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Tingström, Pia
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Sund Levander, M. H. & Tingström, P. (2018). Fever or not fever - that's the question: A cohort study of simultaneously measured rectal and ear temperatures in febrile patients with suspected infection. Clinical Nursing Studies, 6(2), 47-54
Open this publication in new window or tab >>Fever or not fever - that's the question: A cohort study of simultaneously measured rectal and ear temperatures in febrile patients with suspected infection
2018 (English)In: Clinical Nursing Studies, ISSN 2324-7940, E-ISSN 2324-7959, Vol. 6, no 2, p. 47-54Article in journal (Refereed) Published
Abstract [en]

Objective: To study how ear and rectal body temperatures relate to each other over time in febrile patients.

Methods: Descriptive cohort study with repeated measurements. The setting was a Unit for Infectious Diseases at a county hospital in Sweden. Patients, ≥ 18 years, admitted for suspected infection and with a rectal or ear temperature of ≥ 37.5°C were invited. 16 females and 24 men, 19 to 94 years were included. Ear and rectal temperature was measured simultaneously every two hours for one day.

Results: Mean rectal temperature was higher, compared to both ear sites. Ninety-five percent of the differences between the rectal and ear sites were within 0.6°C to 1.1°C. Changes in rectal temperature were smaller and slower than in ear temperature, especially when patients were given temperature-lowering drugs.

Conclusions: Adjustments from one temperature site to another is a risk of diagnostic error affecting clinical decision-making. Ear temperature reacts faster than the rectal site to body temperature changes and antipyretics, and is therefore more reliable in the assessment of the patient’s condition. Traditional paradigm for temperature measurement and assessment needs to be replaced with evidence-based science to improve patient safety.

Place, publisher, year, edition, pages
Toronto, Canada: Sciedu Press, 2018
Keywords
Assessment, Body temperature, Clinical decision-making, Evidence-based practice, Fever, Nursing
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-145087 (URN)10.5430/cns.v6n2p47 (DOI)
Available from: 2018-02-09 Created: 2018-02-09 Last updated: 2018-03-05Bibliographically approved
Tingström, P., Jaarsma, T. & Nilsson, S. (2018). Patient empowerment and general self-efficacy in patients with coronary heart disease: a cross-sectional study. BMC Family Practice, 19, Article ID 76.
Open this publication in new window or tab >>Patient empowerment and general self-efficacy in patients with coronary heart disease: a cross-sectional study
2018 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 19, article id 76Article in journal (Refereed) Published
Abstract [en]

Abstract

Background:

In managing a life with coronary heart disease and the possibility of planning and following a

rehabilitation plan, patients

’ empowerment and self-efficacy are considered important. However, currently there is

limited data on levels of empowerment among patients with coronary heart disease, and demographic and clinical

characteristics associated with patient empowerment are not known.

The purpose of this study was to assess the level of patient empowerment and general self-efficacy in patients six

to 12 months after the cardiac event. We also aimed to explore the relationship between patient empowerment,

general self-efficacy and other related factors such as quality of life and demographic variables.

Methods:

A sample of 157 cardiac patients (78% male; age 68 ± 8.5 years) was recruited from a Swedish hospital.

Patient empowerment was assessed using the SWE-CES-10. Additional data was collected on general self-efficacy

and well-being (EQ5D and Ladder of Life). Demographic and clinical variables were collected from medical records

and interviews.

Results:

The mean levels of patient empowerment and general self-efficacy on a 0–4 scale were 3.69 (±0.54) and

3.13 (±0.52) respectively, and the relationship between patient empowerment and general self-efficacy was weak

(

r = 0.38). In a simple linear regression, patient empowerment and general self-efficacy were significantly correlated

with marital status, current self-rated health and future well-being. Multiple linear regressions on patient empowerment

(Model 1) and general self-efficacy (Model 2) showed an independent significant association between patient

empowerment and current self-rated health. General self-efficacy was not independently associated with any of the

variables.

Conclusions:

Patients with a diagnosis of coronary heart disease reported high levels of empowerment and general

self-efficacy at six to 12 months after the event. Clinical and demographic variables were not independently associated

with empowerment or low general self-efficacy. Patient empowerment and general self-efficacy were not mutually

interchangeable, and therefore both need to be measured when planning for secondary prevention in primary health

care.

Trial registration:

NCT01462799.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Patient empowerment, General self-efficacy, Coronary heart disease, Self-rated health, Well-being, Primary health care
National Category
Other Health Sciences Cardiac and Cardiovascular Systems General Practice
Identifiers
urn:nbn:se:liu:diva-148478 (URN)10.1186/s12875-018-0749-y (DOI)000434076700001 ()
Funder
The Swedish Heart and Lung Association, E091/10, E122/11, E083/12, E103/13
Note

Funding agencies: Swedish Heart and Lung Association [E091/10, E122/11, E083/12, E103/13]; County Council/Region Ostergotland, Sweden [LIO-92281, LIO-125151, LIO-27535, LIO-354951, LIO-433801]

Available from: 2018-06-12 Created: 2018-06-12 Last updated: 2019-04-17
Kärner Köhler, A., Nilsson, S., Jaarsma, T. & Tingström, P. (2017). Health beliefs about lifestyle habits differ between patients and spouses 1 year after a cardiac event – a qualitative analysis based on the Health Belief Model. Scandinavian Journal of Caring Sciences, 31(2), 332-341
Open this publication in new window or tab >>Health beliefs about lifestyle habits differ between patients and spouses 1 year after a cardiac event – a qualitative analysis based on the Health Belief Model
2017 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 2, p. 332-341Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Spousal concordance on risk factors and lifestyle habits exists and can partly be explained by patients' and spouses' health beliefs and underuse of cardiac rehabilitation. However, there have been very few qualitative comparisons of health beliefs between patients and spouses after a cardiac event.

AIM:

To examine and qualitatively compare the health beliefs of patients with coronary heart disease and their spouses about lifestyle habits, 1 year after the cardiac event.

DESIGN:

Explorative and descriptive.

METHOD:

Semi-structured focus group interviews were conducted with patients (n = 14) 1 year after a cardiac event, as well as individual interviews with spouses (n = 8). The transcriptions underwent a deductive qualitative content analysis, within the framework of the Health Belief Model.

FINDINGS:

Patients' and spouses' health beliefs about lifestyle habits qualitatively differed in most predetermined main analytical categories of the Health Belief Model. The patients relied more on their own capacity and the healthcare system than on collaboration with their spouses who instead emphasised the importance of mutual activities to establish lifestyle habits. The spouses therefore experienced problems with different family preferences compared to the patients' wishes. Moreover, only patients believed supervised exercise was beneficial for risk reduction of coronary heart disease and they related barriers for medication to a self-healing body and a meaningless life without relatives and old habits. Patients and spouses agreed that despite the severity of illness, life was captured and that normalisation to a life as usual was possible.

CONCLUSION:

The patients' and spouses' qualitatively different health beliefs regarding health-related behaviours imply a new approach. Nurses and associated professionals need to follow-up patients' and spouses' in primary health care to support them in a tailored way, for example in problem-based sessions. Recognition and understanding of their different views and otherness could lead to compromises and goals to work with.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Coronary Heart Disease, Primary Care, Health Psychology, Qualitative content analysis.
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-130771 (URN)10.1111/scs.12351 (DOI)000404644100014 ()27439667 (PubMedID)
Projects
The COR-PRIM study
Funder
Region Östergötland, Lio-433801
Note

Funding agencies: Swedish Heart and Lung Association [E103/13, E090/14]; Region Ostergotland, Sweden [LIO-433801]

Available from: 2016-08-23 Created: 2016-08-23 Last updated: 2018-07-02
Andersson, S.-O., Lundberg, L., Jonsson, A., Tingström, P. & Abrandt Dahlgren, M. (2015). Fixing the Wounded or Keeping Lead in the Air: Tactical Officers’ Views of Emergency Care on the Battlefield. Military medicine, 180(2), 224-229
Open this publication in new window or tab >>Fixing the Wounded or Keeping Lead in the Air: Tactical Officers’ Views of Emergency Care on the Battlefield
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2015 (English)In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 180, no 2, p. 224-229Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to identify tactical officers’ views of pre-hospital emergency care in the field before an international mission. A qualitative study with a phenomenographic approach based on interviews was used. The result of this study is a set of descriptive categories on a collective level, showing the variation in how the tactical officers perceived the phenomenon of emergency care in the battlefield. The result can be viewed as (1) noncombat oriented including being able to do one’s specialist task, being able to talk with local people and being able to give first aid, (2) combat oriented including soldiers’ skills and roles in the unit, being able to act in the unit and being able to lead the care of  injured These findings are important for officers’ preparation for international missions. The interaction between military and medical knowledge on-site care should be developed between the tactical officer and the medical personnel in order to minimize suffering and to enhance the possibility for survival of the casualty.

Place, publisher, year, edition, pages
Association of Military Surgeons Us, 2015
National Category
Social Sciences Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-111668 (URN)10.7205/MILMED-D-13-00558 (DOI)000349101900016 ()25643391 (PubMedID)
Note

Funding Agencies|Swedish Armed Forces; Centre for Defence Medicine; VastraFrolunda; Department of Medical and Health Sciences, University of Linkoping

Available from: 2014-10-28 Created: 2014-10-28 Last updated: 2017-12-05Bibliographically approved
Tingström, P., Milberg, A., Rodhe, N., Ernerudh, J., Grodzinsky, E. & Sund-Levander, M. (2015). Nursing assistants: "He seems to be ill" - a reason for nurses to take action: validation of the Early Detection Scale of Infection (EDIS). BMC Geriatrics, 15(122)
Open this publication in new window or tab >>Nursing assistants: "He seems to be ill" - a reason for nurses to take action: validation of the Early Detection Scale of Infection (EDIS)
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2015 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, no 122Article in journal (Refereed) Published
Abstract [en]

Background: Signs and symptoms of infection in frail elderly are atypical, causing delay in diagnosis and treatment. To improve communication between healthcare staff of signs and symptoms of infection we developed an instrument, using qualitative data from observations by nursing assistants when they suspected infection. The aim of this study was to assess the validity of nursing assistants observations by developing and testing the instrument for early detection of infection in elderly nursing home residents. Methods: The early detection of infection (EDIS) instrument was based on data from focus interviews with nursing assistants. Over one year the nursing assistants used EDIS to document episodes of suspected early signs and symptoms of infection in 204 nursing home residents. Two physicians classified documented episodes as "no infection", "possible infection", and "infection". The content validity of the 13 items of the EDIS was established to explore the relationships between the items. The construct validity was used to explore the relationship between the items and the presence or absence of infection. The predictive value of the developed model was evaluated by the percentage of correct classifications of the observed cases. Generalized linear model (ordinal multinomial distribution and logit link) was used. Results: Of the 388 events of suspected infection, 20 % were assessed as no infection, 31 % as possible infection and 49 % as infection. Content validity analysis showed that 12/13 of the items correlated significantly with at least one other statement. The range in number of significant inter-correlations was from 0 ("pain") to 8 ("general signs and symptoms of illness"). The construct validity showed that the items "temperature", "respiratory symptoms" and "general signs and symptoms of illness" were significantly related to "infection", and these were also selected in the model-building. These items predicted correct alternative responses in 61 % of the cases. Conclusion: The validation of EDIS suggests that the observation of "general signs and symptoms of illness", made by nursing assistants should be taken seriously in detecting early infection in frail elderly. Also, the statement "He/She is not as usual" should lead to follow-up.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2015
Keywords
Nursing home residents; Clinical assessment; Instrument validation; Instrument construction
National Category
Clinical Medicine Sociology
Identifiers
urn:nbn:se:liu:diva-122527 (URN)10.1186/s12877-015-0114-0 (DOI)000362866800002 ()26459627 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden; Futurum/The Academy for Health and Care, Jonkoping County, Sweden

Available from: 2015-11-09 Created: 2015-11-06 Last updated: 2017-12-01
Andersson, S.-O., Lundberg, L., Jonsson, A., Tingström, P. & Abrandt Dahlgren, M. (2014). Doctors’ and Nurses’ Perceptions of Military Pre-hospital Emergency Care.
Open this publication in new window or tab >>Doctors’ and Nurses’ Perceptions of Military Pre-hospital Emergency Care
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2014 (English)Manuscript (preprint) (Other academic)
Abstract [en]

The aim of this study was to identify physicians’ and nurses’ perceptions of military prehospital emergency care before and after an international mission. A qualitative empirical study with a phenomenographic approach was used. The aim is to identify the area of knowledge, pre-hospital care in a military environment, in terms of expressions from doctors and nurses focussing on the variation in how learning of pre-hospital care is perceived. The result of the study is a set of descriptive categories on a collective level, showing the variation in how doctors and nurses perceived the phenomenon of military pre-hospital emergency care. The results after predeployment training can be categorized as (1) to learn military medicine, (2) to take care of the casualty and (3) to have safety awareness. The results after an international mission can be categorized as (1) to collaborate with others, (2) to deliver general health care, and (3) to improve competence in military medicine. Possible implications of the results from the present study are the following; (I) better conditions for doctors and nurses to provide appropriate military medical care by clarification and better understanding of professions in the mission area (doctors, nurses, officers), since they may have different goals for their actions, (II) to pay attention to all aspects of military health care during predeployment training, including general health care in the mission area, (III) to implement new knowledge in military medicine in the predeployment training, and (IV) to train for the reality all doctors and nurses are about to meet. These results indicate  that the training should be developed in order to optimize the prepare physicians and nurses for international assignments. This may result in increased safety for the provider of care, while at the same time minimizing suffering and enhancing the possibility of survival of the injured.

National Category
Medical and Health Sciences Social Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-111669 (URN)
Available from: 2014-10-28 Created: 2014-10-28 Last updated: 2014-10-28Bibliographically approved
Grönlund, V., Rudenas, A., Appel, M., Ednarsson, T., Nilsson, S., Tingström, P., . . . Kärner Köhler, A. (2014). Problem-based learning after Coronary artery disease - how do patients experience it?. In: : . Paper presented at EuroHeartCare 2014, 4-5 April 2014, Stavanger, Norway. Sage Publications
Open this publication in new window or tab >>Problem-based learning after Coronary artery disease - how do patients experience it?
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2014 (English)Conference paper, Poster (with or without abstract) (Other academic)
Place, publisher, year, edition, pages
Sage Publications, 2014
Series
European Journal of Cardiovascular Nursing, ISSN 1474-5151 ; 2014:13, Suppl.1
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-107998 (URN)10.1177/1474515114521363 (DOI)
Conference
EuroHeartCare 2014, 4-5 April 2014, Stavanger, Norway
Note

The DOI links to a summary of all Moderated Posters. Se page S41 in PDF file for the publication (P 103).

Available from: 2014-06-25 Created: 2014-06-24 Last updated: 2016-08-31Bibliographically approved
Hjelmfors, L., Abrandt Dahlgren, M., Kärner, A. & Tingström, P. (2014). Problem-based learning used in the context of cardiac rehabilitation: different scenes and different roles. Studies in Continuing Education, 36(2), 218-232
Open this publication in new window or tab >>Problem-based learning used in the context of cardiac rehabilitation: different scenes and different roles
2014 (English)In: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 36, no 2, p. 218-232Article in journal (Refereed) Published
Abstract [en]

Several studies show that how patients have difficulties in changing lifestyle even though such changes are essential because they are suffering from a life-threatening disease. Coronary artery disease (CAD) patients met 13 times during a year and used problem-based learning (PBL) to improve their empowerment and self-efficacy in making lifestyle changes. District nurses functioned as tutors, helping patients to formulate issues and to state self-care goals. To identify and describe the enactment of PBL, an ethnographic approach was used, including, for example, participant observations and interviews, all derived from six sessions of the education programme. Five different enactments were found, metaphorically expressed as: ‘The study circle’, ‘The classroom’, ‘The expert consultation’, ‘The therapy session’ and ‘The coffee party’. The education programme did not always function as it was supposed to according to the model, but perhaps this should not be seen as a failure of the pedagogical intervention since these enactments as a whole seem to be a way for the patients to be able to make healthy lifestyle changes. The metaphors can broaden the understanding of what can happen when implementing problem-based learning in health care practice.

Place, publisher, year, edition, pages
Routledge, 2014
Keywords
problem-based learning, patient education, ethnography, lifestyle change, empowerment
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-107493 (URN)10.1080/0158037X.2014.904779 (DOI)000337964500008 ()
Projects
COR-PRIM
Available from: 2014-06-13 Created: 2014-06-13 Last updated: 2017-12-05Bibliographically approved
Sund-Levander, M. & Tingström, P. (2013). Clinical decision-making process for early nonspecific signs of infection in institutionalised elderly persons: experience of nursing assistants. Scandinavian Journal of Caring Sciences, 27(1), 27-35
Open this publication in new window or tab >>Clinical decision-making process for early nonspecific signs of infection in institutionalised elderly persons: experience of nursing assistants
2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 1, p. 27-35Article in journal (Refereed) Published
Abstract [en]

Aim: To illuminate nursing assistants experiences of the clinical decision-making process when they suspect that a resident has an infection and how their process relates to other professions.

Background: The assessment of possible infection in elderly individuals is difficult and contributes to a delayed diagnosis and treatment, worsening the goal of good care. Recently we explored that nursing assistants have a keen observational ability to detect early signs and symptoms that might help to confirm suspected infections early on. To our knowledge there are no published papers exploring how nursing assistants take part in the clinical decision-making process.

Design: Explorative, qualitative study.

Setting: Community care for elderly people.

Participants: Twenty-one nursing assistants, 2261years.

Methods: Focus groups with verbatim transcription. The interviews were subjected to qualitative content analysis for manifest and latent content with no preconceived categories.

Findings: The findings are described as a decision-making model consisting of assessing why a resident feels unwell, divided into recognition and formulation and strategies for gathering and evaluating information, influenced by personal experiences and preconceptions and external support system and, secondly, as taking action, consisting of reason for choice of action and action, influenced by feedback from the nurse and physician.

Conclusion: Nursing assistants assessment is based on knowing the resident, personal experiences and ideas about ageing. Nurses and physicians response to the nursing assistants observations had a great impact on the latters further action. A true inter-professional partnership in the clinical decision-making process would enhance the possibility to detect suspected infection early on, and thereby minimize the risk of delayed diagnosis and treatment and hence unnecessary suffering for the individual.

Relevance to clinical practice: In order to improve the clinical evaluation of the individual, and thereby optimise patient safety, it is important to involve nursing assistants in the decision-making process.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2013
Keywords
decision-making process, elderly people, infection and nonspecific signs
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-90195 (URN)10.1111/j.1471-6712.2012.00994.x (DOI)000314819900005 ()22536887 (PubMedID)
Available from: 2013-04-03 Created: 2013-03-21 Last updated: 2017-12-06Bibliographically approved
Arvidsson, S., Bergman, S., Arvidsson, B., Fridlund, B. & Tingström, P. (2013). Effects of a self-care promoting problem-based learning programme in people with rheumatic diseases: a randomized controlled study. Journal of Advanced Nursing, 69(7), 1500-1514
Open this publication in new window or tab >>Effects of a self-care promoting problem-based learning programme in people with rheumatic diseases: a randomized controlled study
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2013 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 7, p. 1500-1514Article in journal (Refereed) Published
Abstract [en]

Aim

To evaluate the effects of a self-care promoting problem-based learning programme for people with rheumatic diseases in terms of health-related quality of life, empowerment, and self-care ability.

Background

Individuals with rheumatoid arthritis express a great need for education and support in adapting to the disease, but the average qualities of studies about patient education interventions are not high. There is no evidence of long-term benefits of patient education.

Design

Randomized controlled trial.

Methods

A randomized controlled design was selected with test at baseline, 1-week and 6-month post-interventions after completed the 1-year programme. The tests consisted of validity and reliability tested instruments. The participants were randomly assigned in spring 2009 to either the experimental group (n = 54) or the control group (n = 148). The programme was running alongside the standard care the participants received at a rheumatology unit. Parametric and non-parametric tests were used in the analyses.

Results

The participants in the experimental group had statistically significant stronger empowerment after participation in the self-care promoting problem-based learning programme compared with the control group, at the 6-month post-intervention. Approximately, two-thirds of the participants in the experimental group stated that they had implemented lifestyle changes due to the programme.

Conclusion

The self-care promoting problem-based learning programme enabled people with rheumatic diseases to improve their empowerment compared with the control group. It is important to continue to develop problem-based learning in patient education to find the very best way to use this pedagogical method in rheumatology care.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2013
Keywords
empowerment; nursing; patient education; problem-based learning; rheumatic diseases; self-care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-96464 (URN)10.1111/jan.12008 (DOI)000319829000006 ()
Available from: 2013-08-23 Created: 2013-08-20 Last updated: 2017-12-06
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