Aim: The aim was to identify planned and completed preventive interventions among older persons with oral health problems receiving municipal health care. A further aim was to determine the correspondence between oral health problems and planned preventive interventions among older persons with oral health problems receiving municipal health care. Design: Cross-sectional register study. Methods: Oral health data from the Swedish national quality registry, Senior Alert, were extracted for 4,024 older persons (>= 65 years) receiving municipal health care in a county in Southern Sweden. Data were statistically analysed. Results: A large majority of older persons (97.4%) with assessed oral health problems had at least one planned preventive intervention, and approximately three quarters of the planned interventions were completed. There seemed to be a mismatch between type of oral health problems and preventive interventions as not all older persons had a planned preventive intervention related to their specific oral health problem.

Patients with intellectual and developmental disability (IDD) are often misinterpreted and misunderstood. Studies show that, in general, healthcare professionals have limited knowledge about IDD, and registered nurses (RNs) often report feeling unprepared to support this group of patients. Therefore, more knowledge about how to adequately address care for this patient group is warranted. This qualitative study employs an interpretative descriptive design to explore and describe Swedish RNs' perceptions of caring for patients with IDD, here in a home-care setting. Twenty RNs were interviewed between September 2018 and May 2019, and the resulting data were analysed through an inductive qualitative content analysis. The study adheres to consolidated criteria for reporting qualitative research (COREQ). Our analysis found that nurses' perceptions of caring for patients with an IDD could be understood from three overarching categories: nursing held hostage in the context of care, care dependent on intuition and proven experience and contending for the patients' right to adequate care. Our findings show that the home-care context and organisation were not adjusted to the needs of the patients. This resulted in RNs feeling unable to provide care in accordance with their professional values. They also explained that they had not mastered the available augmentative and alternative communication tools, instead using support staff as interpreters for their patients. Finally, on a daily basis, the RNs caring for this group of patients took an active stance and fought for the patients' right to receive the right care at the right time by the right person. This was particularly the case with issues involving psychiatric care.

Diabetic peripheral neuropathy is a diabetes-related complication with vague and progressive symptoms with few available treatments. The aim of this study was to describe the experiences of diabetic peripheral neuropathy among adults living with type 1 diabetes. Twelve interviews were performed and qualitative content analysis was used. The overarching theme ‘living with challenges in the shadow of diabetes’ substantiated by the categories ‘pay attention to changes over time’, ‘frequent needs to facilitate living’ and ‘burdens to manage’ represents a daily awareness of the complication where autodidactic strategies were implemented. The conclusion indicates that it might be beneficial if nurses in diabetes care initiate an open-minded dialogue with adults with diabetic peripheral neuropathy to highlight their experiences and to discuss further strategies to facilitate living.

Background: Research suggests that registered nurses (RNs) do not feel adequately prepared to support patients with intellectual disability disorder (IDD). This is unsurprising, as few European health sciences curricula include undergraduate and graduate training courses in IDD. As RNs are often in the front line of care, eliciting in-depth knowledge about how they experience nursing this group of patients is vital. Our aim in this study was to develop a conceptual understanding about RNs’ experiences of nursing patients with IDD. Method: We undertook a systematic review and meta-ethnography to synthesise qualitative research studies found in PubMed, CINAHL, PsycINFO, ERIC databases and by manual searching to identify additional studies. We condensed translatable second-order constructs, and developed an idiomatic translation. Finally, we formulated line of argument (LOA) syntheses to capture the core of the idiomatic translations. Results: We included eighteen published studies from eight countries involving 190 RNs. The RNs’ experience of nursing patients with IDD were reflected in 14 LOAs. Six of these reflected a tentatively more distinctive and at times unique conceptualisation of RNs’ experience of nursing this group of patients. The remaining eight LOAs represented a conceptualisation of nursing per se, a conceptualisation of nursing that was interpreted as a universal experience regardless of context and patient group. Conclusion: Lack of awareness and knowledge are likely breeding grounds for the ‘otherness’ that still surrounds this group of patients. In encounters between patients and RNs, focusing on the person behind the disability label could be one way to secure relevant nursing care for patients with IDD. Undertaking appropriate under- and postgraduate education alongside the implementation of nursing models focusing on patient-centred care would help RNs in reducing the health and care inequalities this group of patients still face.

Background Experiences of abuse are common among women in general psychiatric care. Even so, there are to our knowledge no previous national or international studies exploring disclosure in a general psychiatric setting of female patient’s experiences of abuse to staff or to formal and informal networks. This study aimed to explore women’s disclosure of experiencing physical, emotional and/or sexual abuse during their most recent contact with staff at a general psychiatric clinic. The study also aimed to determine whether the women have previously disclosed abuse to anyone. Methods A consecutive sampling of eligible female patients at a general psychiatric clinic in an urban area of southern Sweden answered the NorVold Abuse Questionnaire, NorAQ, a self-administrated questionnaire. NorAQ has previously been used and further developed to compare the prevalence of abuse in women present in gynecological outpatient settings in the five Nordic countries. Seventy-seven women with experiences of abuse participated in the research. Descriptive statistics were used to analyse the data. Results Most respondents did not disclose their experiences of abuse to staff at the general psychiatric clinic. Women with experiences of physical abuse (n = 40), emotional abuse (n = 37) and sexual abuse (n = 37) chose not to disclose their experiences. Respondents disclosed abuse more often to others than to staff. Conclusions Our findings indicated the importance of including routine questions concerning abuse experiences as a natural part of female patients’ medical history.

Evidensbaserad omvårdnad definieras i denna bok som både ett förhållningssätt och en process. Förhållningssättet innebär en vilja att använda bästa tillgängliga vetenskapliga bevis som underlag för vårdbeslut. Processen består i hur man praktiskt går tillväga för att finna, sammanställa, kritiskt värdera och implementera detta underlag. Evidensbaserad omvårdnad handlar således om en strävan att bedriva omvårdnad på en god och säker grund och att tillgodose samhällets krav på att forskningsresultat utnyttjas på bästa sätt. Denna fjärde upplaga har förtydligats och alla länkar samt webbadresser har uppdaterats. Ett nytt avsnitt om ledarskapets betydelse för implementering av evidens har tillkommit. På bokens webbsida finns en film som visar evidensbaserad omvårdnad i klinisk verksamhet.

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.

A reduction in the incidence of cardiovascular diseases (CVD) has been reported in the Western world, but post-infarction depression often occurs and is related to poor medical outcomes. The aim of this study was to examine the scientific literature by a systematic review, in order to find evidence for whether physical activity can be a tool to reduce depression in patients who have suffered a cardiac event. Three databases were systematically searched (PubMed, CINAHL, and Cochrane), and the GRADE protocol was used in combination with a revised Amstar-protocol for the systematic review. Scientific reports fitting the area were scarce. Finally, ten studies were included in this study: one meta-analysis, five randomized controlled trials, and four clinical trials. The results showed low to moderate evidence for the use of low to moderate levels of exercise as a tool to reduce depression in post-coronary artery event patients. This study concluded positive effects of physical activity as a tool to reduce depression in post-coronary artery event patients. Physiotherapists could be further involved in increasing physical activity after cardiac events. More studies are needed in the area.

Violence against women is a worldwide problem and has an impact on the lives of women and girls. The study aims to investigate the life course of women within psychiatric care who have experienced abuse. The women’s resources, stressful events, experience of abuse, perpetrators, mental ill health, and care and support throughout the life course are also highlighted. Eleven women who had all sought general psychiatric care in an urban area in Sweden participated. A computer software program was used for constructing life charts for each participant, and manifest content analysis was used to analyse the data. The women’s social status and resources differed, and some of them spoke of only experiencing few stressful events growing up, while others described a stressful childhood. All of the women had been abused sometime during their life course, and most of the perpetrators were known to the women. Even so, the women had seldom disclosed their childhood abuse. As adults, the women were diagnosed with psychiatric diagnoses, and suicidal behaviour increased. The life chart offers rich information and a broader picture of the life history of women who experienced abuse as well as constituting a tool useful for identifying women with experiences of abuse.

Aims and objectives To elucidate how women subjected to physical, emotional and/or sexual abuse experience the care provided at a general psychiatric clinic after the disclosure of abuse. Background Violence against women is a major global public health issue, which has an impact on women's lives and mental health as well as generating frequent hospital admission. Design Qualitative design with an inductive approach. Methods Interviews with nine women who were recipients of general psychiatric care and had disclosed experiences of abuse to a member of staff were conducted. Qualitative inductive content analysis was used. Results The overall theme emerging from the narratives, ‘dependency as a reality containing a duality of suffering and trust,’ links the categories together. Each subcategory is presented in relation to the categories ‘being belittled,’ ‘being misinterpreted’ and ‘being cared for.’ Experiences of care as caring and noncaring were found in the narratives. Caring could include situations experienced as the women being acknowledged and listened to, situations where staff approached and supported the women in a sensitive way. Experiences of noncaring were when the abuse was disregarded, and when the women were not believed in, were left with burdens of guilt and were offended. A noncaring environment focused primarily on the diagnosis, and the experienced abuse was seen as secondary. Conclusions Abused women are subjected to psychiatric environments where staff are divided into groups of those who believed in and supported the abused women and those who regarded experiences of abuse as a secondary issue and focused on the mental disorder. Relevance to clinical practice This study provides knowledge of how abused women experience the care provided at a general psychiatric clinic after the disclosure of abuse.

Violence against women is a major global public health issue, and experiencing violence has substantial consequences for the lives of abused women. This study aims to illustrate experiences of abuse and its influence on mental ill health among women seeking general psychiatric care. Ten women seeking general psychiatric care in southern Sweden participated in a qualitative interview study. Content analysis resulted in four categories: Living in fear that persistently influences the substance of life, living with the sense of being worthless, living with a constant question about who you are and living between hope and despair. The theme evolving from the analysis was: Being vulnerable and without protection in a frightful reality that limits one’s possibilities of living and being the person one wishes to be. The results showed that the women described their mental ill health not only in terms of depression, anxiety and suicidal ideation and self-harm, but also in relation to feelings of hope and despair, fear, worthlessness and living with a constant question about who they are. The abuse reduces freedom of action, and leads to feelings of insecurity, of not having any boundaries, isolation, and self-contempt and a need to escape. This study provides knowledge of abused women self-reported mental ill health in relation to abuse.

Aim. This literature study highlights patients with diabetes mellitus and / or peripheral vascular disease and their experiences of changes in life after a leg or lower extremity amputation. Background. Living with a chronic disease such as peripheral vascular disease and / or diabetes, can lead to strains and affect daily life, including pain, sleep difficulties, problems with ulcers and fear of amputation. Being amputated can lead to shock and grief postoperatively. The mental preparation preoperatively is important for how the patient's experience life postoperatively. Patients need support and encouragement from the nursing staff and relatives in order to increase well-being and for greater autonomy in the postoperative phase. Method. A systematic literature review, based on review and compilation of qualitative studies, was chosen in order to answer the research question. Three articles were found relevant to the purpose of the study, one study was found to be of high quality and two studies of medium quality. Two of the studies were conducted in Western and one in the Asian context. The authors used the SBU's manual in the selection process of literature. Results. After compilation of the three studies two overall third-level themes were identified: Suffering and to regain hope. Conclusion. There is scientific evidence that a leg or lower extremity amputation alters a patient’s situation in life. This may cause distress in different dimensions. In this study emotional, psychosocial and physical suffering were identified. There is also evidence that patients who has time can develop some acceptance and adjustment to their new situation. Support from family and friends are important for the motivation to fight and regain hope for the future. Similar experiences / experiences identified despite different cultural backgrounds.

INTRODUCTION AND AIMS: Research concerning domestic violence and intimate partner violence reports life time prevalence of abuse and associations between suicidal behaviors among female psychiatric patients. The aim of the study was to describe abused women’s experiences of emotional, physical, sexual abuse and suicidal behavior experienced by women in general psychiatric care. METHODS: Women attending general psychiatric in-and outpatient care were asked to participate, using the NorVold abuse questionnaire, and seventy seven abused women contributed. RESULTS: Thoughts of suicide were significantly more common among women subjected to severe emotional abuse (n= 35, 71%), compared to women not subjected (n=14, 29%).Women suffering from mild emotional abuse register higher frequency of thoughts of suicide (n=39, 80%) compared to women with no experience (n=10, 20%). Suicide attempts were significantly higher among women experiencing severe emotional abuse (n=14, 82%) compared to women with no experience (n=3, 18%). Women who endured severe physical abuse made suicide attempt significantly more often (n=14, 74%) than women with no experience (n=5, 26%). Acts of self-deliberate harm were significantly higher among women experiencing mild emotional abuse (n=24, 86%) compared to the women with no experience (n=4, 14%). CONCLUSIONS: Results indicate that women with suicidal behavior could be victims of mild and severe emotional abuse and severe physical abuse. Even when suffering from the abuse, the women rarely confide to personnel.

This study was aimed to create a practical supervision model, in which three levels of academic work are weaved together: undergraduate studies, PhD stidies and research programs. The research methods used in development of the supervision model include literature studies, seminars connected to the subject and abductive reasoning. This work resulted in development of a multipart model called TRIAD SUPERVISION. This TRIAD model of supervising is meant to be used at bachelor-level in nursing education where the supervision may become a didactically conducted process of learning. It is concluded that the TRIAD way of crating learning environment may be a smooth introduction to empiric concepts of students.

The implementation of clinical practice guidelines (CPGs) has become an increasingly common element of clinical care, but little qualitative research has been conducted in real-life clinical settings. The aim was to elucidate experiences and factors of importance for the implementation of CPGs in hospital care. Twenty interviews were conducted, audio-taped and transcribed verbatim. A manifest and latent content analysis was performed to interpret the text. A system of subcategories related to five categories and one overall theme were developed. The data reveal that the implementation of CPGs is continuous processes of creating reliable and tenable routines that involve all staff members and expect to lead to better and safer patient care as well as to increased knowledge and confidence among staff. The process is initiated by internal or external demands and represents a way to keep abreast of knowledge development. Several factors facilitate the implementation and have an influence on the use and compliance with CPGs. To increase support for and willingness to use the CPG, it appears important to involve all staffs in the implementation process as well as to follow up and give feedback continuously to staff and management. It seems necessary to evaluate the process to supervise compliance with CPGs and to balance priorities and costs. Evaluation can also demonstrate importance of the application.

Rationale and Aim: There is a lack of evidence about how to successfully implement standardized nursing care plans (SNCP) in various settings. The aim of this study was to use the “Promotion Action on Research Implementation in Health Services framework” (PARIHS) to explore important factors and conditions at hospital wards that had implemented SNCPs. Method: We employed a retrospective, cross-sectional design and recruited nurses from four units at a rural hospital and seven units at a university hospital in the western and southern region of Sweden where SNCPs had been implemented. Outcome was measured by means of a questionnaire based on the PARIHS-model. Result: In total, 137 nurses participated in the study. The main factors that had motivated the nurses to implement SNCPs were that they were easy to understand and follow as well as corresponding to organisational norms. The SNCPs were normally based on clinical experience, although research more frequently formed the basis of the SNCPs at the university hospital. Internal facilitators acted as important educators, who provided reminders to use the SNCP and feedback to the SNCP users. The patient experience was not considered valuable. Those who claimed that the implementation was successful were generally more positive in all measurable aspects. The use of SNCPs was rarely evaluated. Conclusions: Clinical experience was considered important by the nurses, while they attributed little value to the patient experiences. Successful implementation of research based SNCPs requires internal facilitators with knowledge of evidence-based nursing.

Implementering som kontinuerliga processer i klinisk verksamhet Det finns en rad faktorer som påverkar möjligheterna att bedriva en evidensbaserad vård. Bland annat krävs det beslutsunderlag som så långt det är möjligt vilar på vetenskaplig grund, men även att man använder strategier för implementering som är lämpliga och systematiskt utvärderar dessa. Kliniska riktlinjer kan beskrivas vara beslutsunderlag som på ett praktiskt vis omsätter en stor mängd fakta. Implementering av kliniska riktlinjer är ett komplext område och det finns en hel del forskning redovisad internationellt sett. Trots detta är kunskapen om hur implementering bäst låter sig göras begränsad, framförallt avseende svenska förhållanden. I en studie med kvalitativ metodansats intervjuades sammanlagt 20 avdelningschefer och sjuksköterskor, alla verksamma inom olika kliniska specialiteter vid åtta sjukhus i södra Sverige. Syftet var att klargöra erfarenheter och faktorer av vikt vid implementering av kliniska riktlinjer inom sjukhusvård. Resultatet visar att på ett övergripande plan är implementering av kliniska riktlinjer kontinuerliga processer för att skapa trovärdiga och hållbara rutiner som involverar all personal och förväntas leda till en bättre och säkrare vård för patienterna, samt en ökad kunskap och trygghet hos personalen. Processerna drivs av olika komponenter som i sin tur har anknytning till ett flertal faktorer som påverkar huruvida implementeringen blir framgångsrik eller inte. Det är alltså möjligt att i den kliniska verksamheten visa på strukturer och faktorer som främjar eller motverkar en framgångsrik implementering och dessa kommer att förevisas och diskuteras under presentationen.

Title: Using the PARIHS framework in development of an instrument for the evaluation of clinical practice guidelines Rationale and aim: Some factors presented in the PARISH framework was used in the development of an instrument for the evaluation of implementation and use of clinical practice guidelines (CPG:s). The aim is to exhibit the scales constructed from the PARIHS framework and report about the test-retest reliability of these scales. Method: A questionnaire was designed to survey the implementation and use of CPG:s. Some of the questions were constructed as visual analogue scales in which contradictory statements were drawn from the PARIHS framework. The scales dealt with the perceptions of circumstances in clinical practice such as patient’s experiences (5 items), personnel’s clinical experiences (5 items), and the context (1 item) of care in term of culture (2 item), leadership (1 item), forms of evaluation (1 item), feed-back (1 item) and function of facilitators (2 items). A test-retest was conducted with 39 health professionals at a University hospital in the southern region of Sweden. All 39 respondents completed the questionnaire twice, with a mean time between completions of 5.5 weeks. Cohen’s Kappa and percentage concordance between responses was used to investigate the test-retest reliability of the scales. Results: Concerning the Kappa value most of the items (12) showed moderate strength of agreement, four items showed good agreement, and two showed only fair agreement. The percentage concordance was high for 6 items (80% and over), run between 71% - 79% in 10 items, and two items was below 70%. These scores indicate a reasonable stability suggesting a possibility of further developing the instrument. The scales are further being used in different Swedish research projects, for instance concerning evaluation of implementation of Standardized Nursing Care Plans.

Rationale and aims: This study focuses on the development of an instrument for the evaluation of clinical practice guidelines and is one part of a research project about the implementation and use of such guidelines among hospitals in the southern region of Sweden. The aim of the present paper was to investigate the test-retest reliability of a questionnaire. Method: A questionnaire was designed to gather data about guidelines that have been implemented as well as information about factors, which, according to the Promoting Action on Research Implementation in Health Service (PARIHS)-model, influence the success of implementation. Thirty-nine professionals at one of the hospitals included in the survey completed the questionnaire on two occations within a mean time of 5.5 weeks. The test-retest reliability was analyzed by means of Cohen's Kapps and percentage concordance. Results: Eight items had good agreement in terms of strength and high percentage concordance. With regard to the Kappa values 13 items show moderate and two fair agreement. Conclusions: The test-retest reliability scores show mainly acceptable results indicating a reasonable stability, thus suggesting the possibility of further developing the instrument. The factors described in the PARIHS-model seem relevant for use in evaluating implementation and use of guidelines. The instrument could benefit from a revision of the language in order to enhance clarity and make it less abstract.

Within the evidence-based movement means are developed to support the practitioner in becoming a research consumer with knowledge and skills to create an evidence-based practice (EBP). But little is actually known about whether, and how, this evidence-based accumulation of knowledge is used by practitioners and in what way any actual use leads to improved outcomes. Clinical practice guidelines (CPGs) are described to provide means to keep up with scientific development and may serve as an interface between science and practice. Implementation of evidence and guidelines in daily care are very complex and knowledge about the best way to implement evidence to facilitate best practices is still limited. The overall aim of this thesis was to explore factors that influence an evidence-based clinical practice, and more specifically, to investigate outcomes of an evidence-based practice, the dissemination and awareness of evidence-based literature, and to describe factors of importance when implementing CPGs. A systematic review was conducted to identify outcomes, and different experimental designs have been used for the purpose of describing awareness and dissemination of evidence-based literature as well as experience of the implementation of CPGs. Furthermore, a test-retest was conducted to test the reliability of items constructed from factors drawn from The Promoting Action on Research Implementation in Health Services (PARIHS) framework.The findings of the systematic review showed that it is difficult to prove effects of an EBP and the studies that managed this had implemented evidence-based CPGs. Although improvements in outcomes were reported for patients, personnel and the organisation, the synthesis showed a weak scientific foundation for the overall result since the studies included were heterogeneous in their designs. In a questionnaire study, in the area of psychiatric nursing with a pre-post design in relation to published evidence-based nursing reports, some differences were detected over time. But still 39.5 % of the sample reported no access to evidence-based literature one year after the publication of the two evidence-based nursing reports, and few of the respondents who had access to evidence-based literature reported any use of it. In the test-retest items of factors such as clinical experience, patients experience, leadership, context, culture, evaluation and facilitation was included. The findings of the test-retest showed that the reliability varied from good to fair agreement regarding the Kappa values, with a predominance of moderate agreement. The interview study, with an interpretive qualitative design, revealed several factors that appeared to be of importance for the implementation CPGs. The factors seemed to form a base consisting of circumstances, conditions and requirements. These have a relation to components that constitute a process, thus illustrating that implementing CPGs are continuous processes of creating reliable and tenable routines which involve all staffs member and are expected to lead to better and safer care of patients and increase knowledge and confidence among the staff.In conclusion, it is complicated, but not impossible, to demonstrate the outcomes of an EBP. To implement evidence-based CPGs is one way to make an evidence-based care visible. But more research is needed to strengthen the scientific foundation and to establish whether the tendency towards improved outcomes reported can be further supported. To implement CPGs is described as processes of bringing about a certain level of best practice that benefits patients as well as the staff. There are several factors influencing the process in relation to both positive and negative aspects and depending on which aspects will rise in the foreground the processes are visible or concealed, move forward or stagnate, promote or impede a successful implementation.

Evidensbaserad omvårdnad definieras i denna bok som både ett förhållningssätt och en process. Förhållningssättet innebär en vilja att använda bästa tillgängliga vetenskapliga bevis som underlag för vårdbeslut. Processen består i hur man praktiskt går till väga för att finna, sammanställa, kritiskt värdera och implementera detta underlag. Evidensbaserad omvårdnad handlar således om en strävan att bedriva omvårdnad på en god och säker grund och att tillgodose samhällets krav på att forskningsresultat utnyttjas på bästa sätt. I denna andra upplaga har bland annat två helt nya kapitel om implementering, kliniska riktlinjer och standardvårdplaner tillkommit. Boken vänder sig främst till studerande vid sjuksköterskeprogrammet samt kliniskt verksamma sjuksköterskor men även till alla som vill veta hur man gör systematiska litteraturstudier.

En av de största utmaningarna just nu är att åstadkomma en evidensbaserad vård i det dagliga vårdarbetet. I princip handlar denna utmaning om att hantera en stor mäng föränderlig information, främst vetenskaplig sådan, och att systematiskt tillämpa den i det dagliga arbetet. Denna artikel avser dels att tydliggöra innebörden av begreppet evidensbaserad vård, dels att visa på möjliga vägar att åstadkomma en evidensbaserad vård.