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Dahlberg, K., Jaensson, M. & Nilsson, U. (2019). “Let the patient decide” – person-centered postoperative follow-up contacts, initiated via a phone app after day surgery: secondary analysis of a randomized controlled trial. International Journal of Surgery, 33-37
Open this publication in new window or tab >>“Let the patient decide” – person-centered postoperative follow-up contacts, initiated via a phone app after day surgery: secondary analysis of a randomized controlled trial
2019 (English)In: International Journal of Surgery, ISSN 1743-9191, E-ISSN 1743-9159, p. 33-37Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patients undergoing day surgery are expected to manage their recovery on their own. Follow-up routines differ, but many patients have expressed a need for more professional support during recovery. The aim of this study was to describe how many follow-up contacts were initiated, and when and why, via a digital solution. Also, we wanted to compare postoperative recovery and characteristics between patients requesting, and patients not requesting, contact.

MATERIALS AND METHODS: This was a secondary analysis of a multicenter, two-group, parallel randomized controlled trial. Participants used a digital solution called "Recovery Assessment by Phone Points (RAPP)" for initiating follow-up contacts after day surgery. The quality of postoperative recovery was measured with the Swedish web-version of Quality of Recovery.

RESULTS: Of 494 patients, 84 (17%) initiated contact via RAPP. The most common reasons for initiating contact were related to the surgical wound and pain. Contacts were initiated across the 14-day assessment period, with 62% (62/100) in the first postoperative week. The RAPP contact group had significantly poorer postoperative recovery on days 1-14 compared to those not requesting contact via RAPP (p < 0.001). There was a significantly higher proportion of patients who had undergone general anesthesia in the RAPP contact group (85% [71/84]) compared to the non-RAPP contact group (71% [291/410]), p = 0.003.

CONCLUSION: Letting the patient decide him/herself whether, and when, contact and support is needed during the postoperative period, is possible and does not increase the frequency of contacts. This study investigates a digital solution, RAPP, as one example of a person-centered approach that can be implemented in day surgery follow-up.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Ambulatory surgery, Follow-up, eHealth
National Category
Medical and Health Sciences Health Care Service and Management, Health Policy and Services and Health Economy Surgery
Identifiers
urn:nbn:se:oru:diva-70268 (URN)10.1016/j.ijsu.2018.11.022 (DOI)30503602 (PubMedID)2-s2.0-85057781234 (Scopus ID)
Available from: 2018-11-22 Created: 2018-11-22 Last updated: 2019-01-14Bibliographically approved
Hälleberg Nyman, M., Nilsson, U., Dahlberg, K. & Jaensson, M. (2018). Association Between Functional Health Literacy and Postoperative Recovery, Health Care Contacts, and Health-Related Quality of Life Among Patients Undergoing Day Surgery Secondary Analysis of a Randomized Clinical Trial. JAMA Surgery, 153(8), 738-745
Open this publication in new window or tab >>Association Between Functional Health Literacy and Postoperative Recovery, Health Care Contacts, and Health-Related Quality of Life Among Patients Undergoing Day Surgery Secondary Analysis of a Randomized Clinical Trial
2018 (English)In: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262, Vol. 153, no 8, p. 738-745Article in journal (Refereed) Published
Abstract [en]

Importance: Day surgery puts demands on the patients to manage their own recovery at home according to given instructions. Low health literacy levels are shown to be associated with poorer health outcomes.

Objective: To describe functional health literacy levels among patients in Sweden undergoing day surgery and to describe the association between functional health literacy (FHL) and health care contacts, quality of recovery (SwQoR), and health-related quality of life.

Design, Setting, and Participants: This observational study was part of a secondary analysis of a randomized clinical trial of patients undergoing day surgery and was performed in multiple centers from October 2015 to July 2016 and included 704 patients.

Main Outcomes and Measures: The primary end point was SwQoR in the FHL groups 14 days after surgery. Secondary end points were health care contacts, EuroQol-visual analog scales, and the Short Form (36) Health Survey in the FHL groups.

Results: Of 704 patients (418 [59.4%] women; mean [SD] age with inadequate or problematic FHL levels, 47 [16] years and 49 [15.1], respectively), 427 (60.7%) reported sufficient FHL, 223 (31.7%) problematic FHL, and 54 (7.7%) inadequate FHL. The global score of SwQoR indicated poor recovery in both inadequate (37.4) and problematic (22.9) FHL. There was a statistically significant difference in the global score of SwQoR (SD) between inadequate (37.4 [34.7]) and sufficient FHL (17.7 [21.0]) (P < .001). The patients with inadequate or problematic FHL had a lower health-related quality of life than the patients with sufficient FHL in terms of EuroQol-visual analog scale scores (mean [SD], 73 [19.1], 73 [19.1], and 78 [17.4], respectively; P = .008), physical function (mean [SD], 72 [22.7], 75 [23.8], and 81 [21.9], respectively; P < .001), bodily pain (mean [SD], 51 [28.7], 53 [27.4], and 61 [27.0], respectively; P = .001), vitality (mean [SD], 50 [26.7], 56 [23.5], and 62 [25.4], respectively; P < .001), social functioning (mean [SD], 73 [28.2], 81 [21.8], and 84 [23.3], respectively; P = .004), mental health (mean [SD], 65 [25.4], 73 [21.2], and 77 [21.2], respectively; P < .001), and physical component summary (mean [SD], 41 [11.2], 42 [11.3], and 45 [10.1], respectively; P = .004). There were no differences between the FHL groups regarding health care contacts.

Conclusions and Relevance: Inadequate FHL in patients undergoing day surgery was associated with poorer postoperative recovery and a lower health-related quality of life. Health literacy is a relevant factor to consider for optimizing the postoperative recovery in patients undergoing day surgery.

Place, publisher, year, edition, pages
American Medical Association, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology Surgery
Identifiers
urn:nbn:se:oru:diva-66778 (URN)10.1001/jamasurg.2018.0672 (DOI)000441758600015 ()29710226 (PubMedID)2-s2.0-85051572829 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-4765Swedish Research Council, 2015-02273
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-08-31Bibliographically approved
Arenhall, E., Eriksson, M., Nilsson, U., Steinke, E. & Fridlund, B. (2018). Decreased sexual function in partners after patients’ first-time myocardial infarction. European Journal of Cardiovascular Nursing, 17(6), 521-526
Open this publication in new window or tab >>Decreased sexual function in partners after patients’ first-time myocardial infarction
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2018 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 6, p. 521-526Article in journal (Refereed) Published
Abstract [en]

Background: A myocardial infarction event affects not only patients but also partners, although how it affects the partners’ sexual function is not studied.

Aim: The purpose of this study was to describe and compare how partners experienced their sexual function one year before with one year after first-time myocardial infarction of their partner.

Methods: A longitudinal and comparative design was used. Self-reported data on Watts Sexual Function Questionnaire was collected retrospectively at two occasions from 123 partners (87 women and 36 men), measuring the year prior to the first-time myocardial infarction and the year after. Data were analysed using descriptive and inferential statistics.

Results: The total score for Watts Sexual Function Questionnaire showed a significant decrease over time. In all four subscales a decrease was found, which were statistically significant in three out of the four subscales (sexual desire, 19.39 vs 18.61; p<0.001, orgasm, 14.11 vs 13.64; p=0.027 and satisfaction, 12.61 vs 12.31; p=0.042). Twenty-six partners reported that their intercourse frequencies decreased over time, while six partners reported an increased intercourse frequency.

Conclusions: Partners’ sexual function decreased after patients’ first-time myocardial infarction. It is important for health personnel to offer information and discussion about sexual function and concerns with both patients and partners after a first-time myocardial infarction.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Longitudinal, myocardial infarction, sexual function, sexual relationships, spouse, Watts Sexual Function Questionnaire
National Category
Nursing Cardiac and Cardiovascular Systems
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-63744 (URN)10.1177/1474515117751904 (DOI)000440433800007 ()29291637 (PubMedID)2-s2.0-85041537787 (Scopus ID)
Available from: 2018-01-02 Created: 2018-01-02 Last updated: 2018-08-16Bibliographically approved
Dahlberg, K., Jaensson, M., Nilsson, U., Eriksson, M. & Odencrants, S. (2018). Holding It Together - Patients' Perspectives on Postoperative Recovery When Using an e-Assessed Follow-Up: Qualitative Study. JMIR mhealth and uhealth, 20(5), Article ID e10387.
Open this publication in new window or tab >>Holding It Together - Patients' Perspectives on Postoperative Recovery When Using an e-Assessed Follow-Up: Qualitative Study
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2018 (English)In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 20, no 5, article id e10387Article in journal (Refereed) Published
Abstract [en]

Background: There is an emerging trend to perform surgeries as day surgery. After a day surgery, most of the recovery period takes place at home, and patients are responsible for their own recovery. It has been suggested that electronic health (eHealth) technologies can support patients in this process. A mobile app has recently been developed to assess and follow up on postoperative recovery after a day surgery.

Objective: The aim of this study was to explore experiences associated with postoperative recovery after a day surgery in patients using a mobile app to assess the quality of their recovery.

Methods: This is a qualitative interview study with an explorative and descriptive design. Participants were recruited from 4 different day surgery units in different parts of Sweden. The study included 18 participants aged >17 years who had undergone day surgery and used the Recovery Assessment by Phone Points, a mobile app for follow-up on postoperative recovery after day surgery. Participants were purposively selected to ensure maximum variation. Semistructured individual interviews were conducted. Data were analyzed using thematic analysis.

Results: A total of two themes and six subthemes emerged from the data: (1) the theme Give it all you’ve got with the subthemes Believing in own capacity, Being prepared, and Taking action, where participants described their possibilities of participating and themselves contributing to improving their postoperative recovery; and (2) the theme The importance of feeling safe and sound with the subthemes Feeling safe and reassured, Not being acknowledged, and Not being left alone, which describe the importance of support from health care professionals and next of kin.

Conclusions: It is important that patients feel safe, reassured, and acknowledged during their postoperative recovery. They can achieve this themselves with sufficient support and information from the health care organization and their next of kin. Using a mobile app, both for assessment and to enable contact with the day surgery unit during the postoperative recovery period, can improve care and create a feeling of not being alone after surgery. We propose that postoperative recovery starts in the prerecovery phase when patients prepare for their recovery to get the best possible outcome from their surgery.

Place, publisher, year, edition, pages
JMIR Publications Inc., 2018
Keywords
Ambulatory surgical procedures, mobile apps, postoperative period, qualitative research
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-67100 (URN)10.2196/10387 (DOI)000433585700001 ()2-s2.0-85047567613 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-4765Swedish Research Council, 2015-02273
Available from: 2018-05-28 Created: 2018-05-28 Last updated: 2018-11-16Bibliographically approved
Wistrand, C., Falk-Brynhildsen, K. & Nilsson, U. (2018). National Survey of Operating Room Nurses' Aseptic Techniques and Interventions for Patient Preparation to Reduce Surgical Site Infections. Surgical Infections, 19(4), 438-445
Open this publication in new window or tab >>National Survey of Operating Room Nurses' Aseptic Techniques and Interventions for Patient Preparation to Reduce Surgical Site Infections
2018 (English)In: Surgical Infections, ISSN 1096-2964, E-ISSN 1557-8674, Vol. 19, no 4, p. 438-445Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Surgical site infection (SSI), the third most common type of nosocomial infection in Sweden, is a patient injury that should be prevented. Methods of reducing SSIs include, for instance, disinfecting the skin, maintaining body temperature, and ensuring an aseptic environment. Guidelines for most of these interventions exist, but there is a lack of studies describing to what extent the preventive interventions have been implemented in clinical practice. We describe the daily clinical interventions Swedish operating room (OR) nurses performed to prevent SSIs following national guidelines.

METHODS: A descriptive cross-sectional study using a Web-based questionnaire was conducted among Swedish OR nurses. The study-specific questionnaire included 32 items addressing aspects of the interventions performed to prevent SSI, such as preparation of the patient skin (n = 12), maintenance of patient temperature (n = 10), and choice of materials (n = 10). The response format included both closed and open-ended answers.

RESULTS: In total, 967 nurses (43% of the total) answered the questionnaire; of these, 77 were excluded for various reasons. The proportions of the OR nurses who complied with the preventive interventions recommended in the national guidelines were high: skin disinfection solution (93.5%), sterile drapes (97.4%) and gowns (83.8%) for single use, and the use of double gloves (73.0%). However, when guidelines were lacking, some interventions differed, such as the frequency of glove changes and the use of adhesive plastic drapes.

CONCLUSION: To standardize OR nurses' preventive interventions, implementing guidelines seems to be the key priority. Overall, OR nurses have high compliance with the national guidelines regarding interventions to prevent bacterial growth and SSIs in the surgical patient. However, when guidelines are lacking, the preventive interventions lose conformity.

Place, publisher, year, edition, pages
Mary Ann Liebert, 2018
Keywords
Patient preparation, skin disinfection, surgical site infection
National Category
Surgery Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-66708 (URN)10.1089/sur.2017.286 (DOI)000430589700001 ()29672240 (PubMedID)2-s2.0-85047351296 (Scopus ID)
Available from: 2018-04-23 Created: 2018-04-23 Last updated: 2018-10-09Bibliographically approved
Luhr, K., Eldh, A. C., Nilsson, U. & Holmefur, M. (2018). Patient preferences for patient participation: Psychometric evaluation of The 4Ps tool in patients with chronic heart or lung disorders. Nordic journal of nursing research, 38(2), 68-76
Open this publication in new window or tab >>Patient preferences for patient participation: Psychometric evaluation of The 4Ps tool in patients with chronic heart or lung disorders
2018 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 38, no 2, p. 68-76Article in journal (Refereed) Published
Abstract [en]

The Patient Preferences for Patient Participation tool (The 4Ps) was developed to aid clinical dialogue and to help patients to 1) depict, 2) prioritise, and 3) evaluate patient participation with 12 pre-set items reiterated in the three sections. An earlier qualitative evaluation of The 4Ps showed promising results. The present study is a psychometric evaluation of The 4Ps in patients with chronic heart or lung disease (n¼108) in primary and outpatient care. Internal scale validity was evaluated using Rasch analysis, and two weeks test–retest reliability of the three sections using kappa/weighted kappa and a prevalence- and bias-adjusted kappa. The 4Ps tool was found to be reasonably valid with a varied reliability. Proposed amendments are rephrasing of two items, and modifications of the rating scale in Section 2. The 4Ps is suggested for use to increase general knowledge of patient participation, but further studies are needed with regards to its implementation.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Chronic heart failure, chronic obstructive pulmonary disease, clinical tool, instrument testing, patient participation
National Category
Health Sciences Nursing Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-66035 (URN)10.1177/2057158517713156 (DOI)
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2018-09-07Bibliographically approved
Gillespie, B. M., Harbeck, E. B., Falk-Brynhildsen, K., Nilsson, U. & Jaensson, M. (2018). Perceptions of perioperative nursing competence: a cross-country comparison. BMC Nursing, 17, Article ID 12.
Open this publication in new window or tab >>Perceptions of perioperative nursing competence: a cross-country comparison
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2018 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 17, article id 12Article in journal (Refereed) Published
Abstract [en]

Background: Throughout many countries, professional bodies rely on yearly self-assessment of competence for ongoing registration; therefore, nursing competence is pivotal to safe clinical practice. Our aim was to describe and compare perioperative nurses' perceptions of competence in four countries, while examining the effect of specialist education and years of experience in the operating room.

Methods: We conducted a secondary analysis of cross-sectional surveys from four countries including; Australia, Canada, Scotland, and Sweden. The 40-item Perceived Perioperative Competence Scale-Revised (PPCS-R), was used with a total sample of 768 respondents. We used a factorial design to examine the influence of country, years of experience in the operating room and specialist education on nurses' reported perceived perioperative competence.

Results: Regardless of country origin, nurses with specialist qualifications reported higher perceived perioperative competence when compared to nurses without specialist education. However, cross-country differences were dependent on nurses' number of years of experience in the operating room. Nurses from Sweden with 6-10 years of experience in the operating room reported lower perceived perioperative competence when compared to Australian nurses. In comparing nurses with >10 years of experience, Swedish nurses reported significantly lower perceived perioperative competence when compared to nurses from Australia, Canada and Scotland.

Conclusion: Researchers need to consider educational level and years of experience in the perioperative context when examining constructs such as competence.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Perioperative nursing; Competence; Cross-national; Survey; Patient safety
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-66346 (URN)10.1186/s12912-018-0284-0 (DOI)000429063700001 ()29632435 (PubMedID)2-s2.0-85044847473 (Scopus ID)
Available from: 2018-04-04 Created: 2018-04-04 Last updated: 2018-04-25Bibliographically approved
Nilsson, U., Jaensson, M., Dahlberg, K. & Hugelius, K. (2018). Postoperative recovery after general and regional anesthesia in patients undergoing day surgery: A mixed methods study. Journal of Perianesthesia Nursing
Open this publication in new window or tab >>Postoperative recovery after general and regional anesthesia in patients undergoing day surgery: A mixed methods study
2018 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473Article in journal (Refereed) Epub ahead of print
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:oru:diva-68568 (URN)10.1016/j.jopan.2018.08.003 (DOI)
Available from: 2018-08-24 Created: 2018-08-24 Last updated: 2018-12-03Bibliographically approved
Sundqvist, A.-S., Nilsson, U., Holmefur, M. & Anderzen-Carlsson, A. (2018). Promoting person-centred care in the perioperative setting through patient advocacy: an observational study. Journal of Clinical Nursing, 27(11-12), 2403-2415
Open this publication in new window or tab >>Promoting person-centred care in the perioperative setting through patient advocacy: an observational study
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 11-12, p. 2403-2415Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: To examine the extent to which the findings from an integrative review regarding perioperative patient advocacy could be empirically supported, and to describe Swedish registered nurse anaesthetists' patient advocacy actions and interactions during the perioperative period.

BACKGROUND: Patient advocacy is practiced by various health care professionals in promoting the well-being of patients. It is complex, and in a general health care context it has been described as supporting the patients both physiologically and psychologically. During general anaesthesia, the patient enters an unconscious state, and the registered nurse anaesthetist safeguards patient privacy and autonomy.

DESIGN: Qualitative descriptive.

METHODS: Individual, nonparticipant observations (n=16) with eight registered nurse anaesthetists. The observer followed the nurses unobtrusively by shadowing them during the perioperative phase on two separate occasions. The analysis was conducted with a directed content analysis in the light of four predetermined categories, identified in a previous integrative review of patient advocacy in the perioperative setting: protecting, value preserving, supporting, and informing.

RESULTS: The predetermined categories were empirically supported. They were further refined by identifying 11 new subcategories leading to a conceptual extension of the theoretical frame. The registered nurse anaesthetists interacted with the patient and all members of the surgical team when practicing perioperative patient advocacy and the actions were mostly initiated by the registered nurse anaesthetists themselves.

CONCLUSIONS: The findings offer a new insight into the registered nurse anaesthetist's professional role. The observations deepen the understanding of the registered nurse anaesthetists' perioperative patient advocacy actions, and can contribute to a more reflective and theory-oriented view of practice.

RELEVANCE TO CLINICAL PRACTICE: The results from this study could be used to help registered nurse anaesthetists and their students understand practice in a more complete and insightful way.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
Anaesthetic nursing, directed content analysis, observational study, patient advocacy
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-63022 (URN)10.1111/jocn.14181 (DOI)000434127600018 ()29149509 (PubMedID)2-s2.0-85047827991 (Scopus ID)
Note

Funding Agencies:

Örebro Universitet  

Research Committee at Region Örebro County  

Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2018-08-13Bibliographically approved
Sundqvist, A.-S., Anderzen-Carlsson, A., Nilsson, U. & Holmefur, M. (2018). Protective nursing advocacy: translation and psychometric evaluation of an instrument and a descriptive study of Swedish nurse anesthetists’ beliefs and actions. In: : . Paper presented at Nordic Conference in Nursing Research 2018, Oslo, Norway, 13-15 June, 2018.
Open this publication in new window or tab >>Protective nursing advocacy: translation and psychometric evaluation of an instrument and a descriptive study of Swedish nurse anesthetists’ beliefs and actions
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-67256 (URN)
Conference
Nordic Conference in Nursing Research 2018, Oslo, Norway, 13-15 June, 2018
Available from: 2018-06-14 Created: 2018-06-14 Last updated: 2018-06-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5403-4183

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