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  • 1.
    Arving, Cecilia
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Creating a new profession in cancer nursing?: Experiences of working as a psychosocial nurse in cancer care2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 19-20, p. 2939-2947Article in journal (Refereed)
    Abstract [en]

    AIMS: To describe the nature of being a psychosocial nurse in cancer care.

    BACKGROUND: Psychosocial nurses in cancer care are a new profession in cancer nursing in Sweden, with potential to offer unique support to patients regarding somatic and psychological needs. This new profession is hitherto unexplored.

    DESIGN: A qualitative inductive interview approach was used.

    METHODS: A strategic sample of five nurses working as psychosocial nurses in cancer care in Sweden was interviewed. A thematic stepwise analysis was performed.

    RESULTS: The analysis revealed the twofold experience of being a psychosocial nurse in cancer care. The nurses felt as if they had two professions: nurse and therapist. They used skills from both professions to help the person, who had cancer and a psychosocial problem. It was stimulating to be able to combine the knowledge and practices of two professions. It was also difficult because they felt an uncertainty about what their roles and responsibilities really were.

    CONCLUSIONS: This new profession seems to need role descriptions and formal education so that psychosocial nurses receive respect and appreciation in their new and relatively unknown work in cancer care. RELEVANCE TO CLINICAL PRACTICES: The adjustment to the cancer disease and treatment side effects can be difficult for the patients and their families, which has highlighted the need for psychosocial support. To meet this need the health care system has to provide such support. Nurses are available and can be successfully educated to handle psychosocial problems among cancer patients. A new profession among nurses is emerging, which the present study aimed at describing. The present findings have potential to make healthcare professionals grasp what the core of psychosocial cancer nursing is, as well as its potential and pitfalls.

  • 2. Bastholm Rahmner, Pia
    et al.
    Gustafsson, Lars L.
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences.
    Rosenqvist, Urban
    Tomson, Göran
    Whose job is it anyway?: Swedish general practitioners' perception of their responsibility for the patient's drug list2010In: Annals of Family Medicine, ISSN 1544-1709, E-ISSN 1544-1717, Vol. 8, no 1, p. 40-46Article in journal (Refereed)
    Abstract [en]

    PURPOSE Information about the patient's current drug list is a prerequisite for safe drug prescribing. The aim of this study was to explore general practitioners' (GPs) understandings of who is responsible for the patient's drug list so that drugs prescribed by different physicians do not interact negatively or even cause harm. The study also sought to clarify how this responsibility was managed. METHODS We conducted a descriptive qualitative study among 20 Swedish physicians. We recruited the informants purposively and captured their view on responsibility by semistructured interviews. Data were analyzed using a phenomenographic approach. RESULTS We found variation in understandings about who is responsible for the patient's drug list and, in particular, how the GPs use different strategies to manage this responsibility. Five categories emerged: (1) imposed responsibility, (2) responsible for own prescriptions, (3) responsible for all drugs, (4) different but shared responsibility, and (5) patient responsible for transferring drug information. The relation between categories is illustrated in an outcome space, which displays how the GPs reason in relation to managing drug lists. CONCLUSIONS The understanding of the GP's responsibility for the patient's drug list varied, which may be a threat to safe patient care. We propose that GPs are made aware of variations in understanding responsibility so that health care quality can be improved.

  • 3. Ernesäter, Annica
    et al.
    Engström, Maria
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences.
    Winblad, Ulrika
    Incident reporting in nurse-led national telephone triage in Sweden: the reported errors reveal a pattern that needs to be broken2010In: Journal of telemedicine and telecare, ISSN 1758-1109, Vol. 16, no 5, p. 243-247Article in journal (Refereed)
    Abstract [en]

    We conducted a retrospective study of incident reports concerning the national, nurse-led telephone triage system in Sweden. The Swedish Health Care Direct organization (SHD) is staffed by registered nurses who act as telenurses and triage the callers' need for care, using a computerized decision support system. Data were collected during 2007 from all county councils that participated in the SHD and were analysed using content analysis. Incident reports were then compared concerning differences in reported categories and who reported the errors. The 426 incident reports included 452 errors. Of the analysed incident reports, 41% concerned accessibility problems, 25% incorrect assessment, 15% routines/guidelines, 13% technical problems and 6% information and communication. The most frequent outgoing incident reports (i.e. sent from SHD to other health-care providers) concerned accessibility problems and the most frequently incoming reports (i.e. sent to SHD from other health-care providers) concerned incorrect assessment. There was a significant difference (P < 0.001) between outgoing and incoming reports regarding the main category. Telenurses have limited possibilities for referring the caller to their primary health-care provider or specialist, which may cause them to over-triage or under-triage the callers' need for care. This over-triage or under-triage may in turn cause other health-care providers to report incorrect assessment to SHD. The implications for practice are that poor accessibility is a matter that should be addressed and that the reasons for incorrect assessment should be explored.

  • 4.
    Ernesäter, Annica
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Faculty of Health and Occupational Studies,University of Gävle, Gävle, Sweden.
    Winblad, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Holmström, Inger K.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Malpractice claims regarding calls to Swedish telephone advice nursing: what went wrong and why?2012In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 18, no 7, p. 379-383Article in journal (Refereed)
    Abstract [en]

    We analysed the characteristics of all malpractice claims arising out of telephone calls to Swedish Healthcare Direct (SHD) during 2003-2010 (n = 33). The National Board of Health and Welfare's (NBHW) investigations describing the causes of the malpractice claims and the healthcare providers' reported measures were analysed using Qualitative Content Analysis. The original telephone calls themselves, which had been recorded, were analysed using the Roter Interaction Analysis System (RIAS). Among the 33 cases, 13 patients died and 12 were admitted to intensive care. Failure to listen to the caller (n = 12) was the most common reason for malpractice claims, and work-group discussion (n = 13) was the most common measure taken to prevent future re-occurrence. Male patients (n = 19) were in the majority, and females (n = 24) were the most common callers. The most common symptoms were abdominal (n = 11) and chest pain (n = 6). Telenurses followed up on caller understanding in six calls, and mainly used closed-ended questions. Despite the severity of these malpractice claims, the measures taken mainly addressed active failure, rather than the latent conditions. Third-party communication should be regarded as a risk. When callers make repeated contacts, telenurses need to re-evaluate their need for care.

  • 5.
    Ewertsson, Mona
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Allvin, Renée
    Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nurse students’ experiences of learning in clinical skills laboratory: the bridge between university and clinical settings2013In: Nordic Conference on Advances in Health Care Sciences Research 2013, 2013Conference paper (Refereed)
  • 6. Hjelmblink, Finn
    et al.
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences.
    Kjeldmand, Dorte
    Stroke patients' delay of emergency treatment2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 2, p. 307-311Article in journal (Refereed)
    Abstract [en]

    Treatment of stroke victims with fibrinolysis should take place within a time limit of 3 hours. In spite of comprehensive endeavours to reduce hospital arrival time, too many patients still delay arrival beyond this time limit. This qualitative case study explored the meaning of acute stroke and treatment to four patients with more than 24-hour delayed arrival. The setting of the study was the catchment area of a university hospital. Semi-structured interviews were analysed through the empirical psychological, phenomenological method. An essence was found which was constituted by four themes. The essence of stroke symptoms and treatment was: 'Threatened control of bodily function, autonomy and integrity'. When the patients fell ill they acted as if nothing had happened. They treated their body like a defective device. In encounters with physicians they demanded to be met as a person by a person; otherwise they rejected both the physician and her or his prescriptions. They did not involve their near ones in decision-making. The conclusions were the following: Health care information about how to act in cases of early stroke symptoms may need to imbue people with an understanding of how early treatment of neurological symptoms and preserved control of life are intimately connected. Furthermore emergency care of acute stroke patients might need to take place in an organisation where patients are sure to be met by physicians as a person by a person.

  • 7.
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences.
    Diabetes telehealth and computerized decision support systems: a sound system with a human touch is needed2010In: Journal of diabetes science and technology, ISSN 1932-2968, Vol. 4, no 4, p. 1012-1015Article in journal (Refereed)
    Abstract [en]

    Telehealth holds the promise of improved consistency and fast and equal access to care, and will have great impact on future care. To enhance its quality and safety, computerized decision support systems (CDSS) have been launched. This commentary focuses specifically on the impact of telehealth and CDSS on diabetes patient management. Ideally, clinical information should be linked to evidence based recommendations and guidelines in the CDSS to provide tailored recommendations at the moment of care. However, technical support such as CDSS is not enough. The human touch is essential. A named healthcare provider with access to telehealth and CDSS seems to promise a way of providing both patient-centered and evidence-based care.

  • 8.
    Holmström, Inger K.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dept Publ Hlth & Caring Sci, Uppsala Univ, Uppsala, Sweden.
    Bastholm-Rahmner, Pia
    Publ Healthcare Adm, Dept Hlth Care Dev, Stockholm Cty Council, Stockholm, Sweden.
    Bernsten, Cecilia
    Dept Publ Hlth & Caring Sci, Uppsala Univ, Uppsala, Sweden.
    Röing, Marta
    Dept Publ Hlth & Caring Sci, Uppsala Univ, Uppsala, Sweden.
    Björkman, Ingeborg
    Dept Publ Hlth & Caring Sci, Uppsala Univ, Uppsala, Sweden.
    Swedish teenagers and over-the-counter analgesics: Responsible, casual or careless use2014In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 10, no 2, p. 408-418Article in journal (Refereed)
    Abstract [en]

    Background: Teenagers in Sweden were given greater access as consumers of OTC drugs in 2009 after the reregulation of the pharmacy market, which allowed for the establishment of private pharmacies and sale of specific over-the-counter (OTC) drugs in retail stores and gas stations. Increased access to OTC drugs could provide new opportunities for self-care but attenuates the opportunity for the traditional expert surveillance of pharmacists, thus increasing the possibility of inappropriate OTC drug use.

    Objectives: Views of 16-19 year old Swedish teenagers on OTC drugs, with special regard to analgesic drugs were explored and described, based on the following questions: How and where did they acquire their knowledge and attitudes regarding OTC drugs? What perceptions did they have about the use of OTC drugs?

    Methods: A qualitative approach with a descriptive design was chosen. Data were collected in 2011 with 10 focus group discussions with high school students aged 16-19 years from different parts of Sweden. A total of 77 teenagers participated, 33 males and 44 females. A manifest qualitative content analysis was performed.

    Results: While most teenagers appeared to have responsible attitudes toward OTC drugs and their use, some teenagers had attitudes that ranged from casual to careless. The focus group discussions also revealed knowledge gaps among teenagers regarding OTC drugs, and the significant influence of parents and peers on their OTC drug use.

    Conclusions: This study provides insight into how vulnerable some teenagers could be as new consumers of OTC drugs and suggested that educational efforts could be geared toward parents as well as teenagers. (C) 2014 Elsevier Inc. All rights reserved.

  • 9.
    Holmström, Inger
    et al.
    Örebro University, School of Health and Medical Sciences.
    Röing, Marta
    The relation between patient-centeredness and patient empowerment: a discussion on concepts2010In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 79, no 2, p. 167-172Article in journal (Refereed)
    Abstract [en]

    Objective: The concepts of patient-centeredness and patient empowerment offer opportunities for patients to increase their autonomy and involvement in their care and treatment. However, these concepts appear to be understood in different ways by professional groups involved in healthcare and research. To optimize understanding there is a need to create a common language. To explore and compare the concepts of patient-centeredness and patient empowerment, and clarify a possible relationship between the two from the perspective of the encounter between patients and their healthcare providers. Methods: Concept analysis approach in which the concepts are compared based on literature review. Results: Patient-centeredness can be the goal of an encounter between patient and caregiver. As a process, it is of great value in the process of patient empowerment. Patient empowerment appears to be broader than patient-centeredness, and may place greater demands on caregivers and the organisation of healthcare. Conclusion: Patient-centeredness and patient empowerment are complementary concepts which do not oppose one-another. Patient empowerment can be achieved by patient-centeredness, but patients can also empower themselves. Practice implications: Clarification of patient-centeredness and patient empowerment can facilitate their use by those involved in healthcare, improve the quality of healthcare, and aid future research. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

  • 10. Kaminsky, Elenor
    et al.
    Carlsson, Marianne
    Höglund, Anna T.
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences.
    Paediatric health calls to Swedish telenurses: a descriptive study of content and outcome2010In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 16, no 8, p. 454-457Article in journal (Refereed)
    Abstract [en]

    We collected data about telephone triage calls concerning children in Sweden. A sample of 110 paediatric calls were recorded. The transcribed data were analysed regarding word count, reasons for calling, results of calls, ages and gender of children, and gender of parents. The median call length was 4.4 min and the median child's age was 3.5 years. Mothers made 73% of calls, but mothers and fathers called to the same extent about daughters and sons, and regardless of age. The most common reasons for calls were ear problems, rash/wound or fever. In nearly half the calls, the telenurses provided self-care advice. Call length, word count or caller's part of word count did not differ according to gender of parents or children. However, mothers were more likely to receive self-care advice while fathers were more often referred to other health services by the telenurses. Telenurses might need to improve their gender competence, and more male telenurses in the service would potentially be beneficial to callers.

  • 11. Kjeldmand, Dorte
    et al.
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences.
    Difficulties in Balint groups: a qualitative study of leaders' experiences2010In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 60, no 580, p. 808-814Article in journal (Refereed)
    Abstract [en]

    Background Balint groups (BGs) are a means of enhancing competence in the physician-patient relationship and are also regarded as beneficial for GPs' mental health. However, voluntary BGs are still few, some members terminate their participation, and problems are reported in obligatory groups in residency programmes. This raises questions about possible negative aspects of BGs. Aim To examine difficulties in BGs as experienced by BG leaders. Design of study Qualitative study using interviews. Setting Eight BG leaders from five countries were interviewed. Method The interviews focused on the informants' experiences' of difficulties in their groups and were analysed with a systematic text-condensation method. Results Three categories of difficulties emerged from the analysis: 1) the individual physician having needs, vulnerabilities, and defences; 2) the group (including the leader) having problems of hidden agendas, rivalries, and frames; and 3) the surrounding environment defining the conditions of the group. BGs were found to fit into modern theories of small groups as complex systems. They are submitted to group dynamics that are sometimes malicious, and are exposed to often tough environmental conditions. Conclusion Professionally conducted BGs seem to be a gentle, efficient method to train physicians, but with limitations. Participation of a member demands psychological stability and an open mind. BGs need support from the leadership of healthcare organisations in order to exist.

  • 12. Lannerstrom, Linda
    et al.
    Wallman, Thorne
    Holmström, Inger K.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Losing independence: the lived experience of being long-term sick-listed2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, no 745, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Background: Sickness absence is a multifaceted problem. Much is known about risk factors for being long-term sick-listed, but there is still little known about the various aftermaths and experiences of it. The aim of this qualitative study was to describe, analyze and understand long-term sickness-absent people's experiences of being sick-listed.

    Methods: The design was descriptive and had a phenomenological approach. Sixteen long-term sickness-absent individuals were purposively sampled from three municipalities in Sweden in 2011, and data were collected through semi-structured, individual interviews. The interview questions addressed how the participants experienced being sick-listed and how the sick-listing affected their lives. Transcribed interviews were analysed using Giorgi's phenomenological method.

    Results: The interviews revealed that the participants' experiences of being sick-listed was that they lost their independence in the process of stepping out of working society, attending the mandatory steps in the rehabilitation chain and having numerous encounters with professionals. The participants described that their life-worlds were radically changed when they became sick-listed. Their experiences of their changing life-worlds were mostly highly negative, but there were also a few positive experiences. The most conspicuous findings were the fact that stopping working brought with it so many changes, the participants' feelings of powerlessness in the process, and their experiences of offensive treatment by and/or encounters with professionals.

    Conclusions: Sick-listed persons experienced the process of being on long-term sickness absent as very negative. The negative experiences are linked to consequences of stopping to work, consequences of social insurance rules and to negative encounters with professionals handling the sickness absence. The positive experiences of being sick-listed were few in the present study. There is a need to further examine the extent of these negative experiences are and how they affect sick-listed people's recovery and return to work. Long-term sickness absence; sick leave; experiences; interviews; phenomenology; Sweden.

  • 13. Larsson, J.
    et al.
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    How excellent anaesthetists perform in the operating theatre: a qualitative study on non-technical skills2013In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 110, no 1, p. 115-121Article in journal (Refereed)
    Abstract [en]

    Background Teaching trainees to become competent professionals who can keep the complex system of anaesthesia safe is important. From a safety point of view, non-technical skills such as smooth cooperation and good communication deserve as much attention as theoretical knowledge and practical skills, which by tradition have dominated training programmes in anaesthesiology. This study aimed to describe the way excellent anaesthetists act in the operating theatre, as seen by experienced anaesthesia nurses.                                                                                                     

    Methods The study had a descriptive and qualitative design. Five focus group interviews with three or four experienced Swedish anaesthesia nurses in each group were conducted. Interviews were analysed by using a qualitative method, looking for common themes.                                                                                                                  

    Results Six themes were found: (A) structured, responsible, and focused way of approaching work tasks; (B) clear and informative, briefing the team about the action plan before induction; (C) humble to the complexity of anaesthesia, admitting own fallibility; (D) patient-centred, having a personal contact with the patient before induction; (D) fluent in practical work without losing overview; and (F) calm and clear in critical situations, being able to change to a strong leading style.                                                                                                                  

    Conclusions Experienced anaesthesia nurses gave nuanced descriptions of how excellent anaesthetists behave and perform. These aspects of the anaesthetist's work often attract too little attention in specialist training, notwithstanding their importance for safety and fluency at work. Creating role models based on studies like the present one could be one way of increasing safety in anaesthesia.   

  • 14.
    Larsson, Jan
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden.
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Understanding anesthesia training and trainees2012In: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 25, no 6, p. 681-685Article in journal (Refereed)
    Abstract [en]

    Purpose of review: Patient safety is topical today. Competent professionals are necessary to keep anesthesia care safe, and teaching trainees is an important element in safety work. The purpose of this review is to present the latest research on anesthesia training and trainees.

    Recent findings: Most trainees of today aim for excellence, for which personal qualities are as important as knowledge and skills. The definition of excellence is the first subject covered here. Trainees of today can train many procedural skills in a simulators setting, a step forward for patient safety. Several studies about simulator training are reported. A dimension of competence that has received much attention during the last years is anesthesiologists' nontechnical skills. Studies on anesthesiologists' nontechnical skills as a valuable tool for assessing trainees' progress in nontechnical skills are presented.

    Summary: Much research about anesthesia training concerns simulator training and assessment of trainees' competence. More research is needed to understand the process of learning anesthesia.

  • 15.
    Larsson, Jan
    et al.
    Uppsala universitet, Uppsala, Sweden.
    Knutsson Holmström, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Fenomenografi2012In: Vetenskaplig teori och metod: från idé till examination inom omvårdnad / [ed] Maria Henricson, Lund: Studentlitteratur AB, 2012, 1, p. 389-405Chapter in book (Other academic)
  • 16.
    Rahmqvist, Mikael
    et al.
    Department of Medical and Health Sciences, Centre for Medical Technology Assessment, Linköping University, Linköping, Sweden.
    Ernesäter, Annica
    Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
    Holmström, Inger
    Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
    Triage and patient satisfaction among callers in Swedish computer-supported telephone advice nursing2011In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 17, no 7, p. 397-402Article in journal (Refereed)
    Abstract [en]

    We investigated satisfaction with a Swedish telenursing service and the health-care-seeking behaviour among callers who received a less urgent level of health care than they expected. A postal questionnaire was sent to a random selection of callers (n = 273) to Swedish Healthcare Direct in October 2008. The 'cases' were 18 callers where the telenurse recommended a lower level of health care than the caller expected and who were not in complete agreement with the nurse. The 'controls' were 22 callers who either received a lower recommendation, or were in disagreement with the recommendation. There were no differences between cases, controls and other callers regarding background factors or the telenurse classification of emergency. However, both cases and controls considered their need for health care as more urgent than the other callers. An independent test of the nurses' reception, ability to listen and to take notice of the callers' health problem, showed that nurses who had served cases, had received a significantly lower rating than other nurses. For nurses who had served controls, there was no such difference in rating. Cases and controls had fewer subsequent care visits than other callers, in the three days following the call, although the proportion of emergency visits was higher among cases and controls compared to other callers. If the caller and the nurse disagree about the nurse's recommendations, the consequence can be a dissatisfied caller and more visits to unnecessary high levels of health care. Further training of the nurses may improve the telenurse service.

  • 17.
    Röing, Marta
    et al.
    Dept Publ Hlth & Caring Sci, Uppsala Univ, Uppsala, Sweden.
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Involving patients in treatment decisions: a delicate balancing act for Swedish dentists2014In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 17, no 4, p. 500-510Article in journal (Refereed)
    Abstract [en]

    Background: This study focuses on patients' participation in treatment decisions related to the delivery of oral health care in the social welfare state of Sweden. In 1985, the National Dental Service Act gave dental patients the right to take an active role in decisions regarding their treatment and, in doing so, strengthened them as consumers. Little is known how dentists in Sweden have adapted to this change.

    Objective: This study explores how dentists in Sweden perceive and experience involving patients in dental treatment decisions.

    Design: Data were collected from open-ended interviews with nineteen dentists, and an inductive qualitative content analysis was chosen to analyse the transcribed interviews.

    Findings: Involving patients in treatment decisions appeared to be delicate balancing acts between the ideals of patient involvement and the reality of how it is practised in Sweden. These balancing acts in turn revealed obstacles to patient involvement and the role that economy can play on the decisions of some patients regarding their treatment.

    Conclusions: This study has given insight into a relationship in which some dentists in Sweden find it hard to adapt to and change their professional role with patients who appear to act more as consumers. For these dentists, better practice of patient involvement may require adoption of a more consumerist approach. However, in situations where economy influences patients' treatment choices, the ideals of patient involvement may remain unattainable.

  • 18.
    Röing, Marta
    et al.
    Uppsala University, Uppsala, Sweden.
    Rosenqvist, Urban
    Uppsala University, Uppsala, Sweden.
    Holmstrom, Inger K.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Uppsala University, Uppsala, Sweden.
    Threats to patient safety in telenursing as revealed in Swedish telenurses' reflections on their dialogues2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 4, p. 969-976Article in journal (Refereed)
    Abstract [en]

    Telenursing is a rapidly expanding actor in the Swedish healthcare system, as in other Western nations. Although rare, tragic events occur within this context, and are reminders of the importance of giving patient safety the highest priority. As telenurses' main sources of information are their dialogues with the callers, the provision of safe care can depend on the quality of this dialogue.

    The aim of this study was to identify issues that could threaten patient safety in telenurses' dialogues with callers. As part of an educational intervention, a researcher visited a sample of six telenurses five to six times at their workplace to listen to and discuss, together with the telenurses, their dialogues with callers in stimulated recall sessions. Each call and the following discussion between researcher and telenurse was tape-recorded and transcribed as text, resulting in a total of 121 calls. Qualitative content analysis of the reflections and following discussions revealed that threats to patient safety could be related to the surrounding society, to the organisation of telenursing, to the telenurse and to the caller.

    This study gives insight into significant problem areas that can affect patient safety in telenursing in Sweden. Issues that need to be focused on in telenursing educational programmes and future research are suggested, as well as the need for organisational development.

  • 19. Wihlman, Ulla
    et al.
    Stålsby Lundborg, Cecilia
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences.
    Axelsson, Runo
    Organizing vocational rehabilitation through interorganizational integration: a case study in Sweden2011In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 26, no 3, p. E169-E185Article in journal (Refereed)
    Abstract [en]

    This study describes and analysis five years of experiences from organising an interorganisational project on vocational rehabilitation. A qualitative case study approach was used based on interviews, focus group discussions and documents. The aim was to analyse how and why the project was organised in the way it was in relation to theories of integration, organisational change and learning. The results show that the vocational rehabilitation project was initiated mainly for financial reasons. It was organised as a mechanistic system with the aim of producing different activities, where financial control and support from all the levels of the organisations involved was important. A new bureaucracy between the different authorities involved was built up, where the vertical (top-down) integration was more important than the horizontal. The result was scattered islands of interprofessional work in different teams, but without contacts between them. The project did not influence the processes or workflows of the organisations involved in the project, which would be important from a service-user perspective. It may therefore be questionnable to organise the development of interorganisational integration for vocational rehabilitation in a separate project organisation. Instead, interorganisational networks with focus on interconnections of processes and workflows may be more flexible and adaptable. Copyright (C) 2010 John Wiley & Sons, Ltd.

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