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Johansson Stark, Åsa
Publications (9 of 9) Show all publications
Koekenbier, K., Leino-Kilpi, H., Cabrera, E., Istomina, N., Johansson Stark, Å., Katajisto, J., . . . Eloranta, S. (2016). Empowering knowledge and its connection to health-related quality of life: a cross-cultural study. Applied Nursing Research, 29, 211-216
Open this publication in new window or tab >>Empowering knowledge and its connection to health-related quality of life: a cross-cultural study
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2016 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 29, p. 211-216Article in journal (Refereed) Published
Abstract [en]

Aims

Assess the association between patient education (i.e. empowering knowledge) and preoperative health-related quality of life, 6 months postoperative health-related quality of life, and the increase in health-related quality of life in osteoarthritis patients who underwent total hip or total knee arthroplasty.

Method

This is a cross-cultural comparative follow-up study using structured instruments to measure the difference between expected and received patient education and self-reported health-related quality of life (EQ-5D) in Finland, Greece, Iceland, Spain and Sweden.

Results

The health-related quality of life was significantly increased 6 months postoperatively in all countries due to the arthroplasties. In the total sample, higher levels of empowering knowledge were associated with a higher health-related quality of life, both pre- and postoperatively, but not with a higher increase in health-related quality of life. On the national level, postoperative health-related quality of life was associated with higher levels of empowering knowledge in Finland, Iceland and Sweden. The increase in health-related quality of life was associated with levels of empowering knowledge for Greece.

Conclusions

Overall, it can be concluded that the level of empowering knowledge was associated with high postoperative health-related quality of life in the total sample, even though there is some variation in the results per country.

Place, publisher, year, edition, pages
Saunders Elsevier, 2016
Keywords
Health-related quality of life, Osteoarthritis, Empowerment, Empowerment knowledge, Patient-centred education, Cross-cultural
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-121067 (URN)10.1016/j.apnr.2015.05.004 (DOI)000370881800038 ()
Projects
EEPO
Note

Funding agencies: Finland-University of Turku; Academy of Finland; Finnish Association of Nursing Research; Finnish Foundation of Nursing Education; EVO funds at the Intermunicipal Hospital District of Southwest Finland; Spain-Colegio Oficial de Enfermeria de Barcelona; Sw

Available from: 2015-09-04 Created: 2015-09-04 Last updated: 2017-04-21Bibliographically approved
Johansson Stark, Å. (2016). Empowering knowledge and Quality of Recovery after hip or knee replacement. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Empowering knowledge and Quality of Recovery after hip or knee replacement
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today’s shorter hospital stay may be a challenge for the patients and their spouses. Patient education is linked to and promotes the recovery process and can improve the outcome after elective hip or knee replacement. Fulfilment of knowledge expectations is essential for enabling people to become empowered during the period of recovery.

Aim

The overall aim was to explore the association between empowering knowledge and patients’ quality of recovery after elective hip or knee replacement.

Methods

The design of the four papers was descriptive, prospective and comparative. Consecutively included patients and their spouses from Cyprus, Finland, Greece, Iceland and Sweden answered questionnaires before surgery and at discharge from hospital. Data was collected during the years 2009-2012. Relationships and associations between a number of factors and fulfilment of knowledge expectations, and patients’ quality of recovery were investigated. Comparisons between patients undergoing hip or knee replacement and between patients and their spouses were made.

Results

Patients and their spouses had similar knowledge expectations, and these were not fulfilled during the hospital stay. Spouses had less fulfilled knowledge expectations compared with the patients. Swedish patients and spouses had less fulfilled knowledge expectations compared with the Icelandic and Finnish ones. Patients who experienced the hospital stay as meeting their general expectations had more fulfilled knowledge expectations compared with those who did not.

Access to knowledge was the main predictor of the variance in fulfilment of knowledge expectations. Negative emotions, such as depressive state and impatience, were associated with less fulfilled knowledge expectations. For patients undergoing hip replacement, a higher level of professional education was associated with less fulfilled knowledge expectations. For patients undergoing knee replacement, a history of employment in social services or healthcare was associated with less fulfilled knowledge expectations.

Patients’ experience of greater satisfaction with care was associated with better quality of recovery for both kinds of arthroplasty. Patients with fulfilled knowledge expectations experienced better quality of recovery. The spouserelated factors, namely uncertainty and depressive state, were associated with lower quality of recovery. Factors associated with greater quality of recovery among the patients were spouses with a history of employment in social services or health care, and nurses explaining matters concerning the care and treatment for the spouses.

Conclusion

Patients and their spouses had high knowledge expectations that were not fulfilled during the hospital stay. Patients’ emotional state and their access to knowledge were important for their fulfilment of knowledge expectations. Patients’ and spouses’ emotional state also played an important role in determining the patients’ quality of recovery, and greater satisfaction with care among the patients was associated with better quality of recovery.

These results emphasise the need to detect patients and their spouses in need of support in their preparation and recovery process. It is therefore important to assess patients’ and spouses’ personal knowledge expectations, and adapt to their emotional state while fulfilling them.

The content of patient education should be personalised in future care, and informal caregivers should be seriously taken into account during the period of early recovery. The results of this thesis can be used in the development and testing of person-centred educational interventions for patients undergoing elective hip or knee replacements.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. p. 70
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1496
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-125237 (URN)10.3384/diss.diva-125237 (DOI)978-91-7685-876-9 (ISBN)
Public defence
2016-03-18, K1, Kåkenhus, Campus Norrköping, Norrköping, 13:00 (English)
Opponent
Supervisors
Available from: 2016-02-17 Created: 2016-02-17 Last updated: 2016-02-17Bibliographically approved
Johansson Stark, Å., Salanterä, S., Sigurdardottir, A. K., Valkeapää, K. & Bachrach-Lindström, M. (2016). Spouse-related factors associated with Quality of Recovery of patients after hip or knee replacement: a Nordic perspective. International Journal of Orthopaedic and Trauma Nursing, 23, 32-46
Open this publication in new window or tab >>Spouse-related factors associated with Quality of Recovery of patients after hip or knee replacement: a Nordic perspective
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2016 (English)In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 23, p. 32-46Article in journal (Refereed) Published
Abstract [en]

Background: Today’s shorter hospital stays means that patients may need support from informal caregivers during their recovery period. The responsibility for providing this support shifts from the health care staff to their family members fairly early in the recovery process. Spousal caregivers are considered to be primary caregivers as their relationship with the patient is more interdependent than other family members or caregivers.

Objectives: The aim was to describe spouse-related factors that were associated with patients’ quality of recovery on discharge from hospital after elective hip or knee replacement.

Design: The design was prospective, descriptive and comparative with two measurements; before arthroplasty and on discharge.

Settings: Two Finnish, three Icelandic and two Swedish university or community hospitals.

Participants: The sample consisted of spouses and patients. The inclusion criteria were: age ≥ 18 years, able to complete the questionnaires, and able to understand Finnish/Icelandic/Swedish. The patients were asked to identify one family member. Spouses were those defining themselves as; wife, husband or cohabiting partner. Out of 463 spouses, 306 (66%) were included. The mean age of the included spouses was 64 years, and 54% of them were females.

Methods: Self-reported instruments on; expected and received knowledge, access to knowledge, emotional state and quality of recovery were used.

Results: If the spouses were or had been employed in the social services or healthcare their partner had greater quality of recovery (p=0.006). Spouses experiencing negative emotions had partners who experienced lower quality of recovery (p<0.001). Spouses who experienced that nurses had enough time and explained matters concerning their family members’ care and treatment had partners who experienced greater quality of recovery (p=0.011, 0.044).

Conclusions: Spouses’ emotional state played an important role in the patients’ quality of recovery, with uncertainty and depressive state as the main predictors. The importance of nurses explaining matters sufficiently to spouses was emphasized, while spouses’ fulfilment of knowledge expectations was not associated with patients’ recovery.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Access to knowledge, empowering knowledge, emotional state, fulfilment of knowledge expectations, hip replacement, knee replacement, recovery, spousal caregivers
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-125236 (URN)10.1016/j.ijotn.2016.03.001 (DOI)
Note

At the time for thesis presentation publication was in status: Manuscript

Available from: 2016-02-17 Created: 2016-02-17 Last updated: 2017-04-21Bibliographically approved
Johansson Stark, Å., Charalambous, A., Istomina, N., Salanterä, S., Sigurdardottir, A. K., Sourtzi, P., . . . Bachrach-Lindström, M. (2016). The quality of recovery on discharge from hospital, a comparison between patients undergoing hip and knee replacement: a European study. Journal of Clinical Nursing, 25(17-18), 2489-2501
Open this publication in new window or tab >>The quality of recovery on discharge from hospital, a comparison between patients undergoing hip and knee replacement: a European study
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2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 17-18, p. 2489-2501Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. To describe and compare the quality of recovery (QoR) on discharge from hospital between patients undergoing elective hip or knee replacement. The study will also attempt to identify any predicting factors.

Background. Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today’s shorter hospital stay may be a challenge for the patients during the early period of recovery. It is therefore important to identify factors associated with QoR at discharge from hospital.

Design. A descriptive, comparative study including 12 hospitals in five European countries; Cyprus, Finland, Greece, Iceland and Sweden.

Methods. Consecutively included patients responded on: Health-Related Quality of Life, and emotions before surgery and at hospital discharge; Quality of Recovery, Patient Satisfaction and fulfilment of knowledge expectations. Related factors and associations were analysed separately for each kind of arthroplasty. In total 865 patients were included (hip n=413, knee n=452).

Results. In the dimension of pain, patients undergoing hip replacement had significantly better QoR compared to those undergoing knee replacement. Both patient groups experienced negative emotions before surgery that were related to poorer QoR. Fulfilment of knowledge expectations has a limited effect on QoR. Greater satisfaction with care predicted better QoR.

Conclusions. Negative preoperative emotions were related to poorer QoR. For both kinds of arthroplasty, greater satisfaction with care was associated with better QoR.

Relevance to clinical practice. The result emphasises the need to detect patients in need of support in their preparation and recovery process, taking into account the perspective of their emotional state.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2016
Keywords
Fulfilment of knowledge expectations, health-related quality of life, hip replacement, knee replacement, preoperative emotional state, quality of recovery, satisfaction with care
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-125235 (URN)10.1111/jocn.13278 (DOI)
Note

At the time of thesis presentation publication was in status: Manuscript

Available from: 2016-02-17 Created: 2016-02-17 Last updated: 2017-04-21Bibliographically approved
Sigurdardottir, A. K., Leino-Kilpi, H., Charalambous, A., Katajisto, J., Johansson Stark, Å., Sourtzi, P., . . . Valkeapää, K. (2015). Fulfilment of knowledge expectations among family members of patients undergoing arthroplasty: a European perspective. Scandinavian Journal of Caring Sciences, 29(4), 615-624
Open this publication in new window or tab >>Fulfilment of knowledge expectations among family members of patients undergoing arthroplasty: a European perspective
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2015 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, p. 615-624Article in journal (Refereed) Published
Abstract [en]

In the recovery process of arthroplasty patients, their family members play an important role due to short hospital stay and increased age of patients. Family members need to have knowledge to be able to support the patient. The aim of this study was to explore expected and received knowledge in family members of arthroplasty patients and describe the relationships between the differences in received and expected knowledge and background factors, country, information and control preferences and access to knowledge. The study was conducted in six European countries (Cyprus, Greece, Finland, Iceland, Spain and Sweden). The study design was cross-cultural, prospective and comparative with two measurement points: pre-operative and at discharge from hospital. Knowledge Expectations of significant other-scale and Krantz Health Opinion Survey were used before surgery and Received Knowledge of significant other-scale and Access to Knowledge at discharge. Patients undergoing elective hip or knee arthroplasty in seventeen hospitals were asked to identify one family member. The sample size was decided by power calculation. A total of 615 participants answered the questionnaires at both measurements. Family members perceived to receive less knowledge than they expected to have, most unfulfilled knowledge expectations were in the financial, social and experiential dimensions of knowledge. Seventy-four per cent of participants had unfulfilled knowledge expectations. Increased access to information from healthcare providers decreased the difference between received and expected knowledge. Compared to family members in southern Europe, those in the Nordic countries had more unfulfilled knowledge expectations and less access to information from healthcare providers. The evidence from this study highlights the need to involve the family members in the educational approach.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
Keywords
arthroplasty, family members, international perspectives, knowledge expectations, osteoarthritis, patient education
National Category
Infectious Medicine
Identifiers
urn:nbn:se:liu:diva-116468 (URN)10.1111/scs.12199 (DOI)000368345900002 ()25648518 (PubMedID)
Projects
EEPO
Note

Funding agencies: University of Turku; Academy of Finland; Finnish Association of Nursing Research; Finnish Foundation of Nursing Education; Cyprus University of Technology; Colegio Oficial de Enfermeria de Barcelona; Linkoping University; Swedish Rheumatism Association; C

Available from: 2015-03-26 Created: 2015-03-26 Last updated: 2017-12-04Bibliographically approved
Johansson Stark, Å., Ingadottir, B., Salanterä, S., Sigurdardottir, A. K., Valkeapää, K., Bachrach-Lindström, M. & Unosson, M. (2014). Fulfilment of knowledge expectations and emotional state among people undergoing hip replacement: A multi-national survey. International Journal of Nursing Studies, 51(11), 1491-1499
Open this publication in new window or tab >>Fulfilment of knowledge expectations and emotional state among people undergoing hip replacement: A multi-national survey
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2014 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 51, no 11, p. 1491-1499Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Patient education in connection with hip replacement is intended to prepare patients for surgery, discharge and postoperative recovery. Patients experience symptoms and emotions due to disease or upcoming surgery which can affect how their knowledge expectations are fulfilled.

OBJECTIVES:

To describe the differences between received and expected knowledge in patients undergoing elective hip replacement in three Nordic countries, and to analyse how these differences are related to patients' characteristics, preoperative symptoms and emotions.

DESIGN:

A descriptive, prospective survey with two data collection points; before admission and at hospital discharge after surgery.

SETTINGS:

Two Finnish, three Icelandic and two Swedish hospitals.

PARTICIPANTS:

The population consisted of patients on a waiting list for hip replacement. Of the consecutively included patients, 320 answered questionnaires both before admission and at discharge and were included in the study. The mean age of the patients was 64 years, and 55% were women.

METHODS:

Structured questionnaires were used; the knowledge expectations of hospital patients scale and self-reported scales for symptoms and emotions before admission and received knowledge of hospital patients scale at discharge. Fulfilment of knowledge expectation was assessed by calculating the difference between received and expected knowledge with a paired sample t-test. A multiple stepwise regression model was used to explain the variance of fulfilled knowledge expectations.

RESULTS:

Patients expected more knowledge than they received (p<0.001) and 77% of them had unfulfilled knowledge expectations. Patients with a higher level of education were more likely to have unfulfilled knowledge expectations. A higher level of education was also related to a greater difference between received and expected knowledge. The difference was more correlated with patients' emotions than their symptoms. A depressive state was the major predictor of the variance in the difference between received and expected knowledge.

CONCLUSIONS:

In order to better support patients by education it is necessary to assess their emotional state, educational level and knowledge expectations before surgery.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Emotions, Empowering knowledge, Hip replacement, Knowledge expectations, Orthopaedic nursing, Patient education, Symptoms
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-109769 (URN)10.1016/j.ijnurstu.2014.03.006 (DOI)000343351900009 ()24751503 (PubMedID)
Projects
Empowering Patient Education
Available from: 2014-08-27 Created: 2014-08-27 Last updated: 2017-12-05Bibliographically approved
Johansson Stark, Å., Ingadottir, B., Sigurdardottir, A. K., Valkeapää, K., Bachrach-Lindström, M. & Unosson, M. (2014). Fulfilment of patients’ knowledge expectations in connection with hip or knee replacement – a Nordic perspective. In: : . Paper presented at Nordic Conference in Nursing Research, Methods and Networks for the future, 10-12 June 2014, Odense, Denmark.
Open this publication in new window or tab >>Fulfilment of patients’ knowledge expectations in connection with hip or knee replacement – a Nordic perspective
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2014 (English)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Objective: To describe and compare the differences between received and expected knowledge in patients undergoing elective hip or knee replacement in three Nordic countries, and to analyse if these differences are related to patients’ characteristics.

Method: A descriptive, prospective and comparative survey of patients with osteoarthritis treated at two Finnish, three Icelandic and two Swedish hospitals (n=612). Patients answered questionnaires about their knowledge expectations (KEhp) before surgery and about received knowledge (RKhp) at discharge. These two parallel instruments include: bio-physiological, functional, experiential, ethical, social and financial dimensions of knowledge.

Results: Among the 29% Finnish, 34% Icelandic and 37% Swedish patients (hip: 53%, knee: 47%) were 54% females and the mean age was 65 years. Patients` knowledge expectations were higher, mean: 3.6 (±SD 0.5), than their perception of received knowledge 3.0 (0.7). The difference between expected and received knowledge was larger in Sweden -0.9(0.8) compared with Finland -0.4(0.8) and Iceland -0.5(0.7) (p<0.001) but not statistically different between patients having hip or knee replacement. Patients perceived having received most bio-physiological -0.3(0.6) and functional -0.3(0.6) knowledge but least financial -1.2(1.2) knowledge. A relationship was found between the difference of expected and received knowledge and whether the hospital stay was as expected. For patients undergoing hip replacement this difference was also related to the level of education, for knee replacement patients if they had their first arthroplasty and employment in social or health care.

Conclusions: Patients expect multidimensional knowledge during hospital stay which was inadequately met. Assessing patients’ knowledge needs could improve patient education.

National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-109770 (URN)
Conference
Nordic Conference in Nursing Research, Methods and Networks for the future, 10-12 June 2014, Odense, Denmark
Projects
Empowering Patient Education
Available from: 2014-08-27 Created: 2014-08-27 Last updated: 2014-09-25
Valkeapää, K., Klemetti, S., Cabrera, E., Cano, S., Charalambous, A., Copanitsanou, P., . . . Leino-Kilpi, H. (2014). Knowledge expectations of surgical orthopaedic patients: A European survey. International Journal of Nursing Practice, 20(6), 597-607
Open this publication in new window or tab >>Knowledge expectations of surgical orthopaedic patients: A European survey
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2014 (English)In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 20, no 6, p. 597-607Article in journal (Refereed) Published
Abstract [en]

Ageing population entails a growing international problem of osteoarthritis. Best practices for education of these patients are lacking. This study focused on empowering education in Northern (Finland, Iceland, Lithuania and Sweden) and Southern Europe (Cyprus, Greece and Spain). The aim was to analyse associations between expected knowledge and background factors. The data were collected from European arthroplasty patients with the Knowledge Expectations of hospital patients- scale, (KEhp - scale), including bio-physiological, functional, experiential, ethical, social and financial dimensions. Patients had essential bio-physiological and functional knowledge expectations. Women expected more than men, employed less than retired, unemployed or who worked at home. Generally, patients in Northern countries expected more than in Southern countries. However, highest expectations were found in Sweden and Greece, lowest in Spain and Cyprus. There are differences in knowledge expectations based on patients' backgrounds. Development of common standards in European patient education needs further research.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keywords
empowering patient education, knowledge expectations, orthopaedics
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-105224 (URN)10.1111/ijn.12189 (DOI)000346766000008 ()24118436 (PubMedID)
Available from: 2014-03-13 Created: 2014-03-13 Last updated: 2017-12-05Bibliographically approved
Ingadottir, B., Johansson Stark, Å., Leino-Kilpi, H., Sigurdardottir, A. K., Valkeapää, K. & Unosson, M. (2014). The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty - a Nordic perspective. Journal of Clinical Nursing, 23(19-20), 2896-2908
Open this publication in new window or tab >>The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty - a Nordic perspective
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2014 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 19-20, p. 2896-2908Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: To describe the possible differences between knowledge expectations and received knowledge of patients undergoing elective knee arthroplasty in Iceland, Sweden and Finland and also to determine the relationship between such a difference and both background factors and patient satisfaction with care.

BACKGROUND: Knee arthroplasty is a fast-growing and a successful treatment for patients with osteoarthritis. Patient education can improve surgery outcomes, but it remains unknown what knowledge patients expect to receive and actually acquire during the perioperative period and what factors are related to that experience.

DESIGN: Descriptive, prospective survey.

METHODS: In total, 290 patients answered questionnaires about their expectations (Knowledge Expectations of hospital patients - scale) before surgery and about received knowledge (Received Knowledge of hospital patients - scale) and satisfaction with hospital care (Patient Satisfaction Scale) at discharge. Sociodemographics, clinical information, accessibility to knowledge from healthcare providers (Access to Knowledge Scale), and preferences for information and behavioural control (Krantz Health Opinion Survey) were collected as background data.

RESULTS: Patients` knowledge expectations were higher (mean 3·6, SD 0·4) than their perception of received knowledge (mean 3·0, SD 0·7). Multiple linear regression analysis showed that access to knowledge, information preferences and work experience within health- or social care explained 33% (R²) of the variation in the difference between received and expected knowledge. Patients reported high satisfaction with their care except regarding how their family was involved.

CONCLUSION: Patients undergoing knee arthroplasty receive less knowledge than they expect, and individual factors and communication with healthcare providers during hospitalisation are related to their experience. The content of patient education and family involvement should be considered in future care.

RELEVANCE TO CLINICAL PRACTICE: The results strengthen the knowledge base on the educational needs of knee arthroplasty patients and can be used to develop and test new interventions.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keywords
Knee arthroplasty, osteoarthritis, patient education, patient expectations, patient satisfaction, surgery
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-105225 (URN)10.1111/jocn.12552 (DOI)000343857700020 ()24476393 (PubMedID)
Projects
EEPO
Available from: 2014-03-13 Created: 2014-03-13 Last updated: 2017-12-05Bibliographically approved
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