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  • 1.
    Allvin, R.
    et al.
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden, Department of Clinical Medicine, Örebro University, Örebro, Sweden.
    Berg, Katarina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Nilsson, U.
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden, Department of Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden, Department of Health Sciences, Örebro University, Örebro, Sweden.
    Postoperative recovery: A concept analysis2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 57, no 5, p. 552-558Article in journal (Refereed)
    Abstract [en]

    Aim. This paper presents a concept analysis of the phenomenon of postoperative recovery. Background. Each year, millions of patients throughout the world undergo surgical procedures. Although postoperative recovery is commonly used as an outcome of surgery, it is difficult to identify a standard definition. Method. Walker and Avant's concept analysis approach was used. Literature retrieved from MEDLINE and CINAHL databases for English language papers published from 1982 to 2005 was used for the analysis. Findings. The theoretical definition developed points out that postoperative recovery is an energy-requiring process of returning to normality and wholeness. It is defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions, and results in a return to preoperative level of independence/dependency in activities of daily living and optimum level of psychological well-being. Conclusion. The concept of postoperative recovery lacks clarity, both in its meaning in relation to postoperative recovery to healthcare professionals in their care for surgical patients, and in the understanding of what researchers in this area really intend to investigate. The theoretical definition we have developed may be useful but needs to be further explored. © 2007 The Authors. Journal compilation 2007 Blackwell Publishing Ltd.

  • 2.
    Allvin, R
    et al.
    Örebro.
    Ehnfors, M
    Örebro.
    Rawal, N
    Örebro.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Experiences of the Postoperative Recovery Process: An interview Study2008In: Open nursing journal, ISSN 1874-4346, Vol. 2Article in journal (Refereed)
  • 3.
    Allvin, Renee
    et al.
    Örebro University Hospital.
    Ehnfors, Margareta
    University of Örebro.
    Idvall , Ewa
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability2009In: JOURNAL OF EVALUATION IN CLINICAL PRACTICE, ISSN 1356-1294 , Vol. 15, no 3, p. 411-419Article in journal (Refereed)
    Abstract [en]

    In this study we describe the development of a short, easy-to-use questionnaire to measure postoperative recovery and evaluate its content validity and intra-patient reliability. The questionnaire is designed to evaluate the progress of postoperative recovery and the long-term follow-up of possible effects of interventions during recovery. The study involved four steps. (1) A conceptualization and item definitions were based on a theoretical framework and a description of patients postoperative recovery from the perspective of patients, registered nurses and surgeons; (2) Content validity of items was tested through expert judgements; (3) A test run of the questionnaire was performed to confirm its feasibility and workload requirement; and (4) The stability of the questionnaire was evaluated through intra-patient reliability assessment. As a result of the operationalization process of the concept postoperative recovery, five dimensions (physical symptoms, physical functions, psychological, social, activity) and 19 items were identified. Each item was formulated as a statement in the questionnaire. Content validity was judged to be high. After the pre-test of the questionnaire a revision with refinements in the layout was made. The vast majority of items showed a high level of intra-patient reliability. Based on a theoretical framework and empirical data, we developed a short and easy-to-use tentative questionnaire to measure patient-reported postoperative recovery. Initial support for content validity was established. The vast majority of items showed a high level of test-retest reliability.

  • 4.
    Athlin, Elsy
    et al.
    Karlstad University.
    Idvall, Ewa
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Jernfalt, Margareth
    Karlstad University.
    Johansson, Inger
    Karlstad University.
    Factors of importance to the development of pressure ulcers in the care trajectory: perceptions of hospital and community care nurses2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 15-16, p. 2252-2258Article in journal (Refereed)
    Abstract [en]

    Aim. The study aimed at describing contributing factors for the progression or regression of pressure ulcers in the care trajectory as they were understood by nurses working in hospitals or community care. Background. The development of pressure ulcers is considered to be connected with early prevention and awareness among nurses and some studies have indicated that the care trajectory may be a weak point. Design. The study was carried out with a qualitative design. Method. Fifteen nurses from two Swedish hospitals and 15 nurses from community care were interviewed during 2005. Qualitative content analysis was used to make an understanding of patterns possible. Findings. Three main categories arose, showing that pressure ulcers were considered to be affected in the care trajectory by factors related to the individual patient, to the healthcare personnel and to the healthcare structure. Hospital and community care nurses mostly had corresponding perceptions of these factors. Conclusion. The study both confirmed previous findings and added new knowledge about factors that may affect pressure ulcer in the trajectory of care. The informants views of nurses responsibilities and their attitudes towards the care of pressure ulcers could, along with their views on the organisation of care, increase the understanding of the occurrence of pressure ulcers. The need for development and clarification of the organisation and responsibility of pressure ulcer care in the care trajectory was stressed. Relevance to clinical practice. The study highlighted attitudes and values among registered nurses, as well as to how to preserve their commitment and increase their knowledge concerning prevention of pressure ulcers.

  • 5.
    Bachrach-Lindström, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Christensson, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Lindgren, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Kvalitetsindikationer för områdena smärta, munhålan, nutrition, trycksår2005Report (Other academic)
  • 6.
    Berg, Agneta
    et al.
    Kristianstad.
    Suhonen, Riitta
    Finland.
    Idvall, Ewa
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    A survey of orthopaedic patients' assessment of care using the Individualised Care Scale2007In: Journal of Orthopaedic Nursing, ISSN 1361-3111, E-ISSN 1873-4839, Vol. 11, no 3-4, p. 185-193Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe orthopaedic patients' assessments of how individuality in patient care was supported during specific nursing interventions and how that individuality was perceived during hospitalisation. Orthopaedic inpatients (370) from two central county and two county hospitals in Sweden were surveyed using the Individualised Care Scale (ICS) during 2004/2005, (response rate 74% n = 274). The data were analysed using both descriptive and inferential statistics. Eighty-six percent of the respondents stated that it was very important to be treated as an individual or unique person and 59% experienced this type of care. The lowest rated assessments concerned the personal life situation and the highest were concerned with the clinical situation and the decisional control over care. This analysis of patient assessments of individualised nursing care can be used to implement changes to individualise care processes in orthopaedic wards. This will be useful in the evaluation of health care quality improvement, planning and personnel management. © 2007 Elsevier Ltd. All rights reserved.

  • 7.
    Berg, Katarina
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Idvall, Ewa
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilsson, Ulrica
    Örebro University Hospital.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Psychometric evaluation of the post-discharge surgical recovery scale2010In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 4, p. 794-801Article in journal (Refereed)
    Abstract [en]

    Rationale, aim and objectives Day surgery patients are discharged after a short period of postoperative surveillance, and reliable and valid instruments for assessment at home are needed. The aim of this study was to evaluate the psychometric properties of a Swedish version of the post-discharge surgical recovery (PSR) scale, an instrument to monitor the patients recovery after day surgery, in terms of data quality, internal consistency, dimensionality and responsiveness. Methods Data were collected on postoperative days 1 and 14 and included 525 patients. Data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbachs alpha. The dimensionality of the scale was determined through an exploratory factor analysis. Responsiveness was evaluated using the standardized response mean and the area under the receiver operating characteristics curve (AUC). The correlation between change score in PSR and change score in self-rated health was assessed using Pearsons correlation coefficient. Patients ability to work and their self-rated health on postoperative day 14 were used as external indicators of change. Results Six items showed floor or ceiling effects. Cronbachs coefficient alpha was 0.90 and the average inter-item correlation coefficient was 0.44 after the deletion of two items. The items were closely related to each other, and a one-factor solution was decided on. A robust ability to detect changes in recovery (standardized response mean = 1.14) was shown. The AUC for the entire scale was 0.60. When initial PSR scores were categorized into three intervals, the ability to detect improved and non-improved patients varied (AUC 0.58-0.81). There was a strong correlation between change scores in PSR and health (0.63). Conclusions The Swedish version of the PSR scale demonstrates acceptable psychometric properties of data quality, internal consistency, dimensionality and responsiveness. In addition to previous findings, these results strengthen the PSR scale as a potential instrument of recovery at home.

  • 8.
    Berg, Katarina
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Idvall, Ewa
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilsson, Ulrica
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Postoperativerecovery after different orthopaedic day surgical proceduresManuscript (preprint) (Other academic)
    Abstract [en]

    Orthopaedic day surgery is common. Postoperative recovery may differ according to surgical procedures and personal factors. We studied postoperative recovery up to two weeks after different orthopaedic day surgical procedures, and tried to identify possible predictors associated with recovery. Three-hundred and fifty-eight patients who had undergone knee arthroscopy or surgery on the hand/arm, foot/leg or shoulder were included. Data were collected preoperatively and on postoperative days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale, the emotional state, physical comfort and physical independence dimensions in the Quality of Recovery-23, and a general health question. A multiple linear regression was used to explore predictors of recovery. The shoulder patients experienced significantly lower postoperative recovery and general health one and two weeks after surgery compared to the other patient groups (p<0.001). Significant predictors of recovery were age, perceived health and emotional status on the first postoperative day, and type of surgery. Postoperative recovery after common orthopaedic day surgical procedures differs, and factors influencing it need to be further explored. The impact of a patient’s emotional state on recovery after day surgery can be of particular interest in this work. Post-discharge planning needs to be tailored to the surgical procedure.

  • 9.
    Berg, Katarina
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Idvall, Ewa
    Linköping University, Department of Medicine and Care.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Postoperative recovery for day surgery patients2004In: 12th Biennal Conference of the Workgroup of European Nurse Researchers,2004, 2004, p. 77-77Conference paper (Other academic)
  • 10.
    Bååth, Carina
    et al.
    Karlstad universitet Karlstad.
    Hall-Lord, Marie-Louise
    Karlstad universitet Karlstad.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Wiberg-Hedman, Katarina
    Karlstad universitet Karlstad.
    Wilde Larsson, Bodil
    Karlstad universitet Karlstad.
    Interrater reliability using Modified Norton Scale, Pressure Ulcer Card, Short Form-Mini Nutritional Assessment by registered and enrolled nurses in clinical practice2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 5, p. 618-626Article in journal (Refereed)
    Abstract [en]

    Aim. Examine the interrater reliability between and among registered and enrolled nurses using Modified Norton Scale, Pressure Ulcer Card and Short Form-Mini Nutritional Assessment. Background. In Sweden, registered nurses and enrolled nurses usually co-operate in patient care. National guidelines emphasize that reliable and valid assessment tools should be used. Interrater reliability for regular use of assessment tools is seldom studied. Design cross-sectional. Registered nurses and enrolled nurses made 228 assessments of patients' skin, risk for pressure ulcer and malnutrition, in patients with hip fracture and patients who had suffered a stroke. Results. The interrater reliability of the Modified Norton Score total score was very good among registered nurses, good among enrolled nurses and between both groups. There was good, moderate and fair agreement on the subscales. Interrater reliability of Short Form Mini-Nutritional Assesment screening score was very good between both groups, good among registered nurses and moderate among enrolled nurses. There was good and moderate agreement on the items. There was good, moderate and fair agreement between and among registered nurses and enrolled nurses when using the Pressure Ulcer Card. Conclusion. The Modified Norton Scale and Short Form Mini-Nutritional Assessment were reasonably understandable and easy to utilize in clinical care. Therefore, it seems possible for nurses to accomplish assessment using these tools. The agreement level was low for most skin sites except sacrum when nurses assessed patients' skin with the Pressure Ulcer Card. Relevance to clinical practice. The utilize of reliable and valid assessment tools is important in clinical practice. The tools could be used as an aid to the clinical judgement and therefore identify patients at risk for pressure ulcers and malnutrition. Pressure ulcer grading is a difficult skill that requires training and time to develop. © 2007 Blackwell Publishing Ltd.

  • 11. Claesson, A
    et al.
    Mattson, H
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Experiences expressed by artificially ventilated patients.2003In: 16th annual congress European Society of intensive care medicine,2003, 2003, p. 78-78Conference paper (Refereed)
  • 12.
    Claesson, Annica
    et al.
    Department of Intensive Care Unit, Oskarshamn Hospital, Kalmar County Council, Sweden.
    Mattson, Helen
    Department of Intensive Care Unit, Oskarshamn Hospital, Kalmar County Council, Sweden.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Experiences expressed by artificially ventilated patients2005In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, no 1, p. 116-117Article in journal (Other academic)
  • 13.
    Dahlman, Gull-Britt
    et al.
    Lund.
    Holmner, Britt
    Umeå.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Omvårdnadsfenomenet långvarig smärta2002In: Svensk sjuksköterskeförening, Linköping: Linköpings universitet , 2002, p. 63-64Chapter in book (Other academic)
  • 14. Gunningberg, L
    et al.
    Idvall, Ewa
    Linköping University, Department of Medicine and Care.
    The quality of postoperative pain management according to patients and nurses in a university hospital2004In: 12th Biennal Conference of the Workgroup of European Nurse Researchers,2004, 2004Conference paper (Other academic)
  • 15.
    Gunningberg, Lena
    et al.
    Uppsala universitet.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    The quality of postoperative pain management from the perspectives of patients, nurses and patient records2007In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 15, no 7, p. 756-766Article in journal (Refereed)
    Abstract [en]

    To study the quality of postoperative pain management in a university hospital. Paired patient and nurse assessments of the patient's pain management were conducted in two departments, complemented with audit of patient records. The Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire was answered by 121 patients and 47 Registered Nurses. Of 14 items in the Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire, four items in general surgery and five items in thoracic surgery reached the threshold for high quality of care. No significant differences were found between the assessments in the two departments, but the patients in general surgery experienced more pain than the patients in thoracic surgery. In general surgery, the patients assessed their worst pain significantly higher than the nurse did. The patients who experienced more pain than expected were less satisfied with the quality of their care and experienced higher pain intensity levels. For 25 (41.0%) patients in general surgery and four (6.7%) patients in thoracic surgery, pain intensity was documented according to hospital quality goals. In both departments, areas for improvements could be found in all subscales of the Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire, i.e. communication, action, trust and environment. It is important to discuss what information the patient needs, as well as how and when it should be given. Furthermore, considering earlier pain experience and the goal of pain relief for the individual patient may facilitate an adequate assessment of the patient's pain. In future, electronic health records have the potential to support the use of clinical guidelines. © 2007 The Authors. Journal compilation 2007 Blackwell Publishing Ltd.

  • 16.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Development of strategic and clinical quality indicators in postoperative pain management2002In: 10th International pain clinic world society of pain clinicians, Sardinien, Italien,2002, 2002, p. 35-39Conference paper (Refereed)
  • 17.
    Idvall, Ewa
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Development of Strategic and Clinical Quality: Indicators in Postoperative Pain Management2001Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis was to identify important aspects of surgical nursing care, designing strategic and clinical quality indicators in postoperative pain management, investigate content validity, develop and evaluate psychometric properties of an instrument to measure the indicators, test the applicability of the instrument and investigate patient and nurse assessment.

    To identify the important aspects of nursing care which might impact on quality of care in surgical wards, it was conducted 4 focus group interviews with clinical nurses (n=20). A tentative model with 15 categories in 2 dimensions, elements of performance and prerequisites, emerged from the data analysis. The categories were, e.g. detecting and acting on signs and symptoms, informing and educating, promoting relationships, responsibility and attitudes. The model was used as a foundation for developing indicators in postoperative pain management, one in each category, each supported by a literature review. To assess the content validity of the indicators, a questionnaire was compiled and sent to registered nurses with a special interest in pain (n=210) and to a random sample of clinical nurses working in surgical wards (n=321). The groups assessed the indicators as essential for achieving high quality, realistic to carry out and possible for nurses to influence management. The first group validated 14 of the 15 indicators and the second group validated 12 as “major” factors in terms of being essential to achieve high quality of care. The remaining factors were classified as “supportive”. No indicator was discarded.

    To measure the indicators, an instrument was developed and psychometric properties were evaluated. The indicators were converted to statements suitable for a patient questionnaire and were scored on a 5-point scale with higher values indicating higher quality of care. Patients (n=198) answered the questionnaire on their second postoperative day. The inter-item and item-total correlation coefficients were in a satisfactory range, and Cronbach’s coefficient alpha (0.84) supported internal consistency reliability. Four sub-scales, entitled communication, action, trust and environment emerged from the factor analysis with a total variance of 61.4%. The total scale correlated (rs=0.53) with the single item pain-relief-satisfaction question. The patients who reported more pain than expected scored lower on the total scale and the patients who received epidural analgesia reported higher scores on the total scale. A nurse questionnaire, similar to the patient questionnaire, was compiled. The responsible nurse at the time (n=63) answered 196 questionnaires paired with the individual patient. The new instrument appeared to be useful in identifying important areas for improvement both from the patients’ and nurses’ perspectives, based on the number of disagreements (1 and 2). Differences were found among departments. The patients’ assessments on the environment sub-scale and the overall satisfaction question were higher than the nurses’ assessments. The findings suggest initial support for the instrument as a means to measure the quality of nursing care in postoperative pain management. Key words: quality indicators; health care, pain; postoperative, focus groups, psychometrics, questionnaires, nursing care.

    List of papers
    1. Important aspects of nursing care in surgical wards as expressed by nurses
    Open this publication in new window or tab >>Important aspects of nursing care in surgical wards as expressed by nurses
    1998 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 7, no 6, p. 512-520Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to find out clinical nurses' perceptions of important aspects of nursing care that might have an impact on quality of care in surgical wards. A qualitative approach using focus group interviews was used. The data analysis revealed 15 categories of important aspects of care which could be condensed into two dimensions, here called 'prerequisites' (i.e., staffing, routines and attitudes) and 'elements of performance' (i.e., detecting and acting on signs and symptoms and acting on behalf of the patients). These aspects could be a starting point for developing quality indicators. Carper's four fundamental patterns of knowing were used to make a theoretical interpretation, and three of them were identified.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13613 (URN)
    Available from: 2001-05-29 Created: 2001-05-29
    2. A tentative model for developing strategic and clinical nursing quality indicators: postoperative pain management
    Open this publication in new window or tab >>A tentative model for developing strategic and clinical nursing quality indicators: postoperative pain management
    1999 (English)In: International journal of nursing practice, ISSN 1322-7114, Vol. 5, no 4, p. 216-226Article in journal (Refereed) Published
    Abstract [en]

    The purpose of the study was to evaluate the usefulness of a tentative model, based on important aspects of surgical nursing care, for designing strategic and clinical quality indicators. Objective postoperative pain management was chosen for the model because it is a priority area in surgical nursing care. Items within a questionnaire were designed by using the tentative model as a base and by means of a literature review. The questionnaire, directed to clinical nurses (n = 233), was compiled to establish the validity and the usefulness of the indicators. Fourteen items were assessed as essential for achieving high quality outcomes in postoperative pain management (11 as realistic to carry out, and 13 as possible for nurses to influence) with mean scores > or = 4 (on a 5-point scale). The conclusion reached was that the tentative model combined with a literature search was found to be effective for designing items that might be useful as strategic and clinical indicators of quality in postoperative pain management.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13614 (URN)
    Available from: 2001-05-29 Created: 2001-05-29 Last updated: 2009-05-19
    3. Quality indicators in postoperative pain management: a validation study
    Open this publication in new window or tab >>Quality indicators in postoperative pain management: a validation study
    2001 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, Vol. 15, no 4, p. 331-338Article in journal (Refereed) Published
    Abstract [en]

    In a previous study, strategic and clinical quality indicators were developed from a tentative model to assess high quality in postoperative pain management. The aim of the present study was to investigate the content validity of these 15 indicators. The indicators were compiled in a questionnaire, and two groups of nurses (n=210, n=321) scored each indicator on a 5-point scale (strongly disagree to strongly agree) from three different standpoints: whether it was essential for achieving high quality, whether it was realistic to carry out, and whether it was possible for nurses to influence management. The respondents were also asked to choose the most crucial indicators for the quality of care. The results showed that both groups of nurses judged the 15 indicators to have content validity from all three standpoints. Both groups also found the same six indicators to be the most crucial. These indicators concerned detecting and acting on signs and symptoms, performing prescriptions, informing and educating, acting on behalf of patients, competence/knowledge, and attitudes. The validated indicators should be useful to consider when implementing a strategy for postoperative pain management and when planning to evaluate the quality of care.

    Keyword
    pain, postoperative, quality indicators, validitym, clinical nursing research
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13615 (URN)10.1046/j.1471-6712.2001.00037.x (DOI)
    Available from: 2001-05-29 Created: 2001-05-29 Last updated: 2009-05-19
    4. Development of an instrument to measure strategic and clinical quality indicators in postoperative pain management
    Open this publication in new window or tab >>Development of an instrument to measure strategic and clinical quality indicators in postoperative pain management
    2002 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 37, no 6, p. 532-540Article in journal (Refereed) Published
    Abstract [en]

    AIM OF THE STUDY: To develop and evaluate psychometric properties, that is reliability and validity, of an instrument to measure strategic and clinical quality indicators in postoperative pain management.

    BACKGROUND: Strategic and clinical quality indicators in postoperative pain management were previously developed from a tentative model of important aspects of surgical nursing care and assessed to have content validity, that is to be essential for the quality of care, realistic to carry out and possible for nurses to use to influence management.

    METHODS: The quality indicators were converted to items suitable for a patient questionnaire and were scored on a 5-point scale, with higher scores indicating higher quality of care. Inpatients from five surgical wards took part in this study on their second postoperative day. The response rate was 96% and the average ages of the female (n=120) and the male (n=78) respondents were 62 and 63 years, respectively.

    RESULTS: Items in the total scale had an average inter-item correlation >0.20 and an item-total correlation >0.30. Cronbach's coefficient alpha was 0.84 for the total scale. Four factors entitled 'communication', 'action', 'trust' and 'environment' emerged from an orthogonal factor analysis, with a cumulative variance of 61.4%. Patients who received epidural analgesia had higher scores on the total scale compared with those who did not receive epidural analgesia. Patients who reported more pain than expected had lower scores on the total scale compared with those who did not report more pain than expected. Correlation between the total scale and an overall pain relief satisfaction question was 0.53.

    CONCLUSION: The results suggest initial support for the new instrument as a measure of strategic and clinical quality indicators in postoperative pain management, but it must be further refined, tested and evaluated.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13616 (URN)10.1046/j.1365-2648.2002.02130.x (DOI)
    Available from: 2001-05-29 Created: 2001-05-29 Last updated: 2009-05-19
    5. Patient and nurse assessment of quality of care in postoperative pain management
    Open this publication in new window or tab >>Patient and nurse assessment of quality of care in postoperative pain management
    2002 (English)In: Quality & Safety in Health Care, ISSN 1475-3898, Vol. 11, no 4, p. 327-334Article in journal (Refereed) Published
    Abstract [en]

    Objective: To describe and compare patient and nurse assessments of the quality of care in postoperative pain management, to investigate differences between subgroups of patients, and to compare patient assessments in different departments.

    Design: Patient and nurse questionnaires.

    Setting: Five surgical wards in general surgery, orthopaedics, and gynaecology in a central county hospital in Sweden.

    Sample: Two hundred and nine inpatients and 64 registered nurses. The response rates were 96% for the patients and 99% for the nurses; there were 196 paired patient-nurse assessments.

    Method: The Strategic and Clinical Quality Indicators in Postoperative Pain Management patient questionnaire was used which comprises14 items in four subscales (communication, action, trust, and environment). The items were scored on a 5 point scale with higher values indicating a higher quality of care. Five complementary questions on levels of pain intensity and overall satisfaction with pain relief were scored on an 11 point scale. Twelve of the 14 items in the patient questionnaire and two of the complementary questions were adjusted for use in the nurse questionnaire.

    Results: The patients’ mean (SD) score on the total scale (scale range 14–70) was 58.6 (8.9) and the nurses’ mean (SD) score (scale range 12–60) was 48.1 (6.2). The percentage of patients who scored 1 or 2 for an individual item (disagreement) ranged from 0.5% to 52.0%, while for nurses the percentage ranged from 0.0% to 34.8%. Forty two patients (24%) reported more pain than they expected; these patients assessed the quality of care lower. There were differences between patient and nurse assessments concerning the environment subscale, the question on overall satisfaction, and patients’ experience of worst possible pain intensity.

    Conclusion: The results provided valuable baseline data and identified important areas for quality improvement in postoperative pain management.

    Keyword
    postoperative pain, quality improvement, patient assessment, nurse assessment
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13617 (URN)
    Available from: 2001-05-29 Created: 2001-05-29 Last updated: 2009-05-19
  • 18.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Klinisk dokumentation: hur, vad, vem och varför mäter vi resultaten efter en intervention.2001In: Svensk ortopedisk förenings vårmöte, Norrköping,2001, 2001Conference paper (Refereed)
  • 19.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Kvalitetsindikatorer inom omvårdnad2001In: Kvalitetsindikatorer inom omvårdnad. / [ed] Ewa Idvall, Linköping: Linköpings universitet , 2001Chapter in book (Other academic)
  • 20.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Patient assessment of postoperative pain management - Orthopaedic patients compared to other surgical patients2008In: Journal of Orthopaedic Nursing, ISSN 1361-3111, E-ISSN 1873-4839, Vol. 12, no 1, p. 35-40Article in journal (Refereed)
    Abstract [en]

    We used a 14-item patient questionnaire, Strategic and Clinical Quality Indicators in Postoperative Pain Management, to describe how orthopaedic patients assessed the quality of care they received. The patients highest and lowest assessments were compared to assessments by other groups of surgical patients as reported in studies being published. Our study included 300 inpatients from four different orthopaedic wards in two county councils in Sweden. Patients answered a questionnaire on the day of discharge. The response rate was 74%, and 44% of the respondents were male. Elective surgery was the main reason for admission, and the mean length of stay was 7.3 days. One of the items rated highest was that pain relief was given quickly when requested. A literature review showed that this item also received a high rating in other studies using the same patient questionnaire. The item rated lowest concerned the regular use of a pain assessment instrument, which also received a low rating from patient groups other than the orthopaedics in this study. In conclusion, we found that orthopaedic patients and other groups of surgical patients gave similar assessments concerning the highest and lowest assessments of postoperative pain management. Nevertheless, further improvement is needed. © 2007 Elsevier Ltd. All rights reserved.

  • 21.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Post-operative patients in severe pain but satisfied with pain relief.2002In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 6, p. 841-842Article in journal (Refereed)
  • 22.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Quality of care in postoperative pain management: What is realistic in clinical practice?2004In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 12, no 3, p. 162-166Article in journal (Refereed)
    Abstract [en]

    This paper presents a study describing nurses' assessment of whether it was realistic to carry out good quality of care in postoperative pain management. Further, the study compared their assessment with the quality of care actually performed in clinical practice as assessed by both patients and nurses. Three questionnaires were used, one for patients (n = 198) and two for nurses (n = 63). Nurses and patients responded to similar questions, the patients assessed the quality of care they had received, and the nurses assessed the quality of care they had delivered. The nurses also responded to questions concerning whether the different aspects of good quality of care were realistic to carry out in practice. The results show that in several important aspects of postoperative pain management, both patients and nurses assessed the quality of care to be lower than the nurses' assessment of what was actually possible to effectuate in clinical practice, e.g. pain assessment and information. This finding highlights the problem of applying evidence-based care in actual clinical practice.

  • 23.
    Idvall, Ewa
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strategic and clinical quality indicators in surgical nursing care1998Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    The general aim of this study was to identify strategic and clinical quality indicators in surgical nursing care. The methods used were a literature review, focus group interviews and a survey with a questionnaire.

    In the literature the most frequently found definition of a clinical indicator was "a quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support activities". To uncover clinical nurses' perceptions of important aspects of surgical nursing care, four focus group interviews were undertaken. A tentative model with two dimensions and fifteen categories emerged from the data analysis. This model was used as a base for designing items to be effective as strategic and clinical quality indicators in postoperative pain management. A questionnaire to 233 clinical nurses was compiled to establish the usefulness and relevance of the items designed. Generally, all the items had high scores as being essential, realistic to carry out, and possible for nurses to influence. The tentative model was found useful for designing items that might be effective as strategic and clinical quality indicators in postoperative pain management.

  • 24.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Studentlitteratur: Kirurgiska sjukdomar. Patofysiologi Behandling Specifik Omvårdnad2004Other (Other (popular science, discussion, etc.))
  • 25.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Utveckling av stategiska och kliniska kvalitetsindikatorer inom postoperativ smärtbehandling2002In: Smärta, ISSN 1402-1048, Vol. 1Article in journal (Other (popular science, discussion, etc.))
  • 26.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Berg, Katarina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Brudin, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    Differences between nurse and patient assessments on postoperative pain management in two hospitals2005In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 11, no 5, p. 444-451Article in journal (Refereed)
    Abstract [en]

    Rationale: Differences between patient and professional assessments on pain and pain management have been reported, but no further analysis has described the statistical problems of pseudocorrelation concerning the nature of these differences. Aim: The aim of the present study was: (1) to investigate the differences between nurse and patient assessments of post-operative pain management in two hospitals, and (2) to discuss the nature and scope of these differences. Method: The subjects were 209 inpatients and 63 nurses from a central county hospital and 77 inpatients and 34 nurses from a university hospital. The 'Strategic and Clinical Quality Indicators in Postoperative Pain Management' questionnaire was used, comprising 14 items in four sub-scales (communication, action, trust and environment) and two questions concerning the worst pain experienced during the past 24 hours and general satisfaction. Result: Except for the trust sub-scale in one hospital, the correlations between patient and nurse ratings concerning all assessments were significant in both hospitals (r = 0.22 - 0.59). Both groups of patients had significantly higher (better) scores than judged by the nurses on the environment sub-scale and general satisfaction. In contrast, nurses from both hospitals tended to significantly underestimate patients' worst pain during the past 24 hours. Other differences between patient and nurse assessments were either non-significant or inconsistent between hospitals. Using so-called Oldham plots nurses tended to under-estimate severe pain more often than mild pain, as judged by the patients, but this association was weak and statistically significant in one hospital only. Conclusion: Although the effects of pseudocorrelation are minimized by using Oldham plots, they are not cancelled. This issue is discussed, and we conclude that this study does not support the notion that the nurses tend to underestimate severe pain more often than mild pain. © 2005 Blackwell Publishing Ltd.

  • 27.
    Idvall, Ewa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Berg, Katarina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Brudin, Lars
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Nilsson , U
    Örebro University Hospital.
    Assessment of recovery after day surgery using a modified version of quality of recovery-402009In: ACTA ANAESTHESIOLOGICA SCANDINAVICA, ISSN 0001-5172 , Vol. 53, no 5, p. 673-677Article in journal (Refereed)
  • 28.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Bergqvist, Anna
    Vrinnevisjukhuset Norrköping.
    Silverhjelm, Jenny
    Länssjukhuset Ryhov Jönköping.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Perspectives of Swedish patients on postoperative pain management2008In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 10, no 2, p. 131-136Article in journal (Refereed)
    Abstract [en]

    This study aimed to describe the perspectives of surgical patients towards postoperative pain management during their hospital stay. Thirty strategically chosen postoperative inpatients from different surgical wards in a university hospital in Sweden participated. A qualitative, descriptive approach using individual interviews was chosen. These were tape-recorded, transcribed verbatim, and analyzed according to a qualitative content analysis. The patients' descriptions of postoperative pain management indicated that pain was a symptom that was always in focus, either because it was constantly present or because pain could appear abruptly during different activities and movements. Although the focus was on pain and an awareness that it should be relieved or avoided, the solutions were often routine, short-term, and involved the regular intake of drugs, plus additional medication if needed for an acute pain episode. From the patients' descriptions of their experience with postoperative pain management, we distinguished three categories: "patients' pain knowledge", "patients' pain management approaches", and "patients' views of health-care professionals". The findings from this study highlight important aspects of nursing care that should receive greater attention in postoperative pain management. The patients' narratives could be a valuable asset in the quality improvement of postoperative pain management as these narratives highlight episodes difficult to elicit in other ways. © 2008 The Authors Journal compilation © 2008 Blackwell Publishing Asia Pty Ltd.

  • 29.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Brudin, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    Do health care professionals underestimate severe pain more often than mild pain? Statistical pitfalls using a data simulation model2005In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 11, no 5, p. 438-443Article in journal (Refereed)
    Abstract [en]

    Rationale: When comparing patients' pain ratings with the health care professional's conception of pain assessed by Visual Analogue Scales (VAS) ratings, statistical problems arise. Method and Result: In this data simulation study we have shown that the tendency for health care professionals to underestimate severe pain compared with mild pain is probably not attributed to difficulties in judging severe pain more often than mild but the result of professionals having a different and often narrower distribution of their ratings compared with patients. © 2005 Blackwell Publishing Ltd.

  • 30.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Ehrenberg, A.
    Health and Caring Sciences, Dalarna University, Falun Campus, Falun, Sweden.
    Nursing documentation of postoperative pain management2002In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 6, p. 734-742Article in journal (Refereed)
    Abstract [en]

    • Previous studies have shown that nursing documentation is often deficient in its recording of pain assessment and treatment. In Sweden, documentation of the care process, including assessment, is a legal obligation. • The aim of this study was to describe nursing documentation of postoperative pain management and nurses' perceptions of the records in relation to current regulations and guidelines. • The sample included nursing records of postoperative care on the second postoperative day from 172 patients and 63 Registered Nurses from surgical wards in a central county hospital in Sweden. • The records were reviewed for content and comprehensiveness based on regulations and guidelines for postoperative pain management. Three different auditing instruments were used. The nurses were asked if the documentation concurred with current regulations and guidelines. • The result showed that pain assessment was based mainly on patients' self-report, but less than 10% of the records contained notes on systematic assessment with a pain assessment instrument. Pain location was documented in 50% of the records and pain character in 12%. About 73% of the nurses reported that the documentation concurred with current regulations and guidelines. • The findings indicate that significant flaws existed in nurses' recording of postoperative pain management, of which the nurses were not aware. © 2002 Blackwell Science Ltd.

  • 31.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Ehrenberg, Anna
    Falun.
    Ehrenberg, A
    Nursing documentation of postoperative pain management2004In: 12th Beinnal Conference of the Workgroup of European Nurse Researchers,2004, 2004Conference paper (Other academic)
  • 32.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Gunningberg, L
    Forsberg, C
    Quality indicators in nursing - development, implementation and evaluation on an national level.2003In: The international council of nurses 2003 conference. Building exellence through evidence. Geneve. Schweiz,2003, 2003, p. 55-55Conference paper (Refereed)
  • 33.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Gunningberg, Lena
    Uppsala universitet.
    Evidence for elective replacement of peripheral intravenous catheter to prevent thrombophlebitis: A systematic review2006In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 55, no 6, p. 715-722Article in journal (Refereed)
    Abstract [en]

    Aim. This paper reports a review of the scientific evidence for elective replacement of peripheral intravenous catheters in adults in the absence of any clinical complications, with the aim being to reduce the incidence and severity of thrombophlebitis. Background. The incidence of thrombophlebitis associated with peripheral intravenous catheters has been reported to range from 5.3% to 77.5%. Many factors that increase the risk for thrombophlebitis have been reported, of which time in situ is one. In Sweden, the recommended guideline is elective replacement of peripheral intravenous catheters every 12-24 hours. Method. A systematic literature review was carried out in 2005 using the Cochrane Library, OvidMedline and CINAHL databases and hand searching of reference lists and with keywords catheterization, peripheral, thrombophlebitis and parenteral nutrition. The review included randomized controlled trials of elective replacement of peripheral intravenous catheters in adults. Three reviewers assessed the data found according to predetermined criteria. Finding. Three randomized control trials met the inclusion criteria and were retrieved for critical appraisal. The samples in two of the trials included patients requiring total parenteral nutrition. Patients in the third trial were receiving crystalloid and drugs. Time intervals for elective replacement varied. Study quality and relevance were rated as 'medium' in two of the trials and as 'low' in the third trial. Conclusion. Limited scientific evidence suggests that elective replacement of peripheral intravenous catheters reduces the incidence and severity of thrombophlebitis. © 2006 The Authors.

  • 34.
    Idvall, Ewa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hamrin, Elisabeth
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
    Rooke, L.
    Sjöström, Björn
    Department of Health Care Pedagogics, Göteborg University and Department of Health Sciences, University of Skövde, Skövde, Sweden.
    A tentative model for developing strategic and clinical nursing quality indicators: postoperative pain management1999In: International journal of nursing practice, ISSN 1322-7114, Vol. 5, no 4, p. 216-226Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to evaluate the usefulness of a tentative model, based on important aspects of surgical nursing care, for designing strategic and clinical quality indicators. Objective postoperative pain management was chosen for the model because it is a priority area in surgical nursing care. Items within a questionnaire were designed by using the tentative model as a base and by means of a literature review. The questionnaire, directed to clinical nurses (n = 233), was compiled to establish the validity and the usefulness of the indicators. Fourteen items were assessed as essential for achieving high quality outcomes in postoperative pain management (11 as realistic to carry out, and 13 as possible for nurses to influence) with mean scores > or = 4 (on a 5-point scale). The conclusion reached was that the tentative model combined with a literature search was found to be effective for designing items that might be useful as strategic and clinical indicators of quality in postoperative pain management.

  • 35.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Hamrin, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Pharmacology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pharmacology.
    Rooke, Liselotte
    Malmö.
    Sjöström, Björn
    Göteborg.
    Kvalitetsindikatorer inom postoperativ smärtbehandling2001In: Hälso- och sjukvårsstämman,2001, 2001, p. 80-80Conference paper (Refereed)
  • 36.
    Idvall, Ewa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hamrin, Elisabeth
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
    Sjöström, Björn
    Department of Health Care Pedagogics, Göteborg University and Department of Health Sciences, University of Skövde, Skövde, Sweden .
    Unosson, Mitra
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Patient and nurse assessment of quality of care in postoperative pain management2002In: Quality & Safety in Health Care, ISSN 1475-3898, Vol. 11, no 4, p. 327-334Article in journal (Refereed)
    Abstract [en]

    Objective: To describe and compare patient and nurse assessments of the quality of care in postoperative pain management, to investigate differences between subgroups of patients, and to compare patient assessments in different departments.

    Design: Patient and nurse questionnaires.

    Setting: Five surgical wards in general surgery, orthopaedics, and gynaecology in a central county hospital in Sweden.

    Sample: Two hundred and nine inpatients and 64 registered nurses. The response rates were 96% for the patients and 99% for the nurses; there were 196 paired patient-nurse assessments.

    Method: The Strategic and Clinical Quality Indicators in Postoperative Pain Management patient questionnaire was used which comprises14 items in four subscales (communication, action, trust, and environment). The items were scored on a 5 point scale with higher values indicating a higher quality of care. Five complementary questions on levels of pain intensity and overall satisfaction with pain relief were scored on an 11 point scale. Twelve of the 14 items in the patient questionnaire and two of the complementary questions were adjusted for use in the nurse questionnaire.

    Results: The patients’ mean (SD) score on the total scale (scale range 14–70) was 58.6 (8.9) and the nurses’ mean (SD) score (scale range 12–60) was 48.1 (6.2). The percentage of patients who scored 1 or 2 for an individual item (disagreement) ranged from 0.5% to 52.0%, while for nurses the percentage ranged from 0.0% to 34.8%. Forty two patients (24%) reported more pain than they expected; these patients assessed the quality of care lower. There were differences between patient and nurse assessments concerning the environment subscale, the question on overall satisfaction, and patients’ experience of worst possible pain intensity.

    Conclusion: The results provided valuable baseline data and identified important areas for quality improvement in postoperative pain management.

  • 37.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Hamrin, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Pharmacology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pharmacology.
    Sjöström, Björn
    Göteborg.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Patients and nurse assessment on quality of care in postoperative pain management2002In: 10th World congress on pain, San Diego, USA,2002, 2002, p. 563-563Conference paper (Refereed)
  • 38.
    Idvall, Ewa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hamrin, Elisabeth
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
    Sjöström, Björn
    Department of Health Care Pedagogics, Göteborg University and Department of Health Sciences, University of Skövde, Skövde, Sweden.
    Unosson, Mitra
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Quality indicators in postoperative pain management: a validation study2001In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, Vol. 15, no 4, p. 331-338Article in journal (Refereed)
    Abstract [en]

    In a previous study, strategic and clinical quality indicators were developed from a tentative model to assess high quality in postoperative pain management. The aim of the present study was to investigate the content validity of these 15 indicators. The indicators were compiled in a questionnaire, and two groups of nurses (n=210, n=321) scored each indicator on a 5-point scale (strongly disagree to strongly agree) from three different standpoints: whether it was essential for achieving high quality, whether it was realistic to carry out, and whether it was possible for nurses to influence management. The respondents were also asked to choose the most crucial indicators for the quality of care. The results showed that both groups of nurses judged the 15 indicators to have content validity from all three standpoints. Both groups also found the same six indicators to be the most crucial. These indicators concerned detecting and acting on signs and symptoms, performing prescriptions, informing and educating, acting on behalf of patients, competence/knowledge, and attitudes. The validated indicators should be useful to consider when implementing a strategy for postoperative pain management and when planning to evaluate the quality of care.

  • 39.
    Idvall, Ewa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hamrin, Elisabeth
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Development of an instrument to measure strategic and clinical quality indicators in postoperative pain management2002In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 37, no 6, p. 532-540Article in journal (Refereed)
    Abstract [en]

    AIM OF THE STUDY: To develop and evaluate psychometric properties, that is reliability and validity, of an instrument to measure strategic and clinical quality indicators in postoperative pain management.

    BACKGROUND: Strategic and clinical quality indicators in postoperative pain management were previously developed from a tentative model of important aspects of surgical nursing care and assessed to have content validity, that is to be essential for the quality of care, realistic to carry out and possible for nurses to use to influence management.

    METHODS: The quality indicators were converted to items suitable for a patient questionnaire and were scored on a 5-point scale, with higher scores indicating higher quality of care. Inpatients from five surgical wards took part in this study on their second postoperative day. The response rate was 96% and the average ages of the female (n=120) and the male (n=78) respondents were 62 and 63 years, respectively.

    RESULTS: Items in the total scale had an average inter-item correlation >0.20 and an item-total correlation >0.30. Cronbach's coefficient alpha was 0.84 for the total scale. Four factors entitled 'communication', 'action', 'trust' and 'environment' emerged from an orthogonal factor analysis, with a cumulative variance of 61.4%. Patients who received epidural analgesia had higher scores on the total scale compared with those who did not receive epidural analgesia. Patients who reported more pain than expected had lower scores on the total scale compared with those who did not report more pain than expected. Correlation between the total scale and an overall pain relief satisfaction question was 0.53.

    CONCLUSION: The results suggest initial support for the new instrument as a measure of strategic and clinical quality indicators in postoperative pain management, but it must be further refined, tested and evaluated.

  • 40.
    Idvall, Ewa
    et al.
    Linköping University, Department of Medicine and Care.
    Hamrin, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Pharmacology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pharmacology.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Development of an instrument to measure the quality of postoperative pain management2004In: 12th Biennal Conference of the Workgroup of European Nurse Researchers,2004, 2004Conference paper (Other academic)
  • 41.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Hamrin, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Pharmacology.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Development of an instrument to measure the quality of postoperative pain management.2003In: The 4th congres of the european federation of IASP chapters - Pain in Europe IV Prag - Tjeckien,2003, 2003, p. 774-774Conference paper (Refereed)
  • 42.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Hamrin, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Pharmacology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pharmacology.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Kvalitetsindikatorer inom postoperativ smärtbehandling: en valideringsstudie2002In: Vårdfacket, ISSN 0347-0911, Vol. 3, p. 49-49Article in journal (Other (popular science, discussion, etc.))
  • 43.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Holm, Charlotta
    Västervik.
    Runesson, Ingrid
    Kalmar.
    Pain experiences and non-pharmacological strategies for pain management after tonsillectomy: a qualitative interview study of children and parents.2005In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 9, no 3, p. 196-207Article in journal (Refereed)
    Abstract [en]

    Tonsillectomy is one of the most common paediatric surgical procedures. This study aimed to investigate children's experience of pain and the nonpharmacological strategies that they used to manage pain after tonsillectomy. A further aim was to investigate parental views on these same phenomena. Six children (aged seven to 18 years) and their parents (four mothers and two fathers) were interviewed separately on the day after tonsillectomy. The data were analysed using a qualitative approach. Pain experiences were divided into the categories of physiological pain and psychological pain. Children rated their 'worst pain' during the past 24 hours between 6 and 10 (visual analogue scale, 0-10). The non-pharmacological strategies used most frequently to manage pain were thermal regulation (physical method) and distraction (cognitive-behavioural method) according to the framework used. Specific non-pharmacological strategies for pain management relative to different surgical procedures need to be considered.

  • 44.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Karlsson, Lena
    Kvalitetsrutiner av sårvårdsrutiner på en kirurgisk vårdavdelning.2001In: Sjukskötersketidningen, ISSN 0283-541X, Vol. 1, p. 28-30Article in journal (Other (popular science, discussion, etc.))
  • 45.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Karlsson, Lena
    Västervik.
    Kvalitetsutveckling av sårvårdsrutiner.2001In: Svensk kirurgisk förenings årsmöte, Malmö,2001, 2001Conference paper (Refereed)
  • 46.
    Idvall, Ewa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Rooke, L.
    Important aspects of nursing care in surgical wards as expressed by nurses1998In: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 7, no 6, p. 512-520Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to find out clinical nurses' perceptions of important aspects of nursing care that might have an impact on quality of care in surgical wards. A qualitative approach using focus group interviews was used. The data analysis revealed 15 categories of important aspects of care which could be condensed into two dimensions, here called 'prerequisites' (i.e., staffing, routines and attitudes) and 'elements of performance' (i.e., detecting and acting on signs and symptoms and acting on behalf of the patients). These aspects could be a starting point for developing quality indicators. Carper's four fundamental patterns of knowing were used to make a theoretical interpretation, and three of them were identified.

  • 47.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Strand, Margareta
    Utveckling av kvalitet - med fokus på patienter med perifer venkanyl.2001In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 21, p. 36-41Article in journal (Other (popular science, discussion, etc.))
  • 48. Lindskog, K
    et al.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Preoperative huddesinfektion inför dagkirurgi - patienters följsamhet2004In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 72, p. 45-47Article in journal (Other academic)
  • 49. Lindskog, K
    et al.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Preoperativt huddesinfektion inför dagkirurgipatienternas följsamhet.2003In: Vårdstämman,2003, 2003, p. 100-100Conference paper (Refereed)
  • 50.
    Lundgren, Anna
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Kvalitetsindikatorer för patienter med perifer intravenös venkanyl (PIV)2001In: Kvalitetsindikatorer inom omvårdnad / [ed] Ewa Idvall, Linköping: Linköpings universitet , 2001, p. 41-62Chapter in book (Other academic)
12 1 - 50 of 63
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