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  • 1.
    Antonsson, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. University West, Department of Health Sciences, Trollhättan, Sweden.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Åström, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. University West, Department of Health Sciences, Trollhättan, Sweden.
    Lundström, Mats O.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Evaluation of a Web-Based Training Program for Professional Carers Working With People With Learning Disabilities and Challenging Behavior: A Pilot Study with SSED-Design2016Ingår i: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 37, nr 10, s. 734-743Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The interaction between people with intellectual disabilities and professional carers is often influenced by communicative difficulties contributing challenging behaviours. The aims of this study were to evaluate to a web-based training program aimed at improving carers' abilities to interact with people with learning disabilities who exhibit challenging behaviours and to explore carers' experiences of participating in such a program. A single-subject experimental design and mixed methods were used to integrate qualitative and quantitative data. Triangulation of questionnaires, interviews with carers, and assessments of one woman's behaviour was performed. The participants were professional carers aged 20 to 55 years. The web-based training program increased carers' abilities to handle challenging behaviours and decreased challenging behaviours in daily care. The program improved the opportunities to offer training to carers who work in community-based accommodations with limited time to receive training.

  • 2.
    Boström, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Asa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Role clarity and role conflict among Swedish diabetes specialist nurses2013Ingår i: Primary care diabetes, ISSN 1878-0210, Vol. 7, nr 3, s. 207-212Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 3.
    Boström, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Bent
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Graneheim, Ulla H.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes2014Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 94, nr 2, s. 187-192Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 4.
    Boström, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Egan Sjölander, Annika
    Umeå universitet, Humanistiska fakulteten, Institutionen för kultur- och medievetenskaper.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Diabetes specialist nurses' perceptions of their multifaceted role2012Ingår i: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 9, nr 2, s. 39-44Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 5.
    Boström, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes2014Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 94, nr 2, s. 187-192Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of this study was to explore the interaction between diabetes specialist nurses (DSNs) and patients with type 2 diabetes (T2D) during group sessions about self-management.

    Methods: Ten DSNs and 44 patients were observed during group sessions about self-management, and thereafter the observations were analyzed using qualitative content analysis.

    Results: The interaction was characterized by three themes: becoming empowered, approaching each other from different perspectives, and struggling for authority. The interaction was not a linear process, but rather a dynamic process with distinct episodes that characterized the content of the sessions.

    Conclusion: It is important to achieve an interaction that is patient-centered, where the DSN is aware of each patient's individual needs and avoids responding to patients in a normative way. A satisfying interaction may strengthen patients' self-management, and also may strengthen the DSNs in their professional performance.

    Practice implications: Authority struggles between patients and DSNs could be a prerequisite for patients to become autonomous and decisive in self-management. DSNs might benefit from an increased awareness about this issue, because they can better support patients if they do not perceive authority struggles as threats to their professional role.

  • 6.
    Boström, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lehuluante, Abraraw
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Patient-centred care in type 2 diabetes: an altered professional role for diabetes specialist nurses2014Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, nr 4, s. 675-682Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 7.
    Dorell, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Östlund, Ulrika
    Centre for Research & Development, Uppsala University/ Region Gävleborg, Gävle.
    Sundin, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Family Health Conversations have positive outcomes on families: A mixed method study2017Ingår i: Open Nursing Journal, E-ISSN 1874-4346, nr 11, s. 14-25Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A Family Systems Nursing intervention, “Family Health Conversations” (FamHC) was conducted in order to strengthen the health of families having relatives at residential home for older people. Having a family member living in a residential home affects the entire family and can be hard to handle. Family members require encouraging and open communication support from nurse during and after relocation to a residential home.

    Objectives: The aims of this study were to evaluate the responses to and effects of the Family Health Conversations in families with a member living at a residential home for older people and to integrate the empirical results with a theoretical assumption upon which the intervention was based.

    Methods: A mixed method research design was used. The Swedish Health-Related Quality of Life Survey and the Family Hardiness Index were administered before and 6 months after the intervention. Qualitative data was collected by semi-structured interviews with each family 6 months post-intervention. The sample included families of residents, a total of 10 families comprising 22 family members.

    Result: Main finding was that FamHCs helped family members process their feelings about having a member living at a residential home and made it easier for them to deal with their own situations. FamHCs helped to ease their consciences, improve their emotional well-being, and change their beliefs about their own insufficiency and guilt. Seeing problems from a different perspective facilitated the families’ thinking in a new way.

    Conclusion: These findings showed that FamHC can be an important type of intervention to improve family functioning and enhance the emotional well-being.

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  • 8.
    Fischer Grönlund, Catarina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Brännström, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Psychometric testing of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP)2023Ingår i: BMC Medical Ethics, E-ISSN 1472-6939, Vol. 24, nr 1, artikel-id 35Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Moral distress has been described as moral constraints and uncertainty connected with guilty feelings of being unable to give care in accordance with one's values for good care. Various instruments to measure moral distress have been developed. The instrument measure of moral distress for healthcare professionals (MMD-HP) was developed to capture the experience and frequency of moral distress among various healthcare professionals. The MMD-HP has been translated and culturally adapted into the Swedish language and context; however, the translation has not been validated. Therefore, this study aimed to evaluate the validity and reliability of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP).

    Methods: Eighty-nine staff from various professions at a hospital in northern Sweden participated in the study. A confirmatory factor analysis was performed to check for consistency with the original version of the MMD-HP. To evaluate internal consistency, Cronbach's alpha was calculated for each domain and for the scale as a whole.

    Results: The scale as a whole showed a Cronbach's alpha of 0.96, with a range between 0.84 and 0.90 between the different subscales. A confirmatory factor analysis based on the original four-factor structure showed good fit indices with a χ2/df of 0.67, CFI at 1.00, TLI at 1.02 and NFI at 0.97. RMSEA was at 0.00, and SRMR was at 0.08. A comparison of the total score between three equally large groups of years of experience at the present workplace showed no significant differences (F = 0.09, df = 2, p = 0.912).

    Conclusions: We found that the Swedish version of the MMD-HP has shown validity and reliability for use in a Swedish context for measuring moral distress among health personnel.

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  • 9.
    Fischer Grönlund, Catarina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Brännström, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Moral distress thermometer: Swedish translation, cultural adaptation and validation2023Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Moral distress is a problem and negative experience among health-care professionals. Various instruments have been developed to measure the level and underlying reasons for experienced moral distress. The moral distress thermometer (MDT) is a single-tool instrument to capture the level of moral distress experienced in real-time.

    Aim: The aim of this study was to translate the MDT and adapt it to the Swedish cultural context. R

    esearch design: The first part of this study concerns the translation of MDT to the Swedish context, and the second part the psychometric testing of the Swedish version.

    Participants and research context: 89 healthcare professionals working at a hospital in northern Sweden participated. Convergent validity was tested between MDT and Measure of Moral Distress-Healthcare Professionals (MMD-HP), and construct validity was tested by comparing MDT scores among healthcare professionals. MDT was compared with responses to the final questions in MMD-HP. One-way ANOVA, Welch’s ANOVA, Games–Howell post-hoc test and Pearson’s correlation analysis were done.

    Ethical considerations: The study was approved by the Swedish Ethics Review Authority (dnr 2020-04120) in accordance with Helsinki Declaration.

    Results: The translated Swedish version of MDT was described as relevant to capture the experience of moral distress. The mean value for MDT was 2.26, with a median of 2 and a mode value of 0. The result showed moderate correlations between the MDT and MMD-HP total scores. There was a significant difference when comparing MDT and healthcare professionals who had never considered leaving their present position with those who had left and those who had considered leaving but had not done so, with the latter assessing significantly higher moral distress.

    Conclusion: The MDT is an easily available instrument useful as an extension to MMD-HP to measure the real-time experience of moral distress among healthcare professionals in a Swedish context.

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  • 10.
    Fischer Grönlund, Catarina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Söderberg, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Dahlqvist, Vera
    Andersson, Lars
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Development, validity and reliability testing the Swedish Ethical Climate Questionnaire2019Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, nr 7-8, s. 2482-2493Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: An ethical climate has been described as a working climate embracing shared perceptions about morally correct behaviour concerning ethical issues. Various ethical climate questionnaires have been developed and validated for different contexts, but no questionnaire has been found concerning the ethical climate from an inter-professional perspective in a healthcare context. The Swedish Ethical Climate Questionnaire, based on Habermas’ four requirements for a democratic dialogue, attempts to assess and measure the ethical climate at various inter-professional workplaces. This study aimed to present the construction of and to test the psychometric properties of the Swedish Ethical Climate Questionnaire.

    Method: An expert group of six researchers, skilled in ethics, evaluated the content validity. The questionnaire was tested among 355 healthcare workers at three hospitals in Sweden. A parallel analysis (PA), an exploratory factor analysis and confirmatory factor analysis were performed.

    Ethical considerations: The participants included in the psychometric analysis were informed about the study, asked to participate in person and informed that they could withdraw at any time without giving any reason. They were also assured of confidentiality in the reporting of the results.

    Findings: The parallel analysis (PA) recommended one factor as a solution. The initial exploratory factor analysis with a four-factor solution showed low concordance with a four-factor model. Cronbach’s alpha varied from 0.75 to 0.82; however, since two factors only consisted of one item, alpha could not be reported. Cronbach’s alpha for the entire scale showed good homogeneity (α = 0.86). A confirmatory factory analysis was carried out based on the four requirements and showed a goodness-of-fit after deleting two items. After deletion of these items, Cronbach’s alpha was 0.82.

    Discussion: Based on the exploratory factor analysis, we suggest that the scale should be treated as a one-factor model. The result indicates that the instrument is unidimensional and assesses ethical climate as a whole.

    Conclusion: After testing the Swedish Ethical Climate Questionnaire, we found support for the validity and reliability of the instrument. We found the 10-item version of Swedish Ethical Climate Questionnaire satisfactory. However, we found no support for measuring different dimensions and, therefore, this instrument should be seen as assessing ethical climate as of whole.

  • 11.
    Gustafsson, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, 171 77 Stockholm, Sweden.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Behavioral and psychological symptoms and psychotropic drugs among people with cognitive impairment in nursing homes in 2007 and 20132016Ingår i: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 72, nr 8, s. 987-994Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The use of psychotropic drugs to treat behavioral and psychological symptoms among people with dementia has been widely questioned because of its limited efficacy and risk of harmful side-effects. The objectives of this study was to compare the prevalence of behavioral and psychological symptoms and the use of psychotropic drug treatments among old people with cognitive impairment living in geriatric care units in 2007 and 2013.

    METHODS: Two questionnaire surveys were performed in 2007 and 2013, comprising all those living in geriatric care units in the county of Västerbotten in northern Sweden. A comparison was made between 1971 people from 2007 and 1511 people from 2013. Data were collected concerning psychotropic and antidementia drug use, functioning in the activities of daily living (ADL), cognition, and behavioral and psychological symptoms, using the Multi-Dimensional Dementia Assessment Scale (MDDAS).

    RESULTS: Between 2007 and 2013, the use of antipsychotic drugs declined from 25.4 to 18.9 %, and of anxiolytic, hypnotic, and sedative drugs from 35.5 to 29.4 %. The prevalence of people prescribed antidepressant drugs remained unchanged while antidementia drug prescription increased from 17.9 to 21.5 %. When controlled for demographic changes, 36 out of 39 behavioral and psychological symptoms showed no difference in prevalence between the years.

    CONCLUSIONS: The use of antipsychotic, anxiolytic, hypnotic, and sedative drugs declined considerably between 2007 and 2013 among old people with cognitive impairment living in geriatric care units. Despite this reduction, the prevalences of behavioral and psychological symptoms remained largely unchanged.

  • 12.
    Gustafsson, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Lämås, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Constipation and laxative use among people living in nursing homes in 2007 and 20132019Ingår i: BMC Geriatrics, E-ISSN 1471-2318, Vol. 19, artikel-id 38Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Constipation is a common condition among older people, particularly among people living in nursing homes, and the use of drugs such as opioids is one of many factors that contribute to its high prevalence. The aim of this study was to compare the prevalence of constipation and the use of laxatives between 2007 and 2013, to analyze constipation and laxative use among people who are prescribed opioids, and to identify factors associated with constipation. Methods: In 2007 and 2013, two surveys were performed in the county of Vasterbotten in Northern Sweden, comprising all those living in nursing homes. The Multi-Dimensional Dementia Assessment Scale was used to collect data regarding laxative, opioid and anticholinergic drug use, functioning in activities of daily living (ADL), cognition and symptoms of constipation. A comparison was made between 2820 people from 2007 and 1902 people from 2013. Results: The prevalence of symptoms of constipation among people living in nursing homes increased from 36% in 2007 to 40% in 2013. After controlling for age, sex, ADL, cognitive impairment and use of opioid and anticholinergic drugs, this difference was found to be statistically significant. When controlled for demographic changes, there was a statistically significant difference in the regular use of laxatives between the respective years, from 46% in 2007 to 59% in 2013. People prescribed opioids and anticholinergic drugs were at increased risk of constipation, while people with a higher ADL score were at decreased risk. Further, among people prescribed opioids and rated as constipated, 35% in 2007 and 20% in 2013 were not prescribed laxatives for regular use, a difference that was found to be statistically significant. Conclusions: The prevalence of symptoms of constipation increased between 2007 and 2013. Although there was a decrease between the years, there were still a number of people being prescribed with opioids and rated as constipated who were not treated with laxatives. This study therefore indicates that constipation remains a significant problem among people in nursing homes and also indicates that those prescribed opioids could benefit from an increased awareness of the risk of constipation and treatment, if required.

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  • 13.
    Gustafsson, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Sandman, Per-Olof
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, 171 77 Stockholm, Sweden.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Schneede, Jörn
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Sjölander, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Reduction in the use of potentially inappropriate drugs among old people living in geriatric care units between 2007 and 20132015Ingår i: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 71, nr 4, s. 507-515Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The aims of this study were to investigate trends in the prevalence of potentially inappropriate drug use among old people living in geriatric care units in the county of Västerbotten between 2007 and 2013 using six national quality indicators and to assess the impact of medication reviews on those quality indicators.

    METHODS: Data were collected concerning potentially inappropriate drug use, function in the activities of daily living (ADL) and cognitive function, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). A comparison was made between the years 2007 and 2013, comprising 2772 and 1902 people, respectively, living in geriatric care in the county of Västerbotten, Sweden. We conducted a parallel investigation of a separate corresponding population in Västerbotten County from 2012, where potentially inappropriate drug use was measured before and after 895 medication reviews which involved a clinical pharmacist.

    RESULTS: After controlling for age, sex, ADL and cognitive impairment, there was a significant improvement in five out of six quality indicators between 2007 and 2013. While 44 % of the people were exposed to one or more potentially inappropriate medications in 2007, this number had declined to 26 % by 2013. In the separate population from 2012, the frequency of potentially inappropriate drug use was significantly reduced amongst the people who had a medication review performed.

    CONCLUSION: The extent of potentially inappropriate drug use declined between 2007 and 2013 according to the quality indicators used. Medication reviews involving clinical pharmacists might be an important factor in reducing potentially inappropriate drug use and improving drug treatment among old people.

  • 14.
    Hajdarevic, Senada
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sundbom, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Schmitt-Egenolf, Marcus
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Dermatologi och venereologi.
    Health care delay in malignant melanoma: various pathways to diagnosis and treatment2014Ingår i: Dermatology Research and Practice, ISSN 1687-6105, E-ISSN 1687-6113, s. 294287-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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  • 15.
    Hajdarevic, Senada
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Dermatologi och venereologi. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Schmitt-Egenolf, Marcus
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Dermatologi och venereologi.
    Sundbom, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Coping styles in decision making among men and women diagnosed with malignant melanoma2013Ingår i: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 18, nr 11, s. 1445-1455Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 16.
    Hemmingsson, Eva-Stina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustavsson, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Gustavsson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Sweden; Department of Health Sciences, Luleå University of Technology, Sweden.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Prevalence of pain and pharmacological pain and treatment among old people in nursing homes in 2007 and 20132018Ingår i: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 74, nr 4, s. 483-488Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Many elderly people living in nursing homes experience pain and take analgesic medication. The aim of this study was to analyze the prevalence of pain and pharmacological pain treatment among people living in nursing homes in Sweden, in two large, comparable, samples from 2007 to 2013.

    Methods: Cross-sectional surveys were performed in 2007 and 2013, including all residents in nursing homes in the county of Västerbotten, Sweden. A total of 4933 residents (2814 and 2119 respectively) with a mean age of 84.6 and 85.0 years participated. Of these, 71.1 and 72.4% respectively were cognitively impaired. The survey was completed by the staff members who knew the residents best.

    Results: The prescription of opioids became significantly more common while the use of tramadol decreased significantly. The staff reported that 63.4% in 2007 and 62.3% in 2013 had experienced pain. Of those in pain, 20.2% in 2007 and 16.8% in 2013 received no treatment and 73.4 and 75.0% respectively of those with pain, but no pharmacological treatment, were incorrectly described by the staff as being treated for pain.

    Conclusions: There has been a change in the pharmacological analgesic treatment between 2007 and 2013 with less prescribing of tramadol and a greater proportion taking opioids. Nevertheless, undertreatment of pain still occurs and in many cases, staff members believed that the residents were prescribed analgesic treatment when this was not the case.

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  • 17.
    Hällgren Graneheim, Ulla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Female caregivers' perceptions of reasons for violent behaviour among nursing home residents2012Ingår i: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 19, nr 2, s. 154-161Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Accessible summary

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

    Abstract

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

  • 18.
    Hällgren Graneheim, Ulla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Persson Ljung, Inga-Maj
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jansson, Lilian
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Balancing between contradictions: the meaning of interaction with people suffering from dementia and "behavioral disturbances"2005Ingår i: The International Journal of Aging & Human Development, ISSN 0091-4150, E-ISSN 1541-3535, Vol. 60, nr 2, s. 145-157Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Interacting with people who suffer from dementia poses a challenge for care providers, and the presence of behavioral disturbances adds a further complication. Our article is based on the assumption that behavioral disturbances are meaningful expressions of experiences. Six narrative interviews were conducted with care providers with the aim of illuminating the meaning of interaction with people suffering from dementia and behavioral disturbances. The interviews were tape-recorded, transcribed into text, and interpreted using a phenomenological hermeneutic methodology. The findings indicate that interacting with people with dementia and behavioral disturbances, as narrated by care providers, means balancing between contradictions concerning meeting the person in my versus her/his world, feeling powerless versus capable, and feeling rejected versus accepted. Interaction involves being at various positions along these continua at different points in time. Furthermore, it means facing ethical dilemmas concerning doing good for the individual or the collective. This is interpreted as a dialectic process and is reflected on in light of Hegel's reasoning about the struggle between the master and the slave.

  • 19.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Exposure to challenging behaviour from nursing home residents is associated with reduced general health and work ability, and increased burnout reported by nurses2013Ingår i: Evidence-Based Nursing, ISSN 1367-6539, E-ISSN 1468-9618, Vol. 16, nr 4, s. 124-125Artikel i tidskrift (Övrigt vetenskapligt)
  • 20.
    Isaksson, Ulf
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Våld mot vårdare i sjukhemsvård2008Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    This thesis aimed to explore factors related to the prevalence of violence towards caregivers working in a nursing home context. The aim was also to describe caregivers’ perceptions and experiences of violence in a nursing home context. The thesis comprises four studies. Study I includes data regarding environmental and organizational factors, residents’ and caregivers’ characteristics, and violence. Data concerning job satisfaction and working climate were also obtained. In study II, questionnaires were used to collect data concerning caregivers’ exposure to violence and their personal characteristics. Data concerning personality traits, coping resources, and burnout were collected by means of instruments. In order to illuminate caregivers’ perceptions of violence (III) and experiences of being exposed to violence (IV) interviews were performed. Quantitative data were analyzed by means of comparative and descriptive statistics. The interviews were transcribed and interpreted using a qualitative content analysis method.

    The results showed that 15 percent of the residents exhibited violent behaviour during the week of in-vestigation. A significant higher proportion of male residents were assessed by the caregivers to present violent behaviour compared to female residents. A discriminate analysis showed that the prevalence of behavioural symptoms and psychiatric symptoms, residents needing assistance with dressing, the caregivers’ psychological workload, and job satisfaction were the strongest discriminators between nursing home wards with a high versus low proportion of residents with violent behaviour (I).

    The results from study II showed that among the 196 caregivers participating in the study, 68 % re-ported exposure to violence during the previous year. Twenty-two percent reported exposure several times per week, and 51 % reported exposure at least once during the previous month. A higher proportion of caregivers 50 years or younger were exposed to violence compared to older caregivers. A higher proportion of caregivers with a work experience of three years or more reported exposure to violence compared to less experienced caregivers. A higher proportion caregivers who reported exposure to violence assessed symptoms on burnout and motherly rejection. No significant differences between the two groups were found concerning coping resources, defence mechanisms, temperament, and character.

    Study III showed that caregivers’ perceptions of violence are subjective and in the eye of the beholder. The caregivers perceive violence as challenging and expressed that caring situations had to be solved even though their own safety is perceived to be in danger. The caregivers perceive violence as intentional when the residents are judged to have a good cognitive capacity and are perceived to be conscious. However, the care-givers perceive violence as excusable when the residents are described as old and sick. The caregivers perceive violence as ordinary and as a part of the work situation. The caregivers also perceive violence as contextual since similar violence is accepted at the work place but not outside it.

    The result from study IV showed that the caregivers’ experiences of exposure to violence range be-tween being overwhelmed by contradictory emotions and being resigned. The caregivers have preconceived ideas towards the violent behaviour and describe being on guard in order to avoid being exposed to violence. The caregivers experience that they lose the control over a violent situation and strive to regain the control. They are overwhelmed by emotions such as surprise, anger, and repulsiveness and describe a resignation hav-ing to care for violent residents. Caring for violent residents is described as a constant struggle and the care-givers express a disappointment over insufficient support. The caregivers strive to regain the control by means of seeking excuses for the violent behaviour or by support from colleagues.

    The conclusions from this thesis are that the prevalence of violence is related to factors among the residents as well as the caregivers, that caregivers’ perceptions of violence are subjective and caregivers’ experi-ences varies between being overwhelmed by contradictory emotions and resignation. There is a risk that vio-lence in nursing homes becomes a norm, is accepted, and in this way is maintained. The boundary between what is acceptable and what is not acceptable becomes erased, the caregiver resigns, and the violence is not looked upon as a divergence but becomes a part of the working situation. It is therefore important that the problems with violence at nursing homes are attended to and that the caregivers are supported in their work.

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  • 21.
    Isaksson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Aström, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Factors associated with the prevalence of violent behaviour among residents living in nursing homes2009Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, nr 7, s. 972-980Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study was to investigate the associations between environmental and organisational factors as well as resident and caregiver characteristics in nursing home wards with a high respectively low prevalence of residents with violent behaviour. BACKGROUND: Earlier studies have indicated that different factors are related to violent behaviour among residents living in nursing homes, such as environmental and organisational variations, and resident and caregiver characteristics. However, few studies have simultaneously examined the relationship between these factors. DESIGN: A cross-sectional descriptive survey design. METHODS: The study was performed in 10 nursing homes consisting of 33 wards. Data were collected using the Multi-Dimensional Dementia Assessment Scale and the Geriatric Rating Scale. Variables concerning organisation and environment were gathered by means of a questionnaire. Differences between wards with high (HPW) or low prevalence of violence (LPW) were analysed. RESULTS: In HPWs, the prevalence of behaviour and psychiatric symptoms, residents needing assistance with dressing and psychological workload were found to be higher, while job satisfaction was lower compared to LPWs. This study has also shown that caregivers in HPWs had less experience of working with older people and they experienced their working climate as less positive. Furthermore, HPWs had more residents, lower caregiver-to-resident ratio and longer corridors, and caregivers in these wards experienced more difficulties to supervise the residents. CONCLUSION: This study has shown that the prevalence of residents with violent behaviour is significantly associated with other behavioural and psychiatric symptoms and ADL (activities of daily life)-functions, as well as caregivers' experiences of job satisfaction and psychological workload. RELEVANCE TO CLINICAL PRACTICE: This study underlines the importance of a multifactorial approach to understand the prevalence of violent behaviour, including the physical environment, organisational factors, as well as characteristics of the resident and the caregiver.

  • 22.
    Isaksson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Graneheim, Ulla Hällgren
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Åström, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Female caregivers' experiences of exposure to violence in nursing homes2009Ingår i: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 16, nr 1, s. 46-53Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Although earlier studies have examined caregivers' experiences of exposure to violence, few have investigated female caregivers working in nursing homes with a specific focus on experiences throughout the entire scenario of a violent situation. This study illuminates female caregivers' experiences of being exposed to violence in nursing homes. Twenty caregivers working in three nursing homes located in northern Sweden were asked to narrate about a situation in which they had been exposed to violence. Their narratives were analysed by using qualitative content analysis. We found that the caregivers had preconceived ideas about violent behaviour, that they experienced a loss of control over the situation, and that they then strove to regain control. Experiences such as these may influence caregivers' interactions with residents who display violent behaviour. As a result of violent interactions, caregivers may distance themselves from the residents, an attitude that may decrease the quality of care. There is a risk that violence in nursing homes is accepted and normalized as a part of the job and hence persists.

  • 23.
    Isaksson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hajdarevic, Senada
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Abramsson, MaiGreth
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Stenvall, Jessica
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hornsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Diabetes empowerment and needs for self-management support among people with type 2 diabetes in a rural inland community in northern Sweden2015Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, nr 3, s. 521-527Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 24.
    Isaksson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hajdarevic, Senada
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jutterström, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Validity and reliability testing of the Swedish version of Melbourne Decision Making Questionnaire2014Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, nr 2, s. 405-412Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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  • 25.
    Isaksson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Richter, Jörg
    Eisemann, Martin
    Åström, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Exposure to violence in relation to personality traits, coping abilities, and burnout among caregivers in nursing homes: a case-control study.2008Ingår i: Scandinavian journal of caring sciences, ISSN 1471-6712, Vol. 22, nr 4, s. 551-559Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Although violence toward caregivers occurs often and caregivers' ability to interact and deal with difficult situations is relevant in preventing such violence, few studies have been conducted that focus on caregivers' characteristics.

    AIM: This study explores the relationship between perceived exposure to violence and demographical factors, parental rearing, personality traits including coping abilities, defence styles, and burnout among caregivers working in nursing homes.

    METHOD: A total of 196 caregivers working in nursing homes were included. They were asked to complete questionnaires concerning demographical factors and exposure to violence. One group of female caregivers reporting no exposure to violence (n = 20) was matched with one group of exposed to violence (n = 20). Both groups were asked to complete questionnaires concerning parental rearing, personality traits, coping abilities, and burnout.

    RESULT: Around 68.4% of the caregivers had been exposed to violence during the previous year and 22.4% several times a week. Caregivers 50 years of age or younger and employed in geriatric care for more than 3 years were more frequently exposed to violence. Inter-group differences were found regarding 'maternal rejection' and 'burnout'. No statistical differences could be found concerning defence styles, coping ability, temperament, or character aspects.

    CONCLUSION: Violence toward caregivers occurs frequently and appears to be influenced by several factors. 'Maternal rejection' and 'burnout' among caregivers exposed to violence might influence the communication between caregivers and residents, rendering more violence. However, personality traits among caregivers do not seem to be associated with exposure to violence.

  • 26.
    Isaksson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Åström, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Physically violent behaviour in dementia care: characteristics of residents and management of violent situations2011Ingår i: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 15, nr 5, s. 573-579Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Physically violent behaviour (PVB) is common among residents with dementia and often complicates nursing care. This study aims to explore types of caring situations, resident characteristics related to PVB and professional caregivers' management of PVB.

    Methods: The study included 40 group homes for 309 residents with dementia. Data was gathered by means of structured interviews, the Multi-Dimensional Dementia Assessment Scale and the Geriatric Rating Scale.

    Results: Ninety-eight of the residents (31.7%) were assessed as showing PVB during the preceding week. Three factors were independently associated with PVB: male gender, antipsychotic treatment and decline in orientation. Violent residents were more likely to have impaired speech, difficulties understanding verbal communication and prescribed analgesics and antipsychotics than were non-violent residents. PVB occurred mainly in intimate helping situations and was managed by symptom-oriented approaches, such as distraction, medication and isolation. The working team also held frequent discussions about the residents with PVB.

    Conclusion: This study shows that PVB is frequently displayed among residents in group homes for persons with dementia and the caregivers mainly manage PVB in a symptom-oriented way. To enhance the quality of care for patients with dementia, there is a need for interventions that aim to understand and manage the residents' physical violent behaviour.

  • 27.
    Isaksson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lämås, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Från undersköterska till doktor: En resa i Edmund Hillary och Tenzing Norgays fotspår2009Rapport (Övrig (populärvetenskap, debatt, mm))
  • 28.
    Isaksson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Santamäki-Fischer, Regina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Åström, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Supporting the oldest old when completing a questionnaire: risking bias or gaining reliable results?2007Ingår i: Research on aging, Vol. 29, nr 6, s. 576-89Artikel i tidskrift (Refereegranskat)
  • 29.
    Isaksson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Åström, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Being flexible and tuning in: professional caregivers' reflections on management of violent behaviour in nursing homes2013Ingår i: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 8, nr 4, s. 290-298Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectives: This qualitative, descriptive study aimed to illuminate professional caregivers' reflections on managing residents' violent behaviour in nursing homes.

    Background: Violence towards caregivers in the care of older people is a challenge attracting increasing attention in nursing research. However, studies that focus on the approaches caregivers in nursing homes resort to and how they manage everyday care situations involving threats and violent situations are relatively few.

    Methods: The study was based on 41 interviews in which the caregivers reflected on their own courses of action in violent situations. The interviews were subjected to qualitative content analysis.

    Results: This study showed that caregivers were flexible and in tune with the resident by averting and defusing threatening and violent situations. The caregivers tried to give care in line with the residents' condition, control their own spontaneous reactions and interpret the residents' reactions as communicative signs indicating how they should interact with the resident in the situation. As a last resort, when previous approaches had been unsuccessful, the caregivers took a firm stand, confronted the resident and the violent behaviour more directly, but with respect and with the residents' best interests in mind.

    Conclusions: These findings illuminate how caregivers successfully can manage threatening and violent behavior in nursing homes by being flexible and tuning in with the resident but also by taking a firm stand with the residents' best interests in mind. To be flexible and in tune with residents, it is important to know the residents' personal histories. This may mean involving stakeholders, such as family members and friends, in the care of residents with violent behaviour.

    Implications for practice: We believe that it is important to involve stakeholders in the care of threatening and violent residents in nursing homes as it is important to get information on the residents' personal history. However, there are risks when interpreting residents' behaviour in light of their personal histories as relatives experiences may be subjective and the information may give the caregivers preconceived ideas about the resident.

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  • 30.
    Isaksson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Åström, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    In the eye of the beholder: How female caregivers in nursing homes perceive violence2007Ingår i: 5th European congress on violence in clinical psychiatry., 2007Konferensbidrag (Refereegranskat)
  • 31.
    Isaksson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Åström, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Violence in nursing homes: perceptions of female caregivers.2008Ingår i: Journal of clinical nursing, ISSN 1365-2702, Vol. 17, nr 12, s. 1660-6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: This study illuminates how female caregivers in nursing home perceive violence.

    BACKGROUND: Previous studies have focused on prevalence and types of violence and injuries in various settings and among various professionals. There are, however, few studies that examine how caregivers perceive violence.

    METHODS: Forty-one female caregivers at nursing homes were asked to reflect on a vignette containing a situation where a female caregiver is exposed to violence from a male resident. The reflections were analysed by qualitative content analysis.

    FINDINGS: The main finding indicates that perceiving an action as violent is in the eye of the beholder. Caregivers perceive violence to be challenging, intentional, excusable, ordinary and contextual relative to their own experience and attitudes.

    CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: As the perception of violence is subjective, there is a risk that violent incidents will be under-reported as well as over-reported. To avoid this, it is important to construct a well-defined operationalised definition of violence for research purposes. Our findings also indicate the need for individually structured and adjusted support for caregivers. To explore the complexity of violence, further research should focus on how caregivers and residents experience violence in a nursing home.

  • 32.
    Jutterström, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ideal versus real conditions for type 2 diabetes care: diabetes specialty nurses’ perspectives2012Ingår i: The Internet Journal of Advanced Nursing Practice, ISSN 1523-6064, Vol. 11, nr 2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

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  • 33.
    Jutterström, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandström, Herbert
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes: A randomized study2016Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, nr 11, s. 1821-1829Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 34.
    Jutterström, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandström, Herbert
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Turning points in self-management of type 2 diabetes2012Ingår i: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 9, nr 2, s. 46-50Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 35.
    Jutterström, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandström, Herbert
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Diabetes control by patient-centred self-management support: a randomised controlled trialManuskript (preprint) (Övrigt vetenskapligt)
  • 36.
    Lindbo, Agnes
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustafsson, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Sweden; Department of Health Sciences, Luleå University of Technology, Sweden.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Dysphoric symptoms in relation to other behavioral and psychological symptoms of dementia, among elderly in nursing homes2017Ingår i: BMC Geriatrics, E-ISSN 1471-2318, Vol. 17, nr 1, artikel-id 206Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are common and varied in the elderly. The aim of the current study was to explore associations between BPSD and dysphoric symptoms at different levels of cognitive impairment.

    METHODS: Assessments of 4397 elderly individuals living in nursing homes in Sweden were performed. Data on cognitive function and BPSD were collected using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The relationships between dysphoria and eight BPSD factors were plotted against cognitive function to investigate how dysphoria affects BPSD throughout the dementia disease.

    RESULTS: Overall, dysphoric symptoms were most prevalent in persons with moderate cognitive impairment. However, moderate to severe dysphoric symptoms showed no clear variation with cognitive impairment. Furthermore, aggressive behavior, verbally disruptive/attention-seeking behavior, hallucinatory symptoms and wandering behavior were more common with concurrent dysphoria regardless of cognitive function. In contrast, passiveness was more common with concurrent dysphoria in mild cognitive impairment but not in moderate to severe cognitive impairment.

    CONCLUSIONS: BPSD, including aggressive behavior and hallucinations, were more common with concurrent dysphoric symptoms, providing insight into behavioral and psychological symptoms among individuals with cognitive impairment. Apathy was more commonly associated with concurrent dysphoria at early stages of cognitive decline but not at later stages, indicating that apathy and dysphoria represent separate syndromes among elderly patients with moderate to severe cognitive impairment.

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  • 37.
    Ludvigsson, Carola
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Hajdarevic, Senada
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Experiencing improved assessment and control of pain in end-of-life care when using the Abbey Pain Scale systematically2020Ingår i: Nursing Open, E-ISSN 2054-1058, Vol. 7, nr 6, s. 1798-1806Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To describe staff's reflections on aspects influencing pain assessment at end‐of‐life (EoL) care in nursing homes before and after the implementation of the Abbey Pain Scale (APS).

    Background: People with cognitive impairment in the EoL care often suffer from underdiagnosed and undertreated pain due to the lack of knowledge and guidelines for systematic pain assessment.

    Methods: Semi‐structured focus group interviews were conducted and analysed using qualitative content analysis.

    Results: The staff described their experiences before the implementation of APS as striving to achieve control of pain by trusting in themselves and the team, while the experiences after the implementation of APS were described as improving symptom control with remaining weak confidence in the team .

    Conclusions: Implementation of APS was experienced as improving systematic pain assessment. Efforts to establish clear routines and improve confidence in the care team would be prioritized to optimize pain assessment and pain relief in EoL care.

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  • 38.
    Lundell, Sara
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Coe, Anna-Britt
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Harrison, Samantha L.
    Teesside University, School of Health and Life Sciences, Centuria Building, Middlesbrough, UK.
    Hajdarevic, Senada
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Swedish translation and psychometric testing of the self-conscious emotions in COPD questionnaire2024Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 226, artikel-id 107624Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Assessment of self-conscious emotions is important to develop tailored interventions for people with chronic obstructive pulmonary disease (COPD). Previous instruments have largely been developed for mental health populations. The Self-Conscious Emotions in COPD Questionnaire was the first instrument to assess self-conscious emotions in people with COPD, but it was only available in English.

    The aim was to translate the Self-Conscious Emotions in COPD Questionnaire into Swedish and to evaluate its psychometric properties and internal structure in a Swedish context.

    The translation process included forward and backward translation, a multidisciplinary meeting, assessment of content validity, and cognitive interviews. The translated instrument was tested in a sample of 173 people with COPD between September 2021 and September 2022. Parallel analysis (PA), exploratory factor analysis (EFA), and test-retest reliability was performed.

    The content validity index (CVI) for the instrument was 0.88. Based on the PA, an EFA with a two-factor solution was conducted, with a high Cronbach's alpha (0.786-0.821), and one item about self-blame was excluded. The two factors were labelled: The burden of living with a disability and The desire to hide vulnerability. Test-retest reliability showed no difference between scale scores on factor or item level, except for one item.

    The Swedish Self-Conscious Emotions in COPD showed good validity and reliability. One item was excluded from the two subscales, indicating that the instrument needs to be further developed to cover the concept of self-blame. The instrument is expected to be a valuable tool for assessing self-conscious emotions in people with COPD.

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  • 39.
    Lundström, Mats
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Handbok för hälso- och sjukvårdspersonal. Hot och våld inom vården: hantering och bemötande.2010Övrigt (Övrig (populärvetenskap, debatt, mm))
  • 40.
    Lövheim, Hugo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustafsson, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk farmakologi.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Karlsson, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
    Gottfries' Cognitive Scale for Staff Proxy Rating of Cognitive Function Among Nursing Home Residents2019Ingår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 72, nr 4, s. 1251-1260Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: For research purposes, there is a need for tools to assess an individual's level of cognitive function. For survey-based investigations in nursing home contexts, proxy ratings allow the assessment also of individuals with severe cognitive impairment. Objective: The aim of this study was to describe the feasibility and psychometric properties of Gottfries' cognitive scale when used in a nursing home context for proxy rating of cognitive function. Method: The psychometric properties of Gottfries' cognitive scale were investigated in a sample of 8,492 nursing home residents in Vasterbotten County, Sweden, using item response theory and classic scale theory-based approaches. Results: Cognitive function could be scored in 97.1% of the assessed individuals. The scale had a negligible floor effect, it had items with a large spread in difficulties, it appeared linear, and it distributed the assessed individuals equally over the scale. Internal consistency (Cronbach's alpha) was 0.967, and an exploratory factor analysis revealed three factors of the scale - interpreted to represent orientation to time, to place, and to person. Conclusion: Gottfries' cognitive scale is a feasible tool for grading cognitive function among nursing home residents using staff proxy ratings. The scale has excellent psychometric properties with a very high internal consistency, a favorable distribution of item difficulties producing an almost rectangular distribution of scores, and a negligible floor effect. The scale thus can be recommended for use in survey-based investigations in nursing home contexts.

  • 41.
    Norberg, Catharina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Santamäki Fischer, Regina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Health Sciences, Åbo AkademiUniversity, Vasa, Finland.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Lämås, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Something wonderful and incomprehensible: Expressions and experiences of spirituality among very old people2019Ingår i: Journal for the Study of Spirituality, ISSN 2044-0243, E-ISSN 2044-0251, Vol. 9, nr 2, s. 125-137Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study aimed to illuminate very old people’s experiences and expressions of spirituality and is a part of the Umeå 85+/Gerontological Regional Database (GERDA). The participants (n = 12) had declared an interest in spirituality, were 86–99 years of age, and were interviewed in their own homes. The interviews were analyzed using qualitative content analysis. The findings revealed that spirituality was experienced as being in communion, transcending life’s circumstances, and living in a spiritual reality. Spirituality was expressed as an inner sense of communion with God and with other people, and as a spiritual reality. The participants expressed a desire to talk about spiritual experiences and personal beliefs but regarded spirituality as an uncommon topic. Nurses and other professionals need to be aware of spiritual needs and prepared to give spiritual care.

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  • 42.
    Norberg, Catharina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Santamäki Fischer, Regina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lämås, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Spirituality as it is perceived and expressed by the very old peopleManuskript (preprint) (Övrigt vetenskapligt)
  • 43.
    Nordlander, Marlene
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Perceptions of What Is Important for Appetite: An Interview Study With Older People Having Food Distribution2019Ingår i: Sage Open Nursing, E-ISSN 2377-9608, Vol. 5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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  • 44.
    Orre, Carl Johan
    et al.
    Dept. of Computer Science and Media Technology, DVMT, Malmö University, Sweden.
    Pusa, Susanna
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Tibblin, Anton
    Dept. of Computer Science and Media Technology, DVMT, Malmö University, Sweden.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Implementation and involvement of a dynamic instrument as a practice support in rehabilitation processes of chronic diseases2020Ingår i: Proceedings of the 6th International Conference on Design4Health: Volume 3 / [ed] Kirsty Christer; Claire Craig; Paul Chamberlain, Sheffield: Lab4Living, Sheffield Hallam University , 2020, s. 28-35Konferensbidrag (Refereegranskat)
    Abstract [en]

    In the rehabilitation of chronic and severe illnesses, it is common to use paper-based questionnaires to capture experiences of symptoms associated with illness or treatment. Managing such instruments consumes time, and offers care professionals a narrow space of possible actions toward the patients. The purpose of this paper was to report the initial concerns we encountered in the early phases involving a dynamic instrument in nursing practice. 

    This project is based on the Self Management Assessment Scale (SMASc) with the purpose to provide digital support that enables personalized work methods with the patient. With SMASc, patients answer questions on a mobile phone, tablet or computer. The compiled result is provided instantly before the patient-nurse consultation. SMASc is here understood as an interactive artefact with dynamic affordances. A dynamic instrument manifests a theoretical foundation aligning to the use situation, is programmable and digitally distributed, and offers individually compiled datafied views that connect the person's situation and the theoretical apparatus - in this case, a person's need for self-management support. 

    The data this report builds on was produced during two project meetings and throughout the design and development of the instrument prototype. Data analysis approach applied was an analysis focusing on emerging concerns surfacing from discussions that followed the introduction of the prototype. 

    We found that the nurses cared for the development of their practice and strived to advance and steer it in a more nursing-oriented direction. They did not fully comply with the instrument's item formulations and how these should or could be used. Further work has to be done to involve more stakeholders in the future work so that everyone feels engaged and can put their views on the design of the instrument, and on the implementation work itself.

  • 45.
    Pusa, Susanna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sundin, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Evaluation of the Implementation Process of a Family Systems Nursing Approach in Home Health Care: A Mixed-Methods Study2021Ingår i: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 27, nr 3, s. 235-249Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    To support the incorporation of Family Systems Nursing (FSN) in clinical practice, more understanding is needed about the implementation of FSN in home health practice settings. Thus, the aim of this study was to evaluate nurses' perspectives about the implementation process of Family Systems Nursing Conversations (FSNCs) in home health care. A mixed-methods research design was used, integrating qualitative and quantitative data, and using triangulation as a methodological metaphor. The Quality Implementation Framework (QIF) was applied to guide the implementation process, and Proctor et al.'s taxonomy of implementation outcomes was used to evaluate the process. The findings demonstrated that FSN implementation was in progress. Overall, acceptability and appropriateness of FSNCs were evaluated as positive by home health nurses; however, some obstacles were found relating to feasibility, adoption, and fidelity. These results contribute to an increased understanding of the process and challenges of implementing FSNCs in home health care.

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  • 46.
    Pusa, Susanna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sundin, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Implementation outcomes of a family systems nursing approach in home health care: A mixed-methods studyManuskript (preprint) (Övrigt vetenskapligt)
  • 47.
    Richter, Jörg
    et al.
    Regional Centre of Child and Adolescent Mental Health, Oslo, Norway.
    Åström, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Personality characteristics of staff in elderly care-a cross-cultural comparison2012Ingår i: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 33, nr 2, s. 96-100Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Communication and interaction between carers and residents in elderly and dementia care can be challenging and demanding. The carer's personality, one factor shaping this interaction, seems to have been neglected in the literature. This article looks at cross-cultural comparisons of staff in elderly and dementia care with individuals from the general population matched by age and gender. Compared to individuals in the general population, elderly and dementia care staff are usually slower tempered, more stoic and reflective, tolerant to monotony, and more systematic. They also have more optimistic attitudes in situations that might worry most people, and more confidence in social situations and in the face of danger and uncertainty.

  • 48.
    Sahlén, Klas-Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Isaksson, Ulf
    Östlund, Ulrika
    Lämås, Kristina
    Lindgren, Britt-Marie
    Enarsson, Per
    Juthberg, Christina
    Isaksson, Rose Marie
    Hajdarevic, Senada
    Saveman, Brittinger
    Nursing research in Sweden2014Ingår i: The Japanese Journal of Nursing Research, ISSN 0022-8370, Vol. 47, nr 2, s. 126-133Artikel i tidskrift (Refereegranskat)
  • 49.
    Sjöström, Anna E.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hajdarevic, Senada
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    eHealth literacy and health-related internet use among Swedish primary healthcare visitorsManuskript (preprint) (Övrigt vetenskapligt)
  • 50.
    Sjöström, Anna E.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hajdarevic, Senada
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Kristjánsdóttir, Ólöf
    Faculty of Nursing, University of Iceland, Reykjavik, Iceland.
    Castor, Charlotte
    Department of Health Sciences, Lund University, Lund, Sweden.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    The Swedish version of the eHealth literacy questionnaire: Translation, cultural adaptation, and validation study2023Ingår i: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 25, artikel-id e43267Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: With the increasing digitalization in health care, an effective instrument is necessary to assess health care consumers' digital competencies-their "eHealth literacy." The 7-scale eHealth Literacy Questionnaire (eHLQ), based on the theoretically robust eHealth Literacy Framework, has shown strong psychometric properties in Denmark and Australia.

    OBJECTIVE: The aim of this study was to translate, culturally adapt, and evaluate the psychometric properties of the Swedish version of the eHLQ.

    METHODS: We followed the Translation Integrity Procedure guidelines to translate and culturally adapt the questionnaire to Swedish using forward and backward translations, review by an expert panel, and cognitive interviewing. The psychometric properties of the Swedish eHLQ were investigated by evaluating its internal consistency (Cronbach α) and a priori-defined factor structure (confirmatory factor analysis).

    RESULTS: A total of 236 primary health care patients and parents of hospitalized children were included in the validation analysis. The mean age was 48.5 years, and 129 (55%) were women. All 7 eHLQ scales showed good internal consistency, with the Cronbach α ranging from .82 to .92. Single-factor and 7-factor confirmatory factor analysis showed satisfactory model-fit values. With one exception, all items demonstrated satisfactory loadings on their respective factors.

    CONCLUSIONS: The Swedish eHLQ demonstrated strong psychometric properties. It has the potential as a useful tool for a variety of purposes, including population surveys, intervention evaluations, and eHealth service implementations.

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