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  • 1.
    Andersson, Ewa
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Sjöstrand-Strand, Annica
    Willman, Ania
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Borglin, Gunilla
    Registered nurses views of caring in coronary care: a deductive and inductive content analysis2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 23-24, p. 3481-3493Article in journal (Refereed)
    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.

  • 2. Hertzberg, Annika
    et al.
    Ekman, Sirkka-Liisa
    Axelsson, Karin
    "Relatives are a Resource, but...": Registered Nurses' Views and Experiences of Relatives of Residents in Nursing Homes2003In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 3, p. 431-441Article in journal (Refereed)
    Abstract [en]

    Registered Nurses (RNs) working in nursing homes in Sweden have obligations towards the residents' relatives, besides the care of residents. Relatives' involvement and satisfaction with the care partly depend on their contacts and communication with the staff. • This study aimed to explore and describe RNs' views and experiences of relatives of residents who live in nursing homes. • Open interviews were conducted with 19 RNs at three nursing homes. The verbatim-transcribed interviews were subjected to qualitative content analysis. • Relatives were seen as a resource (with some restrictions) and nice, although demanding. The RNs saw relatives as part of their work - a part that could be time-consuming and had low priority. • Interviewees noticed a difference between young and old relatives, and between female and male relatives. • A large proportion of accounts could be related to issues about communication and interpersonal relationships with relatives. • Building a trusting relationship with relatives may result in them being involved in residents' care and thus giving the nurses time rather than consuming time.

  • 3.
    Lindberg, Catharina
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Fagerström, Cecilia
    Linnéuniversitetet, SWE.
    Willman, Ania
    Malmö Universitet, SWE.
    Patient autonomy in a high-tech care context: A theoretical framework2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 21-22, p. 4128-4140Article in journal (Refereed)
    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.

  • 4.
    Nilsson, Åsa
    et al.
    Luleå tekniska universitet, Omvårdnad.
    Skär, Lisa
    Luleå tekniska universitet, Omvårdnad.
    Söderberg, Siv
    Luleå tekniska universitet, Omvårdnad.
    Nurses' views of shortcomings in patent care encounters in one hospital in Sweden2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 19-20, p. 2807-2814Article in journal (Refereed)
    Abstract [en]

    Aim and objectiveTo describe nurses' views of shortcomings in patient care encounters in one hospital in Sweden.BackgroundShortcomings in encounters in healthcare have increased during recent years. Dissatisfaction with encounters in healthcare can affect patients' experiences of dignity, health and well-being.DesignA qualitative design was used in the study.MethodsThree focus group discussions with 15 nurses were conducted. The nurses worked in five different wards. The focus group discussions were subjected to a thematic content analysis.ResultsThe results are presented in two themes. The first theme, ‘Disregard for the patient's unique nursing needs’, describes that information without consideration of the patient's needs, and nurses not being completely present in the meeting with the patient affected healthcare encounters and experiences of quality of care. In the second theme, ‘Difficulty managing obstacles’, nurses described care situations over which they could not always prevail due to lack of time and/or lack of awareness of the patient's vulnerability.ConclusionThe findings illustrate the importance of nurses and their approaches to patients. The nurse's attitude is important for the patient's experiences of participation, security, dignity, and well-being. The findings also illustrate the importance of routines in the healthcare organisation that support and facilitate positive encounters between patients, their close relatives and the healthcare staff.Relevance to clinical practiceNurses require understanding, presence and commitment in their relationships to every unique patient, and their goal should be to adopt interventions with regard to positive healthcare encounters based on each patient's experiences of good nursing care.

  • 5.
    Nygren Zotterman, Anna
    et al.
    Lulea Univ Technol, SWE.
    Skär, Lisa
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Olsson, Malin
    Lulea Univ Technol, SWE.
    Söderberg, Siv
    Mid Sweden Univ, SWE.
    Being in togetherness: Meanings of encounters within primary healtcare setting for patients living with long-term illness2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 19-20, p. 2854-2862Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: The aim of this study was to elucidate meanings of encounters for patients with long-term illness within the primary healthcare setting. Background: Good encounters can be crucial for patients in terms of how they view their quality of care. Therefore, it is important to understand meanings of interactions between patients and healthcare personnel. Design: A phenomenological hermeneutic method was used to analyse the interviews. Methods: Narrative interviews with ten patients with long-term illness were performed, with a focus on their encounters with healthcare personnel within the primary healthcare setting. A phenomenological hermeneutical approach was used to interpret the interview texts. Results: The results demonstrated that patients felt well when they were seen as an important person and felt welcomed by healthcare personnel. Information and follow-ups regarding the need for care were essential. Continuity with the healthcare personnel was one way to establish a relationship, which contributed to patients’ feelings of being seen and understood. Good encounters were important for patients’ feelings of health and well-being. Being met with mistrust, ignorance and nonchalance had negative effects on patients’ perceived health and well-being and led to feelings of lower confidence regarding the care received. Conclusions: Patients described a great need to be confirmed and met with respect by healthcare personnel, which contributed to their sense of togetherness. Having a sense of togetherness strengthened patient well-being. Relevance to clinical practice: By listening and responding to patients’ needs and engaging in meetings with patients in a respectful manner, healthcare personnel can empower patients’ feelings of health and well-being. Healthcare personnel need to be aware of the significance of these actions because they can make patients experience feelings of togetherness, even if patients meet with different care personnel at each visit. © 2016 John Wiley & Sons Ltd.

  • 6. Wann-Hansson, Christine
    et al.
    Hagell, Peter
    Willman, Ania
    Commentary on Wann-Hannson C, Hagell P, Willman A (2008) Risk factors and prevention among patients with hospital-acquired and pre-existing pressure ulcers in an acute care hospital. Journal of Clinical Nursing 17, 1718-1727 Response2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 23, p. 3257-3258Article in journal (Refereed)
  • 7. Wann-Hansson, Christine
    et al.
    Hagell, Peter
    Willman, Ania
    Risk factors and prevention among patients with hospital-acquired and pre-existing pressure ulcers in an acute care hospital2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 13, p. 1718-1727Article in journal (Refereed)
    Abstract [en]

    Thisstudy aimed to describe and identify risk factors associated with hospital-acquired pressure ulcers among adults in an acute care hospital compared with patients with pre-existing pressure ulcers present on admission. A further aim was to identify the preventive measures performed with both groups respectively. Pressure ulcers occur most often in older and immobile persons with severe acute illness and neurological deficits. However, few studies have adressed risk factors that are associated with hospital-acquired pressure ulcers compared with patients with pre-existing pressure ulcers. A point prevalence study with a cross-sectional survey design was conducted at a Swedish university hospital. Data on 535 patients were recorded using a modified version of the protocol developed and tested by the European Pressure Ulcer Advisory Panel, including the Braden scale for risk assessment. The prevalence of pressure ulcers was 27% (95% confidence interval, 23-31%.) Higher age and total Braden score below 17 were significantly associated with the presence of pressure ulcers. Among individual risk factors higher age, limited activity level and friction and shear while seated or lying down were associated with hospital-acquired pressure ulcers, whereas only higher age and friction and shear were associated with the presence of pressure ulcers in the overall sample. There was an overall sparse use of preventive measures to relieve pressure. The findings of the present study revealed that pressure ulcers and the insufficient use of preventive measure to relieve pressure is still a problem in acute care settings. A continued focus must be placed on staff training in identifying patients at risk for pressure ulcers development.

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