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  • 1.
    de Groot, Gudrun Cathrine Lindgren
    et al.
    Telemark Hospital, Norway / Buskerud University College, Norway.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur. Buskerud University College, Norway / Lovisenberg Deaconale University College, Norway.
    Older adults' motivating factors and barriers to exercise to prevent falls2011Ingår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 18, nr 2, s. 153-160Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to describe motivating factors and barriers for older adults to adhere to group exercise in the local community aiming to prevent falls, and thereby gain knowledge about how health professionals can stimulate adherence. The motivation equation was used as a theoretical framework. Data were collected from individual semi-structured interviews (n = 10). The interviews were taped, transcribed, and thereafter analysed by using a descriptive content analysis consisting of four steps. The results showed that motivating factors to adhere to recommended exercise were perceived prospects of staying independent, maintaining current health status, and improving physical balance and the ability to walk. Barriers were reduced health status, lack of motivation, unpleasant experience during previous exercise group sessions, and environmental factors. All participants wanted information from health professionals on the benefit of exercise. Many considered individual variations in functional skills within each group as a disadvantage. The knowledge gained from this study suggests a greater involvement from all health professionals in motivating older adults to attend exercise groups. The results also suggest that physical therapists should be more aware of the importance of comparative levels of physical function when including participants in exercise groups.

  • 2.
    Eriksson, Irene
    et al.
    Högskolan i Skövde, Institutionen för vård och natur.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur.
    Olofsson, Birgitta
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University.
    Prevalence and factors associated with urinary tract infections (UTIs) in very old women2010Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 50, nr 2, s. 132-135Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to describe the prevalence of urinary tract infection (UTI) and associated factors among very old women. In a cross-sectional, population-based study in Sweden and Finland, 532 women were asked to participate and 395 (74.2%) were possible to evaluate for UTI. Data were collected from structured interviews and assessments made during home visits, from medical charts, caregivers and relatives. UTI diagnosis documented in medical records during the preceding 1 and 5 years was registered. About one-third (117/395, 29.6%) were diagnosed as having suffered from at least one UTI in the preceding year and 60% in the preceding 5 years. In a multivariate logistic regression model, UTI in the preceding year, was associated with vertebral fractures (odds ratio (OR) = 3.2; 95% confidence interval (95% CI) = 1.4–7.1), incontinence (OR = 2.8; 95% CI = 1.8–4.5), inflammatory rheumatic disease (OR = 2.8; 95% CI = 1.4–5.7) and multi-infarct dementia (OR = 2.4; 95% CI = 1.3–4.5). UTI is a major public health problem in very old women and were independently associated with vertebral fractures, urinary incontinence, inflammatory rheumatic disease and multi-infarct dementia which might indicate that UTI is not a harmless disease.

  • 3.
    Eriksson, Irene
    et al.
    Högskolan i Skövde, Institutionen för vård och natur. Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur. Department of Health and Life Sciences, University of Buskerud, Kongsberg, Norway.
    Olofsson, Birgitta
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden / Department of Nursing, Umeå University, Umeå, Sweden.
    Urinary tract infection in very old women is associated with delirium2011Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 23, nr 3, s. 496-502Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The aim of the study was to investigate whether urinary tract infection (UTI) in a representative sample of 85-, 90- and ≥95-year-old women is associated with delirium.

    Methods: In 504 out of 643 women (78.4%) it was possible to evaluate UTI and delirium. Assessments such as the Organic Brain Syndrome (OBS) Scale, the Geriatric Depression Scale-15 (GDS-15) and the Mini-mental State Examination (MMSE) were performed during home visits. Delirium, dementia and depression were diagnosed according to the DSM-IV criteria. A diagnosed, symptomatic UTI with or without ongoing treatment, documented in medical records or detected in association with the assessments, was registered.

    Results: Eighty-seven of 504 women (17.2%), were diagnosed as having a UTI with or without ongoing treatment when they were assessed, and almost half of them (44.8%) were diagnosed to be delirious or having had episodes of delirium during the past month. One hundred and thirty-seven of the 504 women (27.2%) were delirious or had had episodes of delirium during the past month and 39 (28.5%) of them were diagnosed to have a UTI. In a multivariate logistic regression model, delirium was significantly associated with Alzheimer's disease (OR = 5.8), multi-infarct dementia (OR = 5.4), depression (OR = 3.1), heart failure (OR = 2.3) and urinary tract infection (OR = 1.9).

    Conclusions: A large proportion of very old women with UTI suffered from delirium which might indicate that UTI is a common cause of delirium. There should be more focus on detecting, preventing and treating UTI to avoid unnecessary suffering among old women.

  • 4.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur. Buskerud University College, Drammen, Norway / Åbo Akademi University, Vaasa, Finland.
    Benchmarking by the RAFAELA Patient Classification System: a Descriptive Study of Optimal Nursing Intensity Levels2009Ingår i: Connecting Health and Humans: Proceedings of NI2009 - the 10th International Congress on Nursing Informatics / [ed] Kaija Saranto, Patricia Flatley Brennan, Hyeoun-Ae Park, Marianne Tallberg and Anneli Ensio, IOS Press, 2009, s. 25-29Konferensbidrag (Refereegranskat)
    Abstract [en]

    The overall aim of the RAFAELA system is that the personnel resources should be in balance with the patients' caring needs, i.e. when the nursing intensity per nurse is on the optimal level of the unit. The RAFAELA system consists of three parts: the OPCq (Oulu Patient Classification Qualisan) instrument for measuring the nursing intensity, registration of the daily nursing resources and the PAONCIL (Professional Assessment of Optimal Nursing Care Intensity Level) method. The aim of this paper is (1) to describe the structure of benchmarking with the RAFAELA system and (2) to present comparisons of optimal nursing intensity levels in Finnish hospitals by using data from RAFAELA benchmarking reports in 2001. Totally 86 wards from 14 different hospitals in Finland took part in the study, the optimal nursing intensity had been decided for 53 wards. Data was analyzed using descriptive statistics. The avarage workload was on adult wards 25.2 NCI points per nurse. The optimal NCI was exceeded during 48% of the days and under during 22% of the days. An imbalance between nursing intensity and personnel resources clearly affects the care quality and the results. Benchmarking with the RAFAELA system provides nurse managers with many opportunities in their decision processes in human resource management.

  • 5.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur.
    Developing the scope of practice and education for advanced practice nurses in Finland2009Ingår i: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 56, nr 2, s. 269-272Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The reorganization of Finnish healthcare services has required a restructuring of the areas of responsibility between healthcare professionals.

    Aim: To describe the need for Advanced Practice Nurses in Finland and the development process of a Master's programme in Health Promotion, Advanced Clinical Care.

    Methods: The study consisted of a survey of nurse managers (24) and focus group interviews with clinical nurse specialists (46).

    Findings: The expanded role includes advanced clinical skills and responsibility for health prevention and promotion, education, supervision, leadership, research and development.

    Conclusions: The legislation, scope and models have to be supported and further developed to promote the full scope of advanced practice.

  • 6.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur.
    Dialektik som metod och förhållningssätt i vårdvetenskaplig forskning2008Ingår i: X Nationella vårdvetenskapliga konferensen: Vårdvetenskap i hälsans och vårdandets tjänst, Åbo Akademis Förlag, 2008, s. 39-44Konferensbidrag (Refereegranskat)
  • 7.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur. Buskerud University College, Drammen, Norway / Lovisenberg Deaconale, University College, Oslo, Norway.
    Evidence-based human resource management: a study of nurse leaders' resource allocation2009Ingår i: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 17, nr 4, s. 415-425Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims The aims were to illustrate how the RAFAELA system can be used to facilitate evidence-based human resource management.

    Background The theoretical framework of the RAFAELA system is based on a holistic view of humankind and a view of leadership founded on human resource management.

    Methods Nine wards from three central hospitals in Finland participated in the study. The data, stemming from 2006–2007, were taken from the critical indicators (ward-related and nursing intensity information) for national benchmarking used in the RAFAELA system. The data were analysed descriptively.

    Results The daily nursing resources per classified patient ratio is a more specific method of measurement than the nurse-to-patient ratio. For four wards, the nursing intensity per nurse surpassed the optimal level 34% to 62.2% of days. Resource allocation was clearly improved in that a better balance between patients' care needs and available nursing resources was maintained.

    Conclusions The RAFAELA system provides a rational, systematic and objective foundation for evidence-based human resource management.

    Implications for nursing management Data from a systematic use of the RAFAELA system offer objective facts and motives for evidence-based decision making in human resource management, and will therefore enhance the nurse leaders' evidence and scientific based way of working.

  • 8.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur.
    Kliniska expertsjukskötare2008Ingår i: Epione, Sjuksköterskeföreningen i Finland , 2008, s. 21-31Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 9.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur.
    Positive life orientation - an inner health resource among older people2010Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, nr 2, s. 349-356Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    As pertains to life orientation, the study's conceptual framework demonstrates the importance of close relationships, meaning in life, and the strength of individuals to look forward and make plans for future. The aim of this study is to discover, in relation to background factors such as language, living situation, and culture, how people aged 65 and 75 experience life orientation. The study is a population-based cross-sectional survey with its material taken from 3,370 questionnaires which included the six-question Life Orientation scale. The SPSS static program, version 14.0, was used for all calcuations and the Chi-squared test was applied to determine if any significant differences between the groups existed. As seen in this study, most respondents aged 65 (85%) and 75 (73.2%) experienced a high degree of positive life orientation, clearly expressing a zest for life (93.5%), overall satisfaction with their lives (88.4%), and feelings of being needed (83.7%). Lower scores were given for never/seldom being depressed/sad (55.3%) and never/seldom feeling lonely (71.8%). Approximately every second respondent (51.9%) had plans for the future. A clear decreasing trend was seen in all questions for respondents aged 75 in comparison to those aged 65: only ``are you satisfied with life?'' showed no significant differences. Language/culture seems to clearly affect experiences of life orientation and well-being. Additionally, older people living alone reported significantly more negative response to all dimensions of life orientation. Positive life orientation is an important inner health resource for older. Accordingly, health promotion for older people should focus on facilitating the maintenance of important and close relationships and should include supporting older people's need to be needed.

  • 10.
    Fagerström, Lisbeth
    et al.
    Högskolan i Skövde, Institutionen för vård och natur.
    Salmela, Susanne
    Åbo Akademi University.
    Leading change: a challenge for leaders in Nordic health care2010Ingår i: Journal of Nursing Management, ISSN 1365-2834, Vol. 18, nr 5, s. 613-617Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: The aim of the present study was to describe personnel's attitudes to change processes between a regional hospital and the primary health care centre as well as investigate these results with regards to theories pertaining to change and leading change. Background: Leadership has three crucial dimensions: focusing on personnel, results/key processes and the ethical base of activities. Methods: A survey was conducted in 2003 using a comprehensive questionnaire. The total sample consisted of the personnel (n = 899) at the two organizations (answering rate was 68.8%). The data were analysed descriptively. Results: Approximately two-thirds of the respondents understood why the merger was occurring. Only one-third expressed that they had received sufficient information regarding the merger. In total 67% felt that the merger would create conflict while approximately one-fourth expressed uncertainty. Despite such negative responses, approximately two-thirds felt there were advantages to the merger. Significant differences were seen between the groups. Conclusions: In times of change personnel expect leaders to focus on dialogue with their personnel and to anchor the vision of the change process amongst the personnel. Implications for nursing management: By identifying the 'prison of thought' and creating an atmosphere where reflection and discussion are valued the nurse leader can help prevent resistance to change.

  • 11.
    Fagerström, Lisbeth
    et al.
    Högskolan i Skövde, Institutionen för vård och natur. Department of Health Sciences, Buskerud University College, Drammen, Norway.
    Wikblad, Annika
    Svenska University of Applied Sciences, Vaasa, Finland.
    Nilsson, Jenny
    Svenska University of Applied Sciences, Vaasa, Finland.
    An integrative research review of preventive home visits among older people: is an individual health resource perspective a vision or a reality?2009Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, nr 3, s. 558-568Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study has two aims: (i) to explore and evaluate the health-promoting effect of preventive home visit (PHV) by analysing the activities conducted during the PHV and the reported results, and (ii) to critically analyse if PHV is characterized by an individualized health resource perspective. The material was compiled through a systematic literature search in the databases Ebsco, CINAHL, Medline, Science Direct and CSA from the period 1984 to 2004. The result of the systematic database search was a total number of 49 scientific research articles, of which 18 are included in this study. The analysing method was a four-step integrating research review. The review describes the following content concerning (i) activities during home visits: screening, observation and evaluation, guidance, support, referral to care and other services, follow-up and individual aim; (ii) positive effects: reduced mortality, improved ability to function, improved life quality, improved subjective health, fewer admittances for care, older people's experiences of home visits and increased knowledge on health and (iii) unclear/negative effects: admittance to care, no effect on mortality, unaffected ability to function, unaffected general health and uninfluenced life quality. PHVs had been implemented based on an individual perspective in a total of 13 studies out of 18. The focus on sickness was surprisingly clear, and in 10 studies out of 18 a health resource perspective was lacking. The effects of PHVs have been questioned. Despite this, current research results imply that this method has a positive affect on older people's health and well-being. This form of care must still be developed to include extensive screenings and interventions, as well as a health resource perspective where the starting point during every home visit is the older person's individual needs and wishes.

  • 12.
    Frilund, Marianne
    et al.
    Yrkeshögskolan Novia University of Applied Sciences, Vaasa, Finland.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur.
    Managing the optimal workload by the PAONCIL method: a challange for nursing leadership in care of older people2009Ingår i: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 17, nr 4, s. 426-434Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim The aim of the study was to test the ability of the professional assessment of optimal nursing care intensity level (PAONCIL)-method to establish the optimal nursing intensity (NI) per care giver within the care of older people by testing whether the method's prerequisites for hospital settings can be fulfilled within the care of older people as well.

    Background The PAONCIL method is included in the RAFAELA system as a method for calculating personnel resources based on NI.

    Method The PAONCIL assessments were collected through questionnaires (n = 3512). The data was analysed by simple linear regression analysis.

    Results It can be stated that the prerequisites for the PAONCIL method were fulfilled and that the optimal NI-level could be determined on seven participating units.

    Discussion It can be stated that the RAFAELA system is a useful system for measuring NI within the care of older people, but additional research is needed, especially within the home care setting.

    Conclusion Although an instrument never provides a complete overview of the patient's care needs and need satisfaction, it provides information about the daily situation as well as gives guidelines for long-term strategic planning.

  • 13.
    Frilund, Marianne
    et al.
    Yrkeshögskolan Novia University of Applied Sciences, Vaasa, Finland.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur. Buskerud University College, Drammen, Norway / Åbo Akademi University, Vaasa, Finland.
    Oulu Patient Classification Instrument within Primary Health Care2009Ingår i: Connecting Health and Humans: Proceedings of NI2009 - The 10th International Congress on Nursing Informatics / [ed] Kaija Saranto, Patricia Flatley Brennan, Hyeoun-Ae Park, Marianne Tallberg, Anneli Ensio, IOS Press, 2009, s. 30-35Konferensbidrag (Refereegranskat)
    Abstract [en]

    As patients have become older their care needs have increased, and this has consequences for the work conditions within primary health care. Objectives: The aim of this study was to evaluate, whether the OPC instrument, which has been developed for hospital care, is valid and useful within primary healthcare for older people. Materials and Methods: Reliability and validity testing of the OPC instrument was carried out at a health care centre in Eastern Finland spring 2004. A total number of 92 questionnaires were handed out, and the response rate was 67% (n=61) in order to test the validity. The inter-rater reliability was tested through parallel classification. A total number of 860 patient's were classified; in total 1722 classifications were done. Cohens Kappa was chosen as the measurement for the consensus between the nurses' classification. Results: The consensus of the NI scores in total (OPC points) was 71%. The consensus measured with Kappa (k) showed a strong (0.65) consensus degree. Discussion: It can be said that the OPC instrument achieved a high enough reliability and validity in order to be seen as a reliable and useful instrument to measure the NCI within primary healthcare for the elderly. Conclusion: The OPC instrument can be seen as providing a fairly comprehensive view of the patient's caring needs, without claiming to be covering everything.

  • 14.
    Frilund, Marianne
    et al.
    Åbo Akademi University, Vaasa.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur.
    Validity and reliability testing of the Oulu patient classification: instrument within primary health care for the older people2009Ingår i: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 4, nr 4, s. 280-287Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim. The aim of the study was to evaluate the reliability and validity of The Oulu Patient Classification (OPC) instrument to see whether the instrument that has been developed for hospital care is valid and useful within primary health care for older people.

    Background. Although different patient classification instruments have been under development since the 1960s, this is still a very important research area today.

    Method. Inter-rater reliability testing of the OPC instrument was undertaken. The inter-rater reliability was tested through parallel classification (n = 1722). Validity testing was conducted as an expert validation of the manual for the OPC instrument, using a questionnaire during June and July of 2005 (n = 61).

    Results. The inter-rater reliability testing achieved over 70% consensus, Cohen's Kappa showed a strong consensus for OPC classifications (0.65). The reliability measured with Cronbach's Alpha was also acceptable.

    Conclusion. The results show that the OPC instrument provides a good overview of the patient's care needs and is a reliable instrument within primary health care for older people.

  • 15.
    Glasberg, Ann-Louise
    et al.
    Yrkeshögskolan Novia, University of Applied Sciences, Seriegatan 2, FIN 65320 Vasa.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur.
    Räihä, Gunilla
    Yrkeshögskolan Novia, University of Applied Sciences, Seriegatan 2, FIN 65320 Vasa.
    Jungerstam, Susanne
    Yrkeshögskolan Novia, University of Applied Sciences, Seriegatan 2, FIN 65320 Vasa.
    Erfarenheter av den nya yrkesrollen som klinisk expertsjukskötare: en kvalitativ studie2009Ingår i: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 29, nr 2, s. 33-37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Recommendations from national Finnish projects indicate the need for reorganization of future healthcare, raising the question of an advanced role for nurses. The first Advanced Practice Nurse (APN) course in Finland started in January 2005, at the University of Applied Sciences in Vaasa. The course concentrated on two main areas, assessment of acute care needs and care of patients with chronic diseases. Seventeen students completed their education in December 2006. The purpose of this study was to describe the consequences of the APN role from a personal and an organizational perspective.All 17 APNs who completed their education where interviewed. The interviews focused on the role of the APN, possible changes in working patterns, and attitudes towards the role. The interviews were analysed using qualitative content analysis.Results shows a great need for APNs in the clinics, however there are still much role confusion and attitudes are still pending. Some indicate that the content of their work has not changed at all. Others describe both increased responsibility and autonomy. However, everyone described that the education program had influenced them in their work: they describe an increased competence and capability; and altered notions of security and work satisfaction.

  • 16.
    Jonsén, Elisabeth
    et al.
    Umeå University.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur. Department of Health Sciences, Buskerud University College, Drammen, Norway / Lovisenberg Deaconale University College, Oslo, Norway.
    Lundman, Berit
    Umeå University.
    Nygren, Björn
    Umeå University.
    Vähäkangas, Magdalena
    Department of Caring Science, Åbo Academy University, Vaasa, Finland.
    Strandberg, Gunilla
    Umeå University.
    Psychometric properties of the Swedish version of the Purpose in Life scale2009Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, nr 1, s. 41-48Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to test the theoretical assumptions beyond the Purpose in Life (PIL) scale, and to elucidate the underlying structure of the Swedish version of the PIL. The PIL, originally created by Crumbaugh and Maholick, is a 20-item scale of the Lickert type with possible scores ranges from 20 to 140, the higher score, the stronger PIL. The analysis was based on 449 participants, 62% of whom were women, from five different samples, ranging from 19 to 103 years old. An exploratory factor analysis restricted to three factors was performed. The factors were labelled meaning in existence, freedom to create meaning in daily life, and will to find meaning in future challenges. These factors reflected the three dimensions described by Frankl. Cronbach's alpha coefficient for the total scale was 0.83 and varied between 0.54 and 0.83 in the three factors. We concluded that the Swedish version of the PIL scale seems to have construct validity and reliability. Our results give support to the fact that the PIL scale captures and confirms the theoretical assumptions of Frankl's existential theory. We consider the PIL scale to be both feasible and appropriate for use in nursing research.

  • 17.
    Lindblad, Emma
    et al.
    University of Stockholm.
    Hallman, Elsie-Britt
    Högskolan i Skövde, Institutionen för vård och natur.
    Gillsjö, Catharina
    Högskolan i Skövde, Institutionen för vård och natur.
    Linblad, Ulf
    Örebro University.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur.
    Experiences of the new role of advanced practice nurses in Swedish primary health care - A qualitative study2010Ingår i: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 16, nr 1, s. 69-74Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to investigate and describe the experiences of the first advanced practice nurses (APNs), a new profession for Swedish health care, and of their supervising general practitioners (GPs), regarding the new role and scope of practice of APNs in primary health care. Individual interviews were conducted with the four first APNs and one focus group interview was conducted with five supervising physicians. The material was transcribed verbatim and analysed using latent content analysis. The respondents expressed confidence and trust in the new role of APNs. Some opposition to this new role from the GPs and other colleagues was observed, but was nonetheless overcome. The experiences of the APN role indicate that the new role is clearly demarcated from the role of physicians. The APNs were considered an extra resource for both the GPs and other nurses, which contributed to an increased availability of care for patients. The APN role requires an explicit definition and demarcation in relation to responsibility and roles among colleagues. Further development of the APN role presupposes the right to prescribe medication and order treatments, as well as an evaluation of patient, organizational and inter-professional perspectives on the matter.

  • 18.
    Slåtten, Kari
    et al.
    Lovisenberg Diaconal University College, Oslo.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur. Lovisenberg Diaconal University College, Oslo / Buskerud University College, Drammen, Norway.
    Hatlevik, Ove Edvard
    Center for ICT in Education, University of Oslo, Blindern, Oslo, Norway.
    Clinical competence in palliative care in Norway: the importance of good care routines2010Ingår i: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 16, nr 2, s. 80-86Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: This paper examines how clinical nurse specialists assessed their competences in relief of symptoms, and explores factors affecting good care routines in palliative care. Methods: A prospective survey among 235 former post-bachelor (response rate 50.6 %) students at two university colleges in Norway. Results: Correlations between the measured concepts showed a medium to high correlation between all the five competences. Use of care routines correlated with all the other factors. The ability to identify lack of care showed significant correlation with one concept: time available for nursing. The results from the regression analysis supported a model with good care routines as dependent variable (F=22.59, df=91, P<0.001). The independent variables in the model explained almost 57% of the variance in using care routines. Competences dealing with mouth problems, nausea, anxiety and the use of the Edmonton symptom assessment system (ESAS) had a positive effect on care routines. On the other hand, the ability to identify lack of care had a significant negative effect on the use of care routines. Conclusion: The importance of systematic assessment of the palliative patient's care needs and symptom management are emphasized, and use of the ESAS, and good care routines was affected by post-bachelor competences.

  • 19.
    Thorsell, K. B. E.
    et al.
    Section of Nursing, Department of Health Sciences, Faculty of Medicine, Lund University, Sweden / Section of Elderly, Municipality of Hässleholm, Sweden.
    Nordström, B. M.
    Section of Nursing, Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur. Department of Health Sciences, Buskerud University College, Drammen, Norway.
    Sivberg, B. V.
    Section of Nursing, Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.
    Time in Care for Older People Living in Nursing Homes2010Ingår i: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, s. Article ID 148435, 10 pages-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In order to measure actual care needs in relation to resources required to fulfill these needs, an instrument (Time in Care) with which to evaluate care needs and determine the time needed for various care activities has been developed with the aim of assessing nursing intensity in municipal care for older people. Interreliability (ICC=0.854) of time measurements (n = 10´546) of 32 nursing activities in relation to evaluated care levels in two nursing homes (staff n = 81) has been determined. Nursing intensity for both periods at the two nursing homes comprised on average a direct care time of 75 (45%) and 101 (42%) minutes, respectively. Work time was measured according to actual schedule (462 hours per nursing home during two weeks). Given that the need for care was high, one must further investigate if the quality of care the recipients received was sufficiently addressed.

  • 20.
    Tofthagen, Randi
    et al.
    Lovisenberg Diaconal University College, Oslo.
    Fagerström, Lisbeth
    Högskolan i Skövde, Institutionen för vård och natur.
    Clarifying self-harm through evolutionary concept analysis2010Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, nr 3, s. 610-619Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Clarification of the concept self-harm is needed in order to enable research and theory development and facilitate the development and evaluation of medical interventions and nursing care for individuals who self-harm. This study presents such a conceptual analysis. Articles from 1997 to 2007 were sought from the Medline, PubMed, Cinahl, and PsychINFO search engines by entering the search words ‘self-harm’, ‘self-harming’, and ‘psychiatric care’. 25 medicine and 23 nursing science articles were chosen for inclusion and analysed. Rodgers’ evolutionary concept analysis process was used to delineate and clarify the concept’s context, surrogate terms, antecedents, attributes, and consequences, as well as to determine implications for further research. Attributes of self-harm may include repetitive injury of mouth or exterior body, that is to say the infliction of physical pain to alleviate mental pain, and time spent self-harming. Antecedents may be gender, mental pain, substance abuse and relational problems. Consequences often include the need for medication and help with altering coping behaviour. Some self-harm patients met with negative attitudes from nurses. Individualized care and treatment is recommended. Accordingly, inter-professional collaboration and postgraduate education is needed in order to provide better care and treatment for self-harm patients. Furthermore, better understanding is needed to help enable health care personnel understand why individuals self-harm. The conceptual analysis presented in this study may be helpful as regards theory development within this still rather unexplored field.

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