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  • 1.
    Carlsson, Tommy
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Melander Marttala, Ulla
    Department of Scandinavian Languages, Uppsala University, Uppsala, Sweden.
    Mattsson, Elisabeth
    Department of Public Health and Caring Sciences, Uppsala University; Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Experiences and preferences of care among Swedish immigrants following a prenatal diagnosis of congenital heart defect in the fetus: A qualitative interview study2016Inngår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, artikkel-id 130Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Immigrants experience significant challenges when in contact with healthcare and report less satisfaction with maternity care compared to native Swedes. Research that gives voice to pregnant immigrant women and their partners following a prenatal diagnosis of a fetal anomaly is scarce. Thus, the aim of this study was to explore experiences and preferences of care following a prenatal diagnosis of congenital heart defect among Swedish immigrants.

    Methods: Pregnant immigrants and their partners were consecutively recruited following a prenatal diagnosis of a congenital heart defect in the fetus. Nine respondents were interviewed in five interviews, four with the aid of a professional interpreter. The material was analyzed using manifest qualitative content analysis.

    Results: The analysis resulted in five categories: 1) “Trustworthy information”, 2) “Language barriers”, 3) “Psychosocial situation”, 4) “Peer support”, and 5) “Religious positions”.

    Conclusion: The potential need for interpreter services, visual information, psychosocial support, coordination with welfare officers, and respect for religious positions about termination of pregnancy are all important aspects for health professionals to consider when consulting immigrants faced with a prenatal diagnosis of fetal anomaly in the fetus. Peer support within this context needs to be further explored in future studies.

  • 2.
    Lindgren, Britt-Marie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Molin, Jenny
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundström, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strömbäck, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Salander Renberg, Ellinor
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Does a new spatial design in psychiatric inpatient care influence patients’ and staff’s perception of their care/working environment?: A study protocol of a pilot study using a single-system experimental design2018Inngår i: Pilot and Feasibility Studies, ISSN 2055-5784, Vol. 4, artikkel-id 191Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Research shows that worn-out physical environments are obstacles to psychiatric inpatient care. Patients want better relationships with staff and things to do; staff want an environment that offers hope, a calm atmosphere, and joint activities. A county council in northern Sweden and Philips Healthcare partnered to create solutions to the environmental challenges of psychiatric inpatient care. One ward at a county psychiatric clinic was selected for a pilot project to test solutions that could improve the care environment for patients, staff, and relatives. The aim of the overall project is to evaluate the effects of a newly designed psychiatric inpatient ward on patients and staff in terms of quality of care and stress. In this study, we focus on the feasibility through testing questionnaires and exploring barriers to recruiting staff and patients.

    Methods: This study had a single-system experimental design, comparing a psychiatric unit pre- and post-implementation of the novel spatial design, using repeated measures with the same questionnaires twice a week during baseline and intervention phases. Primary outcomes were quality interactions (patients) and perceived stress (staff). Secondary outcomes were levels of anxiety and depression (patients), and stress of conscience (staff). A process evaluation was aimed to describe contextual factors and participant experiences of the new design. Data was collected using questionnaires and semi-structured individual interviews with patients and focus group discussions with staff. Both visual and statistical methods were used to analyse the quantitative data and content analysis for the qualitative data.

    Discussion: The findings will contribute insights into whether and how a new spatial design might contribute to quality interactions and reduced stress. This is relevant both nationally and internationally, as similar interventions are needed but sparse. The findings will be disseminated through peer-reviewed publications and conference presentations.

    Trial registration: ClinicalTrials.gov, NCT03140618, registered 4 May 2017.

  • 3.
    Lindgren, Britt-Marie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Molin, Jenny
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Health Sciences, University West,Trollhättan, Sweden.
    Patients' experiences of isolation in psychiatric inpatient care: insights from a meta-ethnographic study2019Inngår i: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 28, nr 1, s. 7-21Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Historically, people with mental ill-health have been isolated from society. Although mental health care has moved from closed to more open forms of care, in many societies care is still provided in locked wards, and people with mental ill-health are sometimes secluded from their fellow patients, families, friends, and visitors. The aim of this study was to illuminate patients' experiences of isolation in psychiatric inpatient care. A systematic review of qualitative research was conducted, and the key findings were subjected to meta-ethnographic synthesis. The findings were twofold: 'being admitted to prison' and 'having access to shelter'. The experience of isolated care as prison-like symbolizes patients' longing for freedom and feeling restricted and limited by rules, stripped of rights, abandoned, controlled, powerless, and unsupported. In contrast, the experience of isolation as shelter symbolizes safety and the opportunity to regain control over one's own situation. A stigmatizing public view holds that people with mental ill-health are dangerous and unpredictable and, therefore, unsafe to themselves and others. Being placed in isolation because these fears contribute to self-stigma among patients. Promoting a sheltered experience in which isolation is used with respect for patients and the reasons are made explicit may encourage recovery. A shift in emphasis in ward culture from observation to engagement is needed to reduce blame, shift patient experiences from prison to shelter, and to support autonomy as a therapeutic intervention.

  • 4. Mattsson, E
    et al.
    Ringnér, Anders
    Department of Public Health and Caring Sciences, Psychosocial Oncology, Uppsala University.
    Ljungman, G
    von Essen, L
    Positive and negative consequences with regard to cancer during adolescence. Experiences two years after diagnosis.2007Inngår i: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 16, nr 11, s. 1003-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: The purpose was to explore negative and positive consequences of cancer during adolescence experienced two years after diagnosis. METHODS: Two years after diagnosis 38 persons, 15-21 years old, were asked two questions over the telephone: What, if anything, is bad for you due to the cancer disease? and What, if anything, is good for you due to the cancer disease? The answers were analysed by content analysis. RESULTS: Four categories of negative experiences were identified: a problematic body; unpleasant thoughts and feelings; outside the circle of friends; and difficulties with schoolwork. Six categories of positive experiences were identified: a more positive view of life; good self-esteem; knowledge and experience with regard to disease and hospital care; good relations; broader perspectives; and material gains. CONCLUSIONS: Two years after diagnosis those struck by cancer during adolescence experience not only a number of negative, but also positive, consequences of the cancer disease and its treatment.

  • 5. Minnock, Patricia
    et al.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Bresnihan, Barry
    Veale, Douglas
    Oliver, FitzGerald
    McKee, Gabrielle
    Perceptions of the cause, impact and management of persistent fatigue in patients with rheumatoid arthritis following tumour necrosing factor inhibition therapy2017Inngår i: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 15, nr 1, s. 23-35Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Fatigue is a major symptom of rheumatoid arthritis (RA), the most common chronic inflammatory joint disease. The present study explored patients' experiences of RA fatigue to elucidate unique elements and management strategies.

    Methods: This single site study recruited tumour necrosis factor-α inhibitor (TNFi)-treated RA patients with a moderate/good response in disease activity and persistent moderate/greater fatigue on a five-point verbal rating scale. This qualitative descriptive design used semi-structured questions, individual interviews and content analysis of narrative data.

    Results: Ten patients were interviewed (six women), with age and disease duration ranges of 44–75 and 6–36 years, respectively. Perceptions of the RA fatigue experience generated four categories (experiencing a distinct, yet seldom discussed RA symptom; seeking an explanation for fatigue; being in an incapacitating state; and trying to manage) and eight subcategories. Fatigue was newly identified as a distinct part of the entity of RA. While patients proposed many plausible root causes, the only rational explanation for the nature of this fatigue was that it was integral to their RA. Singularly, fatigue contributed considerably to RA-imposed lifestyle restrictions. Patients had learnt to accommodate and self-manage fatigue in the absence of professional input. Novel management strategies proposed included patients talking about the nature of RA fatigue with others and the need for staff to alert patients to this distinct symptom of RA.

    Conclusion: Fatigue, branded as a distinct symptom of RA, exerted an identifiable impact on patients. Fatigue is potentially amenable to modification; talking about fatigue was proposed as a novel management strategy.

  • 6.
    Molin, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindgren, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    From ideals to resignation: interprofessional teams perspectives on everyday life processes in psychiatric inpatient care2016Inngår i: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 23, nr 9-10, s. 595-604Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Patients and ward staff describe psychiatric inpatient care as demanding, characterized by unpredictable events, yet research on interprofessional teams perspectives of everyday life processes in psychiatric inpatient care lacks. Aim: This study aims to explore everyday life processes in psychiatric inpatient care, as reported by staff in interprofessional teams. Method: A grounded theory design was used and 36 participants were interviewed. Results: The analysis resulted in a process-oriented core category From ideals to resignation. Related to this core category were three further categories: Knowing where to go, Walking a path of obstacles and Shifting focus from the patient's best interests to self-survival. The staff had ideals about care and collaboration, but a poor environment, power asymmetry, lacking structure and demands of managing chaos meant that they appeared to resign from putting their ideals into practice. Discussion: Different professions in general describe the same obstacles in everyday life on the wards but there are also profession-specific perspectives on distancing and feelings of abandonment. To our knowledge similar findings have not been reported in the international evidence. Implications: In order to support interprofessional teams to work according to their ideals, interventions such as Protected Engagement Time and reflective dialogues within the teams are suggested.

  • 7.
    Molin, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindgren, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Patient experiences of taking part in Time Together – a nursing intervention in psychiatric inpatient careManuskript (preprint) (Annet vitenskapelig)
  • 8.
    Molin, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindgren, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Patients' experiences of taking part in Time Together - A nursing intervention in psychiatric inpatient care2019Inngår i: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 28, nr 2, s. 551-559Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This qualitative study aimed to illuminate patients' experiences of taking part in the nursing intervention Time Together. The data were drawn from 11 individual semi-structured interviews with patients and analysed with qualitative content analysis using an inductive approach. The results show that patients taking part in Time Together felt confirmed and participated on equal terms; thus, they experienced being seen as humans among other humans. Time Together offered patients a break, and they felt strengthened, which contributed to their hopes for recovery. Furthermore, when Time Together was absent patients felt disconfirmed, which fostered feelings of distance from staff. The results support the effectiveness of the intervention, indicating that Time Together may be a tool to facilitate patients' personal recovery. However, the success of the intervention depends on staff compliance with the predetermined structure of the intervention in combination with engagement.

  • 9.
    Molin, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindgren, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Graneheim, Ulla Hällgren
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Time Together: a nursing intervention in psychiatric inpatient care : feasibility and effects2018Inngår i: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, nr 6, s. 1698-1708Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The facilitation of quality time between patients and staff in psychiatric inpatient care is useful to promote recovery and reduce stress experienced by staff. However, interventions are reported to be complex to implement and are poorly described in the literature. This multisite study aimed to evaluate the feasibility and effects of the nursing intervention Time Together, using mixed methods. Data consisted of notes from participant observations and logs to evaluate feasibility, and questionnaires to evaluate effects. The primary outcome for patients was quality of interactions, and for staff, it was perceived stress. The secondary outcome for patients was anxiety and depression symptom levels, and for staff, it was stress of conscience. Data were analysed using visual analysis, percentage of nonoverlapping data, and qualitative content analysis. The results showed that Time Together was a feasible intervention, but measurements showed no effects on the two patient outcomes: quality of interactions and anxiety and depressive symptoms and, questionable effects on perceived stress and stress of conscience among staff. Shared responsibility, a friendly approach, and a predictable structure enabled Time Together, while a distant approach and an unpredictable structure hindered the intervention. In conclusion, the intervention proved to be feasible with potential to enable quality interactions between patients and staff using the enabling factors as supportive components. It also had some effects on perceived stress and stress of conscience among staff. Further evaluation is needed to build on the evidence for the intervention.

  • 10.
    Molin, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindgren, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Does 'Time Together' increase quality of interaction and decrease stress?: A study protocol of a multisite nursing intervention in psychiatric inpatient care, using a mixed method approach2017Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 8, artikkel-id e015677Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Despite the long-known significance of the nurse–patient relationship, research in psychiatric inpatient care still reports unfulfilled expectations of, and difficulties in, interactions and relationships between patients and staff. Interventions that create structures to allow quality interactions between patients and staff are needed to solve these problems. The aim of this project is to test effects of the nursing intervention Time Together and to evaluate the intervention process.

    Methods and analysis: This is a multisite study with a single-system experimental design using frequent measures. The primary outcomes are quality interactions for patients and perceived stress for staff. Secondary outcomes are levels of symptoms of anxiety and depression for patients and stress of conscience for staff. A process evaluation is performed to describe contextual factors and experiences. Data are collected using questionnaires, participant observations and semistructured interviews. For analysis of quantitative data, both visual and statistical methods will be used. Qualitative data will be analysed using qualitative content analysis.

    Ethics and dissemination: Ethical approval was granted by the Ethical Review Board in the region (Dnr 2016/339-31). The findings will contribute to the development of nursing interventions in general, but more specifically to the development of the intervention. This is relevant both nationally and internationally as similar interventions are needed but sparse. The findings will be disseminated through conference presentations and peer-reviewed publications.

  • 11. Olsson, Cecilia
    et al.
    Björk, Maria
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå University Hospital, Department of Pediatrics, Umeå, Sweden.
    The Pediatric Inventory for Parents - Swedish Translation and Psychometric Testing2018Inngår i: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 42, s. E97-E102Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abstract: The Pediatric Inventory for Parents (PIP) measures parental stress related to caring for a child with an illness. However, no Swedish translation is available.

    Purpose: This study reports a Swedish translation of the PIP and psychometric properties of the instrument.

    Design and Methods: This is a descriptive/methodological paper. The PIP was translated and culturally adapted to Swedish, and comprehensibility was tested. Data were collected twice from 48 parents of children with different illnesses, and initial psychometric properties of the instrument were examined. The IES-R (Impact of Event Scale-Revised) was used for concurrent validity.

    Results: The Swedish version of the PIP demonstrated good correlations with the IES-R, and temporal changes were similar. Endorsement frequencies and test-retest were also satisfactory. When comparing groups of parents, the parents of children with cancer were statistically significantly more distressed, both on total score and for emotional distress and role function. Discriminative validity was demonstrated by comparing parents of children with cancer with parents of children with other diseases.

    Conclusions: The Swedish version of the PIP seems to be a valid and reliable instrument. However, as we used relatively small sample, for the future, we suggest further testing with larger samples.

    Practice Implications: Clinicians and researchers seeking to measure parental distress in chronic illness could use the Swedish version of the PIP.

  • 12.
    Olsson, Cecilia
    et al.
    Karlstads Universitet.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Borglin, Gunilla
    Blekinge tekniska högskola, Malmö högskola.
    Including systematic reviews in PhD programmes and candidatures in nursing: 'Hobson's choice'?2014Inngår i: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 14, nr 2, s. 102-105Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Nowadays, gathering and synthesising evidence, i.e. conducting systematic reviews, is considered an important part of any health service research endeavour. Reviewing the literature, however suggest that it is not yet common that PhD students/doctoral candidates publish systematic reviews or even include a high quality review of the literature as a part of their PhD programme or candidature. Implying that systematic reviewing skills might not be acquired by going through an education on a postgraduate level. Additionally, scholars debating systematic reviews ‘to be or not to be’ as a part of research training seem to be sparse, especially within the field of nursing. In this issue for debate, we would like to propose that the absence of systematic reviews' in this context might severely hamper the ‘up and coming’ researchers as well as the research conducted. We envisage that this lack can have a negative impact on international nursing practice, and therefore propose that systematic reviews should be considered, whenever appropriate, as a mandatory part of any PhD programme or candidature. We believe that abilities in systematic reviewing will be a sought after research skills in the near future. Including systematic reviews would promote i) refined, well-grounded adequate research questions, ii) PhDs with broad and elevated methodological skills, iii) an increased level of evidence based nursing praxis. However, to make this a reality, supervisors, PhD students, and candidates would need to understand the value of this kind of research activity. Finally, lobbying University faculty boards and grant providers that are not inclined to view literature reviews as ‘proper’ research or as an important part of health service research, needs to be put on the agenda.

  • 13.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Caregivers’ perceptions of providing information to parents within paediatric oncology2010Konferansepaper (Annet vitenskapelig)
  • 14.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Föräldrars erfarenhet av information inom barnonkologin2011Inngår i: Pågående omvårdnadsforskning: en guldgruva för säker patientvård, 2011Konferansepaper (Fagfellevurdert)
    Abstract [sv]

    Bakgrund Information är en viktig del av det stöd som ges till föräldrar till cancersjuka barn och gör att föräldrarna kan skapa kunskap om sitt barns sjukdom. Genom att få bra information minskas känslan av kaos hos föräldrarna och de kan skapa en känsla av kontroll och normalitet men det finns också många problem och processen har beskrivits som att lära sig ett nytt språk.

    Syfte Syftet med denna studie var att beskriva föräldrars erfarenheter av att skaffa och använda information för att skapa kunskap om barnets sjukdom.

    Resultat Att känna sig bekräftad som en viktig person hade tre subteman. Att känna sig trygg trots otryggheten handlade om när föräldrarna fick bra information trots emotionell påfrestning och kaos. När personalen förmedlade lugnande information fick föräldrarna hjälp att hålla hoppet uppe. Andra familjer fungerade som exempel ur verkligheten och deras upplevelser gav lindring. Temat känna sig som en ovälkommen gäst var betonat i de senare delarna av behandlingen och hade också tre subteman. Föräldrarna kände sig övergivna vid viktiga milstolpar, såsom när barnet avslutade behandlingen. Att vara tvungen att tjata om information gav somliga föräldrar dåligt samvete. Att belastas av att behöva informera andra i stället var en paradoxal situation när föräldrarna själva fick informera sjukvårdspersonalen i stället för tvärtom.

    Denna forsknings relevans för vården Vårdpersonal bör ägna extra uppmärksamhet till föräldrar under senare delar av behandlingen och i synnerhet vid viktiga milstolpar som behandlingsavslut genom att tillämpa informationsmöten som grundas i föräldrarnas egna behov.

  • 15.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Information till föräldrar som har barn med cancer2013Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [sv]

    Bakgrund. Föräldrar till barn som har cancer upplever en livssituation som präglas av osäkerhet och oro och de ställs inför sociala och känslo­mässiga utmaningar. Jämfört med föräldrar till friska barn, upplever de också högre stress och drabbas i större utsträckning av posttraumatiska stres­symptom. Trots att information om barnets sjukdom är ett centralt behov för föräldrarna, upplever de otillfredsställelse med den information som ges.

    Syfte. Syftet med denna avhandling var att inom barnonkologisk vård beskriva vårdares och föräldrars upplevelser av information, studera deras inbördes interaktion samt beskriva upplevelser och effekter av en intervention för personcentrerad information till föräldrar.

    Metod. I delstudie I–III användes fokusgruppintervjuer (I, II), individ­uella intervjuer (II, III) och deltagande observationer (III). Deltagarna bestod av 20 vårdare (I), 14 föräldrar till barn med cancer (II) respektive 25 vårdare och 25 föräldrar (III). Data analyserades med kvalitativ innehållsanalys (I, II) och diskurspsykologi (III). I delstudie IV testades en intervention för per­son­cen­tre­rad information på åtta föräldrar med hjälp av en experimentell single-case-design. Data samlades in med kvalitativa intervjuer och internetenkäter. Upplevd stress, kroppsliga symptom på stress, ångest, nedstämdhet och tillfredsställelse med information var utfallsmått.

    Resultat. I delstudie I bestod resultatet av två teman: anpassa mängden information till föräldrarnas behov, som handlade om skillnader i hur mycket information som gavs till föräldrarna utifrån vårdarnas bedömning av föräldrarnas behov, och navigera i en vag struktur, som handlade om brister i ansvar, miljö, tajming och språk när informationen lämnades.

    I delstudie II konstruerades två teman. Känna sig bekräftad som en viktig person handlade om att föräldrarna kände sig trygga, kunde hålla hoppet uppe och fick stöd från andra föräldrar. Temat var mer framträdande under behandlingens tidiga skeden. Det andra temat var känna sig som en objuden gäst vilket handlade om att kännas övergiven vid viktiga milstolpar, att tvingas tjata sig till information och att belastas av att själv behöva informera andra inom sjukvården.

    I delstudie III använde vårdarna tolkningsrepertoarer som var barn-, föräldra- eller familjeorienterade, vilket avspeglade deras primära fokus i interaktionen. Föräldrarna använde tolkningsrepertoarer som talesperson, observatör eller familjemedlem. Hur dessa kombinerades inbördes påverkade interaktionen.

    I delstudie IV erfor föräldrarna stor tillfredsställelse med den per­son­cen­tre­rade informationen och upplevde att de hade nytta av att på egen hand få diskutera barnets sjukdom och ställa frågor de annars inte skulle ställt. Interventionen visade ingen effekt på stress eller kroppsliga symptom på stress, ångest och nedstämdhet.

    Slutsatser. För att förbättra information till föräldrar som har barn med cancer är det en central uppgift att bedöma hur mycket och vilken information som ska ges vid varje tillfälle, att uppmärksamma att föräldrarna kan ha andra informationsbehov än barnet och att möten med föräldrarna ska ske i lugn och ro samt att organisera vården så att ansvaret är tydligt. I synnerhet bör det ske förbättringar kring det som föräldrarna upplever som viktiga milstolpar under barnets sjukdomstid. Interventionen för per­son­cen­tre­rad information uppskattades av föräldrar som har barn med cancer men effekten på föräldrarnas psykosociala välbefinnande behöver utforskas ytterligare.

  • 16.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Information till föräldrar som har barn med cancer2013Inngår i: Barnbladet, ISSN 0349-1994, Vol. 38, nr 6, s. 32-33Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

    Föräldrar till barn som drabbats av cancer känner sig ibland övergivna av sjukvården – men de uppskattar specialanpassade informationsprogram där de kan få svar på sina egna frågor om barnets sjukdom. Det är det viktigaste fyndet i den avhandling som Anders Ringnér försvarar vid Umeå universitet den 31 maj.

  • 17.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strategier för att minska barns obehag vid sårbehandling2016Inngår i: Sårmagasinet, ISSN 2001-9920, nr 4, s. 21-23Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 18.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Why, when, where and how to inform parents within paediatric oncology?2014Inngår i: NOPHO/NOBOS Annual Meeting: Programme and Abstract Book, 2014, s. 98-Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Information about the illness and its implications is a key factor for parents of children with cancer. Nevertheless, many parents experience low satisfaction with the information provided. As a starting point for this research project, we interviewed health care professionals and parents about their experiences of information. Health care professionals described difficulties in matching the amount of information to the parents’ needs and shortcomings in responsibilities, setting, timing, and language when parents were informed. The parents felt acknowledged as persons of significance when the information worked well. However, some parents felt abandoned at important milestones and were forced to nag for information. We also studied the interaction between parents and health care professionals and identified different patterns depending on how active parents were the interaction combined with the health care professionals primary focus of the interaction. Grounded on these findings and previous research, we designed a person-centred information intervention aiming at parents of children with cancer. So far, it has been pilot tested on eight parents. They were highly satisfied with the person-centred information intervention and perceived benefits from having their own time to discuss the child’s disease and pose questions that they otherwise would not have an opportunity to ask. However, no effects from the intervention were demonstrated on perceived stress, physical symptoms of stress, anxiety, and depressive mood. To sum up, central tasks are to assess the amount of and what information the parents need, to pay attention to possible differences in information needs between parents and children, and, to organise the care so that the responsibilities are clear and that parents are met in a calm setting. Improvements at important milestones during the illness period should be prioritised.

  • 19.
    Ringnér, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Björk, Maria
    Jönköping University, Jönköping, Sweden; University of Skövde, Skövde, Sweden.
    Olsson, Cecilia
    Karlstad University, Karlstad, Sweden.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Health Sciences, University West, Trollhättan, Sweden.
    Person-centred information to parents in paediatric oncology (the PIFBO study): a study protocol of an ongoing RCT2015Inngår i: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 14, artikkel-id 69Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Parents of children with cancer experience a demanding situation and often suffer from psychological problems such as stress. Trying to coping with the complex body of information about their child’s disease is one factor that contributes to this stress. The aim of this study is to evaluate an intervention for person-centred information to parents of children with cancer that consists of four sessions with children’s nurses trained in the intervention method.

    Methods/Design

    This is a multi-centre RCT with two parallel arms and a 1:1 allocation ratio. The primary outcome is illness-related parental stress. Secondary outcomes are post-traumatic stress symptoms, anxiety, depression, satisfaction with information, expected and received knowledge, and experiences with health care providers. A process evaluation is performed to describe experiences and contextual factors. Data are collected using web questionnaires or paper forms according to the parents’ preference, audio recording of the intervention sessions, and qualitative interviews with parents and the intervention nurses.

    Discussion

    Few studies have evaluated information interventions for parents of children with cancer using large multi-centre RCTs. This intervention is designed to be performed by regular staff children’s nurses, which will facilitate implementation if the intervention proves to be effective.

  • 20.
    Ringnér, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jansson, Lilian
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Parental experiences of information within pediatric oncology2011Inngår i: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 28, nr 4, s. 244-251Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Parents of children with cancer use information to create knowledge about their child's disease. Information can help parents reduce chaos and create a feeling of control, but there are often obstacles to its acquisition, which has been described as similar to learning a new language. The purpose of this study was to describe parents' experiences of acquiring and using information to create knowledge about their child's cancer during the course of the illness. The authors used qualitative content analysis on data from focus groups and individual interviews with 14 parents of children with cancer. Two themes were constructed: (a) feeling acknowledged as a person of significance included feeling safe and secure in spite of uncertainty, having one's hopes supported, and getting relief from other families' experiences; (b) feeling like an unwelcome guest included feeling abandoned at important milestones, feeling forced to nag for information, and feeling burdened by the obligation to inform others. Parents may need extra attention at important milestones such as treatment cessation, with information meetings grounded in the parents' own needs.

  • 21.
    Ringnér, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jansson, Lilian
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Parental experiences of information within pediatric oncology2011Konferansepaper (Fagfellevurdert)
  • 22.
    Ringnér, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jansson, Lilian
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Professional caregivers' perceptions of providing information to parents of children with cancer2011Inngår i: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 28, nr 1, s. 34-42Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Information has been described as a critical part of the care for parents of children with cancer, but not much is known about how caregivers makes decisions about informing parents. This study aims to illuminate professional caregivers' perceptions of providing information to parents of children with cancer. Twenty caregivers at a Swedish pediatric oncology ward participated in four focus group interviews. The interviews were transcribed verbatim and subjected to qualitative content analysis. Two themes were found: Matching the amount of information to the parents' needs concerned situations where the amount of information provided according to the caregivers' assessment is deemed too small, appropriate, or too large. Navigating through a vague structure dealt with a disrupted setting, unclear responsibilities within the team, difficult timing, unintelligible information, and underused tools for communication. Implications for intervention development are discussed.

  • 23.
    Ringnér, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    A person-centred intervention for information to parents of children with cancer: experiences and effectsManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Objective. The aim of this paper was to describe the experiences and effects of participating in a person-centred information intervention aimed at parents of children with cancer.

    Methods. Eight parents participated in the intervention, which started two months after the child’s diagnosis and was based upon the representational approach for patient education. A mixed method approach was employed. The experiences were captured via quali­tative interviews and the effects were evaluated using a single-case design with web-based questionnaires.

    Results. Parents expressed a high satisfaction with the inter­vention, as reported in the follow-up interviews and/or in the scale measuring satisfaction. However, no changes were seen in the measures for psychosocial distress.

    Conclusion. The intervention was feasible and appreciated by parents but further research is needed considering the effect on parental perceived stress.

  • 24.
    Ringnér, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    A person-centred intervention for providing information to parents of children with cancer: experiences and effects2015Inngår i: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 19, nr 3, s. 318-324Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The aim of this paper is to describe the experiences of participating in a person-centred information intervention aimed at parents of children with cancer.

    Methods: Eight parents participated in the intervention, beginning two months after their child's diagnosis. The intervention was based upon the representational approach to patient education and a mixed method approach was employed in the study. The experiences of parents and intervention nurses were captured via qualitative interviews and the effects of the intervention on parental psychosocial measures, primarily perceived stress, were evaluated using a single-case design with web-based questionnaires.

    Results: Parents expressed high satisfaction with the intervention, as reported in the follow-up interviews and on the scale measuring satisfaction. However, no changes were seen in the quantitative measures of psychosocial distress. The nurses performing the intervention felt it was useful and feasible.

    Conclusions: A representational approach to providing person-centred information to parents of children with cancer was appreciated and considered feasible by both the parents and the intervention nurses. However, further research is needed considering the lack of effect on the parents' perceived stress.

  • 25.
    Ringnér, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    ”Låt sjuksköterskestudenterna få göra empiriska studier”2015Inngår i: Dagens Medicin, ISSN 1104-7488Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 26.
    Ringnér, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Öster, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Björk, Maria
    Högskolan i Skövde, Institutionen för vård och natur.
    Graneheim, Ulla H
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Talking via the child: discursively created interaction between parents and health care professionals in a pediatric oncology ward2013Inngår i: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 19, nr 1, s. 29-52Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to describe discursively constructed interactions between parents and health care professionals (HCPs) in a pediatric oncology ward. Field notes from 70 focused participant observations and 16 informal interviews with 25 HCPs interacting with 25 parents of children with cancer were analyzed using discursive psychology. Six dominant interpretative repertoires (flexible parts of discourses used in everyday interaction) were found. Repertoires used by the HCPs were child, parent, or family oriented, mirroring the primary focus of the interaction. Parents used a spokesperson repertoire to use their own expertise to talk on behalf of the child; an observer repertoire, in which they kept in the background and interfered only when needed; or a family member repertoire to position themselves on a level equal to the ill child. The results are discussed in relation to philosophies influencing pediatric nursing, such as family-centered nursing and child-centered nursing.

  • 27.
    Rydmell, Linda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lagerfors, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Öster, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Does Gender Matter?: Nurses' communications with children during blood test procedures2013Inngår i: Nordisk sygeplejeforskning, ISSN 1892-2678, E-ISSN 1892-2686, Vol. 3, nr 4, s. 300-312Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Equal opportunities for children are in general regarded as crucial; nevertheless, children are still often treated differently due to their sex. This could limit a child's inherent way of expressing him/herself. Nurses need to be aware of how gender constructions influence their interactions with children. The aim of this study was to illuminate interpretative repertoires that a group of nurses use when communicating with children during blood test procedures in two children's hospitals in Sweden. Data was collected by semi-structured observations of nurses conducting blood test procedures on children, and the observations were analyzed using discourse psychology. Two main groups of interpretative repertoires were found. In one group the repertoires were supporting gender stereotyping and in the other group the repertoires were weakening gender stereotyping. In conclusion, nurses' interactions with children during procedures offer the children different socially and culturally constructed interpretative repertoires about gender. Increased consciousness of gender issues is needed among nurses to enable children to be and act freely, without being forced into limited gendered expectations.

  • 28. Senn, B
    et al.
    Kirsch, M
    Sanz, CC
    Karlou, C
    Tulus, K
    de Leeuw, J
    Ringnér, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Goossens, GA
    Cleary, V
    How cancer research could benefit from the Complex Intervention Framework: students' experiences of the European Academy of Nursing Science summer school2011Inngår i: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 20, nr 1, s. 1-4Artikkel i tidsskrift (Fagfellevurdert)
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