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  • 1.
    Andersson, Maria
    et al.
    Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden.
    Wilde-Larsson, Bodil
    Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden; Faculty of Public Health Studies, Inland Norway University of Applied Sciences, Elverum, Norway.
    Carlsson, Eva
    Örebro University, School of Health Sciences. Örebro University Hospital. Health Care Research Center.
    Persenius, Mona
    Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden.
    Older people's perceptions of the quality of oral care in short-term care units: A cross-sectional study2018In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 13, no 2, article id e12185Article in journal (Refereed)
    Abstract [en]

    Background: There is a lack of knowledge about oral care among older people living in short-term care (STC) units and how the quality of oral care provided by nursing staff is perceived by the older people.

    Aim: To (i) describe person-related conditions among older people in STC, (ii) describe and compare perceptions of the quality of oral care (including perceptions of care received and the subjective importance of such care), within and between older people who have the ability to perform oral self-care and those who are dependent on help with oral care and (iii) examine the relationship between person-related conditions and the quality of oral care.

    Methods: A cross-sectional study was conducted with 391 older people in STC units in Sweden based on self-reported questionnaire and clinical assessments.

    Results: The older people were assessed as having normal oral health (2%), moderate oral health problems (78%) or severe oral health problems (20%). When comparing older people's perceptions of quality of oral care in terms of perceived reality and subjective importance, significant differences appeared within and between groups. Psychological well-being had a significant relationship with perception of the quality of oral care (both perceived reality and subjective importance), and gender and oral health status had a significant relationship with subjective importance.

    Conclusions: Older people's perceptions of areas for improvement regarding quality of oral care is a new and important knowledge for nursing staff in STC units. Older people want personalised information regarding oral health and oral care. Registered Nurses who take the responsibility in nursing care for older people's oral health may avoid unnecessary suffering by older people caused by oral health problems.

    Implications for practice: Older people's perspective is an important component for quality work and might lead to improvements in the quality of oral care in STC.

  • 2.
    Carlsson, Eva
    Örebro University, School of Health and Medical Sciences.
    Communication about eating difficulties after stroke: from the perspectives of patients and professionals in health care2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Stroke is one of the major causes of eating difficulties (EDs). It is one of the leading causes of death and disability and one of the most important factors contributing to health-care costs. There is a clear association between EDs after stroke and undernutrition, where studies have shown that structured screening of eating function among stroke patients can predict nutritional problems as well as need for subsequent institutional care. Reliable and valid instruments that can identify EDs exist, but there is lack of knowledge on how persons experience living with EDs after stroke. Stroke unit care is evidence-based and grounded in multidisciplinary collaboration and continuity of care. The overall aim of this thesis is to explore and describe EDs after stroke as represented by health care professionals in patient records (PRs) and transferred information, and as described by persons living with EDs after stroke. An additional aim is to explore methodological aspects related to the inclusion of persons with EDs and communication impairment in research studies.

    Both quantitative and qualitative methods were used. Two studies used descriptive designs (I, II), one an explorative design (III) and one applied a methodological discussion (IV). In one of the studies PR data were used (I), in another study data were derived from three sources: PRs, screening of patients and interviews with nurses (II). Persons with EDs after stroke participated in Study III while literature, empirical data and researchers' experiences served as the data in study IV. Data were analysed by categorisation of phrases (I), content analysis (II) and descriptive statistics (I, II), by qualitative analysis (III) and by processing of literature and empirical findings in two research groups (IV).

    The main findings from the studies on representation of stroke care in PRs (I, II) showed that, despite that >50% of patients in Study I and all patients in Study II had EDs, there were few signs of multidisciplinary collaboration dealing with this problem. Unsystematic screening for swallowing difficulties was routine, whereas screening for nutritional risk and EDs was lacking (I, II). Multidisciplinary discharge summaries proved to have low quality and entailed little information on patients' eating ability (I). The two EDs most frequently documented were swallowing and lack of energy to complete a meal (I,II). EDs were described in vague terms (I, II). In Study II, all patients had swallowing difficulties and most patients had lack of energy to complete a meal. The electronic information transfer tool held information on eating ability for most patients (II), but the nursing staff in residential home care perceived deficiencies in that information, even identifying several EDs not reported at discharge (II).

    Experiences from persons living with EDs after stroke were presented in one main theme: Striving to live a normal life, including three sub-themes: Abandoned to learn on one's own (little support from health care professionals to learn to handle eating), Experiencing losses (loss of eating functions and loss of valued activities) and Feeling dependent in mealtime situations (III). One major finding from the methodological exploration (IV) is that creative approaches and suitable methods for inclusion of participants with EDs and communication impairment into qualitative studies can be found in the fields of aphasiology and learning disabilities. Another major finding from Study IV is that researchers need good communication skills as well as knowledge in neuropsychology.

    A general conclusion is that screening for EDs should be routine in stroke care and that a multidisciplinary terminology to express EDs must be developed to provide accurate information transfer. Health care professionals need to enhance their knowledge in nutrition and provide support to stroke patients with EDs with the goal that they can eat and perform meal-related activities in accordance with their habits before the stroke. To gain access to the experiences of persons with EDs and communication impairment researchers need to test participatory approaches when planning for inclusion of those persons.

    List of papers
    1. Multidisciplinary recording and continuity of care for stroke patients with eating difficulties
    Open this publication in new window or tab >>Multidisciplinary recording and continuity of care for stroke patients with eating difficulties
    2010 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 24, no 3, p. 298-310Article in journal (Refereed) Published
    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

    Place, publisher, year, edition, pages
    New York, USA: Informa Healthcare, 2010
    National Category
    Social Sciences Interdisciplinary Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3039 (URN)10.3109/13561820903011976 (DOI)000276624100009 ()20178426 (PubMedID)2-s2.0-77951112541 (Scopus ID)
    Note

    Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-2712

    Available from: 2009-01-12 Created: 2009-01-12 Last updated: 2020-01-28Bibliographically approved
    2. Informational continuity at discharge in patients with eating difficulties after stroke
    Open this publication in new window or tab >>Informational continuity at discharge in patients with eating difficulties after stroke
    (English)Manuscript (preprint) (Other academic)
    National Category
    Social Sciences Interdisciplinary Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3040 (URN)
    Available from: 2009-01-12 Created: 2009-01-12 Last updated: 2018-01-13Bibliographically approved
    3. Stroke and eating difficulties: long-term experiences
    Open this publication in new window or tab >>Stroke and eating difficulties: long-term experiences
    2004 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 7, p. 825-834Article in journal (Refereed) Published
    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.

    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3041 (URN)10.1111/j.1365-2702.2004.01023.x (DOI)
    Available from: 2009-01-12 Created: 2009-01-12 Last updated: 2020-01-28Bibliographically approved
    4. Methodological Issues in Interviews Involving people with Communication Impairments After acquired Brain Damage
    Open this publication in new window or tab >>Methodological Issues in Interviews Involving people with Communication Impairments After acquired Brain Damage
    Show others...
    2007 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 17, no 10, p. 1361-1371Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    Newbury Park, Calif.: Sage Publications, 2007
    Keywords
    communication impairnment, qualitative research, interviewing, informed consent, fatigue
    National Category
    Nursing Social Sciences Interdisciplinary
    Research subject
    vårdvetenskap
    Identifiers
    urn:nbn:se:oru:diva-4329 (URN)10.1177/1049732307306926 (DOI)
    Note
    Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-2712 Available from: 2008-01-18 Created: 2008-01-18 Last updated: 2020-01-28Bibliographically approved
    Download full text (pdf)
    FULLTEXT01
    Download (pdf)
    ERRATA01
  • 3.
    Carlsson, Eva
    Örebro University, Department of Health Sciences.
    Understanding Persons with Eating Difficulties and Communication Impairment after Stroke: Patients Experiences and Methodological Issues in Qualitative Interviews2006Licentiate thesis, monograph (Other academic)
    Abstract [en]

    Difficulties with eating are common after stroke and are often associated with communication problems. Although numerous aspects of dysfunction have been identified, little is known about the experiences of living with eating difficulties after stroke. A few researchers have attempted to explore how best to ensure that the voices of people with communication impairment can be captured in qualitative research interviews, but several methodological issues related to including this population in qualitative research have remained unexamined. The purpose of the thesis was to illuminate the phenomenon of eating difficulties after stroke and to discuss methodological issues involved in interviewing persons with communication impairment. Study I had a qualitative, descriptive design involving repeated interviews and participant observations with three persons 1½ years post-stroke. Eating difficulties after stroke were experienced as Striving to live a normal life with the sub-themes Abandoned to learn on one’s own, Experiences of losses, and Feeling dependent. The findings showed that “eating difficulties after stroke” is a complex phenomenon, and that, based on the experiences of stroke survivors, there is a need for health care professionals to develop and use methods for eating training and other forms of support during the continuum of care. The combination of repeated interviews and participant observations seemed to be an approach that should be tested in larger studies. Study II was a methodological exploration based on the experiences gained in Study I and in a qualitative study involving persons with traumatic brain injury. Methodological issues related to sampling, obtaining informed consent, and fatigue in participant and researcher were discussed, and strategies for conducting qualitative interviews with these populations were suggested.

  • 4.
    Carlsson, Eva
    et al.
    Örebro University, School of Health Sciences.
    Anderzén Carlsson, Agneta
    Örebro University, School of Health Sciences.
    Prenkert, Malin
    Örebro University, School of Health Sciences.
    Svantesson, Mia
    Örebro University, School of Health Sciences.
    Ways of understanding being a healthcare professional in the role of family member of a patient admitted to hospital: A phenomenographic study2016In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 53, p. 50-60Article in journal (Refereed)
    Abstract [en]

    Healthcare professionals' experience of being family member of a patient can contribute to knowledge development and organizational learning in further ways than the experiences of general family members. However, there is little research on healthcare professionals' experience being on 'the other side of the bed'.

    Objective: To describe how healthcare professionals understand the role of being a healthcare professional and a family member of a patient admitted to hospital.

    Design: Qualitative with a phenomenographic approach.

    Setting: Three Swedish hospitals.

    Participants: All healthcare professionals in three hospitals were invited. Twenty-one volunteered for the study and 18 met the inclusion criteria; to have one year of professional experience and to have visited the family member in hospital daily during hospitalization. Family members in maternity or psychiatric care were excluded.

    Methods: Semi-structured interviews were used for data collection. Transcripts were analyzed with a phenomenographic method to describe variation and commonality in the ways of understanding the phenomenon under study.

    Results: Four dominant ways of understanding the phenomenon were identified; the informed bystander, the supervisor, the advocate and the carer. The four ways of understanding were hierarchically related with "The informed bystander" being least involved in the care of the family member and "The carer" more or less taking over the patient's care because of inappropriate, unsafe or omitted care. Common for all ways of understanding the phenomenon, except "The informed bystander", was the difficult balance between their loyalty toward the family member and their colleagues among the staff. "The informed bystander" and "The supervisor" are ways of understanding the phenomenon under study that, to our knowledge, has not been described before.

    Conclusions: This study describes how being a family member of a patient can be understood in four different ways when the family member is a healthcare professional. The findings show similarities to previous studies on general family members as well as nurse-family members of patients in critical care. The need for professional communication, support and coordination will be substantially different if the family member understands his/her role as an informed bystander compared to if they perceive themselves as a carer. The role conflict and ambivalence toward building relationships described are aspects that need further exploration, as does the experience of being forced to care for a family member. Our findings contribute with new knowledge developing patient- and family-centered care.

  • 5.
    Carlsson, Eva
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ehnfors, Margareta
    Ehrenberg, Anna
    Informational continuity at discharge in patients with eating difficulties after strokeManuscript (preprint) (Other academic)
  • 6.
    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

  • 7.
    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.

  • 8.
    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.

  • 9.
    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.

  • 10.
    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.

  • 11.
    Carlsson, Sofia
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Carlsson, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    'The situation and the uncertainty about the coming result scared me but interaction with the radiographers helped me through': a qualitative study on patients' experiences of magnetic resonance imaging examinations2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 21-22, p. 3225-3234Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesTo describe patients' expectations before and experiences during a head-first magnetic resonance imaging scan. BackgroundPrevious studies have reported that patients experience fear and anxiety leading to discomfort before, during and after magnetic resonance imaging scans. Frequent problems persist in producing high-quality images due to motion artefacts. These results imply a need for improvement of patient conditions to allow for the added benefit of better diagnostic quality. Provision of extended written information has not appeared to reduce patients' stress, while interaction with staff has been described as the most important factor for reducing such feelings. Design and methodsA qualitative, phenomenological approach. Semi-structured interviews were conducted, and data were analysed with systematic text condensation. ResultsThe experiences of the ten participants were encapsulated by the main theme: The situation and the uncertainty about the coming result scared me but interaction with the radiographers helped me through'. Subthemes were Prescan preparation', Mastering threats to self-control' and Personal achievements by completing the scan'. ConclusionsOur study has provided a deeper understanding of the expectations before, and experiences during, a head-first magnetic resonance imaging scan. Valuable insight into patients' apprehension about written and verbal information was obtained. The patients reported how they coped with the unfamiliar and stressful magnetic resonance imaging scanning procedure. A trustful dialogue with the radiographer was described as being crucial for patients' ability to manage fear, discomfort and feelings of loss of self-control. We suggest a need for individualised information based on patient participation. Relevance to clinical practiceRadiographers, as well as nurses caring for patients who will undergo magnetic resonance imaging examinations, should recognise the difficulties inherent in written information. It is also of importance to adjust the patient-radiographer interaction to address patients' expressions of worries about the scanning procedure or the following result.

  • 12.
    Eldh, Ann Catrine
    et al.
    Örebro University, School of Health and Medical Sciences.
    Carlsson, Eva
    Seeking a balance between employment and the care of an ageing parent2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 2, p. 285-293Article in journal (Refereed)
    Abstract [en]

    Rationale: A growing number of middle-aged people are engaged in informal care of their parents while employed. To provide support as employers, co-workers or staff, health care professionals need insight into the experiences of people managing these responsibilities. Aim: To elucidate the experience of providing informal care to an ageing parent while managing the responsibilities of a working life. Methods: Narrative interviews were performed with 11 persons with experience of the phenomenon. Transcribed interviews were analysed with phenomenological hermeneutics. Ethics: Informed consent was given prior to the interviews. The study was approved by a research ethics committee. Findings: Providing informal care to an ageing parent while also pursuing a working life implies seeking balance: a balance between providing support to the parent's needs and one's responsibilities at work. Being employed supports this balance as it provides both fulfilment and refuge. Being capable of managing both roles grants a sense of satisfaction, supporting one's sense of balance in life. The balance can be supported by sharing the responsibility of caring for the ageing parent with others. Study limitations: Despite perceived saturation and an effort to provide for the possibility to consider internal consistency, the findings should be considered as a contribution to the understanding of the phenomenon, as experienced by individuals in their life world. Conclusions: It is essential to recognise the impact that providing care for an ageing parent may have on the lives of a growing number of people, particularly if they have employment responsibilities. Acknowledgement by others supports one's ability to attain balance; as co-workers and managers, we can acknowledge the efforts of an informal caregiver and as health care staff recognise the valuable contribution made by people in mid-life who provide informal care for their ageing parents.

  • 13.
    Fägerstad, Anida
    et al.
    Örebro University, School of Health Sciences. Public Dental Service, Region Örebro County, Örebro, Sweden.
    Lundgren, Jesper
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Carlsson, Eva
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Barriers and facilitators for adolescent girls to take on adult responsibility for dental care: a qualitative study2019In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, article id 1678971Article in journal (Refereed)
    Abstract [en]

    Purpose: This study aims to explore and describe experiences of the dental care system among adolescent dental patients with a recent history of missed dental appointments at public dental clinics (PDCs) in a Swedish county.

    Methods: Twelve adolescent girls participated in the study. Data were collected by individual, semi-structured, open-ended interviews and analysed with qualitative content analysis.

    Results: The study findings could be summed into the theme ?Triggers for adolescent girls to take on or not take on adult responsibility for dental care?. The experience of free dental care could be summarized in five main categories: Pain and discomfort; Attractive and healthy teeth; Feeling safe and secure; Taking on the responsibility; and Free of charge. These five categories consisted of 15 subcategories.

    Conclusions: The results of this study should increase the knowledge on how to meet and treat adolescent girls in dental care. Knowing what will happen during the dental visit was highlighted by the participants as decisive to whether or not they would attend their dental appointments. Therefore, we should as far as possible ensure that our patients feel safe at their dental visits and by trying to avoid painful treatments.

  • 14.
    Hägglund, Patricia
    et al.
    Oral and Maxillofacial Radiology, Department of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden.
    Olai, Lena
    School of Education Health and Social Science, Dalarna University, Falun, Sweden; Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.
    Ståhlnacke, Katri
    Örebro University Hospital. Örebro University, School of Medical Sciences. Public Dental Services, Örebro County Region, Örebro, Sweden.
    Persenius, Mona
    Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden.
    Hägg, Mary
    Speech and Swallowing Centre, Department of Otorhinolaryngology, Hudiksvall Hospital, County Council of Gävleborg, Hudiksvall, Sweden; Centre for Research and Development, Uppsala University, Uppsala, Sweden.
    Andersson, Maria
    Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden.
    Koistinen, Susanne
    Örebro University, School of Health Sciences. School of Education Health and Social Science, Dalarna University, Falun, Sweden.
    Carlsson, Eva
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Study protocol for the SOFIA project: Swallowing function, Oral health, and Food Intake in old Age: a descriptive study with a cluster randomized trial2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 78Article in journal (Refereed)
    Abstract [en]

    Background: Extensive studies have shown that older people are negatively impacted by impaired eating and nutrition. The abilities to eat, enjoy food, and participate in social activities associated with meals are important aspects of health-related quality of life (HRQoL) and recovery after illness. This project aims to (i) describe and analyze relationships between oral health and oral HRQoL, swallowing ability, eating ability, and nutritional risk among older individuals admitted to short-term care; (ii) compare the perceptions that older individuals and staff report on care quality related to oral hygiene and eating; and (iii) study the feasibility and effects of a training program for people with impaired swallowing (i.e., dysphagia).

    Methods/Design: This project consists of two parts, which will be performed in five Swedish counties. It will include approximately 400 older individuals and 200 healthcare professionals. Part 1 is a cross-sectional, descriptive study of older people admitted to short-term care. Subjects will be assessed by trained professionals regarding oral health status, oral HRQoL, eating and nutritional risk, and swallowing ability. Swallowing ability will be measured with a teaspoon test and a swallowing capacity test (SCT). Furthermore, subjects and staff will complete a questionnaire regarding their perceptions of care quality. Part 2 is a cluster randomized intervention trial with controls. Older participants with dysphagia (i.e., SCT < 10 ml/s, measured in part 1) will be recruited consecutively to either the intervention or control group, depending on where they were admitted for short-term care. At baseline, all subjects will be assessed for oral health status, oral HRQoL, eating and nutritional risk, swallowing ability, and swallowing-related QoL. Then, the intervention group will receive 5 weeks of training with an oral screen for neuromuscular training focused on orofacial and pharyngeal muscles. After completing the intervention, and at six months post-intervention, all assessments will be repeated in both study groups.

    Discussion: The results will make important contributions to rehabilitation knowledge, including approaches for improving swallowing function, oral health, and food intake and for improving the quality of oral care for older people.

  • 15.
    Persenius, Mona
    et al.
    Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Hall-Lord, Marie-Louise
    Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden; Department of Nursing, Gjøvik University College, Elverum, Norway.
    Wilde-Larsson, Bodil
    Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden; Department of Nursing, Hedmark University College, Elverum, Norway.
    Carlsson, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Quality and Patient Safety, Lindesberg Hospital, Lindesberg, Sweden.
    Clinical nursing leaders' perceptions of nutrition quality indicators in Swedish stroke wards: a national survey2015In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 23, no 6, p. 705-715Article in journal (Refereed)
    Abstract [en]

    Aim To describe nursing leaders’ perceptions of nutrition quality in Swedish stroke wards.

    Background A high risk of undernutrition places great demand on nutritional care in stroke wards. Evidence-based guidelines exist, but healthcare professionals have reported low interest in nutritional care. The Donabedian framework of structure, process and outcome is recommended to monitor and improve nutrition quality.

    Method Using a descriptive cross-sectional design, a web-based questionnaire regarding nutritional care quality was delivered to eligible participants.

    Result Most clinical nursing leaders reported structure indicators, e.g. access to dieticians. Among process indicator s, regular assessment of patients’ swallowing was most frequently reported in comprehensive stroke wards compared with other stroke wards. Use of outcomes to monitor nutrition quality was not routine. Wards using standard care plans showed significantly better results.

    Conclusion Using the structure, process and outcome framework to examine nutrition quality, quality-improvement needs became visible. To provide high-quality nutrition, all three structure , process and outcome components must be addressed.

    Implications for nursing management The use of care pathways, standard careplans, the Senior Alert registry, as well as systematic use of outcome measures could improve nutrition quality. To assist clinical nursing leaders in managing all aspects of quality, structure, process and outcome can be a valuable framework.

  • 16.
    Prenkert, Malin
    et al.
    Örebro University, School of Health Sciences.
    Carlsson, Eva
    Örebro University, School of Health Sciences.
    Svantesson, Mia
    Örebro University, School of Health Sciences.
    Anderzén-Carlsson, Agneta
    Örebro University, School of Health Sciences.
    Healthcare-professional patients’ conceptions of being ill and hospitalised: a phenomenographic study2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 11-12, p. 1725-1736Article in journal (Refereed)
    Abstract [en]

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

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

    Design: This study has an inductive descriptive design.

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

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

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

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

  • 17.
    Svantesson, Mia
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Carlsson, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Prenkert, Malin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Anderzen-Carlsson, Agneta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    'Just so you know, the patient is staff': healthcare professionals' perceptions of caring for healthcare professional-patients2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 1, article id e008507Article in journal (Refereed)
    Abstract [en]

    Objective: To explore healthcare professionals' conceptions of the care of patients who are also healthcare professionals.

    Design: Explorative, with a qualitative, phenomenographic approach.

    Participants and setting: 16 healthcare personnel within different professions (doctors, nurses, assistant nurses, physiotherapists, occupational therapists) were interviewed about the care of 32 patients who were themselves members of different healthcare professions, in one healthcare organisation in Sweden.

    Results: The care of patients who are healthcare professionals was conceived in five different ways, as: usual, dutiful, prioritised and secure, insecure and responsive. An initial conception was that their care was usual, just as for any other patient, and also a perceived duty to treat them and to protect their right to be a patient-as any other patient. Exploring further, informants described that these patients did receive secure and prioritised care, as the informants experienced making a greater commitment, especially doctors giving privileges to doctor-patients. A conception of insecure care infused the informants' descriptions. This comprised of them feeling intimidated in their professional role, feeling affected by colleagues' stressful behaviour and ambiguity whether the healthcare professional-patient could be regarded as a competent professional. The deepest way of understanding care seemed to be responsive care, such as acknowledging and respecting the patient's identity and responding to their wishes of how treatment was to be met.

    Conclusions: Caring for healthcare professionals seems to trigger different ethical approaches, such as deontology and ethics of care. According to ethics of care, the findings may indeed suggest that these patients should be cared for just as any other patients would be, but only if this means that they are cared for as persons, that is, they are given 'person-centred care'. This would imply balancing between acknowledging the vulnerable patient in the colleague and acknowledging the identity of the colleague in the patient.

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