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  • 1.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Pain in the elderly: rating scales, prevalence and verbal expression of pain and pain relief2003Doctoral thesis, comprehensive summary (Other academic)
  • 2.
    Bergh, Ingrid
    et al.
    University of Skövde, School of Life Sciences.
    Björk, Maria
    University of Skövde, School of Life Sciences.
    Sense of coherence over time for parents with a child diagnosed with cancer2012In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 12, p. Article number 79-Article in journal (Refereed)
    Abstract [en]

    Background: When a child is diagnosed with childhood cancer this creates severe stress in the parents. The aim of the study was to describe the sense of coherence and its change over time in a sample of parents of children diagnosed with cancer.

    Methods: The Swedish version of SOC (29 items) was used to measure the parents’ (n = 29) sense of coherence. Data were collected at four time-points: Time-point 1 at the time of diagnosis; time-point 2 during the treatment; time-point 3 after the child had completed their treatment and time-point 4 when the child had been off treatment for some years or had died.

    Results: The results showed that SOC in the investigated population is not stable over time. The parents decreased in total SOC between time-points 1, 2 and 3. Mothers had significantlyweaker total SOC score including the components Manageability and Meaningfulness at time-points 1 as well time-point 2 compared to the fathers. However, for the component Comprehensibility no significant differences were shown between mothers and fathers. This study indicates that mothers’ and fathers’ SOC scores change over time during the child’s cancer trajectory. However, the pattern in these changes varies between mothers and fathers.

    Conclusions: This study indicates that mothers and fathers may have different support needs during their child’s cancer trajectory.

  • 3.
    Bergh, Ingrid
    et al.
    University of Skövde, School of Life Sciences.
    Gunnarsson, Magnus
    Department of Linguistics, Göteborg University, Göteborg, Sweden.
    Allwood, Jens
    Department of Linguistics, Göteborg University, Göteborg, Sweden.
    Odén, Anders
    Department of Geriatric Medicine, Göteborg University, Göteborg, Sweden.
    Sjöström, Björn
    University of Skövde, School of Life Sciences.
    Steen, Bertil
    Department of Geriatric Medicine, Göteborg University, Göteborg, Sweden.
    Descriptions of pain in elderly patients following orthopaedic surgery2005In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, no 2, p. 110-118Article in journal (Refereed)
    Abstract [en]

    The aims of this study were to investigate what words elderly patients, who had undergone hip surgery, used to describe their experience of pain in spoken language and to compare these words with those used in the Short-Form McGill Pain Questionnaire (SF-MPQ) and Pain-O-Meter (POM). The study was carried out at two orthopaedic and two geriatric clinical departments at a large university hospital in Sweden. Altogether, 60 patients (mean age =77) who had undergone orthopaedic surgery took part in the study. A face-to-face interview was conducted with each patient on the second day after the operation. This was divided into two parts, one tape-recorded and semi-structured in character and one structured interview. The results show that a majority of the elderly patients who participated in this study verbally stated pain and spontaneously used a majority of the words found in the SF-MPQ and in the POM. The patients also used a number of additional words not found in the SF-MPQ or the POM. Among those patients who did not use any of the words in the SF-MPQ and the POM, the use of the three additional words 'stel' (stiff), 'hemsk' (awful) and 'räd(d)(sla)' (afraid/fear) were especially marked. The patients also combined the words with a negation to describe what pain was not. To achieve a more balanced and nuanced description of the patient's pain and to make it easier for the patients to talk about their pain, there is a need for access to a set of predefined words that describe pain from a more multidimensional perspective than just intensity. If the elderly patient is allowed, and finds it necessary, to use his/her own words to describe what pain is but also to describe what pain is not, by combining the words with a negation, then the risk of the patient being forced to choose words that do not fully correspond to their pain can be reduced. If so, pain scales such as the SF-MPQ and the POM can create a communicative bridge between the elderly patient and health care professionals in the pain evaluation process.

  • 4.
    Bergh, Ingrid H. E.
    et al.
    University of Skövde, School of Life Sciences.
    Ek, Kristina
    University of Skövde, School of Life Sciences.
    Mårtensson, Lena B.
    University of Skövde, School of Life Sciences.
    Midwifery students attribute different quantitative meanings to "hurt", "ache" and "pain": A cross-sectional survey2013In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 26, no 2, p. 143-146Article in journal (Refereed)
    Abstract [en]

    Background: Assessment of women's labor pain is seldom acknowledged in clinical practice or research. The words "aching" and "hurting" are frequently used by women to describe childbirth pain. The aim of this study was to determine the quantitative meanings midwifery students attribute to the terms "hurt", "ache" and "pain". Data was collected by self-administered questionnaire from students at seven Swedish midwifery programs. A total of 230 filled out and returned a completed questionnaire requesting them to rate, on a visual analog scale, the intensity of "hurt", "ache" or "pain" in the back, as reported by a fictitious parturient. Results: The midwifery students attributed, with substantial individual variation, different quantitative meanings to the studied pain descriptors. Conclusions: To be able to communicate about pain with a woman in labor, it is essential that the midwife be familiar with the value of different words and what they mean to her as this may affect her assessment when the woman describes her pain. © 2012.

  • 5.
    Bergh, Ingrid H. E.
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Johansson, Anna
    Univ Hosp Örebro, Dept Obstet, Örebro, Sweden.
    Bratt, Annelie
    Skaraborgs Hosp, Dept Obstet & Gynecol, Skövde, Sweden.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Assessment and documentation of women's labour pain: A cross-sectional study in Swedish delivery wards2015In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 28, no 2, p. E14-E18Article in journal (Refereed)
    Abstract [en]

    Background: A woman's pain during labour plays a dominant role in childbirth. The midwife's role is to assess the degree of pain experienced during labour. When professionals respond to labour pain with acknowledgement and understanding, the woman's sense of control and empowerment is increased, which could contribute to a positive experience of childbirth. The aim of this study is to describe how labour pain in Swedish delivery wards is assessed and documented. Methods: This quantitative descriptive study was designed as a national survey performed through telephone interviews with the representatives of 34 delivery wards in Sweden. Results and conclusion: The majority of the participating delivery wards assessed and documented women's labour pain, but in an unstructured manner. The wards differed in how the assessments and documentation were performed. In addition, almost all the delivery wards that participated in the survey lacked guidelines for the assessment and documentation of the degree of pain during labour. The findings also showed that the issue of labour pain was sometimes discussed in the delivery wards, but not in a structured or consistent way. (C) 2015 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.

  • 6.
    Bergh, Ingrid H. E.
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Stener-Victorin, Elisabet
    Institute of Neuroscience and Physiology/Endocrinology, Sahlgrenska Academy, University of Gothenburg.
    Wallin, Gunnar
    Institute of Clinical Sciences, Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg.
    Mårtensson, Lena
    University of Skövde, School of Life Sciences.
    Comparison of the PainMatcher and the Visual Analogue Scale for assessment of labour pain following administered pain relief treatment2011In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 1, p. E134-E139Article in journal (Refereed)
    Abstract [en]

    Objective: during childbirth, it is necessary to assess and monitor experienced pain and to evaluate the effect of pain relief treatment. The aim of this study was to compare the PainMatcher® (PM) with the Visual Analogue Scale (VAS) for the assessment of labour pain and the effect of pain relief treatment.Design: randomised controlled trial.Setting: labour ward with approximately 2500 childbirths per year in western Sweden.Participants: 57 women with labour pain treated with acupuncture or sterile water injections scored their electrical pain threshold and pain intensity with the PM. Pain intensity was also assessed with the VAS. Electrical pain threshold and pain intensity were assessed immediately after a uterine contraction before and 30, 60, 90, 120, 150 and 180 minutes after treatment.Measurements and findings: the results showed a weak correlation (r=0.13, p<0.05) between the pain intensity scores on the PM and the VAS. The PM detected changes (decrease) in pain intensity to a lower degree than the VAS. Surprisingly, in over 10% of sessions, women scored their pain intensity during a uterine contraction lower than their electrical pain threshold with the PM. However, electrical pain thresholds with the PM correlated well throughout all measurements.Conclusions: the PM is a reliable tool for the assessment of electrical pain threshold; however, the VAS is more sensitive than the PM for recording changes in pain intensity when assessing the effects of treatment on labour pain.Implications for practice: the PM and the VAS are not interchangeable in the case of labour pain, and there is still a need for research in this area to find a more suitable assessment instrument for the evaluation of labour pain.

  • 7.
    Bergh, Ingrid
    et al.
    University of Skövde, School of Life Sciences.
    Jakobsson, Eva
    University of Skövde, School of Life Sciences.
    Sjöström, Björn
    University of Skövde, School of Life Sciences.
    Worst experiences of pain and conceptions of worst pain imaginable among nursing students2008In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 61, no 5, p. 484-491Article in journal (Refereed)
    Abstract [en]

    This paper is a report of a study to explore nursing students' own worst experiences of pain as well as their conceptions of the worst pain imaginable. Background.

    Pain is a personal experience, often assessed using a visual analogue scale. The endpoints of this scale are labelled with the extremes for pain experience (e.g. no pain to worst pain imaginable). People may understand the meaning of `no pain', but it is unclear what meaning they assign to `worst pain imaginable'. This indicates that a rating along the Visual Analogue Scale-line is dependent on the individual's previous experiences. Methods. Data were collected during the autumn of 2002. In total, 549 nursing students completed a questionnaire focusing on two main questions: `What is the worst experience of hurt, ache or pain you have had?' and `What is the worst pain imaginable for you?' Content analysis was used for data analysis. Results. The students' worst experience of pain was mostly related to acute or traumatic painful conditions, pain associated with female physiology, inflicted pain, psychological suffering and chronic painful conditions. The worst pain imaginable was described as condition-related pain, overwhelming pain, experiences of losses, deliberately inflicted pain, psychological suffering and as vicarious pain. Conclusion. The findings imply that nursing students, when they are imagining pain, include dimensions such as hope of relief, grief, control over the situation, powerlessness and empathy for and suffer with other people's pain. Further research is needed to explore why professional experience as a nurse diminishes the ability to imagine patients' pain.

  • 8.
    Bergh, Ingrid
    et al.
    University of Skövde, School of Life Sciences.
    Jakobsson, Eva
    University of Skövde, School of Life Sciences.
    Sjöström, Björn
    University of Skövde, School of Life Sciences.
    Steen, Bertil
    University of Skövde, School of Life Sciences.
    Ways of talking about experiences of pain among older patients following orthopaedic surgery2005In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 52, no 4, p. 351-359Article in journal (Refereed)
    Abstract [en]

    Aim. The aim of this study was to examine how older patients who had undergone hip surgery described their experience of pain.

    Background. A verbal report of pain is considered to be the single most reliable indicator of a person's pain experience. When assessing pain, healthcare professionals must be able to interpret the content of pain reports in order to understand older patient's pain experiences.

    Methods. The study was carried out in two orthopaedic and two elder care wards in a large university hospital in Sweden in 2000. Altogether, 38 patients with hip replacement (mean age = 75) and 22 patients with hip fracture (mean age = 81) took part. A face-to-face interview was conducted with each patient on the second day after operation. Data were transcribed and analysed using descriptive qualitative content analysis.

    Findings. Participants expressed their pain in a nuanced and detailed way in everyday language. Four main themes with sub-themes emerged: (a) objectification (localizing; quantifying; characterizing; temporalizing); (b) compensating (substitution; picturing); (c) explaining (functionalizing pain and its relief; externalizing pain and its relief); (d) existentializing (present pain orientation; future pain orientation).

    Conclusions. Exploring the ways older patients talk about pain is expected to result in a better understanding of the older patient's need of empathic individualized care and in the optimization of pain management.

  • 9.
    Bergh, Ingrid
    et al.
    Department of Geriatric Medicine, Göteborg University, Sweden.
    Sjöström, Björn
    Department of Geriatric Medicine, Göteborg University, Sweden.
    A comparative study of nurses' and elderly patients' ratings of pain and pain tolerance1999In: Journal of Gerontological Nursing, ISSN 0098-9134, E-ISSN 1938-243X, Vol. 25, no 5, p. 30-36Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to compare elderly patients' and nurses' ratings of pain and pain tolerance. Data were collected through structured interviews with the patients. The attending nurses completed a questionnaire after conducting a pain assessment. Independent of each other, patients and nurses were asked to rate on a VAS when pain should be treated (pain tolerance) and pain intensity. The VAS has been used both by patients and nurses. The initial selection consisted of 43 patients; however, 9% (n = 4) were unable to complete the VAS. These patients were not significantly older than those who completed the study (n = 39). The results shows that nurses tend to overestimate mild pain and underestimate severe pain. Nurses rated pain tolerance significantly lower than patients. The results also suggest that nurses with training beyond basic nursing education tend to assess patients' pain more accurately than those without additional training. For patients who reported that they had pain prior to hospitalization, the nurses' pain ratings showed a higher agreement than for those who reported that they did not have pain before being hospitalized. At the time of the interviews, 21% (n = 8) of patients felt that their pain was so great they needed treatment. Those patients also were recognized by the attending nurses as being in pain. To improve elderly patients' pain management, practicing nurses must collaborate with researchers to develop specific empirical research nursing knowledge within geriatric pain management. This research-based knowledge should be incorporated into nurses' clinical practice regarding pain management. Specific guidelines must be developed for the assessment, treatment, and documentation of elderly patients' pain.

  • 10.
    Bergh, Ingrid
    et al.
    University of Skövde, School of Life Sciences.
    Sjöström, Björn
    University of Skövde, School of Life Sciences.
    Quantification of the pain terms hurt, ache and pain among nursing students2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 2, p. 163-168Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to determine the quantitative meaning nursing students ascribe to the pain terms hurt (ont), ache (värk) and pain (smärta). In total, 549 nursing students filled in a questionnaire including questions about age, gender, and health care work experience. The students were also requested to rate response using a Visual Analogue Scale (VAS) rating for different statements about hurt, ache and pain. The results show that there were significant differences (p < 0.001) between rated intensity of the statements of hurt, ache and pain. There were, however, large variations in the students’ ratings of the pain terms; hurt ranged from 3 to 97 mm, ache from 7 to 97 mm and pain from 27 to 100 mm. There were no significant differences between male and female students regarding their ratings of hurt and ache when they were used to describe the worst self-experienced pain. Female students rated their experience of pain significantly higher (p < 0.001) on the VAS compared with male students. There was no significant correlation between previous experience of health care work and rated intensity of hurt, ache and pain. In conclusion, this study shows that there exist significant differences between the pain terms hurt, ache and pain according to a rating on a VAS. However, the results also demonstrate that there are large individual variations in how the students quantify the fictitious patient statements of hurt, ache and pain.

  • 11.
    Bergh, Ingrid
    et al.
    University of Skövde, School of Life Sciences.
    Sjöström, Björn
    University of Skövde, School of Life Sciences.
    Oden, Anders
    Steen, Bertil
    University of Skövde, School of Life Sciences.
    An application of pain rating scales in geriatric patients2000In: Aging, ISSN 0394-9532, Vol. 12, no 5, p. 380-387Article in journal (Refereed)
    Abstract [en]

    This study examined the applicability of three different pain rating scales, the Visual Analogue Scale (VAS), the Graphic Rating Scale (GRS) and the Numeric Rating Scale (NRS), in geriatric patients. Data collection was performed in a geriatric clinic at a university hospital. A structured interview was conducted with 167 patients (mean age = 80.5 years). Patients rated their current experience of pain twice with a 5-minute pause in-between on the VAS, GRS and NRS, and were then asked if they experienced pain, ache or hurt (PAH) or other symptoms. The correlations were high and significant both between the ratings of the VAS, GRS and NRS (r = 0.78-0.92; p < 0.001) (alternative-forms reliability), and between the test and retesting (r = 0.75-r = 0.83; p < 0.001) (test-retest reliability). A logistic regression analysis showed that the probability to accomplish a rating on the pain scales decreased with advancing age of the patient, and this was especially marked for the VAS. The probability of agreement between the patients' ratings of pain and the verbal report of PAH tended to decrease with advancing age; this was especially so for the VAS. Patients who verbally denied PAH but reported pain on the scales rated it significant lower (p < 0.001) than those who verbally reported PAH and rated the pain as well. Eighteen percent of patients who denied pain but rated a pain experience verbally expressed suffering or distress. The study suggests that pain rating scales such as the VAS, GRS and NRS can be used to evaluate pain experience in geriatric patients. However, agreement between verbally expressed experience of PAH, and the rated experience of pain tended to decrease with advancing age. This indicates that the pain-evaluating process will be substantially improved by an additional penetration supported by a wide variety of expression of hurt, ache, pain, discomfort and distress.

  • 12.
    Bergh, Ingrid
    et al.
    University of Skövde, School of Life Sciences.
    Sjöström, Björn
    University of Skövde, School of Life Sciences.
    Odén, Anders
    Steen, Bertil
    Assessing pain and pain relief in geriatric patients with non-pathological fractures with different rating scales2001In: Aging, ISSN 0394-9532, Vol. 13, no 5, p. 355-361Article in journal (Refereed)
    Abstract [en]

    Although pain is a frequent problem among elderly patients, they are often omitted in clinical trials and few studies have focused on assessing pain relief in this population. The aim of this study was to compare geriatric patients' verbally reported effect of analgesics with changes in pain experience rated with four different rating scales: the Visual Analogue Scale (VAS), the Graphic Rating Scale (GRS), the Numeric Rating Scale (NRS), and the Pain Relief Scale (PRS). Altogether 53 geriatric patients (mean=82 yrs) with non-pathological fractures in 4 geriatric units at a large university hospital were selected. In connection with the administration of analgesics, the patients were asked to "Mark the point that corresponds to your experience of pain just now at rest" on the VAS, GRS and NRS. This was repeated after 1.5-2 hours, and a direct question was asked about whether the analgesic medication given in connection with the initial assessment had had any pain-alleviation effect. Two comparisons were conducted with each patient. The results show that the probability of accomplishing a rating on the VAS, GRS, NRS, and PRS was lower with advancing age in these elderly fracture patients. The correlations between the ratings of the VAS, GRS and NRS were strong and significant (r=0.80-0.95; p<0.001) both at the initial assessments and at the re-assessments. However, the verbally reported effects of the analgesics were often directly opposite to the changes in rated pain. Therefore, application of the VAS, NRS, GRS and PRS for the purpose of assessing pain relief must be combined with supplementary questions that allow the patient to verbally describe possible experience of pain relief.

  • 13.
    Bergh, Ingrid
    et al.
    University of Skövde, School of Life Sciences.
    Sjöström, Björn
    University of Skövde, School of Life Sciences.
    Steen, Bertil
    University of Skövde, School of Life Sciences.
    Smärta hos äldre: Skattningsskalor – förekomst och verbala uttryck för smärta och smärtlindring2003In: Incitament: för en hälso- & sjukvård i förvandling, ISSN 1103-503X, Vol. 7, p. 642-Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Smärta är inte en del av det normala åldrandet, men många äldre drabbas av sjukdomar som leder till smärta. Smärta är en subjektiv sensorisk och emotionell obehagsupplevelse med faktisk eller potentiell vävnadsskada. Varje person upplever smärta på sitt sätt och denna uppfattning får avgörande betydelse för hur hälso- och sjukvårdspersonal kan förhålla sig till människor med smärta.

    Utgångspunkten för denna avhandling var att studera smärtförekomst bland äldre och att evaluera användandet av smärtskalor. Våra resultat visar att skattningsskalor kan vara till hjälp.

    Artikeln baseras Ingrid Berghs avhandling: Pain in the elderly - Rating scales, prevalence and verbal expression of pain relief

  • 14.
    Bergh, Ingrid
    et al.
    University of Skövde, School of Life Sciences.
    Steen, Gunilla
    Waern, Magda
    Johansson, Boo
    Odén, Anders
    Sjöström, Björn
    University of Skövde, School of Life Sciences.
    Steen, Bertil
    Pain and its relation to cognitive function and depressive symptoms: A Swedish population study of 70-year-old men and women2003In: Journal of pain and symptom management, ISSN 1873-6513, Vol. 26, no 4, p. 903-912Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the prevalence of pain and its characteristics, and to examine the association of pain with cognitive function and depressive symptoms, in a representative sample of 70-year-old men and women. Data were collected within the gerontological and geriatric population studies in Göteborg, Sweden (H-70). A sample of 124 men and 117 women living in the community took part in the study. A questionnaire was applied which included four different aspects of pain experience: prevalence, frequency of episodes of pain, duration and number of locations. In close connection to this, depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. The prevalence of pain during the last 14 days was higher in women (79%; n=91) than in men (53%; n=65) (P<0.001). Women (68%; n=78) also reported pain that had lasted for >6 months to a greater extent than men (38%; n=46) (P<0.001). The frequency of episodes of pain was also higher among women, 64% (n=74) reporting daily pain or pain several days during the last 14 days while 37% of the men (n=45) did so (P<0.001). Women (33%, n=38) also reported pain experience from ≥3 locations more often than men (11%; n=13) (P<0.001). On the other hand, the association between depressive symptoms and pain experience was more evident in men than in women. Women were taking significantly more antidepressants compared to men (P<0.03). The results show that pain is common in 70-year-old people and especially in women. However, associations between depressive symptoms and the four aspects of pain experience were more pronounced among men

  • 15.
    Bergh, Ingrid
    et al.
    University of Skövde, School of Life Sciences.
    Söderlund, Tina
    Department of Obstetrics and Gynaecology, Skaraborg Hospital, SE-541 85 Skövde, Sweden.
    Vinterskog, Linda
    Department of Obstetrics and Gynaecology, Skaraborg Hospital, SE-541 85 Skövde, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Life Sciences.
    Reliability and validity of the Acceptance Symptom Assessment Scale in assessing labour pain2012In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 5, p. e684-e688Article in journal (Refereed)
    Abstract [en]

    Objective: to investigate the reliability and validity of the Acceptance Symptom Assessment Scale (ASAS) in assessing labour pain.

    Design: a test-retest approach was used to assess reliability and validity.

    Setting: labour ward with approximately 2,400 deliveries annually in western part of Sweden.

    Participants: forty-seven pregnant women in the latent or active phase of labour.

    Methods: a total of five pain assessments with both the ASAS and the VAS were conducted in three sessions.

    Main outcome measures: correlation between ASAS and VAS.

    Findings: both scales demonstrated high and significant test–retest correlations (r=0.83–0.92; p<0.001). High and significant alternative-form reliability correlations (r=0.76–0.93, p<0.001) were found between ASAS and VAS ratings at all five assessments. Construct validity was established when both the ASAS and the VAS identified a pain reduction(p<0.001) 2 hrs after birth, compared to the previous assessment. Over two-thirds of the women preferred the ASAS to the VAS ,mainly(n=30) because the ASAS provided more choices relating to the pain experience, making it possible to label pain acceptable/unacceptable.

    Conclusions: the ASAS is interchangeable with the VAS for assessing labour pain. Over two-thirds of the women preferred it to the VAS.

  • 16.
    Ek, Kristina
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Westin, Lars
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Prahl, Charlotte
    Ersta Sköndal University College and Ersta Hospital, Palliative Research Centre, Stockholm, Sweden / Ersta Sköndal University College, Department of Health Care Sciences, Stockholm, Sweden.
    Österlind, Jane
    Ersta Sköndal University College and Ersta Hospital, Palliative Research Centre, Stockholm, Sweden / Ersta Sköndal University College, Department of Health Care Sciences, Stockholm, Sweden.
    Strang, Susann
    Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Göteborg, Sweden / Angered Local Hospital, Angered, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Henoch, Ingela
    Angered Local Hospital, Angered, Sweden / University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden / Ersta Sköndal University College and Ersta Hospital, Palliative Research Centre, Stockholm, Sweden.
    Hammarlund, Kina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Death and caring for dying patients: exploring first-year nursing students' descriptive experiences2014In: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 20, no 10, p. 509-515Article in journal (Refereed)
    Abstract [en]

    Aim: To describe first-year nursing student`s expereinces of witnessing death and providing end-of-life care. Methods: This study is a part of a larger longitudial prject. Interviews (n=17) were conducted with nursing students at the end of their fisrt year of education. To analyse the interviews (lived-expereince description), a thematic analysis, "a search for meaning" (Van Manen, 1997) was applied. Result: The results are presented within the framework of four separate themes: (1) The thought of death is more frightening than the actual epereince, (2) Daring to approach the dying patient and offering something of oneself, (3) The expereince of not sufficing in the face of death and (4) being confronted with one`s own feelings. Conclusion: Nursing students require continous support and opportunity to reflect and discuss their experiences about caring for dying patients and confronting death throughout the entirety of their education. In addition, teachers and clinical superviosors need t give support using reflective practice to help students to devlo confidence in their capacity for caring dying patients.

  • 17.
    Erichsen Andersson, Anette
    et al.
    University of Gothenburg, The Sahlgrenska Academy.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Eriksson, Bengt
    Sahlgrenska University Hospital.
    Karlsson, Jon
    Sahlgrenska University Hospital.
    Nilsson, Kerstin
    University of Gothenburg, The Sahlgrenska Academy.
    The application of evidence-based measures to reduce surgical site infections during orthopedic surgery - report of a single-center experience in Sweden2012In: Patient Safety in Surgery, ISSN 1754-9493, E-ISSN 1754-9493, Vol. 6, no 1, p. Article number 11-Article in journal (Refereed)
    Abstract [en]

    Background: Current knowledge suggests that, by applying evidence-based measures relating to the correct use of prophylactic antibiotics, perioperative normothermia, urinary tract catheterization and hand hygiene, important contributions can be made to reducing the risk of postoperative infections and device-related infections. The aim of this study was to explore and describe the application of intraoperative evidence-based measures, designed to reduce the risk of infection. In addition, we aimed to investigate whether the type of surgery, i.e. total joint arthroplasty compared with tibia and femur/hip fracture surgery, affected the use of protective measures.

    Method: Data on the clinical application of evidence-based measures were collected structurally on site during 69 consecutively included operations involving fracture surgery (n = 35) and total joint arthroplasties (n = 34) using a pre-tested observation form. For observations in relation to hand disinfection, a modified version of the World Health Organization hand hygiene observation method was used.

    Results: In all, only 29 patients (49%) of 59 received prophylaxis within the recommended time span. The differences in the timing of prophylactic antibiotics between total joint arthroplasty and fracture surgery were significant, i.e. a more accurate timing was implemented in patients undergoing total joint arthroplasty (p = 0.02). Eighteen (53%) of the patients undergoing total joint arthroplasty were actively treated with a forced-air warming system. The corresponding number for fracture surgery was 12 (34%) (p = 0.04).

    Observations of 254 opportunities for hand hygiene revealed an overall adherence rate of 10.3% to hand disinfection guidelines.

    Conclusions: The results showed that the utilization of evidence-based measures to reduce infections in clinical practice is not sufficient and there are unjustifiable differences in care depending on the type of surgery. The poor adherence to hand hygiene precautions in the operating room is a serious problem for patient safety and further studies should focus on resolving this problem. The WHO Safe Surgery checklist “time out” worked as an important reminder, but is not per se a guarantee of safety; it is the way we act in response to mistakes or lapses that finally matters.

  • 18.
    Erichsen Andersson, Annette
    et al.
    University of Gothenburg.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Karlsson, Jon
    University of Gothenburg.
    Nilsson, Kerstin
    University of Skövde, School of Life Sciences.
    Patients' experiences of acquiring a deep surgical site infection: An interview study2010In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 38, no 9, p. 711-717Article in journal (Refereed)
    Abstract [en]

    Background: The negative impact of surgical site infection (SSI) in terms of morbidity, mortality, additional costs, and length of stay (LOS) in the hospital is well described in the literature, as are risk factors and preventive measures. Given the lack of knowledge regarding patients’ experiences of SSI, the aim of the present study was to describe patients’ experiences of acquiring a deep SSI. Methods: Content analysis was used to analyze data obtained from 14 open interviews with participants diagnosed with a deep SSI. Results: Patients acquiring a deep SSI suffer significantly from pain, isolation, and insecurity. The SSI changes physical, emotional, social, and economic aspects of life in extremely negative ways, and these changes are often persistent. Conclusion: Health care professionals should focus on strategies to enable early diagnosis and treatment of SSIs. The unacceptable suffering related to the infection, medical treatment, and an insufficient patient-professional relationship should be addressed when planning individual care, because every effort is needed to support this group of patients and minimize their distress. All possible measures should be taken to avoid bacterial contamination of the surgical wound during and after surgery to prevent the development of SSI.

  • 19.
    Erichsen Andersson, Annette
    et al.
    University of Gothenburg.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Karlsson, Jón
    University of Gothenburg.
    Eriksson, Bengt I.
    University of Gothenburg.
    Nilsson, Kerstin
    University of Gothenburg.
    Traffic flow in the operating room: An explorative and descriptive study on air quality during orthopedic trauma implant surgery2012In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 40, no 8, p. 750-755Article in journal (Refereed)
    Abstract [en]

    Background:Understanding the protective potential of operating room (OR) ventilation under different conditions is crucial to optimizing the surgical environment. This study investigated the air quality, expressed as colony-forming units (CFU)/m³, during orthopedic trauma surgery in a displacementventilated OR; explored how traffic flow and the number of persons present in the OR affects the air contamination rate in the vicinity of surgical wounds; and identified reasons for door openings in the OR.

    Methods:Data collection, consisting of active air sampling and observations, was performed during 30 orthopedic procedures.

    Results:In 52 of the 91 air samples collected (57%), the CFU/m³ values exceeded the recommended level of <10 CFU/m³. In addition, the data showed a strongly positive correlation between the total CFU/m³ per operation and total traffic flow per operation (r=0.74;P=.001; n=24), after controlling for duration of surgery. A weaker, yet still positive correlation between CFU/m³ and the number of persons present in the OR (r=0.22;P=.04; n=82) was also found. Traffic flow, number of persons present, and duration of surgery explained 68% of the variance in total CFU/m³ (P=.001).

    Conclusions:Traffic flow has a strong negative impact on the OR environment. The results of this study support interventions aimed at preventing surgical site infections by reducing traffic flow in the OR.

  • 20.
    Erichsen Andersson, Annette
    et al.
    The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden / Department of Anesthesia, Surgery, and Intensive Care, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Petzold, Max
    Akademistatistik - Centre for Applied Biostatistics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Karlsson, Jón
    Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden / The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
    Eriksson, Bengt I.
    Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden / The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
    Nilsson, Kerstin
    The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
    Comparison between mixed and laminar airflow systems in operating rooms and the influence of human factors: Experiences from a Swedish orthopedic center2014In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 42, no 6, p. 665-669Article in journal (Refereed)
  • 21.
    Gillsjö, Catharina
    et al.
    University of Skövde, School of Life Sciences.
    Schwartz-Barcott, Donna
    College of Nursing, University of Rhode Island, USA.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Learning to Endure Long-Term Musculoskeletal Pain in Daily Life at Home: A Qualitative Interview Study of the Older Adult’s Experience2013In: Gerontology & Geriatric Research, ISSN 2167-7182, Vol. 2, no 4, article id 1000136Article in journal (Refereed)
  • 22.
    Gillsjö, Catharina
    et al.
    University of Skövde, School of Life Sciences. College of Nursing, University of Rhode Island, USA.
    Schwartz-Barcott, Donna
    College of Nursing, University of Rhode Island, USA.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences. College of Nursing, University of Rhode Island, USA.
    Learning to endure long-term musculoskeletal pain in daily life at home: The older adult's experienceManuscript (preprint) (Other academic)
  • 23.
    Gillsjö, Catharina
    et al.
    University of Skövde, School of Life Sciences. College of Nursing, The University of Rhode Island, Kingston, RI, USA.
    Schwartz-Barcott, Donna
    College of Nursing, The University of Rhode Island, Kingston, RI, USA.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences. College of Nursing, The University of Rhode Island, Kingston, RI, USA.
    Dahlgren, Lars Owe
    Linköping University, Linköping, Sweden.
    Older Adults' Ways of Dealing With Daily Life While Living With Long-Term Musculoskeletal Pain at Home2012In: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523, Vol. 31, no 5, p. 685-705Article in journal (Refereed)
    Abstract [en]

    Long-term musculoskeletal pain is a global health problem among older adults. Yet little is known about how these older adults actually deal with daily life. This study’s aim is to describe the ways these older adults dealt with daily life at home. Phenomenography is used to collect and analyze data from semistructured interviews with 19 older adults and to identify the range in which they dealt with daily life. Findings consist of an outcome space that encompassed four categories: ignore, struggle, adjust, and resign. The different ways older adults dealt with daily life when living with long-term pain at home strengthen the importance of individualized plans of care in the home and a holistic perspective. Findings contribute to enhanced understanding of a common health problem among older adults that can be used to promote quality of care and improve the quality of life of older adults.

  • 24.
    Hagelin, Carina Lundh
    et al.
    Sophiahemmet University, Stockholm, Sweden / Stockholms Sjukhem Foundation, Stockholm, Sweden / Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Melin-Johansson, Christina
    Department of Nursing, Mid Sweden University, Östersund, Sweden / Institute of Caring Sciences and Health, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Henoch, Ingela
    Institute of Caring Sciences and Health, The Sahlgrenska Academy, University of Gothenburg, Sweden / Angered's Local Hospital, Gothenburg, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ek, Kristina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Hammarlund, Kina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Prahl, Charlotte
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Strang, Susann
    Institute of Caring Sciences and Health, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Westin, Lars
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Österlind, Jane
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Factors influencing attitude toward care of dying patients in first-year nursing students2016In: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 22, no 1, p. 28-36Article in journal (Refereed)
    Abstract [en]

    AIM: To describe Swedish first-year undergraduate nursing students' attitudes toward care of dying patients. Possible influences such as age, earlier care experiences, care education, experiences of meeting dying patients and place of birth were investigated.

    METHOD: The Frommelt Attitude Toward Care of the Dying Scale (FATCOD) was used in six universities. Descriptive statistics and regression analysis were used.

    RESULTS: Some 371 students (67.3%) reported overall positive attitude toward caring for dying patients (total mean FATCOD 119.5, SD 10.6) early in their first semester. Older students, students with both earlier care experience and earlier education, those with experience of meeting a dying person, and students born in Sweden reported the highest scores, a more positive attitude.

    CONCLUSION: Age, earlier care experience and education, experiences of meeting a dying person and place of birth seems to affect students' attitudes toward care of the dying and need to be considered among nursing educators.

  • 25.
    Henoch, Ingela
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Melin-Johansson, Christina
    Department of Health Sciences, Mid Sweden University, Östersund.
    Danielson, Ella
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg / Department of Health Sciences, Mid Sweden University, Östersund.
    Udo, Camilla
    Department of Health Sciences, Mid Sweden University, Östersund.
    Johansson Sundler, Annelie
    University of Skövde, School of Health and Education.
    Björk, Maria
    University of Skövde, School of Health and Education.
    Ek, Kristina
    University of Skövde, School of Health and Education.
    Hammarlund, Kina
    University of Skövde, School of Health and Education.
    Bergh, Ingrid
    University of Skövde, School of Health and Education.
    Strang, Susann
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg / Angered Local Hospital, Gothenburg, Sweden.
    The Swedish version of the Frommelt attitude toward care of the dying scale: Aspects of validity and factors influencing nurses' and nursing students' attitudes2014In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 37, no 1, p. E1-E11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nurses' attitudes toward caring for dying persons need to be explored. The Frommelt Attitude Toward Care of the Dying (FATCOD) scale has not previously been used in Swedish language. OBJECTIVES: The objectives of this study were to compare FATCOD scores among Swedish nurses and nursing students with those from other languages, to explore the existence of 2 subscales, and to evaluate influences of experiences on attitudes toward care of dying patients. METHODS: A descriptive, cross-sectional, and predictive design was used. The FATCOD scores of Swedish nurses from hospice, oncology, surgery clinics, and palliative home care and nursing students were compared with published scores from the United States, Israel, and Japan. Descriptive statistics, t tests, and factor and regression analyses were used. RESULTS: The sample consisted of 213 persons: 71 registered nurses, 42 enrolled nurses, and 100 nursing students. Swedish FATCOD mean scores did not differ from published means from the United States and Israel, but were significantly more positive than Japanese means. In line with Japanese studies, factor analyses yielded a 2-factor solution. Total FATCOD and subscales had low Cronbach α's. Hospice and palliative team nurses were more positive than oncology and surgery nurses to care for dying patients. CONCLUSIONS: Although our results suggest that the Swedish FATCOD may comprise 2 distinct scales, the total scale may be the most adequate and applicable for use in Sweden. Professional experience was associated with nurses' attitudes toward caring for dying patients. IMPLICATION FOR PRACTICE: Care culture might influence nurses' attitudes toward caring for dying patients; the benefits of education need to be explored.

  • 26.
    Henoch, Ingela
    et al.
    The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden / Angered Local Hospital, Gothenburg, Sweden.
    Melin-Johansson, Christina
    The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden / Mid Sweden University, Department of Health Sciences, Östersund, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Strang, Susann
    The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden / Angered Local Hospital, Gothenburg, Sweden.
    Ek, Kristina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Hammarlund, Kina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Lundh Hagelin, Carina
    Sophiahemmet University, Stockholm, Sweden / Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden / Stockholms Sjukhem Foundation, Stockholm, Sweden.
    Westin, Lars
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Österlind, Jane
    Ersta Sköndal University College and Ersta Hospital, Palliative Research Centre, Stockholm, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Karolinska Institutet, Department of Neurobiology, Care Science and Society, Division of Nursing, Stockholm, Sweden.
    Undergraduate nursing students' attitudes and preparedness toward caring for dying persons: A longitudinal study2017In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 26, p. 12-20, article id S1471-5953(17)30384-0Article in journal (Refereed)
    Abstract [en]

    Nursing education needs to prepare students for care of dying patients. The aim of this study was to describe the development of nursing students' attitudes toward caring for dying patients and their perceived preparedness to perform end-of-life care. A longitudinal study was performed with 117 nursing students at six universities in Sweden. The students completed the Frommelt Attitude Toward Care of the Dying Scale (FATCOD) questionnaire at the beginning of first and second year, and at the end of third year of education. After education, the students completed questions about how prepared they felt by to perform end-of-life care. The total FATCOD increased from 126 to 132 during education. Five weeks' theoretical palliative care education significantly predicted positive changes in attitudes toward caring for dying patients. Students with five weeks' theoretical palliative care training felt more prepared and supported by the education to care for a dying patient than students with shorter education. A minority felt prepared to take care of a dead body or meet relatives.

  • 27.
    Jaarsma, Tiny
    et al.
    Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
    Beattie, James M.
    Ryder, Mary
    Rutten, Frans H.
    McDonagh, Theresa
    Mohacsi, Paul
    Murray, Scott A.
    Grodzicki, Thomas
    Bergh, Ingrid
    Metra, Marco
    Ekman, Inger
    Angermann, Christiane
    Leventhal, Marcia
    Pitsis, Antonis
    Anker, Stefan D.
    Gavazzi, Antonello
    Ponikowski, Piotr
    Dickstein, Kenneth
    Delacretaz, Etienne
    Blue, Lynda
    Strasser, Florian
    McMurray, John
    Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology2009In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 11, no 5, p. 433-443Article in journal (Refereed)
    Abstract [en]

    Heart failure is a serious condition and equivalent to malignant disease in terms of symptom burden and mortality. At this moment only a comparatively small number of heart failure patients receive specialist palliative care. Heart failure patients may have generic palliative care needs, such as refractory multifaceted symptoms, communication and decision making issues and the requirement for family support. The Advanced Heart Failure Study Group of the Heart Failure Association of the European Society of Cardiology organized a workshop to address the issue of palliative care in heart failure to increase awareness of the need for palliative care. Additional objectives included improving the accessibility and quality of palliative care for heart failure patients and promoting the development of heart failure-orientated palliative care services across Europe. This document represents a synthesis of the presentations and discussion during the workshop and describes recommendations in the area of delivery of quality care to patients and families, education, treatment coordination, research and policy.

  • 28.
    Jakobsson, Eva
    et al.
    University of Skövde, School of Life Sciences.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Gaston-Johansson, Fannie
    Faculty of Health Caring Sciences, Sahlgrenska Academy at Göteborg University, Institute of Nursing, Gothenburg, Sweden.
    Stolt, Carl-Magnus
    Centre of Bioethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Öhlén, Joakim
    Faculty of Health Caring Sciences, Sahlgrenska Academy at Göteborg University, Institute of Nursing, Gothenburg, Sweden.
    The Turning Point: Clinical Identification of Dying and Reorientation of Care2006In: Journal of Palliative Medicine, ISSN 1096-6218, E-ISSN 1557-7740, Vol. 9, no 6, p. 1348-1358Article in journal (Refereed)
    Abstract [en]

    Palliative care is increasingly organized within the setting of formal health care systems but the demarcation has become unclear between, on the one hand, care directed at cure and rehabilitation and palliative care aimed at relief of suffering on the other. With the purpose to increase the understanding about the turning point reflecting identification of dying and reorientation of care, this study explores this phenomenon as determined from health care records of a representative sample (n = 229). A turning point was identified in 160 records. Presence of circulatory diseases, sporadic confinement to bed, and deterioration of condition had a significant impact upon the incidence of such turning point. The time interval between the turning point and actual death ranged between one and 210 days. Thirty percent of these turning points were documented within the last day of life, 33% during the last 2–7 days, 19.5% during the last 8–30 days, 13% during the last 31–90 days, and 4.5% during the last 91–210 days of life. The time interval between the turning point and actual death was significantly longer among individuals with neoplasm(s) and significantly shorter among individuals suffering from musculoskeletal diseases. Perhaps this reflects a discrepancy between the ideals of palliative care, and a misinterpretation of the meaning of palliative care in everyday clinical practice. The findings underscore that improvement in timing of clinical identification of dying and reorientation of care will likely favour a shift from life-extending care to palliative care.

  • 29.
    Jakobsson, Eva
    et al.
    Institute of Health and Care Sciences, University of Gothenburg, Sweden.
    Bergh, Ingrid
    Institute of Health and Care Sciences, University of Gothenburg, Sweden.
    Öhlén, Joakim
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    The turning point: Identifying end-of-life care in everyday health care practice2007In: Contemporary Nurse: health care across the lifespan, ISSN 1037-6178, E-ISSN 1839-3535, Vol. 27, no 1, p. 107-118Article in journal (Refereed)
    Abstract [en]

    There is a broad consensus among international policy statements that care provided at end-of-life should be different from care provided during other periods of life which assumes a turning point which reflects the onset of the dying process and the associated care reorientation. Few studies derived from empirical data have described this turning point from a clinical perspective. With the purpose to increase the clinical understanding about the nature Of such turning points this study explores this phenomenon as determined from health-care records Of a representative sample of adults who accessed the public health care system, and who died in the County of Vastra Gotaland, Sweden, during 2001 (n = 229). Record entries reflecting a turning point, that is recognition as being at the end-of-life and a message about a switch from curative, life-extending or rehabilitative care to an emphasis on palliation, were found in slightly less than 70% of the records while slightly more than 30% lacked such descriptions. The record entries were analyzed with content analysis. As a whole, the descriptions were largely relying on a biomedical discourse and typically put in terms of signs of declining processes, undefined serious condition, Prognostications of fatal outcome or justifications of given up active treatments. The procedures which followed the recognition of a turning point revealed that nurses and physicians typically emphasize procedures directed to the patients' families, on re-orientation Of treatments and on approaches to further care. The picture of the patients' last time of life as reflected from these record entries is that end-of-life is described in biomedical and factual-oriented terms. The end-of-life care was broadly described in vague terms with lack Of concrete care plans. Holistic and good end-of-life care as revealed in this study is indistinguishable, highly embedded in a medical model of care and, hence, an abstract and unknown territory without specific content.

  • 30.
    Jakobsson, Eva
    et al.
    University of Skövde, School of Life Sciences.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Öhlén, Joakim
    Faculty of Health Caring Sciences, The Sahlgrenska Academy, Göteborg University, Gothenburg, Sweden.
    Odén, Anders
    Department of Mathematical Statistics, Chalmers University of Technology, S-412 96 Gothenburg, Sweden.
    Gaston-Johansson, Fannie
    Faculty of Health Caring Sciences, The Sahlgrenska Academy at G¨oteborg University, Institute of Nursing, Gothenburg, Sweden and Johns Hopkins School of Nursing, Baltimore, MD, USA.
    Utilization of health-care services at the end-of-life2006In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 82, no 3, p. 276-287Article in journal (Refereed)
    Abstract [en]

    End-of-life care poses a growing clinical and policy concern since most people who are dying utilize health-care services during this period of life. Hence, end-of-life care is a common and integral part of the care provided by health-care systems. There is a growing call for the implementation of a palliative approach as an integral part of all end-of-life care. The purpose of this study was thus to provide policy-makers, health-care providers and professional caregivers with increased knowledge about mainstream patterns of health-care utilization during end-of-life. The patterns of use of health-care services in a Swedish population who accessed the health-care system during their last 3 months of life were in this study examined through a retrospective examinations of medical and nursing records (n = 229). We found high prevalences of use of both hospital care, primary care and care provided in people's homes and nearly three quarters of the persons included in the study used between two and three health-care services. However, the probability of using different health-care services was found to be strongly depending on demographic, social, functional and disease related characteristics. The study reveals a considerable use of different health-care services during end-of-life. It is hence essential to, on one hand delineate how such health-care services best can support people at the end-of-life, and on the other hand develop policies which facilitate the process of dying, both in hospitals as well as in peoples’ homes. Implications for policy are discussed.

  • 31.
    Jakobsson, Eva
    et al.
    University of Skövde, School of Life Sciences.
    Gaston-Johansson, Fannie
    Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, SE-40530 Gothenburg, Sweden / Johns Hopkins Sch Nursing, Baltimore, MD USA.
    Öhlén, Joakim
    Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, SE-40530 Gothenburg, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Clinical problems at the end of life in a Swedish population, including the role of advancing age and physical and cognitive function2008In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, no 2, p. 177-182Article in journal (Refereed)
    Abstract [en]

    To improve the understanding of specific clinical problemsat the end of life, including the role of advancing age, physicalfunction and cognitive function. Methods: The study is partof an explorative survey of data relevant to end-of-life healthcareservices during the last 3 months of life of a randomly selectedsample of the population of a Swedish county. Data were selectedthrough retrospective reviews of death certificates and medicalrecords, and comprise information from 12 municipalities and229 individuals. Results: A range of prevalent concerns wasfound. Overall deterioration, urinary incontinence, constipation,impaired skin integrity, anxiety and sleep disturbances weresignificantly associated with dependency on others for activitiesof daily living; pulmonary rattles and swallowing disturbanceswere associated with cognitive disorientation; excepting cough,advancing age did not have significant impacts on these prevalentclinical concerns. Conclusions: A range of distressing conditionsconstitute a common pathway for many individuals at or nearthe end of life. The incorporation of health promotion as aprinciple of palliative care will probably benefit individualsat the end of life, and includes a proactive focus and emphasison enhanced well-being at the time of diagnosis of a life-threateningillness. For individuals with physical and cognitive limitationsimparting a state of dependency, it is reasonable to provideassurance of care for individuals' specific needs by professionalswith both training for and competence in this special and sometimesunique clinical environment.

  • 32.
    Jangsten, Elisabeth
    et al.
    Univ Gothenburg, Inst Hlth & Care Sci, Sahlgrenska Acad, S-40530 Gothenburg, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Mattsson, Lars - Ake
    Sahlgrens Univ Hosp, Dept Obstet & Gynecol, Gothenburg, Sweden.
    Hellstrom, Anna - Lena
    Univ Gothenburg, Inst Hlth & Care Sci, Sahlgrenska Acad, S-40530 Gothenburg, Sweden .
    Berg, Marie
    Univ Gothenburg, Inst Hlth & Care Sci, Sahlgrenska Acad, S-40530 Gothenburg, Sweden .
    Afterpains: A Comparison Between Active and Expectant Management of the Third Stage of Labor2011In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 38, no 4, p. 294-301Article in journal (Refereed)
    Abstract [en]

    Background: Management of the third stage of labor, the period following the birth of the infant until delivery of the placenta, is crucial. Active management using synthetic oxytocin has been advocated to decrease blood loss. It has been suggested, but not studied, that oxytocin may increase afterpains. The aim of this study was to compare womens experience of pain intensity when the third stage of labor was managed actively and expectantly and their experience of afterpains. Methods: A single-blind, randomized, controlled trial was performed at two delivery units in Sweden in a population of healthy women with normal, singleton pregnancies, gestational age of 34 to 43 weeks, cephalic presentation, and expected vaginal delivery. Women (n = 1,802) were randomly allocated to either active management or expectant management of the third stage of labor. Afterpains were assessed by Visual Analog Scale (VAS) and the Pain-o-Meter (POM-WDS) 2 hours after delivery of the placenta and the day after childbirth. Results: At 2 hours after childbirth, women in the actively managed group had lower VAS pain scores than expectantly managed women (p = 0.014). Afterpains were scored as more intense the day after, compared with 2 hours after, childbirth in both groups. Multiparas scored more intense afterpains, compared with primiparas, irrespective of management (p < 0.001). Conclusions: Active management of the third stage of labor does not provoke more intense afterpains than expectant management. (BIRTH 38: 4 December 2011)

  • 33.
    Johansson, Yvonne A.
    et al.
    Skaraborg Hospital, Skövde, Sweden / Jönköping University, Jönköping, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ericsson, Iréne
    Jönköping University, Jönköping, Sweden.
    Kenne Sarenmalm, Elisabeth
    Skaraborg Hospital, Skövde, Sweden.
    Delirium in older hospitalized patients—signs and actions: a retrospective patient record review2018In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, no 1, p. 1-11, article id 43Article, review/survey (Refereed)
    Abstract [en]

    Background

    Delirium is common in older hospitalized patients, and is associated with negative consequences for the patients, next of kin, healthcare professionals and healthcare costs. It is important to understand its clinical features, as almost 40% of all cases in hospitals may be preventable. Yet, delirium in hospitalized patients is often unrecognized and untreated. Few studies describe thoroughly how delirium manifests itself in older hospitalized patients and what actions healthcare professionals take in relation to these signs. Therefore, the aim of this study was to describe signs of delirium in older hospitalized patients and action taken by healthcare professionals, as reported in patient records.

    Methods

    Patient records from patients aged ≥65 (n = 286) were retrospectively reviewed for signs of delirium, which was found in 78 patient records (27%). Additionally, these records were reviewed for action taken by healthcare professionals in relation to the patients’ signs of delirium. The identified text was analyzed with qualitative content analysis in two steps.

    Results

    Healthcare professionals responded only in part to older hospitalized patients’ needs of care in relation to their signs of delirium. The patients displayed various signs of delirium that led to a reduced ability to participate in their own care and to keep themselves free from harm. Healthcare professionals met these signs with a variation of actions and the care was adapted, deficient and beyond the usual care. A systematic and holistic perspective in the care of older hospitalized patients with signs of delirium was missing.

    Conclusion

    Improved knowledge about delirium in hospitals is needed in order to reduce human suffering, healthcare utilization and costs. It is important to enable older hospitalized patients with signs of delirium to participate in their own care and to protect them from harm. Delirium has to be seen as a preventable adverse event in all hospitals units. To improve the prevention and management of older hospitalized patients with signs of delirium, person-centered care and patient safety may be important issues.

  • 34.
    Karlsson, Christina Elisabeth
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ernsth Bravell, Marie
    Institute of Gerontology, University of Jönköping, Jönköping, Sweden.
    Ek, Kristina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Home healthcare teams' assessments of pain in care recipients living with dementia: a Swedish exploratory study2015In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 10, no 3, p. 190-200Article in journal (Refereed)
  • 35.
    Karlsson, Christina
    et al.
    Department of Nursing, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Sidenvall, Birgitta
    Department of Nursing, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Ernsth-Bravell, Marie
    School of Health Sciences, Institute of Gerontology, Jönköping University, Jönköping, Sweden.
    Certified nursing assistants' perception of pain in people with dementia: a hermeneutic enquiry in dementia care practice2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 13-14, p. 1880-1889Article in journal (Refereed)
    Abstract [en]

    Aims and objectives To interpret certified nursing assistants' perception of pain in people with dementia in nursing care practice. Background Detection and understanding of pain in people with dementia remains a challenge due to their difficulty in verbalising their pain. Nursing assistants provide daily nursing care and therefore play a vital role in pain detection. Nevertheless, pain research from the nursing assistants' perspective is sparse. Design A qualitative approach within the interpretive tradition was adopted. Methods Individual interviews with twelve certified nursing assistants, all working in dementia care, were conducted and interpreted using philosophical hermeneutics. Results Nursing assistants' perception of pain is on three levels. Each level consists of a theme. The first theme Being in the facing phase' refers to the initial perception of the person's expressions. The second theme Being in the reflecting phase' means ability to reflect more deeply on one's perception, together with other colleagues and next of kins. The third theme Being in the acting phase' means perception arising from preventive and protective care focusing on contributing to well-being. The themes served as a basis for comprehensive understanding, where perception of pain arises from closeness, compassion and dialogue based on personhood, accompanied by professional knowledge of pain and dementia. Conclusion Nursing assistants' perception of pain is based on ethical concerns and on their own subjective pain experiences rather than on medical skills. Their perception derives from fundamental values that are important aspects of nursing care. Interdisciplinary solidarity may strengthen cooperation amongst CNAs and RNs to achieve best pain management practice. Relevance to clinical practice Attention to nursing assistants' perception of pain needs to be highlighted when they are front-line staff and have developed important pain detection skills. Their skills are essential complements and must be used in the development of pain management in dementia care practice.

  • 36.
    Karlsson, Christina
    et al.
    University of Skövde, School of Life Sciences. Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Sidenvall, Birgitta
    Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Ernsth-Bravell, Marie
    Institute of Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Registered Nurses' View of Performing Pain Assessment among Persons with Dementia as Consultant Advisors2012In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 6, no 1, p. 62-70Article in journal (Refereed)
    Abstract [en]

    Background: Pain assessment in persons with dementia is well known as a challenging issue to professional caregivers, because of these patients´ difficulties in verbalising pain problems. Within municipal dementia care in Sweden, pain assessment has become problematic for registered nurses, as they have entered a new role in their nursing profession, from being clinical practitioners to becoming consultant advisers to other health care staff.

    Aim: To present municipal registered nurses´ view of pain assessment in persons with dementia in relation to their nursing profession as consultant advisers.

    Methods: Purposive sampling was undertaken with 11 nurses invited to participate. Data were collected by focus groups. Qualitative content analysis was used to analyse the data.

    Findings: Four categories were identified to describe registered nurses´ view of pain assessment: estrangement from practical nursing care, time consuming and unsafe pain documentation, unfulfilled needs of reflection possibilities, and collaboration and coordination.

    Conclusions: The performance of pain assessment through a consultant advising function is experienced as frustrating and as an uncomfortable nursing situation. The nurses feel resistance to providing nursing in this way. They view nursing as a clinical task demanding daily presence among patients to enable them to make accurate and safe assessments. However, due to the consultative model, setting aside enough time for the presence seems difficult to accomplish. It is necessary to promote the quality of systematic routines in pain assessment and reflection, as well as developing professional knowledge of how pain can be expressed by dementia patients, especially those with communication difficulties.

  • 37.
    Kenne Sarenmalm, Elisabeth
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Andersson, Bengt A.
    Department of Clinical immunology and transfusion medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Karlsson, Per
    Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital,Sweden University of Gothenburg, Gothenburg, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Mindfulness and its efficacy for psychological and biological responses in women with breast cancer2017In: Cancer Medicine, ISSN 2045-7634, E-ISSN 2045-7634, Vol. 6, no 5, p. 1108-1122Article in journal (Refereed)
    Abstract [en]

    Many breast cancer survivors have to deal with a variety of psychological andphysiological sequelae including impaired immune responses. The primary purposeof this randomized controlled trial was to determine the efficacy of amindfulness-basedstress reduction (MBSR) intervention for mood disorders inwomen with breast cancer. Secondary outcomes were symptom experience, healthstatus, coping capacity, mindfulness, posttraumatic growth, and immune status.This RTC assigned 166 women with breast cancer to one of three groups: MBSR(8 weekly group sessions of MBSR), active controls (self-instructingMBSR) andnon-MBSR.The primary outcome measure was the Hospital Anxiety and DepressionScale. Secondary outcome measures were: Memorial Symptom AssessmentScale, SF-36,Sense of Coherence, Five Facets of Mindfulness Questionnaire,and Posttraumatic Growth Index. Blood samples were analyzed using flow cytometryfor NK-cellactivity (FANKIA) and lymphocyte phenotyping; concentrationsof cytokines were determined in sera using commercial high sensitivityIL-6and IL-8ELISA (enzyme-linkedimmunosorbent assay) kits. Results provideevidence for beneficial effects of MBSR on psychological and biological responses.Women in the MBSR group experienced significant improvements in depressionscores, with a mean pre-MBSRHAD-scoreof 4.3 and post-MBSRscore of 3.3(P = 0.001), and compared to non-MBSR(P = 0.015). Significant improvementson scores for distress, symptom burden, and mental health were also observed.Furthermore, MBSR facilitated coping capacity as well as mindfulness and posttraumaticgrowth. Significant benefits in immune response within the MBSRgroup and between groups were observed. MBSR have potential for alleviatingdepression, symptom experience, and for enhancing coping capacity, mindfulnessand posttraumatic growth, which may improve breast cancer survivorship.MBSR also led to beneficial effect on immune function; the clinical implicationsof this finding merit further research.

  • 38.
    Kenne Sarenmalm, Elisabeth
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden / Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden / Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Life Sciences.
    Holmberg, Stig B.
    Department of Surgery, SU/Sahlgrenska University Hospital, Gothenburg, Sweden.
    Andersson, Bengt A.
    Microbiology and Immunology, Göteborg University, Göteborg, Sweden.
    Odén, Anders
    Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Mindfulness based stress reduction study design of a longitudinal randomized controlled complementary intervention in women with breast cancer2013In: BMC Complementary and Alternative Medicine, ISSN 1472-6882, E-ISSN 1472-6882, Vol. 13, article id 248Article in journal (Refereed)
    Abstract [en]

    Background: The stress of a breast cancer diagnosis and its treatment can produce a variety of psychosocial sequelae including impaired immune responses. Mindfulness Based Stress Reduction (MBSR) is a structured complementary program that incorporates meditation, yoga and mind-body exercises. Despite promising empirical evidence for the efficacy of MBSR, there is a need for randomized controlled trials (RCT). There is also a need for RCTs investigating the efficacy of psychosocial interventions on mood disorder and immune response in women with breast cancer. Therefore, the overall aim is to determine the efficacy of a Mindfulness Based Stress Reduction (MBSR) intervention on well-being and immune response in women with breast cancer.Methods and design: In this RCT, patients diagnosed with breast cancer, will consecutively be recruited to participate. Participants will be randomized into one of three groups: MBSR Intervention I (weekly group sessions + self-instructing program), MBSR Intervention II (self-instructing program), and Controls (non-MBSR). Data will be collected before start of intervention, and 3, 6, and 12 months and thereafter yearly up to 5 years. This study may contribute to evidence-based knowledge concerning the efficacy of MBSR to support patient empowerment to regain health in breast cancer disease.Discussion: The present study may contribute to evidence-based knowledge concerning the efficacy of mindfulness training to support patient empowerment to regain health in a breast cancer disease. If MBSR is effective for symptom relief and quality of life, the method will have significant clinical relevance that may generate standard of care for patients with breast cancer.Trial registration: ClinicalTrials.gov: NCT01591915. © 2013 Kenne Sarenmalm et al.; licensee BioMed Central Ltd.

  • 39.
    Leijon, Siv
    et al.
    Skövde City Hospital, Kärnsjukhuset, Dept Dermatol, Skövde, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Terstappen, Karin
    Skövde City Hospital, Kärnsjukhuset, Dept Dermatol, Skövde, Sweden.
    Pressure Ulcer Prevalence, Use of Preventive Measures, and Mortality Risk in an Acute Care Population: A Quality Improvement Project2013In: Journal of Wound, Ostomy and Continence Nursing (WOCN), ISSN 1071-5754, E-ISSN 1528-3976, Vol. 40, no 5, p. 469-474Article in journal (Refereed)
    Abstract [en]

    The primary aim of this quality improvement project was to determine pressure prevalence, risk of mortality, and use of preventive measures in a group of hospitalized patients. Two hundred fifty-eight patients recruited from Skaraborg Hospital in Sweden were assessed. A 1-day point prevalence study was carried out using a protocol advocated by the European PU Advisory Panel. Patients' age, gender, severity of PU (grades I-IV), anatomical location of PU, and use of preventive measures were recorded. The Swedish language version of the Modified Norton Scale was used for PU risk assessment. Data were collected by nurses trained according to the Web-based training: PU classification, “ePuclas2.” After 21 months, a retrospective audit of the electronic records for patients identified with pressure ulcers was completed. The point prevalence of pressure ulcers was 23%. The total number of ulcers was 85, most were grade 1 (n = 39). The most common locations were the sacrum (n = 15) and the heel (n = 10). Three percent of patients (n = 9) had been assessed during their current hospital stay using a risk assessment tool. There was a statistically significant relationship between pressure ulcer occurrence and a low total score on the Modified Norton Scale. The patients' ages correlated significantly to the presence of a pressure ulcer. Patients with a pressure ulcer had a 3.6-fold increased risk of dying within 21 months, as compared with those without a pressure ulcer. Based on results from this quality improvement project, we recommend routine pressure ulcer risk assessment for all patients managed in a hospital setting such as ours. We further recommend that particular attention should be given to older and frail patients who are at higher risk for pressure ulcer occurrence and mortality.

  • 40.
    Melin-Johansson, Christina
    et al.
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences and Palliative Research Centre, Stockholm, Sweden.
    Österlind, Jane
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences and Palliative Research Centre, Stockholm, Sweden.
    Henoch, Ingela
    Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Sweden.
    Ek, Kristina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Hagelin, Carina Lundh
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences and Palliative Research Centre, Stockholm, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Jönköping University, Department of Nursing School of Health and Welfare, Sweden.
    Undergraduate nursing students' transformational learning during clinical training2018In: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 24, no 4, p. 184-192Article in journal (Refereed)
    Abstract [en]

    Background: Undergraduate nursing students encounter patients at the end of life during their clinical training. They need to confront dying and death under supportive circumstances in order to be prepared for similar situations in their future career.

    Aim: To explore undergraduate nursing students' descriptions of caring situations with patients at the end of life during supervised clinical training.

    Methods: A qualitative study using the critical incident technique was chosen. A total of 85 students wrote a short text about their experiences of caring for patients at the end of life during their clinical training. These critical incident reports were then analysed using deductive and inductive content analysis.

    Findings: The theme 'students' transformational learning towards becoming a professional nurse during clinical training' summarises how students relate to patients and relatives, interpret the transition from life to death, feel when caring for a dead body and learn end-of-life caring actions from their supervisors.

    Implications: As a preparation for their future profession, students undergoing clinical training need to confront death and dying while supported by trained supervisors and must learn how to communicate about end-of-life issues and cope with emotional stress and grief.

  • 41.
    Mårtensson, Lena B.
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ek, Kristina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Bergh, Ingrid H. E.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Midwifery students' conceptions of worst imaginable pain2014In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 27, no 2, p. 104-107Article in journal (Refereed)
    Abstract [en]

    Background: The Visual Analogue Scale (VAS) is one of the most widely used pain assessment scales in clinical practice and research. However, the VAS is used less frequently in midwifery than in other clinical contexts. The issue of how people interpret the meaning of the VAS endpoints (i.e. no pain and worst imaginable pain) has been discussed. The aim of this study was to explore midwifery students' conceptions of 'worst imaginable pain'. Methods: A sample of 230 midwifery students at seven universities in Sweden responded to an open-ended question: 'What is the worst imaginable pain for you?' This open-ended question is a part of a larger study. Their responses underwent manifest content analysis. Results: Analysis of the midwifery students' responses to the open-ended question revealed five categories with 24 sub-categories. The categories were Overwhelming pain, Condition-related pain, Accidents, Inflicted pain and Psychological suffering. Conclusions: The midwifery students' conceptions of 'worst imaginable pain' are complex, elusive and diverse. © 2014 Australian College of Midwives.

  • 42.
    Mårtensson, Lena B.
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Hutton, Eileen K.
    Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada / Vrije Universiteit, Amsterdam, The Netherlands.
    Lee, Nigel
    Mater Research Institute University of Queensland, Brisbane, Australia / School of Nursing, Midwifery and Social Work University of Queensland, St Lucia, Australia.
    Kildea, Sue
    Mater Research Institute University of Queensland, Brisbane, Australia / School of Nursing, Midwifery and Social Work University of Queensland, St Lucia, Australia.
    Gao, Yu
    Mater Research Institute University of Queensland, Brisbane, Australia / School of Nursing, Midwifery and Social Work University of Queensland, St Lucia, Australia.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Sterile water injections for childbirth pain: An evidenced based guide to practice2017In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799Article in journal (Refereed)
    Abstract [en]

    Background: About 30% of women in labour suffer from lower back pain. Studies of sterile water injectionsfor management of low back pain have consistently shown this approach to be effective. The objective ofthis evidence-based guide is to facilitate the clinical use of sterile water injections to relieve lower backpain in labouring women.Methods: To identify relevant publications our search strategy was based on computerised literaturesearches in scientific databases. The methodological quality of each study was assessed using themodified version of the Jadad scale, 12 studies were included.Findings: Recommendations regarding the clinical use of sterile water injections for pain relief in labourare reported in terms of the location of injection administration, various injection techniques, number ofinjections used, amount of sterile water in each injection and adverse effects.Discussion: Both injection techniques provide good pain relief for lower back pain during labour. Thesubcutaneous injection technique is possibly less painful than the intracutaneous techniqueadministered, but we are unsure if this impacts on effectiveness. The effect seems to be related tothe number of injections and the amount of sterile water in each injection.Conclusion: The recommendation at present, based on the current state of knowledge, is to give fourinjections. Notwithstanding the differences in injection technique and number of injections the methodappears to provide significant levels of pain relief and can be repeated as often as required with noadverse effect (apart from the administration pain) on the woman or her foetus.

  • 43.
    Mårtensson, Lena
    et al.
    University of Skövde, School of Life Sciences.
    Bergh, Ingrid
    University of Rhode Island.
    Effect of treatment for labor pain: Verbal reports versus visual analogue scale scores - A prospective randomized study2011In: International Journal of Nursing and Midwifery, ISSN 2141-2456, Vol. 3, no 4, p. 43-47Article in journal (Refereed)
    Abstract [en]

    Assessing pain in relation to childbirth is one of the midwife’s more important tasks. However, pain research shows that health care professionals often assess patients’ pain inaccurately. The Visual Analogue Scale (VAS) is one of the most used instruments for assessing pain and pain relief both in research and clinical practice. On the other hand, a patient’s verbal report is considered to be the single most reliable indicator of how much pain the patient is experiencing. The aim of this study was to compare women’s verbally reported effect of treatment for labor pain with changes in VAS scores. This comparative prospective study was carrying out on a labor ward with approximately 2,500 deliveries annually in western part of Sweden. Women (n=122) at gestational week 37 to 42 with spontaneous onset of labor, requesting pain relief, were randomized to one of two treatments: acupuncture or sterile water injections. Pain was assessed on a VAS before as well as 30, 60, 90, 120, 150 and 180 min after treatment. Within two hours after delivery the women were asked to verbally report the effectiveness with the treatment. Main outcome measure was agreement between VAS scores and verbal reports. Non-parametric tests were used. All tests were two-tailed at the significance level p< 0.05. The distribution of the VAS scores 30 min after administration of pain relief showed that the women verbally responding that treatment was “very effective”, also rated their pain significantly lower (p< 0.001) on the VAS, compared to the women verbally reporting otherwise. A moderate correlation (r = 0.56; p< 0.001) was obtained between VAS-scored pain change after 30 min and verbally reported pain relief effect. The women who stated that treatment was “very effective” also rated their pain significantly lower at 30, 60 and 90 min on the VAS, compared to baseline. This study confirms that verbal reports and changes in VAS scores are reliable indicators of treatment effect for labor pain. It might, however, be valuable to combine VAS scores with verbal reports for a more extensive assessment of treatment effect.

  • 44.
    Rosén, Helena I.
    et al.
    University of Skövde, School of Life Sciences.
    Bergh, Ingrid H. E.
    University of Skövde, School of Life Sciences.
    Lundman, Berit M.
    University of Skövde, School of Life Sciences.
    Mårtensson, Lena B.
    University of Skövde, School of Life Sciences.
    Patients' experiences and perceived causes of persisting discomfort following day surgery2010In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 9, p. artikelnummer 16-Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to describe patients’ experiences and perceived causes of persisting discomfort following day surgery. Earlier research has mainly covered symptoms and signs during a recovery period of up to one month, and not dealt with patients’ perceptions of what causes persisting, longer-term discomfort. Methods: This study is a part from a study carried out during the period May 2006 to May 2007 with a total of 298 day surgery patients. Answers were completed by 118 patients at 48 hours, 110 at seven days and 46 at three months to one open-ended question related to discomfort after day surgery constructed as follows: If you are stillexperiencing discomfort related to the surgery, what is the reason, in your opinion? Data was processed, quantitatively and qualitatively. Descriptive, inferential, correlation and content analyses were performed. Results: The results suggest that patients suffer from remaining discomfort e.g. pain and wound problem, with effects on daily life following day surgery up to three months. Among patients’ perceptions of factors leading to discomfort may be wrongful or suboptimal treatment, type of surgery or insufficient access to provider/information. Conclusions: The results have important implications for preventing and managing discomfort at home followingday surgery, and for nursing interventions to help patients handle the recovery period better.

  • 45.
    Rosén, Helena I.
    et al.
    University of Skövde, School of Health and Education.
    Bergh, Ingrid H. E.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Schwartz-Barcott, Donna
    Nursing College, University of Rhode island, Kingstown, RI.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    The Recovery Process After Day Surgery Within the Symptom Management Theory2014In: Nursing Forum, ISSN 1744-6198, Vol. 49, no 2, p. 100-109Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim was to illustrate two cases in a postoperative situation following day surgery within the framework of the symptom management theory. Method: Template analysis using the symptom management theory. Result: Neither the woman nor the man was able to return to their normal activities, health status or functional status, within a week. Conclusion: The results illustrate how a postoperative situation may involve personal suffering up to 3 months. Practical Implication: To obtain an outcome following day surgery, as optimal as possible, improving clinical practices and routines, such as discharge criteria, guidelines, and care pathways, is necessary. © 2014 Wiley Periodicals, Inc.

  • 46.
    Rosén, Helena I.
    et al.
    University of Skövde, School of Life Sciences.
    Bergh, Ingrid H.
    University of Skövde, School of Life Sciences.
    Odén, Anders
    Mårtensson, Lena B.
    University of Skövde, School of Life Sciences.
    Patients´ Experiences of Pain Following Day Surgery - At 48 Hours, Seven Days and Three Months2011In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 5, p. 52-59Article in journal (Refereed)
    Abstract [en]

    Recent studies indicate that patients experience pain after day surgery for a longer period than previously known. This requires verification. This was a prospective, descriptive correlational study. A convenience sample of 298 day surgery patients undergoing various surgical procedures was asked to report pain intensity and its interference with daily function 48 hours, seven days and three months after day surgery. Correlation and regression analyses were performed. On a NRS, 55% (n=230) reported pain (≥4) 48 hours after surgery, as did 43% (n=213) at seven days. Pain interfered with normal activities at ≥4 NRS at 48 hours and at seven days, after which it decreased.

  • 47.
    Strang, Susann
    et al.
    Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Sweden / Angered Local Hospital, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ek, Kristina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Hammarlund, Kina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Prahl, Charlotte
    Ersta Sköndal University College / Ersta Hospital, Palliative Research Centre, Stockholm, Sweden / Department of Health Care Sciences, Ersta Sköndal University College, Sweden.
    Westin, Lars
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Österlind, Jane
    Ersta Sköndal University College / Ersta Hospital, Palliative Research Centre, Stockholm, Sweden / Department of Health Care Sciences, Ersta Sköndal University College, Sweden.
    Henoch, Ingela
    Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Sweden / University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Swedish nursing students' reasoning about emotionally demanding issues in caring for dying patients2014In: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 20, no 4, p. 194-200Article in journal (Refereed)
    Abstract [en]

    AIM: To describe nursing students' reasoning about emotionally demanding questions concerning the care of dying patients.

    METHODS: The Frommelt Attitude Toward Care of the Dying (FATCOD) Scale was completed by students at the beginning of their education, and there was great variation in the responses to five items. At a follow-up measurement in the second year, an open-ended question, 'How did you reason when completing this question?', was added to each of the these five items. Qualitative content analysis was used to analyse the responses.

    RESULTS: Of 140 students who completed the FATCOD, 111 provided free-text responses. The analysis of these responses revealed three themes: death perceptions, the students' understanding of their current situation, and the nurse's responsibility.

    CONCLUSION: This study provides useful information on students' reasoning about emotionally demanding questions relating to the care of dying patients. Such knowledge is valuable in helping students to overcome their fear and fulfil their expectations concerning their future proficiency.

  • 48.
    Svensson, Ann-Marie
    et al.
    University of Skövde, School of Life Sciences.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Jakobsson, Eva
    Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg.
    Older Peoples' Descriptions of Becoming and Being Respite Care Recipients2011In: Journal of Housing for the Elderly, ISSN 0276-3893, E-ISSN 1540-353X, Vol. 25, p. 159-174Article in journal (Refereed)
    Abstract [en]

    The number of older people in the western world is increasing. Advancing age creates the need for care, including respite care. The aim of this study is to describe the experience of older people of becoming and being respite care recipients. Admission to respite care is a response to a range of practicalities in the home, such as the need to maintain privacy, dissatisfaction with home care, and deterioration in health. However, the participants in this study had little or no involvement in the decision regarding respite care placement. Activities, training, and medical treatment were found to be important to respite care recipients’ satisfaction with their care.

  • 49.
    Wennström, Berith
    et al.
    Department of Anaesthesia, Skaraborg Hospital, Skövde, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences. Faculty of Health Caring Sciences, Göteborg University, Sweden.
    Bodily and verbal expressions of postoperative symptoms in 3- to 6-year-old boys2008In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 23, no 1, p. 65-76Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate how small boys between 3 and 6 years of age describe bodily and verbal expressions of postoperative symptoms. The data collection was carried out at a large general hospital in Sweden and included both participant observations and semistructured interviews. The results provided a description of how 3- to 6-year-old boys bodily and verbally express postoperative symptoms. The results also showed that small children have difficulties in distinguishing pain, nausea, and anxiety and that postoperative discomfort was experienced in many different ways.

  • 50.
    Wennström, Berith
    et al.
    Department of Anaesthesia, Skaraborg Hospital, Kärnsjukhuset, Skövde, Sweden.
    Hallberg, Lillemor R.-M.
    Public Health and Health Care Science, School of Social and Health Sciences, Halmstad University, Sweden.
    Bergh, Ingrid
    Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    Use of perioperative dialogues with children undergoing day surgery2008In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 62, no 1, p. 96-106Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of a study to explore what it means for children to attend hospital for day surgery. Background. Hospitalization is a major stressor for children. Fear of separation, unfamiliar routines, anaesthetic/operation expectations/experiences and pain and needles are sources of children's negative reactions. Method. A grounded theory study was carried out during 2005-2006 with 15 boys and five girls (aged 6-9 years) scheduled for elective day surgery. Data were collected using tape-recorded interviews that included a perioperative dialogue, participant observations and pre- and postoperative drawings. Findings. A conceptual model was generated on the basis of the core category 'enduring inflicted hospital distress', showing that the main problem for children having day surgery is that they are forced into an unpredictable and distressful situation. Pre-operatively, the children do not know what to expect, as described in the category 'facing an unknown reality'. Additional categories show that they perceive a 'breaking away from daily routines' and that they are 'trying to gain control' over the situation. During the perioperative period, the categories 'losing control' and 'co-operating despite fear and pain' are present and intertwined. Post-operatively, the categories 'breathing a sigh of relief' and 'regaining normality in life' emerged. Conclusion. The perioperative dialogue used in our study, if translated into clinical practice, might therefore minimize distress and prepare children for the 'unknown' stressor that hospital care often presents. Further research is needed to compare anxiety and stress levels in children undergoing day surgery involving the perioperative dialogue and those having 'traditional' anaesthetic care.

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