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  • 1.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences. Department of Obstetrics and Gynecology, Skaraborgs Hospital, Skövde, Sweden.
    Applying Heidegger's interpretive phenomenology to women's miscarriage experience2010In: Psychology Research and Behavior Management, ISSN 1179-1578, E-ISSN 1179-1578, Vol. 2010, no 3, p. 75-79Article in journal (Refereed)
    Abstract [en]

    Much has been written about measuring the feelings and impressions of women regarding their experience of miscarriage. According to the existential philosopher Heidegger life experiences such as the experience of a woman having a miscarriage can be interpreted and explained only in the context of the totality of the women’s experiences in the past, the present, and the future. Thirteen in-depth interviews with women about their experiences of miscarriage were interpreted with respect to Heidegger’s “Being and Time”. By using his inter-pretive phenomenology the essence of the miscarriage experience was explored and defined. The women’s feelings and impressions were influenced by past experiences of miscarriage, pregnancy, and births. Present conditions in the women’s lives contributing to the experience include their relationships, working situation, and living conditions. Each woman’s future prospects and hopes have been structurally altered with regard to their aspirations for their terminated pregnancy. The impact of miscarriage in a woman’s life was found to be more important than caregiver providers and society have previously attributed to in terms of scale. The results of the interviews reveal that the women believed that only women who had experienced their own miscarriages were able to fully understand this complex womanly experience and its effects on the woman who had miscarried.

  • 2.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    Barnmorskans avancerade kliniska omvårdnad vid gynekologisk öppenvårdsmottagning2011In: Avancerad klinisk sjuksköterska: Avancerad klinisk omvårdnad i teori och praxis / [ed] Lisbeth Fagerström, Lund: Studentlitteratur AB, 2011, 1, p. 355-376Chapter in book (Refereed)
  • 3.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    Meta-analysis to obtain a scale of psychological reaction after perinatal loss: focus on miscarriage2011In: Psychology Research and Behavior Management, ISSN 1179-1578, E-ISSN 1179-1578, Vol. 4, p. 29-39Article in journal (Refereed)
    Abstract [en]

    Pregnancy has different meanings to different women depending upon their circumstances. A number of qualitative studies have described the experience of miscarriage by women who had desired to carry their pregnancy to full term. The aim of this meta-analysis was to identify a scale of psychological reaction to miscarriage. Meta-analysis is a quantitative approach for reviewing articles from scientific journals through statistical analysis of findings from individual studies. In this review, a meta-analytic method was used to identify and analyze psychological reactions in women who have suffered a miscarriage. Different reactions to stress associated with the period following miscarriage were identified. The depression reaction had the highest average, weighted, unbiased estimate of effect (d+= 0.99) and was frequently associated with the experience of perinatal loss. Psychiatric morbidity was found after miscarriage in 27% of cases by a diagnostic interview ten days after miscarriage. The grief reaction had a medium d+ of 0.56 in the studies included. However, grief after miscarriage differed from other types of grief after perinatal loss because the parents had no focus for their grief. The guilt is greater after miscarriage than after other types of perinatal loss. Measurement of the stress reaction and anxiety reaction seems to be difficult in the included studies, as evidenced by a low d+ (0.17 and 0.16, respectively). It has been recommended that grief after perinatal loss be measured by an adapted instrument called the Perinatal Grief Scale Short Version.

  • 4.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    Women's well-being improves after missed miscarriage with more active support and application of Swanson's Caring Theory2011In: Psychology Research and Behavior Management, ISSN 1179-1578, E-ISSN 1179-1578, Vol. 4, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was to provide better organization and more efficient use of resources within the health care system in order to identify women with nonviable pregnancy earlier in their gestation terms and also to identify those women who experience severe grief reaction after the miscarriage. The proposed solution is to offer an appointment with a gynecologist during regular office hours after consultation with the patient’s midwife to women experiencing symptoms and who are concerned with the viability of their pregnancy. Unnecessary contact with the emergency room by the patients would be reduced as a result of this improvement in organization. The aim of the study was to give the women experiencing missed miscarriage an increased sense of well-being by applying Swanson’s Caring Theory to their recovery, in addition to the better organization and more efficient use of resources.

    Method: Both the original study from 2002 to 2003 and the later study from 2004 to 2005 applied Swanson’s Caring Theory in the follow-up care management of the women, but only the later study was influenced by the changes made in the health care system. In the past, diagnosis of missed miscarriage was delayed because women experiencing minor symptoms were not highly prioritized in the health care system. More active support was introduced in order to get the proper information to the patient throughout the health care system. The size of the original study database was n=43, compared with the later study database, which was n=56. All of the women answered the Perinatal Grief Scale (PGS) questions twice, 1 month and 4 months after their diagnosis. Some additional questions about their circumstances unrelated to the PGS were also mailed to the women 4 months after their diagnosis.

    Results: As a result of the more active support, women felt that they received professional care when they needed it most. The patients were satisfied that they were treated as if they were suffering from normal grief. The group score above the limits for deep grief 4 months after diagnosis was significantly lowered. The chances of receiving their diagnosis at an appointment during office hours increased (odds ratio 3.38). Sick leave time of more than a week was reduced from 44% in the original study to 22% in the later study.

  • 5.
    Adolfsson, Annsofie
    et al.
    University of Skövde, School of Life Sciences.
    Granevik, Karin
    Paulson, Kerstin
    The Reason Why Women Do Not Participate in the Papsmear Screening and Testing Program in Sweden2012In: Advances in Sexual Medicine, ISSN 2164-5191, Vol. 2, no 3, p. 31-37Article in journal (Refereed)
    Abstract [en]

    Cervical cancer is the second most common type of cancer among women worldwide. In Sweden cervical cancer is the fifteenth most common cancer among women and accounts for 1.9 percent of all female cancers. The Swedish Pap smear screening program is enabling early detection of cell changes in order that treatment may be administered to prevent the development of cancerous cells. There are approximately four hundred and fifty cases of cervical cancer detected each year in Sweden and of these cases, approximately seventy five percent occur in women who do not participate in the screening and testing program. The purpose of this study was to illustrate and examine the reasons why women did not participate in the program even though they had received a notice that they had an appointment for a Pap smear test. In the study fourteen women from a district in the west of Sweden were interviewed. In order to analyse the interviews a qualitative content analysis according to Lundman and Graneheim was used. The analysis resulted in the development of three categories which were identified as communication, treatment and subterfuge (reasons or excuses for not participating). The theme of the study was the professional treatment of the women’s conditions. In the interviews the women emphasize the importance of professional treatment that is administered with respectful and sympathetic care throughout the whole healthcare system regardless of where and when the visit was conducted. Efficient organization and clear communication would minimize the inconvenience for the women during their visit.

  • 6.
    Adolfsson, Annsofie
    et al.
    University of Skövde, School of Life Sciences.
    Jansson, Malin
    University of Skövde, School of Life Sciences.
    Prototype for Internet support of pregnant women and mothers with type I diabetes: focus group testing2012In: Psychology Research and Behavior Management, ISSN 1179-1578, E-ISSN 1179-1578, Vol. 5, p. 97-103Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to pilot test a prototype website called MODIAB-web designed to support pregnant women and mothers with type 1 diabetes.

    Method: A focus group was undertaken and the results were analyzed using qualitative content analysis.

    Results: Eight subthemes were identified, comprising "blood glucose versus insulin," "application for smart phones," "the time aspect," "interface and technology," "forum," "direct link to the diabetes midwife," "ask the expert," and "lack of contact information." These subthemes were condensed into two main themes. The first theme was "easily understood interface, but in need of a more blood-glucose focused orientation" and the second theme was "forum for interaction with both equals and experts."

    Conclusion: The women in this study had positive impressions of several of the MODIAB-web functions, including a forum for pregnant mothers with type 1 diabetes and the possibility of being able to put their blood glucose levels into a diagram which could be sent directly to the diabetes midwife. Access to articles and information via the "fact" tab and the ability to ask questions of experts were also significantly helpful to women in the focus group. Pregnant women and mothers with type 1 diabetes can gain support from such a Web-based self-help system.

  • 7.
    Adolfsson, Annsofie
    et al.
    University of Skövde, School of Life Sciences.
    Johansson, Cecilia
    Nilsson, Emma
    Swedish Women's Emotional Experience of the First Trimester in a New Pregnancy after One or More Miscarriages: A Qualitative Interview Study2012In: Advances in Sexual Medicine, ISSN 2164-5191, Vol. 2, no 3, p. 38-45Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to evaluate how Swedish women describe their emotional state of being during the eighth week through the eleventh week after they have become pregnant again after suffering a previous miscarriage. Method: A qualitative content analysis with an inductive approach has been used to analyze fourteen interviews that served as the data base for this study. The content analysis resulted in the development of five categories which evolved into one primary theme. Findings: The five categories identified were Worry and preoccupation; Distance; managing their feelings; Mourning what is lost; Guarded happiness and expectations. These categories were compiled into a main theme, “Worry consumes a lot of energy, but on the other side lies happiness”. This theme focused on whether the women could feel any happiness about being pregnant again despite their concerns with the previous miscarriage. Conclusions: The emotional states of the women when they get pregnant again are typically characterized by anxiety, worry and concerns about their current pregnancy. The women have a tendency to distance themselves emotionally from their pregnancy but also strive to find the joy of being pregnant again. During the new pregnancy they find themselves in need of support from their family and friends as well as in need of support from the healthcare system.

  • 8.
    Adolfsson, Annsofie
    et al.
    University of Skövde, School of Life Sciences.
    Johansson, Marianne
    Sahlgrenska Akademin, Göteborgs universitet.
    Berg, Marie
    Sahlgrenska akademin, Göteborgs universitet.
    Francis, Jynfiaf
    Sahlgrenska universitetssjukhuset, Göteborg.
    Hogström, Lars
    Kärnsjukhuset, Skövde.
    Janson, Per Olof
    Sahlgrenska akademin, Göteborgs universitet.
    Sogn, Jan
    Uddevalla sjukhus.
    Hellström, Anna-Lena
    Sahlgrenska akademin, Göteborgs universitet.
    Quality of life for couples 4-5.5 years after unsuccessful IVF treatment2009In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 88, no 3, p. 291-300Article in journal (Refereed)
    Abstract [en]

    Objective. To describe quality of life in men and women who had terminated in vitro fertilization (IVF) within the public health system 4-5.5 years previously, and for whom treatment did not result in childbirth. Design. Cross-sectional study. Setting. Reproductive Unit, Sahlgrenska University Hospital, Gothenburg, Sweden. Sample. Four hundred pairs were invited to participate, 71% accepted and 68% completed questionnaires. Methods. Questionnaire study. Study subgroups were compared with a control group with children and with each other. Main outcome measure. Psychological General Well-Being (PGWB), Sense of Coherence (SOC), experience of infertility, demographic-socio-economic and health characteristics were measured. Results. Surprisingly, 76.7% had or lived together with children; 39.6% had biological children, 34.8% had adopted and 3.7% were parents to both biological and adopted children. No differences were found between the study and the control groups, except in SOC which scored lower in the study group. The study group with children had a higher PGWB index than the 23.3% without children and the controls. SOC scored higher in the subgroup with than those without children. Infertility was still a central issue in the subgroup without children. Conclusion. Despite having undergone unsuccessful IVF within the public health system, more than 75% lived with children 4-5.5 years later. This subgroup had a better quality of life, compared to those without children. Additional IVF treatment may result in increased quality of life.

  • 9.
    Adolfsson, Annsofie
    et al.
    University of Skövde, School of Life Sciences.
    Larsson, Per - Göran
    University of Skövde, School of Life Sciences.
    Applicability of general grief theory to Swedish women's experience after early miscarriage, with factor analysis of Bonanno's taxonomy, using the Perinatal Grief Scale2010In: Upsala Journal of Medical Sciences, ISSN 0300-9734, Vol. 115, no 3, p. 201-209Article in journal (Refereed)
    Abstract [en]

    Background. Grief is a normal phenomenon but showing great variation depending on cultural and personal features. Bonanno and Kaltman have nonetheless proposed five aspects of normal grief. The aim of this study was to investigate if women with miscarriage experience normal grief. Material and methods. Content analyses of 25 transcribed conversations with women 4 weeks after their early miscarriages were classified depending on the meaning-bearing units according to Bonanno and Kaltman’s categories. In the factor analyses, these categories were compared with the Perinatal Grief Scale and women's age, number of children and number of miscarriages, and gestational weeks. Results. Women with miscarriage fulfill the criteria for having normal grief according to Bonanno and Kaltman. All of the 25 women had meaning-bearing units that were classified as cognitive disorganization, dysphoria, and health deficits, whereas disrupted social and occupational functioning and positive aspects of bereavement were represented in 22 of 25 women. From the factor analysis, there are no differences in the expression of the intensity of the grief, irrespective of whether or not the women were primiparous, younger, or had suffered a first miscarriage. Conclusion. Women’s experience of grief after miscarriage is similar to general grief after death. After her loss, the woman must have the possibility of expressing and working through her grief before she can finish her pregnancy emotionally. The care-giver must facilitate this process and accept that the intensity of the grief is not dependent on the woman’s age, or her number of earlier miscarriages.

  • 10.
    Adolfsson, Annsofie
    et al.
    University of Skövde, School of Life Sciences.
    Tullander - Tjörnstrand, Karin
    Central Hospital Skövde.
    Larsson, Per-Göran
    University of Skövde, School of Life Sciences.
    Decreased need for emergency services after changing management for suspected miscarriage2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 8, p. 921-923Article in journal (Refereed)
    Abstract [en]

    We investigated the effect of a changed routine to identify women with a nonviable pregnancy, in order to utilize health care resources more efficiently during office hours rather than relying on emergency care services. From hospital register data about where and when women with miscarriages were treated, there was a significant trend during a nine-year period for miscarriages to be more rarely diagnosed (p-value<0.001) in the emergency ward after office hours. The proportion of miscarriages that were diagnosed and handled at the emergency ward decreased from 31% in 2001 to 17% in 2009. Furthermore, the number of women showing up with bleeding at the emergency ward, but who also had a normal viable pregnancy, declined during the same period (p-value<0.01). Women with suspected miscarriage benefit from structured information and standardized management and can effectively be scheduled for day-time assessment including ultrasound with a concomitant reduced need for emergency services.

  • 11.
    Andersson, Ida-Maria
    et al.
    University of Skövde.
    Nilsson, Sandra
    University of Skövde.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    How women who have experienced one or more miscarriages manage their feelings and emotions when they become pregnant again: a qualitative interview study2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 2, p. 262-270Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate how women who have experienced one or more miscarriages manage their feelings when they become pregnant again.

    Method:  Individual qualitative interviews were conducted with 16 women who were pregnant again after experiencing one or more miscarriages. The interviews were analysed using qualitative content analysis with an inductive approach.

    Results: The analysis of the material ended up in five categories: distancing herself from her pregnancy, focusing on her pregnancy symptoms, searching for confirming information, asking for ultrasound examination and asking for professional and social support. Because of their past experience with miscarriage, it could be painful to have another pregnancy terminate in disappointment. Therefore, the women manage their feelings by distancing themselves from their pregnancies. Simultaneously, they are managing their emotions by seeking affirmation that their current pregnancy is normal.

    Conclusion: Generally speaking, women manage their emotions by themselves. They feel isolated with their worries and concerns, and they are in need of the support provided from their intimate circle of friends and family as well as from the staff of the maternity health care ward. Unfortunately, the women do not feel that they get the support they need from the staff, instead they have to rely on their friends, family and partners to help them manage their emotions.

  • 12.
    Dahlén, Ingrid
    et al.
    University of Skövde, School of Life Sciences.
    Westin, Lars
    University of Skövde, School of Life Sciences.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    Experience of being a low priority patient during waiting time at an emergency department2012In: Psychology Research and Behavior Management, ISSN 1179-1578, E-ISSN 1179-1578, Vol. 5, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background: Work in the emergency department is characterized by fast and efficient medical efforts to save lives, but can also involve a long waiting time for patients. Patients are given a priority rating upon their arrival in the clinic based on the seriousness of their problem, and nursing care for lower priority patients is given a lower prioritization. Regardless of their medical prioritization, all patients have a right to expect good nursing care while they are waiting. The purpose of this study was to illustrate the experience of the low prioritized patient during their waiting time in the emergency department. Methods: A phenomenological hermeneutic research method was used to analyze an interview transcript. Data collection consisted of narrative interviews. The interviewees were 14 patients who had waited more than three hours for surgical, orthopedic, or other medical care.Results: The findings resulted in four different themes, ie, being dependent on care, being exposed, being vulnerable, and being secure. Lower priority patients are not paid as much attention by nursing staff. Patients reported feeling powerless, insulted, and humiliated when their care was delayed without their understanding what was happening to them. Not understanding results in exposure that violates self-esteem. Conclusion: The goal of the health care provider must be to minimize and prevent suffering, prevent feelings of vulnerability, and to create conditions for optimal patient well being.

  • 13.
    Ekström, Linnéa
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Adolfsson, Annsofie
    Department of Obstetrics and Gynaecology, Skaraborg Hospital, Skövde, Sweden / School of Health and Medical Sciences, University of Örebro, Örebro, Sweden.
    Ericson, Henrik
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre.
    Poutakidis, Georgios
    Department of Obstetrics and Gynaecology, Skaraborg Hospital, Skövde, Sweden.
    Charonis, Georgios
    Department of Obstetrics and Gynaecology, University of Linköping, Linköping, Sweden / Mitera General and Maternity Hospital, Athens, Greece.
    Larsson, Per-Göran
    Department of Obstetrics and Gynaecology, Skaraborg Hospital, Skövde, Sweden.
    Vaginal flora and urinary and vaginal group B streptococci in early pregnancy2013In: Gynecology, ISSN 2052-6210, Vol. 1, article id 6Article in journal (Refereed)
    Abstract [en]

    Background: Bacterial vaginosis (BV) is a risk factor for premature birth and group B streptococci (GBS) colonizing the vagina are etiological agents of neonatal infections. Significant growth of GBS in the vagina has been assumed to be detectable through urinary culture. The aim was to investigate the correlation between BV and the presence of GBS in qualitative vaginal or quantitative urinary culture, since this could predict a higher risk for perinatal morbidity. Design and setting: A consecutive prospective study of women in early pregnancy included 3101 women between 2007 and 2010, in a region of south-western Sweden. Methods: Vaginal and urine samples were obtained from women in early pregnancy at maternity health care clinics. BV was diagnosed according to the Ison/Hay classification. GBS in urine were detected in amounts as low as 100 CFU/ml. Vaginal culturing for GBS was obtained from a selected group of 481 women. Results: There was no difference in the prevalence of GBS in the urine among women with BV compared with women with lactobacilli flora (OR 0.7; 95% CI 0.4-1.1). Vaginal presence of GBS was found among 17.3% of women with BV and among 23.5% of women with lactobacilli flora (OR 0.7; 95% CI 0.3-1.4). Among the 105 women who had vaginal GBS, the urine culture of GBS was positive in only 21.9% of cases. Conclusions: Even though women with BV. have much higher concentration of bacteria in the vagina, they do not necessarily have more GBS in the vagina or urine. The modest correlation between positive vaginal culture and positive urine culture of GBS question the value of urinary culture for detection of vaginal GBS.

  • 14.
    Eriksson, Katarina
    et al.
    Department of Obstetrics and Gynecology, Ålands Centralsjukhus, Finland.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences. Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköpings University.
    Forsum, Urban
    Department of Obstetrics and Gynecology, Kärnsjukhuset, Skövde.
    Larsson, Per Göran
    University of Skövde, School of Life Sciences.
    Prevalence of BV on the Åland Islands. Reply to Professor Donders2011In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 119, no 3, p. 226-226Article in journal (Refereed)
  • 15.
    Eriksson, Katarina
    et al.
    Linköping University.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    Forsum, Urban
    Linköping University.
    Larsson, Per-Göran
    University of Skövde, School of Life Sciences.
    The prevalence of BV in the population on the Åland Islands during a 15-year period2010In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 118, no 11, p. 903-908Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe the prevalence and age distribution of bacterial vaginosis (BV) during an observation period of 15 years in a population study with cross-sectional samples of adult women living on the Åland Islands. The Åland Islands form an archipelago in the Baltic Sea and are a province of Finland. Every fifth year, specific age groups in the adult female population are invited to participate in a screening program for early diagnosis of cervical cancer using a papanicolaou (PAP)-stained vaginal smear. Women in the age groups of 20, 25, 30, 35, 40, 45, 50, 55, and 60 years are called each year. BV diagnosis of the PAP-stained smears uses the classification according to Nugent. The PAP-stained smears from the screening program of cervical cancer 1993, 1998, 2003, and 2008 were used in this study. A total of 3456 slides were investigated and 271 women could be followed for the 15-year observation period. The prevalence of BV declined from 15.6% in 1993 to 8.6% in 2008. The highest prevalence occurred among the age groups of 35 and 50 years. Among the 271 women who could be followed for the 15-year observation period, two-third showed normal ⁄ intermediate flora and one-third were infected with BV at least once. As this is a cross-sectional population study spanning 15 years, the prevalence of BV in the female adult population of the Åland Islands can be estimated. The prevalence has declined between 1993 and 2008 from 15.6% to 8.6%.

  • 16.
    Hogström, Lars
    et al.
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden.
    Johansson, Marianne
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden / Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / School of Health Sciences, University of Borås, Borås, Sweden.
    Jansson, Per Olof
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Berg, Marie
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Francis, Jynfiaf
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sogn, Jan
    Department of Obstetrics and Gynecology, Central Hospital, Uddevalla, Sweden.
    Hellström, Anna-Lena
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences. Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden.
    Quality of life after adopting compared with childbirth with or without assisted reproduction2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 9, p. 1077-1085Article in journal (Refereed)
    Abstract [en]

    Objective. This study compares quality of life among couples who had adopted a child 4–5.5 years previously with couples whose conception was spontaneous, as well as with couples who had successful or unsuccessful in vitro fertilization (IVF) treatment. Design. Cross-sectional study. Setting. Tertiary level university hospital. Sample. From the following groups, 979 responses were obtained: adoption; successful IVF; unsuccessful IVF–living with children; unsuccessful IVF–living without children; and childbirth after spontaneous conception (controls). Methods. Quality of life was studied with the Psychological General Well Being (PGWB) and Sense of Coherence (SOC) instruments. Demographic, socio-economic and health data were obtained with additional questionnaires. Multiple variance analysis was applied. Main outcome measures. The PGWB and SOC scores. Results. After adjustment for seven confounders, the adoption group had higher PGWB scores than the unsuccessful IVF–living without children and the controls and higher SOC scores than all other groups. The unsuccessful IVF–living without children had lower PGWB and SOC scores than all other groups. The PGWB and SOC scores among controls did not differ from those with successful IVF or unsuccessful IVF–living with children. Conclusions. Adjusted PGWB and SOC scores revealed a high quality of life in the adoption group. However, the group unsuccessful IVF–living without children had low quality of life scores. Quality of life appears to be independent of the outcome of IVF treatment as long as there are children in the family.

  • 17.
    Jansson, Caroline
    et al.
    Division of Reproductive and Perinatal Health Care, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    A Swedish study of midwives' and nurses' experiences when women are diagnosed with a missed miscarriage during a routine ultrasound scan2010In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 1, no 2, p. 67-72Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim was to describe midwives’ and nurses’ experiences when women are diagnosed with a missed miscarriage during a routine ultrasound scan in pregnancy weeks 18–20.

    Study designs: A qualitative content analysis with an inductive approach and 13 semi-structured interviews were used for data collection from these three domains: midwives at an ultrasound department, midwives at a maternity clinic and nurses at a gynecological ward. Content analysis resulted in six codes, four categories and one primary theme.

    Main outcome measures: The four categories identified were: the interviewees’ experiences of women’s reactions, support from the midwife and nurse, the interviewees’ experiences of men’s reactions and communication between care providers and women. The main theme focused on the interviewees’ noting that women had a premonition that something was wrong with their pregnancy. This could for example have been in the form of minor bleeding or the fact that pregnancy symptoms had receded and there were no movements by the fetus. The midwives carried out a follow-up with assessment.

    Conclusions: Women need confirmation of their premonitions of a missed miscarriage so that a diagnosis can be made as early as possible in their pregnancy. Women and their partners who have suffered a missed miscarriage need extended support on an individual basis in addition to follow-up assistance as assessed by the midwives.

  • 18.
    Jansson, Caroline
    et al.
    Division of Reproductive and Perinatal Health Care, Department of Women’s Health, Karolinska Institutet, Stockholm, Sweden.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    Application of "Swanson's Middle Range Caring Theory" in Sweden after miscarriage2011In: International Journal of Clinical Medicine, ISSN 2158-284X, E-ISSN 2158-2882, Vol. 2, no 2, p. 102-109Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to apply Swanson’s Middle Range Caring Theory to the follow-up visit with a midwife for Swedish women who have suffered early miscarriage or received care for late missed miscarriage in pregnancy week 18-20. Methods: Twenty-five tape recorded interviews with women four weeks after their early miscarriages and thirteen tape recorded semi-structured interviews with midwives and nurses who had the experience of caring for women who have been diagnosed with a missed miscarriage during a routine ultrasound scan. The interviews were transcribed verbatim and interpreted deductively from the text using the theory. Results: Each woman described her personal experience of miscarriage in the relative terms of a human experience. The midwives and nurses described their experiences with women who received care for missed miscarriage. The interviews included information about the treatment provided by the caregivers during the period afterward of the diagnosis. The caregiver attitude was formed from Swanson’s caring categories: “Maintaining belief”, “knowing”, “being with”, “doing for”, “enabling”. Conclusions: Swanson’s Middle Range Caring Theory as applied to the caregiver includes being emotionally present, giving support with respect for the woman’s dignity, being competent, meeting each woman’s own individual needs. Given the proper care after a miscarriage every woman has the power within herself to improve their wellbeing.

  • 19.
    Johansson, Ann - Marie
    et al.
    University of Skövde, School of Life Sciences.
    Landahl, Inga
    University of Skövde, School of Life Sciences.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    How the Health Care Nurse Supports and Enhances the Child’s Attachment to Their Parents2011In: International Journal of Clinical Medicine, ISSN 2158-284X, E-ISSN 2158-2882, Vol. 2, p. 418-428Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to provide insight into how the Child Healthcare Clinic (BVC) nurse supports and encourages  the  child’s  bonding  to  their  parents  during  the  regularly  scheduled  checkups  at  the  healthcare  clinics. Method: The study was done using a qualitative approach. The data was collected from the interviews of four focus groups which were comprised of a total of eighteen BVC nurses who work solely for the BVC. The resulting data was analyzed  using  qualitative  content  analysis.  Results:  The  following  theme  emerged  from  the  research  material:  Empower the parents in order to enable the child to have a healthy connection to the parents. This is accomplished by the BVC nurse building and creating a trusting relationship with the parents and providing support for them in their new roles as parents. The BVC nurses must have comprehensive knowledge about the needs and development of children and they need to have exceptional communication skills as well. It is also mandatory that the BVC nurse have access to cooperation  and  support  from  their  colleagues  and  the  support  of  other  related  professions.  Conclusion:  Providing support to parents during the bonding period of their infant children is a most important function for BVC nurses because there is much to be determined about children’s development and future possibilities during this formative period.  

  • 20.
    Johansson, Marianne
    et al.
    Sahlgrenska Academy, University og Gothenburg.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    Berg, Marie
    Sahlgrenska Academy, University of Gothenburg.
    Francis, Jynfiaf
    Sahlgrenska University Hospital.
    Hogström, Lars
    Central Hospital, Skövde.
    Janson, Per Olof
    Sahlgrenska Academy, University of Gothenburg.
    Sogn, Jan
    Central Hospital, Uddevalla.
    Hellström, Anna-Lena
    Sahlgrenska Academy, University of Gothenburg.
    Gender perspective on quality of life, comparisons between groups 4-5.5 years after unsuccessful or successful IVF treatment2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 5, p. 683-691Article in journal (Refereed)
    Abstract [en]

    Objective. To describe and compare quality of life in men and women who had in vitro fertilization (IVF) within the Swedish public health system 4–5.5 years previously, either unsuccessfully and were subsequently living without children, or successfully, having children aged 4–5.5 years. These groups were compared to a control group of men and women with children born at the same time as in the successful group. Design. Cross-sectional study. Setting. Reproductive Unit Sahlgrenska University Hospital, Gothenburg, Sweden. Sample. Twenty-six men and 37 women in the unsuccessful group, 135 men and 154 women in the successful group and 93 men and 118 women in the control group. Methods. Questionnaire study. The respective gender differences were studied in the control and study groups. Main outcome measures. Psychological general well-being (PGWB), sense of coherence (SOC), experience of infertility, demographic-socio-economic, and health characteristics. Results. Men in the unsuccessful IVF group scored lower in total PGWB and SOC indices than the successful group men. They reported more depression, lower PGWB and lower SOC than the control group men. Women in the unsuccessful IVF group reported more anxiety, depression, and lower SOC than the successful group women and more depression and lower SOC indices than control group women. Men and women in the unsuccessful IVF group did not differ in any of the parameters. Men in the successful IVF group had higher PGWB, less signs of depression and more self-confidence than women in that group. Conclusion. Quality of life in men seems more negatively affected by involuntary infertility than reported in earlier studies.

  • 21.
    Norling - Gustafsson, Ann
    et al.
    University of Skövde, School of Life Sciences.
    Skaghammar, Katarina
    University of Skövde, School of Life Sciences.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    Expectant parents’ experiences of parental education within the antenatal health service2011In: Psychology Research and Behavior Management, ISSN 1179-1578, E-ISSN 1179-1578, Vol. 4, p. 159-167Article in journal (Refereed)
    Abstract [en]

    Being an expectant parent is a life changing event and it is something that most people will experience in their lifetime. Many people who are parents for the first time will participate in parenting education. Most of the previous studies associated with parenting education focus on subjects such as birth outcome and breastfeeding. The purpose of this study is to focus on the less investigated aspect of the parents’ experience of participating in parenting education with Maternal Healthcare Services (MVC). A qualitative, phenomenological, hermeneutical method was selected to be used to analyze our findings and we used the statements of twenty participants to accumulate enough material to develop it into twelve sub-themes and five themes. The results of this study show that these expectant parents had few or no expectations of the parenting education that they were going to participate in. Generally speaking the parents seemed to be satisfied with the program. They described their reasons for participating as a chance to get together with other people in similar circumstances and to share information and they found a midwife to be a trustworthy professional person to confirm the information that was available to them from other sources.

  • 22.
    Olsson, Agneta
    et al.
    University of Skövde, School of Life Sciences.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    Midwife’s experiences of using intuition as a motivating element in conveying assurance and care2011In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 3, no 7, p. 453-461Article in journal (Refereed)
    Abstract [en]

    The expectations of a successful outcome during childbirth are high for all of the parties concerned. The overall objective of prenatal care and birth care is that midwives contribute to create the most positive experience for the expectant parents concerning their pregnancy, the actual childbirth and the child’s infancy. During the past thirty years, there has been a significant increase in Caesarean section frequency both in Sweden and in the rest of the Western World. More parents feel an overall insecurity when it comes to the labor phase leading up to childbirth. The purpose of this study was to describe how midwives experience their work of creating a sense of security and providing good nursing care when meeting with the expectant parents. A phenomenological approach was implemented using eleven qualitative interviews and these were analyzed with Giorgis’ method of analysis. The results of this analysis revealed three themes: organizational-professional conditions, the communicative ability of the midwives and their reflective-emotional competence. The ability of the midwives to trust their inner sensibility and intuition was something that was characteristic of all the interviews and consequently this was the essence of the results. Managements’ organization of the workload and how management utilized competent and experienced midwives affected the midwives’ ability to contribute to a sense of security and provide competent nursing care for expectant parents. When the communication was based on sensibility and compassion, the midwives’ were enabled to create a sound and trusting relationship between themselves, the MVC and with the expectant parents. The emotional involvement on the part of the midwives was an essential requirement for carrying out the work in a satisfactory manner. Perhaps a question for future research is how inner knowledge based on practical experience can benefit new personnel and how the organization and the education of healthcare providers can utilize the intuitive knowledge of midwives.

  • 23.
    Rosebrink, Malin
    et al.
    University of Skövde, School of Life Sciences. Kvinnokliniken, Skaraborgs Sjukhus KSS.
    Zekaj, Milihate
    University of Skövde, School of Life Sciences. Kvinnokliniken, Skaraborgs Sjukhus KSS.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences. Kvinnokliniken, Skaraborgs Sjukhus KSS.
    Kvinnors upplevelser av tidig graviditet, efter att ha upplevt ett eller flera missfall tidigare i livet2012In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 32, no 1, p. 4-8Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe women’s experiences of early pregnancy after their experience of earlier miscarriage(s).

    Method: This study used a qualitative method with a phenomenological perspective. Midwives working in Maternity Healthcare Center were intermediaries in the data collection. The analysis material consisted of six open interviews with women in early stages of pregnancy that have experienced miscarriage in the past. The data analysis created an essence of the women´s experiences.

    Results: All of the interviewees are happy to be pregnant. For some of the women the happiness is mixed with worry about experiencing another miscarriage. They are reluctant to experience the grief and loss that had accompanied their previous miscarriages. Those women are able to explain their misgivings to friends and family experience less worry and reluctance. A positive outlook for their pregnancy and to see miscarriage as something natural makes it easier to live with the outcomes.

    Conclusion: Women who have had a previous experience of miscarriage have mixed feelings of happiness and worry in early stages of pregnancy. Those women that choose to think positively accept miscarriage as part of nature’s way and feel an inner peace. All of the women realize the importance of finding peace in their pregnancy.

  • 24.
    Wilsson, Margareta
    et al.
    University of Skövde, School of Life Sciences. Primary Health, Mariestad, Sweden.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences. Department of Obstetrics and Gynecology, Skaraborg Hospital, Skövde, Sweden.
    Mother’s need of support and their expectations of the BVC nurse at the first home visit: an interview study2011In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 1, no 3, p. 1-8Article in journal (Refereed)
    Abstract [en]

    One of the main priorities of the child healthcare services in Sweden is a home visit by the Child Health Care (BVC) nurse to newborn babies and their parents. It is essential that the BVC nurses have a comprehensive knowledge of the parent’s need of support and their expectations as new parents in order to be able to fulfill their needs. The aim of this study was to describe what type of support the mothers of infant children are in need of and what their expectations are of the BVC nurse when it is time for the home visit from the nurse. In this qualitative study twelve women were interviewed within one to two weeks after delivering a baby. The transcripts were analyzed using qualitative content analysis. The study shows that mothers who have previously given birth to children feel more secure in their parental role compared to what they experienced as first time mothers. The findings include that first time mother’s experienced uncertainty in their new role as a mother and caring for a baby. Parents seek support from the BVC nurse and they expect her behavior and attitude towards them to be friendly and professional. The fact that she is privy to personal knowledge of the family gives the parents a feeling of security when they contact the child healthcare center for various reasons. The mother’s need for support to develop as a parent and to feel secure in the parental role was a reoccurring theme in the interviews and became the theme of the study.

  • 25.
    Wojnar, Danuta M.
    et al.
    Seattle Univ, Coll Nursing, Seattle, WA 98122 USA.
    Swanson, Kristen M.
    Univ N Carolina, Sch Nursing, Chapel Hill, NC USA.
    Adolfsson, Ann-Sofie
    University of Skövde, School of Life Sciences.
    Confronting the inevitable: A conceptual model of miscarriage for use in clinical practice and research2011In: Death Studies, ISSN 0748-1187, E-ISSN 1091-7683, Vol. 35, no 6, p. 536-558Article in journal (Refereed)
    Abstract [en]

    In spite of scientific evidence that miscarriage has negative psychological consequences for many individuals and couples, silence and dismissal continue to surround this invisible loss in North American culture and beyond. The grief and sorrow of miscarriage has important implications for clinical practice. It indicates a need for therapeutic interventions delivered in a caring, compassionate, and culturally sensitive manner. This research, based on data from 3 phenomenological investigations conducted with 42 women from diverse geographical locations, sexual orientations, and cultural backgrounds offers a theoretical framework for addressing miscarriage in clinical practice and research.

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