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  • 1. Allvin, Renée
    et al.
    Ehnfors, Margareta
    Rawal, Narinder
    Svensson, Elisabeth
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS).
    Development of a questionnaire to measure patient reported postoperative recovery: content validity and intra-patient reliability2009In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 3, p. 411-419Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: In this study we describe the development of a short, easy-to-use questionnaire to measure postoperative recovery and evaluate its content validity and intra-patient reliability. The questionnaire is designed to evaluate the progress of postoperative recovery and the long-term follow-up of possible effects of interventions during recovery. METHODS: The study involved four steps. (1) A conceptualization and item definitions were based on a theoretical framework and a description of patients' postoperative recovery from the perspective of patients, registered nurses and surgeons; (2) Content validity of items was tested through expert judgements; (3) A test run of the questionnaire was performed to confirm its feasibility and workload requirement; and (4) The stability of the questionnaire was evaluated through intra-patient reliability assessment. RESULTS: As a result of the operationalization process of the concept postoperative recovery, five dimensions (physical symptoms, physical functions, psychological, social, activity) and 19 items were identified. Each item was formulated as a statement in the questionnaire. Content validity was judged to be high. After the pre-test of the questionnaire a revision with refinements in the layout was made. The vast majority of items showed a high level of intra-patient reliability. CONCLUSION: Based on a theoretical framework and empirical data, we developed a short and easy-to-use tentative questionnaire to measure patient-reported postoperative recovery. Initial support for content validity was established. The vast majority of items showed a high level of test-retest reliability.

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

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

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  • 3. Allvin, Renée
    et al.
    Svensson, Elisabeth
    Rawal, Narinder
    Ehnfors, Margareta
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS).
    The Postoperative Recovery Profile (PRP) - a multidimensional questionnaire for evaluation of recovery profiles2011In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 17, no 2, p. 236-243Article in journal (Refereed)
    Abstract [en]

    Aims and objectives  The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self-assessment of general recovery after surgery. The aim of this study was to further evaluate the questionnaire regarding the construct validity and ability to discriminate recovery profiles between groups. Furthermore, the item variables of greatest importance during the progress of recovery were investigated. Methods  Post-operative recovery was assessed during the period from discharge to 12 months after lower abdominal and orthopaedic surgery. Construct validity was evaluated by comparing the assessments from the PRP questionnaire and a global recovery scale. Recovery profiles of the diagnose groups were displayed by the cumulative proportion recovered participants over time. The importance of item variables was investigated by ranking ordering. Results  A total of 158 patients were included. Support was given for good construct validity. The result showed that 7.6% of all possible pairs were disordered when comparing the assessments from the PRP questionnaire and the global recovery scale. Twelve months after discharge the PRP assessments discriminated significantly the recovery profiles of the abdominal and orthopaedic groups. The variable pain was one of the top five most important issues at each follow-up occasion in both study groups. The importance of the item variables was thereby emphasized. Conclusions  The PRP questionnaire allows for evaluation of the progress of post-operative recovery, and can be useful to assess patient-reported recovery after surgical treatment both on individual and group levels. Knowledge about recovery profiles can assist clinicians in determining the critical time points for measuring change.

  • 4.
    Andersson, Ann-Christine
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Elg, Mattias
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS).
    Perseius, Kenth-Inge
    Towards an empiricallydefined taxonomy for health care improvement projects in a county council in Sweden2009Conference paper (Refereed)
  • 5.
    Andersson, Ann-Christine
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Elg, Mattias
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS).
    Perseius, Kent-Inge
    Five types of practice-based improvement ideas in health care services: an empirically defined typology2011In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 20, no 2, p. 122-130Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to empirically identify and present different kinds of practice-based improvement ideas developed in health care services. The focus is on individual placement needs, problems/issues, and the ability to organize work on the development, implementation, and institutionalization of ideas for the health care sector. This study is based on a Swedish county council improvement program. Health care departments and primary health care centers in the Kalmar County Council were invited to apply for money to accomplish improvement projects. A qualitative content analysis was done of 183 proposed applications from various health care departments and primary health care centers. The following 5 types of improvement projects were identified: organizational process, evidence and quality, competence development, process technology, and proactive patient work. This illustrates the range of strategies that encourage letting individual units define their own improvement needs. These projects point to the various problems and experiences health care professionals encounter in their day-to-day work. To generalize beyond this improvement program and to validate the typology, we applied it to all articles found when searching for quality improvement projects in the journal Quality Management in Health Care during the last 2 years and found that all of them could be fitted into at least 1 of those 5 categories. This article provides valuable insights into the current state of improvement work in Swedish health care, and will serve as a foundation for further investigations in this quality improvement program.

  • 6.
    Andersson, Ann-Christine
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Elg, Mattias
    Perseius, Kent-Inge
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare2013In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 13, no 48Article in journal (Refereed)
    Abstract [en]

    Background: Quality improvement initiatives have expanded recently within the healthcare sector. Studies have shown that less than 40% of these initiatives are successful, indicating the need for an instrument that can measure the progress and results of quality improvement initiatives and answer questions about how quality initiatives are conducted. The aim of the present study was to develop and test an instrument to measure improvement process and outcome in Swedish healthcare. Methods: A questionnaire, founded on the Minnesota Innovation Survey (MIS), was developed in several steps. Items were merged and answer alternatives were revised. Employees participating in a county council improvement program received the web-based questionnaire. Data was analysed by descriptive statistics and correlation analysis. The questionnaire psychometric properties were investigated and an exploratory factor analysis was conducted. Results: The Swedish Improvement Measurement Questionnaire consists of 27 items. The Improvement Effectiveness Outcome dimension consists of three items and has a Cronbach’s alpha coefficient of 0.67. The Internal Improvement Processes dimension consists of eight sub-dimensions with a total of 24 items. Cronbach’s alpha coefficient for the complete dimension was 0.72. Three significant item correlations were found. A large involvement in the improvement initiative was shown and the majority of the respondents were satisfied with their work. Conclusions: The psychometric property tests suggest initial support for the questionnaire to study and evaluate quality improvement initiatives in Swedish healthcare settings. The overall satisfaction with the quality improvement initiative correlates positively to the awareness of individual responsibilities.

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  • 7.
    Andersson, Ann-Christine
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Perseius, Kent-Inge
    Elg, Mattias
    Evaluating a Breakthrough Series Collaborative in a Swedish Health Care Context2014In: Journal of Nursing Care Quality, ISSN 1057-3631, E-ISSN 1550-5065, Vol. 29, no 2, p. E1-E10Article in journal (Refereed)
    Abstract [en]

    This study evaluated the use of the Breakthrough Series Collaborative methodology in a Swedish county council improvement program, comparing measurements at the beginning and after 6 months. A questionnaire was used, and improvement processes and outcomes were analyzed. The results showed an overall large engagement in improvements, although the methodology and facilitators were seen as only moderately supportive.

  • 8.
    Andersson, Ann-Christine
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Perseius, Kent-Inge
    Elg, Mattias
    Sustainable outcomes of an improvement programme: do financial incentives matter?2013In: Total Quality Management and Business Excellence, ISSN 1478-3363, E-ISSN 1478-3371, Vol. 24, no 7-8, p. 959-969Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to evaluate whether an improvement programme can contribute to positive sustainable improvements in an organisation, and whether financial incentives are driving forces for improvements. The material was all projects (n¼232) that applied for funding in a county council improvement programme between 2007 and 2010. The projects were analysed as to whether they received funding (n¼98) or were rejected (n¼95). In addition, a categorisation of the projects’ intentions was analysed. Some projects were still ongoing, but 50 projects were implemented and sustained two or more years after being finalised. Implemented improvements were on different levels, from (micro-level) units up to the entire (macro-level) organisation. In addition, 27 rejected projects were finalised without funding. Eighteen of those 27 were sustainably implemented. This study indicates that there are incentives other than financial at work if an improvement programme contributes to sustainable improvements in the organisation. To encourage practice-based improvements is one way of incentivising the intention and effort to become and perform better.

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  • 9.
    Andersson, Ann-Christine
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Perseius, Kent-Inge
    Elg, Mattias
    Two different strategies to facilitate involvment in healthcare improvements: a Swedish county council initiative2014In: Global Advances in Health and Medicine, ISSN 2164-957X, E-ISSN 2164-9561, Vol. 3, no 5, p. 22-28Article in journal (Refereed)
    Abstract [en]

    Background: From a management point of view, there are many different approaches from which to choose to engage staff members in initiatives to improve performance. Objective: The present study evaluated how two different types of improvement strategies facilitate and encourage involvement of different professional groups in health-care organizations. Methods/Design: Empirical data of two different types of strategies were collected within an improvement project in a County Council in Sweden. The data analysis was carried out through classifying the participants' profession, position, gender, and the organizational administration of which they were a part, in relation to their participation. Setting: An improvement project in a County Council in Sweden. Participants: Designed Improvement Processes consisted of n=105 teams and Intrapreneurship Projects of n=202 projects. Intervention: Two different types of improvement strategies, Designed Improvement Processes and Intrapreneurship Projects. Main Outcome Measures: How two different types of improvement strategies facilitate and encourage involvement of different professional groups in healthcare organizations. Results: Nurses were the largest group participating in both improvement initiatives. Physicians were also well represented, although they seemed to prefer the less structured Intrapreneurship Projects approach. Assistant nurses, being the second largest staff group, were poorly represented in both initiatives. This indicates that the benefits and support for one group may push another group aside. Conclusions: Managers need to give prerequisites and incentives for staff who do not participate in improvements to do so. Comparisons of different types of improvement initiatives are an underused research strategy that yields interesting and thoughtful results.

  • 10. Athlin, Elsy
    et al.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS).
    Jernfält, Margareta
    Johansson, Inger
    Factors of importance to the development of pressure ulcers in the care trajectory: perceptions of hospital and community care nurses2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 15-16, p. 2252-2258Article in journal (Refereed)
    Abstract [en]

    Aim. The study aimed at describing contributing factors for the progression or regression of pressure ulcers in the care trajectory as they were understood by nurses working in hospitals or community care. Background. The development of pressure ulcers is considered to be connected with early prevention and awareness among nurses and some studies have indicated that the care trajectory may be a weak point. Design. The study was carried out with a qualitative design. Method. Fifteen nurses from two Swedish hospitals and 15 nurses from community care were interviewed during 2005. Qualitative content analysis was used to make an understanding of patterns possible. Findings. Three main categories arose, showing that pressure ulcers were considered to be affected in the care trajectory by factors related to the individual patient, to the healthcare personnel and to the healthcare structure. Hospital and community care nurses mostly had corresponding perceptions of these factors. Conclusion. The study both confirmed previous findings and added new knowledge about factors that may affect pressure ulcer in the trajectory of care. The informants' views of nurses' responsibilities and their attitudes towards the care of pressure ulcers could, along with their views on the organisation of care, increase the understanding of the occurrence of pressure ulcers. The need for development and clarification of the organisation and responsibility of pressure ulcer care in the care trajectory was stressed. Relevance to clinical practice. The study highlighted attitudes and values among registered nurses, as well as to how to preserve their commitment and increase their knowledge concerning prevention of pressure ulcers.

  • 11.
    Bahtsevani, Christel
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Malmö, Sweden.
    To Assess Prerequisites Before an Implementation Strategy in an Orthopaedic Department in Sweden2016In: Orthopedic Nursing, ISSN 0744-6020, E-ISSN 1542-538X, Vol. 35, no 2, p. 100-107Article in journal (Refereed)
    Abstract [en]

    Promoting Action on Research Implementation in Health Services (PARiHS) asserts that the success of knowledge implementation relates to multiple factors in a complex and dynamic way, and therefore the effects of implementation strategies vary by method and context. An instrument based on the PARiHS framework was developed to help assess critical factors influencing implementation strategies so that strategies can be tailored to promote implementation. The purpose of this study was to use the Evaluation Before Implementation Questionnaire (EBIQ), to describe staff perceptions in one orthopaedic department, and to investigate differences between wards. Staff members in four different wards at one orthopaedic department at a university hospital in Sweden were invited to complete a questionnaire related to planning for the implementation of a clinical practice guideline. The 23 items in the EBIQ were expected to capture staff perceptions about the evidence, context, and facilitation factors that influence the implementation process. Descriptive statistics and differences between wards were analyzed. Although the overall response rate was low (n = 49), two of the four wards accounted for most of the completed questionnaires (n = 25 and n = 12, respectively), enabling a comparison of these wards. We found significant differences between respondents' perceptions at the two wards in six items regarding context and facilitation in terms of receptiveness to change, forms of leadership, and evaluation and presence of feedback and facilitators. The EBIQ instrument requires further testing, but there appears to be initial support for pre-implementation use of the EBIQ as a means to enhance planning for implementation.

  • 12. Berg, Agneta
    et al.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Katajisto, Joukko
    Suhonen, Riitta
    A comparison between orthopaedic nurses' and patients' perception of individualised care2012In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 16, no 3, p. 136-146Article in journal (Refereed)
    Abstract [en]

    This exploratory study compares orthopaedic nurses’ perceptions of individualised nursing care with previously published orthopaedic patients’ perceptions. Orthopaedic nurses (N = 243) from one university, two central and two county hospitals working within in-patient care were surveyed using the Individualised Care Scale-Nurse (ICS-Nurse) in 2009 (response rate 74%, n = 180). The data were analysed using both descriptive and inferential statistics. About 60% of the nurses stated that it was very important that the care provided is individualised in comparison with 86% of the patients as previously reported (p-value <0.001). The highest rated assessment of individualised care was the clinical situation and the lowest the personal life situation which is in line with the patients’ experiences. This result demonstrates the need of managers in healthcare organisations to redouble their efforts in the implementation of individualised care by investigating nurses’ contemporary beliefs about, and forces that hinder the provision of individualised nursing care.

  • 13. Berg, Katarina
    et al.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS).
    Nilsson, Ulrica
    Franzen Årestedt, Kristofer
    Unosson, Mitra
    Psychometric evaluation of the Post-discharge Surgical Recovery Scale2010In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 4, p. 794-801Article in journal (Refereed)
    Abstract [en]

    AIM AND OBJECTIVES: Day surgery patients are discharged after a short period of postoperative surveillance, and reliable and valid instruments for assessment at home are needed. The aim of this study was to evaluate the psychometric properties of a Swedish version of the post-discharge surgical recovery (PSR) scale, an instrument to monitor the patient's recovery after day surgery, in terms of data quality, internal consistency, dimensionality and responsiveness. METHODS: Data were collected on postoperative days 1 and 14 and included 525 patients. Data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbach's alpha. The dimensionality of the scale was determined through an exploratory factor analysis. Responsiveness was evaluated using the standardized response mean and the area under the receiver operating characteristics curve (AUC). The correlation between change score in PSR and change score in self-rated health was assessed using Pearson's correlation coefficient. Patients' ability to work and their self-rated health on postoperative day 14 were used as external indicators of change. RESULTS: Six items showed floor or ceiling effects. Cronbach's coefficient alpha was 0.90 and the average inter-item correlation coefficient was 0.44 after the deletion of two items. The items were closely related to each other, and a one-factor solution was decided on. A robust ability to detect changes in recovery (standardized response mean = 1.14) was shown. The AUC for the entire scale was 0.60. When initial PSR scores were categorized into three intervals, the ability to detect improved and non-improved patients varied (AUC 0.58-0.81). There was a strong correlation between change scores in PSR and health (0.63). CONCLUSIONS: The Swedish version of the PSR scale demonstrates acceptable psychometric properties of data quality, internal consistency, dimensionality and responsiveness. In addition to previous findings, these results strengthen the PSR scale as a potential instrument of recovery at home.

  • 14. Berg, Katarina
    et al.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS).
    Nilsson, Ulrica
    Unosson, Mitra
    Postoperative recovery after different orthopaedic day surgical procedures2011In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 15, no 4, p. 165-175Article in journal (Refereed)
    Abstract [en]

    Orthopedic day surgery is common. Postoperative recovery may differ according to surgical procedures and personal factors. We studied postoperative recovery up to 2weeks after different orthopedic day surgical procedures and tried to identify possible predictors associated with recovery. Three-hundred and fifty eight patients who had undergone knee arthroscopy or surgery to the hand/arm, foot/leg or shoulder were included. Data were collected on postoperative days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale, the emotional state, physical comfort and physical independence dimensions in the Quality of Recovery-23 and a general health question. Multiple linear regression was used to explore predictors of recovery. The shoulder patients experienced significantly lower postoperative recovery and general health 1 and 2weeks after surgery compared to the other patient groups (p<0.001). Significant predictors of recovery were age, perceived health and emotional status on the first postoperative day and type of surgery. Postoperative recovery after common orthopedic day surgical procedures varies and factors influencing it need to be further explored. The impact of a patient’s emotional state on recovery after day surgery can be of particular interest in this work. Post-discharge planning needs to be tailored to the surgical procedure.

  • 15.
    Bramhagen, Ann-Cathrine
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Skåne University Hospital, Malmö, Sweden.
    Eriksson, Mats
    Faculty of Medicine and Health, School of Health and Medical Science, Örebro University, Örebro, Sweden.
    Ericsson, Elisabeth
    Faculty of Medicine and Health, School of Health and Medical Science, Örebro University, Örebro, Sweden.
    Nilsson, Ulrica
    Faculty of Medicine and Health, School of Health and Medical Science, Örebro University, Örebro, Sweden.
    Harden, Sue
    Skane University Hospital, Malmö, Sweden.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Skåne University Hospital, Malmö, Sweden.
    Self-reported Postoperative Recovery in Children: development of an instrument2016In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 22, no 2, p. 180-188Article in journal (Refereed)
    Abstract [en]

    Abstract Rationale, aims, and objectives: According the United Nations (1989), children have the right to be heard and to have their opinions respected. Since postoperative recovery is an individual and subjective experience and patient-reported outcome measures are considered important, our aim was to develop and test an instrument to measure self-reported quality of recovery in children after surgical procedures. Methods: Development of the instrument Postoperative Recovery in Children (PRiC) was influenced by Quality of Recovery-24, for use in adults. Eighteen children and nine professionals validated the items with respect to content and language. A photo questionnaire was developed to determine whether the children’s participation would increase compared to the text questionnaire. The final instrument was distributed consecutively to 390 children, ages 4–12 years, who underwent tonsil surgery at four hospitals in Sweden. Results: A total of 238 children with a mean age of 6.5 years participated. According to the parents, 23% circled the answers themselves and 59% participated to a significant degree. However, there was no significant difference in participation between those who received a photo versus a text questionnaire. Psychometric tests of the instrument showed that Cronbach’s alpha for the total instrument was 0.83 and the item-total correlations for 21 of the items were >0.20. Conclusion: Our results support use of the PRiC instrument to assess and follow up on children’s self-reported postoperative recovery after tonsil operation, both in clinical praxis as well in research.

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  • 16.
    Bååth, Carina
    et al.
    Faculty of Health, Science and Technology, Department of Health Sciences, Karlstad University and Research, County Council of Värmland, Karlstad, Sweden.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Skåne University Hospital, Malmö, Sweden.
    Gunningberg, Lena
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.
    Hommel, Ami
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Pressure-reducing interventions among persons with pressure ulcers: resultas from the first three national pressure ulcer prevalence surveys in Sweden2014In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 20, no 1, p. 58-65Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives The overall aim of this study was to describe preventive interventions among persons with pressure ulcer (PU) in three nationwide PU prevalence surveys in Sweden. Methods A cross-sectional research design was used; more than 70 000 persons from different hospitals and nursing homes participated in the three prevalence surveys conducted in March 2011, October 2011 and March 2012. The methodology used was that recommended by the European Pressure Ulcers Advisory Panel. Results The overall prevalence of PU categories I–IV in hospitals was 16.6%, 14.4% and 16.1%, respectively. Corresponding figures for nursing homes were 14.5%, 14.2% and 11.8%, respectively. Heel protection/floating heels and sliding sheets were more frequently planned for persons with PU category I. Conclusions Despite the three prevalence studies that have showed high prevalence of PU the use of preventing interventions is still not on an acceptable level. Heel protection/floating heels and sliding sheets were more frequently planned for persons with PUs, and individual-planned repositioning also increased. However, when persons already have a PU they should all have pressure-reducing preventive interventions to prevent the development of more PUs. Preventing PUs presents a challenge even when facilities have prevention programmes. A PU prevention programme requires an enthusiastic leader who will maintain the team's focus and direction for all staff involved in patient care.

  • 17.
    Bååth, Carina
    et al.
    Department of Nursing, Karlstad University, SE-651 88 Karlstad, Sweden.
    Wilde-Larsson, Bodil
    Department of Nursing, Karlstad University, SE-651 88 Karlstad, Sweden; Department of Nursing, Hedmark University College, Norway.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Hall-Lord, Marie-Louise
    Department of Nursing, Karlstad University, SE-651 88 Karlstad, Sweden; Department of Nursing, Gjovik University College, Norway.
    Assessments of patients’ pain, nutrition and skin in clinical practice: Registered and enrolled nurses’ perceptions2012In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 16, no 1, p. 3-12Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to describe registered and enrolled nurses’ perceptions of how they assess patients’ pain, nutrition and skin.

    Introduction: Planning for pain, nutrition and skin care management is an essential part of nursing. In Sweden, it is common that registered and enrolled nurses work together in the care of patients.

    Method: Interviews with nine registered and nine enrolled nurses were analyzed using qualitative content analysis.

    Results: One theme; blurring boundaries between registered and enrolled nurses regarding pain, nutrition and skin suit assessments was identified. The manifest content of interviews is described in four categories: nurse–patient interaction, using oneself as a tool, collaborating with colleagues and listening to patients’ next of kin.

    Conclusion: The analysis showed a blurring of boundaries between RNs and ENs regarding pain, nutrition and skin suit assessments. How they perform their assessments conforms to a large extent. However, even if the activities are the same, the education levels of RNs and ENs are different and therefore the assessment of the patients might be different in clinical practice. Taking the results into account it is important that RNs and ENs collaborate regarding assessment of the patients’ pain, nutrition and skin suit.

  • 18. Bååth, Carina
    et al.
    Wilde-Larsson, Bodil
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS).
    Lord-Hall, Marie-Louise
    Registered nurses and enrolled nurses assessments of postoperative pain and risk for malnutrition and pressure ulcers in patients with hip fracture2010In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 14, no 1, p. 30-39Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe and compare registered (RNs’) and enrolled nurses’ (ENs’) assessments of postoperative pain, risk for malnutrition and pressure ulcers in patients with hip fracture. Furthermore, the aim was to describe and compare their perceptions of using assessment tools. Thirty-four (34) RNs and forty-three (43) ENs, working on orthopaedic wards in Sweden, took part in the study. The assessments were carried out on 82 patients with hip fracture. The assessment tools included the numerical rating scale (NRS), short-form nutritional assessment tool (MNA-SF), modified Norton scale (MNS) and pressure ulcer card. Many patients were assessed to be in postoperative pain and at possible risk for malnutrition. Around 50% were assessed as being at risk for pressure ulcer formation (PU). There is a difference between RNs and ENs assessments of patients’ postoperative pain, risk for malnutrition and PU. ENs assessed to a greater degree that patients were in intense pain currently. RNs assessed to a greater degree that patients had been in intense pain in the past 24h. Single items on the tools showed differences. However, there was no statistically difference for MNA-SF screening score and MNS total score. ENs found it easier to assess postoperative pain with the NRS compared to RNs.

  • 19.
    Carlson, Elisabeth
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Nursing students' experiences of the clinical learning environment in nursing homes: A questionnaire study using the CLES+T evaluation scale2014In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 34, no 7, p. 1130-1134Article in journal (Refereed)
    Abstract [en]

    Background: One major challenge facing the health care systems worldwide is the growing demand for registered nurses able to provide qualified nursing care for a vulnerable population. Positive learning experiences during clinical practice influence not only learning outcomes, but also how students reason in relation to future career choices. Objectives: To investigate student nurses' experiences of the clinical learning environment during clinical practice in nursing homes, and to compare perceptions among student nurses with or without priorwork experience as health care assistants in elderly care. Design: A cross-sectional study was designed, utilising the Swedish version of the CLES + T evaluation scale. Methods: 260 student nurses (response rate 76%)who had completed a five week long clinical placement in nursing homes returned the questionnaire during the data collection period in 2011–2012. Data were analysed using descriptive statistics. Mann–Whitney U-test was used to examine differences in relation to students with or without prior experience of elderly care. Results: Overall, the clinical learning environment was evaluated in a predominantly positive way. The subdimension Supervisory relationship displayed the highest mean value, and the lowest score was calculated for the sub-dimension Leadership style of the ward manager. Statistical significant differences between sub-groups were displayed for four out of 34 items. Conclusion: The supervisory relationship had the greatest impact on how student nurses experienced the clinical learning environment in nursing homes. It is therefore, of utmost importance that collaborative activities, between educational and nursing home settings, supporting the work of preceptors are established and maintained.

  • 20.
    Carlson, Elisabeth
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Who wants to work with older people? Swedish student nurses’ willingness to work in elderly care: a questionnaire study2015In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 35, no 7, p. 849-853Article in journal (Refereed)
    Abstract [en]

    Background: The ageing population is a globally recognised challenge for the health care service. The growing number of older people will probably lead to increased demands for registered and specialised nurses working in nursing homes and home-based care. Clinical practice is of great importance not only to clinical learning processes, but also how student nurses perceive a particular field of nursing. Objectives: To compare perceptions of the clinical learning environment in nursing homes among students considering a career in aged care or not, and to examine the difference in age, gender and previous working experience as health care assistants in elderly care between the two groups. Design: This was a cross-sectional study. Data were obtained by means of the Swedish version of the Clinical Learning Environment and Nurse Teacher evaluation scale. Methods: Consecutive sampling was performed over three semesters commencing in September 2011 through to December 2012. The survey was conducted with 183 student nurses after completion of a compulsory five week long clinical practice in a nursing home. Mann-Whitney U-test was used to examine differences in relation to two groups namely student nurses who did or did not consider to work in elderly care. A chi-square test of independence was performed to examine the difference in age, gender and previous working experience between the two groups. Results: The analysis leaned towards an overall positive evaluation of the clinical learning environment with more positive values for students considering a career. There were no significant differences between younger students (18-23) and older students (24-50) regarding willingness to work in elderly care or not. Neither was any significant difference displayed between students, based on gender nor for previous work experience. Conclusion: Age, gender and previous work experiences as health care assistants did not impact on students willingness to work in elderly care or not. Therefore, future studies need to acknowledge the complexity of why student nurses choose a particular pathway in nursing by longitudinal studies following cohorts of students during the course of the nursing programme.

  • 21.
    Ekdahl, S.
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Perseius, K. I.
    Red Cross University College, Department of psychiatric nursing, Stockholm, Sweden.
    Family skills training in dialectical behaviour therapy: The experience of the significant others2016In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 33, no S1, p. S210-S210Article in journal (Other academic)
    Abstract [en]

    Introduction

    Borderline personality disorder (BPD) is a severe psychiatric health problem with reputation of being difficult to deal with and to treat. Significant others (SOs) of patients with BPD show higher levels of psychological distress compared with the general population. Strengthening the coping strategies of SOs plays an important role in the recovery of the patient. Support and education for SOs is important, both for SOs themselves and for the patients recovery.

    Objectives

    Research around support and education for SOs is of great importance not only for SOs and patients, but also for psychiatric staff, in order to offer help and support, for the whole family.

    Aim

    The aim was to describe significant others’ experiences of dialectical behaviour therapy-family skills training (DBT-FST), their life situation before and after DBT-FST, and measurement of their levels of anxiety and depressive symptoms.

    Methods

    The study had a descriptive mixed method design. Data were collected with free text questionnaires (n = 44), group interviews (n = 53) and the HAD scale (n = 52) and analysed by qualitative content analysis and descriptive and inferential statistics.

    Results

    The results show that life before DBT-FST was a struggle. DBT-FST gave hope for the future and provided strategies, helpful in daily life. For the subgroup without symptoms of anxiety and depression before DBT-FST, anxiety increased significantly. For the subgroup with symptoms of anxiety and depression the symptoms decreased significantly. This indicates, despite increased anxiety for one group, that DBT-FST is a beneficial intervention and most beneficial for those with the highest anxiety and depressive symptoms.

    Disclosure of interest

    The authors have not supplied their declaration of competing interest.

  • 22.
    Ekdahl, S.
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Perseius, Kent-Inge
    Red Cross Univ Coll, Psychiat Nursing, Stockholm, Sweden.
    Mats, S.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    A life tiptoeing: Being a significant other to persons with borderline personality disorder2016In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 33, no S1, p. S505-S505, article id EV877Article in journal (Other academic)
    Abstract [en]

    Introduction: Borderline Personality Disorder (BPD) is a severe psychiatric health problem with a reputation of being difficult to deal with and to treat. Significant Others (SOs) of patients with BPD show higher levels of psychological distress compared with the general population. Strengthening the coping strategies of SOs has been shown to play an important role in the recovery of the person with psychiatric health problems. Research around SOs of persons with BPD is, to our knowledge, scarce, especially qualitative research exploring their experiences.

    Objective: We believe that if the personnel working in health care and psychiatric care are able to better understand SOs experiences and life situation, it could be an important step toward improved care.

    Aim: The aim of this study was to describe SOs experiences of living close to a person with BPD and their experience of encounter with psychiatric care.

    Methods: Data were collected by free-text questionnaires and group interviews and were analyzed by qualitative content analysis.

    Results and conclusion: The results revealed four categories: a life tiptoeing; powerlessness, guilt, and lifelong grief; feeling left out and abandoned; and lost trust. The first two categories describe the experience of living close to a person with BPD, and the last two categories describe encounter with psychiatric care.

    Disclosure of interest: The authors have not supplied their declaration of competing interest.

  • 23.
    Ekdahl, Susanne
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Nyckeln Competence Center, Kalmar County Hospital, Kalmar, Sweden.
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Idvall, Ewa
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Perseius, Kent-Inge
    Department of Health and Caring Science, Linnaeus University, Kalmar, Sweden.
    Need of support for significant others to persons with borderline personality disorder: A Swedish focus groupstudy2024In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 38, no 1, p. 240-248Article in journal (Refereed)
    Abstract [en]

    Background: Being a significant other (SO) to a person with borderline personalitydisorder (BPD) affect their health. High incidence of substance use disorder, posttraumaticstress disorder, stress, fear, anxiety, depression, family burden and griefare common. Some specific therapies for BPD, have included support to SOs, howeverresources are scarce and to participate in the support it assumes that the personwith BPD is included in these therapies. Although the SO support has been shown tobe helpful, they all have a similar structure, and only a small exclusive group of SOshave access to the support.

    Aim: The aim was to describe experiences and need of support for significant othersto persons with borderline personality disorder from the perspective of themselvesand of health care workers.

    Methods: Data was collected via two focus groups. One with five SOs to personswith BPD, one with five health care workers. Two interview sessions in each groupwere conducted and data were analysed with qualitative content analysis. The studywas approved by the research ethics committee of Lund (2016–1026).

    Results: The results revealed four themes; not being seen by health care professionalscreates hopelessness, being seen by healthcare professionals creates trust, experienceof support - helpful or shameful and the step from loosely structured supportto a structured support group. Both groups expressed a need for further support as acomplement to already existing support.

    Conclusions: The need of support is extensive. The results suggest a professionalcoordinator intended for SOs and peer support groups not linked to a particular psychiatrictreatment yet offering support in a structured way. Further studies examiningthese complements to existing support, is therefore recommended.

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  • 24. Ekdahl, Susanne
    et al.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Perseius, Kent-Inge
    Family skills training in dialectical behaviour therapy: the experience of the significant others2014In: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 28, no 4, p. 235-241Article in journal (Refereed)
    Abstract [en]

    Aim. The aim was to describe significant others' experiences of dialectical behaviour therapy- family skills training (DBT-FST), their life situation before and after DBT-FST, and measurement of their levels of anxiety and depressive symptoms. Methods. The study had a descriptive mixed method design. Data were collected with free text questionnaires (n = 44), group interviews (n = 53) and the HAD scale (n = 52) and analysed by qualitative content analysis and descriptive and inferential statistics. Results. The results show that life before DBT-FST was a struggle. DBT-FST gave hope for the future and provided strategies, helpful in daily life. For the subgroup without symptoms of anxiety and depression before DBT-FST, anxiety increased significantly. For the subgroup with symptoms of anxiety and depression the symptoms decreased significantly. This indicates, despite increased anxiety for one group, that DBT-FST is a beneficial intervention and most beneficial for those with the highest anxiety- and depressive symptoms.

  • 25. Ekdahl, Susanne
    et al.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS).
    Samuelsson, Mats
    Perseius, Kent-Inge
    A life tiptoeing: being a significant other to persons with borderline personality disorder2011In: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 25, no 6, p. e69-e76Article in journal (Refereed)
    Abstract [en]

    Aim The aim of this study was to describe significant others' experiences of living close to a person with borderline personality disorder and their experience of encounter with psychiatric care. Methods Data were collected by free-text questionnaires and group interviews and were analyzed by qualitative content analysis. Results and Conclusion The results revealed four categories: a life tiptoeing; powerlessness, guilt, and lifelong grief; feeling left out and abandoned; and lost trust. The first two categories describe the experience of living close to a person with BPD, and the last two categories describe encounter with psychiatric care.

  • 26. Ekström, Louise
    et al.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Being a team leader: newly registered nurses relate their experiences2015In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 23, no 1, p. 75-86Article in journal (Refereed)
    Abstract [en]

    Aim This paper presents a study that explores how newly qualified registered nurses experience their leadership role in the ward-based nursing care team. Background A nurse's clinical leadership affects the quality of care provided. Newly qualified nurses experience difficulties during the transition period from student to qualified professional and find it challenging to lead nursing care. Methods Twelve nurses were interviewed and the transcribed texts analysed using qualitative content analysis to assess both manifest and latent content. Results Five themes were identified: feeling stranded; forming well-functioning teams; learning to lead; having the courage, strength, and desire to lead; and ensuring appropriate care. The findings indicate that many factors limit nurses’ leadership but some circumstances are supportive. Conclusion The leadership prerequisites for newly registered nurses need to improve, emphasizing different ways to create a supportive atmosphere that promotes professional development and job satisfaction. Implications for nursing management To increase nurse retention and promote quality of care, nurse managers need to clarify expectations and guide and support newly qualified nurses in a planned way.

  • 27.
    Eriksson, Mats
    et al.
    School of Health Sciences, Faculty of Medicine and Health, Örebro University, S-701 82 Örebro, Sweden.
    Nilsson, Ulrica
    School of Health Sciences, Faculty of Medicine and Health, Örebro University, S-701 82 Örebro, Sweden.
    Bramhagen, Ann-Cathrine
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Ericsson, Elisabeth
    School of Health Sciences, Faculty of Medicine and Health, Örebro University, S-701 82 Örebro, Sweden.
    Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy2017In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 96, p. 47-54Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES Tonsil surgery is associated with significant morbidity during recovery. Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this respect. METHODS In total, 238 children (4-12 years old) with a history of obstructive problems and/or recurrent tonsillitis, and undergoing tonsil surgery were included. Forty-eight per cent were operated with partial tonsil resection/tonsillotomy (TT) and 52 % with total tonsillectomy (TE), all in day surgery. Postoperative recovery was assessed on days 1, 4, and 10 using the validated self-rating instrument PRiC, Postoperative Recovery in Children. This includes 23 items covering different aspects of recovery after tonsil surgery. A higher score indicates worse status in the respective items. RESULTS Daily life activities (sleeping, eating, and playing), physical symptoms (e.g. headache, stomach ache, sore throat, otalgia, dizziness, nausea, defecation, urination), and emotional aspects (sadness, frightening dreams) were affected during the recovery period. The TE-girls showed higher scores then boys regarding stomach ache, defecation, and dizziness. Children above 6 years of age reported higher values for the physical comfort variables, while the younger group showed worse emotional states. Postoperative recovery improved from day 1 to 10 in all surgical groups. The TE-group showed lower recovery compared to the TT-groups (p=<0.01-0.001) in most items. CONCLUSION The goal of postoperative management is to minimize or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery, and thus, PRiC seems to be able to serve as a PROM to obtain patient-centered data after tonsil surgery. The recovery process after TT causes less postoperative morbidity and a quicker return to normal activity compared to TE.

  • 28. Gunningberg, Lena
    et al.
    Brudin, Lars
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS).
    Nurse Managers' prerequisite for nursing development: a survey on pressure ulcers and contextual factors in hospital organizations2010In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 18, no 6, p. 757-766Article in journal (Refereed)
    Abstract [en]

    Aim To describe and compare pressure ulcer prevalence in two county councils and concurrently explore Nurse Managers perspective of contextual factors in a hospital organization. Background Despite good knowledge about risk factors and prevention of pressure ulcers, the prevalence of pressure ulcers remains high. Nurse Managers have a key role in implementing evidence-based practice. Methods The present study included five hospitals in two Swedish county councils: county council A (non-university setting) and county council B (university setting). A pressure ulcer prevalence study was conducted according to the methodology developed by the European Pressure Ulcer Advisory Panel. The Nurse Managers answered a (27-item) questionnaire on contextual factors. Results County council B had significantly less pressure ulcers grade (2–4) (7.7%) than county council A (11.3%). The Nurse Managers' assessed only two out of the 27 general contextual items significantly differently. Some significant differences were observed in ward organization. Conclusions In county council B, the Nurse Managers seemed more aware of prevention strategies compared with Nurse Managers in county council A. The Nurse Managers should take more responsibility to develop the prerequisite for quality improvement in nursing. Implication for nursing management Nursing outcomes (e.g. pressure ulcers) should be incorporated into national quality registries for benchmarking and Nurse Managers competence in evidence-based practice and research methodology increased.

  • 29. Gunningberg, Lena
    et al.
    Donaldson, Nancy
    Aydin, Caroline
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS).
    Exploring variation in pressure ulcer prevalence in Sweden and the USA: benchmarking in action2012In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 18, no 4, p. 904-910Article in journal (Refereed)
    Abstract [en]

    Aim - To compare overall unit-level pressure ulcer (PU) prevalence, hospital-acquired pressure ulcer (HAPU) prevalence and prevention strategies, as well as nurse staffing and workload in two hospitals in Sweden with data from the USA. Methods - Medical and surgical units in a university hospital and a general hospital in Sweden were compared with 207 hospitals in the USA participating in the Collaborative Alliance for Nursing Outcomes (CALNOC) benchmarking registry. All adult inpatients in university hospital (n = 630), general hospital (n = 253) and CALNOC hospitals (n = 3506) were included in the study. Outcome indicators were pressure ulcer prevalence for all types (PU) and HAPU prevalence, specifically. Process indicators were risk assessment and PU prevention strategies. Structure indicators were nurse staffing (hours of care, and skill mix) and workload (admissions, discharges and transfers). Results - The prevalence of PU (categories 1–4) was 17.6% (university hospital) and 9.5% (general hospital) compared with 6.3–6.7% in the CALNOC sample. The prevalence of full thickness HAPU (categories 3 and 4) was 2.7% (university hospital) and 2.0% (general hospital) compared with 0–0.5% in the CALNOC sample. Risk and skin assessment varied between 6% and 60% in the Swedish hospitals compared with 100% in the CALNOC sample. Total hours per patient day were 8.4 in both Swedish hospitals and 9.5 to 9.8 in the CALNOC hospitals Conclusions - The findings suggest a link between processes of care and outcomes that is exciting to observe internationally and suggest the opportunity to expedite performance improvement through global benchmarking. Using HAPU as a complement to point prevalence of PU in Sweden has revealed this indicator as a more valid measure for patient care quality.

  • 30.
    Gunningberg, Lena
    et al.
    Department of Public Health and Caring Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden; School of Nursing, University of California, San Francisco, CA, USA.
    Hommel, Ami
    Lund University and Skåne University Hospital, Lund, Sweden.
    Bååth, Carina
    Karlstad University and County Council of Värmland, Karlstad, Sweden.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Skåne University Hospital, Malmö, Sweden.
    The first national pressure ulcer prevalence survey in county council and municipality settings in Sweden2012In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, no 5, p. 862-867Article in journal (Refereed)
    Abstract [en]

    Aim: To report data from the first national pressure ulcer prevalence survey in Sweden on prevalence, pressure ulcer categories, locations and preventive interventions for persons at risk for developing pressure ulcers. Methods: A cross-sectional research design was used in a total sample of 35 058 persons in hospitals and nursing homes. The methodology used was that recommended by the European Pressure Ulcer Advisory Panel. Results: The prevalence of pressure ulcers was 16.6% in hospitals and 14.5% in nursing homes. Many persons at risk for developing pressure ulcers did not receive a pressure-reducing mattress (23.3–27.9%) or planned repositioning in bed (50.2–57.5%). Conclusions: Despite great effort on the national level to encourage the prevention of pressure ulcers, the prevalence is high. Public reporting and benchmarking are now available, evidence-based guidelines have been disseminated and national goals have been set. Strategies for implementing practices outlined in the guidelines, meeting goals and changing attitudes must be further developed.

  • 31. Gunningberg, Lena
    et al.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Mäta för att mäta2013In: Ortopedisk vård och rehabilitering / [ed] Ami Hommel, Carina Bååth, Studentlitteratur AB, 2013, p. 377-385Chapter in book (Other academic)
  • 32. Gunningberg, Lena
    et al.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS).
    Nurse manager's view of hospital context in two county councils in Sweden2009Conference paper (Refereed)
  • 33. Gunningberg, Lena
    et al.
    Stotts, Nancy
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS).
    Hospital-acquired pressure ulcers in two Swedish County Councils: cross-sectional data as a foundation for future quality improvement2011In: International Wound Journal, ISSN 1742-481x, Vol. 8, no 5, p. 465-473Article in journal (Refereed)
    Abstract [en]

    The objectives of the study were to examine the prevalence of pressure ulcers and hospital-acquired pressure ulcers (HAPU) and identify modifiable factors in patients who develop HAPU as the basis for subsequent quality assurance studies and improvement in hospital care. The study was conducted in five hospitals in two Swedish County Councils. A 1-day prevalence study (n = 1192) using the standards of the European Pressure Ulcer Advisory Panel and Collaborative Alliance for Nursing Outcomes was conducted. The prevalence of ulcers was 14·9% and 11·6% were HAPU. Older age, more days of hospitalisation, less activity, problems with shear and friction and reduced sensory perception contributed significantly to HAPU. Pressure ulcer prevention strategies used more often in those with HAPU were risk assessment at admission, provision of a pressure relief mattress, having a turning schedule and using a heel or chair cushion. The prevalence of pressure ulcers continues to be a significant issue in acute care and the prevalence of HAPU is high. There is significant room for quality improvement in pressure ulcer prevention in Swedish hospitals. Future research needs to address both HAPU and community-acquired pressure ulcers and focus on preventive strategies, including when they are initiated and which are effective in mitigating the high HAPU rate.

  • 34.
    Holst-Hansson, Annette
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Skåne University Hospital, Department of Hematology, Oncology and Radiation Physics, Lund, Sweden.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bolinsjo, Ingrid
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Wennick, Anne
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Hoping to reach a safe haven :Swedish families' lived experience when a family member is diagnosed with breast cancer2017In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 31, p. 52-58Article in journal (Refereed)
    Abstract [en]

    Purpose: When a woman is diagnosed with breast cancer, it affects all family members. Therefore, the aim of this study was to elucidate family members lived experience when a family member is diagnosed with breast cancer. Method: The study had a hermeneutic phenomenological design including individual conversational interviews conducted face-to-face with six women with breast cancer and their family members at two different points of time, in order to elucidate families' lived experience, both as individuals and as a unit, from each family member's perspective. Results: Living as a family in the presence of breast cancer is a challenging endeavour to regain an ordinary, safe life, hoping to reach a safe haven. The families felt that life as they knew it had disappeared and they were fumbling in the dark, trying to find support and guidance on their path to ordinary life. The family members were pursuing balance by attempting to keep the family together and maintaining a positive attitude while battling against fear and treatment-related side effects. Finally, the families were struggling with guilt and inadequacy, due to their difficulties in communicating the emotional distress that the illness brought upon them, at the same time as they felt abandoned by the healthcare professionals. Conclusions: Families experience an unmet need of information and support, which implies that healthcare professionals may want to acknowledge and include the family already at the time of diagnosis in order to help them endure and cope with the distressing experience and thus increase their wellbeing.

  • 35.
    Holst-Hansson, Annette
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bolmsjö, Ingrid
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Wennick, Anne
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    "One has to be strong" - immigrant women's experience of their daily life during radiotherapy due to breast cancer2014In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 18, no Suppl 1, p. S51-S51Article in journal (Other academic)
  • 36.
    Holst-Hansson, Annette
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Hematology, Oncology and Radiophysics, Skåne University Hospital, Lund, Sweden.
    Idvall, Ewa
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bolmsjö, Ingrid
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Wennick, Anne
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    The narrow treatment road to survival: Everyday life perspectives of women with breast cancer from Iraq and the former Yugoslavia undergoing radiation therapy in Sweden2018In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 27, no 2Article in journal (Refereed)
    Abstract [en]

    This study aimed at exploring how women from Iraq and the former Yugoslavia, diagnosed with breast cancer and living in Sweden, experience their everyday life during radiation therapy. A qualitative research design was used comprising interviews with ten women, five originating from Iraq and five from the former Yugoslavia. Striving to survive, the women experienced their everyday life during radiation therapy as extremely challenging. This experience can be placed into three categories: strategies for survival, keeping up appearances and staying in control. Because of these specific challenges, immigrant women may need additional information and guidance in conjunction with the diagnosis, which may enable them to identify possible sources of support from those closest to them. Also, greater attention should focus on acknowledging the woman behind the diagnosis, regardless of her origin, to develop an individualised support programme to help her cope with everyday life during radiation therapy.

  • 37.
    Holst-Hansson, Annette
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Sjövall, K.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bolmsjö, Ingrid
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    The breath of life: womens' experiences of breathing adapted radiation therapy2013In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 17, no 3, p. 354-359Article in journal (Refereed)
    Abstract [en]

    Purpose To describe and analyze how women with breast cancer experience breathing adapted radiation therapy (BART) and to explore how women manage daily radiation therapy. Method Individual interviews were conducted with 20 women treated with BART for breast cancer concerning their perception of radiation therapy. The transcribed interviews were analyzed using qualitative content analysis. Results ‘The breath of life’ was the overall theme, as the women experienced the breathing as a way in which to influence their treatment and thus their survival. ‘Participating in one's treatment, for good or ill’, was the main category with four subcategories, ‘Knowing one has done something good’, ‘Getting an extra bonus – healthwise’, ‘The experience of being in control’ and ‘Being in a high-technology environment’. The breathing technique became the strategy by which they could manage their treatment and gave them a sense of participation which led to a feeling of being in control. The women also felt that breathing benefited their health both mentally and physically. The high-technology environment was experienced as both hopeful and frightening. Conclusion Survival or increasing the chances of survival, are of ultimate importance for a woman with breast cancer. BART requires commitment from the women, which was perceived as offering them an opportunity to participate in their own treatment, for their survival. Increasing the women's possibilities to participate in their treatment benefits their health and welfare during an otherwise turbulent time and allow the rehabilitation process to start during treatment.

  • 38.
    Holst-Hansson, Annette
    et al.
    Lund University, Sweden.
    Vejzovic, Vedrana
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Idvall, Ewa
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Wennick, Anne
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    The Usefulness of Brief Family Health Conversations Offered to Families Following the Diagnosis of Breast Cancer.2020In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 26, no 4, article id 1074840720966759Article in journal (Refereed)
    Abstract [en]

    Currently, there are few studies which examine targeted family-focused support when a family member is diagnosed with breast cancer. Thus, the aim of this study was to explore families' experiences of participating in a family nursing intervention identified as Brief Family Health Conversations (BFamHC) following the diagnosis of breast cancer. Semi-structured family interviews were conducted with nine families (including 29 family members) 2 weeks following the family-focused intervention of three sessions of BFamHC. Thematic analysis was used to analyze the data. Families reported the BFamHC as positive and as a unique kind of family health conversation, one that afforded them the opportunity to communicate and share their experiences as a family group. A family conversation, even one as time-limited as BFamHC, offered a sense of relational sharing and togetherness, thus preventing feelings of isolation and vulnerability. Therapeutic family-focused conversations, such as BFamHC, hold promise as a useful family nursing intervention following the diagnosis of breast cancer.

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  • 39.
    Hommel, Ami
    et al.
    Skåne University Hospital, Lund, Sweden.
    Gunningberg, Lena
    Department of Public Health and Caring Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Skane University Hospital, Malmö, Sweden.
    Bååth, Carina
    Department of Health Sciences, Karlstad University, Karlstad, Sweden; County Council of Värmland, Karlstad, Sweden.
    Successful factors to prevent pressure ulcers: an interview study2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 1-2, p. 182-189Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To explore successful factors to prevent pressure ulcers in hospital settings. Background. Pressure ulcer prevalence has been recognised as a quality indicator for both patient safety and quality of care in hospital and community settings. Most pressure ulcer can be prevented if effective measures are implemented and evaluated. The Swedish Association of Local Authorities and Regions initiated nationwide pressure ulcer prevalence studies in 2011. In 2014, after four years of measurement, the prevalence was still unacceptably high on a national level. The mean prevalence of pressure ulcer in the spring of 2014 was 14% in hospital settings with a range from 2.7-36.4%. Design. Qualitative semistructured interviews were conducted. Methods. A qualitative content analysis, in addition to Promoting Action on Research Implementation in Health Services frameworks, was used in the analysis of the data text. Individual interviews and focus groups were used to create opportunities for both individual responses and group interactions. The study was conducted at six hospitals during the fall of 2014. Results. Three main categories were identified as successful factors to prevent pressure ulcer in hospitals: creating a good organisation, maintaining persistent awareness and realising the benefits for patients. Conclusion. The goal for all healthcare personnel must be delivering high-quality, sustainable care to patients. Prevention of pressure ulcer is crucial in this work. It seems to be easier for small hospitals (with a low number of units/beds) to develop and sustain an effective organisation in prevention work. Relevance to clinical practice. The nurse managers' attitude and engagement are crucial to enable the personnel to work actively with pressure ulcer prevention. Strategies are proposed to advance clinical leadership, knowledge, skills and abilities for the crucial implementation of pressure ulcer prevention.

  • 40.
    Hylén, Mia
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden.
    Akerman, Eva
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; General Intensive Care Unit, Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
    Idvall, Ewa
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Alm-Roijer, Carin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Patients´ experiences of pain in the intensive care - The delicate balance of control.2020In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 76, no 10, p. 2660-2669Article in journal (Refereed)
    Abstract [en]

    AIM: To explore the patients´ experiences of pain when being cared for in the intensive care.

    DESIGN: An exploratory, qualitative design was chosen.

    METHOD: Interviews were performed with patients (October 2015-March 2017) within a week of post-intensive care (N = 16). Thematic analysis was used as method for analysis.

    RESULTS: The findings generated two themes - a lack of control and to struggle for control. Pain was described as overwhelming, both in body and mind and generating the experience of a lack of control, with feelings of incapacitation, isolation, and having their needs unmet. Feeling in control of the pain and thus in control of the situation was experienced as a constant struggle. Well-planned care, finding ways to handle the pain and good communication were all helpful in this struggle.

    CONCLUSION: The participants recalled their experience of pain in the ICU and control seems to be crucial for how pain is experienced. They experienced a lack of control due to not only the pain but also the treatment, which can be avoided by the nurse continuously evaluating and individualising the care. Balanced care, meeting the patients' needs and good communication helps the patient feel more in control when experiencing pain.

    IMPACT: The experience of pain is dependent on control for the intensive care patient. The nurse may help them gain control and thereby handle the experience of pain through including the patient, striving for better communication and implementing individualised care that continuously assesses and treats pain.

  • 41.
    Hylén, Mia
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden.
    Alm-Roijer, Carin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Idvall, Ewa
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Åkerman, Eva
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; General Intensive Care Unit, Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
    To assess patients pain in intensive care: developing and testing the Swedish version of the Behavioural Pain Scale2019In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 52, p. 28-34Article in journal (Refereed)
    Abstract [en]

    Objectives: The Behavioural Pain Scale has previously been translated into Swedish and psychometrically tested. One of the domains- 'compliance with ventilation'- did not show equally as good psychometric proprieties as the other domains, which led to the question whether a development of that domain would be beneficial. This study aimed to develop the domain of 'breathing pattern' in the Swedish version of the Behavioural Pain Scale and then test the instrument for discriminant validity, inter-rater reliability and criterion validity. Method: The domain 'breathing pattern' was developed and included when the Swedish version of the Behavioural Pain Scale was psychometrically tested in 360 paired assessments. Results: The instrument showed discriminant validity through a significant positive change on the scale before and during turning and inter-rater reliability with an absence of significant disagreement on the scale between the paired assessments. The developed domain had a better result in discriminant validity than the original domain. The instrument also showed higher sensitivity in discriminating pain compared to assessment without an instrument. Conclusion: The Swedish version of the Behavioural Pain Scale, with a developed domain for 'breathing pattern' showed to be a reliable instrument for pain assessment in the adult intensive-care patient. (C) 2019 Elsevier Ltd. All rights reserved.

  • 42.
    Hylén, Mia
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, 205 02, Sweden.
    Åkerman, Eva
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, 205 02, Sweden.
    Alm-Roijer, Carin
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, 205 02, Sweden.
    Behavioral Pain Scale - translation, reliability, and validity in a Swedish context2016In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 6, p. 821-828Article in journal (Refereed)
    Abstract [en]

    Background: Assessing pain in the intensive care unit (ICU) is challenging. Due to intubation and sedation, communication can be limited. International guidelines recommend assessing pain with instruments based on behavioral parameters when critically ill patients are unable to self-report their pain level. One of the recommended instruments, the Behavioral Pain Scale (BPS), has shown good validity and reliability in international studies. The aim of this study was to translate and adapt the BPS for critically ill intubated and non-intubated patients in a Swedish ICU context and to assess inter-rater reliability and discriminant validity. Methods: The BPS (both for intubated and non-intubated patients) was translated and adapted into Swedish using a translation method consisting of ten steps. The Swedish version was then tested for inter-rater reliability and discriminant validity on 20 critically ill patients (10 intubated and 10 non-intubated) before and directly after a potentially painful procedure (repositioning Results: The Swedish version of the BPS showed inter-rater reliability with a percentage agreement of 85% when tested on a sample of critically ill patients. The instrument also showed discriminant validity between assessments at rest and after repositioning Conclusion: Results of the Swedish version of the BPS support its use in critically ill patients who cannot self-report their pain level. Still, additional studies are needed to further explore its reliability and validity in the Swedish ICU context

  • 43.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Mätning av kvalitet i samband med postoperativ smärtbehandling2012In: Omvårdnad vid kirurgiska sjukdomar / [ed] Lillemor Lindwall, Studentlitteratur AB, 2012, p. 241-248Chapter in book (Other academic)
  • 44.
    Idvall, Ewa
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Bahtsevani, Christel
    Malmö högskola, Faculty of Health and Society (HS).
    Gunningberg, Lena
    Commentary on Hasselberg D, Ivarsson B, Andersson R & Tingstedt B (2010) The handling of peripheral venous catheters – from non-compliance to evidence-based needs2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 13-14, p. 2081-2082Article in journal (Other academic)
  • 45.
    Idvall, Ewa
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Berg, Agneta
    Katajisto, Jouko
    Acaroglu, Rengin
    Antunes da Luz, Maria
    Efstathiou, Georgios
    Kalafati, Maria
    Kanan, Nevin
    Leino-Kilpi, Helena
    Lemonidou, Chryssoula
    Papastavrou, Evridiki
    Sendir, Merdiye
    Suhonen, Riitta
    Nurses' sociodemographic background and assessment to individualised care2012In: Journal of Nursing Scholarship, ISSN 1527-6546, E-ISSN 1547-5069, Vol. 44, no 3, p. 284-293Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to explore the association between nurses’ characteristics (educational level, country, work title, gender, type of work, age, and length of working experience) and their assessments of individualized care. Design: A cross-sectional comparative survey using questionnaires was employed to sample nurses from seven countries. Methods: Data were collected from orthopedic and trauma nurses from Cyprus, Finland, Greece, Portugal, Sweden, Turkey, and the United States (N= 1,163, response rate 70%) using the Individualized Care Scale-Nurse (ICS-Nurse) and a sociodemographic questionnaire in 2008. Data were analyzed using descriptive statistics and general linear models. Results: When compared with practical nurses, registered nurses, length of working experience, and the country of the nurses were associated with assessments of the support of patient individuality in specific nursing activities (ICS-A-Nurse) and country assessments of individuality in the care provided (ICS-B-Nurse). The background and experience within nursing teams together with the country affect the delivery of individualized care. Conclusions: Overall, our findings suggest that nurses’ personal attributes have important effects on their assessments of individualized nursing care that will be useful when making context-dependent recruitment decisions. Clinical Relevance: The characteristics of nurses contribute to the care delivered in healthcare organizations. Recognition of these nurse-related factors may help nurse leaders in the development and management of clinical practice.

  • 46.
    Idvall, Ewa
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Berg, Katarina
    Unosson, Mitra
    Brudin, Lars
    Nilsson, Ulrica
    Assessment of recovery after day surgery using a modified version of Quality of Recovery-402009In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 53, no 5, p. 673-677Article in journal (Refereed)
  • 47.
    Idvall, Ewa
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Gunningberg, Lena
    Trycksårsprevalens - en jämförelse mellan två landsting2009In: Sår, ISSN 1653-9591, Vol. 3, no 3, p. 35-38Article in journal (Other (popular science, discussion, etc.))
  • 48.
    Idvall, Ewa
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Olsson, Jesper
    Kvalitetsutveckling inom omvårdnad2009In: Omvårdnadens grunder: Ansvar och utveckling, Studentlitteratur AB, 2009, p. 335-370Chapter in book (Other academic)
  • 49.
    Idvall, Ewa
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rosvall, Annika
    Nilsson, Roland
    Utvärdering av nätbaserat lärande avseende användarvänlighet, innehåll och kompetensutveckling2013In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 33, no 2, p. 31-33Article in journal (Refereed)
  • 50.
    Idvall, Ewa
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Willman, Ania
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Inledning2013In: Kvalitetsindikatorer inom omvårdnad / [ed] Ewa Idvall, Gothia Förlag AB, 2013, p. 7-9Chapter in book (Other academic)
12 1 - 50 of 94
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