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  • 1.
    Andertun, Sara
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hajdarevic, Senada
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ebola virus disease: caring for patients in Sierra Leone - a qualitative study2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 3, p. 643-652Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to describe Norwegian healthcare staffs' experiences of participating in care of patients with Ebola virus disease in Sierra Leone.

    BACKGROUND: Ebola is one of the most feared viruses known. Ebola virus disease is highly contagious with high mortality. The few qualitative studies made on experiences among healthcare professionals have highlighted problems as lack of protective resources, insufficient personnel and risk of societal stigmatization.

    DESIGN: Descriptive study with qualitative approach.

    METHOD: Individual narrative and focus group interviews were obtained during 2015 with eight nurses and one physician who had worked in Ebola care in Sierra Leone. The interviews were analysed using qualitative content analysis.

    RESULT: The analysis resulted in the two themes: 'Experiencing security by learning to manage risks'; and 'Developing courage and growth by facing personal fears'. Subthemes were: 'Relying on safeguard actions', 'Managing risk of contagion', 'Developing strategies for care despite risks', 'Constantly reminded of death', 'Successively defeating fears' and last, 'Increasing motivation through meaningfulness'. The participants described the reliance on training, organized effort, strict guidelines and equipment. They were respectful of the risk of transmission, made risk assessments, took responsibility, handled risky situations and were reminded of suffering and death.

    CONCLUSION: Despite challenges, the hazardous work with Ebola virus disease patients was experienced as meaningful which was an important motivator. Safe care was central in working with Ebola patients, but the care relation was challenged.

  • 2. Audulv, Åsa
    et al.
    Norbergh, Karl-Gustaf
    Asplund, Kenneth
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    An ongoing process of inner negotiation: a grounded theory study of self-management among people living with chronic illness2009In: Journal of nursing and healthcare of chronic illness, Vol. 1, no 4, p. 283-293Article in journal (Refereed)
    Abstract [en]

    Aim. The aim of this study was to better understand the main concern of self-management processes among people with chronic illness.

    Background. One aspect of living with chronic illness is self-management that can reduce the illness impact on daily life and promote future health. Although factors that influence self-management have been identified in previous research, little attention has been brought to the process of making self-management decisions. In clinical settings, use of a theory could facilitate patient-empowering approaches.

    Method. The data collection for this Grounded Theory was mostly conducted in 2006. Data were collected by interviews with 26 adults with a variety of chronic illnesses, including rheumatoid arthritis, diabetes mellitus, inflammatory bowel syndrome, multiple sclerosis, ischaemic heart disease and chronic kidney failure.

    Results. Individuals are conflicted by competing preferences when taking decisions about self-management. Consequently, the decision-making process can be understood as an ongoing inner negotiation between different incompatible perspectives, e.g. social needs vs. medical needs. The process of negotiating self-management starts with the individual's considering beliefs about health and illness, which make the individual face illness threats and the need for self-management. Several aspects influence negotiating self-management namely, assessing effects of self-management; evaluating own capacity; perceiving normality or stigmatisation; and experiencing support and external resources. The process has been demonstrated in a model.

    Conclusions. The process of negotiating self-management is an ongoing inner debate rather than a one-time decision. This opens up new ways of understanding, and communicating with, patients. The described model also links behavioural theories and research findings in a comprehensive understanding.

    Relevance to clinical practice. This model could be applicable as a communication tool for health-care providers in identifying barriers to, and resources in, self-management behaviour among individuals with chronic illness.

  • 3.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Asa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    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.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Role clarity and role conflict among Swedish diabetes specialist nurses2013In: Primary care diabetes, ISSN 1878-0210, Vol. 7, no 3, p. 207-212Article in journal (Refereed)
    Abstract [en]

    AIM: To explore diabetes specialist nurses (DSNs)' perceptions of their role in terms of clarity, conflict and other psychosocial work aspects.

    METHODS: A cross-sectional study was conducted among DSNs in a county in northern Sweden. The DSNs answered the Nordic Questionnaire of Psychological and Social Factors at Work (QPS Nordic) about psychosocial aspects of their work. Statistical analysis compared DSNs with a reference group of different health professionals. Correlations between role clarity, role conflict, and other variables were analysed.

    RESULTS: The DSNs perceived more, and higher, job demands, including quantitative, decision-making and learning demands, but also more positive challenges at work compared with the reference group. Role clarity correlated with experiences of health promotion, perception of mastery, co-worker support, and empowering leadership, while role conflict correlated with quantitative and learning demands.

    CONCLUSIONS: The DSNs perceived high demands but also positive challenges in their work. Their role expectations correlated with several psychosocial work aspects. It is important that DSNs should be presented with positive challenges as meaningful incentives for further role development and enhanced mastery of their work.

  • 4.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Persson, Chatrin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rising, Inger
    Santamäki Fischer, Regina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Clinical challenges and ongoing role changes for primary health-care nurses2012In: British Journal of Community Nursing, ISSN 1462-4753, E-ISSN 2052-2215, Vol. 17, no 2, p. 68-74Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the perceptions of primary health-care nurses (PHNs) about clinical demands and future challenges.

    METHOD: Qualitative content-analysis of open questions from a questionnaire. A total of 121 PHNs from health-care districts in northern Sweden filled in a questionnaire during a mandatory educational day.

    RESULTS: Key issues that were raised included: defending the specific professional role of the PHNs; strengthening their self-governance and authority; and ensuring adequate care in the future through education that focuses more on nursing practice than on academic work.

    CONCLUSION: To ensure that the role of the PHN continues to develop, it is necessary to enable them to articulate, discuss, and evaluate their profession and to learn, in concrete forms, how to implement science in clinical practice.

  • 5.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Bent
    Umeå University, Faculty of Medicine, Department of Nursing.
    Graneheim, Ulla H.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes2014In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 94, no 2, p. 187-192Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore the interaction between diabetes specialist nurses (DSNs) and patients with type 2 diabetes (T2D) during group sessions about self-management. Methods: Ten DSNs and 44 patients were observed during group sessions about self-management, and thereafter the observations were analyzed using qualitative content analysis. Results: The interaction was characterized by three themes: becoming empowered, approaching each other from different perspectives, and struggling for authority. The interaction was not a linear process, but rather a dynamic process with distinct episodes that characterized the content of the sessions. Conclusion: It is important to achieve an interaction that is patient-centered, where the DSN is aware of each patient's individual needs and avoids responding to patients in a normative way. A satisfying interaction may strengthen patients' self-management, and also may strengthen the DSNs in their professional performance. Practice implications: Authority struggles between patients and DSNs could be a prerequisite for patients to become autonomous and decisive in self-management. DSNs might benefit from an increased awareness about this issue, because they can better support patients if they do not perceive authority struggles as threats to their professional role. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

  • 6.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Egan Sjölander, Annika
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Diabetes specialist nurses' perceptions of their multifaceted role2012In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 9, no 2, p. 39-44Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore diabetes specialist nurses' (DSNs') perceptions of their professional role in diabetes care.

    Exploratory interviews were used to elicit DSNs' perceptions of their professional role. Twenty-nine DSNs working in 23 primary health care centres in northern Sweden were interviewed in focus groups. Data were analysed using qualitative content analysis.

    The DSNs described their profession as encompassing five major roles: ‘expert’, ‘fosterer’, ‘executive’, ‘leader’, and ‘role model’. Challenges interpreted as role ambiguities included feeling uninformed, fragmented, resigned, pressed for time, and self-reproachful.

    The profession of DSN was interpreted as multifaceted, with various roles and role ambiguities. Patient-centred care and empowerment, which are recommended in diabetes care, can be difficult to achieve when DSNs experience role ambiguity.

    Lack of clarity about role demands and difficulty in reconciling different roles may have a negative impact on DSNs' attitudes in clinical encounters and could inhibit patient-centred care. The development of the DSN profession requires improved awareness of the DSN's professional role in the clinical encounter, not only to improve the care of patients with diabetes, but also to retain these professionals.

  • 7.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetesIn: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134Article in journal (Refereed)
  • 8.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lehuluante, Abraraw
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patient-centred care in type 2 diabetes: an altered professional role for diabetes specialist nurses2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 4, p. 675-682Article in journal (Refereed)
    Abstract [en]

    Little research has been done to try to understand how patient-centred care is understood and practised by healthcare professionals specialising in patients with diabetes. Experiences from patient-centred practices need to be highlighted as a way of motivating diabetes specialist nurses to take a patient-centred approach. The aim of this study was to describe diabetes specialist nurses' experiences of practising patient-centred care in the context of a type 2 diabetes intervention. The study design was descriptive and used qualitative methods. Focus group interviews complemented by individual semi-structured interviews were analysed by qualitative content analysis. The main theme of the diabetes specialist nurses' experiences of practising patient-centred care was an altered professional role. The main theme was based on two themes: ambivalence towards practising patient-centred care and enriched relationships with the patients. The ambivalence towards practising patient-centred care was based on the three subthemes: a position of withdrawn expertise, inconvenience of changing routines and insights that patient-centred care is difficult but possible. Their experiences of enriched relationships with patients were based on the two subthemes: courage to discuss the severity of diabetes and increased engagement in patients' daily lives. The diabetes specialist nurses' experiences with practising patient-centred care included doubts about their ability to practise in such a way and about the feasibility of such care. At the same time, their enriched relationships with patients were seen as an opportunity to engage in patients' lives. Training and support for practising patient-centred care may improve diabetes specialist nurses skills in patient-centred care and self-management support in type 2 diabetes.

  • 9.
    Edvardsson, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Raising issues about children's overweight: maternal and child health nurses' experiences2009In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 12, p. 2542-2551Article in journal (Refereed)
    Abstract [en]

    AIM: This paper is a report of a study carried out to describe maternal and child health nurses' experiences of communicating and raising issues with parents about children's overweight. BACKGROUND: Children's overweight and obesity are rapidly increasing in many countries around the world. Maternal and child health nurses are in a unique position to influence parents, but studies of their experiences in communicating with parents about overweight are lacking. METHOD: Ten maternal and child health nurses in culturally diverse rural and urban areas in Melbourne, Australia, were interviewed in 2007. Data were analysed using qualitative content analysis to identify key categories. FINDINGS: During the analysis, eight categories were identified. In summary, nurses described it as difficult to raise weight issues, especially if parents were overweight themselves. The growth chart was felt to be an essential tool in discussions about weight and nurses often described themselves as holding 'expert' roles in conversations. Denial, defensiveness and excuses about children being overweight were common reactions among parents and were described as difficult to deal with. However, a strong nurse-parent relationship was experienced as facilitating conversations about weight. CONCLUSION: Raising issues about weight can be difficult, especially if parents are overweight themselves. Further research in communications is needed to understand and approach parents better--especially overweight parents--about their children's weight. Interventions involving patient-centred approaches in this context have potential, but the area is still relatively unexplored. Maternal and child health centres could be important contributors in such future interventions.

  • 10. Garmo, A.
    et al.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Leksell, J.
    "The pump was a saviour for me." 'Patients' experiences of insulin pump therapy2013In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 30, no 6, p. 717-723Article in journal (Refereed)
    Abstract [en]

    Background and aim The present study formed part of a larger study examining the potential long-term effects of glycaemic control and treatment satisfaction in people with Type1 diabetes mellitus who changed from multiple daily insulin injections to insulin pump therapy. Individuals (n=46) who made the transition between May 1999 and February 2004 participated. The aim of the study was to describe experiences of the impact of insulin pump therapy in adults with Type1 diabetes mellitus after >5years' use of an insulin pump. Method During spring 2009, 16 of the individuals were interviewed through a narrative approach on the effects of insulin pump therapy on daily life. The interviews were analysed using content analysis. Results The overarching theme revealed that insulin pump therapy was experienced as both a shackle and a lifeline. Six sub-themes emerged: subjected vs. empowered; dependent vs. autonomous; vulnerable vs. strengthened; routinized vs. flexible; burdened vs. relieved; and stigmatized vs. normalized. Conclusions Users of insulin pump therapy have different views about and experience of having used the technical equipment over years. Both positive and negative views emerged. However, it is difficult to identify any general trends that cover all views and can predict which individuals will be able to manage pump therapy in the best way. Even so, the sub-themes and theme that emerged could be used by physicians and diabetes specialist nurses when counselling and planning educational programmes aimed at supporting self-management among people with insulin pump treatment.

  • 11.
    Graneheim, Ulla Hällgren
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    A lesson to learn: patients´critiques of diabetes nursing2011In: The Internet Journal of Advanced Nursing Practice, ISSN 1523-6064, Vol. 11, no 1, p. 0-0Article in journal (Refereed)
    Abstract [en]

    Background:  Most nurses sincerely wish the best for their patients and express frustration when they do not follow their advice. Reflecting on a critique of diabetes nursing from a patient perspective is essential to bridge gaps between health professionals and patients with diabetes and their understandings of possibly divergent treatment goals. Aim:  The aim of this study was to describe what patients with type 2 diabetes view as most important for diabetes specialty nurses to learn about receiving care for diabetes. Method:  An interview study was conducted among 44 patients diagnosed with type 2 diabetes over two years in Sweden. Narrative interviews were analysed using qualitative content analysis. Findings: ‘Not making a mountain out of a molehill’, ‘the more routine, the less life’, and ‘to err is human’ were identified as themes in the participants’ views about what nurses could learn, reflecting a criticism of some traditional aspects of diabetes nursing; i.e., a one-sided disease perspective, high adherence expectations, and a paternalistic attitude. Conclusion: Diabetes specialty nurses are focused on preventing complications by striving to regulate diabetes. A challenge for these nurses is to show they are partners; i.e., on the same side as the patients. Otherwise, nurses and patients will both lose. Possibly core caring values of nursing such as consoling, relieving, healing, and relating have not been given enough priority or have been replaced with more goal-oriented values such as treating, curing, and being effective.

  • 12. Graue, Marit
    et al.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Karlsen, Bjørg
    Sigurdardottir, Árún K.
    Diabetes nursing research: 6th Nordic conference: Highlights from the 6th Nordic Diabetes Nursing Research PhD and Post-doc Annual Conference, 23-24 April 2013, Bergen, Norway2013In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 10, no 2, p. 69-70Article in journal (Refereed)
  • 13.
    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.

  • 14.
    Hajdarevic, Senada
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Isaksson, Ulf
    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.
    Health care delay in malignant melanoma: various pathways to diagnosis and treatment2014In: Dermatology Research and Practice, ISSN 1687-6105, E-ISSN 1687-6113, p. 294287-Article in journal (Refereed)
    Abstract [en]

    We aimed to describe and compare patients diagnosed with malignant melanoma (MM), depending on their initial contact with care andwith regard to age, sex, andMMtype and thickness, and to explore pathways and time intervals (lead times) between clinics from the initial contact to diagnosis and treatment.The sample from northern Sweden was identified via the Swedish melanoma register. Data regarding pathways in health care were retrieved from patient records. In our unselected population of 71 people diagnosedwith skinmelanoma of SSMandNMtypes, 75%of patients were primarily treated by primary health-care centres (PHCs). The time interval (delay) from primary excision until registration of the histopathological assessment in the medical records was significantly longer in PHCs than in hospital-based and dermatological clinics (Derm). Thicker tumors were more common in the PHC group. Older patients waited longer times for wide excision. Most MM are excised rapidly at PHCs, but some patients may not be diagnosed and treated in time. Delay of registration of results from histopathological assessments within PHCs seems to be an important issue for future improvement. Exploring shortcomings inMMpatients’ clinical pathways is important to improve the quality of care and patient safety.

  • 15.
    Hajdarevic, Senada
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rasmussen, Birgit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Asa
    Umeå University, Faculty of Medicine, Department of Nursing.
    You never know when your last day will come and your trip will be over - Existential expressions from a melanoma diagnosis.2014In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 18, no 4, p. 355-361Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to further explore expressions of existential experiences by patients diagnosed with malignant melanoma (MM).

    METHOD: Semi-structured interviews were performed consecutively after diagnosis among 30 patients with MM. The methodological approach was inspired by Gadamer's hermeneutic philosophy.

    RESULTS: The analysis of expressions of existential experiences after having been diagnosed with malignant melanoma revealed that it is an existential process that people go through, beginning with feelings of suddenly becoming groundless at the time of the diagnosis, including being empty and in a vacuum, being in chaos and uncertainty and being confronted with one's own death. Next theme searching for solid ground included striving to understand what lies ahead, striving to find a balance in life - fighting, hoping, going on living and striving to prioritize family. The last theme creating islands of solid ground when living with cancer included understanding what is meaningful in life, living in the moment - seizing the day and keeping watch on the body.

    CONCLUSION: On being diagnosed with malignant melanoma, people go through a process where many questions emerge, including an existential turmoil, which health professionals should be aware of to provide these patients with sufficient support.

  • 16.
    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.

  • 17.
    Hajdarevic, Senada
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. 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.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Coping styles in decision making among men and women diagnosed with malignant melanoma2013In: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 18, no 11, p. 1445-1455Article in journal (Refereed)
    Abstract [en]

    Early care seeking is important for prognosis of malignant melanoma. Coping styles in decision-making to seek care can relate to prognosis since avoidant strategies could delay care seeking. The aim of this study was to compare self-reported coping styles in decision-making between men and women diagnosed with malignant melanoma. We used the Swedish version of the Melbourne Decision-Making Questionnaire to assess coping styles. Men generally scored higher in buck-passing while women and those living without a partner scored higher in hypervigilance. This knowledge could be used in the development of preventive programmes with intention to reach those who delay care seeking.

  • 18.
    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.

  • 19.
    Hultstrand Ahlin, Cecilia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Coe, Anna-Britt
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Lilja, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Hajdarevic, Senada
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wishing to be perceived as a capable and resourceful person: A qualitative study of melanoma patients’ experiences of the contact and interaction with healthcare professionals2019In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 7–8, p. 1223-1232Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore patients' experiences of contact and interaction with healthcare professionals (HCPs) during the diagnostic process of melanoma.

    BACKGROUND: In Sweden, most patients with suspected skin lesions seek care at the primary level of services in the first instance. Previous research describes the diagnostic process as a complex journey with uncertainty. Nonetheless, the importance of contact and interaction between patient and HCPs during the diagnostic process is rarely explored.

    DESIGN: This study adopted a qualitative design in which semi-structured interviews were conducted and the COREQ-checklist for qualitative studies employed (EQUATOR guidelines).

    METHODS: A sample of 30 patients (15 women, 15 men) diagnosed with melanoma was included. Secondary analysis of interviews was carried out using qualitative content analysis.

    RESULTS: One theme emerged: Wishing to be perceived as a capable and resourceful person that consisted of three categories: (a) The need of being valued, (b) The need of being informed and (c) The need of taking actions.

    CONCLUSIONS: Our results suggest that patients wish to be valued as capable and resourceful persons as well as to be provided with honest and sufficient information about the diagnosis and subsequent procedures. By fulfilling these wishes, HCPs can involve patients in the diagnostic process and reduce patients' uncertainty. A need of supportive and accessible health care to manage the diagnostic process and to reduce patients' struggle for care was also identified.

    RELEVANCE TO THE CLINICAL PRACTICE: Patients are satisfied when health care is organised in a patient-/person-centred manner, that is, in accordance with patients' needs, avoiding gatekeeping, and when HCPs interact respectfully in encounters. Accessible HCPs during the diagnostic process of melanoma are required to inform, support and navigate patients within the healthcare system and through their diagnostic journey.

  • 20.
    Hällgren Graneheim, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Female caregivers' perceptions of reasons for violent behaviour among nursing home residents2012In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 19, no 2, p. 154-161Article in journal (Refereed)
    Abstract [en]

    Accessible summary

    • Threats and violence against professional caregivers present a growing health and safety problem in elderly care.
    • Caregivers attribute violent behaviour in the elderly to patient characteristics, caregiver approach and disorder in the environment.
    • Caregivers involved in a violent situation should strive to see the person behind the behaviour and the frustration that may have prompted it, to understand what the behaviour is meant to communicate, and to tailor interventions to the individual.

    Abstract

    Threats and violence against professional caregivers present a growing health and safety problem in elderly care. We aimed to explore female caregivers' perceptions of reasons for violent behaviour among nursing home residents. Forty-one caregivers at three nursing homes were interviewed and their responses were subjected to qualitative content analysis, which revealed three content areas of perceived reasons for patient violence: patient characteristics, caregiver approach and environmental aspects. The caregivers' perceptions were formulated in three core statements: ‘they (the residents) are not who they used to be’, ‘we (the caregivers) have acted inappropriately’ and ‘we (residents and caregivers) are all surrounded by disorder’. Our findings indicate that the reasons for violence are complex and multifactorial, so interventions should be individually tailored. Caregivers involved in a violent situation need to see the person behind the behaviour, try to interpret what the behaviour is meant to communicate and adjust the intervention according to individual need.

  • 21.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Experiences of diabetes care - patients' and nurses' perspectives2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: In order to provide good diabetes care it is important for the health care professionals to share patients’ personal understanding of living with diabetes, which differs from a professional understanding of the illness. Patients’ beliefs about health, illness, control and cure are predictive of the outcome of lifestyle changes and pharmacological treatment. Narratives about illness could be used to elucidate what people believe to be central to their experience of an illness and its management. The overall aim of this thesis was to investigate experiences of diabetes and diabetes care among people with type 2 diabetes and district nurses responsible for diabetes care within primary health care.

    Methods: Forty-four patients diagnosed with diabetes during the previous 2 years were interviewed about their personal understanding of illness and experiences of care. They also participated in an intervention study consisting of group sessions during 9 months. The intervention focused on the patients’ understanding of living with diabetes and was directed at the patients and their nurses (n = 5). The outcome variables haemoglobin A1c (HbA1c), lipids, blood pressure (BP) and body mass index (BMI) as well as well-being, treatment satisfaction and diabetes symptoms of the intervention group were compared with those in a control group (n = 60). Another ten patients were interviewed about their views of their lives. Seventeen nurses in diabetes care were interviewed about their views of their work with patients. The narrative, thematic interviews and focus group interviews were analysed using qualitative content analysis.

    Findings: Patients’ personal understanding of illness included the categories “image of the disease”; “meaning of the diagnosis”; “integration of the illness”; “space for the illness”; “responsibility for care”; and “future prospects”. Patients’ narratives about their lives included views of knowledge, and capacity, motivation and courage, aspects important for effective self-management. Patients’ views on clinical encounters in diabetes care, interpreted as satisfying or not, included the themes “being in agreement v. in disagreement about the goals”; “being autonomous and equal v. being forced into adaptation and submission”; “feeling worthy as a person v. feeling worthless”; “being attended to and feeling welcome v. being ignored”; and “feeling safe and confident v. feeling unsafe and lacking confidence”. The results of the intervention study with group sessions showed improvements in metabolic balance and treatment satisfaction in the intervention group. At the 1-year follow-up the mean difference between groups in HbA1c was 0.94% (95% confidence interval (CI) 0.58–1.29).

    Nurses’ views of their work included the themes “Perspectives on illness and caring are not easily integrated into views of disease and its treatment”; “Nurses view their knowledge as more important than the patients’ knowledge”; Nurses’ conscience is challenged by some of their nursing decisions”; “The individuality of each patient is undermined when patients are regarded as a collective group”; and “Nurses are confirmed in their role of nurses by patients who assume a traditional patient role”.

    Conclusion: These results demonstrate that the understanding of illness and care differs between patients and nurses working in diabetes care; furthermore, that an intervention involving patients and their nurses based on patients’ personal understanding of illness is effective with regard to metabolic control and treatment satisfaction. The cost of the intervention is moderate. Also, we believe that it is possible to clinically implement this intervention within the existing resources for primary health care.

  • 22.
    Hörnsten, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jutterström, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Audulv, Åsa
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    A model of integration of illness and self-management in type 2 diabetes2011In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 3, no 1, p. 41-51Article in journal (Refereed)
    Abstract [en]

    Aim. To describe the process of illness integration and self-management among people with type 2 diabetes.

    Background. Integration of illness is a developmental process referring to the emotional and existential aspects of being ill. It is an overarching concept that describes the process that a person undergoes in living with a chronic disease, from prediagnosis to adaptation to illness as a natural part of life. Despite the common use of terms such as illness integration and self-management, there exists little research that investigates how these concepts relate to one another.

    Methods. A narrative interview study applying qualitative content analysis was conducted with people diagnosed with type 2 diabetes. The study focused on their personal understandings of illness, and particularly, the relationship of the participants’ illness integration to self-management of the disease. Data were collected in 2002.

    Results. In the trajectory from prediagnosis to adaptation, there is a turning point when people seem to integrate the illness emotionally and existentially, and in relation to their self-management practice. The trajectory includes the phases of suspecting illness/being diagnosed, understanding and explaining the illness, and negotiating illness and taking stands about self-management. These phases in turn are influenced by perceptions of the seriousness and threat of the disease; the intensity and nature of the ill person’s emotional response to the disease and its management; goals and expectations for living with the disease and for living in general; and lastly, perceptions of the outcomes and impacts of self-management.

    Conclusion. Illness integration and self-management processes develop simultaneously. In some cases, a turning point occurs that causes the person to view self-management as both necessary and feasible.

    Relevance to clinical practice. Nurses may influence the illness integration trajectory and assist people with type 2 diabetes to integrate the disease and its management more readily.

  • 23.
    Hörnsten, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindahl, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Persson, Kristina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, Kristina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Strategies in health-promoting dialogues: primary healthcare nurses' perspectives: a qualitative study2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 235-244Article in journal (Refereed)
    Abstract [en]

    Aim and objectives The aim of this study was to describe dialogic strategies about health and lifestyle used by primary healthcare nurses (PHNs) in the Vasterbotten Intervention Programme (VIP) in Sweden.

    Background The VIP offers all citizens aged 40, 50 and 60 in Vasterbotten County an individual health check-up followed by a health-promoting dialogue with a specialist PHN. Inconsistencies in previous reports of the effects of lifestyle counselling and health promotion suggest that it is important to study dialogues about health and lifestyle to understand health-promoting strategies and to highlight aspects important to improving their effects.

    Method In 2010, we conducted in-depth interviews with ten experienced PHNs working with the VIP at eight healthcare centres in Vasterbotten County, Sweden. Qualitative content analysis was used to illuminate the nurses' strategies in health-promoting dialogues. The Regional Ethics Board (Dno 06-126M) approved the study.

    Results The PHNs used various strategies in dialogues about health and lifestyle that fell under the five themes 'Guiding patients vs. pressuring them; Adjusting to patients vs. directing the conversation; Inspiring confidence vs. instilling fear; Motivating and supporting patients vs. demanding responsibility; and lastly, Introducing emotionally charged subjects or avoiding them'.

    Conclusions The results of this study may add knowledge about the difficulties and opportunities in health counselling. In the discussion, we suggest professional reflection as a means to increase knowledge and awareness about the self and context in the process of health counselling.

  • 24.
    Hörnsten, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Almberg, Agneta
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Nurses' experiences of conflicting encounters in diabetes care2008In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 5, no 2, p. 64-69Article in journal (Refereed)
    Abstract [en]

    Aim: To describe nurses' experiences of encounters with patients in diabetes care.Methods: Focus-group interviews with 17 nurses about their experiences of caring for patients with diabetes. Interviews were analysed by qualitative content analysis.Results: Four themes described conflicts in their encounters with patients, disclosing a complex professional role as a diabetes nurse. Implementing guidelines at the same time as being patient-centred was found to be problematic. Nurses further viewed medical knowledge as being more important than life experience of diabetes. The nurses' comments were distanced from, and judgemental about, patients as a collective. Finally, the nurses felt comfortable in expert roles, but not in equal and mutual relationships with patients.Conclusion: The interviews identified a feeling of frustration over conflicting demands between different goals and ideologies for diabetes care. These conflicts may also arise from the difficulty of integrating medical goals and patients' life experiences of illness.

  • 25.
    Hörnsten, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Selstam, Eva Kihl
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Patient satisfaction with diabetes care2005In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 51, no 6, p. 609-617Article in journal (Refereed)
    Abstract [en]

    Aim. The aim of this paper is to report the findings of a study that elucidated the experiences and reflections of people with type 2 diabetes about clinical encounters.

    Background. Several patient satisfaction surveys have focused on privacy, cheerfulness and amenities rather than on how the care was delivered. A great deal of research has also focused on communication and various consultation styles, particularly within health promotion and diabetes care, but how these factors tie up with patient satisfaction has rarely been discussed. This study was performed in order to elucidate patients' perspectives about clinical encounters in diabetes care.

    Method. Interviews were carried out during 2001 with 44 patients with diabetes. The transcribed interviews were analysed using qualitative content analysis.

    Results. Five themes were connected to patient satisfaction and dissatisfaction, namely 'being in agreement vs. in disagreement about the goals'; 'autonomy and equality vs. feeling forced into adaptation and submission'; 'feeling worthy as a person vs. feeling worthless'; 'being attended to and feeling welcome vs. ignored'; and, lastly, 'feeling safe and confident vs. feeling unsafe and lacking confidence'.

    Conclusion. Despite efforts to individualize diabetes care and find ways to communicate with patients, many people have experiences of clinical encounters that they find dissatisfying. Experiences of dissatisfying encounters have elements that may threaten their perception of self and identity, while elements included in satisfying encounters are those characterizing patient-centred care.

  • 26.
    Hörnsten, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    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.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Metabolic improvement after intervention focusing on personal understanding in type 2 diabetes.2005In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 68, no 1, p. 65-74Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate, whether an educational intervention, focusing on patients' personal understanding of their illness, was more effective than care given according to national guidelines for diabetes care. METHODS: An intervention group (n = 44), with type 2 diabetes was compared with a control group (n = 60), with HbA1c as the primary outcome. The intervention included ten group sessions addressing themes related to the patients' personal understanding of their illness. The diabetes nurses involved were educated in theories about illness/wellness experiences and participated in group sessions where various caring strategies related to the patients' individual needs and understanding were reflected upon. RESULTS: At 1-year follow-up the intervention group showed lower HbA1c levels (mean difference 0.94%; P < 0.001), lower triglycerides (mean difference 0.52 mmol/l; P = 0.002) and higher high-density lipoprotein (mean difference 0.15 mmol/l; P = 0.029) and treatment satisfaction than did the control group. The differences remained when adjusting for age, gender, body mass index or changed treatment during the intervention period. Within the intervention group, BMI and treatment satisfaction were also improved. CONCLUSION: The intervention, which focused on patients' personal understanding of illness, was found to be effective in terms of metabolic control and treatment satisfaction.

  • 27.
    Hörnsten, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Psychosocial maturity among people with diabetes mellitus2002In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 6, p. 777-784Article in journal (Refereed)
    Abstract [en]

    There is a relationship between coping with chronic illness and a person's psychosocial development.

    The aim of this study was to describe dimensions of psychosocial development based on results of a previous factor analysis of the Modified Erikson Psychosocial Stage Inventory among people with type 2 diabetes.

    Interviews were carried out with 10 people with diabetes. The transcribed interviews were analysed by qualitative content analysis into main categories, categories and themes.

    The categories were trust, lack of trust, positive identity, identity confusion, integrity and lack of integrity. Themes that permeated the categories in a positive way were 'activity' and 'involvement', while themes that permeated the categories in a negative way were 'passivity' and 'alienation'. Our interpretation is that the category 'trust' is the basis for 'identity', and together 'trust' and 'identity' are the basis for maturity and 'integrity'.

    A conclusion is that positive psychosocial maturity has to do with attaining trust, identity and integrity through activity and involvement. Qualities important for maturation through trust, identity and integrity are understanding, capacity, purposefulness and fortitude. Our interpretation of maturity is considered as being an important and interesting focus in nursing, while the above related qualities are closely connected to coping with diabetes.

  • 28.
    Hörnsten, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Personal understandings of illness among people with type 2 diabetes2004In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 47, no 2, p. 174-182Article in journal (Refereed)
    Abstract [en]

    Background. Professionals and patients understand the experience of illness from different worlds. Professionals' explanatory models focus on aetiology, diagnosis, pathophysiology and treatment, while patients' explanatory models are more focused on consequences and influences on daily life. The differences between patients and professionals in their understanding often result in conflicting expectations about treatment, priorities and outcomes of care.

    Aim. The aim of this study was to describe personal understandings of illness among people with type 2 diabetes in Sweden.

    Method. A sample of 44 patients, 47–80 years, diagnosed with type 2 diabetes within the last 2 years, was recruited from four health care centres. Narrative thematic interviews were used covering the areas of developing, coping with and living with diabetes. Qualitative content analysis was performed.

    Findings. The findings were formulated into six categories: image of the disease, meaning of the diagnosis, integration of the illness, space for the illness, responsibility for care and future prospects.

    Conclusions. The findings demonstrate that patients' personal understanding of illness is an important complement to the traditional professional view of diabetes. They could serve as a foundation for development of health history interviewing, as well as development of systems of documentation. Patients' personal understandings of diabetes in their daily lives are considered to be an important shared source of information for planning meaningful care.

  • 29.
    Hörnsten, Åsa
    et al.
    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.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Allmänmedicin.
    Improvements in HbA1c remain after 5 years--a follow up of an educational intervention focusing on patients' personal understandings of type 2 diabetes2008In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 81, no 1, p. 50-5Article in journal (Refereed)
    Abstract [en]

    This paper reports a 5-year follow-up from a study aimed at evaluating whether an intervention which focused on patients’ personal understanding of their illness was more effective than conventional diabetes care with regard to metabolic control among patients with type 2 diabetes mellitus (DM2). The study was conducted within Swedish primary health care and included 102 patients (mean age 63 years). At clinic level they were randomised into control or intervention groups. The intervention directed at patients consisted of ten two-hour group sessions over 9 months, focusing on patients’ own needs and questions. The mean HbA1c at baseline was 5.71% (S.D. 0.76) in the intervention group and 5.78% (S.D. 0.71) in the control group. At the 5-year follow-up, the mean HbA1c in the intervention group still was 5.71% (S.D. 0.85) while among the controls it had increased to 7.08% (S.D. 1.71). The adjusted difference was 1.37 (p < 0.0001). Treatment upgrade, BMI, total cholesterol, HDL, LDL and triglycerides at baseline did not influence the difference in HbA1c. These findings indicate that group sessions in patients with DM2 focusing on patients’ personal understanding of their illness are more effective than conventional diabetes care with regard to metabolic control.

  • 30.
    Isaksson, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hajdarevic, Senada
    Umeå University, Faculty of Medicine, Department of Nursing.
    Abramsson, MaiGreth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stenvall, Jessica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hornsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Diabetes empowerment and needs for self-management support among people with type 2 diabetes in a rural inland community in northern Sweden2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 3, p. 521-527Article in journal (Refereed)
    Abstract [en]

    Background: Self-management among people with T2D includes being responsible for attaining a blood sugar level within the normal range, eating healthy food, exercising and following prescriptions for medication, something that may need support. In rural areas, access to health care may be limited, and support from family members becomes important.

    Aim: The aim of this study was to describe perceptions and associations of diabetes empowerment, self-management ability and needs of self-management support among people with T2D in a northern rural community of Sweden.

    Method: People with T2D (n = 159) living a rural municipality in northern Sweden answered the SWE-DES-23 questionnaire and additional questions concerning self-management and needs for self-management support.

    Results: A higher diabetes empowerment was associated with longer diabetes duration and support from healthcare professionals and relatives. Women rated a need for self-management support significantly higher than men did. Nonretired persons rated a significantly higher need for self-management support and a lower perception of support from healthcare professionals compared to retired persons. Cohabitant persons had a significantly higher perception of support from relatives and also estimated a higher need for relatives’ involvement in clinical visits compared to persons living alone. Both the newly diagnosed and also those people with a diabetes duration of 10–15 years rated a higher need for group support. Higher self-awareness and readiness to change were apparent among people with short and long diabetes duration. Furthermore, self-management ability, support from healthcare professionals and from relatives and lastly diabetes duration was associated with diabetes empowerment.

    Conclusion: Not only people newly diagnosed with T2D should be offered patient-centred group support, strengthening patient empowerment. For future, family-focused care and education and training in person-centred care among diabetes specialist nurses is recommended.

  • 31.
    Isaksson, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hajdarevic, Senada
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jutterström, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Validity and reliability testing of the Swedish version of Melbourne Decision Making Questionnaire2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 405-412Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Melbourne Decision-Making Questionnaire (MDMQ) is an attempt to capture and measure coping strategies that people use. The instrument had not previously been translated into Swedish. The aim of this study was to evaluate validity and reliability of the Swedish version of the MDMQ.

    METHOD: A Swedish translation was performed and back-translated. A group of five pilot readers evaluated content validity. The translated questionnaire was tested among 735 patients, healthcare workers, healthcare students and teachers. A parallel analysis (PA), exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed.

    RESULT: An initial EFA with a four-factor solution showed a low concordance with the original 22-item four-factor model with a very low Cronbach's alpha in one of the dimensions. However, a second EFA with a three-factor solution showed a good model fit for the Swedish translation of the Melbourne Decision-Making Questionnaire (MDMQ-S) with a satisfactory Cronbach's alpha. A CFA showed a goodness of fit after deleting six items.

    CONCLUSION: After testing the MDMQ-S, we found support for validity and reliability of the instrument. We found the 16-item version of MDMQ-S to be satisfactory concerning the subscales vigilance, procrastination and buck-passing. However, we found no support that the hypervigilance dimension could be measured by the MDMQ-S.

  • 32.
    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. 

  • 33.
    Jutterström, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ideal versus real conditions for type 2 diabetes care: diabetes specialty nurses’ perspectives2012In: The Internet Journal of Advanced Nursing Practice, ISSN 1523-6064, Vol. 11, no 2Article in journal (Refereed)
    Abstract [en]

    Background: Since diabetes specialty nurses are the professionals who spend the most time with patients living with diabetes, they probably have the greatest influence on the quality of diabetes care. Therefore, their personal perceptions about what constitutes “good care” in type 2 diabetes care are important to explore.

    Aim: The aim of this study was to describe conditions for “good care” in type 2-diabetes as perceived by diabetes specialty nurses.

    Method: Twenty-one experienced diabetes specialty nurses participated in three focus group interviews. Data were analyzed using qualitative content analysis.

    Findings: The findings are presented in four themes describing diabetes specialty nurses’ perspectives on ideal versus real conditions for type 2 diabetes care: 1) Diabetes counseling built on empowerment versus governance; 2) Diabetes management built on comprehensive versus biomedical views; 3) Diabetes organization built on nurse-led versus physician-led care; and 4) Diabetes policies built on quality versus equality.

    Conclusion: The ideal diabetes care is perceived as complex to achieve. Conflicting paradigms, power relations, and departmentalization of work are influencing the potential to deliver ideal diabetes care and to increase satisfaction among diabetes specialty nurses and patients. The diabetes specialty nurses described themselves as the “hub” of diabetes care, and they perceived conflicts between ideal versus real conditions in type 2 diabetes care. Patient centredness is not a real condition in diabetes care.

  • 34.
    Jutterström, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes: A randomized study2016In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, no 11, p. 1821-1829Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to evaluate the effect of a patient-centered self-management support, in type 2 diabetes (T2D) with regard to metabolic changes.

    METHODS: 182 patients were randomized into group intervention (GI), individual intervention (II) or internal controls (IC). An external control (EC) group was recruited from another county council. The intervention consisted of six sessions that featured themes, which regarded different views of their illness experiences. Data were collected in 2010 and 2011.

    RESULTS: HbA1c was significantly decreased at 12-month follow-up with 5mmol/mol in the GI and 4mmol/mol in the II. In the IC group, the HbA1c was close to baseline. The EC group had increased HbA1c, though not significantly. When the HbA1c difference at baseline was adjusted, there was a significant difference between intervention groups and the EC-group.

    CONCLUSION: Patient-centered self-management support, led by nurses, can lower HbA1c among patients with type 2 diabetes.

    PRACTICE IMPLICATIONS: It is possible to train diabetes specialist nurses in clinical patient-centered care, and simultaneously influence patients' metabolic balance positively.

  • 35.
    Jutterström, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Turning points in self-management of type 2 diabetes2012In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 9, no 2, p. 46-50Article in journal (Refereed)
    Abstract [en]

    A turning point is described in the literature as a powerful emotional experience or insight leading to a fundamental change in a person’s life, and requires a new way of managing the illness. However, turning points are not sufficiently described in the literature, particularly not with respect to diabetes.

    The aim of this study was to throw light on turning points in self-management asdescribed by people with type 2 diabetes.

    Eighteen participants diagnosed with type 2 diabetes within the previous two years, and who received treatment in primary health care, were invited to participate. Semi-structured interviews were analysed using qualitative content analysis.

    The findings demonstrated that the turning point in self-management among individuals living with type 2 diabetes included four themes: being in a life and death struggle, being at a crossroads with no return, being the one who decides, and being the one who can change the outcome.

    Turning point transitions include existential and emotional aspects that can increase inner motivation and power for changed behaviour. Turning points are possible to identify, and self-management could be facilitated if more attention is paid to the emotional and existential aspects of having an illness.

  • 36.
    Jutterström, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Diabetes control by patient-centred self-management support: a randomised controlled trialArticle in journal (Refereed)
  • 37.
    Nordlander, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Perceptions of What Is Important for Appetite: An Interview Study With Older People Having Food Distribution2019In: Sage Open Nursing, ISSN 2377-9608, Vol. 5Article in journal (Refereed)
    Abstract [en]

    The proportion of older people in the population increases and more and more continue living in their own homes. Appetite among the elderly people is important to their nutrition and health. The increased risk of unintended weight loss and malnutrition is linked to food distribution among home-living elderly people. The aim was to describe experiences and perceptions of what matters to appetite among home-living elderly people having food distribution. The design was qualitative where interview data were collected among 13 interviewees in 2017 to 2018. Data were analyzed using qualitative content analysis. The results are presented in three domains: the food, the meal situation, and the adaptation to meal service with categories and themes responding to each domain. The six themes related to appetite among the elderly people concerned the following: eating tasty, savory, and culturally adapted food; eating healthy and sustainable food; eating alone or together with others; eating in a pleasant meal environment; having choices to make about the meal; and last, accepting disabilities and increased dependency. One conclusion is that many aspects should be taken into consideration when promoting appetites of people who also get food distribution. It is highly individual and an understanding of which aspects are relevant must be considered; consequently, person-centered care is suggested to promote appetite.

  • 38. Oftedal, Bjorg
    et al.
    Kolltveit, Beate-Christin Hope
    Zoffmann, Vibeke
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Graue, Marit
    Learning to practise the Guided Self-Determination approach in type 2 diabetes in primary care: A qualitative pilot study2017In: Nursing Open, E-ISSN 2054-1058, Vol. 4, no 3, p. 134-142Article in journal (Refereed)
    Abstract [en]

    Aim: To describe how diabetes nurses in primary care experience the process of learning to practise the person-centred counselling approach Guided Self-Determination among adults with type 2 diabetes. Design: A descriptive qualitative design. Method: Data were collected in 2014-2015 by means of individual interviews with four diabetes nurses at two points in time. The data were analysed using qualitative content analysis. Results: Three themes that reflect nurses' processes in learning to use the Guided Self-Determination approach were identified: (1) from an unfamiliar interaction to cracking the code; (2) from an unspecific approach to a structured, reflective, but demanding approach; and (3) from a nurse-centred to a patient-centred approach. The overall findings indicate that the process of learning to practise Guided Self-Determination increased the nurses' counselling competence. Moreover, the nurses perceived the approach to be generally helpful, as it stimulated reflections about diabetes management and about their own counselling practices.

  • 39.
    Olsson, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Nilsson, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Patients’ self-reported function, symptoms and health-related quality of life before and 6 months after transcatheter aortic valve implantation and surgical aortic valve replacement2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 3, p. 213-221Article in journal (Refereed)
    Abstract [en]

    Background: Aortic stenosis is the most common valve disease in western countries and has poor prognosis without treatment. Surgical aortic valve replacement (SAVR) is the gold standard, and transcatheter aortic valve implantation (TAVI) is a new method that is used in high-risk patients who are denied surgery. The purpose of treatment is not only to save life, but also to reduce symptoms and increase health-related quality of life (HRQoL).

    Objective: The aim of this study was to describe patients’ self-reported outcomes in terms of physical function, symptoms, dependence, HRQoL, and cognitive function after TAVI and SAVR.

    Methods: All patients treated with TAVI during 1 year (n = 24) and age-matched patients treated with SAVR (n = 24) were included. Data were collected on the day before and at 6 months after treatment using structural questionnaires.

    Results: Self-rated function was low before treatment and increased at follow-up. A quarter of all patients reported syncope at baseline, and none reported this at follow-up. Breathlessness was reported by all patients to be the most limiting cardiac symptom, but the TAVI patients reported more severe symptoms. At 6 months’ follow-up, symptoms were reduced, but breathlessness and fatigue were still common, especially in the TAVI group. HRQoL, which was very low in the TAVI group at baseline, increased in all dimensions except social function.

    Conclusion: We found no change in cognitive function or dependence at follow-up. There was no difference in the size of improvement between groups. The results could be helpful when informing future patients in order to give them realistic expectations.

  • 40.
    Olsson, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Nilsson, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Experiences of and Coping With Severe Aortic Stenosis Among Patients Waiting for Transcatheter Aortic Valve Implantation2016In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 31, no 3, p. 255-261Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Aortic stenosis (AS) is the most common valve disease in Western countries. Transcatheter aortic valve implantation (TAVI) has made it possible to treat patients with higher surgical risks. These patients are informed about their poor prognosis with only months or a few years to live without treatment. Because of their severe symptoms, limitations, and suffering, patients awaiting TAVI need special attention.

    OBJECTIVE: The aim of this study is to describe patients' experiences of coping with severe AS and of waiting for TAVI.

    METHODS: Swedish participants (n = 24; 9 women, 15 men) with a mean (SD) age of 80 (7.4) years who had been offered TAVI all agreed to participate in a presurgical interview. The interviews were recorded, transcribed verbatim, and analyzed using qualitative content analysis.

    RESULTS: The participants' experiences of coping with AS and awaiting TAVI were described by the main theme "living on the edge, but trying to stay in control," which comprised 3 categories: "trying to cope with physical symptoms and anxiety," "trying to preserve self and self-esteem despite life-threatening illness," and "trying to process the decision to undergo TAVI."

    CONCLUSIONS: Patients with AS and awaiting TAVI must cope with increasing symptoms and limitations in their social lives but still wish to be seen as the people they always have been. These patients may need extra support from healthcare personnel to process their experiences, which could help them to attach personal meaning to clinical information about the condition and its treatment that they could include in their decision about whether to undergo TAVI. Listening to patients' stories could help nurses and physicians to ensure that disease and treatment are meaningfully understood by the patient.

  • 41.
    Olsson, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Nilsson, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hope and despair: patients' experiences of being ineligible for transcatheter aortic valve implantation2019In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 7, p. 593-600Article in journal (Refereed)
    Abstract [en]

    Background: Transcatheter aortic valve implantation may be indicated for patients with aortic stenosis and high risk of postoperative mortality. The assessment of suitability for transcatheter aortic valve implantation requires consensus agreement of a team of cardiologists and cardiac surgeons. The burden of comorbidities, frailty and cognitive impairment are factors included when risks for transcatheter aortic valve implantation are balanced against the expected benefits. Although transcatheter aortic valve implantation is a possibility for many, there are still ineligible patients. Knowledge of their experiences of being deemed ineligible are lacking. Aim: The aim of this study was to explore patients' experiences of being considered for transcatheter aortic valve implantation but judged ineligible. Methods: Individual in-depth interviews were performed with eight persons, and qualitative content analysis was used for the analysis. Results: Being ineligible for transcatheter aortic valve implantation may induce both hope and despair. Hope was linked to experiences of acceptance, relief of symptoms, support and control; despair was associated with feelings of being missed and abandoned, and of grief and insecurity. Some expressed great anxiety, since their incurable heart disease meant an imminent death. Others were more concerned over practical problems that affected everyday life. Conclusion: Being ineligible for transcatheter aortic valve implantation does not necessarily lead to despair. Hope is built through relationships, continuity and support. A combination of person-centred care and palliative care during the end-of-life phase should be offered to patients in order to help clients re-conceptualise hope during this stage of their illness. Cardiovascular nurses in the transcatheter aortic valve implantation team are suitable to facilitate continued care based on the patient's needs, desires and local conditions.

  • 42.
    Olsson, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Nursing.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Nilsson, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patients' Decision Making About Undergoing Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis2016In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 31, no 6, p. 523-528Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Aortic stenosis is the most common valve disease in Western countries, and its prevalence is increasing because of the aging population. Some patients, denied surgery because of high risk, can be offered transcatheter aortic valve implantation (TAVI). These patients are old and have comorbidities, and it is not always easy for them to make the decision about accepting TAVI.

    OBJECTIVE: The aim of this study was to describe the decision-making process about undergoing TAVI treatment among people with severe aortic stenosis who are denied surgery.

    METHODS: The Swedish participants (n = 24) with a mean age of 80 years who had been offered TAVI all agreed to participate in a presurgical interview. The interviews were recorded, transcribed verbatim, and analyzed using qualitative content analysis.

    RESULTS: Three patterns in the decision-making process about TAVI treatment-ambivalent, obedient, and reconciled-were identified. The ambivalent patient is unsure of the value of treatment and aware of the risks; the obedient patient is unsure of the value of one's own decision and wants to leave the decision to others; the reconciled patient has reached a point where there is no choice anymore and is always sure that the decision to undergo TAVI is right.

    CONCLUSIONS: People with aortic stenosis who are offered TAVI need to discuss the risks and benefits in order to participate in decision making about the treatment. They have different patterns in decision making and would benefit from healthcare professionals being observant of them to support them in this process in a manner consistent with their values.

  • 43.
    Olsson, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Nursing.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Nilsson, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patients' experiences of the transcatheter aortic valve implantation trajectory: A grounded theory study2018In: Nursing Open, E-ISSN 2054-1058, Vol. 5, no 2, p. 149-157Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to explore how patients experienced the recovery process from transcatheter aortic valve implantation. Design: A qualitative approach where in-depth interviews were used. Method: Eleven men and eight women undergoing transcatheter aortic valve implantation were individually interviewed 6 months after transcatheter aortic valve implantation. Grounded theory was used for the analysis. Results: The analysis generated the core concept "A journey of balancing between life-struggle and hope" connected to descriptive, bipolar categories. Before transcatheter aortic valve implantation patients not only felt threatened but also experienced hope. The rehabilitation phase was described as demanding or surprisingly simple. At the 6 months follow-up patients were pleased to return to life, however, still struggling with limitations. To feel hope is essential for transcatheter aortic valve implantation patients' well-being, both before and during the recovery process. It is important that healthcare professionals not only support hopeful thinking but also take time to discuss and prepare patients, talk about concerns and build confidence. Individual plans for rehabilitation should be designed.

  • 44.
    Olsson, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Nilsson, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    The trajectory of undergoing transcatheter aortic valve implantation: a grounded theory studyManuscript (preprint) (Other academic)
    Abstract [en]

  • 45.
    Persson, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Winkvist, Anna
    Institute of Medicine, Department of Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    "Dealing with ambiguity": the role of obstetricians in gestational diabetes mellitus2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 4, p. 439-446Article in journal (Refereed)
    Abstract [en]

    Objective. Gestational diabetes mellitus is a pregnancy-related complication; hence obstetricians counsel and manage the maternal health care for these women. This study describes obstetricians’ experiences of management of pregnant women with gestational diabetes mellitus. 

    Design. Interview study. 

    Setting. Hospital-based specialist maternal health care clinics in Sweden. 

    Population. A consecutive purposive national sample of seventeen obstetricians providing maternal health care to pregnant women diagnosed with gestational diabetes mellitus. 

    Methods. Interviews were recorded and transcribed. The data were analyzed using qualitative content analysis. 

    Result. The overall theme describing the experiences of the obstetricians was labeled ‘Dealing with ambiguity’. This ambiguity permeated all aspects of working as an obstetrician within the maternal health care; the role of the obstetrician, the context of organization, the multifaceted maternal and fetal interests to balance, and lack of consensus, recommendations and evidence-based knowledge.

    Conclusions. The study revealed the ambiguous situation experienced and managed by obstetricians providing maternal health care to pregnant women diagnosed with gestational diabetes mellitus. This indicates a need for national guidelines and standardized maternal health care services regarding gestational diabetes mellitus to fulfill the intentions of the health care system. Such recommendations may be beneficial and supportive for the health care professionals as well as for the mother-to-be and her fetus.

  • 46.
    Persson, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Winkvist, Anna
    Inst. för medicin, avd. för klinisk näringslära, Sahlgrenska Akademin, Göteborgs Universitet.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    'Dealing with ambiguity': the role of obstetricians in gestational diabetes mellitusArticle in journal (Other academic)
    Abstract [en]

    Objective: As gestational diabetes mellitus (GDM) is a pregnancy-related complication, obstetricians provide these women with maternal health care and counselling during pregnancy. This study described obstetricians’ experiences providing maternal health care to pregnant women with GDM.

    Methods: A consecutive purposive national sample of seventeen obstetricians providing maternal health care to pregnant women diagnosed with GDM on a regular basis participated in the interview study. The data were analyzed using qualitative content analysis.

    Results: During the analysis, eight sub-categories, three categories and one theme were identified. The overall theme describing the experiences of the obstetricians was labelled ‘Dealing with ambiguity’. This ambiguity permeated all aspects of working as an obstetrician within the maternal health care; the role of the obstetrician, the context of organisation, the multifaceted maternal and foetal interests to balance and lack of consensus, recommendations and evidence-based knowledge.

    Conclusions and Practice Implications: Dealing with ambiguity permeated all aspects of the role of the obstetrician in the maternal health care provided to pregnant women with GDM. This ambiguity comprised the role of the obstetrician and the context of organisation, the multifaceted interests the obstetricians had to balance and the lack of consensus, recommendations and evidence-based knowledge. The study indicates the need for national guidelines and standardised maternal health care services regarding GDM as to fulfil the intentions of the health care system. Such recommendations may be beneficial and supportive for the health care professionals as well as for the mother-to-be and her foetus.

  • 47.
    Persson, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Winkvist, Anna
    Inst. för medicin, avd för klinisk näringslära, Sahlgrenska Akademin, Göteborgs Universitet.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    "Mission Impossible"? Midwives' experiences counseling pregnant women with gestational diabetes mellitus.2011In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 84, no 1, p. 78-83Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Since not all pregnancy-related complications require hospitalization midwives often provide these women with antenatal care and counseling. This study explored the experiences of midwives providing antenatal care and counseling to pregnant women with gestational diabetes mellitus (GDM). METHODS: Twelve midwives participated in the interview study performed in the three northernmost counties in Sweden. Grounded theory was used for analysis. RESULTS: The emerging core category was 'Balancing fear of failure'. The unexpected disease increased the demands and the pressure. Three major conflicting situations were revealed. The midwives believed they were obligated to monitor and control the pregnancy, to initiate and motivate the necessary changes in lifestyle and provide empowering relationships with their patients. The fear of failure with these assignments made the midwives chose different strategies to manage the conflicting situations. CONCLUSIONS AND PRACTICE IMPLICATIONS: The midwives described conflicting encounters providing antenatal care to pregnant women with GDM. The fear of failing to fulfill the assignments caused by the GDM made the midwives chose strategies to handle the conflicting encounters. Similar conflicting situations might be present for other health care professionals promoting lifestyle changes. The challenges might be addressed with an organization focusing on support and coaching sessions.

  • 48.
    Schimmer, Robyn
    et al.
    Umeå University, Faculty of Social Sciences, Department of Informatics. Department of Informatics, Umeå university.
    Orre, Carljohan
    Öberg, Ulrika
    Umeå University, Faculty of Medicine, Department of Nursing.
    Danielsson, Karin
    Umeå University, Faculty of Social Sciences, Department of Informatics.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Digital Person-Centered Self-Management Support for People With Type 2 Diabetes: Qualitative Study Exploring Design Challenges2019In: JMIR Diabetes, ISSN 2371-4379, Vol. 4, no 3, p. 1-10, article id 10702Article in journal (Refereed)
    Abstract [en]

    Background: Self-management is a substantial part of treatment for patients with type 2 diabetes (T2D). Modern digital technology, being small, available, and ubiquitous, might work well in supporting self-management. This study follows the process of developing a pilot implementation of an electronic health (eHealth) service for T2D self-management support in primary health care. The use of digital health, or eHealth, solutions for supporting self-management for patients with T2D is increasing. There are good examples of successful implementations that can serve as guides in the development of new solutions. However, when adding person-centered principles as a requirement, the examples are scarce.

    Objective: The objective of this study was to explore challenges that could impact the design of a person-centered eHealth service for T2D self-management support. The study included data collection from multiple sources, that is, interviews, observations, focus groups, and a Mentimeter (interactive presentation with polling) survey among stakeholders, representing various perspectives of T2D.

    Methods: A user-centered design approach was used to exploratively collect data from different sources. Data were collected from a workshop, interviews, and observations. The different data sources enabled a triangulation of data.

    Results: Results show that user needs related to an eHealth service for person-centered T2D self-management support are multifaceted and situated in a complex context. The two main user groups, patients and diabetes specialist nurses, express needs that both diverge and converge, which indicates that critical design decisions have to be made. There is also a discrepancy between the needs expressed by the potential users and the current work practice, suggesting more attention toward changing the organization of work to fully support a new eHealth service.

    Conclusions: A total of three overarching challenges—flexible access, reducing administrative tasks, and patient empowerment—each having a significant impact on design, are discussed. These challenges need to be considered and resolved through careful design decisions. Special attention has to be given to the patient user group that could greatly impact current work practice and power structures at the primary care unit. A need for further studies investigating patient needs in everyday life is identified to better support the implementation of technology that does not give specific attention to organizational perspectives but instead approach design with the patient perspective in focus.

  • 49.
    Sjöström, Anna E.
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hajdarevic, Senada
    Umeå University, Faculty of Medicine, Department of Nursing.
    Emmoth, Agneta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Primary Health Care Nurses’ Experiences of Consultations With Internet-Informed Patients: Qualitative Study2019In: JMIR Nursing, ISSN 2562-7600, Vol. 2, no 1, article id e14194Article in journal (Refereed)
    Abstract [en]

    Background: Most people in modern societies now use the Internet to obtain health-related information. By giving patients knowledge, digital health information is considered to increase patient involvement and patient-centered interactions in health care. However, concerns are raised about the varying quality of health-related websites and low health literacy in the population. There is a gap in the current knowledge of nurses’ experiences with Internet-informed patients.

    Objective: The objective of this study was to explore primary health care nurses’ experiences of consultations with patients who present health-related information from the Internet.

    Methods: This is a qualitative study based on interviews with 9 primary health care nurses. Data were analyzed using qualitative content analysis. Results are reported according to the consolidated criteria for reporting qualitative research guidelines.

    Results: The phenomenon of Internet-informed patients was considered to change the usual rules in health care, affecting attributes and actions of patients, patterns of interactions in consultations, and roles of nurses and patients. Three categories were identified: (1) Facing the downsides of Googling, (2) Patients as main actors, and (3) Nurse role challenged. Although the benefits of health-related Internet information were described, its negative consequences were emphasized overall. The problems were mainly ascribed to inaccurate Internet information and patients’ inability to effectively manage the information.

    Conclusions: Our study suggests ambivalent attitudes among nurses toward health-related Internet information. In order to promote equitable care in the digital era, increased awareness in health care about useful strategies for overcoming the difficulties and embracing the benefits of conferring with Internet-informed patients seems to be a legitimate goal.

  • 50. Smide, Bibbi
    et al.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    People's reasoning about diagnosis in type 2 diabetes2009In: Journal of nursing and healthcare of chronic illness, ISSN 1752-9816, Vol. 1, no 3, p. 253-260Article in journal (Refereed)
    Abstract [en]

    Aim and objective. To identify how people with type 2 diabetes reason around their experiences of acquiring diabetes.

    Background. Effective self management after getting the diabetes diagnosis lowers the risk to developing late diabetes complications. However the diagnosis experience has received little attention in nursing research as well as psychological and sociological research and therefore the interest in the current study was to further explore the diagnosis experience among people with type 2 diabetes.

    Methods. Face-to-face narrative interviews were conducted in 2006 with nine persons with type 2 diabetes living in Mid Sweden and with 14 living in North Sweden.

    Results. Three main categories emerged. They were 'Diagnosis in a time perspective', and included the three subcategories 'Was prepared and diagnosis was easily integrated', 'Was not prepared and not having diabetes yet' and 'Was not prepared but diagnosis is successively integrated'. The second category emerged as 'Emotional reactions on diagnosis' and consisted of the following subcategories 'Reacted neutrally – the diagnosis was not threatening at all', 'Strived to take control over one's emotions' and 'Diminished the threats – is not really ill yet'. The third category was 'Cognitive reasoning about the diagnosis'. It consisted of the subcategories 'Did not consider diabetes to be an illness', 'Experienced diabetes as a disease hard to understand' and 'Decided not to bother about it'.

    Conclusion. The findings may help nurses working in any country to understand the importance of how to give information about diagnosis and focus on diagnosis experiences among persons with type 2 diabetes. Relevance to clinical practice. Persons newly diagnosed with type 2 diabetes should get adequate time to discuss the situation ongoing with the diabetes specialist nurse or a doctor but our findings are easily transferable to other diseases or other health professionals.

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