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  • 1.
    Andersson, Susanne
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Berglund, Mia
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Vestman, Caroline
    Primary Health Care Center, Gullspång, Sweden.
    Kjellsdotter, Anna
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Research and Development Centre, Skaraborg Hospital Skövde, Skövde, Sweden.
    Experiences of specially trained personnel of group education for patients with type 2 diabetes: A lifeworld approach2019In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 2, p. 635-641Article in journal (Refereed)
    Abstract [en]

    Aim:To describe how the group education process for people with type 2 diabetes is experienced by diabetes nurses and dietitians who support the patients’ learning, in a primary care setting.

    Design:The project took place at two primary care settings in the south of Sweden.

    Methods:Data collected from focus‐group interviews and reflection notes were subjected to phenomenological analysis.

    Results:The specially trained personnel experienced that group education made it possible for the patients to learn through reflection concerning their own and others’ experiences. Furthermore, group education entailed increased knowledge for the trained personnel. When the patients were challenged to make changes in their lives with the illness, the personnel experienced that both patients and personnel supported each other. The study concludes that the trained personnel person‐centred approach, with help of the didactic model, get tools to support patients learning.

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  • 2.
    Andersson, Thomas
    et al.
    University of Skövde, School of Business. University of Skövde, Organising for Sustainable Development Research Environment. Faculty of Theology, Diaconia and Leadership, VID Specialized University, Oslo, Norway.
    Linnéusson, Gary
    School of Engineering, Jönköping University, Sweden.
    Holmén, Maria
    Innovation Platform, Region Västra Götaland, Gothenburg, Sweden.
    Kjellsdotter, Anna
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Nurturing innovative culture in a healthcare organisation: Lessons from a Swedish case study2022In: Journal of Health Organization & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 37, no 9, p. 17-33Article in journal (Refereed)
    Abstract [en]

    Purpose: Healthcare organisations are often described as less innovative than other organisations, since organisational culture works against innovations. In this paper, the authors ask whether it has to be that way or whether is possible to nurture an innovative culture in a healthcare organisation. The aim of this paper is to describe and analyse nurturing an innovative culture within a healthcare organisation and how culture can support innovations in such a healthcare organisation.

    Design/methodology/approach: Based on a qualitative case study of a healthcare unit that changed, within a few years, from having no innovations to repeatedly generating innovations, the authors describe important aspects of how innovative culture can be nurtured in healthcare. Data were analysed using inductive and deductive analysis steps.

    Findings: The study shows that it is possible to nurture an innovative culture in a healthcare organisation. Relationships and competences beyond healthcare, empowering structures and signalling the importance of innovation work with resources all proved to be important. All are aspects that a manager can influence. In this case, the manager's role in nurturing innovative culture was very important.

    Practical implications: This study highlights that an innovative culture can be nurtured in healthcare organisations and that managers can play a key role in such a process.

    Originality/value: The paper describes and analyses an innovative culture in a healthcare unit and identifies important conditions and strategies for nurturing innovative culture in healthcare organisations. 

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  • 3.
    Berglund, Mia
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Andersson, Susanne
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Kjellsdotter, Anna
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Att drabbas av långvarig sjukdom2017In: Vägen till patientens värld och personcentrerad vård: Att bli lyssnad på och förstådd / [ed] Karin Dahlberg, Inger Ekman, Stockholm: Liber, 2017, 1, p. 93-116Chapter in book (Refereed)
  • 4.
    Berglund, Mia
    et al.
    University of Skövde, Digital Health Research (DHEAR). University of Skövde, School of Health Sciences.
    Kjellsdotter, Anna
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Research and Development Centre, Skaraborg Hospital Skövde, Sweden.
    Wills, Joanne
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Johansson, Anita
    Research and Development Centre, Skaraborg Hospital Skövde, Sweden.
    The best of both worlds – entering the nursing profession with support of a transition programme2022In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 36, no 2, p. 446-455Article in journal (Refereed)
    Abstract [en]

    Background: Transition into clinical practice for newly graduated nurses is a difficult time, with high stress levels defined by a demanding period of personal and professional acclimatisation. Transitions are complicated and multi-dimensional, and to understand this process, it is crucial to identify the factors that facilitate or stand in the way of a healthy transition.

    Aim: The phenomenological study aimed to describe newly graduated nurses’ expectations of transitioning into the nursing profession at the start of a clinical nursing introduction programme, including education, supervision, and critical reflection with peers.

    Method: The study was based on seven group interviews with newly graduated nurses. The interviews utilised open-ended and follow-up questions and were carried out as a dialogue to enable reflection on the phenomenon of interest. This was explored and illuminated using the reflective lifeworld research approach, based on phenomenological epistemology.

    Findings: “Expectations of transition into the nursing profession viathe Clinical Nursing Introduction Programme” is signified by an oscillating movement between uncertainty, security, challenge, and growth on the threshold of a new identity. The phenomenon is constituted by the courage to grow, responsibility and fear, belonging and vulnerability, and support and challenge.

    Conclusion: Transitioning into the nursing profession viathe Clinical Nursing Introduction Programme means having the best of both worlds. Newly graduated nurses have the opportunity to receive education and structured support at the same time as they work independently in clinical practice.

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  • 5.
    Johansson, Anita
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Västra Götaland, Sweden.
    Berglund, Mia
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Kjellsdotter, Anna
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Research and Development Centre, Skaraborg Hospital, Skövde, Västra Götaland, Sweden.
    Clinical nursing introduction program for new graduate nurses in Sweden: Study protocol for a prospective longitudinal cohort study2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 2, article id e042385Article in journal (Refereed)
    Abstract [en]

    Introduction High levels of nursing turnover represent a problem for healthcare organisations and patient safety. Experiences during the first years in the nursing profession have a significant impact on nurses' future decisions concerning their careers. Nurses at the start of their professional career need to practise their hands-on skills as well as their theoretical knowledge. In addition, new graduate nurses need regular support and opportunities to reflect on experiences in their new profession. The aim of the present study is to describe the Clinical Nursing Introduction Program (CNIP) and present a study design in which the programme is used to support new graduate nurses' transition into the nursing profession. Method and analysis The present study examines the CNIP at a general hospital in southwest Sweden, which lasts for 14 months. The programme has a unique profile based on a person-centred approach and consists of five components: employment and organisation, a compulsory introduction week, two placements in different clinical settings, education days and process-oriented nursing supervision. The present study presents a protocol for a prospective longitudinal cohort study, using qualitative and quantitative methods in the collection and analysis of data. Measurements will include data collection between 2019 and 2023 when the nurses start the CNIP (baseline) and then after 1 and 2 years. Ethics and dissemination This study has been approved by the Regional Ethical Review Board in Gothenburg (Dnr 1056-18). Study findings will be presented at national and international conferences and published in peer-reviewed journals. Trial registration number 273573 (https://www.researchweb.org/is/vgr). 

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  • 6.
    Johansson, Anna
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Cardiology, Skaraborgs Hospital, Skövde / Department of Medical and Health Sciences, University of Linköping, Sweden.
    Adamson, Anita
    Department of Physical Therapy, Skaraborgs Hospital, Skövde, Sweden.
    Ejdebäck, Jan
    Department of Cardiology, Skaraborgs Hospital, Skövde, Sweden.
    Edéll-Gustafsson, Ulla
    Department of Medical and Health Sciences, University of Linköping, Sweden.
    Evaluation of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease - a randomised intervention study2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 19-20, p. 2822-2834Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To evaluate the effectiveness of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease. Background: Recent scientific findings have shown that low physical exercise and stress interfere with coronary artery disease patients' sleep quality and sleep efficiency independent of gender, age and co-morbidity. Design: A randomised pretest-post-test control design. Methods: Forty-seven patients who had undergone a coronary revascularisation procedure and/or pharmacological treatment three to seven weeks earlier at a general hospital were randomised to either an intervention group or a control group. Data collection was carried out by questionnaires, a study-specific sleep diary and actigraphy registration for 10 consecutive 24-hour periods, with a follow-up after three to four months. The intervention group underwent a nurse-led individualised education programme to promote self-care of sleep-activity. Sleep habits and sleep-related lifestyle together formed the basis for setting up individual goals together with the nurse. Individual advice on physical training, relaxation exercise and a CD-based relaxation programme was provided by a physiotherapist. Both groups received a brochure about sleep and stress. Results: At a three- to four-month follow-up, the main improvements were seen in the intervention group regarding sleep quality, sleep duration and sleep efficiency in the sleep diary and sleep efficiency in actigraphy. Statistical improvements in health-related quality of life were revealed. This was not so obvious in the control group. Conclusions: An individualised intervention programme to promote self-care of sleep-activity including relaxation in patients with coronary artery disease led by a nurse may improve sleep quality. However, a longitudinal study to promote self-care in sleep-activity should be performed using a larger sample and multiple sites with continuous follow-ups to determine whether any positive effects remain stable over time. Relevance to clinical practice: Implementation of a multiprofessional individualised programme to promote self-care of sleep-activity including relaxation based on patients' needs, supported by a healthcare team and led by nurses, is important in clinical practice. © 2014 John Wiley & Sons Ltd.

  • 7.
    Johansson, Anna
    et al.
    Department of Cardiology, Kärnsjukhuset, Skövde Hospital, Skövde / Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Karlsson, Johan
    Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Brödje, Karin
    University Hospital, Linköping / Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Edell-Gustafsson, Ulla
    Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Self-care strategies to facilitate sleep in patients with heart disease—A qualitative study2012In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 18, no 1, p. 44-51Article in journal (Refereed)
    Abstract [en]

    This study aimed at exploring and describing the self-care management strategies used by patients with coronary artery disease to facilitate sleep. Qualitative interviews in a dialogue manner, in a phenomenographic reference frame analyzed according to manifest and latent principles of qualitative content analysis, were performed. A purposeful sampling technique was used including 11 patients with coronary heart disease in a Heart Medical Unit in a general hospital setting. Two main themes were identified: 'sleep-rhythm' and 'sleep-hygiene' including four descriptive categories. The categories reveal five basic responses including emotions, cognition, physical symptoms (reactions), behaviours and/or the sleep environment, which were related to perceived or actual presence of sleep-wake problems and health that were the underlying reason for the self-care management strategies. Basically, intervention studies that address these five responses for choice of non-pharmacological methods based on cognitive behavioural therapy provided by nurses are needed.

  • 8.
    Johansson, Anna
    et al.
    University of Skövde, School of Life Sciences. Department of Cardiology, Skaraborgs Hospital, Skövde, Sweden, Department of Medical and Health Sciences, University of Linköping, Sweden.
    Svanborg, Eva
    Department of Clinical Neurophysiology and Department of Clinical and Experimental Medicine Linköping University Hospital, Faculty of Health Sciences, University of Linköping, Sweden.
    Edéll-Gustafsson, Ulla
    Department of Medical and Health Sciences, University of Linköping, Sweden.
    Sleep-wake activity rhythm and health-related quality of life among patients with coronary artery disease and in a population-based sample: An actigraphy and questionnaire study2013In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 19, no 4, p. 390-401Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore whether there are gender differences in sleep and health-related quality of life in patients with coronary artery disease (CAD) and a matched population-based sample and to see how subjectively rated sleep is associated with actigraphy. Secondly, to explore whether factors that predict patients' sleep quality could be identified. Fifty-seven patients with stable CAD and 47 participants from a population-based sample were included. All participants completed the Uppsala Sleep Inventory (USI), the Epworth Sleepiness Scale and the SF-36. Actigraphy recordings and a sleep diary were performed for seven 24-h periods. Multiple stepwise regression analysis showed that sleep duration, sleep onset latency, nocturnal awakenings, vitality (SF-36) and body mass index explained 60% of the sleep quality outcome (USI). Sleep duration, sleep efficiency and fragmentation index assessed with actigraphy and sleep diary accounted for 36% of the sleep quality outcome (diary). The result can form the basis for a non-pharmacological, self-care programme supported and led by nurses. © 2013 Wiley Publishing Asia Pty Ltd.

  • 9.
    Johansson, Anna
    et al.
    Department of Cardiology, Kärnsjukhuset, Skövde Hospital, Skövde / Department of Medical and Health Sciences, University of Linköping.
    Svanborg, Eva
    Department of Clinical and Experimental Medicine/Clinical Neurophysiology, University of Linköping/University Hospital.
    Swahn, Eva
    Department of Medical and Health Sciences, Division of Cardiology, Linköping University, Linköping.
    Ejdebäck, Jan
    Department of Cardiology, Kärnsjukhuset, Skövde Hospital, Skövde.
    Tygesen, Hans
    Department of Cardiology, Borås Hospital, Borås.
    Edell-Gustafsson, Ulla
    Department of Medical and Health Sciences, Division of Nursing Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Sleep, arousal and health-related quality of life in men and women with coronary artery disease2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 19-20, p. 2787-2801Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate whether there are gender differences in insomnia, sleep quality, sleep efficiency (%), general arousal, disease-specific and health-related quality of life in patients with coronary artery disease, compared with an age- and gender-matched randomly selected group from the general population.

    BACKGROUND: There are gender difference effects of sleep disturbances in the general population, but this perspective among patients with coronary artery disease has been poorly analysed.

    DESIGN: In this prospective study, comparative, descriptive and model testing designs were used.

    METHOD: The patients with coronary artery disease, 556 men and 324 women aged 25-86, were compared with a matched population-based group. Data were collected by validated and reliability-tested questionnaires.

    RESULTS: The prevalence of severe insomnia varied between 17-44% in all four groups. The severe insomniac coronary artery disease patients displayed a two- or threefold higher presleep arousal, had two hours shorter nocturnal sleep duration/night and were more limited in their physical exercise level than the population-based group. Gender differences in sleep quality, sleep efficiency (%) and general arousal disappeared with increased insomnia severity.

    CONCLUSIONS: Independent of gender, age and comorbidity, physical exercise, general arousal behaviour and delayed poststress recovery after mental stress were found to have a negative impact on the coronary artery disease patients' sleep quality and sleep efficiency (%), interfering with their health-related quality of life. The variables significantly explained 41% of the sleep quality outcome and 29% of the sleep efficiency (%).

    RELEVANCE TO CLINICAL PRACTICE: Insomnia because of hyperarousal behaviour can be an important factor in the development of an individual self-care management programme supported by a healthcare team.

  • 10.
    Johansson, Anna
    et al.
    Department of Cardiology, Skövde Hospital, Skövde, Sweden / Nursing Science - Department of Medicine and Care, Faculty of Health Sciences, University of Linkoping, Linkoping.
    Windahl, Maria
    Nursing Science - Department of Medicine and Care, Faculty of Health Sciences, University of Linkoping, Linkoping.
    Svanborg, Eva
    Department of Neuroscience, Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Fredrichsen, Maria
    Department of Social and Welfare Studies, Palliative Research Unit, Vrinnevi Hospital, Norrköping, Sweden.
    Swahn, Eva
    Department of Cardiology, University Hospital Linköping, Linköping.
    Uhlin, Pia Yngman
    Nursing Science - Department of Medicine and Care, Faculty of Health Sciences, University of Linköping, Linköping, Sweden.
    Edéll-Gustafsson, Ulla
    Nursing Science - Department of Medicine and Care, Faculty of Health Sciences, University of Linköping, Linköping, Sweden.
    Perceptions of how sleep is influenced by rest, activity and health in patients with coronary heart disease: a phenomenographical study2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 4, p. 467-475Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: A framework is needed for identifying internal and external factors essential for the nursing management of psychological supportive health care and education for patients' self-care in sleep. In order to generate more knowledge from the patient's perspective, the aim of this study was to describe how patients with coronary artery disease (CAD) perceive that their sleep is influenced by rest, activity and health in outpatient care.

    DESIGN: Qualitative interviews were performed with 33 outpatients.

    METHOD: The data were analysed using a phenomenographic method.

    FINDINGS: Three descriptive categories of the phenomenon were described: my lifestyle is reflected in my sleep behaviour; handling the practices around tiredness and sleep; and feelings of negative and positive efficacy. Feelings of tiredness, fatigue and sleepiness were different pre-sleep stages, but were also related to the patient's adaptation and recovery. Creating one's own personal time and feelings of efficacy gave an inner sense of strength which is indicated as being particularly important in managing stress and the demands of everyday life in a satisfactory manner.

    CONCLUSION: From a contextual, holistic perspective on health, it is important to identify the patient's needs, symptoms and intentional or unintentional self-care management strategies regarding sleep and lifestyle. To promote a positive health outcome it is essential to identify sleeplessness behaviour and perceived self-efficacy for self-care in sleep.

  • 11.
    Kjellsdotter, Anna
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Andersson, Susanne
    Department of Health Sciences, University West, Trollhättan, Sweden ; Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden.
    Berglund, Mia
    University of Skövde, Digital Health Research (DHEAR). University of Skövde, School of Health Sciences.
    Together for the future – development of a digital website to support chronic obstructive pulmonary disease self-management: A qualitative study2021In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 14, p. 757-766Article in journal (Refereed)
    Abstract [en]

    Background: Symptom burden, impaired functional performance and decreased quality of life are not only consequences of the underlying physiological disorder chronic obstructive pulmonary disease (COPD) but also dependent on a patient’s ability to learn to live with and manage their illness. A digital website may be important for empowering patients with COPD to learn about and self-manage their illness. The aim of this study was to describe a developing process of a digital COPD-web as a part of a self-management education program for persons living with COPD. Methods: A qualitative approach with a phenomenological perspective was used. The study was based on group and individual interviews with a multidisciplinary COPD-team and patients who developed the COPD-web. Results: The developing process appears as a person-centred and holistic self-care approach both in content and development. Developing a digital COPD-web requires ongoing multi-disciplinary collaboration and spawns a sense of pride that reinforces shared responsibility. The phenomenon consists of four constituents: learning by participating in development, the patient perspective as guiding approach, responsibility and motivation as driving forces and digital technology as a knowledge arena. Conclusion: The results indicate that constructive collaboration between a multidisciplinary COPD-team and patients as co-creators in an ongoing creative and reflective process is a key concept to develop a digital COPD-web with a holistic approach. Digital resources in the future might create time and space for reflective conversations in a COPD-web with virtual chatrooms. 

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  • 12.
    Kjellsdotter, Anna
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Skaraborg Hospital Skövde, Research and Development Centre, Skövde, Sweden.
    Berglund, Mia
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Jebens, Elisabeth
    Primary Health Care Center, Stenstorp, Sweden.
    Kvick, Jennie
    Primary Health Care Center Mösseberg, Falköping, Sweden.
    Andersson, Susanne
    Department of Health Sciences, University West, Trollhättan, Sweden.
    To take charge of one's life - group-based education for patients with type 2 diabetes in primary care -a lifeworld approach2020In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 15, no 1, article id 1726856Article in journal (Refereed)
    Abstract [en]

    Background: The number of people suffering from diabetes worldwide, including Sweden, has increased. To strengthen the patient's empowerment and thus improve their ability to take care of their own health, patient education in self-care management plays a central role in diabetes care. Purpose: The specific aim in this study was to describe patients' experiences of group-based education using the Taking charge of one's life with type 2 diabetes model. Methods: A qualitative approach with a phenomenological lifeworld perspective was used. The study was based on group and individual interviews and reflection books. Results: The group-based education model made it possible for the patients to learn through reflection concerning their own and others' experiences. The learning that occurred with support from the group reflections and the reflection books contributed to the understanding of the complexity of the illness. This increased the motivation and desire to be responsible for the treatment and implementation of habits. The group contributed to a sense of belonging and community that inspired a continued and active learning. Conclusion: The results showed that from the patients' perspective, this didactic model was both suitable and appreciated, supporting and facilitating learning.

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  • 13.
    Kjellsdotter, Anna
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Edéll-Gustafsson, Ulla
    Department of Medical and Health Sciences, Division of Nursing Sciences, Faculty of Health Sciences, Linköping University, Sweden.
    Yngman-Uhlin, Pia
    Research & Development Unit, and Department of Medicine and Health Sciences, Linköping University, Sweden.
    Associations Between Sleep and Personality Factors Among Patients Living With Coronary Artery Disease2020In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 35, no 6, p. 568-575Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Insomnia symptoms have become increasingly common in patients with coronary artery disease (CAD). Increasing evidence suggests comorbidity between personality traits and health status. Considering personality traits may act as a predisposition for future illness; this state may influence sleep quality and it appears to precipitate cardiac events in high-risk patients.

    OBJECTIVE: The aim of this study was to investigate self-reported sleep deficiency in relation to vicious cycle of sleeplessness (VCS) behavior, hyperarousal behavioral trait (H-personality), and type D personality traits in patients with CAD and in a population-based group. Furthermore, our aim was to explore the association of VCS behavior with H-personality trait and type D personality. Finally, we investigated to what extent type D personality can explain self-reported too little sleep in patients with CAD.

    METHODS: An observational case-control design was applied comprising 859 patients in cardiac outpatient care and 859 participants from a population-based group. Questionnaires assessing VCS behavior, H-personality, type D personality, and perceptions of too little sleep were used.

    RESULTS: Statistically significant higher scores of a hyperarousal and sleeplessness behavior were revealed for those with too little sleep compared with those with sufficient sleep in both the patient and the population-based group. Age, female gender, or sleeplessness behavior significantly predicted too little sleep (P < .001).

    CONCLUSIONS: The current study highlights the advantage of studying heterogeneity in patients with CAD from a person-centered perspective with focus to identify distressed individuals in order to prevent or treat sleep deficiency. A cluster of factors may be a more accurate predictor of patient-reported outcomes than a single psychosocial factor.

  • 14.
    Kjellsdotter, Anna
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Lantz, Björn
    Department of Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden.
    Ottosson, Cornelia
    Division of Neonatology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Healthcare Professionals' Views on Parental Participation in the Neonatal Intensive Care Units2018In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 41, no S1, p. 3-8Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To examine the associations between age, gender, and profession in relation to the perceived importance of parental participation in Neonatal Intensive Care Units.

    DESIGN AND METHODS: A quantitative cross-sectional design was used. Participants were recruited consecutively from all 40 existing NICU units in Sweden. A total of 443 healthcare professionals (372 nurses and 71 physicians) participated in the study. Participants completed the Swedish version of the Empowerment of Parents in the Intensive Care-Neonatology (EMPATHIC-N) questionnaire. Data were analyzed using multiple regression analyses.

    RESULTS: The findings indicated that profession and age, but not gender, had an overall perceived importance on how nurses and physicians rated specific aspects of parental participation in NICUs.

    CONCLUSIONS: Being a nurse, compared to a physician, was associated with an increase in overall perceived importance of parental participation in NICUs. These differences may affect and may be crucial for how parents take a part in the care of their infant and also for how they adapt to the parental role.

    PRACTICE IMPLICATIONS: Nurses and physicians require education and training that support parental participation based on age and their different roles, rather than simply conveying information about the technical medical aspects of NICU care. For a sustainable outcome all team members should be invited to discuss cases from their perspectives.

  • 15.
    Klaeson, Kicki
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Oncology Department, Skaraborgs hospital, Sweden.
    Hovlin, Lina
    Home care, Skara Municipality, Skara, Sweden.
    Guvå, Hanna
    Psychiatric Department, Skaraborgs hospital, Sweden.
    Kjellsdotter, Anna
    University of Skövde, Health and Education. University of Skövde, School of Health and Education.
    Sexual Health in Primary Healthcare: A Qualitative Study of Nurses' Experiences2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 11-12, p. 1545-1554Article in journal (Refereed)
    Abstract [en]

    Aim and objectives: To illuminate nurses’ experiences and opportunities to discuss sexual health with patients in primary healthcare.

    Background: Sexual health is a concept associated with many taboos and research shows that nurses feel uncomfortable talking to patients about sexual health and therefore avoid it. This avoidance forms a barrier between patient and nurse which prevents nurses from giving satisfactory healthcare to patients.

    Design: A qualitative descriptive design.

    Method: Semi-structured interviews were conducted with nine nurses in primary healthcare in Sweden. Data were analysed by using qualitative content analysis.

    Results: During the analysis phase, five subcategories and two main categories were identified. The two main categories were: “Factors that influence nurses’ opportunities to talk to patients about sexual health” and “Nurses’ experiences of talking to patients about sexual health”. Social norms in society were an obstacle for health professionals’ opportunities to feel comfortable and act professionally. The nurses’ personal attitude and knowledge were of great significance in determining if they brought up the topic of sexual health or not. The nurses found it easier to bring up the topic of sexual health with middle-aged men with for example diabetes. One reason for this is that they found it easier to talk to male patients. A further reason is the fact that they had received training in discussing matters of sexual health in relation to diabetes and other conditions affecting sexual health.

    Conclusion: Nurses in primary care express the necessity of additional education and knowledge on the subject of sexual health. The healthcare organization must be reformed to put focus on sexual health.

    Relevance for clinical practiceGuidelines for addressing the topic of sexual health must be implemented to establish conditions that will increase nurse's knowledge and provide them with the necessary tools for discussing sexual health with patients.

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  • 16.
    Linnéusson, Gary
    et al.
    School of Engineering, Jönköping University, Sweden.
    Andersson, Thomas
    University of Skövde, School of Business. University of Skövde, Enterprises for the Future Research Environment.
    Kjellsdotter, Anna
    Research and Development Centre, Skaraborg Hospital Skövde, Sweden.
    Holmén, Maria
    Innovation Platform, Region Västra Götaland, Gothenburg, Sweden.
    Using systems thinking to increase understanding of the innovation system of healthcare organisations2022In: Journal of Health Organization & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 36, no 9, p. 179-195Article in journal (Refereed)
    Abstract [en]

    Purpose – This paper applies systems thinking modelling to enhance the dynamic understanding of how to nurture an innovative culture in healthcare organisations to develop the innovation system in practice and speed up the innovative work. The model aims to provide a holistic view of a studied healthcare organisation’s innovation processes, ranging from managerial values to its manifestation in improved results.

    Design/methodology/approach – The study is based on empirical material from a healthcare unit that, within a few years, changed from having no innovations to repeatedly generating innovations. The study uses the modelling language of causal loop diagrams (CLDs) in the system dynamics methodology to identify the key important aspects found in the empirical material.

    Findings – The proposed model, based on the stories of the interviewees, explores the dynamics of inertia when nurturing an innovative culture, identifying delays attributed to the internal change processes and system relationships. These findings underscored the need for perseverance when developing an innovative culture in the entrepreneurial phases.

    Practical implications – The approach of using systems thinking to make empirical healthcare research results more tangible through the visual notations of CLDs and mental simulations is believed to support exploring complex phenomena to induce and nurture both individual and organisational learning.

    Originality/value – The results from this approach provide deepened analysis and provoke the systems view to explain how the nurturing of the culture can accelerate the innovation processes, which helps practitioners and researchers to further expand their understanding of their healthcare contexts.

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  • 17.
    Nordblom, Ann-Katrin
    et al.
    Department of Cardiology, Skaraborgs Hospital Skövde, Sweden ; Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Sweden.
    Kjellsdotter, Anna
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Research and Development Centre, Skaraborg Hospital Skövde, Sweden.
    Norberg Boysen, Gabriella
    Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Sweden ; Prehospen, Centre for Prehospital Research, University of Borås, Sweden.
    Berglund, Mia
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Foreign movement in one's own body: Patients' experiences of being awake while treated with catheter ablation — a phenomenological study2023In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 18, no 1, article id 2238972Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To address the consequences of living with supraventricular tachycardia and to improve the quality of treatment, there is a need to highlight patient experiences of treatment with catheter ablation. Therefore, the aim was to describe the phenomenon of catheter ablation, as it is experienced by patients being treated awake.

    METHODS: A descriptive design was applied based on a reflective lifeworld research founded on phenomenological epistemology. Interviews were conducted between December 2021 and Mars 2022 with seven women and five men, three to twelve months after they underwent catheter ablation.

    RESULTS: Patients undergoing catheter ablation while awake during treatment, which includes experiences of relying on others expertise, being actively passive, and striving to be cured. It entails experiences of having a foreign object moving in one's body and heart and can be endured through strategies of mainly shifted one's mental focus.

    CONCLUSIONS: The effort of undergoing a catheter ablation procedure is worthwhile as the confirmation of a physical curable condition that opens a future with possibilities instead of the obstacle in daily life that tachycardia entails. For the patients, an informative and caring conversation was needed that would have provided the support they lacked before and during the ablation.

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  • 18.
    Nordblom, Ann-Katrin
    et al.
    Department of Cardiology, Skaraborg Hospital Skövde, Sweden ; Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Sweden.
    Norberg Boysen, Gabriella
    Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Sweden ; PreHospen - Centre for Prehospital Research, University of Borås, Sweden.
    Berglund, Mia
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Kjellsdotter, Anna
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Research and Development Centre, Skaraborg Hospital Skövde, Sweden.
    Health care centre and emergency department utilization by patients with episodes of tachycardia2022In: BMC Cardiovascular Disorders, E-ISSN 1471-2261, Vol. 22, no 1, article id 124Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Outpatients seek to visit health care facilities for episodes of tachycardia-related signs and symptoms. The challenge for physicians is to balance a proper initial assessment and avoid overlooking a possible arrhythmia. This common clinical situation affects individuals and health care utilization, and effective management may substantially affect health care resources. This study aimed to explore health care utilization for outpatients with episodes of tachycardia visiting health care centres (HCCs) and/or emergency departments (EDs). METHOD: This retrospective study used data of adult outpatients (≥ 18 years) who were assessed by a physician as having a specific or nonspecific diagnosis of arrhythmia between 2017 and 2018, and data were retrieved from medical records and a regional registry database. Data was analysed with appropriate statistical analyses to identify disparities between sex, age and terms of search pattern for each health care facility. Analysis of variance was used to test disparities between the sexes, and one-factor ANOVA was used for the incidence of missed arrhythmias. RESULTS: A total of 2719 visits with 2373 outpatients were included in the study. The result showed a significant difference in the total number of visits (n = 2719) between female and male patients (68% vs. 32%, p < .001). In the 60-69- and 70-79-year age groups, females had significantly higher frequencies of visits than males (p = .018). A significant difference was also observed between sexes in terms of which health care facility they tended to visit (p < .001). Ninety-five percent of the outpatients visiting EDs were hospitalized. When estimating the incidence of missed arrhythmias (diagnoses) in relation to assessments, the results showed a 5% missed diagnosis involving potential atrioventricular nodal re-entry tachycardia and atrioventricular re-entry tachycardia. Moreover, the referral rate was low, especially from HCCs to cardiologists. CONCLUSIONS: This study shows a significant difference in total visits in HCCs and/or EDs by patients of different sexes and indicates the need for improved care for outpatients with episodes of tachycardia. Sex- and age-related differences must be addressed with an aim of providing equal care. Finally, the low rate of referral from HCCs to cardiologists compared to the high proportion of hospitalizations from EDs, deserves further investigation. 

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  • 19.
    Yngman-Uhlin, Pia
    et al.
    Linköping University, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping, Sweden / Department of Nephrology, University Hospital, Linköping, Sweden.
    Johansson, Anna
    Linköping University, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping, Sweden / Department of Cardiology, Skövde Hospital, Skövde, Sweden.
    Fernström, Anders
    Department of Nephrology, University Hospital, Linköping, Sweden.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping, Sweden.
    Edéll-Gustafsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping, Sweden.
    Fragmented sleep: an unrevealed problem in peritoneal dialysis patients2011In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 45, no 3, p. 206-215Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to describe the sleep-wake cycle, sleep quality, fatigue and Health Related Quality of Life (HRQoL) measured with questionnaires, actigraphy and a sleep diary during a one-week period in patients undergoing peritoneal dialysis (PD) treatment at home. A further aim was to explore differences compared with patients with coronary artery disease (CAD) and individuals from the general population.

    MATERIAL AND METHODS: In this study one-week actigraphy registration, four questionnaires (Uppsala Sleep Inventory, SF-36, FACIT-fatigue, International Restless Legs Study Groups' form) and a sleep diary were used.

    RESULTS: Data from 68 participants and 470 nights were collected. PD patients (n = 28) had more fragmented sleep (p < 0.001) and worse sleep efficiency (SE%) (p < 0.0001) than the CAD (n = 22) and the population (n = 18) groups. Pruritus (57%), restless legs (46%) and fatigue (89%) were prevalent in PD patients. Pruritus correlated with fragmented sleep (r = -0.45, p = 0.01) and SE (r = -0.49, p = 0.01). In HRQoL, the physical component score was decreased in the PD and CAD groups (p < 0.01) compared to the population group.

    CONCLUSIONS: To the authors' knowledge this study is the first to demonstrate that PD patients have deteriorated sleep, with serious fragmentation measured by a one-week actigraphy registration. Further, PD patients exhibit worse sleep quality than CAD patients and individuals in the population. Evaluation of sleep in clinical practice is highly recommended since PD patients are vulnerable individuals with extended self-care responsibilities and at risk for comorbidity secondary to insufficient sleep. Future research on whether PD patients' sleep problems and fatigue can be improved by an individual non-pharmacological intervention programme is required.

  • 20.
    Yngman-Uhlin, Pia
    et al.
    Department of Research and Development Unit, Department of Medical and Health Sciences, Linköping University, Sweden.
    Kjellsdotter, Anna
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Uhlin, F.
    Department of Nephrology and Medical and Health Sciences, Linköping University, Sweden / Region Östergötland, Linköping, Sweden / Department of Health Technologies, Tallinn University of Technology, Estonia.
    Edéll-Gustafsson, U.
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Sleep Quality, Fatigue, and Health-Related Quality of Life in Patients on Initial Peritoneal Dialysis and Multiple Modalities after Two Years: A Prospective Study2019In: Nephrology Nursing Journal : Journal of The American Nephrology Nurses Association, ISSN 1526-744X, E-ISSN 2163-5390, Vol. 46, no 6, p. 615-649Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate changes in sleep quality, fatigue, mental health, and health-related quality of life (HRQoL) over a two-year period among patients undergoing peritoneal dialysis treatment at home. We further explored the extent to which sleep quality, fatigue, and mental health predicted health-related quality of life outcomes. This prospective study included 55 patients. Sleep parameters changed over two years, independently of treatment. Sleep variables at baseline, to some extent, predicted sleep quality after two years. Daytime sleepiness can be a long-term problem. Findings indicate improvements in nocturnal sleep over a two-year time period, independently of dialysis treatment. In contrast, fatigue remained unchanged over the same time period. Transplantation seems to generally benefit the outcome of HRQoL. Strategies to improve sleep and HRQoL may include systematic risk factor modification and efforts to optimise symptomatic treatment. 

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