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  • 1.
    Christiansen, Line
    et al.
    Blekinge Tekniska Högskola, Fakulteten för teknikvetenskaper, Institutionen för hälsa.
    Sanmartin Berglund, Johan
    Blekinge Tekniska Högskola, Fakulteten för teknikvetenskaper, Institutionen för hälsa.
    Lindberg, Catharina
    Blekinge Tekniska Högskola, Fakulteten för teknikvetenskaper, Institutionen för hälsa.
    Anderberg, Peter
    Blekinge Tekniska Högskola, Fakulteten för teknikvetenskaper, Institutionen för hälsa.
    Skär, Lisa
    Blekinge Tekniska Högskola, Fakulteten för teknikvetenskaper, Institutionen för hälsa.
    Health-related quality of life and related factors among a sample of older people with cognitive impairment2019Inngår i: Nursing Open, E-ISSN 2054-1058, Vol. 6, nr 3, s. 849-859Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: This study aimed to identify factors affecting health-related quality of life (HRQoL) of older adults with cognitive impairment and to describe the association of these factors with different components of HRQoL. Design: A cross-sectional, descriptive research design was used. Methods: Data were collected from 247 individuals aged 60 years and older from a Swedish longitudinal cohort study. The Short-Form Health Survey-12 (SF-12) and EuroQol (EQ-5D) were used to assess HRQoL. The data were analysed using descriptive and comparative statistics. Results: The present study identified several factors that influenced HRQoL of older adults with cognitive impairment. The results of a multiple logistic regression analysis revealed that the following factors were associated with physical and mental HRQoL: dependency in activities of daily living (ADL), receiving informal care and feelings of loneliness and pain. © 2019 The Authors. Nursing Open published by John Wiley & Sons Ltd.

  • 2. Fridlund, Bengt
    et al.
    Andersson, Ewa K.
    Blekinge Tekniska Högskola, Fakulteten för teknikvetenskaper, Institutionen för hälsa.
    Bala, Sidona-Valentina
    Dahlman, Gull-Britt
    Ekwall, Anna K.
    Glasdam, Stinne
    Hommel, Ami
    Lindberg, Catharina
    Blekinge Tekniska Högskola, Fakulteten för teknikvetenskaper, Institutionen för hälsa.
    Persson, Eva I.
    Rantala, Andreas
    Sjöström-Strand, Annica
    Wihlborg, Jonas
    Samuelson, Karin
    Essentials of Teamcare in Randomized Controlled Trials of Multidisciplinary or Interdisciplinary Interventions in Somatic Care: A Systematic Review2015Inngår i: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, ISSN 2162-5344, Vol. 12, nr 5, s. 1089-1101Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background: Teamcare should, like all patient care, also contribute to evidence-based practice (EBP). Randomized controlled trials (RCTs) focusing on teamcare have been performed but no study has addressed its essentials. How far this EBP has progressed in different health aspects is generally established in systematic reviews of RCTs. Aim: The aim is to determine the essentials of teamcare including the nurse profession in RCTs of multi- or interdisciplinary interventions in somatic care focusing on the stated context, goals, strategies, content as well as effectiveness of quality of care. Methods: A systematic review was performed according to Cochrane review assumptions to identify, appraise and synthesize all empirical evidence meeting pre-specified eligibility criteria. The PRISMA statement guided the data selection process of 27 articles from PubMed and CINAHL. Results: Eighty-five percent of RCTs in somatic care showed a positive effectiveness of teamcare interventions, of which interdisciplinary ones showed a greater effectiveness compared with the multidisciplinary approach (100% vs 76%). Also theory-based RCTs presented higher positive effectiveness (85%) compared with non-theory-based RCTs (79%). The RCTs with positive effectiveness showed greater levels for professional-centered ambition in terms of goals and for team-directed initiatives in terms of strategy, and a significantly higher level for patient-team interaction plans in terms of content was shown. Conclusions: Teamcare RCTs are still grounded in the multidisciplinary approach having a professional-centered ambition while interdisciplinary approaches especially those that are theory-based appear to be essential with regard to positive effectiveness and preferable when person-centered careis applied.

  • 3. Fridlund, Bengt
    et al.
    Jönsson, A.C.
    Andersson, Ewa
    Blekinge Tekniska Högskola, Fakulteten för hälsovetenskaper, Institutionen för hälsa.
    Bala, S.-V.
    Dahlman, G.-B.
    Forsberg, A.
    Glasdam, S.
    Krstensson, A.
    Lindberg, Catharina
    Blekinge Tekniska Högskola, Fakulteten för hälsovetenskaper, Institutionen för hälsa.
    Sivberg, B.
    Essentials of Nursing Care in Randomized Controlled Trials of Nurse-Led Interventions in Somatic Care: A Systematic Review2014Inngår i: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 4, nr 3, s. 181-197Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Nursing practice has to contribute to evidence pointing out why there is a need for more nurse-designed randomized control trials (RCTs) focusing on evidence-based practice (EBP). How far this EBP has progressed in different health aspects is usually established by systematic reviews of RCTs. Nurse-led RCTs exist but no study has addressed the essentials of nursing care. Aim: The aim was therefore to determine the essentials of nurses’ interventions by means of nurse-led RCTs in somatic care focusing on the stated context, goals, content, strategies as well as the nurse’s role related to effectiveness. Methods: A systematic review was realized according to Cochrane review assumptions to identify, appraise and synthesize all empirical evidence meeting pre-specified eligibility criteria. The PRISMA statement guided the data extraction process (n = 55) from PubMed and CINAHL. Results: Of the RCTs in somatic care, 71% showed a positive effectiveness of nurse-led interventions, of which the nurse had a significant role with regard to being the main responsible in 67% of the studies. Also, 47% of the RCTs presented a theoretical standpoint related to the nurse-led interventions and most prominent were international evidence-based guidelines. Goals were found to have either a patient-centered or a professional-centered ambition. Strategies were based on patient-directed initiatives, nurse-patient-directed initiatives or nurse-directed initiatives, while contents were built upon either a patient-nurse interaction or a nursing management plan. Conclusions: This review underlines the necessity of a holistic view of a person, as nurse-led RCTs comprising a patient-centered ambition, patient-directed initiative and patient-nurse interaction plan showed beneficial nursing care effectiveness, particularly if theory-based. In a nurse-led RCT, a basic theoretical perspective is advantageous as well as to elucidate the role of the nurse in relation to the estimated effects.

  • 4.
    Lindberg, Catharina
    Blekinge Tekniska Högskola, Fakulteten för teknikvetenskaper, Institutionen för hälsa.
    Patient autonomy in highly technological care environments from a caring perspective2016Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background

    Patients in highly technological care environments are severely ill, and are often suffering from a reduced physical and/or cognitive capacity following their illness and treatment, making them exceedingly vulnerable. The most severely ill patients are cared for in the intensive care unit. These vulnerable persons are cared for in an environment traditionally associated with a paternalistic care culture, which implies that patients are at risk of being overridden in relation to ethical issues, and of having their autonomycompromised. The question is whether it is possible for the patient to be capable and autonomous in this context. Advanced home care involves an increasing amount of advanced medical technology, and is then to be characterized as a highly technological care context. The advancedhome care context is different from the intensive care context in that the patients are not sedated, they are cared for at home, and they are expected to be the masters of theirhome environment. They recognize their home as private territory which gives them the right to decide what to do and how and when to do it. Their need for technology and care from formal/informal carers points to a vulnerability on the part of the patient, risking a hidden paternalism in terms of overprotectiveness, including excesses of care.These aggravating circumstances may exert an influence on the patient’s everyday life, threatening the patient’s possibilities of remaining/becoming autonomous. This thesis is a response to the absence of consensual understanding in nursing of the concept of patient autonomy in a highly technological care context, as well as an answer to the lack of knowledge of the phenomenon of patient autonomy in highly technological care environments from the patient perspective and in a caring context.

    Aim

    The overall aim of this thesis was to describe and elucidate patient experiences of autonomy in highly technological care environments, and to create an extended understanding of the concept of patient autonomy in a highly technological care context, from a caring perspective.

    Methods

    In answering to the aim of this thesis, a diversity of qualitative methods for data collection and data analysis was used. Two empirical studies comprising individual patient interviews (n=23) within highly technological care environments were carried out, in intensive care (II) and in advanced home care (III). The patient experiences were analyzed through inductive content analysis (II) and descriptive phenomenology (III). Theoretical development was accomplished through a concept analysis (I) from scientific literature, and a concluding metasynthesis (IV) of the previous studies (I-III).

    Findings

    The concept analysis (I) revealed that increased vulnerability was the antecedent of patient autonomy in a caring context. It further showed that patient autonomy is not to be understood as absolute but as changing throughout the care episode. The interviews with patients being cared for in intensive care described patient autonomy in this highly technological care environment as a “trajectory towards partnership in care depending on state of health and mutual understanding”. Patient autonomy, in advanced home care including advanced medical technology, was differently described as “befriending everyday life when bringing technology into the private sphere”. The findings of the concept analysis (I) as well as the findings from the empirical studies of patient experiences of autonomy (II-III) resulted in the concluding theoretical framework (IV), adding new knowledge to ameliorate the clarity of the concept. A tentative framework, the Control-Partnership-Transition framework of patient autonomy, was delineated. This framework comprises four strategies, the strategy of control, of partnership, of trust, and of transition, used by patients to preserve or obtain autonomy in highly technological care environments. To experience autonomy, patients in highly technological care environments want to be considered as capable agents, and not only as a vulnerable person in need of care. Their thoughts and experiences reveal that patient autonomy should be understood as a process, something that changes over time, and is dependent on their health conditionas well as on others around them and the care environment. The knowledge obtained could be used to facilitate the adherence of health care professionals to ethical principles and codes related to patient autonomy, hence strengthening the patients’ position in regard to their autonomy.

  • 5.
    Lindberg, Catharina
    et al.
    Blekinge Tekniska Högskola, Fakulteten för hälsovetenskaper, Institutionen för hälsa.
    Fagerström, Cecilia
    Blekinge Tekniska Högskola, Fakulteten för hälsovetenskaper, Institutionen för hälsa.
    Sivberg, Bengt
    Willman, Ania
    Blekinge Tekniska Högskola, Fakulteten för hälsovetenskaper, Institutionen för hälsa.
    Concept analysis: patient autonomy in a caring context2014Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 70, nr 10, s. 2208-2221Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim. This paper is a report of an analysis of the concept of patient autonomy. Background. Many problems regarding patient autonomy in healthcare contexts derive from the patient's dependent condition as well as the traditional authoritarian position of healthcare professionals. Existing knowledge and experience reveal a lack of consensus among nurses regarding the meaning of this ethical concept. Design. Concept Analysis. Data sources. Medline, CINAHL, The Cochrane Library and PsycINFO were searched (2005-June 2013) using the search blocks 'autonomy', 'patient' and 'nursing/caring'. A total of 41 articles were retrieved. Review Methods. The Evolutionary Method of Concept Analysis by Rodgers was used to identify and construct the meaning of the concept of patient autonomy in a caring context. Results. Five attributes were identified, thus creating the following descriptive definition: 'Patient autonomy is a gradual, time-changing process of (re-)constructing autonomy through the interplay of to be seen as a person, the capacity to act and the obligation to take responsibility for one’s actions’'. Patient vulnerability was shown to be the antecedent of patient autonomy and arises due to an impairment of a person's physical and/or mental state. The consequences of patient autonomy were discussed in relation to preserving control and freedom. Conclusion. Patient autonomy in a caring context does not need to be the same before, during and after a care episode. A tentative model has been constructed, thus extending the understanding of this ethical concept in a caring context.

  • 6.
    Lindberg, Catharina
    et al.
    Blekinge Tekniska Högskola, Fakulteten för teknikvetenskaper, Institutionen för hälsa.
    Fagerström, Cecilia
    Linnéuniversitetet, SWE.
    Willman, Ania
    Malmö Universitet, SWE.
    Patient autonomy in a high-tech care context: A theoretical framework2018Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, nr 21-22, s. 4128-4140Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 7.
    Lindberg, Catharina
    et al.
    Blekinge Tekniska Högskola, Fakulteten för hälsovetenskaper, Institutionen för hälsa.
    Sivberg, Bengt
    Lunds universitet, SWE.
    Willman, Ania
    Blekinge Tekniska Högskola, Fakulteten för hälsovetenskaper, Institutionen för hälsa. Malmö University, SWE.
    Fagerström, Cecilia
    Blekinge Tekniska Högskola, Fakulteten för hälsovetenskaper, Institutionen för hälsa.
    A trajectory towards partnership in care - Patient experiences of autonomy in intensive care: A qualitative study2015Inngår i: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 31, nr 5, s. 294-302Artikkel i tidsskrift (Fagfellevurdert)
    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.

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