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Willman, Ania
Publications (10 of 66) Show all publications
Lindberg, C., Fagerström, C. & Willman, A. (2018). Patient autonomy in a high-tech care context: A theoretical framework. Journal of Clinical Nursing, 27(21-22), 4128-4140
Open this publication in new window or tab >>Patient autonomy in a high-tech care context: A theoretical framework
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 21-22, p. 4128-4140Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: To synthesise and interpret previous findings with the aim of developing a theoretical framework for patient autonomy in a high-tech care context. Background: Putting the somewhat abstract concept of patient autonomy into practice can prove difficult as when it is highlighted in healthcare literature, the patient perspective is often invisible. Autonomy presumes that a person has experience, education, self-discipline and decision-making capacity. Reference to autonomy in relation to patients in high-tech care environments could therefore be considered paradoxical, as in most cases, these persons are vulnerable, with impaired physical and/or metacognitive capacity, thus making extended knowledge of patient autonomy for these persons even more important. Design: Theory development. Methods: The basic approaches in theory development by Walker and Avant were used to create a theoretical framework through an amalgamation of the results from three qualitative studies conducted previously by the same research group. Results: A theoretical framework-the control-partnership-transition framework-was delineated disclosing different parts cocreating the prerequisites for patient autonomy in high-tech care environments. Assumptions and propositional statements that guide theory development were also outlined, as were guiding principles for use in day-to-day nursing care. Four strategies used by patients were revealed as follows: the strategy of control, the strategy of partnership, the strategy of trust and the strategy of transition. Conclusions: An extended knowledge base, founded on theoretical reasoning about patient autonomy, could facilitate nursing care that would allow people to remain/become autonomous in the role of patient in high-tech care environments. Relevance to clinical practice: The control-partnership-transition framework would be of help in supporting and defending patient autonomy when caring for individual patients, as it provides an understanding of the strategies employed by patients to achieve autonomy in high-tech care contexts. The guiding principles for patient autonomy presented could be used in nursing guidelines. © 2018 John Wiley & Sons Ltd.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
Autonomy, Caring, Concept development, High-tech care, Metasynthesis, Theory development
National Category
Nursing
Identifiers
urn:nbn:se:bth-16929 (URN)10.1111/jocn.14562 (DOI)000446561500030 ()2-s2.0-85050941568 (Scopus ID)
Available from: 2018-08-21 Created: 2018-08-21 Last updated: 2018-10-30Bibliographically approved
Lindvall, A., Kristensson, J., Willman, A. & Holst, G. (2016). Informal Care Provided by Family Caregivers Experiences of Older Adults With Multimorbidity. Journal of Gerontological Nursing, 42(8), 24-31
Open this publication in new window or tab >>Informal Care Provided by Family Caregivers Experiences of Older Adults With Multimorbidity
2016 (English)In: Journal of Gerontological Nursing, ISSN 0098-9134, E-ISSN 1938-243X, Vol. 42, no 8, p. 24-31Article in journal (Refereed) Published
Abstract [en]

Informal care given by family caregivers is an important part of the total care provided to older adults with multimorbidity. The current study aimed to describe how older adults with multimorbidity experienced care from family caregivers. Interviews were conducted with 24 participants (mean age = 86 years). Older adults with multimorbidity felt gratitude toward family caregivers for their willingness to help with everyday life and for representing their interests in contacts with health care providers. Family caregivers also had a significant impact on older adults' psychological well-being. However, the results also showed that older adults often felt they were a burden to their family caregivers and that their independence might be reduced. Older adults with multimorbidity should have the opportunity to be more involved in and have more influence over their health care so that they do not have to depend on representation by family caregivers.

Place, publisher, year, edition, pages
SLACK INC., 2016
Keywords
QUALITY-OF-LIFE; MULTIPLE CHRONIC CONDITIONS; HEALTH-CARE; HOME; DEPRESSION; PREVALENCE; MORBIDITY; SUPPORT
National Category
Nursing Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:bth-13503 (URN)10.3928/00989134-20160615-06 (DOI)000386651400004 ()27319404 (PubMedID)
Available from: 2016-11-25 Created: 2016-11-25 Last updated: 2018-01-13Bibliographically approved
Lindberg, C., Sivberg, B., Willman, A. & Fagerström, C. (2015). A trajectory towards partnership in care - Patient experiences of autonomy in intensive care: A qualitative study. Intensive & Critical Care Nursing, 31(5), 294-302
Open this publication in new window or tab >>A trajectory towards partnership in care - Patient experiences of autonomy in intensive care: A qualitative study
2015 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 31, no 5, p. 294-302Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to describe and elucidate patient experiences of autonomy in an intensive care context from a caring perspective. Background: Patients in intensive care units (ICUs) are critically ill and in a dependent and vulnerable position. There is thus a risk of staff taking command not only of the patients’ vital functions but also of their decision-making. Methods: A qualitative design was selected. Individual interviews were conducted with 11 adult patients with an intensive care episode of two days or more at six Swedish ICUs. The data were analysed using Inductive Content Analysis. Findings: Patient autonomy in intensive care was shown to be ’A trajectory towards partnership in care depending on state of health and mutual understanding’. It was experienced through acknowledged dependence, being recognised as a person, invited participation and becoming a co-partner in care. Conclusion: Patients in need of intensive care wanted to be involved in making decisions about their care as this creates a trusting and healthy care environment. Greater awareness is required about the ICU patient not only being a passive care recipient but also an active agent and where involvement in decision-making and participation in care are crucial. © 2015 Elsevier Ltd.

Keywords
Caring; Content analysis; Intensive care; Interviews; Patient Autonomy; Qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:bth-10886 (URN)10.1016/j.iccn.2015.04.003 (DOI)000362147700005 ()2-s2.0-84941738418 (Scopus ID)
Available from: 2015-10-26 Created: 2015-10-26 Last updated: 2018-08-27Bibliographically approved
Hjelm, M., Holmgren, A.-C., Willman, A., Bohman, D. & Holst, G. (2015). Family members of older persons with multi-morbidity and their experiences of case managers in Sweden: an interpretive phenomenological approach. International Journal of Integrated Care, 15(Jan-Mar)
Open this publication in new window or tab >>Family members of older persons with multi-morbidity and their experiences of case managers in Sweden: an interpretive phenomenological approach
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2015 (English)In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 15, no Jan-MarArticle in journal (Refereed) Published
Abstract [en]

Background: Family members of older persons (75+) with multi-morbidity are likely to benefit from utilising case management services performed by case managers. However, research has not yet explored their experiences of case managers. Objectives: The aim of the study was to deepen the understanding of the importance of case managers to family members of older persons (75+) with multi-morbidity. Design: The study design was based on an interpretive phenomenological approach. Method: Data were collected through individual interviews with 16 family members in Sweden. The interviews were analysed by means of an interpretive phenomenological approach. Results: The findings revealed one overarching theme: “Helps to fulfil my unmet needs”, based on three sub-themes: (1) “Helps me feel secure – Experiencing a trusting relationship”, (2) “Confirms and strengthens me – Challenging my sense of being alone” and (3) “Being my personal guide – Increasing my competence”. Conclusion and discussion: The findings indicate that case managers were able to fulfil unmet needs of family members. The latter recognised the importance of case managers providing them with professional services tailored to their individual needs. The findings can contribute to the improvement of case management models not only for older persons but also for their family members.

Place, publisher, year, edition, pages
Igitur publishing, 2015
Keywords
case management, integrated care, family members, interpretive phenomenology, multi-morbidity, older persons
National Category
Nursing
Identifiers
urn:nbn:se:bth-6326 (URN)000352658200010 ()oai:bth.se:forskinfo937D754C744053A5C1257E22004A23E7 (Local ID)oai:bth.se:forskinfo937D754C744053A5C1257E22004A23E7 (Archive number)oai:bth.se:forskinfo937D754C744053A5C1257E22004A23E7 (OAI)
External cooperation:
Note

Open Access Journal

Available from: 2015-05-26 Created: 2015-04-09 Last updated: 2017-12-04Bibliographically approved
Westergren, A., Broman, J.-E., Hellström, A., Fagerstrom, C., Willman, A. & Hagell, P. (2015). Measurement properties of the Minimal Insomnia Symptom Scale as an insomnia screening tool for adults and the elderly. Sleep Medicine, 16(3), 379-384
Open this publication in new window or tab >>Measurement properties of the Minimal Insomnia Symptom Scale as an insomnia screening tool for adults and the elderly
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2015 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 16, no 3, p. 379-384Article in journal (Refereed) Published
Abstract [en]

Background: The psychometric properties of the three-item Minimal Insomnia Symptom Scale (MISS) were evaluated using the classical test theory. Different cut-offs for identifying insomnia were suggested in two age groups (>= 6 and >= 7 among adult and elderly people, respectively). The aim of the present study was to test the measurement properties of the MISS using the Rasch measurement model, with special emphasis on differential item functioning by gender and age. Methods: Cross-sectional MISS data from adult (age 20-64 years, n = 1075) and elderly (age 65+, n = 548) populations were analysed using the Rasch measurement model. Results: Data generally met Rasch model requirements and the scale could separate between two distinct groups of people. Differential item functioning was found by age but not gender. The difference between the adult and elderly samples was lower for the originally recommended >= 6 points cut-off (0.09 logits) than for the >= 7 points cut-off (0.23 logits), but greater at the lower and higher ends of the scale. Conclusions: This study provides general support for the measurement properties of the MISS. Caution should be exercised in comparing raw MISS scores between age groups, but applying a = 6 cut-off appears to allow for valid comparisons between adults and the elderly regarding the presence of insomnia. Nevertheless, additional studies are needed to determine the clinically optimal cut-score for identification of insomnia. (C) 2014 Elsevier B.V. All rights reserved.

Keywords
MISS, Psychometric properties, Clinical insomnia, Invariant comparisons, Targeting, Reliability
National Category
Nursing
Identifiers
urn:nbn:se:bth-697 (URN)10.1016/j.sleep.2014.10.016 (DOI)000351714400014 ()25666846 (PubMedID)
Available from: 2015-05-26 Created: 2015-05-26 Last updated: 2017-12-04Bibliographically approved
Sandström, B., Willman, A., Svensson, B. & Borglin, G. (2015). Perceptions of national guidelines and their (non) implementation in mental healthcare: a deductive and inductive content analysis. Implementation Science, 10(1), Article ID 43.
Open this publication in new window or tab >>Perceptions of national guidelines and their (non) implementation in mental healthcare: a deductive and inductive content analysis
2015 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 10, no 1, article id 43Article in journal (Refereed) Published
Abstract [en]

Background: National guidelines are being produced at an increasing rate, and politicians and managers are expected to promote these guidelines and their implementation in clinical work. However, research seldom deals with how decision-makers can perceive these guidelines or their challenges in a cultural context. Therefore, the aim of this study was twofold: to investigate how well Promoting Action on Research Implementation in Health Services (PARIHS) reflected the empirical reality of mental healthcare and to gain an extended understanding of the perceptions of decision-makers operating within this context, in regard to the implementation of evidence-based guidelines. Methods: The study took place in the southeast of Sweden and employed a qualitative design. The data were collected through 23 interviews with politicians and managers working either in the county council or in the municipalities. The transcribed text was analysed iteratively and in two distinct phases, first deductively and second inductively by means of qualitative content analysis. Results: Our deductive analysis showed that the text strongly reflected two out of three categorisation matrices, i.e. evidence and context representing the PARIHS framework. However, the key element of facilitation was poorly mirrored in the text. Results from the inductive analysis can be seen in light of the main category sitting on the fence; thus, the informants' perceptions reflected ambivalence and contradiction. This was illustrated by conflicting views and differences in culture and ideology, a feeling of security in tradition, a certain amount of resistance to change and a lack of role clarity and clear directions. Together, our two analyses provide a rich description of an organisational culture that is highly unlikely to facilitate the implementation of the national guidelines, together with a distrust of the source behind such guidelines, which stands in stark contrast to the high confidence in the knowledge of experienced people in authority within the organisational context. Conclusions: Our findings have highlighted that, regardless of by whom guidelines are released, they are not likely to be utilised or implemented if those who are responsible for implementing them do not trust the source. This aspect (i.e. contextual trust) is not covered by PARIHS.

Keywords
Evidence-based practice, Guidelines, Implementation, Mental health, Nursing, PARIHS, Qualitative research
National Category
Nursing Psychiatry
Identifiers
urn:nbn:se:bth-702 (URN)10.1186/s13012-015-0234-0 (DOI)000352605700001 ()25888854 (PubMedID)
External cooperation:
Available from: 2015-05-26 Created: 2015-05-26 Last updated: 2017-12-04Bibliographically approved
Andersson, E., Willman, A., Sjöstrom-Strand, A. & Borglin, G. (2015). Registered nurses’ descriptions of caring: a phenomenographic interview study. BMC Nursing, 14(1), Article ID Article number 16.
Open this publication in new window or tab >>Registered nurses’ descriptions of caring: a phenomenographic interview study
2015 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 14, no 1, article id Article number 16Article in journal (Refereed) Published
Abstract [en]

Background: Nursing has come a long way since the days of Florence Nightingale and even though no consensus exists it would seem reasonable to assume that caring still remains the inner core, the essence of nursing. In the light of the societal, contextual and political changes that have taken place during the 21st century, it is important to explore whether these might have influenced the essence of nursing. The aim of this study was to describe registered nurses’ conceptions of caring. Methods: A qualitative design with a phenomenographic approach was used. The interviews with twenty-one nurses took place between March and May 2013 and the transcripts were analysed inspired by Marton and Booth’s description of phenomenography. Results: The analysis mirrored four qualitatively different ways of understanding caring from the nurses’ perspective: caring as person-centredness, caring as safeguarding the patient’s best interests, caring as nursing interventions and caring as contextually intertwined. Conclusion: The most comprehensive feature of the nurses’ collective understanding of caring was their recognition and acknowledgment of the person behind the patient, i.e. person-centredness. However, caring was described as being part of an intricate interplay in the care context, which has impacted on all the described conceptions of caring. Greater emphasis on the care context, i.e. the environment in which caring takes place, are warranted as this could mitigate the possibility that essential care is left unaddressed, thus contributing to better quality of care and safer patient care.

Place, publisher, year, edition, pages
BioMed Central/Springer, 2015
Keywords
Caring, Conceptions, Interviews, Nursing, Registered nurses, Person-centredness, Phenomenography, Qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:bth-6391 (URN)10.1186/s12912-015-0067-9 (DOI)000210484900015 ()
Available from: 2015-04-01 Created: 2015-04-01 Last updated: 2017-12-04Bibliographically approved
Andersson, E., Sjöstrand-Strand, A., Willman, A. & Borglin, G. (2015). Registered nurses views of caring in coronary care: a deductive and inductive content analysis. Journal of Clinical Nursing, 24(23-24), 3481-3493
Open this publication in new window or tab >>Registered nurses views of caring in coronary care: a deductive and inductive content analysis
2015 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 23-24, p. 3481-3493Article in journal (Refereed) Published
Abstract [en]

Aims and objectives

To extend nurses’ descriptions of how they understood caring, as reflected in the findings of an earlier study (i.e. the hierarchical outcome space) and to gain additional understandings and perspectives of nurses’ views of caring in relation to a coronary care patient case.

Background

Scientific literature from the 1970s–1990s contains descriptions of caring in nursing. In contrast, the contemporary literature on this topic – particularly in the context of coronary care – is very sparse, and the few studies that do contain descriptions rarely do so from the perspective of nurses.

Design

Qualitative descriptive study.

Methods

Twenty-one nurses were interviewed using the stimulated recall interview technique. The data were analysed using deductive and inductive qualitative content analysis.

Results

The results of the iterative and integrated content analysis showed that the data mainly reproduced the content of the hierarchical outcome space describing how nurses could understand caring; however, in the outcome space, the relationship broke up (i.e. flipped). The nurses’ views of caring could now also be understood as: person-centredness ‘lurking’ in the shadows; limited ‘potential’ for safeguarding patients’ best interests; counselling as virtually the ‘only’ nursing intervention; and caring preceded by the ‘almighty’ context. Their views offered alternative and, at times, contrasting perspectives of caring, thereby adding to our understanding of it.

Conclusion

Caring was described as operating somewhere between the nurses caring values and the contextual conditions in which caring occurred. This challenged their ability to sustain caring in accordance with their values and the patients’ preferences.

Relevance to clinical practice

To ensure that the essentials of caring are met at all times, nurses need to plan and deliver caring in a systematic way. The use of systematic structures in caring, as the nursing process, can help nurses to work in a person-centred way, while sustaining their professional values.

Place, publisher, year, edition, pages
John Wiley & Sons, 2015
Keywords
caring;content analysis;context;deductive analysis;inductive analysis;nursing;qualitative design
National Category
Nursing
Identifiers
urn:nbn:se:bth-11222 (URN)10.1111/jocn.12975 (DOI)000368277900016 ()
Available from: 2015-12-16 Created: 2015-12-16 Last updated: 2017-12-01Bibliographically approved
Hjelm, M., Holst, G., Willman, A., Bohman, D. & Kristensson, J. (2015). The work of case managers as experienced by older persons (75+) with multi-morbidity – a focused ethnography. BMC Geriatrics, 15, Article ID 168.
Open this publication in new window or tab >>The work of case managers as experienced by older persons (75+) with multi-morbidity – a focused ethnography
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2015 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, article id 168Article in journal (Refereed) Published
Abstract [en]

Background

Complex health systems make it difficult for older persons (75+) with multi-morbidity to achieve continuity of care. Case management could be one way to address this difficulty. Currently, there is a need to extend the knowledge regarding case management as experienced by those utilising the services, namely older persons (75+) with multi-morbidity. The study aimed to explore older persons’ (75+) with multi-morbidity experiences of case managers.

Methods

The study design was qualitative and used a focused ethnographic approach. Data was collected through individual interviews with 13 older persons and by participant observations with accompanying field notes, all conducted in 2012–2013.

Results

The data revealed four themes illustrating the older persons’ experiences of case managers:

1) Someone providing me with a trusting relationship; 2) Someone assisting me; 3) Someone who is on my side; and 4) Someone I do not need at present.

Conclusions

This study illustrates the importance of establishing trusting relationships between older persons and their case managers in order to truly provide assistance. The older persons valued the case managers acting as informed but unbiased facilitators. The findings could be of help in the development of case management interventions better designed for older persons with multi-morbidity.

Keywords
Aged, Case management, Comorbidity, Continuity of patient care, Delivery of health care, Ethnography, Intervention, Multi-morbidity, Qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:bth-11231 (URN)10.1186/s12877-015-0172-3 (DOI)000366545100001 ()
Available from: 2015-12-18 Created: 2015-12-18 Last updated: 2017-12-01Bibliographically approved
Hellström, A., Hellström, P., Willman, A. & Fagerström, C. (2014). Association between Sleep Disturbances and Leisure Activities in the Elderly: A Comparison between Men and Women.. Sleep Disorders, 2014(Article ID 595208)
Open this publication in new window or tab >>Association between Sleep Disturbances and Leisure Activities in the Elderly: A Comparison between Men and Women.
2014 (English)In: Sleep Disorders, ISSN 2090-3545, E-ISSN 2090-3553, Vol. 2014, no Article ID 595208Article in journal (Refereed) Published
Abstract [en]

It has been suggested that physical or social activity is associated with fewer sleep disturbances among elderly people. Women report more sleep disturbances than men, which could indicate a variation in activity patterns between the genders. The aim of this study was to investigate associations between sleep disturbances and leisure activities in men and women (n = 945) aged ≥60 years in a Swedish population. Sleep disturbances were measured using eight dichotomous questions and seventeen variables, covering a wide range of leisure activities. Few leisure activities were found to be associated with sleep disturbances and their importance decreased when the models were adjusted for confounders and gender interactions. After clustering the leisure activities and investigating individual activities, socio-intellectual activities were shown to be significant for sleep. However, following adjustment for confounders and gender interactions, home maintenance was the only activity significant for sleep. Being a female increased the effect of home maintenance. Besides those leisure activities, poor/fair self-rated health (OR 7.50, CI: 4.27-11.81) and being female (OR 4.86, CI: 2.75-8.61) were found to have the highest association with poor sleep. Leisure activities pursued by elderly people should focus on activities of a socio-intellectual nature, especially among women, to promote sleep.

Place, publisher, year, edition, pages
Hindawi, 2014
Keywords
Gender differences, Leisure activities, Elderly people, Sleep disturbances
National Category
Nursing Medical and Health Sciences
Identifiers
urn:nbn:se:bth-6701 (URN)10.1155/2014/595208 (DOI)oai:bth.se:forskinfoFB4A5B46046D38EAC1257CDE0044EDD0 (Local ID)oai:bth.se:forskinfoFB4A5B46046D38EAC1257CDE0044EDD0 (Archive number)oai:bth.se:forskinfoFB4A5B46046D38EAC1257CDE0044EDD0 (OAI)
External cooperation:
Note

Open access journal

Available from: 2014-05-21 Created: 2014-05-20 Last updated: 2017-12-04Bibliographically approved
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