductive, that is, the analysis was made in view of a predetermined framework of theory. Twenty calls were strategically chosen and included in the study.

    Results: The CDA resulted in five types of calls, namely a gatekeeping call, a gendered call, a call marked by impersonal traits, a call with voices of the life world, and finally a counter discourse call. The dominating patterns in the calls were of gatekeeping and biomedical character. Patterns of the societal gender order were found, in that representations of the reluctant male caller and the ideal female caller were identified, but also a call representing a counter discourse. The service seemed difficult to use for patients with low language proficiency.

    Conclusion: Telenursing could potentially challenge inequalities in health care. However, the discourse of telenursing is dialectically related to neoliberal ideology and the ideology of medicine. It is also situated in a gendered context of ideal femininity and hegemonic masculinity. Through better awareness of gender biases and the callers’ different resources for making themselves heard, the communication between telenurse and caller might become more equal and thereby better suitable for all callers.

  • 31.
    Harder, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Höglander, Jessica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Appelgren Engström, Heléne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Blomberg, Helena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    An integrative review of communication in a professional-parental relationship provided in child health services: An authoritarian or guiding approach2024In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 118, article id 108029Article in journal (Refereed)
    Abstract [en]

    Objectives

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

    Methods

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

    Results

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

    Conclusions

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

    Practice implications:

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

  • 32.
    Hellerstedt-Borjesson, Susanne
    et al.
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Box 564, SE-75122 Uppsala, Sweden..
    Nordin, Karin
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Box 564, SE-75122 Uppsala, Sweden..
    Fjallskog, Marie-Louise
    Uppsala Univ, Dept Radiol Oncol & Radiat Sci, Uppsala, Sweden..
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala Univ, Dept Publ Hlth & Caring Sci, Box 564, SE-75122 Uppsala, Sweden.;Malardalen Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden..
    Arving, Cecilia
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Box 564, SE-75122 Uppsala, Sweden..
    Women Treated for Breast Cancer Experiences of Chemotherapy-Induced Pain Memories, Any Present Pain, and Future Reflections2016In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 39, no 6, p. 464-472Article in journal (Refereed)
    Abstract [en]

    Background: Breast cancer survivors make up a growing population facing treatment that poses long-standing adverse effects including chemotherapy-related body function changes and/or pain. There is limited knowledge of patients' lived experiences of chemotherapy-induced pain (CHIP). Objective: The aim of this study was to explore CHIP and any long-standing pain experiences in the lifeworld of breast cancer survivors. Methods: Fifteen women participated in a follow-up interview a year after having experienced CHIP. They were interviewed from a lifeworld perspective; the interviews were analyzed through guided phenomenology reflection. Results: A past perspective: CHIP is often described in metaphors, leads to changes in a patient's lifeworld, and impacts lived time. The women become entirely dependent on others but at the same time feel isolated and alone. Existential pain was experienced as increased vulnerability. Present perspective: Pain engages same parts of the body, but at a lower intensity than during CHIP. The pain creates time awareness. Expected normality in relationships/daily life has not yet been achieved, and a painful existence emerges in-between health and illness. Future perspective: There are expectations of pain continuing, and there is insecurity regarding whom to turn to in such cases. A painful awareness emerges about one's own and others' fragile existence. Conclusions: Experiencing CHIP can impact the lifeworld of women with a history of breast cancer. After CHIP, there are continued experiences of pain that trigger insecurity about whether one is healthy. Implications for Practice: Cancer survivors would likely benefit from communication and information about and evaluation of CHIP.

  • 33.
    Hellerstedt-Börjesson, Susanne
    et al.
    Uppsala University, Sweden.
    Nordin, Karin
    Uppsala University, Sweden.
    Fjällskog, Marie-Louise
    Uppsala University, Sweden.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Arving, Cecilia
    Uppsala University, Sweden.
    Women with Breast Cancer: Experience of Chemotherapy-Induced Pain - Triangulation of Methods2015In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 38, no 1, p. 31-39Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chemotherapy treatment for cancer diseases can cause body pain during adjuvant therapy. OBJECTIVE: The aim was to describe the perceived impact of adjuvant chemotherapy-induced pain (CHIP) on the daily lives of women with newly diagnosed breast cancer, using triangulation. METHOD: Fifty-seven women scheduled for chemotherapy in doses of 75 mg/m or greater of epirubicin and/or docetaxel participated. Twenty-two of these women registered pain with values of 4 or more on the visual analog scale on day 10 following chemotherapy. Of these 22, 16 participated in an interview and colored a printed body image. A qualitative thematic stepwise analysis of the interviews was performed. RESULTS: Chemotherapy-induced pain had a profound impact on daily life. Ten women reported the worst possible pain, with visual analog scale scores of 8 to 10. Three different categories crystallized: perception (A) of manageable pain, which allowed the women to maintain their daily lives; perception (B) of pain beyond imagination, whereby the impact of pain had become more complex; and perception (C) of crippling pain, challenging the women's confidence in survival. CONCLUSIONS: The findings highlight the inability to capture CHIP with 1 method only; it is thus necessary to use complimentary methods to capture pain. We found that pain had a considerable impact on daily life, with surprisingly high scores of perceived pain, findings that to date have been poorly investigated qualitatively. IMPLICATIONS FOR PRACTICE: Nurses need to (1) better identify, understand and treat CHIP, using instruments and protocols; and (2) provide improved communication about pain and pain management.

  • 34.
    Hjelmblink, Finn
    et al.
    Uppsala universitet, Uppsala, Sweden.
    Bernsten, Cecilia B
    Uppsala universitet, Uppsala, Sweden.
    Uvhagen, Håkan
    Uppsala universitet, Uppsala, Sweden.
    Kunkel, Stefan
    Uppsala universitet, Uppsala, Sweden.
    Holmström, Inger
    Uppsala universitet, Uppsala, Sweden.
    Understanding the meaning of rehabilitation to an aphasic patient through phenomenological analysis - a case study2007In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 2, no 2, p. 93-100Article in journal (Refereed)
    Abstract [en]

    Stroke patients with aphasia commonly suffer from distress related to their language deficit. They are often unable to express what they experience during their rehabilitation. Hence, the aim of this study was to reveal the meaning of rehabilitation to an aphasic person. With an approach based on the philosophy of Husserl and Merleau-Ponty, two open-ended interviews were analysed through the Empirical Phenomenological Psychological (EPP) method. The essential structure of the meaning of rehabilitation to the informant was that he lived as being responsible in a dichotomised situation. The informant had to adapt his behaviour, thereby destroying his chances of normal interactions; he was supposed to train in a goal-oriented way and believe in recuperation, but at the same time, he had to prepare himself and his next of kin for a failure. The defined impairment of aphasia misled both the informant and health care professionals to focus only language therapy, hence leaving the informant unsupported in other important aspects of the rehabilitation.

  • 35.
    Hjelmblink, Finn
    et al.
    Uppsala universitet, Sweden.
    Holmström, Inger
    Uppsala universitet, Sweden.
    To cope with uncertainty: stroke patients' use of temporal models in narratives2006In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, no 4, p. 367-374Article in journal (Refereed)
    Abstract [en]

    Stroke victims have to cope with a disrupted autobiography and anxiety because of an uncertain future. Professionals share this uncertainty. The patients reveal their experiences in narratives, and when they try to regain coherence and confidence in life, they use narratives in the reconstructions. Because they have a temporal problem, time might be an important issue in these narratives. The aim of this study was to elucidate the use of time models in stroke patients' narratives. Nineteen stroke patients, who had recently been discharged to their homes after the stroke, accepted to participate in the study. Their age span was between 56 and 89 years. They had lived active urban lives before the stroke, and poststroke only three had more serious physical impairment, and none was demented. They were asked to talk about their present life and their conceptions of future life. The interviews were audio-taped and transcribed verbatim and narratives that referred to temporal aspects were thematically analysed with reference to narrative time models. The stroke accident had caused an autobiographical disruption and a temporal split because of a new awareness of human temporality and an uncertainty of the future. Confronted with these problems of time, the stroke victims constructed narratives based on the time models: time cycles and dissolution of time limits, exchange of time and exclusion from time. Hence, the time models worked as tools when the stroke victims re-established coherence in their present and future life. Stroke patients handled an uncertain future by using temporal models in their narratives. Professionals can support stroke patients by reinforcing these models.

  • 36.
    Hjelmblink, Finn
    et al.
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Holmström, Inger
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Kjeldmand, Dorte
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Stroke patients' delay of emergency treatment2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 2, p. 307-311Article in journal (Refereed)
    Abstract [en]

    Treatment of stroke victims with fibrinolysis should take place within a time limit of 3 hours. In spite of comprehensive endeavours to reduce hospital arrival time, too many patients still delay arrival beyond this time limit. This qualitative case study explored the meaning of acute stroke and treatment to four patients with more than 24-hour delayed arrival. The setting of the study was the catchment area of a university hospital. Semi-structured interviews were analysed through the empirical psychological, phenomenological method. An essence was found which was constituted by four themes. The essence of stroke symptoms and treatment was: 'Threatened control of bodily function, autonomy and integrity'. When the patients fell ill they acted as if nothing had happened. They treated their body like a defective device. In encounters with physicians they demanded to be met as a person by a person; otherwise they rejected both the physician and her or his prescriptions. They did not involve their near ones in decision-making. The conclusions were the following: Health care information about how to act in cases of early stroke symptoms may need to imbue people with an understanding of how early treatment of neurological symptoms and preserved control of life are intimately connected. Furthermore emergency care of acute stroke patients might need to take place in an organisation where patients are sure to be met by physicians as a person by a person.

  • 37.
    Hjelmblink, Finn
    et al.
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Holmström, Inger
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Sanner, Margareta
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    The meaning of rehabilitation for older people who have survived stroke2009In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 1, no 2, p. 186-195Article in journal (Refereed)
    Abstract [en]

    Aim. To explore the meaning of rehabilitation to older, Swedish stroke survivors, from the time of the acute stroke to the end of the rehabilitation.

    Background. Many people who are stroke survivors do not resume social activities even though they have regained physical functions. However, the contents of stroke rehabilitation seems to depend on whether rehabilitation is understood from the disease perspective or the illness perspective contained in the International Classification of Functioning, Disability and Health. This in turn may determine the kind of rehabilitation offered to survivors.

    Design. Inductive, qualitative interview study undertaken during 2003.

    Method. Nineteen Swedish stroke survivors were interviewed twice, and the interviews were analysed using a Grounded Theory approach.

    Findings. To the older survivors, the meaning of rehabilitation was social reintegration. To achieve this they tried to regain lost physical and cognitive functions, relations (including play activities, everyday narratives and self-esteem) and lost certainty. The survivors needed to regain their ability to be not only to perform social activities. However, their rehabilitation ended when its focus turned to impairments found in the illness experiences of the survivors. The survivors developed their own cognitive and behavioural strategies for overcoming these kinds of obstacles to their social reintegration.

    Conclusion. Older, Swedish stroke survivors strive for a socially integrated life. Unacknowledged impairments experienced from the illness perspective of the survivors and the survivors’ own rehabilitation strategies should therefore be considered in their rehabilitation.

    Relevance to clinical practice. Stroke survivors need support from professionals who can understand and acknowledge the illness perspective of rehabilitation. Professionals should be able to understand how to facilitate the cognitive and behavioural strategies found in survivors’ illness narratives. In order to socially reintegrate, survivors’ rehabilitation should be transferred to the places where they have previously performed play activities together with family and friends.

  • 38.
    Hoffstedt, C.
    et al.
    Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
    Fredriksson, M.
    Department of Journalism, Media and Communication, University of Gothenburg, Gothenburg, Sweden.
    Winblad, U.
    Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Choosing not to choose—Patients' justification of a disengaged choice of primary care providerIn: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515Article in journal (Refereed)
    Abstract [en]

    A key underpinning of choice of health care provider is that patients make active and informed decisions which stimulate quality competition. By imitating the principles of a market in the steering of health care, patients thus assume the role of consumers. Few patients however neither consider alternative providers nor seek information about quality. The aim of this study was to investigate if and how patients engage in the role of being active and informed consumers in the setting of primary care, and how they argue for their choice. The study was based on semi-structured interviews with 18 respondents in a municipality in mid-Sweden. Respondents were purposefully sampled and interviews were analysed using an inductive thematic approach. Findings demonstrated that patients disengaged from choice by arguing, for instance, that they were satisfied with their current provider or because they perceived no differences in quality. Overall, results were in line with previous studies performed in US and European hospital settings, indicating that patients present some similar arguments regarding disengagement from choice irrespective of level of care or geographical setting. Arguments specifically related to the primary care level were that patients found it more important to achieve continuity in the patient-doctor relationship than ‘shopping around’ for the best provider, or that they desired more profiled services to actively make a choice. In contrast to previous literature, patients refuted the ‘patient-consumer’ role by referring to, for instance, the belief that care should be of equal quality independent of what choice they made. 

  • 39.
    Holmström, Inger
    Uppsala universitet, Sweden.
    Decision aid software programs in telenursing: Tot used as intended? Experiences of Swedish telenurses2007In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 9, no 1, p. 23-28Article in journal (Refereed)
    Abstract [en]

    Telenurses at call centers use decision aid software programs to offer triage recommendations and self-care advice to the general public. Decision aid programs are intended to support medical safety but were suggested by telenurses to be a hindrance to the dialogue. The aim of this study was to explore the use of decision aid software programs for telenursing, from the perspective of the users. A qualitative, descriptive approach was used. Twelve telenurses in Sweden were interviewed twice. The interviews were transcribed and analyzed thematically. Four themes were found: support for assessment but not for the decision; inconsistency between actual practice and the decision aid software; limited support for learning and information; and communication challenges and software programs. The software programs were a support for assessment, rather than decision-making, assuring the nurses that the relevant questions were asked. They were not fully adapted to current clinical practice, focusing mainly on acute conditions. Nurses worked to a large extent with self-care advice, often over-riding the recommendations made.

  • 40.
    Holmström, Inger
    Uppsala university.
    Diabetes telehealth and computerized decision support systems: a sound system with a human touch is needed2010In: Journal of Diabetes Science and Technology, E-ISSN 1932-2968, Vol. 4, no 4, p. 1012-1015Article in journal (Refereed)
    Abstract [en]

    Telehealth holds the promise of improved consistency and fast and equal access to care, and will have great impact on future care. To enhance its quality and safety, computerized decision support systems (CDSS) have been launched. This commentary focuses specifically on the impact of telehealth and CDSS on diabetes patient management. Ideally, clinical information should be linked to evidence based recommendations and guidelines in the CDSS to provide tailored recommendations at the moment of care. However, technical support such as CDSS is not enough. The human touch is essential. A named healthcare provider with access to telehealth and CDSS seems to promise a way of providing both patient-centered and evidence-based care.

  • 41.
    Holmström, Inger
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Från 1477 till 1177. Sjukvårdsrådgivning per telefon2015In: Annales Academiae Regiae Scientiarum Upsaliensis: Kungliga Vetenskapssamhällets i Uppsala årsbok, Kungliga Vetenskapssamhället i Uppsala , 2015, 40, p. 121-130Chapter in book (Other academic)
  • 42.
    Holmström, Inger
    Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap.
    Gaining Professional Competence for Patient Encounters by Means of a New Understanding2002Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Swedish health care is currently facing problems, such as lack of financial resources, staff shortage and dissatisfaction among patients and professionals. Patients’ dissatisfaction was the point of departure for the present study, and one approach dealing with this problem was investigated. It was hypothesised that a patient-centred perspective could offer a possible solution. The aim of the study was to explore health care professionals’ and medical students’ understanding of their professional role and the patient encounter. A further goal was to determine whether these understandings could be developed by educational interventions. Students and professionals have been either interviewed or responded to a survey about their professional role and the patient encounter. Qualitative analysis was used. One group- and one individualised intervention were carried out. The participants’ understandings of their professional role were taken as the starting point for learning. The results showed that a minority of medical students and professionals in diabetes care had incorporated a patient-centred perspective. Nurses in telephone advisory services recognised the patients’ needs, but experienced conflicting demands of being both carer and gatekeeper. A non-optimal match between patients’ needs and what professionals understand as their role could cause some of the problems. Competence development could be achieved by taking the participants understanding of the professionals’ role and of the patient encounter as a starting point for reflection. The results have implications for changes in organisation and education in health care, to optimise outcomes of care. Time for reflection, mentoring and professional development is needed.

  • 43.
    Holmström, Inger
    et al.
    Uppsala University, Uppsala, Sweden .
    Dall' Alba, Gloria
    Karolinska Institutet, Stockholm, Sweden.
    'Carer and gatekeeper' - conflicting demands in nurses' experiences of telephone advisory services2002In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 2, p. 142-148Article in journal (Refereed)
    Abstract [en]

    Millions of calls are made to the telephone advisory services in primary health care in Sweden. The patients seem happy with the advice and counselling they receive, but little has been written about nurses' experiences of performing telephone advisory services. Yet, the nurses are expected to be patient, sensitive and have a broad knowledge of medicine, nursing and pedagogy. The aim of this study was to describe how nurses experience the patient encounter when performing telephone advisory services. A strategic sample of five nurses were interviewed and asked to describe how they experienced the central aspects of the patient encounter by telephone. The transcribed interviews were analysed by the Empirical Phenomenological Psychological method. The nurses' experience of the patient encounter when performing telephone advisory services can be characterized in terms of the conflicting demands of being both carer and gatekeeper. The constituents of these conflicting demands were: reading between the lines while pressed for time; educating patients for self-care while fearful of misinterpreting the situation; encountering patients' satisfaction and dissatisfaction. The conflicting demands of being both professional carer and gatekeeper caused stress among the nurses. The organization of the telephone advisory services seems to hinder high-quality care.

  • 44.
    Holmström, Inger
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala University, Uppsala, Sweden.
    Gustafsson, S.
    Heby Primary Health Care Center, Heby, Sweden.
    Wesström, J.
    Örsundsbro Primary Health Care Center, Örsundsbro, Sweden.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare.
    Telephone nurses’ use of a decision support system: An observational study2019In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 21, no 4, p. 501-507Article in journal (Refereed)
    Abstract [en]

    Telephone nurses give advice and support and make assessments based on verbal communication only. Web-based decision support systems are often used to increase patient safety and make medically correct assessments. The aim of the present this study was to describe factors affecting the use of a decision support system and experiences with this system among telephone nurses in Swedish primary health care. Observations and semistructured interviews were conducted. Six registered nurses with at least 1 year of experience of telephone nursing participated. Field notes and interviews were analyzed by qualitative content analysis. The main findings of the present this study were factors that decrease the decision support system use or promote deviation from decision support system use, factors that are positive for decision support system use and the decision support system complicates the work. Underuse and deviations from decision support systems can be a safety risk, because decisions are based on too little information. Further research with observations of telephone nurses’ use of decision support systems is needed to develop both telephone nursing and decision support systems.

  • 45.
    Holmström, Inger
    et al.
    Uppsala University, Uppsala, Sweden.
    Halford, Christina
    Uppsala University, Uppsala, Sweden.
    Rosenqvist, Urban
    Uppsala University, Uppsala, Sweden.
    Swedish health care professionals' diverse understandings of diabetes care2003In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 51, no 1, p. 53-58Article in journal (Refereed)
    Abstract [en]

    Knowledge of health care professionals’ different understandings of diabetes care is important when preparing such professionals in patient education. For patients to manage illness effectively, the actions of health care professionals are crucial. Patients’ understanding of their condition should be taken as the point of departure when creating a learning situation. The professionals’ understandings of diabetes care were mapped using a survey including 169 primary care doctors, nurses, assistant nurses and chiropodists in Stockholm, Sweden. The responses were analysed using a phenomenographic approach. Five understandings were identified: the professionals treat the patients, the professionals give information, the professionals focus relation and organisation, the professionals seek the patient’s agreement, and the professionals focus the patient’s understanding of the situation. Only 20 (12%) of the 169 professional caregivers focused the patient’s understanding. Professionals need to develop their understandings of health care and the professional–patient interaction in order to support the patients’ learning.

  • 46.
    Holmström, Inger
    et al.
    Uppsala universitet, Sweden.
    Höglund, Anna T
    Uppsala universitet, Sweden.
    Response to commentary by Sarah Winch on Holmström I & Höglund AT: The faceless encounter: ethical dilemmas in telephone nursing2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 23, p. 3251-3252Article in journal (Other academic)
  • 47.
    Holmström, Inger
    et al.
    Uppsala Science Park, Uppsala, Sweden.
    Höglund, Anna T.
    Uppsala Science Park, Uppsala, Sweden.
    The faceless encounter: ethical dilemmas in telephone nursing2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 10, p. 1865-1871Article in journal (Refereed)
    Abstract [en]

    Aim. This paper aims to present the findings of a study designed to describe ethical dilemmas, in the form of conflicting values, norms and interests, which telenurses experience in their work.

    Background. Telephone nursing is an expanding part of health care. Telephone nurses in Sweden assess care needs, provide advice, support and information, and recommend and coordinate healthcare resources. Lately, ethical demands on healthcare professionals in general have increased. The reasons include new biomedical competence, an ageing population and constrained resources which have made priority setting a primary concern for doctors and nurses. When ethical problems arise, colleagues need open dialogue. Despite this, nurses lack such a dialogue.

    Method. A purposeful sample of 12 female telenurses in Sweden was interviewed twice during 2004 and 2005. The transcribed interviews were analysed thematically.

    Results. Five themes were found: talking through a third party; discussing personal and sensitive problems over the phone; insufficient resources and the organization of health care; balancing callers' information needs with professional responsibility; and differences in judging the caller's credibility.

    Conclusion. The present study has identified five different themes in which Swedish telenurses experience ethical dilemmas in their work. This shows how ethical dilemmas in various forms are present in telenursing. Questions of autonomy, integrity and prioritizing are particularly highlighted by the participating nurses. Telenurses in Sweden also experience new ethical demands due to a multicultural society. Although several of the identified dilemmas also occur in other areas of nursing we argue that these situations are particularly challenging in telenursing.

    Relevance to clinical practice. The work organization should provide opportunities for ethical competence-building, where ethical dilemmas in telenursing are highlighted and discussed. Such a strategy might lead to decreased moral uncertainty and distress among telenurses, with positive consequences for callers.

  • 48.
    Holmström, Inger
    et al.
    Health Services Research, University of Uppsala, Sweden .
    Jonsson, AC
    University of Linköping, Sweden.
    Rosenqvist, Urban
    Health Services Research, Uppsala Science Park, Uppsala, Sweden .
    Understanding the job in a new way - a basis for development of competence in diabetes care2000In: Upsala Journal of Medical Sciences, Supplement, ISSN 0300-9726, Vol. 105, no 2, p. 161-169Article in journal (Refereed)
    Abstract [en]

    Patients complain that doctors and nurses do not listen, and therefore a need to develop the patient encounter is at hand. Phenomenological theory has opened new ways to develop professional competence. If the idea holds that we express our understanding about our work through our actions, a change in understanding might further develop professional competence. This idea offers a new way to develop competence in diabetes health care service. The aim of this study was to map health care professionals' understanding of the patient encounter before and after an educational intervention that focused the way the health care professional experienced the encounter, and to describe how their understanding changed. Two general practitioners and two diabetes nurses participated. They were interviewed before and after the intervention. The intervention comprised 4-5 sessions during which they together with a tutor reviewed their videotaped consultations with different persons with diabetes. The tutors' role was to make interventions that could alter the persons understanding of the diabetes consultation through questioning. The interviews were analysed using phenomenographic method. The results show that the professionals changed their ways of experiencing the encounter after the intervention. They started to question their way of working, focused the patient's learning process and became interested in how to stimulate it.

  • 49.
    Holmström, Inger K.
    et al.
    Örebro university, Sweden; Uppsala University Sweden.
    Bastholm-Rahmner, Pia
    Stockholm County Council, Sweden.
    Bernsten, Cecilia
    Uppsala University, Sweden.
    Röing, Marta
    Uppsala University, Sweden.
    Björkman, Ingeborg
    Uppsala University, Sweden.
    Swedish teenagers and over-the-counter analgesics - Responsible, casual or careless use.2014In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 10, no 2, p. 408-418Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Teenagers in Sweden were given greater access as consumers of OTC drugs in 2009 after the reregulation of the pharmacy market, which allowed for the establishment of private pharmacies and sale of specific over-the-counter (OTC) drugs in retail stores and gas stations. Increased access to OTC drugs could provide new opportunities for self-care but attenuates the opportunity for the traditional expert surveillance of pharmacists, thus increasing the possibility of inappropriate OTC drug use.

    OBJECTIVES: Views of 16-19 year old Swedish teenagers on OTC drugs, with special regard to analgesic drugs were explored and described, based on the following questions: How and where did they acquire their knowledge and attitudes regarding OTC drugs? What perceptions did they have about the use of OTC drugs?

    METHODS: A qualitative approach with a descriptive design was chosen. Data were collected in 2011 with 10 focus group discussions with high school students aged 16-19 years from different parts of Sweden. A total of 77 teenagers participated, 33 males and 44 females. A manifest qualitative content analysis was performed.

    RESULTS: While most teenagers appeared to have responsible attitudes toward OTC drugs and their use, some teenagers had attitudes that ranged from casual to careless. The focus group discussions also revealed knowledge gaps among teenagers regarding OTC drugs, and the significant influence of parents and peers on their OTC drug use.

    CONCLUSIONS: This study provides insight into how vulnerable some teenagers could be as new consumers of OTC drugs and suggested that educational efforts could be geared toward parents as well as teenagers.

  • 50.
    Holmström, Inger K.
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Malardalen Univ, Sch Hlth Care & Social Welf, Hogskoleplan 1,Box 883, SE-72123 Vasteras, Sweden.;Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..
    Bohlin, Sofia
    Uppsala Univ, Dept Surg Sci, Sect Vasc Surg, Uppsala, Sweden..
    Wanhainen, Anders
    Uppsala Univ, Dept Surg Sci, Sect Vasc Surg, Uppsala, Sweden..
    Bjorck, Martin
    Uppsala Univ, Dept Surg Sci, Sect Vasc Surg, Uppsala, Sweden..
    Frojd, Camilla
    Uppsala Univ, Dept Surg Sci, Sect Vasc Surg, Uppsala, Sweden..
    Swedish men and smoking: Views on screening-detected abdominal aortic aneurysm2019In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 21, no 1, p. 119-125Article in journal (Refereed)
    Abstract [en]

    Abdominal aortic aneurysms (AAA), most common among elderly male smokers, often show no symptoms before rupture. To facilitate better care and counselling targeted to smoking cessation for these patients, more knowledge is required about their views. Therefore, the aim of the present study was to describe the views on AAA and smoking among male smokers with screening-detected AAA. A qualitative approach with individual interviews with 16 men with screening-detected AAA was applied. Three had quit smoking by the time of the interviews. Thematic analysis was performed, and four themes emerged: (i) accepting the course of life; (ii) the elusive AAA: a disturbing experiencing or merely a minor inconvenience?; (iii) being in safe hands; and (iv) smoking as an unexpected topic of discussion. Most of the participants felt they were in "safe hands", although thoughts about death were also evoked. However, the information about smoking cessation was unexpected, and the relationship between AAA and smoking unclear. Presenting the connection between AAA and smoking in a clear manner and motivating smoking cessation in an individually-targeted way are important.

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