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Publications (10 of 20) Show all publications
Härgestam, M., Lindgren, L. & Jacobsson, M. (2024). Can equity in care be achieved for stigmatized patients? Discourses of ideological dilemmas in perioperative care. BMC Health Services Research, 24(1), Article ID 210.
Open this publication in new window or tab >>Can equity in care be achieved for stigmatized patients? Discourses of ideological dilemmas in perioperative care
2024 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, no 1, article id 210Article in journal (Refereed) Published
Abstract [en]

Background: In the perioperative care of individuals with obesity, it is imperative to consider the presence of risk factors that may predispose them to complications. Providing optimal care in such cases proves to be a multifaceted challenge, significantly distinct from the care required for non-obese patients. However, patients with morbidities regarded as self-inflicted, such as obesity, described feelings of being judged and discriminated in healthcare. At the same time, healthcare personnel express difficulties in acting in an appropriate and non-insulting way. In this study, the aim was to analyse how registered nurse anaesthetists positioned themselves regarding obese patients in perioperative care.

Methods: We used discursive psychology to analyse how registered nurse anaesthetists positioned themselves toward obese patients in perioperative care, while striving to provide equitable care. The empirical material was drawn from interviews with 15 registered nurse anaesthetists working in a hospital in northern Sweden.

Results: Obese patients were described as “untypical”, and more “resource-demanding” than for the “normal” patient in perioperative care. This created conflicting feelings, and generated frustration directed toward the patients when the care demanded extra work that had not been accounted for in the schedules created by the organization and managers.

Conclusions: Although the intention of these registered nurse anaesthetists was to offer all patients equitable care, the organization did not always provide the necessary resources. This contributed to the registered nurse anaesthetists either consciously or unconsciously blaming patients who deviated from the “norm”.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Discourse psychology, Discrimination, Equity, Ideological dilemma, Perioperative care, Stigmatization, Weight bias
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-221533 (URN)10.1186/s12913-024-10580-5 (DOI)001163304600005 ()38360678 (PubMedID)2-s2.0-85185237227 (Scopus ID)
Available from: 2024-03-19 Created: 2024-03-19 Last updated: 2024-03-19Bibliographically approved
Härgestam, M., Jacobsson, M., Bååthe, F. & Brulin, E. (2023). Challenges in preserving the “good doctor” norm: physicians' discourses on changes to the medical logic during the initial wave of the COVID-19 pandemic. Frontiers in Psychology, 14, Article ID 1083047.
Open this publication in new window or tab >>Challenges in preserving the “good doctor” norm: physicians' discourses on changes to the medical logic during the initial wave of the COVID-19 pandemic
2023 (English)In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 14, article id 1083047Article in journal (Refereed) Published
Abstract [en]

Introduction: The COVID-19 pandemic was a tremendous challenge to the practice of modern medicine. In this study, we use neo-institutional theory to gain an in-depth understanding of how physicians in Sweden narrate how they position themselves as physicians when practicing modern medicine during the first wave of the pandemic. At focus is medical logic, which integrates rules and routines based on medical evidence, practical experience, and patient perspectives in clinical decision-making.

Methods: To understand how physicians construct their versions of the pandemic and how it impacted the medical logic in which they practice, we analyzed the interviews from 28 physicians in Sweden by discursive psychology.

Results: The interpretative repertoires showed how COVID-19 created an experience of knowledge vacuum in medical logic and how physicians dealt with clinical patient dilemmas. They had to find unorthodox ways to rebuild a sense of medical evidence while still being responsible for clinical decision-making for patients with critical care needs.

Discussion: In the knowledge vacuum occurring during the first wave of COVID-19, physicians could not use their common medical knowledge nor rely on published evidence or their clinical judgment. They were thus challenged in their norm of being the “good doctor”. One practical implication of this research is that it provides a rich empirical account where physicians are allowed to mirror, make sense, and normalize their own individual and sometimes painful struggle to uphold the professional role and related medical responsibility in the early phases of the COVID-19 pandemic. It will be important to follow how the tremendous challenge of COVID-19 to medical logic plays out over time in the community of physicians. There are many dimensions to study, with sick leave, burnout, and attrition being some interesting areas.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
COVID-19, discursive psychology, healthcare, medical logic, neo-institutional theory, pandemic response, physician
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-211996 (URN)10.3389/fpsyg.2023.1083047 (DOI)001010204600001 ()37359864 (PubMedID)2-s2.0-85163176740 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-00311Region Stockholm, 20191179
Available from: 2023-07-12 Created: 2023-07-12 Last updated: 2023-07-12Bibliographically approved
Morian, H., Härgestam, M., Hultin, M., Jonsson, H., Jonsson, K., Nordahl Amorøe, T. & Creutzfeldt, J. (2023). Reliability and validity testing of team emergency assessment measure in a distributed team context. Frontiers in Psychology, 14, Article ID 1110306.
Open this publication in new window or tab >>Reliability and validity testing of team emergency assessment measure in a distributed team context
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2023 (English)In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 14, article id 1110306Article in journal (Refereed) Published
Abstract [en]

Medical multi-professional teams are increasingly collaborating via telemedicine. In distributed team settings, members are geographically separated and collaborate through technology. Developing improved training strategies for distributed teams and finding appropriate instruments to assess team performance is necessary. The Team Emergency Assessment Measure (TEAM), an instrument validated in traditional collocated acute-care settings, was tested for validity and reliability in this study when used for distributed teams. Three raters assessed video recordings of simulated team training scenarios (n = 18) among teamswith varying levels of proficiency working with a remotely located physician via telemedicine. Inter-rater reliability, determined by intraclass correlation, was 0.74–0.92 on the TEAM instrument’s three domains of leadership, teamwork, and task management. Internal consistency (Cronbach’s alpha) ranged between 0.89–0.97 for the various domains. Predictive validity was established by comparing scores with proficiency levels. Finally, concurrent validity was established by high correlations, >0.92, between scores in the three TEAM domains and the teams’overall performance. Our results indicate that TEAM can be used in distributed acute-care team settings and consequently applied in future-directed learning and research on distributed healthcare teams.

Keywords
interprofessional teams, team performance, teamwork, distributed team, telemedicine, instrument, validation, assessments
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-206995 (URN)10.3389/fpsyg.2023.1110306 (DOI)000979890100001 ()2-s2.0-85158024637 (Scopus ID)
Funder
The Kamprad Family Foundation
Available from: 2023-04-24 Created: 2023-04-24 Last updated: 2023-06-02Bibliographically approved
Jacobsson, M., Härgestam, M., Bååthe, F. & Hagqvist, E. (2022). Organizational logics in time of crises: How physicians narrate the healthcare response to the Covid-19 pandemic in Swedish hospitals. BMC Health Services Research, 22(1), Article ID 738.
Open this publication in new window or tab >>Organizational logics in time of crises: How physicians narrate the healthcare response to the Covid-19 pandemic in Swedish hospitals
2022 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 738Article in journal (Refereed) Published
Abstract [en]

Background: The COVID-19 pandemic has challenged healthcare organizations and puts focus on risk management in many ways. Both medical staff and leaders at various levels have been forced to find solutions to problems they had not previously encountered. This study aimed to explore how physicians in Sweden narrated the changes in organizational logic in response to the Covid-19 pandemic using neo-institutional theory and discursive psychology. In specific, we aimed to explore how physicians articulated their understanding of if and, in that case, how the organizational logic has changed during this crisis response.

Methods: The empirical material stems from interviews with 29 physicians in Sweden in the summer and autumn of 2020. They were asked to reflect on the organizational response to the pandemic focusing on leadership, support, working conditions, and patient care.

Results: The analysis revealed that the organizational logic in Swedish healthcare changed and that the physicians came in troubled positions as leaders. With management, workload, and risk repertoires, the physicians expressed that the organizational logic, to a large extent, was changed based on local contextual circumstances in the 21 self-governing regions. The organizational logic was being altered based upon how the two powerbases (physicians and managers) were interacting over time.

Conclusions: Given that healthcare probably will deal with future unforeseen crises, it seems essential that healthcare leaders discuss what can be a sustainable organizational logic. There should be more explicit regulatory elements about who is responsible for what in similar situations. The normative elements have probably been stretched during the ongoing crisis, given that physicians have gained practical experience and that there is now also, at least some evidence-based knowledge about this particular pandemic. But the question is what knowledge they need in their education when it comes to dealing with new unknown risks.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Neo-institutional theory, COVID-19, Discursive psychology, Healthcare, Management, Pandemic response
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-196035 (URN)10.1186/s12913-022-08094-z (DOI)000805779900002 ()35659289 (PubMedID)2-s2.0-85131623365 (Scopus ID)
Funder
Stockholm County Council, 20191179Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-00311Karolinska Institute
Available from: 2022-06-08 Created: 2022-06-08 Last updated: 2023-03-24Bibliographically approved
Dubois, H., Bergenmar, M., Härgestam, M. & Creutzfeldt, J. (2022). Patient participation in tele-emergencies: experiences from healthcare professionals in northern rural Sweden. Rural and remote health, 22(4), Article ID 7404.
Open this publication in new window or tab >>Patient participation in tele-emergencies: experiences from healthcare professionals in northern rural Sweden
2022 (English)In: Rural and remote health, ISSN 1445-6354, Vol. 22, no 4, article id 7404Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Telemedicine provides opportunities for access to health care in remote and underserved areas. In parts of northern rural Sweden telemedicine is used to connect a remote physician by a video-conference system to an emergency room, staffed by nurses during on-call hours. This can be called 'tele-emergency'. Patient participation, often described as mutual information exchange, a trustful relationship and involvement in decision-making, is challenged in emergency care by short encounters, deteriorating patients and a stressful work situation. Nevertheless, patient participation may be important for the patients' experience. Healthcare professionals (HCPs) have been identified as 'gatekeepers' for patient participation, therefore putting their perspective in focus is important. As emergency care in rural areas is increasingly turning toward telemedicine, patient participation in tele-emergencies needs to be better understood. The aim of this study was to explore and characterise HCPs' perspectives of patient participation in tele-emergencies in northern rural Sweden.

METHODS: A qualitative design based on interviews was used. HCPs working in cottage hospitals in northern rural Sweden were included. Semi-structured interviews were performed, first, in multidisciplinary groups of three informants. Later, because of limited experience of tele-emergencies in the groups, individual interviews with HCPs with substantial experience were added. A qualitative content analysis of the interview transcripts was conducted.

RESULTS: A total of 44 HCPs from northern inland Sweden participated in the interviews. The content analysis resulted in two themes, six categories and 19 subcategories. Theme 1, 'To see, understand, and to build trust through the digital barrier', contains descriptions of the interpersonal relationship between the patient and the HCPs, and the challenges when interacting with the patient during a tele-emergency. The informants also described a need for boundaries between the professional team and the patient. The categories in theme 1 are 'understanding the patient's point of view', 'building a trustful relationship', and 'needing a private space without the patient'. Theme 2, 'The (im)balance of power - tele-emergency reinforces the positions', mirrors the power asymmetry in the patient-professional relationship, and the potential impact of the tele-emergency on the different roles. Tele-emergencies were described as a risk that potentially could weaken the patient's position, but also as providing an opportunity to share power. Categories in theme 2 are 'medical conditions limit patient participation', 'patient involvement in decision-making requires understanding' and 'the inferior patient and the superior professionals'.

CONCLUSION: This study sheds light on patient participation in tele-emergencies in a remote rural setting from the HCP's perspective. The tele-emergency set-up affected patient participation by interfering with familiar patient-HCP relationships and changing group dynamics in interactions with the patient. Due to the extensive changes of the conditions for patient participation imposed in tele-emergencies, suggestions for actions improving patient participation are made.

Keywords
patient participation, qualitative research, Sweden, tele-emergency, telemedicine, emergency medicine
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-203325 (URN)10.22605/RRH7404 (DOI)000894489000001 ()36480908 (PubMedID)2-s2.0-85143560362 (Scopus ID)
Funder
The Kamprad Family Foundation
Available from: 2023-01-18 Created: 2023-01-18 Last updated: 2023-01-18Bibliographically approved
Lämås, K., Härgestam, M., Jonsson, K. & Bölenius, K. (2022). Students’ performance in venous blood specimen collection practice before internship: an observation study. Creative Education, 13(07), 2340-2353
Open this publication in new window or tab >>Students’ performance in venous blood specimen collection practice before internship: an observation study
2022 (English)In: Creative Education, ISSN 2151-4755, E-ISSN 2151-4771, Vol. 13, no 07, p. 2340-2353Article in journal (Refereed) Published
Abstract [en]

Introduction: Newly trained nurses experience a lack of preparedness in practical skills, and research shows  that students and newly trained nurses have deficiencies in performing practical skills such as venous blood specimen collection. There is a lack of knowledge regarding the level of accuracy reached by students after training at clinical training centres and before entering clinical practice. The aim of this study was to assess the performance of venous blood specimen collection among nursing students after regular education and training at the clinical training centre but before starting an internship. 

Methods: Twenty-three nursing students were observed and video-recorded. An observation protocol was developed based on a validated questionnaire measuring adherence to valid guidelines, and a model for practical skills performance. Data were analysed using descriptive statistics. 

Results: A large variation was found in students’ performance with respect to information provided to the patient, patient identification procedures, and tourniquet procedures. The students gave adequate information in 39% of cases, accurately performed patient identification in 83% of cases, and accurately performed the tourniquet procedure in 22% of cases. 

Conclusions: Many nursing students are not prepared to practice on real patients. It is therefore important for university lecturers to develop more efficient teaching methods and to communicate students’ skill levels to the supervisor at the clinic, in order for the clinical training to be adapted to a suitable level. There is a need for further research on how to close the gap between the university and internship in order to ensure patient safety.

Place, publisher, year, edition, pages
Scientific Research Publishing, 2022
Keywords
Noggrannhet, Clinical Training Center, Utbildning, Omvårdnad, Task Performance
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-200771 (URN)10.4236/ce.2022.137149 (DOI)
Available from: 2022-11-07 Created: 2022-11-07 Last updated: 2022-11-07Bibliographically approved
Jonsson, K., Brulin, C., Härgestam, M., Lindkvist, M. & Hultin, M. (2021). Do team and task performance improve after training situation awareness?: A randomized controlled study of interprofessional intensive care teams. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1), Article ID 73.
Open this publication in new window or tab >>Do team and task performance improve after training situation awareness?: A randomized controlled study of interprofessional intensive care teams
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2021 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 29, no 1, article id 73Article in journal (Refereed) Published
Abstract [en]

Background: When working in complex environments with critically ill patients, team performance is influenced by situation awareness in teams. Moreover, improved situation awareness in the teams will probably improve team and task performance. The aim of this study is to evaluate an educational programme on situation awareness for interprofessional teams at the intensive care units using team and task performance as outcomes.

Method: Twenty interprofessional teams from the northern part of Sweden participated in this randomized controlled intervention study conducted in situ in two intensive care units. The study was based on three cases (cases 0, 1 and 2) with patients in a critical situation. The intervention group (n = 11) participated in a two-hour educational programme in situation awareness, including theory, practice, and reflection, while the control group (n = 9) performed the training without education in situation awareness. The outcomes were team performance (TEAM instrument), task performance (ABCDE checklist) and situation awareness (Situation Awareness Global Assessment Technique (SAGAT)). Generalized estimating equation were used to analyse the changes from case 0 to case 2, and from case 1 to case 2.

Results: Education in situation awareness in the intervention group improved TEAM leadership (p = 0.003), TEAM task management (p = 0.018) and TEAM total (p = 0.030) when comparing cases 1 and 2; these significant improvements were not found in the control group. No significant differences were observed in the SAGAT or the ABCDE checklist.

Conclusions: This intervention study shows that a 2-h education in situation awareness improved parts of team performance in an acute care situation. Team leadership and task management improved in the intervention group, which may indicate that the one or several of the components in situation awareness (perception, comprehension and projection) were improved. However, in the present study this potential increase in situation awareness was not detected with SAGAT. Further research is needed to evaluate how educational programs can be used to increase situation awareness in interprofessional ICU teams and to establish which components that are essential in these programs.

Trial registration: This randomized controlled trial was not registered as it does not report the results of health outcomes after a health care intervention on human participants.

Place, publisher, year, edition, pages
BioMed Central, 2021
Keywords
Critical care, Interdisciplinary health team, Leadership, Patient safety, Simulation training, Situation awareness, Team performance
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-177979 (URN)10.1186/s13049-021-00878-2 (DOI)000657440600003 ()34078432 (PubMedID)2-s2.0-85107224687 (Scopus ID)
Funder
Region Västerbotten, VLL-663801Region Västerbotten, VLL-836931Region Västerbotten, RVB-930528The Kempe Foundations
Note

Originally included in thesis in manuscript form with title: "Do team performance and task performance improve in intensive care teams after training situation awareness: a randomized controlled study with in situ simulation team training"

Available from: 2020-12-30 Created: 2020-12-30 Last updated: 2024-01-17Bibliographically approved
Härgestam, M. (2021). Teamarbete och kommunikation (1ed.). In: Gunilla Wihlke; Rebecka Schmidt (Ed.), Traumaomvårdnad: vård av svårt skadade patienter (pp. 54-60). Stockholm: Liber
Open this publication in new window or tab >>Teamarbete och kommunikation
2021 (Swedish)In: Traumaomvårdnad: vård av svårt skadade patienter / [ed] Gunilla Wihlke; Rebecka Schmidt, Stockholm: Liber, 2021, 1, p. 54-60Chapter in book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Liber, 2021 Edition: 1
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-212880 (URN)9789147127818 (ISBN)
Available from: 2023-08-15 Created: 2023-08-15 Last updated: 2023-08-29Bibliographically approved
Silfver, E., Maritha, J., Arnell, L., Bertilsdotter-Rosqvist, H., Härgestam, M., Sjöberg, M. & Widding, U. (2020). Classroom bodies: affect, body language, and discourse when schoolchildren encounter national tests in mathematics. Gender and Education, 32(5), 682-696
Open this publication in new window or tab >>Classroom bodies: affect, body language, and discourse when schoolchildren encounter national tests in mathematics
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2020 (English)In: Gender and Education, ISSN 0954-0253, E-ISSN 1360-0516, Vol. 32, no 5, p. 682-696Article in journal (Refereed) Published
Abstract [en]

The aim of this paper is to analyse how Swedish grade three children are discursively positioned as pupils when they are taking national tests in mathematics and when they reflect on the testing situation afterwards. With support from theories about affective-discursive assemblages, we explore children's body language, emotions, and talk in light of the two overarching discourses that we believe frame the classroom: the 'testing discourse' and the 'development discourse'. Through the disciplinary power of these main discourses children struggle to conduct themselves in order to become recognized as intelligible subjects and 'ideal pupils'. The analysis, when taking into account how affects and discourses intertwine, shows that children can be in 'untroubled', 'troubled', or ambivalent subject positions.

Place, publisher, year, edition, pages
Routledge, 2020
Keywords
affective-discursive assemblages, grade three children, ‘ideal’ pupils, mathematics tests, power
National Category
Pedagogy Nursing
Identifiers
urn:nbn:se:umu:diva-147753 (URN)10.1080/09540253.2018.1473557 (DOI)000545165600008 ()2-s2.0-85047142041 (Scopus ID)
Available from: 2018-05-17 Created: 2018-05-17 Last updated: 2021-11-23Bibliographically approved
Jonsson, K., Hultin, M., Härgestam, M., Lindkvist, M. & Brulin, C. (2020). Factors Influencing Team and Task Performance in Intensive Care Teams in a Simulated Scenario. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 16(1), 29-36
Open this publication in new window or tab >>Factors Influencing Team and Task Performance in Intensive Care Teams in a Simulated Scenario
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2020 (English)In: Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, ISSN 1559-2332, E-ISSN 1559-713X, Vol. 16, no 1, p. 29-36Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Healthcare teams and their performance in a complex environment such as that of intensive care units (ICUs) are influenced by several factors. This study investigates the relationship between team background characteristics and team as well as task performance.

METHODS: This study included 105 professionals (26 teams), working at the ICUs of 2 hospitals in Northern Sweden. The team-based simulation training sessions were video recorded, and thereafter, team performance and task performance were analyzed based on ratings of the TEAM instrument and the ABCDE checklist.

RESULTS: The final analyses showed that a higher age was significantly associated with better total team performance (β = 0.35, P = 0.04), teamwork (β = 0.04, P = 0.04), and task management (β = 0.04, P = 0.05) and with a higher overall rating for global team performance (β = 0.09, P = 0.02). The same pattern was found for the association between age and task performance (β = 0.02, P = 0.04). In addition, prior team training without video-facilitated reflection was significantly associated with better task performance (β = 0.35, P = 0.04). On the other hand, prior team training in communication was significantly associated with worse (β = -1.30, P = 0.02) leadership performance.

CONCLUSIONS: This study reveals that a higher age is important for better team performance when caring for a severely ill patient in a simulation setting in the ICU. In addition, prior team training had a positive impact on task performance. Therefore, on a team level, this study indicates that age and, to some extent, prior team training without video-facilitated reflection have an impact on team performance in the care of critically ill patients.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2020
Keywords
Simulation, nontechnical skills, crisis resource management, clinical competence, teamwork, simulation-based team training, intensive care
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-171296 (URN)10.1097/SIH.0000000000000462 (DOI)000615898000005 ()32433185 (PubMedID)2-s2.0-85101896628 (Scopus ID)
Available from: 2020-06-01 Created: 2020-06-01 Last updated: 2023-09-05Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0680-9962

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