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  • 51. Lukumay, Gift G.
    et al.
    Ndile, Menti L.
    Outwater, Anne H.
    Mkoka, Dickson A.
    Padyab, Mojgan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Backteman-Erlandsson, Susann
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Provision of post-crash first aid by traffic police in Dar es Salaam, Tanzania: a cross-sectional survey2018Inngår i: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 18, artikkel-id 45Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The availability of prehospital trauma care is an important means of reducing serious injuries and fatalities associated with road traffic injuries (RTIs). Lay responders such as traffic police play an important role in the provision of prehospital trauma care to RTI victims, especially where there is no established prehospital care system. Therefore, the objective of the present study was to investigate knowledge, self-reported practice, and attitudes toward post-crash first aid among traffic police officers in Tanzania.

    Method: A cross-sectional survey was conducted in Dar es Salaam, Tanzania between July-September 2017 to investigate knowledge, self-reported practice and attitude among traffic police officers during provision of post-crash care. We used simple random technique to recruit 340 traffic police officers, self -administered questionnaires were used to collect data. The researchers used descriptive statistics and Pearson's chi-square tests to analyze the data.

    Results: A total of 340 traffic police officers were surveyed. Nearly two thirds (65.3%) reported having had post-crash first aid on-the job training; a slightly larger proportion (70.9%) reported that they had cared for RTI victims in the previous year. The survey responses showed that, generally, traffic police officers' level of knowledge about post-crash first aid to RTI victims was low-about 3% of the surveyed officers possessed knowledge at a level considered good. Also, there was a statistically significant correlation between higher educational attainment and greater knowledgeability (p = 0.015). Almost all of the officers (96%) had a positive attitude toward providing post-crash first aid to RTI victims.

    Conclusions: Improved training of Tanzania traffic police officers, by means of an updated post-crash first aid curriculum and updated resources is recommended. Also, user-friendly post-crash first aid leaflets should be provided to traffic police for their reference.

  • 52.
    Lämås, Kristina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sundin, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jacobsson, Catrine
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Östlund, Ulrika
    Possibilities for evaluating cost-effectiveness of family system nursing: an example based on Family Health Conversations with families in which a middle-aged family member had suffered stroke2016Inngår i: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 38, nr 2, s. 74-81Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Family Health Conversations (FamHC) increase health and well-being, but knowledge about their cost-effectiveness, and how to best calculate this, is lacking. In this feasibility study we evaluated the cost-effectiveness of using FamHC with families in which a middle-aged family member had suffered stroke. Seven families participated in a FamHC intervention and seven families received ordinary care. Health-related quality of life (HRQoL) was estimated with SF-6D and EQ-5D over a six-month period. The costeffectiveness of the intervention was calculated. Families receiving FamHC intervention had significantly increased HRQoL at follow up. Cost per quality adjusted life year differed depending on the instrument and analysis method used in the calculation. However, all calculations showed that FamHC were cost-effective. We conclude that FamHC significantly increase HRQoL and suggest that they are cost-effective. Both instruments seemed to be able to capture changes. Considering the participants’ experience of answering the two instruments, we advocate the use of EQ-5D.

  • 53.
    Malmedal, Wenche
    et al.
    Trondheim, Norway.
    Hammervold, Randi
    Trondheim, Norway.
    Saveman, Britt-inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    The dark side of Norwegian nursing homes: factors influencing inadequate care2014Inngår i: Journal of Adult Protection, ISSN 1466-8203, E-ISSN 2042-8669, Vol. 16, nr 3, s. 133-151Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose– The purpose of this paper is to investigate factors that influence the probability that staff will commit acts of inadequate care, abuse, and neglect. Design/methodology/approach– A cross-sectional survey study was carried out in one county in the middle of Norway (Sør-Trøndelag). Random sampling, stratified by size of nursing homes, and location (rural or urban areas), was used to select a variety of nursing homes from a total population of 55 nursing homes. All staff working in 16 nursing homes working were asked to participate in the study. A response rate of 79 per cent was achieved (n=616). Findings– Findings reveal that location and size of the nursing home, age of the staff, education level, job satisfaction, resident aggression, and conflicts between residents and staff predict inadequate care, abuse, and neglect. The most consistent findings are that resident aggression increases the risk for all three types of inadequate care, and that conflicts predict different types of inadequate care depending on whether the conflicts are related to direct care-giving activities or not. Practical implications– Nursing home care is an important part of care for the elderly, and should be characterized by good-quality services. The relation between inadequate care and resident aggression, conflicts, and other factors shown in this study points to the relevance of further improvements in nursing home practices to minimize the occurrence of episodes of inadequate care, abuse, and neglect. Originality/value– This study investigated the relationships between 11 specific factors and different types of inadequate care in a nursing home context.

  • 54. Malmedal, Wenche
    et al.
    Hammervold, Randi
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    To report or not report?: Attitudes held by Norwegian nursing home staff on reporting inadequate care carried out by colleagues2009Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, nr 7, s. 744-750Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: The aims of this study are, first, to describe attitudes held by nursing home staff on reporting acts of inadequate care committed by their colleagues, and second, to investigate whether nursing staff have different attitudes depending on age, education, and length of experience of working in the healthcare services. METHODS: A questionnaire survey was conducted among nursing staff in 16 nursing homes in the central part of Norway. The response rate was 79% (n=616). RESULTS: A positive attitude towards reporting acts of inadequate care committed by their colleagues was held by the participants in this study. Compared with younger staff, the older staff seemed to be more reluctant to report colleagues, to feel less brave, to be more afraid of what would happen to them if they reported, and to agree that it is best to deal with such matters internally. Regarding education, it seemed that a higher educational level was related with a more positive attitude towards a willingness to report and less fear of negative sanctions. CONCLUSIONS: Staff who observe acts of inadequate care committed by colleagues agree that it is their intention to report such incidents. Institutions need to develop and implement mechanisms for understanding and evaluating acts of inadequate care, and staff must be encouraged to speak out on behalf of residents rather than be punished for doing so.

  • 55.
    Malmedal, Wenche
    et al.
    Faculty of Health Education and Social Work, Sør-Trøndelag University College, Trondheim, Norway.
    Ingebrigtsen, Oddbjørn
    Faculty of Nursing, Sør-Trøndelag University College, Trondheim, Norway.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Inadequate care in Norwegian nursing homes: as reported by nursing staff2009Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, nr 2, s. 231-242Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Studies have shown that inadequate care, also referred to as abuse, violence, neglect and maltreatment occur in nursing homes in many countries. The aim of this study was to describe the frequency and types of inadequate care committed by staff in nursing homes. Another aim was to investigate if nursing staff reported differently depending on age, education level and years of experience working at nursing homes. A questionnaire survey was conducted among nursing staff (n = 616) in 16 nursing homes in the central part of Norway. Twenty items concerned staff behaviour in forms of acts of inadequate care. The respondents were asked to report how often they had observed colleagues commit acts and how often they themselves had committed such acts. The response rate was 79%. All in all, 91% of the nursing staff reported that they had observed at least one act of inadequate care and 87% reported that they had committed at least one act of inadequate care. Acts of negligent and emotional character were most frequently reported, both as observed and committed. Depending on the higher educational level that the nursing staff had more acts of all types were observed and committed. The oldest staff and those with longest experience at the present nursing home reported more observed and committed acts of physical character than did the others. The extent of inadequate care confirms that this is a common part of activities in nursing homes. Because emotional and negligent acts can be just as harmful as physical acts, more knowledge is needed about the reasons in order to take preventive actions.

  • 56.
    Marklund, Sonja
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sjödin Eriksson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindh, Viveca
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Family Health Conversations at a pediatric oncology center: a way for families to rebalance the situation2018Inngår i: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 38, s. e59-e65Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The study aimed to describe and understand adult family members' experiences of participating in a Family Health Conversation (FamHC) when a child is diagnosed with cancer.

    Design and Methods: Twelve individual interviews were performed with adult family members who had participated in a FamHC. During the interviews each interviewee was a spokesman for his or her respective family. Thereby the family was included as a system. The interviews were analyzed using a hermeneutic approach.

    Results: The analysis resulted in four themes: "To unburden the burden," "Seeing things in a new light," "To be seen the way you are," and "Talking to someone who is both within and alongside." Finally an overarching theme evolved, " To rebalance the situation" revealing the meaning of taking part in the FamHC.

    Conclusion: All participants considered the FamHC to be valuable. It was surprising that such a relatively small investment of two family conversations and a closing letter could have such significance for the families in their difficult situation.

    Practice Implications: With training, clinical nurses can use a well-established structured interview process such as the Family Health Conversation to help family members to gain insight into each other's experiences, which increase their ability to cope and regain control.

  • 57.
    Rolfsman, Ewa
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för tillämpad utbildningsvetenskap, Beteendevetenskapliga mätningar (BVM).
    Bylund, Per-Olof
    Emergency and Disaster Medical Center, Umeå University Hospital, Sweden.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Single injury incidents among pedestrians and biscyclists in northern Sweden: safety and preventive issues2012Inngår i: Safety Science Monitor, ISSN 1443-8844, Vol. 16, nr 1, s. 5-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Every year, in Sweden, more than 4,000 people require inpatient care for single injury incidents obtained while walking or bicycling in a traffic environment. The aim of this study is to describe causes of single injury incidents among pedestrians and bicyclists and to identify preventive strategies. The study is based on data from the injury registration database at the University Hospital in Umeå and from a complementary questionnaire containing questions regarding the causes of injury and preventive strategies. The questionnaire was distributed to all pedestrians and bicyclists injured in single incidents in a city in northern Sweden and who had visited the hospital in 2009 because of those injuries. The data set is comprised of medical data for all 367 patients (244 pedestrian and 123 bicyclists) who responded to the questionnaire. The results from this study show that the pedestrians and bicyclists differ in their reports regarding causes of their injuries and the differences seem to be related to injury severity. The pedestrians mainly referred to environmental factors as causes to their injuries, while the bicyclists referred to environmental factors, product factors, and human factors as causes of the injury incident. Regarding preventive strategies, the views of the pedestrians and the bicyclists is in line with their views of causes to their injuries. The results are useful for developing preventive strategies for differing groups of road users.

  • 58.
    Sandvide, Åsa
    et al.
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Fahlgren, Siv
    Norberg, Astrid
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Saveman, Britt-Inger
    From perpetrator to victim in a violent situation in institutional care for elderly persons: exploring a narrative from one involved care provider.2006Inngår i: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 13, nr 3, s. 194-202Artikkel i tidsskrift (Fagfellevurdert)
  • 59.
    Sandvide, Åsa
    et al.
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Åström, Sture
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Saveman, Britt-Inger
    Violence in institutional care for elderly people from the perspective of involved care providers.2004Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 18, nr 4, s. 351-357Artikkel i tidsskrift (Fagfellevurdert)
  • 60.
    Sandvide, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Åström, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    How Care Providers' Construct and Frame Problems Related to Violence in Institutional Care for Older People2010Inngår i: Communication & Medicine, ISSN 1612-1783, Vol. 7, nr 2, s. 155-164Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim was to describe how care providers discursively constructed and framed problems related to the occurrence of violence in their interactions with older persons in institutional care. The study followed a social constructionist approach where violence was considered a social phenomenon constructed in discursive processes. It was based on the assumption that the way in which a problem is articulated is closely connected to beliefs, which in turn create and maintain a space for the support of certain actions and solutions that are possible and relevant in the given context. The analyzed text comprised narrative interviews with 46 care providers who had been involved in violence that occurred in social interactions with older persons. The analysis was inspired by discourse theory. The interactions were presented as a difficult and unavoidable problem related to the illness, caring for the body, competence and profession as well as the social order. The descriptions of the violence and related problems are manifestations of discourses. The prevailing discourses in the text were the medical and physical. The presentations of problems can be used to challenge dominant ways of thinking as well as the beliefs and common understandings about the subject.

  • 61.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Family nursing research for practice: the Swedish perspective.2010Inngår i: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 16, nr 1, s. 26-44Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This article offers a synthesis of the significant developments and progress of family nursing in Sweden. A review was conducted to locate Swedish family nursing research produced over the past 10 years. CINAHL, Medline, and PubMed were the primary databases used to locate approximately 75 family nursing studies conducted in Sweden. The majority of the studies used descriptive methods with data collected from surveys and interviews involving nurses and family members either together or individually. Only a few of the studies examined family nursing interventions. This article also reports the results of a recent survey of Swedish nurses that examined how family nursing is used in practice. After 10 years of creating a strong foundation for family-focused nursing in Sweden, there is still a need for nurse researchers, educators, and administrators to collaborate in the implementation of family nursing to practice.

  • 62.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Formal carers in health care and the social services witnessing abuse of the elderly in their homes1994Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The purpose was to elucidate the reactions of formal carers as witnesses and helpers in situations of elder abuse, to illuminate abusive situations and to reflect on the findings from an ethical point of view. Twenty-one district nurses from one county council were interviewed (I, II, III, IV). They described the problems they had when dealing with cases of elder abuse, the uncertainty they felt when they approached the family, identified the abuse and intervened (I). They used no distinct definition of elder abuse but described it as ’overstepping the boundaries of a person’s integrity/autonomy’ (II). In the 44 cases narrated the elderly people were mostly physically and/or psychologically impaired, the person abused could either be the impaired elderly person, the informal carer or both. Abuse was related to the inability of one party to meet the demands made on him/herself, the other person, or to a history of violence (III). The cases narrated were analysed for reliability and were considered reliable (IV). Questionnaires submitted to 163 district nurses revealed 33 cases of elder abuse (V) and to home service assistants 97 cases (VI). The abused elderly people were often very old women, mostly healthy or unhealthy in equal proportions. The perpetrators were mostly close relatives, responsible or not responsible for the caring. The abusive acts often involved a combination of psychological, physical, and financial abuse and neglect. Mental disturbance and alcohol abuse, as well as financial reasons were reported as contributing to the abuse (V, VI). The attitudes of general practitioners, district nurses and home service assistants towards elder abuse and the interventions suggested in hypothetical cases of elder abuse were investigated (VII). All groups were uncertain about their attitudes towards elder abuse. Their suggested interventions were amalgamated into three groups; sparse and of the social type, more specific and of the health care and voluntary type, or overall types of intervention. The situation, profession and organization seemed to result in different interventions (VII). The findings were reflected on using Lögstrup’s ethic as a framework, and the conclusion was that in order to be able to intervene successfully formal carers need to find solutions on a meta-level. Conventions and norms must be developed and public responsibility is needed.

  • 63.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Våld i nära relationer bland äldre2010Inngår i: Att fråga om våldsutsatthet som en del av anamnesen, Uppsala: Nationellt centrum för kvinnofrid (NCK) , 2010, s. 139-145Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 64.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Våld mot äldre personer med demenssjukdom2011Inngår i: Att möta personer med demens / [ed] Anna-Karin Edberg, Lund: Studentlitteratur, 2011, 2, s. 303-322Kapittel i bok, del av antologi (Annet (populærvitenskap, debatt, mm))
  • 65.
    Saveman, Britt-Inger
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Benzein, Eva G
    Engström, Åsa H
    Arestedt, Kristofer
    Refinement and psychometric reevaluation of the instrument: families' importance in nursing care-nurses' attitudes2011Inngår i: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 17, nr 3, s. 312-329Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The instrument Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) was developed to measure nurses' attitudes toward the importance of families in nursing care. The low variations in item responses, which affect the discrimination ability and unstable internal consistency, have been considered as limitations. The aim of this study was to refine and revalidate FINC-NA regarding score distribution, homogeneity, dimensionality, differential item functioning for gender, stability, and internal consistency. There were 246 registered nurses studying at advanced levels who answered the revised FINC-NA. The FINC-NA had five response alternatives. The findings showed that although some subscales still deviated from a normal distribution, the variability of the scores and the homogeneity was improved. In addition, the dimensionality was reproduced and minor problems with differential item functioning for gender were detected. All FINC-NA scales showed good reliability. The results allow the use of the revised FINC-NA in studies where an assessment of nurses' attitudes toward families' importance in nursing care is desired.

  • 66.
    Saveman, Britt-Inger
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Unintentional injuries among older adults in northern Sweden: a one-year population-based study2011Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, nr 1, s. 185-193Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Scand J Caring Sci; 2011; 25; 185-193 Unintentional injuries among older adults in northern Sweden - a one-year population-based study Aim:  To study the epidemiology of unintentional injuries in a population of 21 000 Swedish older adults (65+) and to compare the injury incidence with similar data collected two decades earlier. Method:  This is a retrospective epidemiologic cross-sectional study based on a 1-year data set of all the 1753 registered injury events from a well-defined population. Result:  The injury rate per 1000 individuals was three times higher in the 85+ age group than in the 65-74 age group. The rate was also higher in women than in men aged 75 and older. Fractures, especially on lower and upper extremities, were the most common injuries. Falls in residential care facilities caused the most serious injuries. In transport areas, pedestrian falls and bicyclist crashes were much more common than car crashes. Of the 1753 people injured, 42% were treated as inpatients for a total of 11 569 days; 86% of these days were caused by injury events in the home (57%) or in residential care facilities (29%). Our 65+ age group occupied 69% of all hospital bed-days for trauma in all ages (0-102 years). Conclusion:  Over the last two decades, the injury and fracture rate per 1000 individuals has increased by 40-50%, especially in the older age groups. During this time, the nursing strategy for older adults has changed in Sweden. As a result, more people live in their homes nowadays. This increase is distressing especially when we consider the current knowledge of preventive measures. The high number and proportion (>2/3) of inpatient trauma days for these age groups are a heavy burden for the medical sector. These facts call for more effective preventive measures, especially in the home and in residential care facilities, to minimize the negative health effects and the rising health costs.

  • 67. Scheiman, Simeon
    et al.
    Moghaddas, Hossein S
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Bylund, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Bicycle injury events among older adults in Northern Sweden: A 10-year population based study.2010Inngår i: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 42, nr 2, s. 758-763Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Bicycles are a common mode of transportation and injured bicyclists cause a substantial burden on the medical sector. In Sweden, about half of fatally injured bicyclists are 65 years or older. This study analyzes the injury mechanisms, injuries, and consequences among bicyclists 65 years or older and compare with younger bicyclists (</=64) and older adults as passenger car drivers, to give a basis for an injury preventive discussion for this age group. Umeå University Hospital's primary catchments area had 142,000 inhabitants in 2006. Nearly all injured road users in the well-defined geographic area are treated at this hospital and a 10-year data set (N=456) of injured bicyclists aged 65+ from the hospital's continuous injury registration (1997-2006) was analyzed. The results show that the annual injury incidence was 2.4 and 2.2 per 1000 men and women, respectively, aged 65 or older. For men the incidence rate was constant in the three age groups 65-74, 75-84 and 85+, while it decreased strongly for women. The incidence rate for old adults as passenger car drivers and younger bicyclists was 1.0 and 4.6, respectively. Most frequent injury mechanisms were falls when getting on or off a bicycle (20%) and by potholes or irregularities on the ground, edge of a sidewalk, or similar (13%). Only 6% were hit by cars, trucks, or buses. Half of the injured suffered fractures or dislocations, and 10% suffered concussion or more serious intracranial injuries. Getting on or off the bicycle caused most fractures (especially a high fraction of the hip and femur fractures) and resulted in 27% of all inpatient days in hospital. Three individuals died. One-third of the injured were treated as inpatients for a total of 1413 days (on average 9 days), with 69% of the days being caused by fractures. The cost for out- and inpatient acute treatment was approximately USD 4700 (SEK 33,000) per injured. The results merit an interest for this target group; bicycle injuries among older adults are costly both for the individual and the medical sector. Injury mitigation strategies focused on the needs of this group are probably as well motivated as those focused on older car drivers.

  • 68.
    Stenberg, Maud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Family Illness Trajectory During Seven Years After A Severe Traumatic Brain Injury-Family Interviews2019Inngår i: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 33, s. 147-147Artikkel i tidsskrift (Annet vitenskapelig)
  • 69.
    Stenberg, Maud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Long-Term Follow-Up Observation Study 7 Years after Severe Traumatic Brain Injury in Northern Sweden2019Inngår i: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 33, s. 161-161Artikkel i tidsskrift (Annet vitenskapelig)
  • 70.
    Stålnacke, Britt-Marie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Stenberg, Maud
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Long-Term Follow-Up of Disability, Cognitive, and Emotional Impairments after Severe Traumatic Brain Injury2019Inngår i: Behavioural Neurology, ISSN 0953-4180, E-ISSN 1875-8584, Vol. 2019, artikkel-id 9216931Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim. To assess the clinical course of disability, cognitive, and emotional impairments in patients with severe TBI (s-TBI) from 3 months to up to 7 years post trauma. Methods. A prospective cohort study of s-TBI in northern Sweden was conducted. Patients aged 18-65 years with acute Glasgow Coma Scale 3-8 were assessed with the Glasgow Outcome Scale Extended (GOSE), the Hospital Anxiety and Depression Scale (HADS), and the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) at 3 months, 1 year, and 7 years after the injury. Results. The scores on both GOSE and BNIS improved significantly from 3 months (GOSE mean: 4.4 +/- 2.3, BNIS mean: 31.5 +/- 7.0) to 1 year (GOSE mean: 5.5 +/- 2.7, p=0.003, BNIS mean: 33.2 +/- 6.3, p=0.04), but no significant improvement was found from 1 year to 7 years (GOSE mean: 4.7 +/- 2.8, p=0.13, BNIS mean: 33.5 +/- 3.9, p=0.424) after the injury. The BNIS subscale "speech/language" at 1 year was significantly associated with favourable outcomes on the GOSE at 7 years (OR=2.115, CI: 1.004-4.456, p=0.049). Conclusions. These findings indicate that disability and cognition seem to improve over time after s-TBI and appear to be relatively stable from 1 year to 7 years. Since cognitive function on some of the BNIS subscales was associated with outcome on the GOSE, these results indicate that both screening and follow-up of cognitive function could be of importance for the rehabilitation of persons with s-TBI.

  • 71.
    Sundin, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Bäckström, Britt
    Lindh, Viveca
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindkvist, Marie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Östlund, Ulrika
    Responses after participating in Family Health Conversations in families with a family member who has suffered a stroke: A mixed methods research study2016Inngår i: Clinical Nursing Studies, ISSN 2324-7940, E-ISSN 2324-7959, Vol. 4, nr 4, s. 46-57Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: It has been proposed that support for families in which a family member has suffered a stroke should involve the whole family system. Aim: The aim was to evaluate the responses of Family Health Conversation (FamHC) in families with a member under the age of 65 who has been diagnosed with stroke. Methods: In this mixed methods research study, families were included in an intervention group and in a control group. For both groups pre- and post-intervention quantitative data was collected and for the intervention group, qualitative data was collected post-intervention. Underlying theoretical propositions and the two data sets were then integrated. Results: Family health measured as “the general atmosphere of the interaction of the family” had improved in the intervention group when compared to the control group. The intervention families, moreover, described how they had become more cooperative, their communication had improved, they had become more confident with their situation and also when planning for the future when comparing to before the FamHC. Conclusions: Based on the empirical results supporting the theoretical proposition underlying FamHC, we conclude that it works as intended, and the evidence for the theoretical proposition is thereby strengthened. This paper contributes to the scientific evidence concerning FamHC. With the available evidence, RNs are suggested to consider changing practice so as to work in a more family-centred way to support families living with ill-health. Implementing FamHC can be one way of undertaking such supportive work.

  • 72.
    Sundin, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Pusa, Susanna
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jonsson, Carin
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Östlund, Ulrika
    Envisioning the future as expressed within family health conversations by families of persons suffering from stroke2018Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, nr 2, s. 707-714Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The whole family is affected when a person suffers from stroke, but few studies have focused on families' expectations following the stroke.

    OBJECTIVE: The aim of this study was to illuminate what persons with stroke and their family members talk about in Family Health Conversations (FamHCs) with focus on the future and how nurses leading these conversations apprehended the families' future shown in closing letters based on these conversations.

    METHOD: In this study, seven families with a member ≤65 years who had suffered a stroke participated in FamHC in their homes after the person with stroke had been discharged from the rehabilitation clinic. The FamHC comprised a series of three conversations conducted every other week and a closing letter sent by the nurses to the family to conclude the series. In this study, the third conversations were recorded and they and the closing letters were transcribed and analysed using qualitative content analysis.

    RESULT: The family members including the persons with stroke were found to be able to tell their stories and express their feelings, worries, losses, hopes and wishes for the future within the context of the Family Health Conversations. Support within the family was highlighted as essential to the satisfactory management of future situations.

    CONCLUSION: The persons with stroke and their belonging family members' vision of the future was reflected over in the light of theories about beliefs, possible selves, hope and suffering, and the findings highlight the need for broader use of family conversations to support persons with stroke and their families to manage the future.

  • 73.
    Sundin, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Pusa, Susanna
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundstedt, Erika
    Wincent, Nina
    Östlund, Ulrika
    Bäckström, Britt
    Lindh, Viveca
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    What Couples Choose to Focus on During Nurse-led Family Health Conversations When Suffering Stroke2015Inngår i: International journal for human caring, ISSN 1091-5710Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to illuminate which topics 2 couples, ages younger than 65 years old, where 1 partner has suffered a stroke, choose to focus on when participating in nurse-led family health conversations. Six conversations were audiotaped, transcribed, and analyzed by qualitative content analysis. Three categories emerged illustrating that the couples choose to talk about how they were affected on a personal and family level and, moreover, the importance of support within and outside the family. The altered way of living involved distressed feelings, gratitude, and hopes. This study highlights the importance of nurses viewing the family as a unit.

  • 74. Sveinbjarnardottir, E K
    et al.
    Svavarsdottir, E K
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nurses attitudes towards the importance of families in psychiatric care following an educational and training intervention program.2011Inngår i: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 18, nr 10, s. 895-903Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Accessible summary

    • The attitude that psychiatric nurses have towards the importance of involving families in their care is fundamental to the quality of the intervention family members are offered. Research evidence supports the view that psychiatric nurses' positive attitudes towards families, in psychiatric care, encourage them to engage more frequently in therapeutic conversations with families.
    • The main focus of the family nursing education and intervention program (ETI-PROGRAM) was to educate psychiatric nurses in family systems nursing. One of the beliefs in family nursing is that illness is a family affair and therefore it is important to involve families in the care of the patients to be able to soften the suffering of the psychiatric patients and their family members.
    • The main results of this study emphasize that after the psychiatric nurses had received the education and training program (ETI-PROGRAM) on family system nursing, they viewed families as less burdensome in their psychiatric care.

    Abstract

    This study measures the attitudes of the psychiatric nurses, after having received an education and training intervention program (ETI-PROGRAM) in family systems nursing, towards the importance of the families in their care. Nurses' knowledge of the impact that family nursing intervention can have on family members may increase positive attitudes towards families. However, little is known about the impact that education and training intervention can have on nurses' attitudes, towards families in clinical practice. Quasi-experimental design was used to assess the change in nurses' attitudes towards families in psychiatric care after the intervention, which included a one-day seminar on the Calgary family nursing conceptual frameworks and skills training with clinical vignettes of families from psychiatry. The Families Importance in Nursing Care – Nurses' Attitude questionnaire was used to evaluate nurses' attitudes. A total of 81 nurses (65%) working in psychiatric care responded to the questionnaire. Nurses with more than 15 years of work experience were significantly more supportive of families in their care compared with less experienced nurses. Out of the 81 nurses, 52 (64%) answered the questionnaire again 14 months later. Furthermore, psychiatric nurses saw families significantly less burdensome after having participated in the ETI-PROGRAM.

  • 75. Söderström, Ing-Mari K
    et al.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hagberg, Margaretha S
    Benzein, Eva G
    Family adaptation in relation to a family member's stay in ICU2009Inngår i: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, nr 5, s. 250-257Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To describe and interpret the family adaptation during the ICU hospitalisation and up to 18 months after discharge. RESEARCH METHODOLOGY/DESIGN: A qualitative design was chosen. MAIN OUTCOME MEASURES: Individual and family interviews with eight families including 31 family members. A hermeneutical analysis was performed and paradigm cases were constructed. RESULTS: The result is presented in three themes: striving for endurance, striving for consolation and striving to rebuild life under new conditions. The family adaptation started at the onset of the critical incident and continued during the ICU stay and after discharge. The family members metaphorically went through peaks and valleys during the whole process of adaptation. CONCLUSION: Adaptation is an issue for the whole family and is facilitated by being able to stay close to the patient and receive supportive unambiguous information from the staff both during the ICU stay and after discharge.

  • 76.
    Åhman, Sara
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Styrke, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Long-term follow-up of patients with mild traumatic brain injury: a mixed-methods study2013Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, nr 8, s. 758-764Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To characterize the long-term consequences of mild traumatic brain injury regarding post-concussion symptoms, post-traumatic stress, and quality of life; and to investigate differences between men and women.

    DESIGN: Retrospective mixed-methods study.Subjects/patients and methods: Of 214 patients with mild traumatic brain injury seeking acute care, 163 answered questionnaires concerning post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire; RPQ), post-traumatic stress (Impact of Event Scale; IES), and quality of life (Short Form Health Survey; SF-36) 3 years post-injury. A total of 21 patients underwent a medical examination in connection with the survey. The patients were contacted 11 years later, and 10 were interviewed. Interview data were analysed with content analysis.

    RESULTS: The mean total RPQ score was 12.7 (standard deviation; SD 12.9); 10.5 (SD 11.9) for men and 15.9 (SD 13.8) for women (p = 0.006). The 5 most common symptoms were fatigue (53.4%), poor memory (52.5%), headache (50.9%), frustration (47.9%) and depression (47.2%). The mean total IES score was 9.6 (SD 12.9) 7.1 (SD 10.3) for men and 13.0 (SD 15.2) for women (p = 0.004). In general, the studied population had low scores on the Short Form Health Survey (SF-36). The interviews revealed that some patients still had disabling post-concussion symptoms and consequences in many areas of life 11 years after the injury event.

    CONCLUSION: Long-term consequences were present for approximately 50% of the patients 3 years after mild traumatic brain injury and were also reported 11 years after mild traumatic brain injury. This needs to be taken into account by healthcare professionals and society in general when dealing with people who have undergone mild traumatic brain injury.

  • 77.
    Åström, Sture
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Sandvide, Asa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Bucht, Gösta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Eisemann, Martin
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Saveman, Britt-Inger
    Staff's experience of and the management of violent incidents in elderly care.2004Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, Vol. 18, nr 4, s. 410-6Artikkel i tidsskrift (Fagfellevurdert)
  • 78. Östlund, Ulrika
    et al.
    Bäckström, Britt
    Lindh, Viveca
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sundin, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nurses' fidelity to theory-based core components when implementing Family Health Conversations: a qualitative inquiry2015Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, nr 3, s. 582-590Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND AND AIM: A family systems nursing intervention, Family Health Conversation, has been developed in Sweden by adapting the Calgary Family Assessment and Intervention Models and the Illness Beliefs Model. The intervention has several theoretical assumptions, and one way translate the theory into practice is to identify core components. This may produce higher levels of fidelity to the intervention. Besides information about how to implement an intervention in accordance to how it was developed, evaluating whether it was actually implemented as intended is important. Accordingly, we describe the nurses' fidelity to the identified core components of Family Health Conversation.

    INTERVENTION AND RESEARCH METHODS: Six nurses, working in alternating pairs, conducted Family Health Conversations with seven families in which a family member younger than 65 had suffered a stroke. The intervention contained a series of three-1-hour conversations held at 2-3 week intervals. The nurses followed a conversation structure based on 12 core components identified from theoretical assumptions. The transcripts of the 21 conversations were analysed using manifest qualitative content analysis with a deductive approach.

    RESULTS AND CONCLUSION: The 'core components' seemed to be useful even if nurses' fidelity varied among the core components. Some components were followed relatively well, but others were not. This indicates that the process for achieving fidelity to the intervention can be improved, and that it is necessary for nurses to continually learn theory and to practise family systems nursing. We suggest this can be accomplished through reflections, role play and training on the core components. Furthermore, as in this study, joint reflections on how the core components have been implemented can lead to deeper understanding and knowledge of how Family Health Conversation can be delivered as intended.

  • 79. Östlund, Ulrika
    et al.
    Bäckström, Britt
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindh, Viveca
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sundin, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    A Family Systems Nursing Approach for Families Following a Stroke: Family Health Conversations2016Inngår i: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 22, nr 2, s. 148-171Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Stroke in midlife is a life altering, challenging experience for the whole family thereby necessitating a family approach to intervention. The aim of this study was to describe the experiences of 17 family members living in Sweden, including seven adult stroke patients (six males; one female) under the age of 65 who participated in a series of three nurse-led family conversations that were offered in each family's home. These Family Health Conversations (FamHC) were guided by the conceptual lens of Family System Nursing. Individual, semi-structured, evaluative interviews conducted with each participant one month after the FamHC were analyzed by qualitative content analysis. The FamHC were described by family members as a unique conversation that they had not previously experienced in health care contexts. Family members described possibilities for relational sharing and meaningful conversations as well as changes in family functioning that support the suitability of FamHC for family stroke care.

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