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  • 1.
    Arestedt, Liselott
    et al.
    Linnaeus Univ, Sweden.
    Martinsson, Caroline
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Hjelm, Carina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Uhlin, Fredrik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Nephrology.
    Eldh, Ann Catrine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Context Factors Facilitating and Hindering Patient Participation in Dialysis Care: A Focus Group Study With Patients and Staff2020In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 17, no 6, p. 457-464Article in journal (Refereed)
    Abstract [en]

    Background Safe health care of good quality depends on structured and unceasing efforts to progress, promoting strategies tailored to the context, including elements such as patients preferences. Although patient participation is a common concept in health care, there is yet limited understanding of the factors that facilitate and hinder it in a healthcare context. Aims This paper identifies what patients and health professionals depict in terms of enablers and barriers for patient participation in dialysis care. Methods An explorative qualitative design was applied with seven focus group discussions with patients, staff, and managers across different types of hospitals, with the texts analyzed with content analysis. Results The dialysis context represents three key elements-people, resources, and interactions-that can both enable and hinder patient participation. Both barriers and facilitators for patient participation were found to reside at individual, team, and organizational levels, with a greater number of enabling factors implied by both patients and staff. Linking Evidence to Action While the dialysis context comprises opportunities for progress in favor of patient participation, a shared understanding of the concept is needed, along with how contextual factors can facilitate conditions for participation by patient preferences. In addition, the most favorable strategy for implementing person-centered care is not yet known, but to facilitate patient participation from a patient perspective, creating opportunities to enable staff and patients to share a common understanding is needed, along with tools to facilitate a dialogue on patient participation.

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  • 2.
    Bergstrom, Anna
    et al.
    Uppsala Global Hlth Res Implementat & Sustainabil, Sweden; UCL, England.
    Ehrenberg, Anna
    Dalarna Univ, Sweden; Univ Adelaide, Australia.
    Eldh, Ann Catrine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Graham, Ian D.
    Univ Ottawa, Canada; Ottawa Hosp Res Inst, Canada.
    Gustafsson, Kazuko
    Dalarna Univ, Sweden; Uppsala Univ, Sweden.
    Harvey, Gillian
    Univ Adelaide, Australia.
    Hunter, Sarah
    FlindersUniv, Australia.
    Kitson, Alison
    FlindersUniv, Australia; Univ Oxford, England.
    Rycroft-Malone, Jo
    Univ Lancaster, England.
    Wallin, Lars
    Dalarna Univ, Sweden; Univ Gothenburg, Sweden.
    The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature2020In: Implementation Science, E-ISSN 1748-5908, Vol. 15, no 1, article id 68Article, review/survey (Refereed)
    Abstract [en]

    Background The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. Methods This citation analysis commenced from four core articles representing the key stages of the frameworks development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. Results The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. Conclusions In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.

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  • 3.
    Carlsson, Eva
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Ehnfors, Margareta
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Eldh, Ann Catrine
    Örebro universitet, Institutionen för hälsovetenskap och medicin, Örebro.
    Ehrenberg, Anna
    Örebro universitet, Institutionen för hälsovetenskap och medicin, Örebro.
    Accuracy and continuity in discharge information for patients with eating difficulties after stroke.2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 1-2, p. 21-31Article in journal (Refereed)
    Abstract [en]

    AIMS: To describe the accuracy and continuity of discharge information for patients with eating difficulties after stroke.

    BACKGROUND: Eating difficulties are prevalent and serious problems in patients with stroke. Screening for eating difficulties can predict undernutrition and subsequent care needs. For optimal care, information transferred between care settings has to be comprehensive and accurate.

    DESIGN: Prospective, descriptive.

    METHODS: The study investigated a sample of 15 triads, each including one patient with stroke along with his patient record and discharge summary and two nursing staff in the municipal care to whom the patient was discharged. Data were collected by observations of patients' eating, record audits and interviews with nurses. Data were analysed using content analysis and descriptive statistics.

    RESULTS: Accuracy of recorded information on patients' eating difficulties and informational continuity were poor, as was accuracy in the transferred information according to nursing staff's perceptions. All patients were at risk of undernutrition and in too poor a state to receive rehabilitation. Nevertheless, patients' eating difficulties were described in a vague and unspecific language in the patient records. Co-ordinated care planning and management continuity related to eating difficulties were largely lacking in the documentation. Despite their important role in caring for patients with eating difficulties, little information on eating difficulties seemed to reach licensed practical nurses in the municipalities.

    CONCLUSIONS: Comprehensiveness in the documentation of eating difficulties and accuracy of transferred information were poor based on record audits and as perceived by the municipal nursing staff. Although all patients were at risk of undernutrition, had multiple eating difficulties and were in too poor a state for rehabilitation, explicit care plans for nutritional problems were lacking.

    RELEVANCE TO CLINICAL PRACTICE: Lack of accuracy and continuity in discharge information on eating difficulties may increase risk of undernutrition and related complications for patients in continuous stroke care. Therefore, the discharge process must be based on comprehensive and accurate documentation.

  • 4.
    Drott, Jenny
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Department of Biomedical and Clinical Sciences.
    Fomichov Casaballe, Victoria
    Region Östergötland, Regionledningskontoret, Enheten för folkhälsa. Linköping University.
    Nordén, Maria
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
    Lindhoff Larsson, Anna
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Eldh, Ann Catrine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Patient preferences and experiences of participation in surgical cancer care2022In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 19, no 5, p. 405-414Article in journal (Refereed)
    Abstract [en]

    Background Quality cancer care necessitates opportunities for patient participation, supposedly recognizing the individuals preferences and experiences for being involved in their health and healthcare issues. Previous research shows that surgical cancer patients wish to be more involved, requiring professionals to be sensitive of patients needs. Aims To explore preference-based patient participation in surgical cancer care. Methods A cross-sectional study was conducted. The Patient Preferences for Patient Participation tool (4Ps) was used, which includes 12 attributes of preferences for and experiences of patient participation. Data were analyzed with descriptive and comparative statistical methods. Results The results are based on a total of 101 questionnaires. Having reciprocal communication and being listened to by healthcare staff were commonly deemed crucial for patient participation. While 60% of the patients suggested that taking part in planning was crucial for their participation, they had experienced this only to some extent. Learning to manage symptoms and phrasing personal goals were items most often representing insufficient conditions for preference-based patient participation. Linking Evidence to Action To support person-centered surgical care, further efforts to suffice preference-based participation are needed, including opportunities for patients to share their experiences and engage in the planning of healthcare activities.

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  • 5.
    Duong, Duc M
    et al.
    Hanoi School of Public Health; International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University.
    Bergström, Anna
    International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University; Division of Global Health/IHCAR, Department of Public Health Sciences, Karolinska Institutet.
    Wallin, Lars
    School of Education, Health and Social Studies, Dalarna University; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet.
    Bui, Ha T T
    Hanoi School of Public Health.
    Eriksson, Leif
    nternational Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University.
    Eldh, Ann Catrine
    School of Education, Health and Social Studies, Dalarna University; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet.
    Exploring the influence of context in a community-based facilitation intervention focusing on neonatal health and survival in Vietnam: a qualitative study.2015In: BMC Public Health, E-ISSN 1471-2458, Vol. 15, article id 814Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In the Neonatal health - Knowledge into Practice (NeoKIP) trial in Vietnam, local stakeholder groups, supported by trained laywomen acting as facilitators, promoted knowledge translation (KT) resulting in decreased neonatal mortality. In general, as well as in the community-based NeoKIP trial, there is a need to further understand how context influences KT interventions in low- and middle-income countries (LMICs). Thus, the objective of this study was to explore the influence of context on the facilitation process in the NeoKIP intervention.

    METHODS: A secondary content analysis was performed on 16 Focus Group Discussions with facilitators and participants of the stakeholder groups, applying an inductive approach to the content on context through naïve understanding and structured analysis.

    RESULTS: The three main-categories of context found to influence the facilitation process in the NeoKIP intervention were: (1) Support and collaboration of local authorities and other communal stakeholders; (2) Incentives to, and motivation of, participants; and (3) Low health care coverage and utilization. In particular, the role of local authorities in a KT intervention was recognized as important. Also, while project participants expected financial incentives, non-financial benefits such as individual learning were considered to balance the lack of reimbursement in the NeoKIP intervention. Further, project participants recognized the need to acknowledge the needs of disadvantaged groups.

    CONCLUSIONS: This study provides insight for further understanding of the influence of contextual aspects to improve effects of a KT intervention in Vietnam. We suggest that future KT interventions should apply strategies to improve local authorities' engagement, to identify and communicate non-financial incentives, and to make disadvantaged groups a priority. Further studies to evaluate the contextual aspects in KT interventions in LMICs are also needed.

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  • 6.
    Eld, Ann Catrine
    et al.
    Örebro universitet.
    Ekman, Inger
    Ehnfors, M
    Providing for patient participation and preventing non-participation - two sides of the same coin?2006Conference paper (Refereed)
  • 7.
    Eldh, A.C
    et al.
    Karolinska Institutet, Stockholm.
    Hälleberg Nyman, M
    Forsman, M
    Hommel, A
    Rycroft-Malone, J
    Wallin, L
    Onset prevention of incontinence in orthopaedic nursing and rehabilitation - a multifaceted undertaking2015Conference paper (Refereed)
  • 8.
    Eldh, Ann Catrine
    Karolinska Institutet, Stockholm.
    Delaktighet och gemenskap2014In: Omvårdnadens grunder: Hälsa och ohälsa / [ed] Anna-Karin Edberg, Helle Wijk, Lund: Studentlitteratur, 2014, 2Chapter in book (Refereed)
  • 9.
    Eldh, Ann Catrine
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Delaktighet och patientmedverkan2018Collection (editor) (Other academic)
    Abstract [sv]

    Boken behandlar det för vård och omsorg centrala begreppet patientdelaktighet. Vidden av begreppet delaktighet gör att det behövs vägledning för vardagens möten och samtal, mellan den som är patient och den som är personal. Boken utgör en resurs och bör ses som en diskussionspartner, med utgångspunkt i aktuell kunskap men även andra förutsättningar, som lagtexter och normer.

    Delaktighet och patientmedverkan omfattar två övergripande kapitel som introducerar och problematiserar patientdelaktighet och fyra kapitel som belyser begreppet ur olika, specifika perspektiv. De generella kapitlen kan läsas för sig, eller i kombination med ett eller flera fallbaserade kapitel, utifrån läsarens aktuella kunskapsbehov eller intresse.

    Boken vänder sig till blivande och yrkesverksamma inom hälso- och sjukvård eller omsorg men är också avsedd att vara till nytta för andra nyckelpersoner, som beslutsfattare och patienter.

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  • 10.
    Eldh, Ann Catrine
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Uppsala universitet, Sweden.
    Facilitating patient participation by embracing patients’ preferences: a discussion2019In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, no 6, p. 1070-1073Article in journal (Other academic)
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  • 11.
    Eldh, Ann Catrine
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Is it a bird? Is it a plane? Teasing out clinical interventions and implementation interventions2018Conference paper (Refereed)
  • 12.
    Eldh, Ann Catrine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Six Honest Serving Matters, Teaching Us All We Need to Know About Context in Knowledge Implementation? Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-country Analysis"2022In: International Journal of Health Policy and Management, E-ISSN 2322-5939, Vol. 11, no 8, p. 1574-1576Article in journal (Other academic)
    Abstract [en]

    While context is a vital factor in any attempt to study knowledge translation or implement evidence in healthcare, there is a need to better understand the attributes and relations that constitute context. A recent study by J. Squires et al investigates such attributes and definitions, based on 39 stakeholder interviews across Australia, Canada, the United Kingdom, and the United States. Sixteen attributes, comprising 30 elements suggested as new findings, are proposed as the basis for a framework. This commentary argues for the need to incorporate more perspectives but also suggests an initial taxonomy rather than a framework, comprising a wider range of stakeholders and an enhanced understanding of how context elements are related at different levels and how this affects implementation processes. Aligning with person-centred care, this must include not only professionals but also patients and their next of kin, as partners in shaping more evidence-based healthcare.

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  • 13.
    Eldh, Ann Catrine
    Högskolan Dalarna, Sweden; Karolinska Institutet, Sweden.
    Strategier för behandling av urininkontinens inom äldreomsorgen2014In: Implementering av evidensbaserad praktik / [ed] Per Nilsen, Malmö: Gleerups Utbildning AB, 2014, 1, p. 201-216Chapter in book (Refereed)
    Abstract [sv]

    Ökade krav och förväntningar på att offentlig verksamhet ska nyttiggöra forskning har lett till ett stort intresse för implementeringsfrågor. Detta är en av de första böckerna på svenska om implementering av evidensbaserad praktik. Bokens första del ger en bakgrund till dagens implementeringsforskning och presenterar relevanta teorier, modeller och ramverk. Den andra delen visar hur dessa teorier, modeller och ramverk kan användas för att vägleda och analysera implementering av evidensbaserad praktik i bland annat intensivvård, mödrahälsovård, fysioterapi, äldreomsorg samt lokalsamhället.

  • 14.
    Eldh, Ann Catrine
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Dalarna University, Sweden; Uppsala University, Sweden.
    Almost, Joan
    Queens University, Canada.
    DeCorby-Watson, Kara
    Public Health Ontario, Canada.
    Gifford, Wendy
    University of Ottawa, Canada.
    Harvey, Gill
    University of Adelaide, Australia; University of Manchester, England.
    Hasson, Henna
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Kenny, Deborah
    University of Colorado, CO 80907 USA.
    Moodie, Sheila
    Western University, Canada.
    Wallin, Lars
    Dalarna University, Sweden; Karolinska Institute, Sweden; University of Gothenburg, Sweden.
    Yost, Jennifer
    McMaster University, Canada.
    Clinical interventions, implementation interventions, and the potential greyness in between -a discussion paper2017In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 17, article id 16Article in journal (Refereed)
    Abstract [en]

    Background: There is increasing awareness that regardless of the proven value of clinical interventions, the use of effective strategies to implement such interventions into clinical practice is necessary to ensure that patients receive the benefits. However, there is often confusion between what is the clinical intervention and what is the implementation intervention. This may be caused by a lack of conceptual clarity between intervention and implementation, yet at other times by ambiguity in application. We suggest that both the scientific and the clinical communities would benefit from greater clarity; therefore, in this paper, we address the concepts of intervention and implementation, primarily as in clinical interventions and implementation interventions, and explore the grey area in between. Discussion: To begin, we consider the similarities, differences and potential greyness between clinical interventions and implementation interventions through an overview of concepts. This is illustrated with reference to two examples of clinical interventions and implementation intervention studies, including the potential ambiguity in between. We then discuss strategies to explore the hybridity of clinical-implementation intervention studies, including the role of theories, frameworks, models, and reporting guidelines that can be applied to help clarify the clinical and implementation intervention, respectively. Conclusion: Semantics provide opportunities for improved precision in depicting what is intervention and what is implementation in health care research. Further, attention to study design, the use of theory, and adoption of reporting guidelines can assist in distinguishing between the clinical intervention and the implementation intervention. However, certain aspects may remain unclear in analyses of hybrid studies of clinical and implementation interventions. Recognizing this potential greyness can inform further discourse.

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  • 15.
    Eldh, Ann Catrine
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Arestedt, Liselott
    Linnaeus Univ, Sweden.
    Berterö, Carina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Quotations in Qualitative Studies: Reflections on Constituents, Custom, and Purpose2020In: International Journal of Qualitative Methods, E-ISSN 1609-4069, Vol. 19, article id 1609406920969268Article in journal (Refereed)
    Abstract [en]

    Qualitative studies are often found to be accompanied by quotations from interviews or similar data sources. As with any methodological tradition, it is essential to critically explore the general principle of including quotations in scientific papers: what is the purpose and justification for including quotations? Are there standards and, in that case, what are they and what are their scientific positioning? This paper presents an overview of the somewhat diverse guidance found in the literature in reference to the representation of quotations. Yet, both students and scholars use a variety of approaches to quote from their data, ranging from presenting numerous, extensive, and/or comprehensive quotations throughout the results section to the reporting of a few particular quotations to illustrate certain aspects of the findings only. While their function may be described, scientific reasoning for using quotations is scarce. Along with an overview of the scientific background and options for including quotations in qualitative studies, we discuss the consequences of the different epistemological and methodological aspects found in the literature. In conclusion, we argue that there are incentives for promoting a more deliberate employment of references from data; deriving from the human sciences tradition, a corresponding epistemological stance would suggest that quotations preferably apply for illustrating the analysis process and/or findings, while the idea that quotations can be employed to validate findings has limited support. Further critical examination of the application of and justification for including quotations in the reporting of qualitative studies is needed among researchers, journal editors and reviewers.

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  • 16.
    Eldh, Ann Catrine
    et al.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden and the School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Carlsson, Eva
    Department of Quality and Patient safety, Lindesberg hospital and Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Seeking a balance between employment and the care of an ageing parent.2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 2, p. 285-93Article in journal (Refereed)
    Abstract [en]

    RATIONALE: A growing number of middle-aged people are engaged in informal care of their parents while employed. To provide support as employers, co-workers or staff, health care professionals need insight into the experiences of people managing these responsibilities.

    AIM: To elucidate the experience of providing informal care to an ageing parent while managing the responsibilities of a working life.

    METHODS: Narrative interviews were performed with 11 persons with experience of the phenomenon. Transcribed interviews were analysed with phenomenological hermeneutics.

    ETHICS: Informed consent was given prior to the interviews. The study was approved by a research ethics committee.

    FINDINGS: Providing informal care to an ageing parent while also pursuing a working life implies seeking balance: a balance between providing support to the parent's needs and one's responsibilities at work. Being employed supports this balance as it provides both fulfilment and refuge. Being capable of managing both roles grants a sense of satisfaction, supporting one's sense of balance in life. The balance can be supported by sharing the responsibility of caring for the ageing parent with others.

    STUDY LIMITATIONS: Despite perceived saturation and an effort to provide for the possibility to consider internal consistency, the findings should be considered as a contribution to the understanding of the phenomenon, as experienced by individuals in their life world.

    CONCLUSIONS: It is essential to recognise the impact that providing care for an ageing parent may have on the lives of a growing number of people, particularly if they have employment responsibilities. Acknowledgement by others supports one's ability to attain balance; as co-workers and managers, we can acknowledge the efforts of an informal caregiver and as health care staff recognise the valuable contribution made by people in mid-life who provide informal care for their ageing parents.

  • 17.
    Eldh, Ann Catrine
    et al.
    Örebro universitet.
    Ehnfors, M
    Ekman, Inger
    Inconsistent meanings to 'patient participation' impacts conditions for education2005Conference paper (Refereed)
  • 18.
    Eldh, Ann Catrine
    et al.
    Örebro universitet.
    Ehnfors, M
    Ekman, Inger
    The right to participate in my own health care. How patients attending a nurse-led clinic for chronic heart failure experience the meaning of participation.2004Conference paper (Refereed)
  • 19.
    Eldh, Ann Catrine
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen; Capio St Görans sjukhus, Stockholm.
    Ehnfors, Margareta
    Örebro universitet, Institutionen för vårdvetenskap och omsorg.
    Ekman, Inger
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademin, Göteborg.
    The meaning of patient participation for patients and nurses at a nurse-led clinic for chronic heart failure.2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 1, p. 45-53Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The legislation of many Western countries emphasizes active patient participation. Patients with chronic heart failure (CHF), however, have experienced participation differently from the general interpretation of legal definitions. Education improves uptake of self-management strategies yet knowledge is lacking about support of patients' own resources in CHF.

    AIM: To explore the phenomena of patient participation and non-participation as shown in patient visits to a nurse-led clinic for CHF and as experienced by the patients and nurses.

    METHODS: Data triangulation of field notes from participatory observations and texts from narrative interviews with the patients and assigned nurse specialists. Data were analyzed according to the phenomenological hermeneutic tradition.

    FINDINGS: Patients' experience of participation and non-participation was interpreted as "Being responsible and accepting responsibility" and "Lacking an equal relationship while being controlled", respectively. Nurses experienced patient participation as "Getting information and security to act" and patient non-participation as "Not accepting".

    CONCLUSION: Conflicting values of patients and nurses, which were interpreted with respect to participation and non-participation, presumably might influence patient information and education negatively. The issue of participation should be raised as a means of attaining concordance and to facilitate patient participation with education specifically tailored to the individual patient's needs.

  • 20.
    Eldh, Ann Catrine
    et al.
    St Görans sjukhus, Stockholm; Örebro universitet, Hälsovetenskapliga institutionen.
    Ehnfors, Margareta
    Örebro universitet, Institutionen för vårdvetenskap och omsorg.
    Ekman, Inger
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademin, Göteborg.
    The phenomena of participation and non-participation in health care--experiences of patients attending a nurse-led clinic for chronic heart failure.2004In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 3, no 3, p. 239-46Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patient participation is stressed in the health care acts of many western countries yet a common definition of the concept is lacking. The understanding of experiences of patients with chronic heart failure (CHF) who attend nurse-led specialist clinics, a form of care suggested as beneficiary to this group, may promote a better understanding of participation.

    AIM: To investigate the meanings of participation and non-participation as experienced by patients living with CHF.

    METHODS: Narrative interviews analysed in the phenomenological hermeneutic tradition inspired by Ricoeur where the interpretation is made in the hermeneutic circle, explaining and understanding the experienced phenomena.

    FINDINGS: Participation was experienced as to "be confident", "comprehend" and "seek and maintain a sense of control". Non-participation was experienced as to "not understand", "not be in control", "lack a relationship" and "not be accountable". The findings indicate that the experiences of participation and non-participation can change over time and phases of the disease and treatment.

    CONCLUSION: The study suggests an extended view on the concept of participation. Patients' experiences of participation in health care can vary and should therefore be an issue for dialogue between nurses and patients with CHF in nurse-led specialist clinics.

  • 21.
    Eldh, Ann Catrine
    et al.
    Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden; CRU, Karolinska University Hospital Solna, Eugeniahemmet, Stockholm, Sweden.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Falun, Sweden.
    Squires, Janet E
    University of Ottawa, School of Nursing, Faculty of Health Sciences, Ottawa, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada.
    Estabrooks, Carole A
    University of Alberta, Faculty of Nursing, Knowledge Utilization Studies Program, Edmonton, Canada.
    Wallin, Lars
    Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden; Dalarna University, School of Health and Social Studies, Falun, Sweden.
    Translating and testing the Alberta context tool for use among nurses in Swedish elder care.2013In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 13, article id 68Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is emerging evidence that context is important for successful transfer of research knowledge into health care practice. The Alberta Context Tool (ACT) is a Canadian developed research-based instrument that assesses 10 modifiable concepts of organizational context considered important for health care professionals' use of evidence. Swedish and Canadian health care have similarities in terms of organisational and professional aspects, suggesting that the ACT could be used for measuring context in Sweden. This paper reports on the translation of the ACT to Swedish and a testing of preliminary aspects of its validity, acceptability and reliability in Swedish elder care.

    METHODS: The ACT was translated into Swedish and back-translated into English before being pilot tested in ten elder care facilities for response processes validity, acceptability and reliability (Cronbach's alpha). Subsequently, further modification was performed.

    RESULTS: In the pilot test, the nurses found the questions easy to respond to (52%) and relevant (65%), yet the questions' clarity were mainly considered 'neither clear nor unclear' (52%). Missing data varied between 0 (0%) and 19 (12%) per item, the most common being 1 missing case per item (15 items). Internal consistency (Cronbach's Alpha > .70) was reached for 5 out of 8 contextual concepts. Translation and back translation identified 21 linguistic- and semantic related issues and 3 context related deviations, resolved by developers and translators.

    CONCLUSION: Modifying an instrument is a detailed process, requiring time and consideration of the linguistic and semantic aspects of the instrument, and understanding of the context where the instrument was developed and where it is to be applied. A team, including the instrument's developers, translators, and researchers is necessary to ensure a valid translation. This study suggests preliminary validity, reliability and acceptability evidence for the ACT when used with nurses in Swedish elder care.

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  • 22.
    Eldh, Ann Catrine
    et al.
    Örebro universitet.
    Ekman, Inger
    Ehnfors, M
    Communication errors as definitions of patient participation lacks patient's point of view2007Conference paper (Refereed)
  • 23.
    Eldh, Ann Catrine
    et al.
    Örebro universitet.
    Ekman, Inger
    Ehnfors, M
    Patient participation - the patients view2003Conference paper (Other academic)
  • 24.
    Eldh, Ann Catrine
    et al.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm and School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ekman, Inger
    Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg.
    Ehnfors, Margareta
    Örebro universitet, Institutionen för hälsovetenskap och medicin, Örebro.
    A comparison of the concept of patient participation and patients' descriptions as related to healthcare definitions.2010In: International journal of nursing terminologies and classifications : the official journal of NANDA International, ISSN 1744-618X, Vol. 21, no 1, p. 21-32Article in journal (Refereed)
    Abstract [en]

    PURPOSE. To depict what patients describe as patient participation and whether descriptions of patient participation are affected by gender, age, healthcare contact, and duration of disease. DATA SOURCES. Current patients (n= 362) responded to a questionnaire on participation. DATA SYNTHESIS. Patients' descriptions focused on having knowledge, rather than being informed, and on interacting with health professionals, rather than merely partaking in decision making. CONCLUSIONS. Patients' descriptions of participation correspond with the International Classification of Functioning, Disability and Health's definition, which includes "being involved in a life situation." Healthcare legislation and professionals employ a narrower concept of patient participation as defined by, e.g., Medical Subject Headings. PRACTICE IMPLICATIONS. Findings suggest that health professionals need to embrace what patients describe as participation.

  • 25.
    Eldh, Ann Catrine
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ekman, Inger
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademin, Göteborg.
    Ehnfors, Margareta
    Örebro universitet, Institutionen för vårdvetenskap och omsorg.
    Conditions for patient participation and non-participation in health care.2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 5, p. 503-14Article in journal (Refereed)
    Abstract [en]

    This study explored patients' experiences of participation and non-participation in their health care. A questionnaire-based survey method was used. Content analysis showed that conditions for patient participation occurred when information was provided not by using standard procedures but based on individual needs and accompanied by explanations, when the patient was regarded as an individual, when the patient's knowledge was recognized by staff, and when the patient made decisions based on knowledge and needs, or performed self-care. Thus, to provide conditions for true patient participation, professionals need to recognize each patient's unique knowledge and respect the individual's description of his or her situation rather than just inviting the person to participate in decision making.

  • 26.
    Eldh, Ann Catrine
    et al.
    Örebro University, Sweden.
    Ekman, Inger
    Göteborg University.
    Ehnfors, Margareta
    Örebro University.
    Conditions for Patient Participation and Non-Participation in Health Care2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 5, p. 503-514Article in journal (Refereed)
    Abstract [en]

    This study explored patients' experiences of participation and non-participation in their health care. A questionnaire-based survey method was used. Content analysis showed that conditions for patient participation occurred when information was provided not by using standard procedures but based on individual needs and accompanied by explanations, when the patient was regarded as an individual, when the patient's knowledge was recognized by staff, and when the patient made decisions based on knowledge and needs, or performed self-care. Thus, to provide conditions for true patient participation, professionals need to recognize each patient's unique knowledge and respect the individual's description of his or her situation rather than just inviting the person to participate in decision making.

  • 27.
    Eldh, Ann Catrine
    et al.
    FoU Seniorium, Danderyd; Örebro universitet, Hälsovetenskapliga institutionen.
    Ekman, Inger
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademin, Göteborg.
    Ehnfors, Margareta
    Örebro universitet, Institutionen för vårdvetenskap och omsorg.
    Considering patient non-participation in health care.2008In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 11, no 3, p. 263-71Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to depict patient non-participation as described by a diverse group with recent experiences of being patients.

    BACKGROUND: Patient participation is regarded as a primary condition for optimal quality of care, suggesting that non-participation should be avoided. A common understanding of the concept of patient non-participation is needed. A discrepancy in definitions of patient non-participation has been found in health-care interactions, health-care classifications and health-care research, and little is known of what patient non-participation represents to patients.

    STUDY DESIGN: A survey consisting of closed-ended and open-ended questions was administered to persons that had recently been patients to gather respondents' descriptions of what they considered as patient non-participation. Qualitative content analysis was used to analyse free-text descriptions, and descriptive statistics were used for the close-ended alternatives.

    FINDINGS: Lacking information (e.g. not being provided with appropriate information) and lacking recognition (e.g. not being listened to and/or lacking recognition as an individual with individual needs and concerns) were significant aspects of patient non-participation. Furthermore, non-participation encompassed facing organization-centred, as opposed to patient-centred, health care as well as feeling insecure in health care interactions.

    CONCLUSION: The findings provide input for a better understanding of what patients experience as non-participation. Organising for the caregivers to be able to thoroughly listen to the patients' illness narratives would easily reduce the risk of patient's experiencing what is described as non-participation and would provide a sound base for patient learning needs.

  • 28.
    Eldh, Ann Catrine
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning, Sweden.
    Fredriksson, Mio
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning, Sweden.
    Halford, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning. Sweden.
    Wallin, Lars
    School of Education, Health, and Social Studies, Dalarna University. Sweden.
    Dahlström, Tobias
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning, Sweden.
    Vengberg, Sofie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning, Sweden.
    Winblad, Ulrika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning, Sweden.
    Facilitators and barriers to applying a national quality registry for quality improvement in stroke care.2014In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 14, article id 354Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden.

    METHODS: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis.

    RESULTS: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data.

    CONCLUSION: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.

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  • 29.
    Eldh, Ann Catrine
    et al.
    Department of Public Health and Caring Sciences, Uppsala University; School of Health and Social Science, Dalarna University.
    Fredriksson, Mio
    Department of Public Health and Caring Sciences, Uppsala University.
    Vengberg, Sofie
    Department of Public Health and Caring Sciences, Uppsala University.
    Halford, Christina
    Department of Public Health and Caring Sciences, Uppsala University.
    Wallin, Lars
    School of Health and Social Science, Dalarna University; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
    Dahlström, Tobias
    Department of Public Health and Caring Sciences, Uppsala University.
    Winblad, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University.
    Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden.2015In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 15, article id 519Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study.

    METHODS: We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR).

    RESULTS: In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care.

    CONCLUSIONS: If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process.

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  • 30.
    Eldh, Ann Catrine
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Halleberg-Nyman, Maria
    Orebro Univ, Sweden.
    Joelsson-Alm, Eva
    Karolinska Inst, Sweden; Soder Sjukhuset, Sweden.
    Wallin, Lars
    Dalarna Univ, Sweden.
    Facilitating facilitators to facilitate-Some general comments on a strategy for knowledge implementation in health services2023In: FRONTIERS IN HEALTH SERVICES, ISSN 2813-0146, Vol. 3, article id 1112936Article in journal (Refereed)
    Abstract [en]

    Numerous endeavours to ensure that day-to-day healthcare is both evidence-based and person-centred have generated extensive, although partial, comprehension of what guarantees quality improvement. To address quality issues, researchers and clinicians have developed several strategies as well as implementation theories, models, and frameworks. However, more progress is needed regarding how to facilitate guideline and policy implementation that guarantees effective changes take place in a timely and safe manner. This paper considers experiences of engaging and supporting local facilitators in knowledge implementation. Drawing on several interventions, considering both training and support, this general commentary discusses whom to engage and the length, content, quantity, and type of support along with expected outcomes of facilitators activities. In addition, this paper suggests that patient facilitators could help produce evidence-based and person-centred care. We conclude that research about the roles and functions of facilitators needs to include more structured follow-ups and also improvement projects. This can increase the speed of learning with respect to what works, for whom, in what context, why (or why not), and with what outcomes when it comes to facilitator support and tasks.

  • 31.
    Eldh, Ann Catrine
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Holmefur, Marie
    Orebro Univ, Sweden.
    Luhr, Kristina
    Orebro Univ, Sweden.
    Wenemark, Marika
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Assessing and reporting patient participation by means of patient preferences and experiences2020In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 20, no 1, article id 702Article in journal (Refereed)
    Abstract [en]

    BackgroundAlthough patient participation is strongly associated with high quality of healthcare, valid means to measure and report a comprehensive notion of patient participation are scarce. The Patient Preferences for Patient Participation (4Ps) is a new healthcare practice and research tool, comprising patients preferences as well as experiences. The 4Ps employs 12 items for the patient to conceptualise patient participation. The aim of this paper is to describe how the two perspectives of patient participation, namely preferences and experiences, can be combined to visualise and report preference-based patient participation.MethodsWith four response alternatives in each section, the 4Ps offers sixteen possible combinations of degree of match per item. Theoretical and clinical principles fostered a tentative order of six ranks and three levels of preference-based patient participation. To test the standard, statistical analyses for ordinal data were performed, using data from a randomised controlled trial evaluating an intervention aiming to improve patient participation. Further, structures for visualising the preference-based patient participation of individuals and groups were suggested.ResultsData from the 4Ps demonstrated the individuals preference-based patient participation, indicating either a match or a mismatch for each item. Mismatches represented either the experience of participation surpassing the patients preferences, or the patients preferences for patient participation not being established. At group level, the suggested approach for visualising and reporting the 4Ps demonstrated that the intervention group had a significantly higher proportion of sufficient preference-based patient participation for certain items than the control group. These results had not been identified earlier, when using the preferences and experiences of patient participation as separate measures.ConclusionsWays to easily acquaint stakeholders with patients preferences for patient participation are needed, in order for healthcare staff to better use resources to match the basic requirements of individuals and groups. While the 4Ps can guide professionals to patient participation as framed in legislations, concept analyses and by patients, a visualisation of the results is needed to capture preference-based patient participation. The proposed route to representing degree of match in preferences and experiences may also be relevant to other dimensions of quality of healthcare.

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  • 32.
    Eldh, Ann Catrine
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Joelsson-Alm, Eva
    Karolinska Inst, Sweden.
    Wretenberg, Per
    Orebro Univ, Sweden.
    Hälleberg-Nyman, Maria
    Orebro Univ, Sweden.
    Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION-a study protocol for a randomised trial by a multi-professional facilitator team and their first-line managers implementation strategy2021In: Implementation Science, E-ISSN 1748-5908, Vol. 16, no 1, article id 65Article in journal (Refereed)
    Abstract [en]

    Background: The Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION, project aims to progress knowledge translation vis-a-vis evidence-based bladder monitoring in orthopaedic care, to decrease the risk of urinary retention, and voiding complications. Urinary retention is common whilst in hospital for hip surgery. If not properly identified and managed, there is a high risk of complications, some lifelong and life threatening. Although evidence-based guidelines are available, the implementation is lagging. Methods: Twenty orthopaedic sites are cluster randomised into intervention and control sites, respectively. The intervention sites assemble local facilitator teams among nursing and rehabilitation staff, including first-line managers. The teams receive a 12-month support programme, including face-to-face events and on-demand components to map and bridge barriers to guideline implementation, addressing leadership behaviours and de-implementation of unproductive routines. All sites have access to the guidelines via a public healthcare resource, but the control sites have no implementation support. Baseline data collection includes structured assessments of urinary retention procedures via patient records, comprising incidence and severity of voiding issues and complications, plus interviews with managers and staff, and surveys to all hip surgery patients with interviews across all sites. Further assessments of context include the Alberta Context Tool used with staff, the 4Ps tool for preference-based patient participation used with patients, and data on economic aspects of urinary bladder care. During the implementation intervention, all events are recorded, and the facilitators keep diaries. Post intervention, the equivalent data collections will be repeated twice, and further data will include experiences of the intervention and guideline implementation. Data will be analysed with statistical analyses, including comparisons before and after, and between intervention and control sites. The qualitative data are subjected to content analysis, and mixed methods are applied to inform both clinical outcomes and the process evaluation, corresponding to a hybrid design addressing effectiveness, experiences, and outcomes. Discussion: The OPTION trial has a potential to account for barriers and enablers for guideline implementation in the orthopaedic context in general and hip surgery care in particular. Further, it may progress the understanding of implementation leadership by dyads of facilitators and first-line managers.

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  • 33.
    Eldh, Ann Catrine
    et al.
    Högskolan Dalarna, Sweden.
    Jönsson, Birgitta
    Högskolan Dalarna, Sweden.
    Nordin, Susanna
    Högskolan Dalarna, Sweden.
    Att ha eller riskera funktionsnedsättning och genomgå utbildning till sjuksköterska: To have or to be at risk for dysfunction while training to become a registered nurse2015Report (Refereed)
  • 34.
    Eldh, Ann Catrine
    et al.
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Luhr, Kristina
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Family Medicine Research Centre, Örebro County Council, Örebro, Sweden.
    Ehnfors, Margareta
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    The development and initial validation of a clinical tool for patients' preferences on patient participation--The 4Ps.2015In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 18, no 6, p. 2522-35Article in journal (Refereed)
    Abstract [en]

    AIMS: To report on the development and initial testing of a clinical tool, The Patient Preferences for Patient Participation tool (The 4Ps), which will allow patients to depict, prioritize, and evaluate their participation in health care.

    BACKGROUND: While patient participation is vital for high quality health care, a common definition incorporating all stakeholders' experience is pending. In order to support participation in health care, a tool for determining patients' preferences on participation is proposed, including opportunities to evaluate participation while considering patient preferences.

    METHODS: Exploratory mixed methods studies informed the development of the tool, and descriptive design guided its initial testing. The 4Ps tool was tested with 21 Swedish researcher experts (REs) and patient experts (PEs) with experience of patient participation. Individual Think Aloud interviews were employed to capture experiences of content, response process, and acceptability.

    RESULTS: 'The 4Ps' included three sections for the patient to depict, prioritize, and evaluate participation using 12 items corresponding to 'Having Dialogue', 'Sharing Knowledge', 'Planning', and 'Managing Self-care'. The REs and PEs considered 'The 4Ps' comprehensible, and that all items corresponded to the concept of patient participation. The tool was perceived to facilitate patient participation whilst requiring amendments to content and layout.

    CONCLUSIONS: A tool like The 4Ps provides opportunities for patients to depict participation, and thus supports communication and collaboration. Further patient evaluation is needed to understand the conditions for patient participation. While The 4Ps is promising, revision and testing in clinical practice is required.

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  • 35.
    Eldh, Ann Catrine
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Olai, Lena
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Jönsson, Birgitta
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; The Public Dental Health Service Competence Centre of Northern Norway, Tromsø, Norway.
    Wallin, Laris
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; University of Gothenburg, Göteborg, Sweden.
    Denti, Leif
    University of Gothenburg, Göteborg, Sweden.
    Elf, Marie
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; School of Architecture, Chalmers University of Technology, Göteborg, Sweden.
    Supporting first-line managers in implementing oral care guidelines in nursing homes2018In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Nordic Journal of Nursing Research, Vol. 38, no 2, p. 87-95Article in journal (Refereed)
    Abstract [en]

    This study investigated first-line managers’ experience of and responses to a concise leadership intervention to facilitate the implementation of oral care clinical practice guidelines (CPGs) in nursing homes. Leadership is known to be an important element in knowledge implementation but little is known as to what supports managers to facilitate the process. By means of a process evaluation with mixed methods, the context and a three-month leadership program was explored, including activities during and in relation to the program, and the effects in terms of oral care CPG implementation plans. While the managers appreciated the intervention and considered improved oral care to be a priority, their implementation plans mainly focused the dissemination of an oral care checklist. The findings suggest that extended implementation interventions engaging both managers and clinical staff are needed, and that a concise intervention does not facilitate first-line managers to adopt behaviors known to facilitate knowledge implementation.

  • 36.
    Eldh, Ann Catrine
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Rycroft-Malone, Jo
    Univ Lancaster, England.
    van der Zijpp, Teatske
    Fontys Univ Appl Sci, Netherlands.
    McMullan, Christel
    Univ Birmingham, England.
    Hawkes, Claire
    Univ Warwick, England.
    Using Nonparticipant Observation as a Method to Understand Implementation Context in Evidence-Based Practice2020In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 17, no 3, p. 185-192Article in journal (Refereed)
    Abstract [en]

    Background The uptake of evidence-based knowledge in practice is influenced by context. Observations are suggested as a valuable but under-used approach in implementation research for gaining a holistic understanding of contexts. Aim The aim of this paper is to demonstrate how data from observations can provide insights about context and evidence use in implementation research. Methods Data were collected over 24 months in a randomised trial with an embedded realist evaluation in 24 nursing homes across four European countries; notes from 183 observations (representing 335 hours) were triangulated with interview transcripts and context survey data (from 357 staff interviews and 725 questionnaire responses, respectively). Results Although there were similarities in several elements of context within survey, interview and observation data, the observations provided additional features of the implementation context. In particular, observations demonstrated if and how the resources (staffing and supplies) and leadership (formal and informal, teamwork, and professional autonomy) affected knowledge use and implementation. Further, the observations illuminated the influence of standards and the physical nursing environment on evidence-based practice, and the dynamic interaction between different aspects of context. Linking Evidence to Action Although qualitative observations are resource-intensive, they add value when used with other data collection methods, further enlightening the understanding of the implementation context and how evidence use and sharing are influenced by context elements. Observations can enhance an understanding of the context, evidence use and knowledge-sharing triad in implementation research.

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  • 37.
    Eldh, Ann Catrine
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Seers, Kate
    University of Warwick, Coventry, England.
    Rycroft-Malone, Joanne
    Lancaster university, Lancaster, England.
    Realist evaluation2020In: Handbook on implementation science / [ed] Per Nilsen, Sarah A. Birken, Cheltenham: Edward Elgar Publishing, 2020, Vol. Sidorna 505-511, p. 505-511Chapter in book (Other academic)
  • 38.
    Eldh, Ann Catrine
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Sverker, Annette M.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Bendtsen, Preben
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Nilsson, Evalill
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. e-Health Institute, Department of Medicine and Optometry, Linneaus University, Kalmar, Sweden.
    Health Care Professionals Experience of a Digital Tool for Patient Exchange, Anamnesis, and Triage in Primary Care: Qualitative Study2020In: JMIR Human Factors, E-ISSN 2292-9495, Vol. 7, no 4, article id e21698Article in journal (Refereed)
    Abstract [en]

    Background:Despite a growing body of knowledge about eHealth innovations, there is still limited understanding of the implementation of such tools in everyday primary care.

    Objective:The objective of our study was to describe health care staff’s experience with a digital communication system intended for patient-staff encounters via a digital route in primary care.

    Methods:In this qualitative study we conducted 21 individual interviews with staff at 5 primary care centers in Sweden that had used a digital communication system for 6 months. The interviews were guided by narrative queries, transcribed verbatim, and subjected to content analysis.

    Results:While the digital communication system was easy to grasp, it was nevertheless complex to use, affecting both staffing and routines for communicating with patients, and documenting contacts. Templates strengthened equivalent procedures for patients but dictated a certain level of health and digital literacy for accuracy. Although patients expected a chat to be synchronous, asynchronous communication was extended over time. The system for digital communication benefited assessments and enabled more efficient use of resources, such as staff. On the other hand, telephone contact was faster and better for certain purposes, especially when the patient’s voice itself provided data. However, many primary care patients, particularly younger ones, expected digital routes for contact. To match preferences for communicating to a place and time that suited patients was significant; staff were willing to accept some nuisance from a suboptimal service—at least for a while—if it procured patient satisfaction. A team effort, including engaged managers, scaffolded the implementation process, whereas being subjected to a trial without likely success erected barriers.

    Conclusions:A digital communication system introduced in regular primary care involved complexity beyond merely learning how to manage the tool. Rather, it affected routines and required that both the team and the context were addressed. Further knowledge is needed about what factors facilitate implementation, and how. This study suggested including ethical perspectives on eHealth tools, providing an important but novel aspect of implementation.

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  • 39.
    Eldh, Ann Catrine
    et al.
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden .
    Tollne, AnnaMaria
    Astrid Lindgren Children's Hospital, Stockholm, Sweden.
    Förberg, Ulrika
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Wallin, Lars
    chool of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    What Registered Nurses Do and Do Not in the Management of Pediatric Peripheral Venous Catheters and Guidelines: Unpacking the Outcomes of Computer Reminders.2016In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 13, no 3, p. 207-15Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Clinical practical guidelines (CPGs) may enhance evidence-based practice, but require implementation. Computer reminders have previously shown various effects in supporting implementation; in a concomitant study, we found no effect on complications in peripheral venous catheters (PVCs) or registered nurses' (RNs) adherence to a CPG in pediatric care. Yet, there is a need to determine how reminders operate in particular contexts.

    AIM: To depict if, in what context, and how computer reminders regarding evidence-based management of PVC in pediatric care are applied according to RNs' actions and experience.

    METHODS: Qualitative data from nonparticipant observations and interviews with 18 RNs in four intervention units at a pediatric hospital were analyzed with content analysis.

    FINDINGS: Attention given to the computer reminders varied; the RNs noticed them in units where there was an agreement about the management and recording of PVCs, but not elsewhere. Rather, computer reminders did not facilitate adherence to the PVC-CPG where the CPG was not acknowledged from the start. RNs who knew how to manage PVCs had peer support and received additional reminders, which suggested that the computer reminders added to the significance of PVCs in pediatric care.

    LINKING EVIDENCE TO ACTION: While the computer reminders alone did not support CPG implementation, they further increased the attention to PVCs in contexts where there was a readiness to change along with a supportive culture. We suggest further studies tailoring implementation strategies to include electronic means if there is a beneficial context.

  • 40.
    Eldh, Ann Catrine
    et al.
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    van der Zijpp, Teatske
    Fontys University of Applied Science, Eindhoven, Netherlands.
    McMullan, Christel
    Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
    McCormack, Brendan
    School of Health Sciences, Queen Margaret University, Musselburgh, UK.
    Seers, Kate
    Warwick Medical School, University of Warwick, Coventry, UK.
    Rycroft-Malone, Jo
    School of Healthcare Sciences, Bangor University, Bangor, UK.
    'I have the world's best job' - staff experience of the advantages of caring for older people.2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 2, p. 365-73Article in journal (Refereed)
    Abstract [en]

    RATIONALE: Besides a growing demand for safe high-quality care for older people, long-term care (LTC) often struggles to recruit appropriately qualified nursing staff. Understanding what LTC staff value in their work may contribute to a more comprehensive understanding of what can attract staff and support person-centred care.

    AIM: To explore staff experience of the advantages of working in LTC settings for older people.

    METHODS: Narrative descriptions of 85 LTC staff in Ireland, the Netherlands and Sweden on what they value in their work were analysed with qualitative content analysis.

    ETHICS: Ethical approval was obtained according to the requirements of each country, and participants provided informed consent prior to the individual interviews.

    FINDINGS: Working in LTC signifies bonding with the older people residing there, their next of kin and the team members. It means autonomy in one's daily tasks amalgamated with being a part of an affirmative team. Participants reported a sense of accomplishment and fulfilment; caring meant consideration and recognition of the older people and the relationships formed, which provided for professional and personal growth. The sharing of compassion between staff and residents indicated reciprocity of the relationship with residents.

    STUDY LIMITATIONS: The findings may be transferable to LTC in general although they address only the positive aspects of caring for older people and only the experiences of those staff who had consented to take part in the study.

    CONCLUSIONS: The findings add to what underpins the quality of care in nursing homes: compassion in the nurse-resident relationship and person-centred care in LTC. They indicate reciprocity in the relations formed that may contribute to the empowerment of older people, but further studies are needed to explore this in more detail.

  • 41.
    Eldh, Ann Catrine
    et al.
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
    Vogel, Gisela
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
    Söderberg, Anna
    Division of Nursing, Umeå University, Umeå, Sweden.
    Blomqvist, Hans
    Karolinska Institutet, Department of Clinical Sciences, Stockholm, Sweden.
    Wengström, Yvonne
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
    Use of evidence in clinical guidelines and everyday practice for mechanical ventilation in Swedish intensive care units.2013In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 10, no 4, p. 198-207Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIM: One way to support evidence-based decisions in health care is by clinical guidelines, in particular, in highly specialized care such as intensive care units (ICUs). The aim of this study was to explore the development and dissemination of guidelines regarding mechanical ventilation (MV) in Swedish ICUs, and the use of evidence on MV in guidelines and everyday practice.

    METHODS: Inviting all general ICUs in Sweden (N = 65), a national survey was performed on occurrence of MV guidelines, and a review of submitted ICU guidelines by four evidence items from the AGREE instrument. In addition, ICU head nurses and senior physicians were interviewed using semistructured and open-ended questions to explore development and dissemination of MV guidelines, staff adherence or nonadherence to guidelines, and everyday practice of MV management bedside.

    FINDINGS: Fifty-five ICUs (85%) participated in the study; 51 ICUs submitted a total of 245 guidelines, including recommendations for medical or nursing MV actions. None of the documents included how evidence had been sought or assessed, while 22% included a list of references (n = 54). No guidelines included patients' experiences of MV. According to the managers, the guidelines were most often compiled by a multiprofessional team sharing the information through the ICU's website. The guidelines were mainly used as a basis for MV management bedside, but variation occurred as a result of personal preferences, lack of awareness, and adjustment to patients' needs.

    CONCLUSIONS: Local MV guidelines seem to constitute a basis for healthcare practice in Swedish ICUs, even though the evidence proposed was limited with respect to how it was attained and lacked patient perspectives. In addition, the strategies used for dissemination were limited, suggesting that further initiatives are needed to support knowledge translation in advanced healthcare environments such as ICUs.

  • 42.
    Eldh, Ann Catrine
    et al.
    School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Wallin, Lars
    School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    How Single Is "Single" - Some Pragmatic Reflections on Single Versus Multifaceted Interventions to Facilitate Implementation: Comment on "Translating Evidence Into Healthcare Policy and Practice2015In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 4, no 10, p. 699-701Article in journal (Refereed)
    Abstract [en]

    An earlier overview of systematic reviews and a subsequent editorial on single-component versus multifaceted interventions to promote knowledge translation (KT) highlight complex issues in implementation science. In this supplemented commentary, further aspects are in focus; we propose examples from (KT) studies probing the issue of single interventions. A main point is that defining what is a single and what is a multifaceted intervention can be ambiguous, depending on how the intervention is conceived. Further, we suggest additional perspectives in terms of strategies to facilitate implementation. More specifically, we argue for a need to depict not only what activities are done in implementation interventions, but to unpack functions in particular contexts, in order to support the progress of implementation science.

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  • 43.
    Eldh, Ann Catrine
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; School of Health and Social Science, Dalarna University, Falun, Sweden..
    Wallin, Lars
    School of Health and Social Science, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Fredriksson, Mio
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Vengberg, Sofie
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Winblad, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Halford, Christina
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Dahlström, Tobias
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey.2016In: BMJ Open, E-ISSN 2044-6055, Vol. 6, no 11, article id e011562Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement.

    METHODS: Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression.

    RESULTS: A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R(2)=0.76) with 'Colleagues' call for local results' (p=<0.001), 'Management Request of Registry data' (p=<0.001), and it was said to be 'Simple to explain the results to colleagues' (p=0.02). Using stepwise regression, 'Colleagues' call for local results' was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results.

    CONCLUSIONS: While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.

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  • 44.
    Elf, Marie
    et al.
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Eldh, Ann Catrine
    Department of Nursing, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Malmqvist, Inga
    School of Architecture, Chalmers University of Technology, Göteborg, Sweden.
    Öhrn, Kerstin
    Department of Nursing, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    von Koch, Lena
    Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet (KI), Karolinska University Hospital, Stockholm, Sweden.
    Using of Group-Modeling in Predesign Phase of New Healthcare Environments: Stakeholders Experiences.2016In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 9, no 2, p. 69-81Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Current research shows a relationship between healthcare architecture and patient-related outcomes. The planning and designing of new healthcare environments is a complex process. The needs of the various end users of the environment must be considered, including the patients, the patients' significant others, and the staff. The aim of this study was to explore the experiences of healthcare professionals participating in group modeling utilizing system dynamics in the predesign phase of new healthcare environments. We engaged healthcare professionals in a series of workshops using system dynamics to discuss the planning of healthcare environments in the beginning of a construction and then interviewed them about their experience.

    METHODS: An explorative and qualitative design was used to describe participants' experiences of participating in the group-modeling projects. Participants (N = 20) were recruited from a larger intervention study using group modeling and system dynamics in planning and designing projects. The interviews were analyzed by qualitative content analysis.

    RESULTS: Two themes were formed, representing the experiences in the group-modeling process: "Participation in the group modeling generated knowledge and was empowering" and "Participation in the group modeling differed from what was expected and required the dedication of time and skills."

    CONCLUSIONS: The method can support participants in design teams to focus more on their healthcare organization, their care activities, and their aims rather than focusing on detailed layout solutions. This clarification is important when decisions about the design are discussed and prepared and will most likely lead to greater readiness for future building process.

  • 45.
    Enlund, Karolina Brunius
    et al.
    Swedish Univ Agr Sci, Sweden.
    Pettersson, Ann
    Swedish Univ Agr Sci, Sweden.
    Eldh, Ann Catrine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Dog Owners' Ideas and Strategies Regarding Dental Health in Their Dogs-Thematic Analysis of Free Text Survey Responses2022In: Frontiers in Veterinary Science, E-ISSN 2297-1769, Vol. 9, article id 878162Article in journal (Refereed)
    Abstract [en]

    Periodontal disease is the most common disease in dogs over 3 years of age. In dogs, as in humans, daily tooth brushing, as a means of active dental home care, is considered the gold standard for prophylaxis and prevention of periodontal disease progression. However, the performance of adequate tooth brushing is insufficient in dogs. There is no full account as to why dog owners fail to comply with this routine, but in order to facilitate better practice, a further understanding of dog owners perspectives is needed. The aim of this study was to investigate dog owners ideas and strategies regarding their dogs dental health. In a large-scale Swedish survey regarding dental health in dogs, dog owners free text comments (n = 8,742) from a concluding open-ended query were analyzed using qualitative methods. Many different notions concerning dental health in dogs were identified, of which perceived importance of different diets and chewing being the most prominent. Five common themes represented dog owners ideas and strategies regarding dental health in their dogs: what is considered to cause dental problems; what is deemed not to promote dental health; how to prevent dental problems; what impedes proper dental care, and; needs for increased knowledge and support. Contrary to existing research and knowledge in the field, the respondents commonly trusted that diet procure good dental health in the dog, as does chewing on bones. Seemingly, a range of misconceptions flourish among dog owners, indicating a need to share information and experiences, as well as support to bridge barriers to tooth brushing and other aspects that can enhance dog owners knowledge and practice. In addition, this study highlights the need for randomized controlled trials on effects of diets and supplements on different aspects of dental health; calculus, periodontal disease, and dental fractures, including dogs of different breeds, sizes and ages. Further research is also needed with respect to which strategies that best aid dog owners, by whom the support is best provided, when, and at what time point.

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  • 46.
    Eriksson, Leif
    et al.
    International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden; Departmant of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Bergström, Anna
    International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden; Institute for Global Health, London, United Kingdom.
    Hoa, Dinh Thi Phuong
    Hanoi School of Public Health, Hanoi, Vietnam.
    Nga, Nguyen Thu
    Research Institute for Child Health, Hanoi, Vietnam.
    Eldh, Ann Catrine
    Dalarna University, Sweden; Uppsala University, Sweden.
    Sustainability of knowledge implementation in a low- and middle- income context: Experiences from a facilitation project in Vietnam targeting maternal and neonatal health2017In: PLOS ONE, E-ISSN 1932-6203, Vol. 12, no 8, p. e0182626-Article in journal (Refereed)
    Abstract [en]

    Background

    In a previous trial in Vietnam, a facilitation strategy to secure evidence-based practice in primary care resulted in reduced neonatal mortality over a period of three years. While little is known as to what ensures sustainability in the implementation of community-based strategies, the aim of this study was to investigate factors promoting or hindering implementation, and sustainability of knowledge implementation strategies, by means of the former Neonatal Knowledge Into Practice (NeoKIP) trial.

    Methods

    In 2014 we targeted all levels in the Vietnamese healthcare system: six individual interviews with representatives at national, provincial and district levels, and six focus group discussions with representatives at the commune level. The interviews were transcribed verbatim, translated to English, and analysed using inductive and deductive thematic analysis.

    Results

    To achieve successful implementation and sustained effect of community-based knowledge implementation strategies, engagement of leaders and key stakeholders at all levels of the healthcare system is vital–prior to, during and after a project. Implementation and sustainability require thorough needs assessment, tailoring of the intervention, and consideration of how to attain and manage funds. The NeoKIP trial was characterised by a high degree of engagement at the primary healthcare system level. Further, three years post trial, maternal and neonatal care was still high on the agenda for healthcare workers and leaders, even though primary aspects such as stakeholder engagement at all levels, and funding had been incomplete or lacking.

    Conclusions

    The current study illustrates factors to support successful implementation and sustain effects of community-based strategies in projects in low- and middle-income settings; some but not all factors were represented during the post-NeoKIP era. Most importantly, trials in this and similar contexts require deliberate management throughout and beyond the project lifetime, and engagement of key stakeholders, in order to promote and sustain knowledge implementation.

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  • 47.
    Fredriksson, Mio
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning, Sweden.
    Eldh, Ann Catrine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning, Sweden, Högskolan i Dalarna, Sweden.
    Vengberg, Sofie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning..
    Dahlström, Tobias
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning, Sweden.
    Halford, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning, Sweden.
    Wallin, Lars
    Högskolan Dalarna, Sweden, Karolinska Institutet, Sweden.
    Winblad, Ulrika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning..
    Local politico-administrative perspectives on quality improvement based on national registry data in Sweden: a qualitative study using the Consolidated Framework for Implementation Research.2014In: Implementation Science, E-ISSN 1748-5908, Vol. 9, article id 189Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement's intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data.

    METHODS: Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed.

    RESULTS: The politicians' and administrators' perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians' role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations.

    CONCLUSIONS: The Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.

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  • 48.
    Fredriksson, Mio
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Halford, Christina
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Eldh, Ann Catrine
    Dalarna University, Sweden; Uppsala University, Sweden.
    Dahlström, Tobias
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Vengberg, Sofie
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Wallin, Lars
    School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden; Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Winblad, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Are data from national quality registries used in quality improvement at Swedish hospital clinics?2017In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 29, no 7, p. 909-915Article in journal (Refereed)
    Abstract [en]

    Objective

    To investigate the use of data from national quality registries (NQRs) in local quality improvement as well as purported key factors for effective clinical use in Sweden.

    Design

    Comparative descriptive: a web survey of all Swedish hospitals participating in three NQRs with different levels of development (certification level).

    Setting and Participants

    Heads of the clinics and physician(s) at clinics participating in the Swedish Stroke Register (Riksstroke), the Swedish National Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Lung Cancer Registry (NLCR).

    Main Outcome Measure(s)

    Individual and unit level use of NQRs in local quality improvement, and perceptions on data quality, organizational conditions and user motivation.

    Results

    Riksstroke data were reported as most extensively used at individual and unit levels ( x̅ 17.97 of 24 and x̅ 27.06 of 35). Data quality and usefulness was considered high for the two most developed NQRs ( x̅ 19.86 for Riksstroke and x̅ 19.89 for GallRiks of 25). Organizational conditions were estimated at the same level for Riksstroke and GallRiks ( x̅ 12.90 and x̅ 13.28 of 20) while the least developed registry, the NLCR, had lower estimates ( x̅ 10.32). In Riksstroke, the managers requested registry data more often ( x̅ 15.17 of 20).

    Conclusions

    While there were significant differences between registries in key factors such as management interest, use of NQR data in local quality improvement seems rather prevalent, at least for Riksstroke. The link between the registry’s level of development and factors important for routinization of innovations such as NQRs needs investigation.

  • 49. Gifford, W
    et al.
    Graham, I
    Eldh, Ann Catrine
    Karolinska Institutet, Stockholm.
    Lefebre, N
    Theoretical foundations on dissemination and implementation leadership: A conceptual model for leadership development2014Conference paper (Refereed)
  • 50.
    Gifford, Wendy
    et al.
    University of Ottawa, Ottawa, Ontario, Canada.
    Lewis, Krystina B.
    University of Ottawa, Ottawa, Ontario, Canada.
    Eldh, Ann Catrine
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Fiset, Val
    University of Ottawa, Ottawa, Ontario, Canada.
    Abdul-Fatah, Tara
    University of Ottawa, Ottawa, Ontario, Canada.
    Aberg, Anna Cristina
    Dalarna University, Falun, Sweden; Uppsala University, Uppsala, Sweden.
    Thavorn, Kednapa
    Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
    Graham, Ian D.
    University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
    Wallin, Lars
    Dalarna University, Falun, Sweden; University of Gothenburg, Gothenburg, Sweden; Karolinska Institute, Stockholm, Sweden.
    Feasibility and usefulness of a leadership intervention to implement evidence-based falls prevention practices in residential care in Canada2019In: Pilot and Feasibility Studies, E-ISSN 2055-5784, Vol. 5, no 103, article id 31452925Article in journal (Refereed)
    Abstract [en]

    Background

    Leadership is critical to supporting and facilitating the implementation of evidence-based practices in health care. Yet, little is known about how to develop leadership capacity for this purpose. The aims of this study were to explore the (1) feasibility of delivering a leadership intervention to promote implementation, (2) usefulness of the leadership intervention, and (3) participants’ engagement in leadership to implement evidence-based fall prevention practices in Canadian residential care.

    Methods

    We conducted a mixed-method before-and-after feasibility study on two units in a Canadian residential care facility. The leadership intervention was based on the Ottawa model of implementation leadership (O-MILe) and consisted of two workshops and two individualized coaching sessions over 3 months to develop leadership capacity for implementing evidence-based fall prevention practices. Participants (n = 10) included both formal (e.g., managers) and informal (e.g., nurses and care aids leaders). Outcome measures were parameters of feasibility (e.g., number of eligible candidates who attended the workshops and coaching sessions) and usefulness of the leadership intervention (e.g., ratings, suggested modifications). We conducted semi-structured interviews guided by the Implementation Leadership Scale (ILS), a validated measure of 12-item in four subcategories (proactive, supportive, knowledgeable, and perseverant), to explore the leadership behaviors that participants used to implement fall prevention practices. We repeated the ILS in a focus group meeting to understand the collective leadership behaviors used by the intervention team. Barriers and facilitators to leading implementation were also explored.

    Results

    Delivery of the leadership intervention was feasible. All participants (n = 10) attended the workshops and eight participated in at least one coaching session. Workshops and coaching were rated useful (≥ 3 on a 0–4 Likert scale where 4 = highly useful) by 71% and 86% of participants, respectively. Participants rated the O-MILe subcategories of supportive and perseverant leadership highest for individual leadership, whereas supportive and knowledgeable leadership were rated highest for team leadership.

    Conclusions

    The leadership intervention was feasible to deliver, deemed useful by participants, and fostered engagement in implementation leadership activities. Study findings highlight the complexity of developing implementation leadership and modifications required to optimize impact. Future trials are now required to test the effectiveness of the leadership intervention on developing leadership for implementing evidence-based practices.

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