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  • 1.
    Aasa, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Barnekow-Bergkvist, Margareta
    Angquist, Karl-Axel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Relationships between work-related factors and disorders in the neck-shoulder and low-back region among female and male ambulance personnel.2005In: Journal of Occupational Health, ISSN 1341-9145, E-ISSN 1348-9585, Vol. 47, no 6, p. 481-9Article in journal (Refereed)
    Abstract [en]

    This cross-sectional study on a random sample of 1,500 ambulance personnel investigated the relationships between self-reported work-related physical and psychosocial factors, worry about work conditions, and musculoskeletal disorders among female and male ambulance personnel. Three different outcomes, complaints, activity limitation, and sick leave, for the neck-shoulder and low-back region, respectively, were chosen. Among the female personnel, physical demands was significantly associated with activity limitation in the neck-shoulder (OR 4.13) and low-back region (OR 2.17), and psychological demands with neck-shoulder (OR 2.37) and low-back (OR 2.28) complaints. Among the male personnel, physical demands was significantly associated with low-back complaints (OR 1.41) and activity limitation (OR 1.62). Psychological demands and lack of social support were significantly associated with neck-shoulder complaints (OR 1.86 and OR 1.58, respectively) and activity limitation (OR 3.46 and OR 1.71) as well as activity limitation due to low-back complaints (OR 2.22 and OR 1.63). Worry about work conditions was independently associated with activity limitation due to low-back complaints among the female (OR 5.28), and to both neck-shoulder and low-back complaints (OR 1.79 and OR 2.04, respectively) and activity limitation (OR 2.32 and OR 1.95) among the male personnel. In conclusion, the association patterns between physical and psychological demands and MSDs suggest opportunities for intervention.

  • 2.
    Aasa, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ängquist, Karl-Axel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Barnekow-Bergkvist, Margareta
    Work-related psychosocial factors, worry about work conditions and health complaints among female and male ambulance personnel.2005In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, no 3, p. 251-258Article in journal (Refereed)
  • 3.
    Ahlgren, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Malmgren Olsson, Eva-Britt
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gender analysis of musculoskeletal disorders and emotional exhaustion: interactive effects from physical and psychosocial work exposures and engagement in domestic work2012In: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 55, no 2, p. 212-228Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to assess the relationships between physical and psychosocial work exposures, engagement in domestic work and work-home imbalance in relation to symptoms of musculoskeletal disorders and emotional exhaustion in white- and blue-collar men and women. Three thousand employees from 21 companies were asked to answer a questionnaire on family structure, household and child care tasks, work exposure, work-home imbalance and symptoms of neck/shoulder disorders, low back disorders and emotional exhaustion. Women reported more musculoskeletal disorders and engagement in domestic work. Adverse at-work exposures were highest in blue-collar women. High engagement in domestic work was not separately associated with symptoms but paid work exposure factors were associated. High engagement in domestic work interacted with adverse work exposure and increased risk estimates for low back disorders and emotional exhaustion. Reported work-home imbalance was associated with neck/shoulder disorders in women and with emotional exhaustion in both women and men.

    Practitioner Summary. The current article adds to earlier research by showing that high engagement in domestic work is not separately associated with increased symptoms, but interacts with psychosocial work exposure variables to produce emotional exhaustion in both women and men and low back disorders in women.

  • 4.
    Backteman-Erlanson, Susann
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jacobsson, Ann
    Umeå University, Faculty of Medicine, Department of Nursing.
    Öster, Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Caring for traffic accident victims: the stories of nine male police officers2011In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 19, no 2, p. 90-95Article in journal (Refereed)
    Abstract [en]

    Psychological strain due to the work environment is common, especially in those occupations which involve working in critical situations. Working as a police officer seems to increase the risk of psychological problems such as symptoms of stress and post traumatic stress disorders. The aim of this study was to describe male police officers’ experiences of traumatic situations when caring for victims of traffic accidents, and to reflect the results through the perspective of gender theories. Nine police officers were asked to narrate and reflect upon their experiences in taking care of people who had been severely injured in traffic accidents. The interviews were analysed with qualitative content analysis. The findings are presented in three themes: “being secure with the support system”, “being confident about prior successful actions, and “being burdened with uncertainty”. The officers’ descriptions showed that most of them had strategies that they used when they were first responders, developed on the basis of their own knowledge and actions and the support systems in their organization which enabled them to act in traumatic situations. When support systems, knowledge, and actions were insufficient, they sometimes felt insecure and “burdened with uncertainty”. In this male-dominated context, there was a risk that the officers may not talk enough about traumatic situations, thus influencing their ability to cope successfully.

  • 5.
    Backteman-Erlanson, Susann
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Prevalence of burnout and associations with psychosocial work environment, physical strain, and stress of conscience among Swedish female and male police personnel2012In: Police Practice & Research, ISSN 1561-4263, E-ISSN 1477-271XArticle in journal (Refereed)
    Abstract [en]

    Focus of this study was to investigate prevalence of burnout and relation to psychosocial work environment, physical strain, and stress of conscience amongst female and male police personnel in Sweden. The questionnaire was answered by 856 (55%) patrolling police officers, 437 (56%) women vs. 419 (53%) men. Prevalence and mean values for emotional exhaustion (EE) and depersonalization (DP) was higher in our study compared to other studies including police personnel in Norway and the Netherlands. A multiple logistic regressions showed that for women stress of conscience, high demand, and organizational climate was significant associated with EE, for men it was stress of conscience, decision, and high demand. For DP only stress of conscience contributed statistically significant in our model, respectively, of gender. Further research is needed to develop interventions aiming to reduce levels of burnout among police personnel in Sweden.

  • 6.
    Backteman-Erlanson, Susann
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Öster, Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Exploration of the WOCQ tool in relation to gender and psychometric properties among Swedish patrolling police officersManuscript (preprint) (Other academic)
    Abstract [en]

    Police work is a stressful occupation with frequent exposure to traumatic events. In Sweden knowledge about coping strategies among police personnel is absent probably due to lack of validated measurements. Aim of this study was to explore psychometric properties of the Ways of Coping Questionnaire (WOCQ) among Swedish police personnel, including testing differential item functioning (DIF) for gender. The WOCQ was sent out to 1554 randomly selected patrolling police officers in Sweden. Exploratory factor analysis and confirmatory factor analysis were used. A six factor solution was confirmed with differences and similarities compared to the original eight factor solution. DIF analysis showed similarities and differences in relation to gender. We suggest that the WOCQ can be used when investigating coping strategies in a Swedish police context.

     

  • 7. Blomberg, Frida
    et al.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Andertun, Regina
    Rydh, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Patients' perception of quality of care in a radiology department: a medical-physical approach2010In: Journal of Radiology Nursing, ISSN 1546-0843, Vol. 29, no 1, p. 10-17Article in journal (Refereed)
    Abstract [en]

    The aim of our cross-sectional study was to identify patients' perception of quality of care (QoC), and further to evaluate the relation between QoC and demographic factors in patients who have been subject to a radiology examination or a radiology treatment. Good QoC is the primary aim of the public medical and health service, with the aim of same quality for the whole population. Few scientific studies have been carried out within radiology with the aim of investigating differences between varying demographic factors and patient's perceptions of QoC. The radiology department's version of the Quality from the Patient's Perspective questionnaire (QPP) was used for data collection. Six hundred and ninty-eight patients participated in the study. Low estimation of the QoC was associated with dissatisfaction with telephone contact, long waiting time, neither easy nor hard waiting time experience, not receiving an invitation in time, and age 56 to 75 years. Female patient responses for estimated QoC were higher, as were those from patients with less formal education. Our study shows that factors inducing dissatisfaction concerning QoC, above all long waiting times, can be tolerated if radiology personnel provide good routines for information. Telephone contact, and adequate, timely information, is especially important. The results of this study demonstrate that several factors play a role in a patient's perception of QoC in a radiology department. The further research on patient-focused quality improvement is needed to improve patient's perception of quality care in the radiology department.

  • 8.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Nursing.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine. Medicin.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Being a palliative nurse for persons with severe congestive heart failure in advanced homecare.2005In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 4, no 4, p. 314-323Article in journal (Refereed)
    Abstract [en]

    Advanced homecare for persons with congestive heart failure is a ‘new’ challenge for palliative nurses. The aim of this study is to illuminate the meaning of being a palliative nurse for persons with severe congestive heart failure in advanced homecare. Narrative interviews with 11 nurses were conducted, tape-recorded, and transcribed verbatim. A phenomenological-hermeneutic method was used to interpret the text. One meaning of being a palliative nurse is being firmly rooted and guided by the values of palliative culture. Being adaptable to the patient's way of life carries great weight. On one hand nurses live out this value, facilitating for the patients to live their everydaylife as good as possible. Being a facilitator is revealed as difficult, challenging, but overall positive. On the other hand nurses get into a tight corner when values of palliative culture clash and do not correspond with the nurses interpretation of what is good for the person with congestive heart failure. Being in such a tight corner is revealed as frustrating and giving rise to feelings of inadequacy. Thus, it seems important to reflect critical on the values of palliative culture.

  • 9.
    Burström, Marianne
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Manliga patienter med hjärtsvikt och deras erfarenheter av att vara trygga och otrygga2007In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 3, no 27, p. 24-28Article in journal (Refereed)
    Abstract [en]

    To be safe is a basic human need. Although feelings of being unsafe has been identified as a common problem among persons who live with heart failure there are few qualitative studies focusing on the problem. The aim of this study was to describe what it means to be safe or unsafe for men with heart failure. Seven men with heart failure, functional class NYHA II-III, were interviewed in focus groups. The interviews were analysed with content analysis. Threat of sudden death was described as both a source of safety and unsafety, and living with a fear of drowning in their own body fluid was seen as a source of unsafety for the men. In meetings with caregivers and relatives it was of importance to be received as a unique and valuable person. The confidence to the heart specialist was almost supernatural and the specialist nurse was spoken about as valuable for the feeling of being safe. In conclusion, to be seen with respect by physicians and nurses who have good ability to listen to the men's experience of living with heart failure can probably increase the men's feelings of safety. Further, it is important that physicians and nurses have good knowledge about heart failure.

  • 10.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Söderberg, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    A content validated questionnaire for assessment of self reported venous blood sampling practices2012In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 5, p. 39-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Venous blood sampling is a common procedure in health care. It is strictly regulated by national and international guidelines. Deviations from guidelines due to human mistakes can cause patient harm. Validated questionnaires for health care personnel can be used to assess preventable "near misses"--i.e. potential errors and nonconformities during venous blood sampling practices that could transform into adverse events. However, no validated questionnaire that assesses nonconformities in venous blood sampling has previously been presented. The aim was to test a recently developed questionnaire in self reported venous blood sampling practices for validity and reliability.

    FINDINGS: We developed a questionnaire to assess deviations from best practices during venous blood sampling. The questionnaire contained questions about patient identification, test request management, test tube labeling, test tube handling, information search procedures and frequencies of error reporting. For content validity, the questionnaire was confirmed by experts on questionnaires and venous blood sampling. For reliability, test-retest statistics were used on the questionnaire answered twice. The final venous blood sampling questionnaire included 19 questions out of which 9 had in total 34 underlying items. It was found to have content validity. The test-retest analysis demonstrated that the items were generally stable. In total, 82% of the items fulfilled the reliability acceptance criteria.

    CONCLUSIONS: The questionnaire could be used for assessment of "near miss" practices that could jeopardize patient safety and gives several benefits instead of assessing rare adverse events only. The higher frequencies of "near miss" practices allows for quantitative analysis of the effect of corrective interventions and to benchmark preanalytical quality not only at the laboratory/hospital level but also at the health care unit/hospital ward.

  • 11.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Personnel's Experiences of Phlebotomy Practices after Participating in an Educational Intervention Programme2014In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, p. 1-8, article id 538704Article in journal (Refereed)
    Abstract [en]

    Background. Blood specimen collection is a common procedure in health care, and the results from specimen analysis have essential influence on clinical decisions. Errors in phlebotomy may lead to repeated sampling and delay in diagnosis and may jeopardise patient safety. This study aimed to describe the experiences of, and reflections on, phlebotomy practices of phlebotomy personnel working in primary health care after participating in an educational intervention programme (EIP). Methods. Thirty phlebotomists from ten primary health care centres participated. Their experiences were investigated through face-to-face interviews. Findings were analysed using qualitative content analysis. Results. The participants perceived the EIP as having opened up opportunities to reflect on safety. The EIP had made them aware of risks in relation to identification procedures, distractions from the environment, lack of knowledge, and transfer of information. The EIP also resulted in improvements in clinical practice, such as a standardised way of working and increased accuracy. Some said that the training had reassured them to continue working as usual, while others continued as usual regardless of incorrect procedure. Conclusions. The findings show that EIP can stimulate reflections on phlebotomy practices in larger study groups. Increased knowledge of phlebotomy practices improves the opportunities to revise and maximise the quality and content of future EIPs. Educators and safety managers should reflect on and pay particular attention to the identification procedure, distractions from the environment, and transfer of information, when developing and implementing EIPs. The focus of phlebotomy training should not solely be on improving adherence to practice guidelines.

  • 12.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Personnel’s experiences of venous blood specimen collection practices after participating in an educational intervention programmeManuscript (preprint) (Other academic)
    Abstract [en]

    Aim: The aim of this study was to describe primary healthcare personnel’s experiences of venous blood specimen collection practices after participating in an educational intervention programme.

    Background: Venous blood specimen collection is one of the most frequent procedures in healthcare, and the results from specimen analysis have essential influence on clinical decisions. Errors in specimen collection may lead to repeated sampling and delay in diagnosis, and may jeopardise patient safety.

    Design: This is a qualitative, descriptive study based on individual interviews subjected to qualitative content analysis.

    Methods: A convenient sample of 30 venous blood specimen collection personnel from ten primary healthcare centres participated in this study. Their experiences were investigated through face-to-face interviews and analysed using qualitative content analysis.

    Results: In this study we found that the participants experienced that the education opened up opportunities for reflections on safety. They became aware of risks in relation to identification procedures, environmental disturbances, lack of knowledge and transfer of information. They had also achieved improvements in clinical practice such as standardised ways of working and increased accuracy. However, some described that they felt strengthened in working as usual and worked as usual in a correct way or as usual in an incorrect way.

    Conclusions: Our findings indicate that a short educational programme opens up opportunities for reflections about safety. Education is needed to improve and maintain a good quality of venous blood specimen collection practices.

    Relevance to clinical practice: Developers of education should reflect on and pay attention to the identification procedure, environmental disturbances, and transferral of information, when developing educational intervention programmes, and not focus solely on improving adherence to guideline practices.

  • 13.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Nilsson, Karin
    Umeå University, Faculty of Medicine, Department of Nursing. Institutionen för omvårdnad i Örnsköldsvik.
    Söderberg, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Impact of a large-scale educational intervention program on venous blood specimen collection practices2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, article id 463Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Phlebotomy performed with poor adherence to venous blood specimen collection (VBSC) guidelines jeopardizes patient safety and may lead to patient suffering and adverse events. A first questionnaire study demonstrated low compliance to VBSC guidelines, motivating an educational intervention of all phlebotomists within a county council. The aim was to evaluate the impact of a large-scale educational intervention program (EIP) on primary health care phlebotomists' adherence to VBSC guidelines. We hypothesised that the EIP would improve phlebotomists' VBSC practical performance.

    METHODS: The present study comprise primary health care centres (n = 61) from two county councils in northern Sweden. The final selected study group consisted of phlebotomists divided into an intervention group (n = 84) and a corresponding control group (n = 79). Both groups responded to a validated self-reported VBSC questionnaire twice. The EIP included three parts: guideline studies, an oral presentation, and an examination. Non-parametric statistics were used for comparison within and between the groups.

    RESULTS: Evaluating the EIP, we found significant improvements in the intervention group compared to the control group on self-reported questionnaire responses regarding information search (ES = 0.23-0.33, p < 0.001-0.003), and patient rest prior to phlebotomy (ES = 0.27, p = 0.004). Test request management, patient identity control, release of venous stasis, and test tube labelling had significantly improved in the intervention group but did not significantly differ from the control group (ES = 0.22- 0.49, p = < 0.001- 0.006). The control group showed no significant improvements at all (ES = 0--0.39, p = 0.016-0.961).

    CONCLUSIONS: The present study demonstrated several significant improvements on phlebotomists' adherence to VBSC practices. Still, guideline adherence improvement to several crucial phlebotomy practices is needed. We cannot conclude that the improvements are solely due to the EIP and suggest future efforts to improve VBSC. The program should provide time for reflections and discussions. Furthermore, a modular structure would allow directed educational intervention based on the specific VBSC guideline flaws existing at a specific unit. Such an approach is probably more effective at improving and sustaining adherence to VBSC guidelines than an EIP containing general pre-analytical practices.

  • 14.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Söderberg, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Minor improvement of venous blood specimen collection practices in primary health care after a large-scale educational intervention2013In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 51, no 2, p. 303-310Article in journal (Refereed)
    Abstract [en]

    Background: Venous blood specimen collection is a common health care practice that has to follow strict guidelines, non-compliance among sampling staff may compromise patient safety. We evaluated a large-scale 2 h educational intervention that emphasised guideline adherence to assess possible improvements of venous blood specimen collection practices.

    Methods: Blood specimen haemolysis is usually caused by inadequate venous blood specimen collection and handling, reflecting overall pre-analytical handling. We monitored haemolysis of serum samples with haemolysis index corresponding to ≥150 mg/L of free haemoglobin for specimens sent from 11 primary health care centres and analysed on a Vitros 5,1 clinical chemistry analyser before (2008, n=6652 samples) and after (2010, n=6121 samples) the intervention.

    Results: The total percentage of haemolysed specimens was 11.8% compared to 10.5% (p=0.022) before the intervention. As groups, rural primary health care centres demonstrated a significant reduction [Odds ratios (OR)=0.744] of haemolysed specimens after intervention, whereas urban primary health care centres demonstrated a significant increase (OR=1.451) of haemolysis.

    Conclusions: A large-scale 2 h educational intervention to make venous blood specimen collection staff comply with guideline practices had minor effects on collection practices. Educational interventions may be effective in wards/care centres demonstrating venous blood specimen collection practices with larger deviations from guidelines.

  • 15.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Physical and psychosocial work-related risk factors associated with neck-shoulder discomfort in male and female music teachers.2003In: Medical problems of performing artists, ISSN 0885-1158, E-ISSN 1938-2766, Vol. 18, no 1, p. 33-41Article in journal (Other academic)
  • 16.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Musicianship and teaching: positive health factors in music teachers2002In: Medical problems of performing artists, ISSN 0885-1158, E-ISSN 1938-2766, Vol. 17, no 1, p. 3-10Article in journal (Other academic)
  • 17.
    Franzén, Carin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    A cost-utility analysis of nursing intervention via telephone follow-up for injured road users2009In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 9, p. 98-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Traffic injuries can cause physical, psychological, and economical impairment, and affected individuals may also experience shortcomings in their post-accident care and treatment. In an earlier randomised controlled study of nursing intervention via telephone follow-up, self-ratings of health-related quality of life were generally higher in the intervention group than in the control group. OBJECTIVE: To evaluate the cost-effectiveness of nursing intervention via telephone follow-up by examining costs and quality-adjusted life years (QALYs). METHODS: A randomised controlled study was conducted between April 2003 and April 2005. Car occupants, cyclists, and pedestrians aged between 18 and 70 years and attending the Emergency Department of Umeå University Hospital in Sweden after an injury event in the traffic environment were randomly assigned to an intervention (n = 288) or control group (n = 280). The intervention group received routine care supplemented by nursing via telephone follow-up during half a year, while the control group received routine care only. Data were collected from a mail survey using the non-disease-specific health-related quality of life instrument EQ5D, and a cost-effectiveness analysis was performed including the costs of the intervention and the QALYs gained. RESULTS: Overall, the intervention group gained 2.60 QALYs (260 individuals with an average gain of 0.01 QALYs). The car occupants gained 1.54 QALYs (76 individuals, average of 0.02). Thus, the cost per QALY gained was 16 000 Swedish Crown (SEK) overall and 8 500 SEK for car occupants. CONCLUSION: Nursing intervention by telephone follow-up after an injury event, is a cost effective method giving improved QALY to a very low cost, especially for those with minor injuries. 

  • 18.
    Franzén, Carin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Injured road users' experience of care in the emergency department2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 6, p. 726-734Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the patients' perceptions of quality of care (QoC) in an emergency department (ED) and to analyse associations between patients' background characteristics and estimated QoC.

    BACKGROUND: Each year 1.4 out of every 100 inhabitants are injured in the traffic environment and receive care at the ED. No study has yet analysed different injured road users' perceived QoC, or how important they rate different caring dimensions.

    DESIGN: Cross-sectional study at the ED, in the University Hospital in Umeå, Sweden.

    METHOD: A stratified consecutive sample of 166 car occupants, 200 cyclists and 199 pedestrians, aged 18-70 years, all injured in the traffic environment. Data were collected from medical records and from a mail survey using a short form of the Quality from the Patient's Perspective questionnaire, modified for ED use. The statistical methods used included Mann-Whitney's U-test, the Kruskal-Wallis test and multiple logistic regression.

    RESULTS: The perceived QoC and the subjective importance of the corresponding QoC dimensions were rated at the 'better' half of the rating scale, with no differences between the different road user categories. The most prominent factors associated with a positive perceived QoC rating were a short waiting time, moderate or serious injuries and high age as well as high educational level of the injury victim. For the subjective importance, a short waiting time was rated as the most important but slight differences were seen, related to education and sex.

    CONCLUSION: The association patterns between the areas of perceived reality and subjective importance indicated that expectations were higher than perceived QoC, suggesting that patients expected somewhat higher QoC than they received.

    RELEVANCE TO CLINICAL PRACTICE: Information on factors causing long waiting times, adapted to patients' age, sex and educational level, may reduce dissatisfaction among long waiting patients, especially among those with minor injuries.

  • 19.
    Franzén, Carin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Injured road users' health-related quality of life after telephone intervention: a randomised controlled trial.2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 1, p. 108-116Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate whether nursing intervention via telephone follow-up can affect health-related quality of life among road users in the postinjury phase.

    Background: Injuries in the traffic environment often cause both physical impairment and psychological trauma. Therefore, it is important to investigate whether nursing via telephone follow-up after discharge could affect health-related quality of life among injured road users.

    Design: A randomised controlled study.

    Method: Between April 2003–April 2005, car occupants, cyclists and pedestrians, aged 18–70 years, all injured in the traffic environment, were randomly assigned to an intervention (n = 288) or control group (n = 280). All patients were initially managed by one emergency department with the intervention group being followed up by nurse led telephone follow-up three weeks after discharge, while the control group did not receive any telephone follow-up. Data were collected from a mail survey using the non-disease-specific health-related quality of life instrument EQ5D, at baseline and after six months.

    Results: In general, the intervention group rated significantly higher health-related quality of life than the control group. This difference was most pronounced in the group of those provided with advice as part of telephone follow-up and significantly for the general health status. Car occupants gained most advantage from the nursing telephone follow-up, with significantly lower problems in the dimensions of pain/discomfort and usual activities.

    Conclusion: Nursing intervention via telephone follow-up was effective at increasing the health-related quality of life of injured road users. Early identification of the concerns of the injured and specific advice provided by the intervening nurse seems to be of greatest weight. Thus, more research is needed regarding the usefulness of early support and the advantage of this from a health economic perspective.

    Relevance to clinical practice: There is a need for changes in attitudes and working routines to identify individuals with low health-related quality of life and to give more extensive support from this point of view.

  • 20.
    Hajdarevic, Senada
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Patients' decision making in seeking care for suspected malignant melanoma2010In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 2, no 2, p. 164-173Article in journal (Refereed)
    Abstract [en]

    Aim. To explore patients' decision making about seeking care for malignant melanoma (MM).

    Background. Unlike other cancers, MM is generally visible and can be easily and cheaply cured if treated in time. It is the delay in diagnosis, most often attributable to the patient rather than to care providers, that results in mortality. Self-examination of suspicious lesions is important, but it is not a guarantee of immediate care-seeking, nor is early detection and increased melanoma awareness associated with early care-seeking.

    Method. During 2009, men (n = 10) and women (n = 11) diagnosed with malignant melanoma were interviewed within two years after excision and the text was analysed according to Grounded Theory.

    Results. The perception of a critical level of severity, feelings of fear and threat were found to be a key motivator for patients to seek care for suspected melanomas; as soon as sufficient insight into the severity of the disease was achieved, the patient reached a turning point and sought care immediately.

    Conclusions. Most of the participants described the process from the discovery of the lesion to the decision to seek care as a time-consuming inner negotiation about the severity of the disease, personal and social considerations, and interactions with the healthcare system.

    Relevance to clinical practice. We analysed the complex reasoning of the patients leading up to the turning point when they sought care. This study illustrates for caregivers the importance of simplifying the pathways to care, emphasising the seriousness of MM, and taking worried patients seriously from their first contact with health care. Health professionals, through their attitudes in contact with patients, can either facilitate or obstruct the patient's decision making process.

  • 21.
    Hajdarevic, Senada
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hörnsten, Asa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Malignant melanoma: gender patterns in care seeking for suspect marks2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, p. 2676-2684Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. Gender patterns in self-detection of melanoma are not sufficiently highlighted in the literature. The aim of the study was to identify specific patterns in the decision-making process to seek care for suspect melanoma, as narrated by women and men.

    Background. Females have a more favourable prognosis than males and also a higher level of perceived susceptibility and a higher level of knowledge about melanoma. Women are, furthermore, more prone to participate in screening.

    Method. Thirty patients (15 women and 15 men) with a mean age of 55.5 years and diagnosed with malignant melanoma were interviewed about their decisions to seek care for suspect skin marks. The interviews were transcribed and analysed with qualitative content analysis.

    Results. Care-seeking behaviour for suspect melanoma was influenced by gender constructions. Men seldom or never acknowledged interest in attention to bodily changes, but when they became aware of changes, they often took a quick decision and sought an expert's assessment. Men were compliant with wives' and relatives' advice about seeking care. All women reported that they paid attention to bodily changes, but they often delayed care seeking, due to family responsibilities and emotional struggles. The women also attempted self-care remedies, such as applying ointment, before seeking professional care.

    Conclusions. There are gender-specific patterns that may influence decision making in the care-seeking process. Such patterns are important to identify, since health care professionals must take these factors into account in communicating with men and women.

    Relevance to clinical practice. Nurses and in particular those working in telephone counselling, are often at the frontlines, deciding who can have access to health services. They are ideally placed to tackle the issue of gender constructions in the development of effective health care services.

  • 22.
    Hedberg, Pia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Experiences of purpose in life when becoming and being a very old woman2009In: Journal of Women & Aging, ISSN 0895-2841, E-ISSN 1540-7322, Vol. 21, no 2, p. 125-137Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to illuminate how very old women describe their experiences of purpose in life (PIL) in narratives about becoming and being very old. The participants comprised 30 women selected from 120 women who had answered the PIL test and had been interviewed about their experiences of being very old. The interviews were analyzed with qualitative content analysis, which revealed four themes: having a positive view of life, living in relation to God, having meaningful activities, and simply existing. Our findings show that very old women experience purpose in life both in their daily activities and in their contact with a spiritual world. It seems to be facilitated by a positive view of life. Although the results were dominated by a positive view of life, some of the participants saw their lives in terms of simply existing, and did not experience purpose in life.

  • 23.
    Hedberg, Pia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Purpose in life over a five-year period: a longitudinal study in a very old population2011In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 23, no 5, p. 806-813Article in journal (Refereed)
    Abstract [en]

    Background: Few studies have specifically examined purpose in life among very old people, and we know of none that has used a prospective approach. The aim of this study was to examine changes in pupose in life over five years in very old men and women and to investigate whether depressed mood, malnutrition, inactivity in daily life, or cognitive impairment increased the risk for developing low purpose in life.

    Methods: The study includes data from 51 participants (42 women and 9 men) living in Northern Sweden who completed the Purpose in Life Test once at baseline and again five years later.

    Results: Purpose in life decreased over five years and the decrease was significantly associated with being a woman (p<0.001) and having depressed mood (p=0.009) or depression (p=0.002) at baseline. There were no differences in baseline PIL scores between depressed and not depressed, but those who had depression had significantly decreased PIL scores after five years (p=0.001).

    Conclusion: A strong purpose in life does not seem to prevent very old people from developing depression, and being depressed at baseline and living with depression over five years is associated with a loss of purpose in life.

  • 24.
    Hedberg, Pia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Alèx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Depression in relation to purpose in life among a very old population: a five-year follow-up study2010In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 14, no 6, p. 757-763Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the relationship between purpose in life and depression and, in a five-year follow-up investigate whether purpose in life, adjusted for different background characteristics, can prevent very old men and women from developing depression. Methods: A cross-sectional study included 189 participants (120 women and 69 men) 85–103 years of age living in a county in northern Sweden. Those who had not been diagnosed as depressed at baseline were included in the five-year follow-up study (n=78). Depression was assessed using the Geriatric Depression Scale-15, the Organic Brain Syndrome scale, the Montgomery–Åsberg Depression Rating Scale, and Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Purpose in life was assessed with the Purpose in Life (PIL) scale. Results: In the cross-sectional study, 40 participants out of 189 (21.2%) were depressed, and those with depression had significantly lower PIL scores (mean score 107 vs. 99, p=0.014). In the follow-up study, 78 persons were available for the assessment of depression. Of those, 21 (26.9%) were diagnosed as depressed and their mean PIL score at baseline was 106 (SD=17.4) versus 108 (SD=16.0, p=0.750) among those not depressed. Using multivariate logistic regression analysis controlling for possible confounders, we found no association between purpose in life and the risk of developing depression after five years (OR=1.0, 95% CI 0.97–1.03). Conclusions: The results show a significant inverse relationship between purpose in life and depression in the cross-sectional study; however, a high PIL score does not seem to serve very old people as a protection against the risk of developing depression.

  • 25.
    Hedberg, Pia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Purpose in life among men and women aged 85 years and older2010In: The International Journal of Aging & Human Development, ISSN 0091-4150, E-ISSN 1541-3535, Vol. 70, no 3, p. 213-229Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate purpose in life in relation to psychological well-being, social relations, and physical and psychological symptoms among very old women (n = 120) and men (n = 69). Their purpose in life was evaluated using the Purpose in Life (PIL) scale. Women scored lower on this PIL scale than men (102 vs.108 p = .0.013). Regression analysis was used to estimate influencing factors on the PIL score. Determinants for purpose in life did not differ between the men and women, except for musculoskeletal symptoms. Attitude toward own aging had the strongest relation to PIL scores for both men and women; to have family to talk to was also important, as were musculoskeletal symptoms, for women. Our study indicates that the very old people studied were feeling indecisive about their purpose in life and that feelings are linked with poorer psychological health. For this reason, the purpose in life must be discussed and taken into consideration in the care of the elderly.

  • 26.
    Hedberg, Pia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Purpose in life among very old men2013In: Advances in Aging Research, ISSN 2169-0499, Vol. 2, no 3, p. 100-105Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to illuminate very old men’s experiences and reflections of purpose in life. The participants were 23 men who were interviewed and answered a specific question about purpose in life. The answers were analyzed according to qualitative content analysis, which revealed three content areas: the purpose of one’s life as a whole; purpose in everyday life; and reflections on purpose in life. Our findings showed that very old men experience purpose in life most strongly when remembering the past and when work is stressed as important. The analyzed text was dominated by positive experiences of PIL, although one man said that he had given up and that there was no purpose in his life at all.

  • 27.
    Hellström Ängerud, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    The Process of Care-seeking for Myocardial Infarction Among Patients With Diabetes2015In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 30, no 5, p. E1-E8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: People with diabetes have a higher risk for myocardial infarction (MI) than do people without diabetes. It is extremely important that patients with MI seek medical care as soon as possible after symptom onset because the shorter the time from symptom onset to treatment, the better the prognosis.

    OBJECTIVE: The aim of this study was to explore how people with diabetes experience the onset of MI and how they decide to seek care.

    METHODS: We interviewed 15 patients with diabetes, 7 men and 8 women, seeking care for MI. They were interviewed 1 to 5 days after their admission to hospital. Five of the participants had had a previous MI; 5 were being treated with insulin; 5, with a combination of insulin and oral antidiabetic agents; and 5, with oral agents only. Data were analyzed according to grounded theory.

    RESULTS: The core category that emerged, "becoming ready to act," incorporated the related categories of perceiving symptoms, becoming aware of illness, feeling endangered, and acting on illness experience. Our results suggest that responses in each of the categories affect the care-seeking process and could be barriers or facilitators in timely care-seeking. Many participants did not see themselves as susceptible to MI and MI was not expressed as a complication of diabetes.

    CONCLUSIONS: Patients with diabetes engaged in a complex care-seeking process, including several delaying barriers, when they experienced symptoms of an MI. Education for patients with diabetes should include discussions about their increased risk of MI, the range of individual variation in symptoms and onset of MI, and the best course of action when possible symptoms of MI occur.

  • 28.
    Hellström Ängerud, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Internal Medicine, Sunderbyn, Luleå, Sweden.
    Longer pre-hospital delay in first myocardial infarction among patients with diabetes: an analysis of 4266 patients in the Northern Sweden MONICA Study2013In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 13, no 6Article in journal (Refereed)
    Abstract [en]

    Background: Reperfusion therapy reduces both morbidity and mortality in myocardial infarction, but the effectiveness depends on how fast the patient receives treatment. Despite the time-dependent effectiveness of reperfusion therapy, many patients with myocardial infarction have delays in seeking medical care. The aim of this study was to describe pre-hospital delay in a first myocardial infarction among men and women with and without diabetes and to describe the association between pre-hospital delay time and diabetes, sex, age, symptoms and size of residential area as a proxy for distance to hospital.

    Methods: This population based study was based on data from 4266 people aged 25-74 years, with a first myocardial infarction registered in the Northern Sweden MONICA myocardial infarction registry between 2000 and 2008.

    Results: The proportion of patients with delay times >= 2 h was 64% for patients with diabetes and 58% for patients without diabetes. There was no difference in delay time >= 2 h between men and women with diabetes. Diabetes, older age and living in a town or rural areas were factors associated with pre-hospital delay times >= 2 h. Atypical symptoms were not a predictor for pre-hospital delay times >= 2 h, OR 0.59 (0.47; 0.75).

    Conclusions: A higher proportion of patients with diabetes have longer pre-hospital delay in myocardial infarction than patients without diabetes. There are no differences in pre-hospital delay between men and women with diabetes. The largest risk difference for pre-hospital delay >= 2 h is between women with and without diabetes. Diabetes, older age and living in a town or rural area are predictors for pre-hospital delay >= 2 h.

  • 29.
    Hellström Ängerud, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Internal Medicine, Sunderbyn, Luleå, Sweden.
    Patients with diabetes are not more likely to have atypical symptoms when seeking care of a first myocardial infarction: an analysis of 4028 patients in the Northern Sweden MONICA Study2012In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 29, no 7, p. e82-e87Article in journal (Refereed)
    Abstract [en]

    Aim: To describe symptoms of a first myocardial infarction in men and women with and without diabetes.

    Methods: We conducted a population-based study of 4028 people aged 25-74 years, with first myocardial infarction registered in the Northern Sweden Multinational MONItoring of trends and determinants in CArdiovascular disease (MONICA) myocardial infarction registry between 2000 and 2006. Symptoms were classified as typical or atypical according to the World Health Organization MONICA manual.

    Results: Among patients with diabetes, 90.1% reported typical symptoms of myocardial infarction; the corresponding proportion among patients without diabetes was 91.5%. In the diabetes group, 88.8% of women and 90.8% of men had typical symptoms of myocardial infarction. No differences were found in symptoms of myocardial infarction between women with and without diabetes or between men with and without diabetes. Atypical symptoms were more prevalent in the older age groups (> 65 years) than in the younger age groups (< 65 years). The increases were approximately equal among men and women, with and without diabetes. Diabetes was not an independent predictor for having atypical symptoms of myocardial infarction.

    Conclusions: Typical symptoms of myocardial infarction were equally prevalent in patients with and without diabetes and there were no sex differences in symptoms among persons with diabetes. Diabetes was not a predictor of atypical symptoms.

    © 2011 The Authors. Diabetic Medicine© 2011 Diabetes UK.

  • 30.
    Hellström Ängerud, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Thylen, Ingela
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University.
    Sederholm Lawesson, Sofia
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Symptoms, response to symptoms, and delay times during myocardial infarction in 694 patients with and without diabetesManuscript (preprint) (Other academic)
  • 31.
    Hellström Ängerud, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Nursing.
    Thylén, Ingela
    Sederholm Lawesson, Sofia
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Symptoms and delay times during myocardial infarction in 694 patients with and without diabetes: an explorative cross-sectional study2016In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 16, article id 108Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In myocardial infarction (MI) a short pre-hospital delay, prompt diagnosis and timely reperfusion treatment can improve the prognosis. Despite the importance of timely care seeking, many patients with MI symptoms delay seeking medical care. Previous research is inconclusive about differences in symptom presentation and pre-hospital delay between patients with and without diabetes during MI. The aim of this study was to describe symptoms and patient delay during MI in patients with and without diabetes.

    METHODS: Swedish cross-sectional multicentre survey study enrolling MI patients in 5 centres within 24 h from admittance.

    RESULTS: Chest pain was common in patients both with and without diabetes and did not differ after adjustment for age and sex. Patients with diabetes had higher risk for shoulder pain/discomfort, shortness of breath, and tiredness, but lower risk for cold sweat. The three most common symptoms reported by patients with diabetes were chest pain, pain in arms/hands and tiredness. In patients without diabetes the most common symptoms were chest pain, cold sweat and pain in arms/hands. Median patient delay time was 2 h, 24 min for patients with diabetes and 1 h, 15 min for patients without diabetes (p = 0.024).

    CONCLUSION: Chest pain was common both in patients with and without diabetes. There were more similarities than differences in MI symptoms between patients with and without diabetes but patients with diabetes had considerably longer delay. This knowledge is important not only for health care personnel meeting patients with suspected MI, but also for the education of people with diabetes.

  • 32.
    Hultin, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Hedberg, Hans
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Härgestam, Maria
    Umeå University, Faculty of Medicine, Department of Nursing.
    Söderström, Tor
    Umeå University, Faculty of Social Sciences, Department of Education.
    Thorstensson, Mirko
    Swedish Defense Research Agency (FOI), Linköping, Sweden.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Has five years of team training in non-technical skills improved trauma team performance in our University Hospital?2011In: Inspire... and be inspired: AMEE 2011 Abstract Book: 29-31 August 2011, Vienna, Austria, Scotland: Association for Medical Education in Europe , 2011, p. 447-447Conference paper (Refereed)
    Abstract [en]

    Background: For five years our emergency ward has trained non-technical skills using trauma scenarios in a simulator environment. Reflection-on-action was accomplished by 60 minutes video-facilitated structured debriefing. The aim of this study was to explore whether teams trained in non-technical skills are more efficient in the management of severely wounded patients.

    Summary of work: The standardized trauma patient scenario started with an ambulance crew being called

    to a location outside the hospital. Patient care was followed from the site of trauma, in the ambulance and

    in the emergency room. When the hand-over was finished, the condition was worsened. All ambulance crew and trauma team communication were recorded, synchronised in F-REX and key events time-logged. Nineteen teams with 144 participants were included in the study.

     

    Summary of results: 56% of the participants had trained non-technical skills. 78% of those with ontechnical

    skills training, and 62% of those without previous simulator based training, estimated themselves to have appropriate training for the task. The time from the induced worsened condition until the trauma team had assessed airways, breathing, circulation and disabilities were 74±39, 104±45, 172±85 and 223±194 s respectively. No significant effect on the medical performance on basis of previous training in non-technical skills could be detected. Further video analysis is required to more deeply understand the links between teamwork and medical performance.

     

    Conclusions: Trauma team training in CRM principles improves the self-confidence in trauma teams, but not the medical performance.

     

    Take-home messages: Improved non-technical skills might be difficult to translate into improvements in technical skills.

  • 33.
    Hultin, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Jacobsson, Maritha
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Härgestam, Maria
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Kunskap och kommunikation är en ledares plattform: tvärvetenskaplig studie av traumateamövningar visar betydelsen av verbal och icke-verbal kommunikation2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, no 39, p. 1-5Article in journal (Refereed)
  • 34.
    Hultin, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Jonsson, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Umeå University, Faculty of Medicine, Department of Nursing.
    Härgestam, Maria
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Reliability of instruments that measure situation awareness, team performance and task performance in a simulation setting with medical students2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 9, article id e029412Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The assessment of situation awareness (SA), team performance and task performance in a simulation training session requires reliable and feasible measurement techniques. The objectives of this study were to test the Airways-Breathing-Circulation-Disability-Exposure (ABCDE) checklist and the Team Emergency Assessment Measure (TEAM) for inter-rater reliability, as well as the application of Situation Awareness Global Assessment Technique (SAGAT) for feasibility and internal consistency.

    DESIGN: Methodological approach.

    SETTING: Data collection during team training using full-scale simulation at a university clinical training centre. The video-recorded scenarios were rated independently by four raters.

    PARTICIPANTS: 55 medical students aged 22-40 years in their fourth year of medical studies, during the clerkship in anaesthesiology and critical care medicine, formed 23 different teams. All students answered the SAGAT questionnaires, and of these students, 24 answered the follow-up postsimulation questionnaire (PSQ). TEAM and ABCDE were scored by four professionals.

    MEASURES: The ABCDE and TEAM were tested for inter-rater reliability. The feasibility of SAGAT was tested using PSQ. SAGAT was tested for internal consistency both at an individual level (SAGAT) and a team level (Team Situation Awareness Global Assessment Technique (TSAGAT)).

    RESULTS: The intraclass correlation was 0.54/0.83 (single/average measurements) for TEAM and 0.55/0.83 for ABCDE. According to the PSQ, the items in SAGAT were rated as relevant to the scenario by 96% of the participants. Cronbach's alpha for SAGAT/TSAGAT for the two scenarios was 0.80/0.83 vs 0.62/0.76, and normed χ² was 1.72 vs 1.62.

    CONCLUSION: Task performance, team performance and SA could be purposefully measured, and the reliability of the measurements was good.

  • 35.
    Hägglund, Lena
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine. Medicin.
    Olofsson, Mona
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine. Medicin.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Omvårdnad.
    Fatigue and health-related quality of life in elderly patients with and without heart failure in primary healthcare.2007In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 6, no 3, p. 208-215Article in journal (Refereed)
  • 36.
    Härgestam, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jacobsson, Maritha
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Trauma team leaders' non-verbal communication: video registration during trauma team training2016In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, article id 37Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is widespread consensus on the importance of safe and secure communication in healthcare, especially in trauma care where time is a limiting factor. Although non-verbal communication has an impact on communication between individuals, there is only limited knowledge of how trauma team leaders communicate. The purpose of this study was to investigate how trauma team members are positioned in the emergency room, and how leaders communicate in terms of gaze direction, vocal nuances, and gestures during trauma team training.

    METHODS: Eighteen trauma teams were audio and video recorded during trauma team training in the emergency department of a hospital in northern Sweden. Quantitative content analysis was used to categorize the team members' positions and the leaders' non-verbal communication: gaze direction, vocal nuances, and gestures. The quantitative data were interpreted in relation to the specific context. Time sequences of the leaders' gaze direction, speech time, and gestures were identified separately and registered as time (seconds) and proportions (%) of the total training time.

    RESULTS: The team leaders who gained control over the most important area in the emergency room, the "inner circle", positioned themselves as heads over the team, using gaze direction, gestures, vocal nuances, and verbal commands that solidified their verbal message. Changes in position required both attention and collaboration. Leaders who spoke in a hesitant voice, or were silent, expressed ambiguity in their non-verbal communication: and other team members took over the leader's tasks.

    DISCUSSION:

    In teams where the leader had control over the inner circle, the members seemed to have an awareness of each other's roles and tasks, knowing when in time and where in space these tasks needed to be executed. Deviations in the leaders' communication increased the ambiguity in the communication, which had consequences for the teamwork. Communication cannot be taken for granted; it needs to be practiced regularly just as technical skills need to be trained. Simulation training provides healthcare professionals the opportunity to put both verbal and non-verbal communication in focus, in order to improve patient safety.

    CONCLUSIONS: Non-verbal communication plays a decisive role in the interaction between the trauma team members, and so both verbal and non-verbal communication should be in focus in trauma team training. This is even more important for inexperienced leaders, since vague non-verbal communication reinforces ambiguity and can lead to errors.

  • 37.
    Härgestam, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Lindkvist, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jacobsson, Maritha
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Communication in interdisciplinary teams: Exploring closed-loop communication during in situ trauma team training2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 10, article id e003525Article in journal (Refereed)
    Abstract [en]

    Objectives: Investigate the use of call-out (CO) and closed-loop communication (CLC) during a simulated emergency situation, and its relation to profession, age, gender, ethnicity, years in profession, educational experience, work experience and leadership style.

    Design: Exploratory study.

    Setting: In situ simulator-based interdisciplinary team training using trauma cases at an emergency department.

    Participants: The result was based on 16 trauma teams with a total of 96 participants. Each team consisted of two physicians, two registered nurses and two enrolled nurses, identical to a standard trauma team.

    Results: The results in this study showed that the use of CO and CLC in trauma teams was limited, with an average of 20 CO and 2.8 CLC/team. Previous participation in trauma team training did not increase the frequency of use of CLC while ≥2 structured trauma courses correlated with increased use of CLC (risk ratio (RR) 3.17, CI 1.22 to 8.24). All professions in the trauma team were observed to initiate and terminate CLC (except for the enrolled nurse from the operation theatre). The frequency of team members’ use of CLC increased significantly with an egalitarian leadership style (RR 1.14, CI 1.04 to 1.26).

    Conclusions: This study showed that despite focus on the importance of communication in terms of CO and CLC, the difficulty in achieving safe and reliable verbal communication within the interdisciplinary team remained. This finding indicates the need for validated training models combined with further implementation studies.

  • 38.
    Härgestam, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Jacobsson, Maritha
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Trauma teams and time to early management during in situ trauma team training2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 1, article id e009911Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the association between the time taken to make a decision to go to surgery and gender, ethnicity, years in profession, experience of trauma team training, experience of structured trauma courses and trauma in the trauma team, as well as use of closed-loop communication and leadership styles during trauma team training.

    DESIGN: In situ trauma team training. The patient simulator was preprogrammed to represent a severely injured patient (injury severity score: 25) suffering from hypovolemia due to external trauma.

    SETTING: An emergency room in an urban Scandinavian level one trauma centre.

    PARTICIPANTS: A total of 96 participants were divided into 16 trauma teams. Each team consisted of six team members: one surgeon/emergency physician (designated team leader), one anaesthesiologist, one registered nurse anaesthetist, one registered nurse from the emergency department, one enrolled nurse from the emergency department and one enrolled nurse from the operating theatre.

    PRIMARY OUTCOME: HRs with CIs (95% CI) for the time taken to make a decision to go to surgery was computed from a Cox proportional hazards model.

    RESULTS: Three variables remained significant in the final model. Closed-loop communication initiated by the team leader increased the chance of a decision to go to surgery (HR: 3.88; CI 1.02 to 14.69). Only 8 of the 16 teams made the decision to go to surgery within the timeframe of the trauma team training. Conversely, call-outs and closed-loop communication initiated by the team members significantly decreased the chance of a decision to go to surgery, (HR: 0.82; CI 0.71 to 0.96, and HR: 0.23; CI 0.08 to 0.71, respectively).

    CONCLUSIONS: Closed-loop communication initiated by the leader appears to be beneficial for teamwork. In contrast, a high number of call-outs and closed-loop communication initiated by team members might lead to a communication overload.

  • 39.
    Isaksson, Rose-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Medicine, Sunderby Hospital, Luleå.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Zingmark, Karin
    FoU enheten, Luleå, Norrbottens läns landsting.
    Older women's prehospital experiences of their first myocardial infarction: a qualitative analysis from the Northern Sweden MONICA Study2013In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 28, no 4, p. 360-369Article in journal (Refereed)
    Abstract [en]

    Background: Few qualitative studies have been conducted on older women’s experiences of myocardial infarction (MI) and, in particular, the time before they seek medical care.

    Objective: The aim of this study was to explore older women’s prehospital experiences of their first MI.

    Methods: Qualitative content analysis was performed on data from individual interviews with 20 women, aged 65 to 80 years (mean, 73.0 years). The participants were interviewed 3 days after admission to a hospital for a confirmed first MI.

    Results: The women perceived their symptoms as a strange and unfamiliar development from indistinct physical sensations to persistent and overwhelming chest pain. Throughout the prehospital phase, they used different strategies such as downplaying and neglecting the symptoms. The symptoms were seen as intrusions in their daily lives, against which the participants defended themselves to remain in control and to maintain social responsibilities. As their symptoms evolved into constant chest pain, the women began to realize the seriousness of their symptoms. When the pain became unbearable, the women took the decision to seek medical care.

    Conclusion: Understanding the complex experiences of older women in the prehospital phase is essential to reducing their patient decision times. The findings of this study should be incorporated into the education of professionals involved in the care of cardiac patients, including those who answer informational and emergency telephone lines.

  • 40.
    Isaksson, Rose-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Zingmark, Karin
    Prehospital experiences of older men with a first myocardial infarction: a qualitative analysis within the Northern Sweden MONICA Study2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 4, p. 787-797Article in journal (Refereed)
    Abstract [en]

    Aim:  To explore older men's prehospital experiences of their first myocardial infarction (MI). Background:  The delay between the onset of symptoms to the initiation of medical care is a major determinant of prognosis in MI. The majority of people experiencing MI are men. But few studies have been conducted solely on men's experiences before seeking medical care for MI. The objective of this study was to explore older men's experiences of symptoms and their reasoning during the prehospital phase of their first MI. Method:  Data collection was carried out through individual interviews with 20 men representing the age range 65-80 (mean 71) years. The participants were interviewed 3 days after admission for a confirmed first MI. The interviews were designed to prompt the men to describe their symptoms and their reasoning up to the decision to seek care. A qualitative content analysis was used to analyse the interviews. Findings:  The prehospital phase in older men was found to be a complex and extended journey. The symptoms were perceived from diffuse ill-being to a cluster of alarming symptoms. The participants dealt with conceptions about MI symptoms. They were unsure about the cause of their symptoms, which did not correspond to their expectations about an MI, and whether they should seek medical care. They had difficulty making the final decision to seek care and strived to maintain a normal life. They initially tried to understand, reduce or treat the symptoms by themselves. The decision to seek medical care preceded a movement from uncertainty to conviction. Conclusions:  Understanding older men's prehospital experiences of MI is essential to reduce their patient decision times. This requires knowledge about the complexity and dynamic evolvement of symptoms, beliefs and strategies to maintain an ordinary life.

  • 41.
    Isaksson, Rose-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Zingmark, Karin
    FoU enheten, Luleå, Norrbottens läns landsting.
    Prehospital experiences of older men with a first myocardial infarction: a qualitative analysis within the Northern Sweden MONICA StudyManuscript (preprint) (Other academic)
    Abstract [en]

    Aim: To explore older men’s prehospital experiences of their first MI.

    Background:  The delay between the onset of symptoms to the initiation of medical care is a major determinant of prognosis in myocardial infarction (MI).  The largest single component of the delay is the time it takes the person to respond to the symptoms by seeking care. The majority of people experiencing MI are men. But few studies have been conducted solely on men’s experiences before seeking medical care for MI. The objective of this study was to explore older men’s experiences of symptoms and their reasoning during the prehospital phase of their first MI.

    Method: Data collection was carried out through individual interviews with 20 men representing the age range 65–80 (mean 71) years. The participants were interviewed three days after admission for a confirmed first MI (with or without ST elevation). The interviews were designed to prompt the men to describe their symptoms and their reasoning up to the decision to seek care. A qualitative content analysis was used to analyse the interviews.        

    Findings: The prehospital phase in older men was found to be a complex and extended journey. The symptoms were perceived from diffuse ill-being to a cluster of alarming symptoms. During this journey the participants dealt with conceptions about MI symptoms. They were unsure both about the cause of their symptoms, which did not correspond to their expectations about an MI, and about whether they should seek medical care. They had difficulty making the final decision to seek care and strived to maintain a normal life. They initially tried to understand, reduce, or treat the symptoms by themselves. The decision to seek medical care preceded a movement from uncertainty to conviction.

    Conclusions:Understanding older men’s prehospital experiences of MI is essential to reduce their patient decision times. This requires knowledge about the complexity and dynamic evolvement of symptoms, beliefs and strategies to maintain an ordinary life.

  • 42.
    Isaksson, Rose-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Holmgren, Lars
    Lundblad, Dan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Time trends in symptoms and prehospital delay time in women vs. men with myocardial infarction over a 15-year period. The Northern Sweden MONICA Study.2007In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 2, p. 152-158Article in journal (Refereed)
    Abstract [en]

    Background

    Few studies have examined the time between onset of myocardial infarction (MI) symptoms and arrival at hospital (prehospital delay time) and symptoms in men vs. women.

    Aims

    To describe prehospital delay time and symptoms in men vs. women with MI and to analyse trends over time and according to age.

    Methods

    The Northern Sweden MONICA myocardial infarction registry, 1989–2003, included 5072 men and 1470 women with a confirmed MI.

    Results

    Typical pain was present in 86% of the men and 81% of the women. The proportion with typical symptoms decreased over time for men and increased for women. Typical symptoms were more common among younger persons than older persons. Insufficiently reported symptoms was unchanged in men over time and decreased among women. Up to the age of 65, no gender differences were seen in the prehospital delay. In the oldest age group (65–74 years) time to hospital was longer than among the younger groups, especially among women.

    Conclusion

    There were no major gender differences in prehospital delay or type of symptoms. However, over time the proportion with typical symptoms decreased in men and increased in women. Older patients had longer prehospital delay and less typical symptoms.

  • 43.
    Jacobsson, Ann
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Backteman-Erlandson, Susanne
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Egan Sjölander, Annika
    Umeå University, Faculty of Arts, Department of culture and media studies.
    ’There is nothing wrong with diversity and equality as long as the right people are employed’. Promoting and hindering health in firefighter discourse2018Conference paper (Refereed)
  • 44.
    Jacobsson, Ann
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Backteman-Erlandson, Susanne
    Umeå University, Faculty of Medicine, Department of Nursing.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Egan Sjölander, Annika
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Burnout and association with psychosocial work environment among Swedish firefighters2017In: Global Journal of Health Science, ISSN 1916-9736, E-ISSN 1916-9744, Vol. 9, no 5, p. 214-225Article in journal (Refereed)
    Abstract [en]

    Firefighters are exposed to traumatic and stressful psychosocial and physical strain in their work, and thus they are considered to be a group at high risk of burnout. The aim of this study was to investigate burnout (emotional exhaustion (EE) and depersonalization (DP) among Swedish female and male firefighters and to examine the gender-stratified relationship between psychosocial work environment and burnout when considering the moderating effect of coping strategies among Swedish firefighters. The overall mean values of both EE and DP were notably low in comparison with the general population in Sweden. We found that psychosocial work environment factors increase the risk of burnout among male firefighters. Among men, EE was associated with high demands and lack of social support in work. The association was also confirmed with DP as the outcome and lack of good leadership as the exposure among men. However, among female firefighters the association between psychosocial work environment factors and burnout failed to appear. Among women, EE and DP were only associated with the coping strategy Psychological distancing (PDi). A negative association with DP and the coping strategy Positive Reappraisal (PRe) was also found among women. Regardless of the result from the regression analyses, we must consider that the majority of the female and male firefighters in our study had low scores on the outcome variables EE and DP. Future studies should explore female and male firefighters' context and possible health-protecting environment.

  • 45.
    Jacobsson, Ann
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Backteman-Erlanson, Susann
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Experiences of critical incidents among female and male firefighters2015In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, no 2, p. 100-104Article in journal (Refereed)
    Abstract [en]

    Background: A critical incident is defined as an event stressful enough to overwhelm the usually effective coping skills of an individual. Firefighters are frequently exposed to critical incidents that might have consequences for individuals and their performance in organization. Aim: The aim of this study was to describe experiences of critical incidents among female and male Swedish firefighters. Method: In all 180 participants (16 women, 164 men) who had been involved in up to 25 critical incidents during the last year responded to a survey describing critical incidents experienced in the past year. A qualitative content analysis identified several areas for improvement in firefighters' working conditions. Results: Female firefighters were terse in describing their experiences, while the men described their experiences of critical events more vividly. The critical incidents described by the firefighters concerned such overwhelming situations as traffic accidents, huge fires, and other fatal incidents such as drownings and suicides. Risk of delay due to lack of equipment training and lack of medical education was mentioned. Lack of resources and organizational problems was mentioned as causing risks of failure. Several firefighters expressed frustration over being assaulted and threatened, or exposed to other kinds of violence. Not knowing how close, physically or mentally, one can get to people during ongoing rescue can lead to unsuccessful operations. Conclusions: Gender patterns should always be taken into account, making it possible for all firefighters to express and reflect on existentially tough experiences. Education needs to focus more on medical and mental health issues. Firefighters were sometimes exposed to the difficult challenge of violence and assault during rescue operations. The complexity of this problem needs to be highlighted, not only in firefighter organizations, but also in society in general. 

  • 46.
    Jacobsson, Maritha
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Härgestam, Maria
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Flexible knowledge repertoires: Communication by leaders in trauma teams2012In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, no 1, p. 44-Article in journal (Refereed)
    Abstract [en]

    Background: In emergency situations, it is important for the trauma team to efficiently communicate their observations and assessments. One common communication strategy is “closed-loop communication”, which can be described as a transmission model in which feedback is of great importance. The role of the leader is to create a shared goal in order to achieve consensus in the work for the safety of the patient. The purpose of this study was to analyze how formal leaders communicate knowledge, create consensus, and position themselves in relation to others in the team.

    Methods: Sixteen trauma teams were audio- and video-recorded during high fidelity training in an emergency department. Each team consisted of six members: one surgeon or emergency physician (the designated team leader), one anaesthesiologist, one nurse anaesthetist, one enrolled nurse from the theatre ward, one registered nurse and one enrolled nurse from the emergency department (ED). The communication was transcribed and analyzed, inspired by discourse psychology and Strauss’ concept of “negotiated order”. The data were organized and coded in NVivo 9.

    Results: The findings suggest that leaders use coercive, educational, discussing and negotiating strategies to work things through. The leaders in this study used different repertoires to convey their knowledge to the team, in order to create a common goal of the priorities of the work. Changes in repertoires were dependent on the urgency of the situation and the interaction between team members. When using these repertoires, the leaders positioned themselves in different ways, either on an authoritarian or a more egalitarian level.

    Conclusion: This study indicates that communication in trauma teams is complex and consists of more than just transferring messages quickly. It also concerns what the leaders express, and even more importantly, how they speak to and involve other team members.

  • 47.
    Lindgren, Barbro
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Omvårdnad.
    Holmlund, Kristina
    Umeå University, Faculty of Medicine, Omvårdnad.
    Athlin, Elsy
    Nursing students' perception of group supervision during clinical training.2005In: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 14, no 7, p. 822-9Article in journal (Refereed)
  • 48.
    Lindgren, Lenita
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Lehtipalo, Stefan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Winsö, Ola
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Karlsson, Marcus
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Touch massage: a pilot study of a complex intervention2013In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 18, no 6, p. 269-277Article in journal (Refereed)
    Abstract [en]

    Objectives: To report and evaluate a complex touch massage intervention according to the British Medical Research Council framework. This study aimed to evaluate the effects of touch massage on levels of anxiety and physiological stress in patients scheduled for elective aortic surgery.

    Background: The use of touch massage has increased during the past decade but no systematic studies have been implemented to investigate the effectiveness of such treatment. It is important to conduct multidisciplinary investigations into the effects of complex interventions such as touch massage. For this, the British Medical Research Council has provided a useful framework to guide the development, piloting, evaluation and reporting of complex intervention studies.

    Method: A pilot study with a randomized controlled design including 20 patients (10 + 10) scheduled for elective aortic surgery. Selected outcome parameters included; self-reported anxiety, measured by the State-Trait Anxiety Inventory Form Y instrument, and physiological stress, measured by heart rate variability, blood pressure, respiratory frequency, oxygen saturation and concentrations of cortisol, insulin and glucose in serum.

    Results: There were significant differences in self-reported anxiety levels before and after touch massage (p = 0·007), this was not observed in the control group (p = 0·833). There was a significant difference in self-reported anxiety levels between the touch massage group and the control group after touch massage and rest (p = 0·001). There were no significant differences in physiological stress-related outcome parameters between patients who received touch massage and controls.

    Conclusion: In our study, touch massage decreased anxiety levels in patients scheduled for elective aortic surgery, and the British Medical Research Council framework was a useful guideline for the development, evaluation and reporting of a touch massage intervention.

    Relevance to clinical practice: Touch massage can reduce patients' anxiety levels and is thus an important nursing intervention in intensive and post-operative care.

  • 49.
    Lindgren, Lenita
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Rundgren, S
    Umeå University, Faculty of Medicine, Department of Nursing.
    Winsö, Ola
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Lehtipalo, Stefan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Karlsson, Markus
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jacobsson, Catrine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Physiological responses to touch massage in healthy volunteers2010In: Autonomic Neuroscience: Basic & Clinical, ISSN 1566-0702, E-ISSN 1872-7484, Vol. 158, no 1-2, p. 105-110Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate effects of touch massage (TM) on stress responses in healthy volunteers.

    METHODS: A crossover design including twenty-two (mean age=28.2) healthy volunteers (11 male and 11 female) cardiac autonomic tone was measured by heart rate (HR) and heart rate variability (HRV). Stress hormone levels (cortisol) were followed in saliva. We also measured blood glucose and serum insulin. Extracellular (ECV) levels of glucose, lactate, pyruvate and glycerol were followed using the microdialysis technique (MD). TM was performed on hands and feet for 80min, during control, participants rested in the same setting. Data were collected before, during, and after TM and at rest. Saliva cortisol, serum glucose, and serum insulin were collected before, immediately following, and 1h after intervention or control, respectively.

    RESULTS: After 5min TM, HR decreased significantly, indicating a reduced stress response. Total HRV and all HRV components decreased during intervention. Saliva cortisol and insulin levels decreased significantly after intervention, while serum glucose levels remained stable. A similar, though less prominent, pattern was seen during the control situation. Only minor changes were observed in ECV levels of glucose (a decrease) and lactate (an increase). No significant alterations were observed in glycerol or pyruvate levels throughout the study. There were no significant differences between groups in ECV concentrations of analyzed substances.

    CONCLUSIONS: In healthy volunteers, TM decreased sympathetic nervous activity, leading to decreased overall autonomic activity where parasympathetic nervous activity also decreased, thereby maintaining the autonomic balance.

  • 50.
    Lindgren, Lenita
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Westling, Göran
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lehtipalo, Stefan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Andersson, Micael
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Pleasant human touch is represented in pregenual anterior cingulate cortex2012In: NeuroImage, ISSN 1053-8119, E-ISSN 1095-9572, Vol. 59, no 4, p. 3427-3432Article in journal (Refereed)
    Abstract [en]

    Touch massage (TM) is a form of pleasant touch stimulation used as treatment in clinical settings and found to improve well-being and decrease anxiety, stress, and pain. Emotional responses reported during and after TM have been studied, but the underlying mechanisms are still largely unexplored. In this study, we used functional magnetic resonance (fMRI) to test the hypothesis that the combination of human touch (i.e. skin-to-skin contact) with movement is eliciting a specific response in brain areas coding for pleasant sensations. The design included four different touch conditions; human touch with or without movement and rubber glove with or without movement. Force (2.5N) and velocity (1.5cm/s) were held constant across conditions. The pleasantness of the four different touch stimulations was rated on a visual analog scale (VAS-scale) and human touch was rated as most pleasant, particularly in combination with movement. The fMRI results revealed that TM stimulation most strongly activated the pregenual anterior cingulate cortex (pgACC). These results are consistent with findings showing pgACC activation during various rewarding pleasant stimulations. This area is also known to be activated by both opioid analgesia and placebo. Together with these prior results, our finding furthers the understanding of the basis for positive TM treatment effects.

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