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Mahdi, A., Svantesson, M., Wretenberg, P. & Hälleberg Nyman, M. (2020). Patients’ experiences of discontentment one year after total knee arthroplasty: a qualitative study. BMC Musculoskeletal Disorders, 21(1), Article ID 29.
Open this publication in new window or tab >>Patients’ experiences of discontentment one year after total knee arthroplasty: a qualitative study
2020 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 21, no 1, article id 29Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Total knee arthroplasty is a common procedure with generally good results. However, there are still patients who are dissatisfied without known explanation. Satisfaction and dissatisfaction have previously been captured by quantitative designs, but there is a lack of qualitative studies regarding these patients' experiences. Qualitative knowledge might be useful in creating strategies to decrease the dissatisfaction rate.

METHODS: Of the 348 patients who responded to a letter asking if they were satisfied or dissatisfied with their surgery, 61 (18%) reported discontent. After excluding patients with documented complications and those who declined to participate, semi-structured interviews were conducted with 44 patients. The interviews were analyzed according to qualitative content analysis. The purpose was to describe patients' experiences of discontentment 1 year after total knee arthroplasty.

RESULTS: The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and lacking of relational supports. They were bothered by pain and stiffness, and worried that changes were complications as a result of surgery. They described inability to perform daily activities and valued activities. They also felt a lack of relational supports, and a lack of respect and continuity, support from health care, and information adapted to their needs.

CONCLUSION: Patient expectation seems to be the major contributing factor in patient discontentment after knee replacement surgery. This qualitative study sheds light on the on the meaning of unfulfilled expectations, in contrast to previous quantitative studies. The elements of unfulfilled expectations need to be dealt with both on the individual staff level and on the organizational level. For instance, increased continuity of healthcare staff and facilities may help to improve patient satisfaction after surgery.

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Content analysis, Patient contentment, Patient satisfaction, Qualitative research, Surgery, Total knee arthroplasty
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-79262 (URN)10.1186/s12891-020-3041-y (DOI)31937282 (PubMedID)2-s2.0-85077838536 (Scopus ID)
Available from: 2020-01-20 Created: 2020-01-20 Last updated: 2020-02-21
Silén, M. & Svantesson, M. (2019). Impact of clinical ethics support on daily practice: First-line managers' experiences in the Euro-MCD project. Journal of Nursing Management, 27(7), 1374-1383
Open this publication in new window or tab >>Impact of clinical ethics support on daily practice: First-line managers' experiences in the Euro-MCD project
2019 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 27, no 7, p. 1374-1383Article in journal (Refereed) Published
Abstract [en]

AIM: To explore first-line managers' experiences of what Moral Case Deliberation (MCD) has meant for daily practice, to describe perceptions of context influence and responsibility to manage ethically difficult situations.

BACKGROUND: In order to find measures to evaluate MCD, the European Moral Case Deliberation Outcome instrument (Euro-MCD) was developed and is now in the stage of revision. For this, there is a need of several perspectives, one of them being the managerial bird-eye perspective.

METHOD: Eleven first-line managers at workplaces, participating in the Euro-MCD project, were interviewed and thematic analysis was applied.

RESULTS: Managers' experiences were interpreted as enhanced ethical climate: a closer-knit and more emotionally mature team, morally strengthened individuals, as well as ethics leaving its marks on everyday work and morally grounded actions. Despite organisational barriers they felt inspired to continue ethics work.

CONCLUSION AND IMPLICATIONS: This study confirmed, but also added ethical climate aspects, such as morally grounded actions. Furthermore, adding ethical climate as a construct in the Euro-MCD instrument should be considered. First-line managers need clear directives from their managers that ethics work needs to be prioritised for the good of both the staff and the patients.

Place, publisher, year, edition, pages
Blackwell Publishing, 2019
Keywords
First-line Managers, Impact of Ethics on Everyday Work, Moral Case Deliberation
National Category
Medical Ethics
Identifiers
urn:nbn:se:oru:diva-74785 (URN)10.1111/jonm.12818 (DOI)000474970200001 ()31220384 (PubMedID)
Funder
AFA Insurance
Note

Funding Agency:

University of Gävle, Sweden 

Available from: 2019-06-25 Created: 2019-06-25 Last updated: 2019-11-22Bibliographically approved
Svantesson, M., de Snoo-Trimp, J. C., Ursin, G., de Vet, H. C., Brinchmann, B. S. & Molewijk, B. (2019). Important outcomes of moral case deliberation: a Euro-MCD field survey of healthcare professionals' priorities. Journal of Medical Ethics, 45(9), 608-616
Open this publication in new window or tab >>Important outcomes of moral case deliberation: a Euro-MCD field survey of healthcare professionals' priorities
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2019 (English)In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 45, no 9, p. 608-616Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation (MCD). Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument (Euro-MCD) instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.

METHODS: A North European field survey among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.

RESULTS: All outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%-97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. 'Better interactions with patient/family' emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.

CONCLUSIONS: attitude outcomes, should still be included. In the future, a combination of empirical findings (practice) and normative reflection (theories) will contribute to the revision of the instrument.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
Applied and professional ethics, clinical ethics, education for health care professionals, ethics committees/consultation, health personnel
National Category
Medical Ethics
Identifiers
urn:nbn:se:oru:diva-75582 (URN)10.1136/medethics-2018-104745 (DOI)000487540700011 ()31320403 (PubMedID)2-s2.0-85068895086 (Scopus ID)
Funder
AFA Insurance
Note

Funding Agency:

Norwegian Association of Local and Regional Authorities   120125

Available from: 2019-08-16 Created: 2019-08-16 Last updated: 2019-11-15Bibliographically approved
Bassford, C. R., Krucien, N., Ryan, M., Griffiths, F. E., Svantesson, M., Fritz, Z., . . . Slowther, A.-M. (2019). U.K. Intensivists' Preferences for Patient Admission to ICU: Evidence From a Choice Experiment. Critical Care Medicine, 47(11), 1522-1530
Open this publication in new window or tab >>U.K. Intensivists' Preferences for Patient Admission to ICU: Evidence From a Choice Experiment
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2019 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 47, no 11, p. 1522-1530Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Deciding whether to admit a patient to the ICU requires considering several clinical and nonclinical factors. Studies have investigated factors associated with the decision but have not explored the relative importance of different factors, nor the interaction between factors on decision-making. We examined how ICU consultants prioritize specific factors when deciding whether to admit a patient to ICU.

DESIGN: Informed by a literature review and data from observation and interviews with ICU clinicians, we designed a choice experiment. Senior intensive care doctors (consultants) were presented with pairs of patient profiles and asked to prioritize one of the patients in each task for admission to ICU. A multinomial logit and a latent class logit model was used for the data analyses.

SETTING: Online survey across U.K. intensive care.

SUBJECTS: Intensive care consultants working in NHS hospitals.

MEASUREMENTS AND MAIN RESULTS: Of the factors investigated, patient's age had the largest impact at admission followed by the views of their family, and severity of their main comorbidity. Physiologic measures indicating severity of illness had less impact than the gestalt assessment by the ICU registrar. We identified four distinct decision-making patterns, defined by the relative importance given to different factors.

CONCLUSIONS: ICU consultants vary in the importance they give to different factors in deciding who to prioritize for ICU admission. Transparency regarding which factors have been considered in the decision-making process could reduce variability and potential inequity for patients.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
Keywords
choice experiment, decision-making, intensive care admissions, intensive care triage
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-75817 (URN)10.1097/CCM.0000000000003903 (DOI)000489725000017 ()31385883 (PubMedID)2-s2.0-85073184084 (Scopus ID)
Note

Funding Agencies:

National Institute for Health Research (NIHR) 13/10/14

University of Aberdeen  

Chief Scientist Office of the Scottish Government Health and Social Care Directorates  

NIHR Clinical Research Network  

National Institute for Health Research (NIHR)

Intensive Care Society (United Kingdom)  

United States Department of Health & Human Services National Institute for Health Research (NIHR)

Wellcome  

United States Department of Health & Human Services National Institutes of Health (NIH) - USA

Wellcome Trust/Charity Open Access Fund  

Warwick University  

NIHR Health Service and Delivery Research stream (United Kingdom)  

NIHR Health Technology Assessment program  

NIHR Health Service and Delivery Research program  

Dutch Clinical ethics network 2017  

UK Clinical Ethics Network 

Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-11-15Bibliographically approved
Svantesson Sandberg, M. & Heidenreich, K. (2018). Do analysis methods need to be altered when using software program?. In: : . Paper presented at The third Nordic Conference in Nursing Research – Methods and Networks for the future, Oslo, Norway, June 13-15, 2018.
Open this publication in new window or tab >>Do analysis methods need to be altered when using software program?
2018 (English)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Background: Do analysis methods need to be altered when using software program? Software program facilitating qualitative data analysis are here to stay, but data analysis methods may not be adapted for this aid.

Objective: To reflect on the feasibility to follow qualitative data analysis methods when using data analysis software in a basic way.

Method: Presentation of three different analysis of data, using different data analysis methods, aided by QSR NVivo©.

Results: On the conference we report on own experiences of using QSR NVivo© when following the methods of content analysis according to Graneheim and Lundman [1], framework method according to Gale et. al [2] and phenomenological hermeneutical method according to Lindseth and Norberg [3]. Furthermore, we will discuss how NVivo may facilitate analysis, but also how it may threaten the sense of the whole and impede co-assessment.

National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-67249 (URN)
Conference
The third Nordic Conference in Nursing Research – Methods and Networks for the future, Oslo, Norway, June 13-15, 2018
Available from: 2018-06-14 Created: 2018-06-14 Last updated: 2019-04-05Bibliographically approved
Svantesson, M., Silén, M. & James, I. (2018). It's not all about moral reasoning: Understanding the content of Moral Case Deliberation. Nursing Ethics, 25(2), 212-229
Open this publication in new window or tab >>It's not all about moral reasoning: Understanding the content of Moral Case Deliberation
2018 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 25, no 2, p. 212-229Article in journal (Refereed) Published
Abstract [en]

Background: Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain.

Objective: To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces.

Methods: A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority.

Ethical considerations: No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation.

Findings: Other than ‘moral reasoning’ (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of ‘reflections on the psychosocial work environment’ to a varying extent (md: 29%). Additional content comprised ‘assumptions about the patient’s psychosocial situation’ (md: 6%), ‘facts about the patient’s situation’ (md: 5%), ‘concrete problem-solving’ (md: 6%) and ‘process’ (md: 3%).

Conclusion: The findings suggest that a restorative function of staff’s wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants’ own emotional needs and to develop the use of their emotional knowing to focus on the ethically difficult patient situation.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Clinical ethics, ethics consultation, ethics rounds, healthcare professionals, Moral Case Deliberation, psychosocial aspects, qualitative research
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-58289 (URN)10.1177/0969733017700235 (DOI)000429899900008 ()28421865 (PubMedID)2-s2.0-85044337153 (Scopus ID)
Funder
AFA Insurance
Available from: 2017-06-26 Created: 2017-06-26 Last updated: 2018-09-06Bibliographically approved
Heidenreich, K., Bremer, A., Materstvedt, L. J., Tidefelt, U. & Svantesson, M. (2018). Relational autonomy in the care of the vulnerable: health care professionals' reasoning in Moral Case Deliberation (MCD). Medicine, Health care and Philosophy, 21(4), 467-477
Open this publication in new window or tab >>Relational autonomy in the care of the vulnerable: health care professionals' reasoning in Moral Case Deliberation (MCD)
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2018 (English)In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 21, no 4, p. 467-477Article in journal (Refereed) Published
Abstract [en]

In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals' moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient's nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient's autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients' influence and at the same time take responsibility for their needs as vulnerable humans.

Place, publisher, year, edition, pages
Dordrecht, Netherlands: Springer Netherlands, 2018
Keywords
Clinical ethics, ethics consultation, health care professionals, moral case deliberation, ualitative research
National Category
Medical Ethics
Identifiers
urn:nbn:se:oru:diva-63400 (URN)10.1007/s11019-017-9818-6 (DOI)000451022600004 ()29243015 (PubMedID)2-s2.0-85038102190 (Scopus ID)
Available from: 2018-01-08 Created: 2018-01-08 Last updated: 2019-04-05Bibliographically approved
Prenkert, M., Carlsson, E., Svantesson, M. & Anderzén-Carlsson, A. (2017). Healthcare-professional patients’ conceptions of being ill and hospitalised: a phenomenographic study. Journal of Clinical Nursing, 26(11-12), 1725-1736
Open this publication in new window or tab >>Healthcare-professional patients’ conceptions of being ill and hospitalised: a phenomenographic study
2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 11-12, p. 1725-1736Article in journal (Refereed) Published
Abstract [en]

Aims and Objectives: To describe the variation of conceptions of being ill and hospitalised, from the perspective of health-care-professional-patients.

Background: Previous literature focuses on either physicians' or nurses' experiences of being a patient, without aiming at determining a variation of ways of understanding that phenomena. Nor have we been able to identify any study reporting other health-care-professionals' experiences.

Design: This study has an inductive descriptive design.

Methods: Qualitative interviews with health care professionals (n=16), who had been hospitalised for at least two days. Phenomenographic data analysis was conducted.

Results: The feelings of security were based on knowledge, insight and trust, and acceptance of the health care system. Being exposed and totally dependent due to illness provoked feelings of vulnerability and insecurity. The patients used their knowledge to achieve participation in the care. The more severe they perceived their illness to be, the less they wanted to participate and the more they expressed a need for being allowed to surrender control. The patients' ideal picture of care was sometimes disrupted and based on their experience they criticised care and made suggestions that could contribute to general care improvements.

Conclusions: Health-care-professional patients' have various conceptions of being ill and hospitalised. Based on the general nature of the many needs expressed, we believe that the some insights provided in this study can be transferred so as to also be valid for lay patients. Possibly, an overhaul of routines for discharge planning and follow-up, and adopting a person-centred approach to care, can resolve some of the identified shortcomings. Finally, the results can be used for the purpose of developing knowledge for health-care professions and for educational purposes.

Relevance to clinical practice: The results can be used for the purpose of develop-ing knowledge for healthcare professions and for educational purposes.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Health care professionals, patient safety, phenomenography, qualitative studies, quality of life
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-52724 (URN)10.1111/jocn.13604 (DOI)000400992400028 ()27685871 (PubMedID)2-s2.0-85019022838 (Scopus ID)
Available from: 2016-10-11 Created: 2016-10-03 Last updated: 2017-09-05Bibliographically approved
Rasoal, D., Kihlgren, A. & Svantesson, M. (2017). ‘It’s like sailing’: experiences of the role as facilitator during moral case deliberation. Clinical Ethics, 12(3), 1-8
Open this publication in new window or tab >>‘It’s like sailing’: experiences of the role as facilitator during moral case deliberation
2017 (English)In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 12, no 3, p. 1-8Article in journal (Refereed) Published
Abstract [en]

Moral case deliberation is one form of clinical ethics support, and there seems to be different ways of facilitating thedialogue. This paper aimed to explore the personal experiences of Swedish facilitators of their role in moral casedeliberations. Being a facilitator was understood through the metaphor of sailing: against the wind or with it. Therole was likened to a sailor’s set of skills: to promote security and well-being of the crew, to help crew navigate theirmoral reflections, to sail a course into the wind against homogeneity, to accommodate the crew’s needs and just sail withthe wind, and to steer towards a harbour with authority and expertise. Balancing the disparate roles of being accom-modative and challenging may create a free space for emotions and ideas, including self-reflection and consideration ofmoral demands. This research opens the question of whether all these skills can be taught through systematic training orwhether facilitators need to possess the characteristics of being therapeutic, pedagogical, provocative, sensitive andauthoritarian.

Place, publisher, year, edition, pages
United Kingdom: Royal Society of Medicine Press, 2017
Keywords
Ethics, clinical ethics, ethics consultation, moral case deliberation, healthcare professionals
National Category
Medical and Health Sciences Medical Ethics
Research subject
Health and Medical Care Research
Identifiers
urn:nbn:se:oru:diva-64287 (URN)DOI: 10.1177/1477750917710882 (DOI)2-s2.0-85029502486 (Scopus ID)
Projects
NUPARC
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2018-08-13Bibliographically approved
Nilsson, C., Bremer, A., Blomberg, K. & Svantesson, M. (2017). Responsibility and compassion in prehospital support to survivors of suicide victim - Professionals' experiences. International Emergency Nursing, 35, 37-42
Open this publication in new window or tab >>Responsibility and compassion in prehospital support to survivors of suicide victim - Professionals' experiences
2017 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 35, p. 37-42Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2017
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-59079 (URN)10.1016/j.ienj.2017.06.004 (DOI)000417590900007 ()28687433 (PubMedID)2-s2.0-85021705021 (Scopus ID)
Note

Funding Agency:

Research Commi-tee, Örebro University Hospital OLL-497431

Available from: 2017-08-12 Created: 2017-08-12 Last updated: 2018-01-25Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0679-5695

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