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  • 1.
    Berg, Lena M.
    et al.
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine Solna, Karolinska University Hospital, Stockholm, Sweden.
    Florin, Jan
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Ehrenberg, Anna
    Örebro University, School of Health Sciences.
    Östergren, Jan
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine Solna, Karolinska University Hospital, Stockholm, Sweden.
    Djärv, Therese
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine Solna, Karolinska University Hospital, Stockholm, Sweden.
    Göransson, Katarina E.
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine Solna, Karolinska University Hospital, Stockholm, Sweden.
    Reasons for interrupting colleagues during emergency department work: A qualitative study2016In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 29, p. 21-26Article in journal (Refereed)
    Abstract [en]

    Objective: Emergency department team members frequently need to interact with each other, a circumstance causing multiple interruptions. However, information is lacking about the motives underlying these interruptions and this study aimed to explore clinicians' reasons to interrupt colleagues during emergency department work.

    Method: Semi-structured interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. The interviews were analyzed inductively using content analysis.

    Results: The working conditions to some extent sustained the clinicians' need to interrupt, for example different routines. Another reason to interrupt was to improve the initiator's work process, such as when the initiators perceived that the interruption had high clinical relevance. The third reason concerns the desire to influence the work process of colleagues in order to prevent mistakes and provide information for the person being interrupted to improve patient care.

    Conclusion: The three identified categories for why emergency department clinicians interrupt their colleagues were related to working conditions and a wish to improve/influence the work processes for both initiators and recipients. Several of the reasons given for interrupting colleagues were done in order to improve patient care. Interruptions perceived as negative to the recipient were mostly related to the working conditions.

  • 2.
    Carlsson, Eva
    et al.
    Örebro University, School of Health and Medical Sciences. Dept Qual & Patient Safety, Lindesberg Hosp, Lindesberg, Sweden.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences. Dept Hlth & Social Sci, Hogskolan Dalarna, Falun, Sweden.
    Multidisciplinary recording and continuity of care for stroke patients with eating difficulties2010In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 24, no 3, p. 298-310Article in journal (Refereed)
    Abstract [en]

    Eating difficulties after stroke are common and can, in addition to being a risk for serious medical complications, impair functional capability, social life and self-image. Stroke unit care entails systematic multidisciplinary teamwork and continuity of care. The purpose of this study was to describe (i) multidisciplinary stroke care as represented in patient records for patients with eating difficulties, and (ii) the written information that was transferred from hospital to elderly care. Data from 59 patient records were analysed with descriptive statistics and by categorization of phrases. Signs of multidisciplinary collaboration to manage eating problems were scarce in the records. While two notes from physiotherapists were found, nurses contributed with 78% of all notes (n = 358). Screening of swallowing and body weight was documented for most patients, whereas data on nutritional status and eating were largely lacking. The majority of notes represented patients' handling of food in the mouth, swallowing and lack of energy. Care plans were unstructured and few contained steps for managing eating. Discharge summaries held poor information on care related to eating difficulties. The language of all professionals was mostly unspecific. However, notes from speech-language therapists were comprehensive and entailed information on follow-up and patient participation

  • 3.
    Carlsson, Eva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eldh, Ann Catrine
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Accuracy and continuity in discharge information for patients with eating difficulties after stroke2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 1-2, p. 21-31Article in journal (Refereed)
    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.

  • 4.
    Carlsson, Eva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Sciences, Örebro University Hospital, Örebro, Sweden.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eldh, Ann Catrine
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Information transfer and continuity of care for stroke patients with eating difficulties from the perspectives of nursing staff in Swedish elderly care2012In: Nursing informatics ... : proceedings of the ... International Congress on Nursing Informatics, 2012, p. 61-64Conference 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.

  • 5.
    Carlsson, Eva
    et al.
    Örebro University, Department of Health Sciences.
    Ehrenberg, Anna
    Örebro University, Department of Health Sciences.
    Ehnfors, Margareta
    Örebro University, Department of Health Sciences.
    Stroke and eating difficulties: long-term experiences2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 7, p. 825-834Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous studies have shown that eating difficulties after stroke are common and often associated with communication problems. These difficulties, however, have mainly been studied from a professional perspective. Although numerous aspects of dysfunction have been identified, little knowledge exists about the experiences of living with eating difficulties. AIM: To explore how people affected by stroke experience living with eating difficulties, during a prolonged period. DESIGN: Explorative, qualitative case study. METHODS: Repeated interviews and participant observations with three persons 1.5-2 years after their last stroke. Data were analysed using qualitative analysis. RESULTS: Eating difficulties after stroke were experienced as Striving to live a normal life, with the subthemes Abandoned to learn on one's own, Experiences of losses and Feeling dependent. The process of getting back to a life that resembled life before the stroke was experienced as long-lasting and hard work. The informants felt that they were abandoned to manage eating training on their own. The informants experienced a loss of functional eating ability and the ability to perform activities related to food and meals. Feelings of dependence were experienced in mealtime situations. CONCLUSION: Living with eating difficulties after stroke is a complex phenomenon. The informants felt abandoned because of lack of support from the nursing staff. They were left on their own to deal with the difficult process of adjusting to a new way of eating and losses regarding mealtime activities. The combination of repeated interviews and participant observations seemed to be an approach that should be tested in larger studies. RELEVANCE TO CLINICAL PRACTICE: This case study indicates a need for nurses to develop and use evidence-based guidelines for eating training during the continuum of care. Nurses need to assess patient's habits and desires related to eating, and to adjust environment according to patient preferences.

  • 6.
    Carlsson, Eva
    et al.
    Örebro University, Department of Health Sciences.
    Paterson, Barbara L.
    Scott-Findlay, Shannon
    Ehnfors, Margareta
    Örebro University, Department of Health Sciences.
    Ehrenberg, Anna
    Örebro University, Department of Health Sciences.
    Methodological Issues in Interviews Involving people with Communication Impairments After acquired Brain Damage2007In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 17, no 10, p. 1361-1371Article in journal (Refereed)
    Abstract [en]

    Qualitative research has made a significant contribution to the body of knowledge related to how people experience living with various chronic diseases and disabilities, however, the voices of certain vulnerable populations, particularly those with impairments that affect their ability to communicate, are commonly absent. In recent years, a few researchers have attempted to explore the most effective ways to ensure that the voices of people with communication impairments from acquired brain damages can be captured in qualitative research interviews, yet several methodological issues related to including this population in qualitative research remained unexamined. In this article, the authors draw on insights derived from their research on the experiences of adult survivors of stroke and traumatic brain injury to describe methodological issues related to sampling, informed consent, and fatigue in participant and researcher while also making some recommendations for conducting qualitative interviews with these populations.

  • 7.
    Ehnfors, Margareta
    et al.
    Örebro University, School of Health and Medical Sciences.
    Angermo, Lilly Marit
    Rikshospitalet University Hospital, Centre for Shared Decision Making and Nursing Research, Oslo, Norway.
    Berring, Lene
    Gentofte University Hospital, Copenhagen, Denmark.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences. Department of Health and Social Sciences, Dalarna University, Falun.
    Lindhardt, Tove
    Dept of Health Sciences, Lund University, Lund.
    Rotegard, Ann Kristin
    Rikshospitalet University Hospital, Centre for Shared Decision Making and Nursing Research, Oslo, Norway.
    Thorell-Ekstrand, Ingrid
    Örebro University, School of Health and Medical Sciences.
    Mapping VIPS concepts for nursing interventions to the ISO reference terminology model for nursing actions: A collaborative Scandinavian analysis2006In: Consumer-Centered Computer-Suppported Care for Healthy People, Amsterdam, Netherlands: IOS Press, 2006, Vol. 122, p. 401-5Conference paper (Refereed)
    Abstract [en]

    The aims of this study were to analyze the coherence between the concepts for nursing interventions in the Swedish VIPS model for nursing recording and the ISO Reference Terminology Model for Nursing Actions and to identify areas in the two models for further development. Seven Scandinavian experts analyzed the VIPS model's concepts for nursing interventions using prototypical examples of nursing actions, involving 233 units of analyses, and collaborated in mapping the two models. All nursing interventions in the VIPS model comprise actions and targets, but a few lack explicit expressions of means. In most cases, the recipient of care is implicit. Expressions for the aim of an action are absent from the ISO model. By this mapping we identified areas for future development of the VIPS model and the experience from nursing terminology work in Scandinavia can contribute to the international standardization efforts.

  • 8.
    Ehnfors, Margareta
    et al.
    Örebro University, Department of Nursing and Caring Sciences. Swedish Society of Nursing, Stockholm.
    Florin, Jan
    Örebro University, Department of Nursing and Caring Sciences. Dalarna University, Falun.
    Ehrenberg, Anna
    Örebro University, Department of Nursing and Caring Sciences. Dalarna University, Falun.
    Applicability of the International Classification of Nursing Practice (ICNP) in the areas of nutrition and skin care2003In: International Journal of Nursing Terminologies and Classifications, ISSN 2047-3087, E-ISSN 2047-3095, Vol. 14, no 1, p. 5-18Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate completeness, granularity, multiple axial content, and clinical utility of the beta version of the ICNP in the context of standardized nursing care planning in a clinical setting.

    Methods: An 35-bed acute care ward for infectious diseases at a Swedish university hospital was selected for clinical testing. A convenience sample of 56 patient records with data on nutrition and skin care was analyzed and mapped to the ICNP.

    Findings: Using the ICNP terminology, 59%-62% of the record content describing nursing phenomena and 30%-44% of the nursing interventions in the areas of nutrition and skin care could be expressed satisfactorily. For about a quarter of the content describing nursing phenomena and interventions, no corresponding ICNP term was found.

    Conclusions: The ICNP needs to be further developed to allow representation of the entire range of nursing care. Terms need to be developed to express patient participation and preferences, normal conditions, qualitative dimensions and characteristics, nonhuman focus, and duration.

    Practice implications: The practical usefulness of the ICNP needs further testing before conclusions about its clinical benefits can be determined.

  • 9.
    Ehnfors, Margareta
    et al.
    Örebro University, Department of Nursing and Caring Sciences. Department of Social Medicine, Uppsala University, Uppsala.
    Thorell-Ekstrand, Ingrid
    Department of Nursing Research, Karolinska Hospital; College of Health and Caring Sciences, Stockholm.
    Ehrenberg, Anna
    Department of Planning and Development, Falun Hospital, Falun.
    Towards basic nursing information in patient records1991In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 11, no 3-4, p. 12-31Article, review/survey (Refereed)
    Abstract [en]

    Four key concepts for good nursing care and a list of key words for nursing documentation in patient records were established and to some extent tried in clinical practice in Sweden. The method consisted of the following steps: extensive literature review, review of nursing records, development of a list of key words on two levels, a first level corresponding to the nursing process, and a second level consisting of subdivisions for possible use in practice, use and assessment in clinical practice by nurses and students, expert panel judgement and refinement of the key words including an examination of semantic accuracy of the Swedish key words by an expert in Nordic languages. The proposed key words are presented both in English and Swedish and explanations, comments and references are given. The version of key words presented here is subject to further testing for possible modifications.

  • 10. Ehrenberg, Anna
    et al.
    Angsmo, Ewa
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Florin, Jan
    Fogelberg-Dahm, Marie
    Liljequist, David
    Midboe, Lars
    Nilsson, Gunilla
    Wärn-Hede, Gunnel
    Östlinder, Gerthrud
    Nursing informatics in Sweden: the agenda for the future2009In: Connecting health and humans / [ed] Kaija Saranto, Patricia Flatley Brennan, Hyeoun-Ae Park, Marianne Tallberg, Anneli Ensio, Australian Computer Society , 2009, Vol. 146, p. 866-867Conference paper (Other academic)
    Abstract [en]

    With the purpose of getting an overview of the current research and development in information systems and terminology for nursing practice and outline strategies for the future, an initiative for a workshop was taken at the national level in Sweden by the Section for Nursing Informatics, the Society of Nursing and the Association of Health Professionals in 2007. For the workshop around 30 nurses were invited, representing clinical practice, education, and research. The workshop resulted in recommendations for future strategies to support the development of nursing informatics in Sweden. © 2009 The authors and IOS Press. All rights reserved.

  • 11.
    Ehrenberg, Anna
    et al.
    Department of Public Health & Caring Sciences, Social Medicine, Uppsala University, Uppsala; School of Health and Caring Sciences, University College of Dalarna, Falun.
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences. Department of Public Health & Caring Sciences, Social Medicine, Uppsala University, Uppsala; .
    Patient problems, needs, and nursing diagnoses in Swedish nursing home records1999In: Nursing diagnosis : ND : the official journal of the North American Nursing Diagnosis Association, ISSN 1046-7459, Vol. 10, no 2, p. 65-76Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe the main problems, needs, risks, and nursing diagnoses and to examine the descriptions of some common and serious patient problems in nursing home records.

    Methods: A retrospective audit of a stratified, random sample (N = 12O) of patient records from eight nursing homes in six Swedish municipalities.

    Findings: Results showed major deficiencies in nursing documentation in the patient records. Only one record contained a comprehensive description of one patient problem that corresponded to the requirements of Swedish laws and regulations. No record was found that contained a systematic and comprehensive assessment of any of the selected problems based on established criteria or the use of an assessment instrument.

    Conclusions: Nursing documentation in patient records does not reflect the use of systematic assessment and research-based instruments for determining patient care needs. Nurses need skills in assessment in the care of the elderly to be able to set priorities in care and deliver adequate care.

  • 12.
    Ehrenberg, Anna
    et al.
    Department of Social Medicine, Uppsala University, Uppsala; Falun College of Health and Caring Sciences, Falun.
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences.
    Patient records in nursing homes: Effects of training on content and comprehensiveness1999In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 13, no 2, p. 72-82Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to describe the effects on the contents and comprehensiveness of the nursing-care documentation in the patient records at nursing homes following an educational intervention. A review was made of records (n = 120) from nursing homes in six Swedish municipalities, allocated to a study group and a reference group. All the nursing home nurses in three municipalities received education concerning the nursing process and how to document according to the VIPS model. A retrospective audit of all nursing notes in the records from the nursing homes was made before and after the intervention. Improvements were found in the contents of the records in the study group. The number of notes on nursing history more than doubled. The occurrence of the recording of nursing diagnoses, goals and discharge notes increased. No corresponding changes were observed in the reference group. In the study group, an increase in the number of acceptable notes with contents on nursing history, status, nursing diagnosis, planned and implemented interventions, and nursing discharge notes was found. This increase was significant. The comprehensiveness in the documentation of single nursing problems was only slightly improved in the study group. No record met the requirements of the national regulations on nursing documentation or followed the nursing process thoroughly.

  • 13.
    Ehrenberg, Anna
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala; Health and Caring Sciences, Dalarna University, Falun.
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences. Department of Public Health and Caring Sciences, Uppsala University, Uppsala; Swedish Society of Nursing, Stockholm.
    The accuracy of patient records in Swedish nursing homes: congruence of record content and nurses' and patients' descriptions2001In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 15, no 4, p. 303-10Article in journal (Refereed)
    Abstract [en]

    Data from patient records will increasingly be used for care planning, quality assessment, research, health planning and allocation of resources. Knowledge about the accuracy of such secondary data, however, is limited and only a few studies have been conducted on the accuracy of nursing recording. The aim of this study was to analyse the concordance between the nursing documentation in nursing homes and descriptions of some specific problems of nurses and patients. Comparisons were made between wards where nurses had received training in structured recording based on the nursing process (study group) and wards where no intervention had taken place (reference group). Data were collected from the patient records of randomly selected nursing home residents (n=85). The methods used were audits of patient records and structured interviews with residents and nurses. The study revealed considerable deficiencies in the accuracy of the patient records when the records were compared with the reports from nurses and residents. The overall agreement between the interview data from nurses and from the patient records was low. Concordance was better in the study group as compared with the reference group in which the recorded data were structured only following chronological order. The study unequivocally demonstrates that there are major limitations in using records as a data source for the evaluation, planning and development of care.

  • 14.
    Ehrenberg, Anna
    et al.
    Örebro University, Department of Nursing and Caring Sciences. Department of Health and Society, Dalarna University, Falun .
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences.
    Ekman, Inger
    Institute of Nursing, Sahlgrenska Academy at Göteborg University, Göteborg.
    Older patients with chronic heart failure within Swedish community health care: a record review of nursing assessments and interventions2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 1, p. 90-6Article in journal (Refereed)
    Abstract [en]

    Background: Older patients with chronic heart failure constitute a large group within community home care that is at high risk for re-hospitalization. However, hospital readmission can be prevented if early signs of deterioration are recognized and proper interventions applied.

    Aims and objectives: The aim of the study was to audit nursing care for older chronic heart failure patients within the Swedish community health care system.

    Design: The study adopted a retrospective descriptive design.

    Methods: In a Swedish urban municipality nursing documentation from 161 records on patients diagnosed with chronic heart failure was collected retrospectively from community nursing home care units. Patient records were reviewed for characteristics of nursing care and assessed for comprehensiveness in recording.

    Results: The main results showed that medical care of patients with chronic heart failure was poorly recorded, making it possible only to follow fragments of the care process. The nursing notes showed poor adherence to current clinical guidelines. Only 12% of the records contained notes on patients' body weight and only 4% noted patients' knowledge about chronic heart failure. When interventions did occur, they largely consisted of drug administration.

    Conclusions: The findings revealed flaws in the recording of specific assessment and interventions as well as poor adherence to current international clinical guidelines.

    Relevance to clinical practice: Supportive guidelines available at the point of care are needed to enhance proper community-based home health care for older patients with chronic heart failure.

  • 15.
    Ehrenberg, Anna
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala; School of Health and Caring Sciences, University College of Dalarna, Falun.
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences. Department of Public Health and Caring Sciences, Uppsala University, Uppsala; Swedish Society of Nursing, Stockholm.
    Smedby, Björn
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala.
    Auditing nursing content in patient records2001In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 15, no 2, p. 133-41Article in journal (Refereed)
    Abstract [en]

    The objective of this paper is twofold: (a) to explore different approaches in reviewing records based on a literature review of studies of audits of patient records and (b) to apply these approaches on a sample of records to illuminate consequences of their application. The method used was a literature review of papers on recording of nursing care (n = 56). Based on our findings, an audit of a stratified sample of records (n = 298) from Swedish community health care and nursing homes was performed, applying the different approaches for auditing previously described in the literature. The review showed that audits of patient records were performed using four different approaches with varying aims. The focus of the four approaches can be described as formal structure, process comprehensiveness, knowledge-based and concordance with actual care. The results of this study suggest that audits of patient records should not be solely limited to encompass the formal structure of recording. To avoid a superficial picture or a false sense of high quality and to obtain a more complete and reliable portrait of the quality of recording, we suggest the process comprehensiveness approach in combination with a critical review of the knowledge base for the assessment, diagnosis and interventions of patient records.

  • 16.
    Ehrenberg, Anna
    et al.
    Department of Social Medicine, Uppsala University, Uppsala.
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences.
    Thorell-Ekstrand, Ingrid
    The Swedish Red Cross College of Nursing and Health, Stockholm.
    Nursing documentation in patient records: experience of the use of the VIPS model1996In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 24, no 4, p. 853-67Article in journal (Refereed)
    Abstract [en]

    The VIPS model for the documentation of nursing care in patient records was scientifically developed and published in 1991, with the aim of supporting the systematic documentation of nursing care and promoting individualized care. As the model seemed to be accepted and used in many parts of Sweden, a study was conducted in order to gather further information on the validity of the model, to describe the clinical and educational experience of its use and to refine it. Experience of the use of the model was gathered from a review of the scientific papers and other reports on it, from questionnaires addressed to nurses (n = 514), from comments by key informants, and from interviews with faculty members at all the nursing schools in the country. The findings showed that an intense process of change and development was occurring regarding nursing documentation. However, there were limitations in the use of the entire nursing process, especially in the specification of patient problems and the formulation of nursing diagnoses and nursing interventions. The keywords (Swedish spelling) of the VIPS model had good content validity in different areas of nursing care. The findings also indicated the need for further elaboration and revision of some of the keywords. A revised version of the VIPS model based on these findings is presented.

  • 17.
    Florin, Jan
    et al.
    Department of Health and Social Sciences, Högskolan Dalarna, Falun.
    Ehrenberg, Anna
    Department of Health and Social Sciences, Högskolan Dalarna, Falun.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Clinical decision-making: predictors of patient participation in nursing care2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 21, p. 2935-2944Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate predictors of patients' preferences for participation in clinical decision-making in inpatient nursing care.

    Background: Patient participation in decision-making in nursing care is regarded as a prerequisite for good clinical practice regarding the person's autonomy and integrity.

    Design: A cross-sectional survey of 428 persons, newly discharged from inpatient care.

    Methods: The survey was conducted using the Control Preference Scale. Multiple logistic regression analysis was used for testing the association of patient characteristics with preferences for participation.

    Results: Patients, in general, preferred adopting a passive role. However, predictors for adopting an active participatory role were the patient's gender (odds ratio = 1.8), education (odds ratio = 2.2), living condition (odds ratio = 1.8) and occupational status (odds ratio = 2.0). A probability of 53% was estimated, which female senior citizens with at least a high school degree and who lived alone would prefer an active role in clinical decision-making. At the same time, a working cohabiting male with less than a high school degree had a probability of 8% for active participation in clinical decision-making in nursing care.

    Conclusions: Patient preferences for participation differed considerably and are best elicited by assessment of the individual patient.

    Relevance to clinical practice: The nurses have a professional responsibility to act in such a way that patients can participate and make decisions according to their own values from an informed position. Access to knowledge of patients' basic assumptions and preferences for participation is of great value for nurses in the care process. There is a need for nurses to use structured methods and tools for eliciting individual patient preferences regarding participation in clinical decision-making.

  • 18.
    Florin, Jan
    et al.
    School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Björvell, Catrin
    Karolinska University Hospital, Stockholm, Sweden; Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    A comparison between the VIPS model and the ICF for expressing nursing content in the health care record2013In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 82, no 2, p. 108-17Article in journal (Refereed)
    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.

  • 19. Fossum, Mariann
    et al.
    Alexander, Gregory L.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Ehrenberg, Anna
    Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly2011In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 80, no 9, p. 607-617Article in journal (Refereed)
    Abstract [en]

    Background: Computerized decision support systems (CDSSs) have been shown to help health care professionals to avoid errors and improve clinical practice and efficiency in health care. Little is known about its influence on nursing practice and outcomes for residents in nursing homes.

    Aim: The aim of this study was to evaluate the effects on the risk for and prevalence of pressure ulcers (PUs) and malnutrition of implementing a CDSS to improve prevention and care of PUs and also to improve nutrition in the elderly in nursing homes.

    Design setting and participants: The study used a quasi-experimental design with two intervention groups and one control group. A convenience sample of residents from 46 units in 15 nursing homes in rural areas in Norway was included. A total of 491 residents participated at baseline in 2007 and 480 residents at follow-up in 2009. Methods: The intervention included educational sessions in prevention of PUs and malnutrition for registered nurses (RNs) and nursing aides (NAs) in the two intervention groups. In addition, one intervention group (intervention group 1) had a CDSS integrated into the electronic healthcare record (EHR) based on two research-based risk assessment instruments: the Risk Assessment Pressure Scale (RAPS) for PU risk screening and the Mini Nutritional Assessment (MNA (R)) scale for screening nutritional status. In each participating nursing home trained RNs and NAs examined all residents who consented to participate on the RAPS and the MNA (R) scale. This examination included a skin assessment and details about PUs were collected.

    Results: The proportion of malnourished residents decreased significantly in intervention group 1 between the two data collection periods (2007 and 2009). No other significant effects of the CDSS on resident outcomes based on the RAPS and MNA (R) scores were found.

    Conclusion: CDSSs used by RNs and NAs in nursing homes are still largely unexplored. A CDSS can be incorporated into the EHR to increase the meaningful use of these computerized systems in nursing home care. The effects of CDSS on healthcare provider workflow, clinical decision making and communication about preventive measures in nursing home practice still need further exploration. Based on results from our study, recommendations would be to increase both sample size and the number of RNs and NAs who participate in CDSS education programs.

  • 20. Fossum, Mariann
    et al.
    Alexander, Gregory L.
    Göransson, Katarina E.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences.
    Registered nurses' thinking strategies on malnutrition and pressure ulcers in nursing homes: a scenario-based think-aloud study2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, p. 2425-2435Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to explore the thinking strategies and clinical reasoning processes registered nurses use during simulated care planning for malnutrition and pressure ulcers in nursing home care.

    Background: Clinical reasoning is an essential component of nursing practice. Registered nurses’ thinking strategies and clinical reasoning have received limited attention in nursing science. Further research is needed to understand registered nurses’ clinical reasoning, especially for prevention of malnutrition and pressure ulcers as they are important quality indicators of resident care in nursing homes.

    Design: A qualitative explorative design was used with a think-aloud interview technique.

    Methods: The transcribed verbalisations were analysed with qualitative deductive content analysis. Data were collected during six months in 2007-2008 from 30 registered nurses at nine nursing homes in Norway.

    Results: The registered nurses used a variety of thinking strategies, but there were differences in the frequency of use of the different strategies. The three most commonly used thinking strategies were ‘making choices’, ‘forming relationships’ and ‘drawing conclusions’. None of the nurses performed a structured risk assessment of malnutrition or pressure ulcers. Registered nurses started with assessing data from the scenarios, but after a short and elementary assessment they moved directly to planning.

    Conclusion: Many different thinking strategies were used in registered nurses’ clinical reasoning for prevention of malnutrition and pressure ulcers. The thinking strategy ‘making choices’ was most commonly used and registered nurses’ main focus in their reasoning was on planning nursing interventions. Relevance to clinical practice. This study showed that most of the registered nurses go directly to planning when reasoning clinically about residents in nursing homes. A lack of systematic risk assessments was identified. The insight gained from this study can be used to recommend improvements in tools designed for nursing homes to support the registered nurses.

  • 21.
    Fossum, Mariann
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Fruhling, A.
    School of Interdisciplinary Informatics, College of Information Science and Technology, University of Nebraska, Omaha, USA;.
    Ehrenberg, Anna
    School of Health and Social Studies, Dalarna University, Falun, Sweden.
    An evaluation of the usability of a computerized decision support system for nursing homes2011In: Applied Clinical Informatics, ISSN 1869-0327, Vol. 2, no 4, p. 420-436Article in journal (Refereed)
    Abstract [en]

    Background: Computerized decision support systems (CDSSs) have the potential to significantly improve the quality of nursing care of older people by enhancing the decision making of nursing personnel. Despite this potential, health care organizations have been slow to incorporate CDSSs into nursing home practices.

    Objective: This study describes facilitators and barriers that impact the ability of nursing personnel to effectively use a clinical CDSS for planning and treating pressure ulcers (PUs) and malnutrition and for following the suggested risk assessment guidelines for the care of nursing home residents.

    Methods: We employed a qualitative descriptive design using varied methods, including structured group interviews, cognitive walkthrough observations and a graphical user interface (GUI) usability evaluation. Group interviews were conducted with 25 nursing personnel from four nursing homes in southern Norway. Five nursing personnel participated in cognitive walkthrough observations and the GUI usability evaluation. Text transcripts were analyzed using qualitative content analysis.

    Results: Group interview participants reported that ease of use, usefulness and a supportive work environment were key facilitators of CDSS use. The barriers identified were lack of training, resistance to using computers and limited integration of the CDSS with the facility’s electronic health record (EHR) system. Key findings from the usability evaluation also identified the difficulty of using the CDSS within the EHR and the poorly designed GUI integration as barriers.

    Conclusion: Overall, we found disconnect between two types of nursing personnel. Those who were comfortable with computer technology reported positive feedback about the CDSS, while others expressed resistance to using the CDSS for various reasons. This study revealed that organizations must invest more resources in educating nursing personnel on the seriousness of PUs and poor nutrition in the elderly, providing specialized CDSS training and ensuring that nursing personnel have time in the workday to use the CDSS.

  • 22.
    Fossum, Mariann
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Southern Norway Centre for Caring Research, Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Fruhling, Ann
    School of Interdisciplinary Informatics, College of Information Science and Technology, University of Nebraska, Omaha, USA.
    Ehrenberg, Anna
    School of Health and Social Studies, Dalarna University, Falun, Sweden.
    The experiences of using a computerized decision support system2012Conference 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.

  • 23.
    Fossum, Mariann
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Svensson, Elisabeth
    Örebro University, Örebro University School of Business.
    Hansen, Linda M.
    Ehrenberg, Anna
    Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study2013In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 82, no 10, p. 911-921Article in journal (Refereed)
    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.

  • 24.
    Fossum, Mariann
    et al.
    Örebro University, School of Health and Medical Sciences. Faculty of Health and Sport, University of Agder, Arendal, Norway .
    Terjesen, Solbjørg
    Faculty of Health and Sport, University of Agder, Arendal, Norway .
    Odegaard, Marit
    Skien Municipality, Skien, Norway .
    Sneltvedt, Unni
    Skien Municipality, Skien, Norway .
    Andreassen, Lene
    Skien Municipality, Skien, Norway .
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. School of Health and Social Sciences, Högskolan Dalarna, Falun, Sweden .
    Clinical decision support systems to prevent and treat pressure ulcers and under-nutrition in nursing homes2009In: Studies in Health Technology and Informatics / [ed] Saranto K , Brennan PF , Park HA , Tallberg M , Ensio A, Amsterdam: I O S PRESS , 2009, Vol. 146, p. 877-878Conference paper (Refereed)
    Abstract [en]

    Clinical decision support systems (CDSSs) are believed to have the potential to improve care and change the behavior of health personnel. The project has focused on developing a CDSS to support prevention of pressure ulcer and undernutrition that is completely integrated in the electronic health record in nursing homes. Nursing staff have been involved in all phases in the development of the CDSS, which at present is ready to be implemented and systematically evaluated.

  • 25. Gunningberg, L.
    et al.
    Fogelberg Dahm, M.
    Ehrenberg, Anna
    Örebro University, Department of Health Sciences.
    Accuracy in the recording of pressure ulcers and prevention after implementing an electronic health record in hospital care2008In: Quality and Safety in Healthcare, ISSN 1475-3898, E-ISSN 1470-7934, Vol. 17, no 4, p. 281-285Article in journal (Refereed)
    Abstract [en]

    Objective: To compare the accuracy in recording of pressure-ulcer prevalence and prevention before and after implementing an electronic health record (EHR) with templates for pressure-ulcer assessment. Methods: All inpatients at the departments of surgery, medicine and geriatrics were inspected for the presence of pressure ulcers, according to the European Pressure Ulcer Advisory Panel -methodology, during 1 day in 2002 (n= 357) and repeated in 2006 (n= 343). The corresponding patient records were audited retrospectively for the presence of documentation on pressure ulcers. Results: In 2002, the prevalence of pressure ulcers obtained by auditing paper-based patient records (n= 413) was 14.3%, compared with 33.3% in physical inspection (n= 357). The largest difference was seen in the geriatric department, where records revealed 22.9% pressure ulcers and skin inspection 59.3%. Four years later, after the implementation of the EHR, there were 20.7% recorded pressure ulcers and 30.0% found by physical examination of patients. The accuracy of the prevalence data had improved most in the geriatric department, where the EHR showed 48.1% and physical examination 43.2% pressure ulcers. Corresponding figures in the surgical department were 22.2% and 14.1%, and in the medical department 29.9% and 10.2%, respectively. The patients received pressure-reducing equipment to a higher degree (51.6%) than documented in the patient record (7.9%) in 2006. Conclusions: The accuracy in pressure-ulcer recording improved in the EHR compared with the paper-based health record. However, there were still deficiencies, which mean that patient records did not serve as a valid source of information on pressure-ulcer prevalence and prevention.

  • 26.
    Göransson, Katarina E.
    et al.
    Örebro University, Department of Health Sciences.
    Ehnfors, Margareta
    Örebro University, Department of Health Sciences.
    Fonteyn, Marsha E.
    Ehrenberg, Anna
    Örebro University, Department of Health Sciences.
    Thinking strategies nurses use in emergency department triageManuscript (Other academic)
  • 27.
    Göransson, Katarina E.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Fonteyn, Marsha E.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences.
    Thinking strategies used by Registered Nurses during emergency department triage2008In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 61, no 2, p. 163-172Article in journal (Refereed)
    Abstract [en]

    AIM: This paper is a report of a study to describe and compare thinking strategies and cognitive processing in the emergency department triage process by Registered Nurses with high and low triage accuracy. BACKGROUND: Sound clinical reasoning and accurate decision-making are integral parts of modern nursing practice and are of vital importance during triage in emergency departments. Although studies have shown that individual and contextual factors influence the decisions of Registered Nurses in the triage process, others have failed to explain the relationship between triage accuracy and clinical experience. Furthermore, no study has shown the relationship between Registered Nurses' thinking strategies and their triage accuracy. METHOD: Using the 'think aloud' method, data were collected in 2004-2005 from 16 RNs working in Swedish emergency departments who had previously participated in a study examining triage accuracy. Content analysis of the data was performed. FINDINGS: The Registered Nurses used a variety of thinking strategies, ranging from searching for information, generating hypotheses to stating propositions. They structured the triage process in several ways, beginning by gathering data, generating hypotheses or allocating acuity ratings. Comparison of participants' use of thinking strategies and the structure of the triage process based on their previous triage accuracy revealed only slight differences. CONCLUSION: The wide range of thinking strategies used by Registered Nurses when performing triage indicates that triage decision-making is complex. Further research is needed to ascertain which skills are most important in triage decision-making.

  • 28.
    Göransson, Katarina E.
    et al.
    Örebro University, Department of Health Sciences.
    Ehrenberg, Anna
    Örebro University, Department of Health Sciences.
    Ehnfors, Margareta
    Örebro University, Department of Health Sciences.
    Triage in emergency departments: national survey2005In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, no 9, p. 1067-1074Article in journal (Refereed)
    Abstract [en]

    AIM:

    This paper reports a study the aim of which was to describe how triage-related work was organized and performed in Swedish emergency departments.

    BACKGROUND:

    Hospitals in many developed countries use some kind of system to prioritize the patients attending emergency departments. Triage is a commonly used term to refer to the process of sorting and prioritizing patients for care. How the triage procedure is organized and which personnel perform this type of work vary considerably throughout the world. In Sweden, few studies have explored this important issue.

    METHOD:

    A national survey was conducted using telephone interviews, with nurse managers at each of the emergency departments. The sample represented 87% of emergency departments in Sweden.

    RESULTS:

    The findings clearly illustrate the organization of emergency department triage, focusing on personnel who perform triage, as well as the facilities, resources and procedures available for triage. However, the results indicate that work associated with such triage in Sweden is not organized in any consistent matter. In 81% of the emergency departments a clerk, Licensed Practical Nurse or Registered Nurse were assigned to assess patients not arriving by ambulance. There was also diversity in other areas, including requirements for staff to have particular qualifications and clinical experience for being allocated to triage work, as well as facilities for triage personnel assessing and prioritizing patients. The use of triage scales and acuity ratings also lacked uniformity and disparities were observed in both the design and use of triage scales. A little less than half (46%) of the emergency departments did not use any kind of triage scale to document patient acuity ratings.

    CONCLUSION:

    In contrast to several other countries, this study shows that Swedish emergency departments do not adhere well to established standards and guidelines about triage in emergency care. Research on emergency department triage, especially in the areas of personnel performing triage, triage scales and standards and guidelines are recommended.

    RELEVANCE TO CLINICAL PRACTICE:

    The diversity among several aspects of nursing triage (e.g. use of less qualified personnel performing triage, the use of different triage scales) presented in the study points to a safety risk for the patients. It also shows the need of further education for the personnel in clinical practice as well as further research on triage in order to gain national consensus about this nursing task.

  • 29.
    Göransson, Katarina E.
    et al.
    Örebro University, Department of Health Sciences.
    Ehrenberg, Anna
    Örebro University, Department of Health Sciences.
    Marklund, Bertil
    Ehnfors, Margareta
    Örebro University, Department of Health Sciences.
    Emergency department triage: is there a link between nurses’ personal characteristics and accuracy in triage decisions?2006In: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 14, no 2, p. 83-88Article in journal (Refereed)
    Abstract [en]

    Introduction

    A common task of registered nurses is to perform emergency department triage, often using an especially designed triage scale in their assessment. However, little information is available about the factors that promote the quality of these decisions. This study investigated personal characteristics of registered nurses and the accuracy in their acuity ratings of patient scenarios.

    Methods

    Using the Canadian Triage and Acuity Scale (CTAS), 423 registered nurses from 48 (62%) Swedish emergency departments individually triaged 18 patient scenarios.

    Results

    The registered nurses’ percentage of accurate acuity ratings was 58%, with a range from 22% to 89% accurate acuity ratings per registered nurse. In total, 60.3% of the registered nurses accurately triaged the scenarios in 50–69% of the cases. No relationship was found between personal characteristics of the registered nurses and their ability to triage.

    Discussion

    The lack of a relationship between personal characteristics of registered nurses and their ability to triage suggests that there might be intrapersonal characteristics, particularly the decision-making strategies used which can partly explain this dispersion. Future research that focuses on decision-making is likely to contribute in identifying and describing essential nursing characteristics for successful emergency department triage.

  • 30.
    Göransson, Katarina
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences. Department of Health and Social Sciences, Dalarna University, Falun.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Fonteyn, Marsha
    Dana-Farber Cancer Center, Boston, MA, United States.
    The use of qualitative data analysis software (QDAS) to manage and support the analysis of think aloud (TA) data2006In: Consumer-Centered Computer-Suppported Care for Healthy People, Amsterdam, Netherlands: IOS Press, 2006, Vol. 122, p. 143-6Conference paper (Refereed)
    Abstract [en]

    This methodological paper describes how qualitative data analysis software (QDAS) is being used to manage and support a three-step protocol analysis (PA) of think aloud (TA) data in a study examining emergency nurses' reasoning during triage. The authors believe that QDAS program QRS NVivo will greatly facilitate the PA and will allow them to identify and describe the information that triage nurses concentrate on during triage, and how they structure this information to make a triage decision. These findings could assist in designing and creating decision support systems to guide nurses' triaging. Additionally, details about how to use QRS NVivo for PA of TA data may assist and guide future informatics research using similar methodology are presented here. This innovative use of QDAS holds great promise for future nursing informatics research.

  • 31.
    Göransson, Katarina
    et al.
    Örebro University, Department of Health Sciences.
    Ehrenberg, Anna
    Örebro University, Department of Health Sciences.
    Marklund, Bertil
    Ehnfors, Margareta
    Örebro University, Department of Health Sciences.
    Accuracy and concordance of nurses in emergency department triage2005In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, no 4, p. 432-438Article in journal (Refereed)
    Abstract [en]

    In the emergency department (ED) Registered Nurses (RNs) often perform triage, i.e. the sorting and prioritizing of patients. The allocation of acuity ratings is commonly based on a triage scale. To date, three reliable 5-level triage scales exist, of which the Canadian Triage and Acuity Scale (CTAS) is one. In Sweden, few studies on ED triage have been conducted and the organization of triage has been found to vary considerably with no common triage scale. The aim of this study was to investigate the accuracy and concordance of emergency nurses acuity ratings of patient scenarios in the ED setting. Totally, 423 RNs from 48 (62%) Swedish EDs each triaged 18 patient scenarios using the CTAS. Of the 7,550 triage ratings, 57.6% were triaged in concordance with the expected outcome and no scenario was triaged into the same triage level by all RNs. Inter-rater agreement for all RNs was kappa = 0.46 (unweighted) and kappa = 0.71 (weighted). The fact that the kappa-values are only moderate to good and the low concordance between the RNs call for further studies, especially from a patient safety perspective.

  • 32.
    Göras, Camilla
    et al.
    Örebro University, School of Health Sciences. Department of Anesthesia, Intensive Care Unit, Falu Lasarett, Falun, Sweden; Centre for Clinical Research, Falun, Sweden.
    Maria, Unbeck
    Department of Orthopedics, Danderyd Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Ehrenberg, Anna
    Örebro University, School of Health Sciences. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Interprofessional team assessments of the patient safety climate in Swedish operating rooms: a cross-sectional survey2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 9, article id e015607Article, review/survey (Refereed)
    Abstract [en]

    Background: A positive patient safety climate within teams has been associated with higher safety performance. The aim of this study was to describe and compare attitudes to patient safety among the various professionals in surgical teams in Swedish operating room (OR) departments. A further aim was to study nurse managers in the OR and medical directors’ estimations of their staffs’ attitudes to patient safety.

    Methods: A cross-sectional survey with the Safety Attitudes Questionnaire (SAQ) was used to elicit estimations from surgical teams. To evoke estimations from nurse managers and medical directors about staff attitudes to patient safety, a short questionnaire, based on SAQ, was used. Three OR departments at three different hospitals in Sweden participated. All licensed practical nurses (n=124), perioperative nurses (n=233), physicians (n=184) and their respective manager (n=22) were invited to participate.

    Results: Mean percentage positive scores for the six SAQ factors and the three professional groups varied, and most factors (safety climate, teamwork climate, stress recognition, working conditions and perceptions of management), except job satisfaction, were below 60%. Significantly lower mean values were found for perioperative nurses compared with physicians for perceptions of management (56.4 vs 61.4, p=0.013) and working conditions (63.7 vs 69.8, p=0.007). Nurse managers and medical directors’ estimations of their staffs’ ratings of the safety climate cohered fairly well.

    Conclusions: This study shows variations and some weak areas for patient safety climate in the studied ORs as reported by front-line staff and acknowledged by nurse managers and medical directors. This finding is a concern because a weak patient safety climate has been associated with poor patient outcomes. To raise awareness, managers need to support patient safety work in the OR.

  • 33.
    Göras, Camilla
    et al.
    Anesthesia and Intensive Care Unit, Falu Lasarett, Falun, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Wallentin, Fan Yang
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehrenberg, Anna
    School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Swedish translation and psychometric testing of the safety attitudes questionnaire (operating room version)2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 104, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Background: Tens of millions of patients worldwide suffer from avoidable disabling injuries and death every year. Measuring the safety climate in health care is an important step in improving patient safety. The most commonly used instrument to measure safety climate is the Safety Attitudes Questionnaire (SAQ). The aim of the present study was to establish the validity and reliability of the translated version of the SAQ.

    Methods: The SAQ was translated and adapted to the Swedish context. The survey was then carried out with 374 respondents in the operating room (OR) setting. Data was received from three hospitals, a total of 237 responses. Cronbach's alpha and confirmatory factor analysis (CFA) was used to evaluate the reliability and validity of the instrument.

    Results: The Cronbach's alpha values for each of the factors of the SAQ ranged between 0.59 and 0.83. The CFA and its goodness-of-fit indices (SRMR 0.055, RMSEA 0.043, CFI 0.98) showed good model fit. Intercorrelations between the factors safety climate, teamwork climate, job satisfaction, perceptions of management, and working conditions showed moderate to high correlation with each other. The factor stress recognition had no significant correlation with teamwork climate, perception of management, or job satisfaction.

    Conclusions: Therefore, the Swedish translation and psychometric testing of the SAQ (OR version) has good construct validity. However, the reliability analysis suggested that some of the items need further refinement to establish sound internal consistency. As suggested by previous research, the SAQ is potentially a useful tool for evaluating safety climate. However, further psychometric testing is required with larger samples to establish the psychometric properties of the instrument for use in Sweden.

  • 34.
    Källberg, Ann-Sofie
    et al.
    Department of Medicine Solna, Karolinska Institutet, Solna, Sweden; Department of Emergency Medicine, Falun Hospital, Falun, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Ehrenberg, Anna
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Florin, Jan
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Östergren, Jan
    Department of Emergency Medicine, Karolinska University Hospital, Solna, Sweden; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Göransson, Katarina E.
    Department of Emergency Medicine, Karolinska University Hospital, Solna, Sweden; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Physicians' and nurses' perceptions of patient safety risks in the emergency department2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 33, p. 14-19, article id S1755-599X(16)30114-8Article in journal (Refereed)
    Abstract [en]

    The emergency department has been described as a high-risk area for errors. It is also known that working conditions such as a high workload and shortage off staff in the healthcare field are common factors that negatively affect patient safety. A limited amount of research has been conducted with regard to patient safety in Swedish emergency departments. Additionally, there is a lack of knowledge about clinicians' perceptions of patient safety risks. Therefore, the purpose of this study was to describe emergency department clinicians' experiences with regard to patient safety risks.

    METHOD: Semi-structured interviews were conducted with 10 physicians and 10 registered nurses from two emergency departments. Interviews were analysed by inductive content analysis.

    RESULTS: The experiences reflect the complexities involved in the daily operation of a professional practice, and the perception of risks due to a high workload, lack of control, communication and organizational failures.

    CONCLUSION: The results reflect a complex system in which high workload was perceived as a risk for patient safety and that, in a combination with other risks, was thought to further jeopardize patient safety. Emergency department staff should be involved in the development of patient safety procedures in order to increase knowledge regarding risk factors as well as identify strategies which can facilitate the maintenance of patient safety during periods in which the workload is high.

  • 35.
    Odencrants, Sigrid
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences. Högskolan Dalarna.
    Nutritional status and patient characteristics for hospitalised older patients with chronic obstructive pulmonary disease2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 13, p. 1771-1778Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of the study was to describe and compare nutritional status and social and medical characteristics among older patients with chronic obstructive pulmonary disease admitted to an acute care hospital ward for respiratory medicine. BACKGROUND: Chronic obstructive pulmonary disease is a condition associated with risk of developing malnutrition. A body mass index <20 is predictive of hospitalisation for acute exacerbations of chronic obstructive pulmonary disease. Knowledge about patient characteristics is crucial for the identification of malnourished patients and the development of nursing care for these patients. DESIGN: Quantitative descriptive study. METHODS: Thirty-three hospitalised women and 17 men with a mean age of 75.7 years (SD 6.9) were consecutively included. A very severe case of chronic obstructive pulmonary disease was indicated in 28 out of 39 patients who underwent a lung function test. Data were collected with measurement of nutritional status using Mini Nutritional Assessment, anthropometry and lung function. RESULTS: Nearly half of the patients (48%) were identified as malnourished, an equal part as at risk for malnutrition and two patients as well nourished. The mean Mini Nutritional Assessment score of 17.2 (SD 3.99) for all patients was near the Mini Nutritional Assessment cut-off score (i.e. 17) for malnutrition. Patients identified as malnourished had a mean body mass index of 18.9 and those at risk for malnutrition had a mean of 23.4. It was more common for those identified as malnourished to live singly, to not live in own property and to be dependent on daily community service. Seven patients identified as malnourished died during the data collection period. CONCLUSIONS: This study provides important knowledge about further risks of impaired nutritional status among older patients with chronic obstructive pulmonary disease. RELEVANCE TO CLINICAL PRACTICE: This knowledge can provide registered nurses with the necessary knowledge to make them aware of certain patients needing particular kinds of attention.

  • 36.
    Odencrants, Sigrid
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Ehrenberg, Anna
    Department of Health and Social Sciences, Dalarna University, Falun, Sweden.
    The relationship between nutritional status and body composition among persons with chronic obstructive pulmonary disease2008In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824Article in journal (Refereed)
  • 37.
    Thoroddsen, Asta
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences.
    Content and completeness of care plans after implementation of standardized nursing terminologies and computerized records2011In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 29, no 10, p. 599-607Article in journal (Refereed)
    Abstract [en]

    The nursing process and standardized nursing terminologies are essential elements to structure nursing documentation in daily nursing information management. The aim of this study was to describe sustainability and whether and how standardized nursing terminologies, in handwritten versus preprinted versus computerized nursing care plans, changed the content and completeness of documented nursing care. Three audits of patient records were performed: a pretest (n = 291) before a yearlong implementation of standardized nursing terminologies in nursing care plans followed by two posttests: (1) 3 weeks after implementation of nursing terminologies (n = 299) and (2) 22 months after implementation of nursing terminologies and 8 months after implementation of a computerized system (n = 281) in a university hospital. Content and completeness of documented nursing care improved after implementation of standardized nursing terminologies. Documentation of nursing care plans, signs and symptoms, related factors, and nursing interventions increased, whereas mean number of nursing diagnoses per patient did not change between audits. Computerized nursing care plans had the biggest impact, with more variety of nursing diagnoses and increased documentation of signs and symptoms, related factors, and nursing interventions. The use of standardized nursing terminologies improved nursing content in the nursing care plans. Moreover, computerized nursing care plans, in comparison with handwritten and preprinted care plans, increased documentation completeness.

  • 38.
    Thoroddsen, Asta
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences. School of Health and Social Sciences, Dalarna University, Falun, Sweden.
    Nursing specialty knowledge as expressed by standardized nursing languages2010In: International Journal of Nursing Terminologies and Classifications, ISSN 1541-5147, Vol. 21, no 2, p. 69-79Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe how nursing specialty knowledge is demonstrated in nursing records by use of standardized nursing languages.

    Methods: A cross-sectional review of nursing records (N = 265) in four specialties.

    Findings: The most common nursing diagnoses represented basic human needs of patients across specialties. The nursing diagnoses and related interventions represented specific knowledge in each specialty. Sixty-three nursing diagnoses (nine appeared in four specialties) and 168 nursing interventions were used (24 appeared in four specialties).

    Conclusions: Findings suggest that standardized nursing languages are capable of distinguishing between specialties. Further studies with large data sets are needed to explore the relationships between nursing diagnoses and nursing interventions in order to make explicit the knowledge that nurses use in their nursing practice.

    Practice implications: Nursing data in clinical practice must be stored and retrievable to support clinical decision making, advance nursing knowledge, and the unique perspective of nursing.

  • 39.
    Thoroddsen, Asta
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Landspitali University Hospital, University of Iceland, Reykjavik, Iceland.
    Sigurjónsdóttir, Guðrún
    Landspitali University Hospital, Reykjavik, Iceland .
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehrenberg, Anna
    School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Accuracy, completeness and comprehensiveness of information on pressure ulcers recorded in the patient record2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 1, p. 84-91Article in journal (Refereed)
    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.

  • 40.
    Thoroddsen, Ásta
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences.
    Content and completeness of care plans after implementation of standardized nursing terminologiesManuscript (preprint) (Other academic)
  • 41.
    Tistad, Malin
    et al.
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden .
    Palmcrantz, Susanne
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Wallin, Lars
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ehrenberg, Anna
    Örebro University, School of Health Sciences. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Olsson, Christina B.
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Mörby Academic Primary Healthcare Center, Stockholm County Council, Stockholm, Sweden.
    Tomson, Göran
    International Health Systems Research, Departments of Learning, Informatics, Management, Ethics and Public Health Sciences, Karolinska Institutet, Solna, Sweden.
    Holmqvist, Lotta Widen
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
    Gifford, Wendy
    Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa ON, Canada.
    Eldh, Ann Catrine
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness2016In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 5, no 8, p. 477-486Article in journal (Refereed)
    Abstract [en]

    Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers' leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention's potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation.

    Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention.

    Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation.

    Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers' behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.

  • 42.
    Åberg, Anna Cristina
    et al.
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden.
    Ehrenberg, Anna
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; School of Health Sciences, Örebro University, Örebro, Sweden.
    Inpatient geriatric care in Sweden-Important factors from an inter-disciplinary team perspective.2017In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 72, p. 113-120, article id S0167-4943(17)30237-6Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to describe factors of importance for the quality of inpatient geriatric care from an inter-disciplinary team perspective, an area that has not been previously studied to our knowledge. The study design was qualitative descriptive with data being collected from focus-group interviews with members of geriatric care teams. The data collection was conducted at a Swedish university hospital with 69 beds for geriatric care. It comprised five group interviews with a total of 32 staff members, including representatives of all the seven professions working with geriatric care. Data was analysed using qualitative content analysis and a thematic framework approach. Three main themes were identified as being perceived as characterising important factors essential for quality geriatric care: Interactive assessment processes, A holistic care approach, and Proactive non-hierarchical interaction. Aspects of Time and Goal-Orientation were additionally running like common threads through these themes and informed them. Accessibility, open communication, and staff continuity were experienced as prerequisites for well-functioning teamwork. Including patients and relatives in care planning and implementation was seen as essential for good care, but was at risk due to budget cuts that imposed shortened hospital stays. To meet the care demands of the growing population of older frail people, more specialised team-based care according to the concept of Comprehensive Geriatric Assessment - which is possibly best provided by older-friendly hospitals - appears as a constructive solution for reaching high degrees of both staff and patient satisfaction in geriatric care. More research is needed in this area.

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