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  • 1.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Balancing between being a person and being a patient: A qualitative study of wearing patient clothing2009In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 46, no 1, p. 4-11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The nursing literature is replete with articles on the function of clothing in preventing and controlling infections. However, although contemporary literature demonstrates intimate connections between clothing and identity, there is a lack of studies which illuminate the meanings associated with wearing patient clothing. OBJECTIVES: This study aimed to illuminate the meanings of wearing patient clothing as narrated by patients and nurses in Swedish care settings. DESIGN: The data collection was based on grounded theory. Interviews with patients (n=9) and staff (n=5) were drawn from a larger study and analysed with a phenomenological hermeneutical method. SETTINGS: Data was collected between 2001 and 2003 at a hospice, an in-patient geriatric unit, an acute medical unit, and an in-patient oncology unit in Sweden. RESULTS: The phenomenon of 'wearing patient clothing' was found to consist of four themes: (1) being comfortable and cared for; (2) being depersonalised; (3) being stigmatised; and (4) being devitalised. Interpreted in the light of philosophical literature on identity and symbols, the comprehensive understanding of wearing patient clothing is that it is a balancing between being a person and being a patient. Patient clothes were experienced as being comfortable and practical, but also as being stigmatising symbols of illness, confinement, and depersonalisation. CONCLUSIONS: The tension between patient clothing as being practical and comfortable and at the same time enabling feelings of being depersonalised and stigmatised suggests that nursing staff need to balance the practical benefits of these garments with the social and existential meanings they might have.

  • 2.
    Edvardsson, David
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rasmussen, Birgit
    Umeå University, Faculty of Medicine, Department of Nursing.
    The quest for conceptual consistency: Commentary on Rytterström et al. (2009).2010In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 47, no 2, p. 261-262Article in journal (Other academic)
  • 3. Ekman, Nina
    et al.
    Taft, Charles
    Moons, Philip
    Mäkitalo, Åsa
    Boström, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fors, Andreas
    A state-of-the-art review of direct observation tools for assessing competency in person-centred care2020In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 109, article id 103634Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Direct observation is a common assessment strategy in health education and training, in which trainees are observed and assessed while undertaking authentic patient care and clinical activities. A variety of direct observation tools have been developed for assessing competency in delivering person-centred care (PCC), yet to our knowledge no review of such tools exists.

    OBJECTIVE: To review and evaluate direct observation tools developed to assess health professionals' competency in delivering PCC.

    DESIGN: State-of-the-art review DATA SOURCES: Electronic literature searches were conducted in PubMed, ERIC, CINAHL, and Web of Science for English-language articles describing the development and testing of direct observation tools for assessing PCC published until March 2017.

    REVIEW METHODS: Three authors independently assessed the records for eligibility. Duplicates were removed and articles were excluded that were irrelevant based on title and/or abstract. All remaining articles were read in full text. A data extraction form was developed to cover and extract information about the tools. The articles were examined for any conceptual or theoretical frameworks underlying tool development and coverage of recognized PCC dimensions was evaluated against a standard framework. The psychometric performance of the tools was obtained directly from the original articles.

    RESULT: 16 tools were identified: five assessed PCC holistically and 11 assessed PCC within specific skill domains. Conceptual/theoretical underpinnings of the tools were generally unclear. Coverage of PCC domains varied markedly between tools. Most tools reported assessments of inter-rater reliability, internal consistency reliability and concurrent validity; however, intra-rater reliability, content and construct validity were rarely reported. Predictive and discriminant validity were not assessed.

    CONCLUSION: Differences in scope, coverage and content of the tools likely reflect the complexity of PCC and lack of consensus in defining this concept. Although all may serve formative purposes, evidence supporting their use in summative evaluations is limited. Patients were not involved in the development of any tool, which seems intrinsically paradoxical given the aims of PCC. The tools may be useful for providing trainee feedback; however, rigorously tested and patient-derived tools are needed for high-stakes use.

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  • 4.
    Juthberg, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Registered nurses' and nurse assistants' lived experience of troubled conscience in their work in elderly care: a phenomenological hermeneutic study2010In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 47, no 1, p. 20-29Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In elderly care registered nurses (RNs) and nurse assistants (NAs) face ethical challenges which may trouble their conscience.

    OBJECTIVE: This study aimed to illuminate meanings of RNs' and NAs' lived experience of troubled conscience in their work in municipal residential elderly care.

    DESIGN: Interviews with six RNs and six NAs were interpreted separately using a phenomenological hermeneutic method.

    SETTINGS: Data was collected in 2005 among RNs and NAs working in special types of housings for the elderly in a municipality in Sweden.

    PARTICIPANTS: The RNs and NAs were selected for participation had previously participated in a questionnaire study and their ratings in the questionnaire study constituted the selection criteria for the interview study.

    RESULTS: The RNs' lived experience of troubled conscience was formulated in two themes. The first theme is 'being trapped in powerlessness' which includes three sub-themes: being restrained by others' omission, being trapped in ethically demanding situations and failing to live up to others' expectations. The second theme is 'being inadequate' which includes two sub-themes: lacking courage to maintain one's opinion and feeling incompetent. The NAs' lived experience of troubled conscience was formulated in the two themes. The first is 'being hindered by pre-determined conditions' which includes two sub-themes: suffering from lack of focus in one's work and being restrained by the organisation. The second theme is 'being inadequate' which includes two sub-themes: lacking the courage to object and being negligent.

    CONCLUSIONS: The RNs' lived experience of troubled conscience were feelings of being trapped in a state of powerlessness, caught in a struggle between responsibility and authority and a sense of inadequacy fuelled by feelings of incompetence, a lack of courage and a fear of revealing themselves and endangering residents' well-being. The NAs' lived experience of troubled conscience was feelings of being hindered by pre-determined conditions, facing a fragmented work situation hovering between norms and rules and convictions of their conscience. To not endangering the atmosphere in the work-team they are submissive to the norms of their co-workers. They felt inadequate as they should be model care providers. The findings were interpreted in the light of Fromm's authoritarian and humanistic conscience.

  • 5.
    Lindgren, Britt-Marie
    et al.
    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. Department of Health Sciences, University West, Trollhättan, Sweden.
    Abstraction and interpretation during the qualitative content analysis process2020In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 108, article id 103632Article in journal (Refereed)
    Abstract [en]

    Qualitative content analysis and other ‘standardised’ methods are sometimes considered to be technical tools used for basic, superficial, and simple sorting of text, and their results lack depth, scientific rigour, and evidence. To strengthen the trustworthiness of qualitative content analyses, we focus on abstraction and interpretation during the analytic process. To our knowledge, descriptions of these concepts are sparse; this paper therefore aims to elaborate on and exemplify the distinction and relation between abstraction and interpretation during the different phases of the process of qualitative content analysis. We address the relations between abstraction and interpretation when selecting, condensing, and coding meaning units and creating categories and themes on various levels. The examples used are based on our experiences of teaching and supervising students at various levels. We also highlight the phases of de-contextualisation and re-contextualisation in describing the analytic process. We argue that qualitative content analysis can be both descriptive and interpretative. When the data allow interpretations of the latent content, qualitative content analysis reveals both depth and meaning in participants’ utterances.

  • 6. Lornudd, Caroline
    et al.
    Tafvelin, Susanne
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Schwarz, Ulrica von Thiele
    Bergman, David
    The mediating role of demand and control in the relationship between leadership behaviour and employee distress: A cross-sectional study2015In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 52, no 2, p. 543-554Article in journal (Refereed)
    Abstract [en]

    Background: The relationship between leadership and employee distress is well established, however, the processes involved in this relationship remain largely unclear. For a stretched nursing workforce, understanding in what ways leadership may influence employee distress is particularly important. Objectives: To examine possible mediating effects of the work environment factors demand and control in the relationship between leadership behaviour in change, production, and employee orientation and employee distress. Design: Cross-sectional study design. Settings: The study was conducted at a large county council in Sweden providing both institutional and non-institutional care. Participants: A random sample of 1249 employees (primarily nurses, but also a wide range of other healthcare professionals and administrative staff), who had a healthcare manager that was about to enter a leadership development programme (n = 171), responded to a web-based questionnaire. The response rate was 62%. Methods: The employees rated their healthcare managers' behaviour in change, production, and employee orientation, as well as their own perceptions of level of demand, control (subdivided into decision authority and skill discretion), and five distress outcomes. Multilevel analysis was performed. Results: The mediators demand, decision authority, and skill discretion were significant predictors of all five distress outcomes for all three leadership orientations. In eight of 15 regressions, the mediators fully explained the relationships between leadership orientations and outcomes. Four of five relationships with distress outcomes were fully mediated for change-oriented leadership, whereas two of five outcomes were fully mediated for production- and employee-oriented leadership. In all three leadership orientations, the relationship between the mediator skill discretion and the distress measure disengagement were particularly strong, with B-coefficients (-.44, p < .001) twice as high as for any of the other relationships. Conclusions: It seems that the way that employees perceive healthcare managers' change-oriented behaviour, and how that aspect is related to employee distress, is primarily explained by perception of demand and control. Furthermore, regardless of leadership behaviour orientation, how employees perceive their opportunity to use specific job skills plays an important role in the interplay between perception of healthcare managers' behaviour and disengagement.

  • 7.
    Lundman, Berit
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jonsén, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Santamäki Fischer, Regina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Inner strength-A theoretical analysis of salutogenic concepts.2010In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, International journal of nursing studies, ISSN 1873-491X, Vol. 47, no 2, p. 251-260Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Theoretical and empirical overlaps between the concepts of resilience, sense of coherence, hardiness, purpose in life, and self-transcendence have earlier been described as some kind of inner strength, but no studies have been found that focus on what attributes these concepts have in common. OBJECTIVES: The objective of this study was to perform a theoretical analysis of the concepts of resilience, sense of coherence, hardiness, purpose in life, and self-transcendence, in order to identify their core dimensions in an attempt to get an overarching understanding of inner strength. PRINT METHOD: An analysis inspired by the procedure of meta-theory construction was performed. The main questions underlying the development of the concepts, the major paradigms and the most prominent assumptions, the critical attributes and the characteristics of the various concepts were identified. RESULTS: The analysis resulted in the identification of four core dimensions of inner strength and the understanding that inner strength relies on the interaction of these dimensions: connectedness, firmness, flexibility, and creativity. These dimensions were validated through comparison with the original descriptions of the concepts. CONCLUSION: An overarching understanding of inner strength is that it means both to stand steady, to be firm, with both feet on the ground and to be connected to; family, friends, society, nature and spiritual dimensions and to be able to transcend. Having inner strength is to be creative and stretchable, which is to believe in own possibilities to act and to make choices and influence life's trajectory in a perceived meaningful direction. Inner strength is to shoulder responsibility for oneself and others, to endure and deal with difficulties and adversities. This knowledge about inner strength will raise the awareness of the concept and, in turn, hopefully increase our potential to support people's inner strength.

  • 8.
    Lundman, Berit
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Viglund, Kerstin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jonsén, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fischer, Regina Santamäki
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Development and psychometric properties of the Inner Strength Scale.2011In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, no 10, p. 1266-1274Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Four dimensions of inner strength were previously identified in a meta-theoretical analysis: firmness, creativity, connectedness, and flexibility.

    OBJECTIVE: The aim of this study was to develop an Inner Strength Scale (ISS) based on those four dimensions and to evaluate its psychometric properties.

    METHOD: An initial version of ISS was distributed for validation purpose with the Rosenberg Self-Esteem Scale, the resilience scale, and the sense of Coherence Scale. A convenience sample of 391 adults, aged 19-90 years participated. Principal component analysis (PCA) and confirmatory factor analysis (CFA) were used in the process of exploring, evaluating, and reducing the 63-item ISS to the 20-item ISS. Cronbach's alpha and test-retest were used to measure reliability.

    RESULTS: CFA showed satisfactory goodness-of-fit for the 20-item ISS. The analysis supported a fourfactor solution explaining 51% of the variance. Cronbach's alpha on the 20-item ISS was 0.86, and the test-retest showed stability over time (r=0.79).

    CONCLUSION: The ISS was found to be a valid and reliable instrument for capturing a multifaceted understanding of inner strength. Further tests of psychometric properties of the ISS will be performed in forthcoming studies.

  • 9.
    Lämås, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Engström, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jacobsson, Catrine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Effects of abdominal massage in management of constipation: a randomized controlled trial2009In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 46, no 6, p. 759-767Article in journal (Refereed)
    Abstract [en]

    Background. Associated with decreases in quality of life, constipation is a relatively common problem. Abdominal massage appears to increase bowel function, but unlike laxatives with no negative side effects. Because earlier studies have methodological flaws and cannot provide recommendations, more research is needed.

    Objective. This study investigates the effects of abdominal massage on gastrointestinal functions and laxative intake in people who have constipation.

    Design. Randomized controlled trial.

    Participants and method. A sample of 60 people with constipation was included and randomised in two groups. The intervention group received abdominal massage in addition to an earlier prescribed laxative and the control group received only laxatives according to earlier prescriptions. Gastrointestinal function was assessed with Gastrointestinal Symptoms Rating Scale (GSRS) on three occasions; at baseline, week 4 and week 8. The statistical methods included linear regression, Wilcoxon sign rank test, and Mann-Whitney U-test.

    Result. Abdominal massage significantly decreased severity of gastrointestinal symptoms assessed with GSRS according to total score (p=.003), constipation syndrome (p=.013), and abdominal pain syndrome (p=.019). The intervention group also had significant increase of bowel movements compared to the control group (p=.016). There was no significant difference in the change of the amount of laxative intake after 8 weeks.

    Conclusions. Abdominal massage decreased severity of gastrointestinal symptoms, especially constipation and abdominal pain syndrome, and increased bowel movements. The massage did not lead to decrease in laxative intake, a result that indicates that abdominal massage could be a complement to laxatives rather than a substitute.

  • 10.
    Sjöling, Mats
    et al.
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Anesthesiology and Intensive Care.
    Agren, Ylva
    Olofsson, Niclas
    Hellzén, R N Ove
    Asplund, R N Kenneth
    Waiting for surgery; living a life on hold--a continuous struggle against a faceless system.2005In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 42, no 5, p. 539-457Article in journal (Refereed)
    Abstract [en]

    This interpretive-phenomenological study examined the lived experience of being on the waiting list for arthroplastic surgery of the knee or hip. Interviews reveal that respondents experience suffering in different ways: illness-, caring- and life-suffering. Suffering leads to a struggle in order to have their caring needs met and the struggle is often fruitless-against a faceless enemy-"the system". No one is there to answer their plea or the frustration they experience. This in combination with their present life situation may lead to a disrupted self-image. Finding or creating meaning in suffering appears to be a crucial issue in the struggling process. Respondents who are able to preserve or create meaning in life are able to reformulate their life-world and live a full life, in spite of severe pain and disability.

  • 11.
    Wiitavaara, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Centre for Musculoskeletal Research, University of Gävle, Umeå, Sweden.
    Barnekow-Bergkvist, Margareta
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Striving for balance: a grounded theory study of health experiences of nurses with musculoskeletal problems2007In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 44, no 8, p. 1379-1390Article in journal (Refereed)
    Abstract [en]

    Background: Musculoskeletal disorders (MSD) are one of the major causes of the high levels of long-term sickleave and early retirement, and healthcare personnel are among the occupational groups most affected. Only limited research in the area has focused on the experiences of those affected, and to increase the understanding of MSD, all dimensions of the health experiences need to be taken into consideration.

    Objectives: The aim of this paper was to explore the experiences of illness and wellness among female healthcare personnel with musculoskeletal symptoms.

    Design: A qualitative grounded theory approach guided the study in data collection and analysis.

    Settings: Medical and surgical ward units at three hospitals; one university hospital and two minor hospitals.

    Participants: Eight women, registered nurses and nursing aides, with neck, shoulder and/or back problems in early stages.

    Methods: A grounded theory approach was used with narrative thematic interviews and parallel data analysis with constant comparisons.

    Results: The analysis revealed a process of striving to reach a balance between illness and wellness, through accepting and handling illness. Illness appeared as a threat and an experience, while experiences of wellness were simultaneously nurtured. The informants were striving for balance through an inner reasoning leading to acceptance and by handling illness in various ways depending on the character of the illness.

    Conclusion: This paper indicates the diversity of the illness experience, the parallel importance of wellness, and the process of balancing these two in order to feel well enough. As previous research has shown that MSD has a multifactorial cause, a holistic view of health promotion, prevention and rehabilitation may provide a more effective tool than the bodily physical focus most frequently used today.

  • 12.
    Wiitavaara, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Centre for Musculoskeletal Research, University of Gävle, Umeå, Sweden.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Barnekow-Bergkvist, Margareta
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Striking a balance - health experiences of male ambulance personnel with musculoskeletal symptoms: a grounded theory2007In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 44, no 5, p. 770-779Article in journal (Refereed)
    Abstract [en]

    Background: Musculoskeletal disorders (MSD) are a dominant cause to long-term sick leave and early retirement. Some occupational groups are more affected than others and ambulance personnel are among them. Despite a vast amount of research, only a small part focuses the experiences of the affected.

    Objectives: The aim of the study was to explore the experience of illness and wellness in ambulance personnel with musculoskeletal symptoms.

    Design: An emerging design was used in accordance with Grounded Theory.

    Participants: Informants in the study were ten men with musculoskeletal symptoms, working as ambulance personnel at an ambulance station located in a mid-sized city in Sweden.

    Methods: Narrative interviews were performed, parallel to a constant comparative analysis.

    Results: The study resulted in a model, which describes the experience of illness and wellness as characterised by an effort to strike a balance. Wellness through nurturing appeared parallel to encountering illness as an experience and a threat. Accepting and handling illness was of importance to maintaining wellness, and wellness through nurturing was the motivation for accepting and handling illness.

    Conclusions: Enhancing the understanding of wellness and illness makes it possible to avoid undermining the meaningfulness that support accepting and handling illness, and by understanding different aspects of illness prevention can become facilitated. This is of importance as other aspects than solely physical have shown to be similarly important in the development of MSD.

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