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Ehnfors, Margareta
Publications (10 of 69) Show all publications
Hagvall, M., Ehnfors, M. & Anderzén-Carlsson, A. (2016). Experiences of parenting a child with medical complexity in need of acute hospital care. Journal of Child Health Care, 20(1), 68-76
Open this publication in new window or tab >>Experiences of parenting a child with medical complexity in need of acute hospital care
2016 (English)In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 20, no 1, p. 68-76Article in journal (Refereed) Published
Abstract [en]

Parents of children with medical complexity have described being responsible for providing advanced care for the child. When the child is acutely ill, they must rely on the health-care services during short or long periods of hospitalization. The purpose of this study was to describe parental experiences of caring for their child with medical complexity during hospitalization for acute deterioration, specifically focussing on parental needs and their experiences of the attitudes of staff. Data were gathered through individual interviews and analyzed using qualitative content analysis. The care period can be interpreted as a balancing act between acting as a caregiver and being in need of care. The parents needed skilled staff who could relieve them of medical responsibility, but they wanted to be involved in the care and in the decisions taken. They needed support, including relief, in order to meet their own needs and to be able to take care of their children. It was important that the child was treated with respect in order for the parent to trust the staff. An approach where staff view parents and children as a single unit, as recipients of care, would probably make the situation easier for these parents and children.

Place, publisher, year, edition, pages
London, United Kingdom: Sage Publications, 2016
Keywords
Complex care, disability, qualitative approaches
National Category
Nursing Pediatrics
Research subject
Caring sciences; Pediatrics
Identifiers
urn:nbn:se:oru:diva-41154 (URN)10.1177/1367493514551308 (DOI)000370669300008 ()25352538 (PubMedID)2-s2.0-84958068646 (Scopus ID)
Note

Funding Agencies:

Research Committee at Örebro County Council

Procter Gamble

Available from: 2015-01-14 Created: 2015-01-13 Last updated: 2018-07-09Bibliographically approved
Prenkert, M. & Ehnfors, M. (2016). Growth data of underprivileged children living in rural areas of Chin State, Burma/Myanmar, compared to the WHO reference growth standards: an observational study. BMJ Open, 6(1), Article ID e009119.
Open this publication in new window or tab >>Growth data of underprivileged children living in rural areas of Chin State, Burma/Myanmar, compared to the WHO reference growth standards: an observational study
2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 1, article id e009119Article in journal (Refereed) Published
Abstract [en]

Objectives: To explore growth data (height-for-age, weight-for-age and BMI-for-age) of children living in poor socioeconomic conditions in rural areas of Chin State, Burma/Myanmar; and to compare these data with the growth and development z-score (GDZ) values for school-aged children and adolescents, provided by the WHO.

Setting: A support and educational programme, run by the Swedish association Chin Development and Research Society (CDRS), was carried out among underprivileged school-aged children, unable to attend school without economic and practical support, living in villages and remote areas in Chin State.

Participants: Community leaders who were well familiar with the citizens in the community identified children in need of this support. Other community members could also suggest or apply for this. The sample includes all participating children in the CDRS programme at the time of the data collection in six townships. The children were placed in host families, close to a suitable school. Two samples with a total of 639 children from 144 villages and remote areas were obtained:

1. Children in the CDRS Chin Programme (CCP) (20072010) comprised 558 children: 50% girls and boys.

2. Children in the Chin Society (CCS) (2010) comprised 81 children: 44% girls and 56% boys.

Primary outcome measures: Growth data.

Results: All growth data from both groups deviated significantly from the WHO standard references (p=0.001). The prevalence of stunting (height-for-age <=-2SD) was 52% among girls and 68% among boys. High levels of wasting (weight-for-age <=-2SD) were found among girls 29% and boys 36% aged 5-10 years. In addition, severe thinness (BMI-for-age <=-2SD) was found among girls 31% and boys 44%, all results to be compared to the expected 2.27%.

Conclusions: Many more than expected-according to the WHO reference values-in CCP and CCS suffered from stunting, wasting and thinness.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2016
National Category
General Practice
Research subject
Family Medicine
Identifiers
urn:nbn:se:oru:diva-48944 (URN)10.1136/bmjopen-2015-009119 (DOI)000369993900061 ()26787249 (PubMedID)
Note

Funding Agency:

Örebro University, Sweden

Available from: 2016-03-04 Created: 2016-03-04 Last updated: 2018-01-10Bibliographically approved
Eldh, A. C., Luhr, K. & Ehnfors, M. (2015). The development and initial validation of a clinical tool for patients' preferences on patient participation: The 4Ps. Health Expectations, 18(6), 2522-2535
Open this publication in new window or tab >>The development and initial validation of a clinical tool for patients' preferences on patient participation: The 4Ps
2015 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 18, no 6, p. 2522-2535Article in journal (Refereed) Published
Abstract [en]

Aims: To report on the development and initial testing of a clinical tool, The Patient Preferences for Patient Participation tool (The 4Ps), which will allow patients to depict, prioritize, and evaluate their participation in health care.

Background: While patient participation is vital for high quality health care, a common definition incorporating all stakeholders' experience is pending. In order to support participation in health care, a tool for determining patients' preferences on participation is proposed, including opportunities to evaluate participation while considering patient preferences.

Methods: Exploratory mixed methods studies informed the development of the tool, and descriptive design guided its initial testing. The 4Ps tool was tested with 21 Swedish researcher experts (REs) and patient experts (PEs) with experience of patient participation. Individual Think Aloud interviews were employed to capture experiences of content, response process, and acceptability.

Results: 'The 4Ps' included three sections for the patient to depict, prioritize, and evaluate participation using 12 items corresponding to 'Having Dialogue', 'Sharing Knowledge', 'Planning', and 'Managing Self-care'. The REs and PEs considered 'The 4Ps' comprehensible, and that all items corresponded to the concept of patient participation. The tool was perceived to facilitate patient participation whilst requiring amendments to content and layout.

Conclusions: A tool like The 4Ps provides opportunities for patients to depict participation, and thus supports communication and collaboration. Further patient evaluation is needed to understand the conditions for patient participation. While The 4Ps is promising, revision and testing in clinical practice is required.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
Keywords
clinical tool, content validity, instrument development, patient participation, qualitative analysis
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-41155 (URN)10.1111/hex.12221 (DOI)000368250300058 ()24938672 (PubMedID)2-s2.0-84955180179 (Scopus ID)
Note

Funding Agencies:

Capio Research Fund, Sweden

Family Medicine Research Centre, Örebro county council 

Available from: 2015-01-14 Created: 2015-01-13 Last updated: 2020-01-29Bibliographically approved
Florin, J., Ehrenberg, A., Ehnfors, M. & Björvell, C. (2013). A comparison between the VIPS model and the ICF for expressing nursing content in the health care record. International Journal of Medical Informatics, 82(2), 108-17
Open this publication in new window or tab >>A comparison between the VIPS model and the ICF for expressing nursing content in the health care record
2013 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 82, no 2, p. 108-17Article in journal (Refereed) Published
Abstract [en]

Background: Multi-professional standardized terminologies are needed that cover common as well as profession-specific care content in order to obtain a full coverage and description of the contributions from different health professionals' perspectives in health care. Implementation of terminologies in clinical practice that do not cover professionals' needs for communication might jeopardize the quality of care.

Purpose: The aim of the study was to compare the structure and content of the Swedish VIPS model for nursing documentation and the international classification of function, disability and health (ICF).

Method: Mapping was performed between key words and prototypical examples for patient status in the VIPS model and terms in the ICF and its framework of domains, chapters and specific terms. The study had two phases. In the first phase 13 key words for patient status in the VIPS model and the 289 terms (prototypical examples) describing related content were mapped to comparable terms in the ICF. In phase two, 1424 terms on levels 2-4 in the ICF were mapped to the key words for patient status in the VIPS model.

Results: Differences in classification structures and content were found, with a more elaborated level of detail displayed in the ICF than in the VIPS model. A majority of terms could be mapped, but several essential nursing care concepts and perspectives identified in the VIPS model were missing in the ICF. Two-thirds of the content in the ICF could be mapped to the VIPS' key words for patient status; however, the remaining terms in the ICF, describing body structure and environmental factors, are not part of the VIPS model.

Conclusion: Despite that a majority of the nursing content in the VIPS model could be expressed by terms in the ICF, the ICF needs to be developed and expanded to be functional for nursing practice. The results have international relevance for global efforts to implement unifying multi-professional terminologies. In addition, our results underline the need for sufficient coverage and level of detail to support different professional perspectives in health care terminologies.

Place, publisher, year, edition, pages
Clare, Ireland: Elsevier, 2013
Keywords
Documentation, Classification, ICF, Mapping, Nursing, VIPS
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:oru:diva-41315 (URN)10.1016/j.ijmedinf.2012.05.016 (DOI)000314116700005 ()22824196 (PubMedID)2-s2.0-84873060867 (Scopus ID)
Available from: 2015-01-14 Created: 2015-01-14 Last updated: 2020-01-28Bibliographically approved
Thoroddsen, A., Sigurjónsdóttir, G., Ehnfors, M. & Ehrenberg, A. (2013). Accuracy, completeness and comprehensiveness of information on pressure ulcers recorded in the patient record. Scandinavian Journal of Caring Sciences, 27(1), 84-91
Open this publication in new window or tab >>Accuracy, completeness and comprehensiveness of information on pressure ulcers recorded in the patient record
2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 1, p. 84-91Article in journal (Refereed) Published
Abstract [en]

Aim: To describe the accuracy, completeness and comprehensiveness of information on pressure ulcers documented in patient records.

Design and setting: A cross-sectional descriptive study performed in 29 wards at a university hospital in Iceland. The study included skin assessment of patients and retrospective audits of records of patients identified with pressure ulcers.

Participants: A sample of 219 patients was inspected for signs of pressure ulcers on 1 day in 2008. Records of patients identified with pressure ulcers were audited (n = 45) retrospectively.

Results: The prevalence of pressure ulcers was 21%. Information in patient records lacked accuracy, completeness and comprehensiveness. Only 60% of the identified pressure ulcers were documented in the patient records. The lack of accuracy was most prevalent for stage I pressure ulcers.

Conclusions: The purpose of documentation to record, communicate and support the flow of information in the patient record was not met. The patient records lacked accuracy, completeness and comprehensiveness, which can jeopardise patient safety, continuity and quality of care. The information on pressure ulcers in patient records was found not to be a reliable source for the evaluation of quality in health care. To improve accuracy, completeness and comprehensiveness of data in the patient record, a systematic risk assessment for pressure ulcers and assessment and treatment of existing pressure ulcers based on evidence-based guidelines need to be implemented and recorded in clinical practice. Health information technology, including the electronic health record with decision support, has shown promising results to facilitate and improve documentation of pressure ulcers.

Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell, 2013
Keywords
Accuracy, completeness, comprehensiveness, documentation, patient record, pressure ulcer
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:oru:diva-41314 (URN)10.1111/j.1471-6712.2012.01004.x (DOI)000314819900013 ()22630335 (PubMedID)2-s2.0-84873437341 (Scopus ID)
Available from: 2015-01-14 Created: 2015-01-14 Last updated: 2020-01-28Bibliographically approved
Graaf [Olsson-Graaf], T., Kihlgren, A., Ehnfors, M. & Blomberg, K. (2013). Communication patterns in coordinated care planning conferences with older patients. Journal of Nursing Education and Practice, 3(10), 35-49
Open this publication in new window or tab >>Communication patterns in coordinated care planning conferences with older patients
2013 (English)In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 3, no 10, p. 35-49Article in journal (Refereed) Published
Abstract [en]

Background: When an older patient is discharged from a hospital in Sweden, a care plan in cooperation with the patient should be made through coordinated care planning (COCP). Previous research has described difficulties in the discharge process; consequently, it is important to develop additional knowledge and investigate both whether and how patients are given the opportunity to participate in COCP. The aim of the present study was to determine if older patients are given the opportunity to participate in COCP meetings, and if so, what characterizes these meetings.

Method: This qualitative, descriptive study is based on non-participant observation of interactions between older patients and care staff at six COCP meetings. The data collected were analyzed using directed content analysis and critical discourse analysis (CDA).

Results: The main findings indicate a lack of patient participation in all the COCP meetings held at the hospital. The dialogues in that context were less information intensive, and a professional perspective dominated. The situation in advanced home care (AHC) was the opposite; already from the outset, it was evident that the patient was the chief informant and that the patient’s perspective predominated during the dialogues.

Conclusions: General differences in the way the dialogues were initiated and in how they progressed were observed between the hospital and AHC. Due to both shortage of time in health care today and financial issues, it is important to find solutions that incorporate the older patient’s experiences as well as professional knowledge.

Keywords
Coordinated care planning, Discharge, Patient participation
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-28500 (URN)10.5430/jnep.v3n10p35 (DOI)
Available from: 2013-03-28 Created: 2013-03-28 Last updated: 2017-12-06Bibliographically approved
Fossum, M., Ehnfors, M., Svensson, E., Hansen, L. M. & Ehrenberg, A. (2013). Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study. International Journal of Medical Informatics, 82(10), 911-921
Open this publication in new window or tab >>Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study
Show others...
2013 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 82, no 10, p. 911-921Article in journal (Refereed) Published
Abstract [en]

Background: Nursing documentation is essential for facilitating the flow of information to guarantee continuity, quality and safety in care. High-quality nursing documentation is frequently lacking; the implementation of computerized decision support systems is expected to improve clinical practice and nursing documentation.

Aim: The present study aimed at investigate the effects of a computerized decision support system and an educational program as intervention strategies for improved nursing documentation practice on pressure ulcers and malnutrition in nursing homes.

Design, setting and participants: An intervention study with two intervention groups and one control group was used. Fifteen nursing homes in southern Norway were included. A convenience sample of electronic healthcare records from 46 units was included. Inclusion criteria were records with presence of pressure ulcers and/or malnutrition. The residents were assessed before and after an intervention of a computerized decision support system in the electronic healthcare records. Data were collected through a review of 150 records before (2007) and 141 records after the intervention (2009).

Methods: The nurses in intervention group 1 were offered educational sessions and were trained to use the computerized decision support system, which they used for eight months in 2008 and 2009. The nurses in intervention group 2 were offered the same educational program but did not use the computerized decision support system. The nurses in the control group were not subject to any intervention. The resident records were examined for the completeness and comprehensiveness of the documentation of pressure ulcers and malnutrition with three data collection forms and the data were analyzed with non-parametric statistics.

Results: The implementation of the computerized decision support system and the educational program resulted in a more complete and comprehensive documentation of pressure ulcer- and malnutrition-related nursing assessments and nursing interventions.

Conclusion: This study provides evidence that the computerized decision support system and an educational program as implementation strategies had a positive influence on nursing documentation practice.

Keywords
Decision support system, Documentation, Intervention studies, Malnutrition, Nursing audit, Pressure ulcer
National Category
Medical and Health Sciences Probability Theory and Statistics
Research subject
Caring sciences; Statistics
Identifiers
urn:nbn:se:oru:diva-31983 (URN)10.1016/j.ijmedinf.2013.05.009 (DOI)000324312000002 ()
Available from: 2013-10-14 Created: 2013-10-14 Last updated: 2020-01-28Bibliographically approved
Carlsson, E., Ehnfors, M., Eldh, A. C. & Ehrenberg, A. (2012). Accuracy and continuity in discharge information for patients with eating difficulties after stroke. Journal of Clinical Nursing, 21(1-2), 21-31
Open this publication in new window or tab >>Accuracy and continuity in discharge information for patients with eating difficulties after stroke
2012 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 1-2, p. 21-31Article in journal (Refereed) Published
Abstract [en]

Aims: To describe the accuracy and continuity of discharge information for patients with eating difficulties after stroke.

Design: Prospective, descriptive.

Methods: The study investigated a sample of 15 triads, each including one patient with stroke along with his patient record and discharge summary and two nursing staff in the municipal care to whom the patient was discharged. Data were collected by observations of patients' eating, record audits and interviews with nurses. Data were analysed using content analysis and descriptive statistics.

Results: Accuracy of recorded information on patients' eating difficulties and informational continuity were poor, as was accuracy in the transferred information according to nursing staff's perceptions. All patients were at risk of undernutrition and in too poor a state to receive rehabilitation. Nevertheless, patients' eating difficulties were described in a vague and unspecific language in the patient records. Co-ordinated care planning and management continuity related to eating difficulties were largely lacking in the documentation. Despite their important role in caring for patients with eating difficulties, little information on eating difficulties seemed to reach licensed practical nurses in the municipalities.

Conclusions: Comprehensiveness in the documentation of eating difficulties and accuracy of transferred information were poor based on record audits and as perceived by the municipal nursing staff. Although all patients were at risk of undernutrition, had multiple eating difficulties and were in too poor a state for rehabilitation, explicit care plans for nutritional problems were lacking.

Relevance to clinical practice: Lack of accuracy and continuity in discharge information on eating difficulties may increase risk of undernutrition and related complications for patients in continuous stroke care. Therefore, the discharge process must be based on comprehensive and accurate documentation.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012
Keywords
continuity of care, eating difficulties, information transfer, nursing, record audit, stroke
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-21638 (URN)10.1111/j.1365-2702.2010.03648.x (DOI)000297953700004 ()21564355 (PubMedID)2-s2.0-83355166869 (Scopus ID)
Note

Funding Agency:

Research Committee of Örebro County Council

Available from: 2012-02-14 Created: 2012-02-14 Last updated: 2020-01-29Bibliographically approved
Carlsson, E., Ehnfors, M., Eldh, A. C. & Ehrenberg, A. (2012). Information transfer and continuity of care for stroke patients with eating difficulties from the perspectives of nursing staff in Swedish elderly care. In: Nursing informatics ... : proceedings of the ... International Congress on Nursing Informatics: . Paper presented at 11th International Congress of Nursing Informatics, Motreal, Canada, June 23-27, 2012. (pp. 61-64).
Open this publication in new window or tab >>Information transfer and continuity of care for stroke patients with eating difficulties from the perspectives of nursing staff in Swedish elderly care
2012 (English)In: Nursing informatics ... : proceedings of the ... International Congress on Nursing Informatics, 2012, p. 61-64Conference paper, Published paper (Refereed)
Abstract [en]

Continuity of care is a key issue in the care for elderly people, for example, those having experienced stroke, particularly with regards to informational and managerial continuity based on patient record data. The study aim was to explore municipal nursing staff's (n=30) perceptions of discharge information provided to them for stroke patients with eating difficulties. Structured interviews were used and data were analysed by content analysis and descriptive statistics. Results showed that nursing staff perceived informational continuity and accuracy of information on patients' eating difficulties as poor and that little information on eating difficulties reached licensed practical nurses, who instead relied on their own assessments of patients' eating ability. Co-ordinated care planning and management continuity were largely lacking, increasing the risk for undernutrition and related complications for the patients.

National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:oru:diva-41320 (URN)24199052 (PubMedID)
Conference
11th International Congress of Nursing Informatics, Motreal, Canada, June 23-27, 2012.
Available from: 2015-01-14 Created: 2015-01-14 Last updated: 2020-01-29Bibliographically approved
Fossum, M., Ehnfors, M., Fruhling, A. & Ehrenberg, A. (2012). The experiences of using a computerized decision support system. In: : . Paper presented at The 11th International Congress on Nursing Informatics, Montreal, Canada. June 2012. American Medical Informatics Association (pp. 113-115). , 2012
Open this publication in new window or tab >>The experiences of using a computerized decision support system
2012 (English)Conference paper, Published paper (Other academic)
Abstract [en]

The aim was to describe the facilitators and barriers influencing the ability of nursing personnel to effectively use a CDSS for planning and treating pressure ulcers and malnutrition in nursing homes. Usability evaluations and group interviews were conducted. Facilitators were ease of use, usefulness and a supportive work environment. Lack of training, resistance to using computers and limited integration of the CDSS with the electronic health record system were reported.

National Category
Nursing Information Systems
Identifiers
urn:nbn:se:oru:diva-41316 (URN)24199144 (PubMedID)
Conference
The 11th International Congress on Nursing Informatics, Montreal, Canada. June 2012. American Medical Informatics Association
Available from: 2015-01-14 Created: 2015-01-14 Last updated: 2020-01-28Bibliographically approved
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