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  • 1.
    Allvin, Renee
    et al.
    Örebro University, Department of Clinical Medicine. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro; Centre for Evidence Based Medicine and Assessment of Medical Technology, Örebro.
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences.
    Rawal, Narinder
    Örebro University, Department of Clinical Medicine. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro.
    Idvall, E.
    Research Section, Kalmar County Council, Kalmar; Department of Medicine and Health, Linköping University, Linköping.
    Experiences of the postoperative recovery process: an interview study2008In: The open nursing journal, ISSN 1874-4346, Vol. 2, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Few researchers have described postoperative recovery from a broad, overall perspective. In this article the authors describe a study focusing on patient and staff experiences of postoperative recovery using a qualitative descriptive design to obtain a description of the phenomenon. They performed 10 individual interviews with patients who had undergone abdominal or gynecological surgery and 7 group interviews with registered nurses working on surgical and gynecological wards and in primary care centers, surgeons from surgical and gynecological departments, and in-patients from a gynecological ward. The authors analyzed data using qualitative content analysis. Postoperative recovery is described as a Dynamic Process in an Endeavour to Continue With Everyday Life. This theme was further highlighted by the categories Experiences of the core of recovery and Experiences of factors influencing recovery. Knowledge from this study will help caregivers support patients during their recovery from surgery.

  • 2.
    Allvin, Renée
    Örebro University, School of Health and Medical Sciences.
    Postoperative recovery: development of a multi-dimensional questionnaire for assessment of Recovery2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis aims to present a multi-dimensional instrument for self-assessment of progress in postoperative recovery. The author employs different research paradigms and methodologies to achieve this aim.

    Walker and Avant’s approach to concept analysis was used to examine the basic elements of postoperative recovery (Study I). The analysis identified different recovery dimensions and developed a theoretical definition showing postoperative recovery to be an energy-requiring process of returning to normality and wholeness, defined by comparative standards.

    Fourteen patients and 28 staff members participated in individual and focus group interviews aimed at describing patient and staff experiences of patient recovery (Study II). The essence of the postoperative recovery process was described as a desire to decrease unpleasant physical symptoms, reach a level of emotional wellbeing, regain functions, and re-establish activities.

    In Study III, 5 dimensions and 19 items were identified as a part of the operationalization process of the concept postoperative recovery. Fifteen staff members and 16 patients participated in the evaluation of content validity. On average, 85% of the participants considered the items as essential to the recovery process. In a test run of the questionnaire, 14 of 15 patients considered the questionnaire to be easy to understand and easy to complete. Twenty-five patients participated in the evaluation of intra-patient reliability. Percentage agreement (PA), systematic disagreement (RP, RC), and individual variability (RV) between the two assessments were calculated. PA measures ranged from 72% to 100%. The observed disagreement could be explained mainly by systematic disagreement.

    In total, 158 patients participated in the evaluation of construct validity, the ability to discriminate between groups, and the investigation of important item variables (Study IV). A rank-based statistical method for evaluation of paired, ordered categorical data from rating scales was used to evaluate consistency between the assessments of the Postoperative Recovery Profile (PRP) questionnaire and a global recovery scale. The number of months needed by participants to be regarded as fully recovered was studied by means of recovery profiles displayed by the cumulative proportion of recovered participants over time. A ranking list based on the participant’s appraisal of the five most important item variables in the PRP questionnaire was compiled to illustrate the rank ordering of the items. In comparing the assessments from the PRP questionnaire and the global recovery scale, 7.6% of all possible pairs were disordered. Twelve months after discharge 73% in the orthopaedic group were regarded as fully recovered, compared to 51% of the participants in the abdominal group (95% CI: 6% to 40%). The pain variable appeared among the top five most important items on eight measurement occasions, of eight possible, in both study groups.

    In conclusion, the PRP questionnaire was developed and support was given for validity and reliability. The questionnaire enables one to evaluate progress in postoperative recovery.

    List of papers
    1. Postoperative recovery: a concept analysis
    Open this publication in new window or tab >>Postoperative recovery: a concept analysis
    2007 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 57, no 5, p. 552-558Article in journal (Refereed) Published
    Abstract [en]

    Aim. This papaer presents a concept analysis of the phenomeneon postoperative recovery.

    Background. Each year, millions of patients throughout the world undergo surgical procedures. Although postoperative recovery is commonly used as an outcome of surgery, it is difficult to identify a standard definition.

    Method. Walker and Avant´s concept analysis approach was used. Literature retrieved from MEDLINE and CINAHL databases for english language papers published from 1982 to 2005 was used for the analysis.

    Findings. The theoretical definition developed points out that postoperative recovery is an energy-requiring process of returning to normality and wholeness. It is defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions, and results in a return to preoperative level of independence/dependence in activities of daily living and optimum level of psychological well-being.

    Conclusion. The concept of postoperative recovery lacks clarity, both in its meaning in relation to postoperative recovery to healthcare professionals in their care for surgical patients, and in the understanding of what researchers in this area really intend to investigate. The theoretical definition we have developed may be useful but needs to be further explored.

    Place, publisher, year, edition, pages
    Oxford: Blackwell, 2007
    Keywords
    concept analysis, definition, postoperative, recovery
    National Category
    Surgery Nursing
    Research subject
    Surgery; Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-8079 (URN)10.1111/j.1365-2648.2006.04156.x (DOI)000244244000010 ()17284272 (PubMedID)2-s2.0-33846991897 (Scopus ID)
    Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2017-12-13Bibliographically approved
    2. Experiences of the postoperative recovery process: an interview study
    Open this publication in new window or tab >>Experiences of the postoperative recovery process: an interview study
    2008 (English)In: The open nursing journal, ISSN 1874-4346, Vol. 2, p. 1-7Article in journal (Refereed) Published
    Abstract [en]

    Few researchers have described postoperative recovery from a broad, overall perspective. In this article the authors describe a study focusing on patient and staff experiences of postoperative recovery using a qualitative descriptive design to obtain a description of the phenomenon. They performed 10 individual interviews with patients who had undergone abdominal or gynecological surgery and 7 group interviews with registered nurses working on surgical and gynecological wards and in primary care centers, surgeons from surgical and gynecological departments, and in-patients from a gynecological ward. The authors analyzed data using qualitative content analysis. Postoperative recovery is described as a Dynamic Process in an Endeavour to Continue With Everyday Life. This theme was further highlighted by the categories Experiences of the core of recovery and Experiences of factors influencing recovery. Knowledge from this study will help caregivers support patients during their recovery from surgery.

    Place, publisher, year, edition, pages
    Bentham Science Publishers Ltd, 2008
    Keywords
    postoperative, recovery, experience, interview, content analysis
    National Category
    Surgery Medical and Health Sciences
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-8080 (URN)
    Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2017-10-18Bibliographically approved
    3. Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability
    Open this publication in new window or tab >>Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability
    Show others...
    2009 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 3, p. 411-419Article in journal (Refereed) Published
    Abstract [en]

    Aims and objectives. In this study we describe the development of a short, easy-to-use questionnaire to measure postoperative recovery and evaluate its content validity and intra-patient reliability.   The questionnaire is designed to evaluate the progress of postoperative recovery and the long-term follow-up of possible effects of interventions during recovery.

    Method. The study involved four steps. 1) A conceptualisation and item definitions were based on a theoretical framework and a description of patients´ postoperative recovery from the perspective of patients, registered nurses and surgeons. 2) Content validity of items was tested through expert judgements. 3) A test run of the questionnaire was performed to confirm its feasibility and workload requirement. 4) The stability of the questionnaire was evaluated through intra-patient reliability assessment.

    Results. As a result of the operationalisation process of the concept postoperative recovery, five dimensions (physical symptoms, physical functions, psychological, social, activity) and 19 items were identified. Each item was formulated as a statement in the questionnaire. Content validity was judged to be high. After the pre-test of the questionnaire a revision with refinements in the layout was made. The vast majority of items showed a high level of intra-patient reliability.

    Conclusion. Based on a theoretical framework and empirical data, we developed a short and easy-to-use tentative questionnaire to measure patient-reported postoperative recovery. Initial support for content validity was established. The vast majority of items showed a high level of test-retest reliability.

    Place, publisher, year, edition, pages
    Oxford: Blackwell Publishing Ltd, 2009
    National Category
    Surgery Medical and Health Sciences
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-8081 (URN)10.1111/j.1365-2753.2008.01027.x (DOI)000266425900002 ()
    Note
    Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-7731Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2017-12-13Bibliographically approved
    4. The Postoperative Recovery Profile (PRP): a multidimensional questionnaire for evaluation of recovery profiles
    Open this publication in new window or tab >>The Postoperative Recovery Profile (PRP): a multidimensional questionnaire for evaluation of recovery profiles
    Show others...
    2011 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 17, no 2, p. 236-243Article in journal (Refereed) Published
    Abstract [en]

    Background. The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self-assessment of general recovery after surgery. The aim of this study was to further evaluate the questionnaire regarding the construct validity and ability to discriminate recovery profiles between groups. Furthermore, the item variables of greatest importance during the progress of recovery were investigated.

    Methods. Postoperative recovery was assessed during the period from discharge to 12 months after lower abdominal- and orthopedic surgery. Construct validity was evaluated by comparing the assessments from the PRP-questionnaire and a global recovery scale. Recovery profiles of the diagnose groups were displayed by the cumulative proportion recovered participants over time. The importance of item variables was investigated by ranking ordering.

    Results. A total of 158 patients were included. The result showed that 7.6 % of all possible pairs were disordered when comparing the assessments from the PRP questionnaire and the global recovery scale. Twelve months after discharge 51 % participants in the abdominal group were fully recovered, as compared with the 73%, in the orthopedic group (95% CI: 6 % to 40 %). The item variable pain appeared as top five at eight measurement occasions of eight possible in both the abdominal and the orthopedic groups. The importance of the items was emphasized.

    Conclusions. The PRP questionnaire allows for evaluation of the progress of postoperative recovery, and can be useful to assess patient-reported recovery after surgical treatment. Knowledge about recovery profiles can assist clinicians in determining the critical time points for measuring change.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2011
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-8083 (URN)10.1111/j.1365-2753.2010.01422.x (DOI)000288217700005 ()20846316 (PubMedID)2-s2.0-79952668667 (Scopus ID)
    Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2017-12-13
  • 3.
    Allvin, Renée
    et al.
    Örebro University, Department of Clinical Medicine. Department of Anaesthesiology and Intensive Care, Örebro University Hospital ,Örebro,Sweden.
    Berg, Katarina
    Department of Medicine and Care, Linköping University, Linköping, Sweden.
    Idvall, Ewa
    Research Section, Kalmar County Council, Kalmar,Sweden; Department of Medicine and Care, Linköping University, Linköping, Sweden.
    Nilsson, Ulrica
    Örebro University, Department of Nursing and Caring Sciences. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro,Sweden; Department of Cardiothoracic Surgery, Örebro University Hospital , Örebro, Sweden.
    Postoperative recovery: a concept analysis2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 57, no 5, p. 552-558Article in journal (Refereed)
    Abstract [en]

    Aim. This papaer presents a concept analysis of the phenomeneon postoperative recovery.

    Background. Each year, millions of patients throughout the world undergo surgical procedures. Although postoperative recovery is commonly used as an outcome of surgery, it is difficult to identify a standard definition.

    Method. Walker and Avant´s concept analysis approach was used. Literature retrieved from MEDLINE and CINAHL databases for english language papers published from 1982 to 2005 was used for the analysis.

    Findings. The theoretical definition developed points out that postoperative recovery is an energy-requiring process of returning to normality and wholeness. It is defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions, and results in a return to preoperative level of independence/dependence in activities of daily living and optimum level of psychological well-being.

    Conclusion. The concept of postoperative recovery lacks clarity, both in its meaning in relation to postoperative recovery to healthcare professionals in their care for surgical patients, and in the understanding of what researchers in this area really intend to investigate. The theoretical definition we have developed may be useful but needs to be further explored.

  • 4.
    Allvin, Renée
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Skills Centre, Örebro University Hospital, Örebro, Sweden.
    Berndtzon, Magnus
    Metodikum – Skill Centre of Medical Simulation Region County Jönköping, Jönköping, Sweden.
    Carlzon, Liisa
    Simulation Centre West, Department of Research, Education and Development, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Edelbring, Samuel
    Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Hult, Håkan
    Institute of Medicine and Health, Medical Faculty, Linköping University, Linköping, Sweden.
    Hultin, Magnus
    Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Medical Faculty, Umeå University, Umeå, Sweden.
    Karlgren, Klas
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Department of Research, Education and Development and Innovation, Södersjukhuset Hospital, Stockholm, Sweden.
    Masiello, Italo
    Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset Hospital, Stockholm, Sweden.
    Kallestedt, Marie-Louise Södersved
    Clinical Skills Centre, Centre for Clinical Research, Uppsala University, Västerås, Sweden.
    Tamás, Éva
    Department of Cardiovascular Diseases, Institute of Medicine and Health, Medical Faculty, University of Linköping, Linköping, Sweden.
    Confident but not theoretically grounded - experienced simulation educators' perceptions of their own professional development2017In: Advances in Medical Education and Practice, ISSN 1179-7258, E-ISSN 1179-7258, Vol. 8, p. 99-108Article in journal (Refereed)
    Abstract [en]

    Background: Medical simulation enables the design of learning activities for competency areas (eg, communication and leadership) identified as crucial for future health care professionals. Simulation educators and medical teachers follow different career paths, and their education backgrounds and teaching contexts may be very different in a simulation setting. Although they have a key role in facilitating learning, information on the continuing professional development (pedagogical development) of simulation educators is not available in the literature.

    Objectives: To explore changes in experienced simulation educators' perceptions of their own teaching skills, practices, and understanding of teaching over time.

    Methods: A qualitative exploratory study. Fourteen experienced simulation educators participated in individual open-ended interviews focusing on their development as simulation educators. Data were analyzed using an inductive thematic analysis.

    Results: Marked educator development was discerned over time, expressed mainly in an altered way of thinking and acting. Five themes were identified: shifting focus, from following to utilizing a structure, setting goals, application of technology, and alignment with profession. Being confident in the role as an instructor seemed to constitute a foundation for the instructor's pedagogical development.

    Conclusion: Experienced simulation educators' pedagogical development was based on self-confidence in the educator role, and not on a deeper theoretical understanding of teaching and learning. This is the first clue to gain increased understanding regarding educational level and possible education needs among simulation educators, and it might generate several lines of research for further studies.

  • 5.
    Allvin, Renée
    et al.
    Örebro University, Department of Clinical Medicine.
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences.
    Rawal, Narinder
    Örebro University, Department of Clinical Medicine.
    Idvall, Ewa
    Experiences of the postoperative recovery process: an interview study2008In: The open nursing journal, ISSN 1874-4346, Vol. 2, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Few researchers have described postoperative recovery from a broad, overall perspective. In this article the authors describe a study focusing on patient and staff experiences of postoperative recovery using a qualitative descriptive design to obtain a description of the phenomenon. They performed 10 individual interviews with patients who had undergone abdominal or gynecological surgery and 7 group interviews with registered nurses working on surgical and gynecological wards and in primary care centers, surgeons from surgical and gynecological departments, and in-patients from a gynecological ward. The authors analyzed data using qualitative content analysis. Postoperative recovery is described as a Dynamic Process in an Endeavour to Continue With Everyday Life. This theme was further highlighted by the categories Experiences of the core of recovery and Experiences of factors influencing recovery. Knowledge from this study will help caregivers support patients during their recovery from surgery.

  • 6.
    Allvin, Renée
    et al.
    Örebro University, Department of Clinical Medicine.
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences.
    Rawal, Narinder
    Örebro University, Department of Clinical Medicine.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Idvall, Ewa
    Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability2009In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 3, p. 411-419Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. In this study we describe the development of a short, easy-to-use questionnaire to measure postoperative recovery and evaluate its content validity and intra-patient reliability.   The questionnaire is designed to evaluate the progress of postoperative recovery and the long-term follow-up of possible effects of interventions during recovery.

    Method. The study involved four steps. 1) A conceptualisation and item definitions were based on a theoretical framework and a description of patients´ postoperative recovery from the perspective of patients, registered nurses and surgeons. 2) Content validity of items was tested through expert judgements. 3) A test run of the questionnaire was performed to confirm its feasibility and workload requirement. 4) The stability of the questionnaire was evaluated through intra-patient reliability assessment.

    Results. As a result of the operationalisation process of the concept postoperative recovery, five dimensions (physical symptoms, physical functions, psychological, social, activity) and 19 items were identified. Each item was formulated as a statement in the questionnaire. Content validity was judged to be high. After the pre-test of the questionnaire a revision with refinements in the layout was made. The vast majority of items showed a high level of intra-patient reliability.

    Conclusion. Based on a theoretical framework and empirical data, we developed a short and easy-to-use tentative questionnaire to measure patient-reported postoperative recovery. Initial support for content validity was established. The vast majority of items showed a high level of test-retest reliability.

  • 7.
    Allvin, Renée
    et al.
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Kling, Anna-Maria
    Statistical and Epidemiology Unit, Örebro University Hospital, Örebro, Sweden.
    Idvall, Ewa
    Faculty of Health and Society, Malmö and Skåne University Hospital, Malmö University, Malmö, Sweden.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Patient Reported Outcome Measures (PROMs) after total hip- and knee replacement surgery evaluated by the Postoperative Recovery Profile questionnaire (PRP): improving clinical quality and person-centeredness2012In: The International Journal of Person Centered Medicine, ISSN 2043-7730, E-ISSN 2043-7749, Vol. 2, no 3, p. 368-376Article in journal (Refereed)
    Abstract [en]

    Rationale and aims: The importance of evaluating postoperative recovery with consideration to the patient’s perspectivehas been emphasized. The aim of this study was to demonstrate how the recovery-specific Postoperative Recovery Profile(PRP) questionnaire can be used to evaluate patient-reported outcome measures (PROMs) after hip- and knee replacementin the enhancement of clinical quality and the person-centeredness of clinical services. Method: Patients undergoing primary total knee- and hip replacement were eligible for this longitudinal follow-up study. The participants completed the PRP questionnaire on repeated occasions. In this paper, data from Day 3 and Month 1 afterdischarge were used. The change in recovery, between the two measurement occasions, on item-, dimensional- and globallevels, both for each patient and for the group, were evaluated. Results: A total number of 75 patients were included. One month after discharge the median PRP score was 13 (partly recovered) out of 19. Recovery changes towards lower levels of problems/difficulties were shown in both item-, dimensional- and global levels of recovery month 1 after discharge, as compared with Day 3. The group of patients washomogenous in change. Conclusions: We demonstrated that the PRP questionnaire can be used to evaluate postoperative recovery after hip- andknee replacement surgery on item-, dimensional- and global levels. Data from each recovery level can be useful for quality development and in informing increases in the person-centeredness of clinical services. The global population scores can beused to evaluate treatment effect on a group of patients. It can also be used to define endpoints in follow-up studies.

  • 8.
    Allvin, Renée
    et al.
    Örebro University, School of Medical Sciences. Department of Anaesthesiology and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Rawal, Narinder
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Johanzon, Eva
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Bäckström, Ragnar
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Open versus Laparoscopic Surgery: Does the Surgical Technique Influence Pain Outcome? Results from an International Registry2016In: Pain Research and Treatment, ISSN 2090-1542, E-ISSN 2090-1550, article id 4087325Article in journal (Refereed)
    Abstract [en]

    Postoperative pain management relevant for specific surgical procedures is debated. The importance of evaluating pain with consideration given to type of surgery and the patient's perspective has been emphasized. In this prospective cohort study, we analysed outcome data from 607 patients in the international PAIN OUT registry for assessment and comparison of postoperative pain outcome within the 24 first hours after laparoscopic and open colonic surgery. Patients from the laparoscopic group scored minimum pain at a higher level than the open group (P = 0.012). Apart from minimum pain, no other significant differences in patient reported outcomes were observed. Maximum pain scores >3 were reported from 77% (laparoscopic) and 68% (open) patients (mean >= 5 in both groups). Pain interference with mobilization was reported by 87-93% of patients. Both groups scored high levels of patient satisfaction. In the open group, a higher frequency of patients received a combination of general and regional anaesthesia, which had an impact of the minimum pain score. Our results from registry data indicate that surgical technique does not influence the quality of postoperative pain management during the first postoperative day if adequate analgesia is given.

  • 9.
    Allvin, Renée
    et al.
    Örebro University, Department of Clinical Medicine.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Rawal, Narinder
    Örebro University, Department of Clinical Medicine.
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences.
    Kling, Anna-Maria
    Statistical and Epidemiology Unit, Örebro University Hospital, Örebro, Sweden.
    Idvall, Ewa
    The Postoperative Recovery Profile (PRP): a multidimensional questionnaire for evaluation of recovery profiles2011In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 17, no 2, p. 236-243Article in journal (Refereed)
    Abstract [en]

    Background. The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self-assessment of general recovery after surgery. The aim of this study was to further evaluate the questionnaire regarding the construct validity and ability to discriminate recovery profiles between groups. Furthermore, the item variables of greatest importance during the progress of recovery were investigated.

    Methods. Postoperative recovery was assessed during the period from discharge to 12 months after lower abdominal- and orthopedic surgery. Construct validity was evaluated by comparing the assessments from the PRP-questionnaire and a global recovery scale. Recovery profiles of the diagnose groups were displayed by the cumulative proportion recovered participants over time. The importance of item variables was investigated by ranking ordering.

    Results. A total of 158 patients were included. The result showed that 7.6 % of all possible pairs were disordered when comparing the assessments from the PRP questionnaire and the global recovery scale. Twelve months after discharge 51 % participants in the abdominal group were fully recovered, as compared with the 73%, in the orthopedic group (95% CI: 6 % to 40 %). The item variable pain appeared as top five at eight measurement occasions of eight possible in both the abdominal and the orthopedic groups. The importance of the items was emphasized.

    Conclusions. The PRP questionnaire allows for evaluation of the progress of postoperative recovery, and can be useful to assess patient-reported recovery after surgical treatment. Knowledge about recovery profiles can assist clinicians in determining the critical time points for measuring change.

  • 10.
    Blomberg, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Allvin, Renée
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ewertsson, Mona
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gustafsson, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kullén Engström, Agneta
    Borås högskola, Borås, Sweden.
    Ohlsson, Ulla
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Sundler Johansson, Annelie
    Skövde högskola, Skövde, Sweden.
    Bisholt, Birgitta
    Karlstads universitet, Karlstad, Sweden.
    Clinical group supervision in nursing education for integrate ethical reasoning: students and supervisors’ view2012Conference paper (Refereed)
  • 11.
    Blomberg, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Isaksson, Ann-Kristin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Allvin, Renée
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Skills Centre, Örebro University Hospital, Örebro, Örebro.
    Bisholt, Birgitta
    Department of Nursing, Karlstad University, Karlstad, Sweden.
    Ewertsson, Mona
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kullén Engström, Agneta
    School of Health, University of Borås, Borås, Sweden.
    Ohlsson, Ulla
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Sundler, Annelie Johansson
    School of Life Sciences, University of Skövde, Skövde, Sweden.
    Gustafsson, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Work stress among newly graduated nurses in relation to workplace and clinical group supervision2016In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 24, no 1, p. 80-87Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to investigate occupational stress among newly graduated nurses in relation to the workplace and clinical group supervision.

    Background: Being a newly graduated nurse is particularly stressful. What remains unclear is whether the workplace and clinical group supervision affect the stress.

    Method: A cross-sectional comparative study was performed in 2012. Data were collected by means of a numerical scale measuring occupational stress, questions about workplace and clinical group supervision. One hundred and thirteen nurses who had recently graduated from three Swedish universities were included in the study.

    Results: The stress was high among the newly graduated nurses but it differed significantly between workplaces, surgical departments generating the most stress. Nurses who had received clinical group supervision reported significantly less stress. The stress between workplaces remained significant also when participation in clinical group supervision was taken into account.

    Conclusions: Newly graduated nurses experience great stress and need support, especially those in surgical departments. Nurses participating in clinical group supervision reported significantly less stress.

    Implications for nursing management: It is important to develop strategies that help to adapt the work situation so as to give nurses the necessary support. Clinical group supervision should be considered as an option for reducing stress.

  • 12.
    Bratt, Annika
    et al.
    Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Allvin, Renée
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Wann-Hansson, Christine
    Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Modifying a generic postoperative recovery profile instrument to an instrument specifically targeting coronary artery bypass grafting2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 3, p. 475-486Article in journal (Refereed)
    Abstract [en]

    Patients may suffer from a wide range of postoperative symptoms after coronary artery bypass grafting. In-depth knowledge of the recovery process is a prerequisite for nursing interventions. However, we found no specific instrument covering the entire range and duration of postoperative symptoms related to this procedure. We therefore modified and extended the 19 items, generic Postoperative Recovery Profile questionnaire for the specific evaluation of the recovery after coronary artery bypass grafting. We here report on the development process of the new questionnaire. Procedure-specific symptoms were identified by a literature review and by experts. The content validity was assessed by healthcare professionals (n = 15), inpatients (n = 12) and outpatients (n = 4). A test run was done with inpatients (n = 10), which was followed by a test-retest reliability evaluation with inpatients (n = 24). We identified 15 new symptoms in the literature review and six in the content validity assessment. Only three of the 35 items had an acceptable content validity index, but all 35 items in the test run were reported by at least two patients. The questionnaire took 4-9 minutes to complete and was considered easy to use. The final instrument used in the reliability test included 22 new items, and 25 of the 35 items were satisfactory stable. To conclude, we developed a 35 items, procedure-specific questionnaire that was easy to use and may aid systematic assessment of the recovery after coronary artery bypass grafting.

  • 13.
    Ewertsson, Mona
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Allvin, Renee
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Clinical Skills Centre, Örebro University Hospital, Örebro, Sweden.
    Holmström, Inger K.
    School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden; Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Walking the bridge: Nursing students' learning in clinical skill laboratories2015In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 15, no 4, p. 277-283Article in journal (Refereed)
    Abstract [en]

    Despite an increasing focus on simulation as a learning strategy in nursing education, there is limited evidence on the transfer of simulated skills into clinical practice. Therefore it's important to increase knowledge of how clinical skills laboratories (CSL) can optimize students' learning for development of professional knowledge and skills, necessary for quality nursing practice and for patient safety. Thus, the aim was to describe nursing students' experiences of learning in the CSL as a preparation for their clinical practice. Interviews with 16 students were analysed with content analysis. An overall theme was identified walking the bridge in which the CSL formed a bridge between the university and clinical settings, allowing students to integrate theory and practice and develop a reflective stance. The theme was based on categories: conditions for learning, strategies for learning, tension between learning in the skills laboratory and clinical settings, and development of professional and personal competence. The CSL prepared the students for clinical practice, but a negative tension between learning in CSL and clinical settings was experienced. However, this tension may create reflection. This provides a new perspective that can be used as a pedagogical approach to create opportunities for students to develop their critical thinking.

  • 14.
    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)
  • 15.
    Ewertsson, Mona
    et al.
    Örebro University, School of Health Sciences.
    Bagga-Gupta, Sangeeta
    Jönköping University.
    Allvin, Renèe
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    Tensions in learning professional identities: nursing students narratives and participation in practical skills during their clinical practiceManuscript (preprint) (Other academic)
  • 16.
    Ewertsson, Mona
    et al.
    Örebro University, School of Health Sciences.
    Bagga-Gupta, Sangeeta
    School of Education and Communication, Jönköping University, Jönköping, Sweden.
    Allvin, Renée
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Skills Centre, Örebro University Hospital, Örebro, Sweden.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    Tensions in learning professional identities - nursing students' narratives and participation in practical skills during their clinical practice: an ethnographic study2017In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 16, article id 48Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Clinical practice is a pivotal part of nursing education. It provides students with the opportunity to put the knowledge and skills they have acquired from lectures into practice with real patients, under the guidance of registered nurses. Clinical experience is also essential for shaping the nursing students' identity as future professional nurses. There is a lack of knowledge and understanding of the ways in which students learn practical skills and apply knowledge within and across different contexts, i.e. how they apply clinical skills, learnt in the laboratory in university settings, in the clinical setting. The aim of this study was therefore to explore how nursing students describe, and use, their prior experiences related to practical skills during their clinical practice.

    METHODS: An ethnographic case study design was used. Fieldwork included participant observations (82 h), informal conversations, and interviews (n = 7) that were conducted during nursing students' (n = 17) clinical practice at an emergency department at a university hospital in Sweden.

    RESULTS: The overarching theme identified was "Learning about professional identities with respect to situated power". This encompasses tensions in students' learning when they are socialized into practical skills in the nursing profession. This overarching theme consists of three sub-themes: "Embodied knowledge", "Divergent ways of assessing and evaluating knowledge" and "Balancing approaches".

    CONCLUSIONS: Nursing students do not automatically possess the ability to transfer knowledge from one setting to another; rather, their development is shaped by their experiences and interactions with others when they meet real patients. The study revealed different ways in which students navigated tensions related to power differentials. Reflecting on actions is a prerequisite for developing and learning practical skills and professional identities. This highlights the importance of both educators' and the preceptors' roles for socializing students in this process.

  • 17.
    Ewertsson, Mona
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gustafsson, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Holmström, Inger K.
    School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden; Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.
    Allvin, Renée
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Clinical Skills Centre, Örebro University Hospital, Örebro, Sweden.
    Use of technical skills and medical devices among new registered nurses: A questionnaire study2015In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 35, no 12, p. 1169-1174Article in journal (Refereed)
    Abstract [en]

    Background: One comprehensive part of nursing practice is performing technical skills and handling of medical equipment. This might be challenging for new registered nurses (RNs) to do in patient-safe way.

    Objectives: The aim of this study was to describe and compare the extent to which new RNs perform various technical skills and handle medical devices in different settings, and to investigate their possibility for continued learning in this respect. A further aim was to describe their perceptions of incident reporting related to technical skills and medical devices.

    Design: A cross-sectional study with descriptive and comparative design.

    Participants: RNs who recently graduated from a nursing programme at three Swedish universities and had worked as a RN for up to 1year were included in the study (n=113, response rate 57%).

    Method: Data were collected by means of a postal questionnaire.

    Results: Half of the RNs reported that they performed several of the listed tasks every day or every week, regardless of workplace. These tasks were most frequently performed in surgical departments. The majority of the participants (76%) stated a need of continued practical training. However, less than half of them (48%) had access to a training environment. Several participants (43%) had been involved in incidents related to technical skills or medical devices, which were not always reported. Nearly a third of the participants (31%) did not use the existing guidelines when performing technical skills, and reflection on performance was uncommon.

    Conclusions: This study highlights the importance of shared responsibilities between nurse educators and health care employers to provide learning opportunities for new RNs in technical skills, to maintain patient safety. To increase the safety culture where nursing students and new RNs understand the importance of using evidence-based guidelines and taking a reflective approach in the performance of technical tasks is needed.

  • 18.
    Hartwig, Markus
    et al.
    Department of Anaesthesiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Allvin, Renée
    Örebro University, School of Medical Sciences. Department of Anaesthesiology and Intensive care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Bäckström, Ragnar
    Department of Anaesthesiology and Intensive care, Örebro University Hospital, Örebro, Sweden.
    Stenberg, Erik
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Factors Associated with Increased Experience of Postoperative Pain after Laparoscopic Gastric Bypass Surgery2017In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, no 7, p. 1854-1858Article in journal (Refereed)
    Abstract [en]

    Introduction: Patients with high body mass index (BMI), pre-existing pain and young age and women seem to experience more postoperative pain. Few studies have, however, addressed these risk factors amongst obese patients undergoing bariatric surgery. The aim of the present study was to evaluate risk factors for postoperative pain following laparoscopic gastric bypass surgery.

    Methods: In this cohort study, we used data from the PAIN OUT register for postoperative pain during the first 24 h after surgery. Primary outcome measure was severity of pain after surgery. Multivariate analyses were conducted to evaluate BMI, young age, gender and pre-existing pain as independent risk factors for postoperative pain.

    Results: We included 192 patients in this study. Younger age (B -0.08, 95%CI -0.11 to -0.05/year; p < 0.001), female gender (B 0.92, 95%CI 0.10-1.75; p = 0.029) and pre-existing pain (B 1.06, 95%CI 0.03-2.09; p = 0.044) were all associated with an increased risk for postoperative pain. In the multivariate analyses, only young age ((adjusted OR 0.95, 95%CI 0.92-0.97/year; p < 0.001) and pre-existing pain (adjusted OR 2.56, 95%CI 1.09-6.00; p = 0.031) remained as independent risk factors for severe postoperative pain.

    Conclusion: Younger age and pre-existing pain are associated with severe postoperative pain during the first 24 h after laparoscopic gastric bypass surgery, whereas female gender and high BMI are not.

  • 19.
    Hilding, Ulrika
    et al.
    Örebro University Hospital, Örebro, Sweden.
    Allvin, Renée
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Blomberg, Karin
    Örebro University, School of Health Sciences. Örebro University Hospital, Örebro, Sweden.
    Striving for a balance between leading and following the patient and family - nurses' strategies to facilitate the transition from life-prolonging care to palliative care: an interview study2018In: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 17, no 1, article id 55Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The transition from life-prolonging to palliative care (PC) can be challenging often characterized by psychical, physiological, social and existential changes. Knowledge of how to support the patient and family in this specific care phase is lacking, and this area needs to be further explored. The aim of this study was to investigate strategies that registered nurses (RNs) use to ease the transition from life-prolonging care to PC for patients with incurable disease.

    METHODS: The study has a descriptive design. Fourteen RNs working in a specialized PC unit were interviewed. The data were analysed using content analysis.

    RESULTS: The RNs' strategies can be described under the categories "Getting to know the patient and creating a relationship", "Providing support", "Adapting to individuals' needs" and "Enabling conversations".

    CONCLUSION: The findings show that the RNs in this population used strategies that not only took time but also required knowledge about the transition process and required the ability to identify and meet patients' and families' unique needs. Patients' difficult and exposed situation needs to be addressed through a structured follow-up after informing about the change from life-prolonging care to PC. RNs have a unique role of supporting both the patient and the family in the transition from life-prolonging care to PC for patients with incurable disease.

  • 20.
    Rothaug, Judith
    et al.
    Dept Anesthesiol & Intens Care, Univ Jena, Jena, Germany.
    Zaslansky, Ruth
    Dept Anesthesiol & Intens Care, Univ Jena, Jena, Germany.
    Schwenkglenks, Matthias
    European Ctr Pharmaceut Med, Univ Basel, Basel, Switzerland.
    Komann, Marcus
    Dept Anesthesiol & Intens Care, Univ Jena, Jena, Germany.
    Allvin, Renee
    Dept Anesthesiol & Intens Care, Örebro University Hospital, Örebro, Sweden.
    Backstrom, Ragnar
    Dept Anesthesiol & Intens Care, Örebro University Hospital, Örebro, Sweden.
    Bri, Silviu
    Dept Anesthesiol & Intens Care, Sourasky Med Ctr, Tel Aviv, Israel.
    Buchholz, Ingo
    TAKWA GmbH, Erfurt, Germany.
    Engel, Christoph
    Inst Med Informat Stat & Epidemiol, Univ Leipzig,Leipzig, Germany.
    Fletcher, Dominique
    Dept Anesthesiol & Intens Care, Hop Raymond Poincare, Garches, France.
    Fodor, Lucian
    Spitalul Clinic Judeţean de Urgenţă, Cluj Napoca, Romania.
    Funk, Peter
    School of Innovation, Design & Engineering, Mälardalen Univ, Västerås, Sweden.
    Gerbershagen, Hans J.
    Dept Anesthesiol & Intens Care, Univ Med Ctr Utrecht, Utrecht, Netherlands.
    Gordon, Debra B.
    Dept Anesthesiol & Pain Med, Univ Washington, Seattle WA, USA.
    Konrad, Christoph
    Dept Anesthesiol & Intens Care, Kantonsspital, Luzern, Switzerland.
    Kopf, Andreas
    Dept Anesthesiol & Intens Care, Charite Med Ctr, Berlin, Germany.
    Leykin, Yigal
    Dept Anesthesiol & Intens Care, Univ Trieste & Udine, Trieste, Italy.
    Pogatzki-Zahn, Esther
    Dept Anesthesiol & Intens Care, Univ Hosp Muenster, Munster, Germany.
    Puig, Margarita
    Dept Anesthesiol & Intens Care, IMIM Hosp del Mar UAB, Barcelona, Spain.
    Rawal, Narinder
    Dept Anesthesiol & Intens Care, Örebro University Hospital, Örebro, Sweden.
    Taylor, Rod S.
    Peninsula Coll Med & Dent, University of Exeter, Exeter, England.
    Ullrich, Kristin
    Queen Mary & Westfield Coll, Dept Anesthesiol & Intens Care, University of London, London, England.
    Volk, Thomas
    Dept Anesthesiol & Intens Care, Saarland Univ Hosp, Homburg, Germany.
    Yahiaoui-Doktor, Maryam
    Inst Med Informat Stat & Epidemiol, Univ Leipzig, Leipzig, Germany.
    Meissner, Winfried
    Dept Anesthesiol & Intens Care, Univ Jena, Jena, Germany.
    Patients' Perception of Postoperative Pain Management: Validation of the International Pain Outcomes (IPO) Questionnaire2013In: Journal of Pain, ISSN 1526-5900, E-ISSN 1528-8447, Vol. 14, no 11, p. 1361-1370Article in journal (Refereed)
    Abstract [en]

    PAIN OUT is a European Commission-funded project aiming at improving postoperative pain management. It combines a registry that can be useful for quality improvement and research using treatment and patient-reported outcome measures. The core of the project is a patient questionnaire-the International Pain Outcomes questionnaire that comprises key patient-level outcomes of postoperative pain management, including pain intensity, physical and emotional functional interference, side effects, and perceptions of care. Its psychometric quality after translation and adaptation to European patients is the subject of this validation study. The questionnaire was administered to 9,727 patients in 10 languages in 8 European countries and Israel. Construct validity was assessed using factor analysis. Discriminant validity assessment used Mann-Whitney U tests to detect mean group differences between 2 surgical disciplines. Internal consistency reliability was calculated as Cronbach's alpha. Factor analysis resulted in a 3-factor structure explaining 53.6% of variance. Cronbach's alpha at overall scale level was high (.86), and for the 3 subscales was low, moderate, or high (range, .53-.89). Significant mean group differences between general and orthopedic surgery patients confirmed discriminant validity. The psychometric quality of the International Pain Outcomes questionnaire can be regarded as satisfactory. Perspective: The International Pain Outcomes questionnaire provides an instrument for postoperative pain assessment and improvement of quality of care, which demonstrated good psychometric quality when translated into a variety of languages in a large European and Israeli patient population. This measure provides the basis for the first comprehensive postoperative pain registry in Europe and other countries. (C) 2013 Published by Elsevier Inc. on behalf of the American Pain Society

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