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  • 1.
    Andersson, Ewa
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Borglin, Gunilla
    Blekinge Institute of Technology, School of Health Science.
    Sjöström-Strand, Annica
    Willman, Ania
    Blekinge Institute of Technology, School of Health Science.
    Standing alone when life takes an unexpected turn: Being a midlife next of kin of a relative who has suffered a myocardial infarction2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 4, p. 864-871Article in journal (Refereed)
    Abstract [en]

    Background: Suffering a myocardial infarction (MI) is a life-threatening event that impacts not only on the individual concerned but also on the next of kin. However, there seems to be a paucity of naturalistic inquiries that focus specifically on midlife next of kin and their experience of being close to a relative who has suffered an MI. This study aims to elucidate the experience of being a midlife next of kin of a relative who has suffered a myocardial infarction. Method: Nine women and four men in midlife participated in the focused interviews, which were conducted and analysed during 2010/2011 using Lindseths and Norbergs' description of the phenomenological hermeneutical method. Findings: Four themes - Solely responsible, Lurking unease, Left out of the picture and Life on hold - formed the basis of the core theme Standing alone when life takes an unexpected turn. The core theme was interpreted as a central phenomenon encompassing the experience of being solely responsible for the well-being of their relative and the family, thus putting their own life on hold. The core theme also reflected the next of kin's experience of being left out of the picture when it came to the relative's care before and after the MI. Conclusion: The next of kin's negative feelings of standing alone were further intensified by their experience of being left out of the picture by the healthcare professionals concerning their relative's care. As a cardiac nurse, it would seem essential to have knowledge about the experiences of next of kin in connection with a relative's MI event. Such knowledge can facilitate the planning and organisation of nursing care and at the same time address the next of kin's role in the recovery and rehabilitation process.

  • 2.
    Andersson, Ewa
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Borglin, Gunilla
    Blekinge Institute of Technology, School of Health Science.
    Willman, Ania
    Blekinge Institute of Technology, School of Health Science.
    The experience of younger adults following myocardial infarction2013In: Qualitative Health Research, ISSN 1049-7323 , Vol. 23, no 6, p. 762-772Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to elucidate the meaning of the experience of younger people (< 55 years) during their first year following a myocardial infarction. We analyzed 17 interviews using a phenomenological-hermeneutic method. The core theme and central phenomenon was the everyday fight to redress the balance in life, which encompassed an existential, physical, and emotional battle to regain a foothold in daily life. The aftermath of a life-threatening event involved a process of transition while at the same time creating a new meaning in life. Lack of energy and its impact on the complex interplay of midlife combined with unreasonable demands from employers and health care professionals seemed to color the experience of the informants. The knowledge gained in this study can constitute a valuable contribution to overall quality assurance in nursing care and the development of nursing interventions for the cardiac rehabilitation of younger patients.

  • 3.
    Bohman, Doris
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Borglin, Gunilla
    Blekinge Institute of Technology, School of Health Science.
    Student exchange for nursing students: Does it raise cultural awareness'? A descriptive, qualitative study2014In: Nurse Education in Practice, ISSN 0260-6917, Vol. 14, no 3, p. 259-264Article in journal (Refereed)
    Abstract [en]

    With free movement for citizens within the European Union and with distant parts of our globe becoming more accessible, cultural awareness and cultural competence are becoming important skills for nurses. Internationalisation and raising awareness of other cultural contexts are essential elements in Swedish higher education, thus explaining the variety of student exchange programmes that are available. The aim of this study was to explore Swedish nursing students' perceptions of student exchange and their experiences. Data were collected through group interviews and then analysed following the principles of content analysis. Our analysis resulted in three categories: Preparing to go abroad, Reasons for going abroad and From expectation to experience. Cultural aspects and cultural awareness were emphasised as strong motivational factors, both personal and professional, behind participation in student exchange programmes. Information was also highlighted as a crucial means of reaching potential students as well as the power of knowledge through personal experience. This study highlights the importance of student exchange in expanding the individual student's personal and professional horizons. It also stresses the importance of including a transcultural nursing element in nursing curricula.

  • 4.
    Borglin, Gunilla
    Blekinge Institute of Technology, School of Health Science.
    Promoting Critical Thinking and Academic Writing Skills in Nurse Education2012In: Nurse Education Today, ISSN 0260-6917, Vol. 32, no 5, p. 611-3Article in journal (Refereed)
    Abstract [en]

    Although academic skills, conceptualised as writing and critical thinking, are a vital part of university studies, research indicates that many students leave without having mastered these skills effectively. This research also reflects on nursing students. Nursing could also be said to be hampered by a number of complex educational challenges that are likely to impact on the academic socialisation process in general. These challenges include being a relatively ‘young’ academic discipline, the ‘theory–practice’ divide, a knowledge bed lying on a complex intersection of two ‘antithetical sciences’ and, at least in the Scandinavian countries, an increasing number of nurse educators with a PhD in nursing science but with limited time to develop their own teaching skills. In combination, these challenges have the potential to act as stumbling blocks, both from a teaching and learning perspective. I would suggest that a departure in teaching fromtheoretical educational models, such as Lea and Street's ‘academic literacies model,’ including skills, socialisation and academic literacy models simultaneously, could be one of several ways forward to create a learning environment that takes these issues into account.

  • 5. Borglin, Gunilla
    et al.
    Fagerstrom, Cecilia
    Nursing students understanding of critical thinking and academic writing.2010Conference paper (Refereed)
  • 6.
    Borglin, Gunilla
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Fagerström, Cecilia
    Blekinge Institute of Technology, School of Health Science.
    Nursing students understanding of critical thinking and appraisal and academic writing: A descriptive qualitative study2012In: Nurse Education in Practice, ISSN 0260-6917, Vol. 12, no 6, p. 356-360Article in journal (Refereed)
    Abstract [en]

    In Sweden, regulations from the National Agency for Higher Education advocate an education that equips students with independence as well as critical, problem-based thinking, i.e. academic literacy skills. However, some research findings indicate that students may leave higher education without mastering these skills effectively. As part of quality-assuring a nursing programme at a university college in south-east Sweden we explored the nursing student's view of crucial academic literacy skills, such as critical thinking and appraisal and academic writing, by conducting a descriptive, qualitative study. Informants were recruited through an advertisement posted on the university's e-learning tool. Eight focused interviews were conducted during autumn 2010. The transcribed interviews were analysed – inspired by content analysis – and two categories became apparent: constantly questioning and formality before substance. The latter revealed a gap between the student's perception of academic writing and that of the educators, thus implying that nursing students might not be equipped with the tools they need to develop within academia. We suggest that students could benefit in their academic endeavours from theoretical educational models that integrate several academic skills simultaneously and which could be incorporated into the development of syllabuses and curriculums.

  • 7.
    Borglin, Gunilla
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Gustafsson, Markus
    Blekinge Institute of Technology, School of Health Science.
    Krona, Hans
    Blekinge Institute of Technology, School of Health Science.
    A theory-based educational intervention targeting nurses’ attitudes and knowledge concerning cancer-related pain management: A study protocol of a quasi-experimental design2011In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 11, no 233Article in journal (Refereed)
    Abstract [en]

    Background: Pain is one of the most frequent problems among patients diagnosed with cancer. Despite the availability of effective pharmacological treatments, this group of patients often receives less than optimal treatment. Research into nurses’ pain management highlights certain factors, such as lack of knowledge and attitudes and inadequate procedures for systematic pain assessment, as common barriers to effective pain management. However, educational interventions targeting nurses’ pain management have shown promise. As cancer-related pain is also known to have a negative effect on vital aspects of the patient’s life, as well as being commonly associated with problems such as sleep, fatigue, depression and anxiety, further development of knowledge within this area is warranted. Methods/design: A quasi-experimental study design will be used to investigate whether the implementation of guidelines for systematic daily pain assessments following a theory-based educational intervention will result in an improvement in knowledge and attitude among nurses. A further aim is to investigate whether the intervention that targets nurses’ behaviour will improve hospital patients’ perception of pain. Data regarding nurses’ knowledge and attitudes to pain (primary outcome), patient perception regarding pain (secondary outcome), together with socio-demographic variables, will be collected at baseline and at four weeks and 12 weeks following the intervention. Discussion: Nursing care is nowadays acknowledged as an increasingly complicated activity and “nursing complexity is such that it can be seen as the quintessential complex intervention.” To be able to change and improve clinical practice thus requires multiple points of attack appropriate to meet complex challenges. Consequently, we expect the theory-based intervention used in our quasi-experimental study to improve care as well as quality of life for this group of patients and we also envisage that evidence-based guidelines targeting this patient group’s pain will be implemented more widely. Trial Registration Number: ClinicalTrials.gov NCT01313234

  • 8. Borglin, Gunilla
    et al.
    Richards, David A.
    Bias in experimental nursing research: Strategies to improve the quality and explanatory power of nursing science2010In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 47, no 1, p. 123-128Article in journal (Refereed)
    Abstract [en]

    In a guest editorial in this journal, Rahm Hallberg [Rahm Hallberg, I., 2006. Challenges for future nursing research: providing evidence for health-care practice. International Journal of Nursing Studies 43, 923–927] called for research which has greater explanatory power to determine the effectiveness of nursing interventions. In this paper we critique the suggestion made by the evidence-based nursing movement that randomisation per se is the principal route to better quality nursing research. In contrast, we evaluate the new CONSORT criteria for pragmatic RCTs, which assess the quality of strategies to reduce selection, performance, attrition and detection biases, allowing many different types of comparative studies to be covered by application of the checklist. We propose that randomisation alone is a necessary but insufficient strategy and that nursing researchers rise to Rahm Hallberg’s challenge by adopting the extended criteria to assist in the critical appraisal, design and reporting of all experimental research in nursing.

  • 9. Fagerström, Cecilia
    et al.
    Borglin, Gunilla
    Mobility, functional ability and health-related quality of life among people 60 years and older2010In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 22, no 5, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Knowledge about Health-Related Quality of Life (HRQoL) in advanced age is sparse. This study investigated to what extent mobility factors explained older people’s HRQoL when age, gender and functional ability (ADL) were controlled for. Methods: Subjects were 1128 people aged 60-96 participating in a Swedish longitudinal multi-center cohort study. Besides descriptive and correlation statistics, a three-tier multiple logistic regression analysis was performed, which included the ADL scale, mobility tests and items, with physical and mental HRQoL as outcome variables. Results: In the models containing the control variables, functional ability was found to be associated with both physical and mental HRQoL. In the models including both functional ability and mobility factors, the importance of functional ability remained for mental but not for physical HRQoL. The mobility factors were found to have a stronger negative influence on HRQoL, i.e., physical and mental, than functional ability in itself. Conclusions: For optimal identification of various types of disabilities and their impact on older people’s HRQoL, the ADL scale should be used together with more targetspecific tests of disabilities. However, in certain situations, it appears that one mobility factor alone – the ability to walk – has the capacity to pick up changes in both physical and mental HRQoL. Thus, it is important that healthcare professionals should focus activities toward maintaining older people’s mobility as a means of enhancing their HRQoL.

  • 10. Fagerström, Cecilia
    et al.
    Borglin, Gunilla
    Mobility, functional ability and quality-of-life among people of 60 years or older2009Conference paper (Refereed)
    Abstract [en]

    It is well known that reduced ability to perform activities of daily living (ADL) and declining mobility are both related to advanced age. This relation is also valid for low quality-of-life. It is not, however, the advanced age per se that causes the low quality-of-life. Rather, it seems that it is the declining mobility that unable people to manage their daily lives satisfactory - a circumstance that is often overlooked, since the most frequently used measuring method, the ADL-scale, is mainly focusing on people's functional ability and not their mobility. Hence, the assumption and aim for this study has been to investigate to which extent mobility factors, in comparison to the control factors age, gender and ability to perform ADL, may explain low (physical) quality-of-life (SF-12, PCS-12). The study includes people (n=1402) aged 60-96, who participated in a baseline survey in one (Blekinge) of four included centres of the longitudinal and multi-centre cohort study, The Swedish National study on Ageing and Care (SNAC), in 2001, a study with a 61% response rate. Collected data indicated that mobility factors such as reduced ability either to walk a distance of 200 metres or less without stopping, or walking in stairs, or rising from a chair or opening a bottle played a crucial part when developing conditions of low (physical) quality-of-life (PCS-12), while control factors such as gender, age and ability to perform ADL, did not. The results suggest that multiple factors of reduced mobility, rather than impairment in ability to perform ADL, appear to increase the risk for low (physical) quality-of-life, and that targeting these phenomena in health care interventions, are essential.

  • 11. Fiddler, Magdalen
    et al.
    Borglin, Gunilla
    Galloway, Adrian
    Jackson, Carl
    McGowan, Linda
    Lovell, Karina
    Once-a-week psychiatric ward round or daily inpatient team meeting? A multidisciplinary mental health team’s experience of new ways of working2010In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 2, no 19, p. 119-127Article in journal (Refereed)
    Abstract [en]

    Evidence indicates that while service users are dissatisfied with current ward round practices, studies of how professionals experience this practice are sparse. This study highlights staff view of the once-a-week psychiatric ward round compared to a reformed ward round taking place every weekday. Interviews were conducted at one acute psychiatric ward in north-west England. Our analysis revealed a core theme, ‘forming a new way of working’, which could be understood from three themes. The theme, ‘bound by tradition’, emphasized how the traditional ward round represented a double-edged sword: it provided a safe structure, but it also highlighted a shared awareness of an urgent need to leave old ways of working behind. The process of change became discernable in the themes ‘juggling the change’ and ‘light at the end of the tunnel’, which showed that restructuring the traditional ward round was both possible and valued. We found that staff views on ward rounds are more complex than had been earlier understood, but new ways of working can be implemented, if the impact of tradition, the process of change, and the time to bed down are taken into account.

  • 12. Gustafsson, Ann-Sofie
    et al.
    Eriksson, Terese
    Andersson, Stefan
    Borglin, Gunilla
    Blekinge Institute of Technology, School of Health Science.
    The Occurrence of Problems in Connections with the Saphenous Vein Harvest Surgical Site: A Telephone Interview Project Three Months after Coronary Artery Bypass Grafting Surgery2012In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 32, no 1, p. 41-3Article in journal (Refereed)
    Abstract [en]

    Problems, such as slow-healing wounds and wound infections, arising at the saphenous vein harvest surgical site following Coronary Artery Bypass Grafting (CABG) surgery are more common than was previously thought. Few studies exist that addressing this and which at the same time adopt a nursing – patient perspective. This project came about when staff at the regional cardiothoracic intensive care unit was notified that a number of recently discharged patients were now attending the Tissue Viability Centre for wounds at the saphenous vein harvest site. It was therefore decided to investigate this in more detail as part of quality assuring the care provided at the unit. A telephone interview was conducted with 114 respondents who in the last three months had undergone a CABG. The aim was to explore how they perceived their general health and if they experienced any problems at the harvest site. Although no statistical significance was found concerning some of the well-known risk factors, 13.2% of them experienced problems at the harvest site. The findings indicate that the cardiothoracic nurse can have an important role to play at the pre-discharge stage with regard to the provision of information and support for this group of patients.

  • 13.
    Gustafsson, Markus
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health. Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health. Blekinge Institute of Technology, School of Health Science.
    Bohman, Doris M
    Blekinge Institute of Technology, School of Health Science.
    Gunilla, Borglin
    Blekinge Institute of Technology, School of Health Science.
    Challenges of conducting experimental studies within a clinical nursing context2014In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 27, no 2, p. 133-136Article in journal (Refereed)
    Abstract [en]

    In recent years, several distinguished scholars have advocated for nursing research that may carry strong evidence for practice. Their advocacy have highlighted that nursing science has reached a point where as nurse researchers we need to develop the questions we ask and design studies that have the power to produce solid, translational, evidence-based knowledge. To do so, we need to carry out experimental tests on complex, everyday nursing interventions and activities. We also need to create public space to present accounts of our endeavours pursuing this type of design in clinical practice. This paper will discuss some of the most important insights gained from conducting a quasi-experimental study in which the aim was to investigate the effect of a theory-based intervention, targeting knowledge and attitudes among registered nurses regarding cancer pain management. The importance of careful practical and methodological planning is emphasised and the need for participation-friendly interventions is discussed.

  • 14.
    Gustafsson, Markus
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Borglin, Gunilla
    Blekinge Institute of Technology, School of Health Science.
    Can a theory-based educational intervention change nurses' knowledge and attitudes concerning cancer pain management? a quasi-experimental design2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 328, p. 1-11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Registered Nurses (RNs) play an important role in caring for patients suffering from cancer pain. A lack of knowledge regarding pain management and the RNs' own perception of cancer pain could act as barriers to effective pain management. Educational interventions that target RNs' knowledge and attitudes have proved promising. However, an intervention consisting of evidence-based practice is a multifaceted process and demands behavioural and cognitive changes to sustain the effects of the intervention. Therefore, our study aimed to investigate if a theory-based educational intervention could change RNs' knowledge and attitudes to cancer pain and pain management, both four and 12 weeks after the start of the intervention. METHODS: A quasi-experimental design with non-equivalent control groups was used. The primary outcome was measured using a modified version of the instrument Nurses' Knowledge and Attitudes Survey Regarding Pain (NKAS) at baseline, four weeks and 12 weeks after the start of the intervention to evaluate its persistence. The intervention's educational curriculum was based on the principles of Ajzen's Theory of Planned Behaviour and consisted of interactive learning activities conducted in workshops founded on evidence-based knowledge. The RN's own experiences from cancer pain management were used in the learning process. RESULTS: The theory-based educational intervention aimed at changing RNs knowledge and attitudes regarding cancer pain management measured by primary outcome NKAS resulted in a statistical significant (p<0.05) improvement of total mean score from baseline to four weeks at the intervention ward. CONCLUSIONS: The findings of this study, suggest that a theory-based educational intervention focused at RNs can be effective in changing RN's knowledge and attitudes regarding cancer pain management. However, the high number of dropouts between baseline and four weeks needs to be taken into account when evaluating our findings. Finally, this kind of theory-based educational intervention with interactive learning activities has been sparsely researched and needs to be evaluated further in larger projects.Trial registration: Clinical Trials. Gov: NCT01313234.

  • 15. Holst, Göran
    et al.
    Willman, Ania
    Fagerström, Cecilia
    Borg, Christel
    Hellström, Ylva
    Borglin, Gunilla
    Quality of care: Prevention of pressure ulcers – Nursing students facilitating evidence-based practice2010In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 30, no 1, p. 40-42Article in journal (Refereed)
    Abstract [en]

    This development project was aimed at engaging nursing students in a project targeting the prevention and reduction of pressure ulcers on an education based hospital ward. An intervention was implemented based on systematic assessment, skin observation, together with training and educational sessions, i.e. on how to make risk assessments and how to prevent and treat a pressure ulcer, were carried out. The project demonstrated the importance of offering nursing students an environment for clinical practice which supports them in participating and developing patient care starting from Evidence-Based Practice. During the project no patients developed pressure ulcers while on the ward. The opportunity to act as facilitators of evidence-based methods was found to enhance student ability to draw conclusions and make connections between quality of care and end result.

  • 16. Olsson, Cecilia
    et al.
    Ringner, Anders
    Borglin, Gunilla
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Including systematic reviews in PhD programmes and candidatures in nursing Hobson's choice'?2014In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 14, no 2, p. 102-105Article in journal (Refereed)
    Abstract [en]

    Nowadays, gathering and synthesising evidence, i.e. conducting systematic reviews, is considered an important part of any health service research endeavour. Reviewing the literature, however suggest that it is not yet common that PhD students/doctoral candidates publish systematic reviews or even include a high quality review of the literature as a part of their PhD programme or candidature. Implying that systematic reviewing skills might not be acquired by going through an education on a postgraduate level. Additionally, scholars debating systematic reviews 'to be or not to be' as a part of research training seem to be sparse, especially within the field of nursing. In this issue for debate, we would like to propose that the absence of systematic reviews' in this context might severely hamper the 'up and coming' researchers as well as the research conducted. We envisage that this lack can have a negative impact on international nursing practice, and therefore propose that systematic reviews should be considered, whenever appropriate, as a mandatory part of any PhD programme or candidature. We believe that abilities in systematic reviewing will be a sought after research skills in the near future. Including systematic reviews would promote i) refined, well-grounded adequate research questions, ii) PhDs with broad and elevated methodological skills, iii) an increased level of evidence based nursing praxis. However, to make this a reality, supervisors, PhD students, and candidates would need to understand the value of this kind of research activity. Finally, lobbying University faculty boards and grant providers that are not inclined to view literature reviews as 'proper' research or as an important part of health service research, needs to be put on the agenda. (C) 2014 Elsevier Ltd. All rights reserved.

  • 17. Richards, David A.
    et al.
    Borglin, Gunilla
    Complex Interventions and Nursing: looking through a new lens at nursing research2011In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, no 5, p. 531-533Article in journal (Refereed)
    Abstract [en]

    In this Editorial we urge researchers in nursing to increase the volume of translational research by embracing new complex interventions research methods thinking. We introduce readers to a multi-state strategy, supported by eight European research funding bodies, which aims to develop an international nursing research faculty. This faculty will be equipped to design, plan and implement programmatic, mixed methods and complex interventions research in nursing. The aim of this strategy – the REFLECTION Research Network Programme – is to inculcate ‘complex intervention thinking’ in both experienced and the next generation of researchers in nursing. Nurses have a critical role to play in meeting health and social care challenges at the fore of global health concerns. These include an aging population, chronic diseases and new endemics. Nurses engage in an ever widening range of activities, many of which are highly complex and take place in multiple care environments including acute medicine, chronic care facilities, community and residential care homes. Example activities include patient education programmes; the coordination and delivery of packages of psychosocial care; support for patient self-care, etc. Changes in health care organisation internationally (e.g. short hospital periods and growing responsibility for patient self-care) are placing more health care in the hands of nurses, increasing the scope and the overall need for nursing care. Nursing is thus an increasingly complicated activity. Nursing is also an intervention. Whenever a nurse interacts with someone else to care for them or to teach other nurses, the nurse performs an intervention. Nursing's complexity is such that it can be seen as the quintessential ‘complex intervention’— defined as an activity that contains a number of component parts with the potential for interactions between them which, when applied to the intended target population, produces a range of possible and variable outcomes (Medical Research Council, 2008). Complex interventions are widespread throughout all of health and social care, from the apparently simple example of pharmacological treatment with its combination of biochemical, social and psychological factors influencing patient concordance and physiological response, to more obviously complex educational or psychological interventions where a multi-layered set of dynamic features have great bearing on ultimate effectiveness. Into this maelstrom of complexity comes the fact that the practice of nursing care is by no means assured to be benign. By failing to detect a health care need, giving poor advice or by incompetent and iatrogenic hands-on nursing care, nurses may harm patients (Grol, 2005). In an issue shared with other health care professions, the problem for many nurses is that the knowledge to improve their activities is often uncertain. This has led to multiple calls to improve nurses’ knowledge and for that knowledge to rest on a solid evidence-base. Whilst relatively new to the evidenced-based practice party, nurses have been urged to embrace the principles of the movement through undertaking more experimental tests of their activities ([Borglin and Richards, 2010], [Richards and Hammers, 2009] and [Thompson, 2004]). However, many nurses have strong cultural, epistemological and research traditions which are at odds with the positivist traditions of biomedicine. Nursing has been riven with disagreements between those that support evidence-based nursing and those of a naturalistic orientation who maintain that nursing is so unique to the time, place and people involved that each interaction is impossible to replicate and test empirically (Rolfe, 2009). These debates are not so much wars of methodology as wars of perspective: i.e. of how to see the world and as a consequence which research questions to ask and which methods to use. In nursing, the most sophisticated articulation of these issues has been by (Hallberg, 2006) and (Hallberg, 2009) in two editorials in this journal. She has essentially urged nurses to throw away the purely naturalistic spectacles and exchange them for eyewear that allows us to seek answers to questions which are specifically useful for future patient care. Her analysis of the perceived systemic failings in European nursing research is based on her observation that only a minority of research in nursing is ‘translational’. For example, between 2000 and 2006, studies from the top 10 scientific nursing journals were mainly descriptive and did not report the impact of nursing interventions on patients (Mantzoukas, 2009). Of 210 papers published in two international nursing science journals annually, only 15% addressed ‘research that may carry strong evidence for practice’ (Hallberg, 2006 I. Hallberg, Challenges for future nursing research: providing evidence for health-care practice, International Journal of Nursing Studies 43 (2006), pp. 923–927. Article | PDF (107 K) | View Record in Scopus | Cited By in Scopus (15)Hallberg, 2006, p. 924). As noted in other health care areas (e.g. Chalmers and Glasziou, 2009) where much research is also wasteful, disconnected and unnecessarily repetitive, this situation must change if nursing is to realise its potential for a secure evidence-based contribution to European health and health care. Hallberg called for this re-focus to develop knowledge ‘in a step wise manner, a series of studies from descriptions, theory development, testing, exploring possible explanations, refining models or theories and testing them and implementing valid knowledge in practice. In particular, we need to learn more about the implementation process and about how to make it successful.’ (Hallberg, 2009, p. 410). There are, however, a number of problems. Firstly, developing an evidence base for complex activities and interventions is a considerable challenge. Difficulties in controlling for confounds, specifying both interventions and comparisons and selecting valid indicators of effect can lead either to the application of inappropriate methodological simplicity or a flight from quantification. Secondly, research supervisors are children of the old paradigms. Specific methodological experience and cultures within nursing research departments, are established by senior researchers and supervisors. Sadly, this tradition and past experience, rather than what knowledge is needed to inform practice, often determines what younger researchers do. A final concern is in the implementation of research findings themselves. Failures to describe and understand both inputs and outputs from complex activities can bring the implementation process – itself a complex, poorly understood and badly delivered activity – to a grinding halt. As Richard Grol and colleagues have demonstrated, many health care innovations do not get implemented until a considerable time has elapsed from the time when they were clearly shown to be effective (Grol et al., 2007). As a consequence, during the last 10 years, a great deal of thought has been given to research methods which investigate how to develop and determine the components, efficacy, effectiveness, applicability and translational utility of complex health care interventions. Published guidance has now progressed to the point where researchers are recommended to investigate complex interventions and activities through a mixed methodological process of development, feasibility/piloting, evaluation and implementation, where there is a dynamic interchange (rather than a uni-directional procession) between process stages (Medical Research Council, 2008). These developments echo persistent calls for the integration of research methods and traditions in nursing research. Sequencing qualitative and quantitative methods (Sandelowski, 2000) where each method provides reciprocal guidance to sampling and data analysis and where the findings from one adds to the findings from the other are now strongly advocated in complex interventions (Campbell et al., 2007) and nursing (Pluye et al., 2009). This thinking may offer a relief from the epistemology wars of the past. As noted by Galvin et al. (2008) the integration of phenomenological research and the use of descriptive understandings can aid our knowledge generation in situations where clinical trials can often leave conundrums unanswered. This is to be warmly welcomed, although some may still find it distasteful that in this conceptual framework, the search for meaning is apparently subjugated to the need to directly improve patient care. Nonetheless, if one accepts that nursing is a complex applied science which requires complex and mixed research methods to improve its implementation, the question of methodological research competence in the nursing research community still arises. A cursory examination of most research training curricula will leave the reader in no doubt that most courses favour specific theoretical orientations. Even where multiple methods are taught, these are rarely if ever drawn together in a specific mixed methods paradigm. Our courses rarely consider how research methods can be planned in a programmatic way to deliver Hallberg's vision. If they did, her prescient criticisms would not be required. So we have a situation ripe for change. A nursing research tradition characterised by work which is predominantly descriptive, cross-sectional, context specific and introspective requires shifting to one which is translational, experimental, longitudinal, generalisable and implementation focussed (Hallberg, 2009). The research skills deficits, clinical uncertainties and poor translational focus of nursing knowledge requires a fundamental shift if nurses are to practice their craft with sufficient confidence that good not harm will result from their actions. Happily, we can now report that these challenges are being specifically addressed. In 2011, eight European funding bodies in a partnership brokered by the European Science Foundation (ESF), agreed to provide financial support to an ambitious five year international programme – the REFLECTION Research Network Programme – to tackle these crucial issues in nursing science. Together with other concerned colleagues, REFLECTION is coordinated by members of the European Academy of Nursing Science (EANS) and will bring leading European researchers in nursing together with other multidisciplinary experts in research methods within an overarching complex interventions research framework. Through summer schools and seminar programmes REFLECTION will disseminate cutting-edge research methods to current nursing researchers, the new generation of early stage European researchers and to countries where the translation of research knowledge is still being developed. Although the REFLECTION network programme builds on EANS’ Framework 6 European Union Marie Curie funded ‘ASCEND’ summer school programme (MSCF-CT-2005-029164) for early stage researchers in Europe, in which a multi-disciplinary faculty from 21 European countries has taught more than 250 nurse researchers from 24 nations across Europe, it is a radical departure from the past. REFLECTION will now share knowledge and expertise in advanced translational complex interventions research methods in nursing through a curriculum designed around teaching integrated, mixed methods, programmatic, translational and specific complex interventions research methods in both summer schools and masterclasses. Key immediate tasks for the REFLECTION network will be to develop an interdisciplinary European Faculty network of researchers, equipped to design, plan and implement programmatic, mixed methods and complex interventions research in nursing. Knowledge and expertise will be shared by running summer schools for early stage researchers in Europe using a complex interventions research methods curriculum. Experienced researchers in nursing and research supervisors will be able to attend masterclasses where international experts will engage them in the specific methods and skills required to implement translational research programmes. REFLECTION will facilitate our profession in developing research programmes for nursing which are multi-state, multi-disciplinary, and directed at improving the evidence base of nursing to meet core international health and social care concerns. The REFLECTION research network programme will provide the bedrock upon which the next phase of research in nursing can stand. Our aim is to move the evidence base for nursing from the parlous state described by Hallberg to one where our clinical activities can be undertaken with confidence and increased certainty. It is an ambitious aim. On the way we hope that national education programmes for nurse researchers will become increasingly based on understanding nursing as a complex interdisciplinary and translational activity. We want to create a step change in the quality and focus of research in nursing. We want to enable our practice to be informed by evidence that has a true translational perspective. This can only be to the benefit of all nurses, and ultimately for ourselves as modern citizens and health care consumers, with all our own complex health and social care needs.

  • 18. Richards, David A.
    et al.
    Borglin, Gunilla
    Implementation of psychological therapies for anxiety and depression in routine practice: Two year prospective cohort study2011In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 133, no 1-2, p. 51-60Article in journal (Refereed)
    Abstract [en]

    Introduction: Worldwide, health systems are improving access to empirically supported psychological therapies for anxiety and depression. Evaluations of this effort are limited by the cross sectional nature of studies, short implementation periods, poor data completeness rates and lack of clinically significant and reliable change metrics. Objective: Assess the impact of implementing stepped care empirically supported psychological therapies by measuring the prospective outcomes of patients referred over a two year period to one Improving Access to Psychological Therapies service in the UK. Method: We collected demographic, therapeutic and outcome data on depression (PHQ-9) and anxiety (GAD-7) from 7859 consecutive patients for 24 months between 1st July 2006 and 31st August 2008, following up these patients for a further one year. Results: 4183 patients (53%) received two or more treatment sessions. Uncontrolled effect size for depression was 1.07 (95% CI: 0.88 to 1.29) and for anxiety was 1.04 (0.88 to 1.23). 55.4% of treated patients met reliable improvement or reliable and clinically significant change criteria for depression, 54.7% for anxiety. Patients received a mean of 5.5 sessions over 3.5 h, mainly low-intensity CBT and phone based case management. Attrition was high with 47% of referrals either not attending for an assessment or receiving an assessment only. Conclusions: Recovery rates for patients receiving stepped care empirically supported treatments for anxiety and depression in routine practice are 40 to 46%. Only half of all patients referred go on to receive treatment. Further work is needed to improve routine engagement of patients with anxiety and depression.

  • 19. Richards, David A.
    et al.
    Coulthard, Vania
    Borglin, Gunilla
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    The State of European Nursing Research: Dead, Alive, or Chronically Diseased? A Systematic Literature Review2014In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X , Vol. 11, no 3, p. 147-155Article in journal (Refereed)
    Abstract [en]

    Background Reviews of nursing research have suggested that most is descriptive; with no more than 15% providing strong evidence for practice. No studies have examined this from the perspective of nursing research conducted in Europe. Objective The aim of this study was to review reports of European clinical nursing research in the top 20 nursing journals in 2010 to establish a baseline of nursing research activity in the year immediately prior to the launch of a European Science Foundation network to increase the proportion of intervention research in Europe. Methods We identified eligible reports that were then data-extracted by two independent reviewers. Disagreements were resolved through pair discussion and independent arbitration. We appraised and synthesized topics, methods, and the extent to which studies were programmatic. We synthesized data as proportions of study reports meeting our a priori categorization criteria. Results We identified 1995 published reports and included 223 from 21 European countries, of which 193 (86.6%) reported studies of primary research only, 30 (13.5%) secondary research, and three (1.4%) a mix of primary and secondary. Methodological description was often poor, misleading, or even absent. One hundred (44.8%) articles reported observational studies, 87 (39.0%) qualitative studies. We found 26 (11.7%) articles reporting experimental studies, 10 (4.5%) of which were randomized controlled trials. We found 29 (13.0%) reports located within a larger program of research. Seventy-six (34.1%) articles reported studies of nursing interventions. Linking Evidence to Action European research in nursing reported in the leading nursing journals remains descriptive and poorly described. Only a third of research reports concerned nursing interventions, and a tiny proportion were part of a programmatic endeavor. Researchers in nursing must become better educated and skilled in developing, testing, evaluating, and reporting complex nursing interventions. Editors of nursing journals should insist on systematic reporting of research designs and methods in published articles.

  • 20. Richards, David
    et al.
    Borglin, Gunilla
    Dieppe, Paul
    Implementing the MRC's complex interventions research framework for allied health professionals.2010Conference paper (Refereed)
  • 21. Sandström, Boel
    et al.
    Borglin, Gunilla
    Nilsson, Roland
    Willman, Ania
    Promoting the implementation of evidence-based practice: A literature review focusing on the role of nursing leadership2011In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X , Vol. 8, no 4, p. 212-223Article, review/survey (Refereed)
    Abstract [en]

    Objectives: Despite a growing interest in evidence-based practice (EBP), the implementation into clinical practice of knowledge derived from research has proved to be a cumbersome process. Additionally, the literature seems to present a fragmented picture with research mainly focusing on a few factors of possible importance, among which leadership appears to be one of the more important. Thus, this study aimed to systematically review the literature regarding leadership and its possible influence on the process of implementing EBP. Approach: A literature review was conducted. Electronic database searches were conducted to identify studies on leadership, administrators, managers, implementation, evidence-based and nursing. The search identified 43 potentially relevant papers, of which 36 were excluded after an appraisal was performed by two independent reviewers. Results were extracted and synthesised into a narrative text. Findings: Seven papers were included in the literature review. The findings can be divided into three major areas: (1) characteristics of the leader, (2) characteristics of the organisation and (3) characteristics of the culture. Our findings indicate that leadership is vital for the process of implementing EBP in nursing and also highlights the possible importance of the organisation and the culture in which the leader operates. These factors together with their characteristics were interpreted to be intrinsic in the creation of a nursing milieu that is open and responsive to the implementation of EBP. Conclusions: Although there seems to be scholarly agreement that leadership is a vital part of the process of implementing EBP, more rigorous research is needed concerning the possible role of the leader. Our findings also indicate that leadership cannot be studied in isolation or without being clearly defined.

  • 22.
    Sandström, Boel
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Willman, Ania
    Blekinge Institute of Technology, School of Health Science.
    Svensson, Bengt
    Lunds universitet, SWE.
    Borglin, Gunilla
    Blekinge Institute of Technology, School of Health Science.
    How do we know if this is the best? Mental health-care professionals' views on national guidelines for psychosocial interventions2014In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 23, no 3, p. 221-231Article in journal (Refereed)
    Abstract [en]

    National guidelines are released regularly, and professionals are expected to adopt and implement them. However, studies dealing with mental health-care professionals' views about guidelines are sparse. The aim of the present study was to highlight mental health-care staff's views on the Swedish national guidelines for 'psychosocial interventions for schizophrenia or schizophrenia-type symptoms' and their implementation. The study took place in the southeast parts of Sweden, and data were collected through five group interviews consisting of 16 professionals working either in the county council or in the municipalities. The transcribed text was analysed by content analysis, revealing two categories. The first category 'a challenge to the practice of care as known' reflected that the release of guidelines could be perceived as a challenge to prevailing care and culture. The second category 'anticipating change to come from above' mirrored views on how staff expected the implementation process to flow from top to bottom. To facilitate working in accordance with guidelines, we suggest that future guidelines should be accompanied by an implementation plan, where the educational needs of frontline staff are taken into account. There is also a need for policy makers and managers to assume responsibility in supporting the implementation of evidence-based practice.

  • 23.
    Sandström, Boel
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Willman, Ania
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Svensson, Bengt
    Borglin, Gunilla
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Perceptions of national guidelines and their (non) implementation in mental healthcare: a deductive and inductive content analysis2015In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 10, no 1, article id 43Article in journal (Refereed)
    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.

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