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  • 1.
    Andersson, Inger S.
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Perceptions of nursing care quality, in acute hospital settings measured by the Karen instruments2013In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 21, no 1, p. 87-93Article in journal (Refereed)
    Abstract [en]

    Aims The objectives of this study were to measure the quality of nursing care from the perspectives of patients and personnel and to compare these perspectives. Background The perception of quality in nursing care is affected by patient needs and it is common that patients and personnel disagree on the nature of the quality. Thus, it is important to measure the quality from both perspectives. Method A total of 95 patients and 120 personnel from surgical and medical wards at a hospital in Sweden participated. The Karen instruments were used for data collection. A scale index was used for comparison of the perspectives. Results The patients and personnel were satisfied with the quality of care and there were no obvious differences in the total index. The different subscales indicated areas of lower care quality in need of improvement. Conclusion The quality of the care seemed to be satisfactory from the perspectives of both the patients and the personal. Further analysis from the subscale or a variable level is needed to define areas of lower care quality. Implications for Nursing Management Measurements have to be carried out continuously to guarantee care quality over time, as a result of organisational changes and financial cutbacks.

  • 2.
    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)
  • 3. Bader, Dan
    et al.
    Clark, Michael
    Dealey, Carol
    Rithalia, Shyam
    Oomens, Cees
    Goossens, Richard
    Ask, Per
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Takahashi, Makamoto
    Laboratory measurement of the interface pressures applied by active therapy support surfaces: A consensus document2010In: Journal of Tissue Viability, ISSN 0965-206X, Vol. 19, no 1, p. 2-6Article in journal (Refereed)
    Abstract [en]

    A key element in pressure ulcer prevention and management is the selection of appropriate pressure redistributing (PR) patient support surfaces for use while seated and in bed. However little explicit guidance exists allowing standardised quantitative comparison of different PR surfaces based upon their ability to redistribute pressure from anatomical landmarks such as the heels and sacrum. In 2008 a working group was established in Europe through the US National Pressure Ulcer Advisory Panel (NPUAP) support surface standardisation initiative (S3I) and under the aegis of the European Pressure Ulcer Advisory Panel with the specific remit of developing test methods for the evaluation of active therapy support surfaces (alternating pressure air mattresses). This report describes a consensus development process to agree test methods appropriate to compare active therapy surfaces based upon their ability to redistribute pressure from the sacrum and the heels.

  • 4.
    Bergstrand, Sara
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Källman, Ulrika
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Department of Dermatology, Södra Älvsborgs Sjukhus, Borås, Sweden.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Health Sciences.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Microcirculatory responses of sacral tissue in healthy individuals and inpatients on different pressure-redistribution mattresses2015In: Journal of Wound Care, ISSN 0969-0700, E-ISSN 2052-2916, Vol. 24, no 8, p. 346-358Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore the interaction between interface pressure and pressure-induced vasodilation and reactive hyperemia with different pressureredistribution mattresses.

    Method: A cross-sectional study was performed with a convenience sample of 42 healthy individuals between 18 and 64 years of age, 38 healthy individuals 65 years or older, and 35 inpatients 65 years or older at a university hospital in Sweden. Blood flow was measured at depths of 1 mm, 2 mm, and 10 mm using a combined system of laser Doppler flowmetry and photoplethysmography. The blood flow, interface pressure and skin temperature were measured in the sacral tissue before, during, and after load while lying on one standard hospital mattress and three different pressure-redistribution mattresses.

    Results: There were significant differences between the three foam mattresses with regard to average sacral pressure, peak sacral pressure, and local probe pressure with the lowest values at the visco-elastic foam/air mattress (23.5 ± 2.5 mmHg, 49.3 ± 11.1 mmHg, 29.2 ± 14.0 mmHg respectively). A greater proportion of subjects had affected blood flow in terms of lack of pressure-induced vasodilation on the visco-elastic foam/air mattress compared to the alternating pressure mattress at tissue depths of 2 mm (39.0% vs. 20.0%, respectively) and 10 mm (56.9 % vs. 35.1%, respectively). Eleven individuals, including subjects in all three subject groups were identified with no pressure-induced vasodilation or reactive hyperemia in any mattress, and this was considered a high-risk blood flow response.

    Conclusion: Interface pressure magnitudes considered not harmful during pressure-exposure lying on different pressure-redistribution mattresses can affect the microcirculation in different tissue structures. Despite having the lowest pressure values compared to the other mattresses, the visco-elastic foam/air mattress had the highest proportion of subjects with decreased blood flow indicating a more affected blood flow. Three young healthy individuals were identified with the high-risk blood flow response, indicating an innate vulnerability to pressure exposure and may not benefit from pressure-redistribution mattresses. Finally it was shown that the evaluation of pressure-redistribution support surfaces in terms of mean blood flow during and after tissue exposure is not feasible but assessment of pressure-induced vasodilation and reactive hyperemia could be a new possibility to assess individualized physiological measurements of mechanisms known to be related to pressure ulcer development.

  • 5.
    Bergstrand, Sara
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Källman, Ulrika
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Department of Dermatology, Södra Älvsborgs Sjukhus, Borås, Sweden.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Pressure-induced vasodilation and reactive hyperemia at different depths in sacral tissue under clinically relevant conditions2014In: Microcirculation, ISSN 1073-9688, E-ISSN 1549-8719, Vol. 21, no 8, p. 761-771Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To characterize pressure-induced vasodilatation and reactive hyperemia at different sacral tissue depths in different populations under clinically relevant pressure exposure.

    METHODS: Forty-two subjects (< 65 years), 38 subjects (≥ 65 years), and 35 patients (≥ 65 years) participated. Interface pressure, skin temperature, and blood flow at tissue depths of 1 mm, 2 mm, and 10 mm (using laser Doppler flowmetry and photoplethysmography) were measured in the sacral tissue before, during, and after load in a supine position.

    RESULTS: pressure-induced vasodilatation and reactive hyperemia were observed at three tissue depths. At 10 mm depth, the proportion of subjects with a lack of pressure-induced vasodilatation was higher compared to superficial depths. The patients had higher interface pressure during load than the healthy individuals, but there were no significant differences in blood flow. Twenty-nine subjects in all three study groups were identified with a lack of pressure-induced vasodilatation and reactive hyperemia.

    CONCLUSIONS: pressure-induced vasodilatation and reactive hyperemia can be measured at different tissue depths. A lack of these responses was found in healthy individuals as well as in patients indicating an innate susceptibility in some individuals, and are potential important factors to evaluate in order to better understand the etiology of pressure ulcers.

  • 6.
    Bergstrand, Sara
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Lindgren, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Blood flow at different depth in the tissue measured with PPG and laser Doppler technique2008In: Third Congress of the World Unionof Wound Healing Societies,2008, 2008, p. 31-31Conference paper (Other academic)
    Abstract [en]

       

  • 7.
    Bergstrand, Sara
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Lindén, Maria
    Mälardalen University, Västerås, Sweden.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Blood flow measurements at different depths using photoplethysmography and laser Doppler techniques2009In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 15, no 2, p. 139-147Article in journal (Refereed)
    Abstract [en]

    Background/purpose: This study has evaluated a multi-parametric system combining laser Doppler flowmetry and photoplethysmography in a single probe for the simultaneous measurement of blood flow at different depths in the tissue. This system will be used to facilitate the understanding of pressure ulcer formation and in the evaluation of pressure ulcer mattresses.

    Methods: The blood flow in the tissue over the sacrum was measured before, during and after loading with 37.5 mmHg, respectively, 50.0 mmHg. The evaluation of the system consisted of one clinical part, and the other part focusing on the technicalities of the probe prototype.

    Results: An increase in blood flow while loading was the most common response, but when the blood flow decreased during loading it was most affected at the skin surface and the blood flow responses may be different due to depths of measurement. Reactive hyperaemia may occur more frequently in the superficial layers of the tissue.

    Conclusion: The study showed that the new system is satisfactory for measuring tissue blood flow at different depths. The laser Doppler complements the photoplethysmography, and further development of the system into a thin flexible probe with the ability to measure a larger area is required.

  • 8.
    Bergstrand, Sara
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Health Sciences.
    Lindén, Maria
    n/a.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Länne, Toste
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Lindgren, Margareta
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Tissue blood flow responses to external pressure in the sacral region using PPG and laser Doppler technique.2009In: European Pressure Ulcer Advisory Panels, Amsterdam., 2009Conference paper (Refereed)
  • 9.
    Bergstrand, Sara
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Länne, Toste
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Linden, Maria
    Mälardalen University.
    Lindgren, Margareta
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Existence of Tissue Blood Flow in Response to External Pressure in the Sacral Region of Elderly Individuals - Using an Optical Probe Prototype2010In: MICROCIRCULATION, ISSN 1073-9688, Vol. 17, no 4, p. 311-319Article in journal (Refereed)
    Abstract [en]

    Pandgt;Objective: The aim was to investigate the existence of sacral tissue blood flow at different depths in response to external pressure and compression in elderly individuals using a newly developed optical probe prototype. Methods: The tissue blood flow and tissue thickness in the sacral area were measured during load in 17 individuals using laser Doppler flowmetry and photoplethysmography in a combined probe, and digital ultrasound. Results: The mean age was 68.6 +/- 7.0 years. While loading, the mean compression was 60.3 +/- 11.9%. The number of participants with existing blood flow while loading increased with increased measurement depth. None had enclosed blood flow deep in the tissue and at the same time an existing more superficial blood flow. Correlation between tissue thickness and BMI in unloaded and loaded sacral tissue was shown: r = 0.68 (P = 0.003) and r = 0.68 (P = 0.003). Conclusions: Sacral tissue is highly compressed by external load. There seems to be a difference in responses to load in the different tissue layers, as occluded blood flow in deeper tissue layers do not occur unless the blood flow in the superficial tissue layers is occluded.

  • 10.
    Dini, Francesca
    et al.
    Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy.
    Capuano, Rosamaria
    Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy.
    Strand, Tillan
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Paolesse, Roberto
    Department of Chemical Science and Technology, University of Rome Tor Vergata, Rome, Italy.
    Di Natale, Corrado
    Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy.
    Lundström, Ingemar
    Linköping University, Department of Physics, Chemistry and Biology, Biosensors and Bioelectronics. Linköping University, The Institute of Technology.
    Volatile Emissions from Compressed Tissue2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 7Article in journal (Refereed)
    Abstract [en]

    Since almost every fifth patient treated in hospital care develops pressure ulcers, early identification of risk is important. A non-invasive method for the elucidation of endogenous biomarkers related to pressure ulcers could be an excellent tool for this purpose. We therefore found it of interest to determine if there is a difference in the emissions of volatiles from compressed and uncompressed tissue. The ultimate goal is to find a non-invasive method to obtain an early warning for the risk of developing pressure ulcers for bed-ridden persons. Chemical analysis of the emissions, collected in compresses, was made with gas-chromatography – mass spectrometry and with a chemical sensor array, the so called electronic nose. It was found that the emissions from healthy and hospitalized persons differed significantly irrespective of the site. Within each group there was a clear difference between the compressed and uncompressed site. Peaks that could be certainly deemed as markers of the compression were, however, not identified. Nonetheless, different compounds connected to the application of local mechanical pressure were found. The results obtained with GC-MS reveal the complexity of VOC composition, thus an array of non-selective chemical sensors seems to be a suitable choice for the analysis of skin emission from compressed tissues; it may represent a practical instrument for bed side diagnostics. Results show that the adopted electronic noses are likely sensitive to the total amount of the emission rather than to its composition. The development of a gas sensor-based device requires then the design of sensor receptors adequate to detect the VOCs bouquet typical of pressure. This preliminary experiment evidences the necessity of studies where each given person is followed for a long time in a ward in order to detect the insurgence of specific VOCs pattern changes signalling the occurrence of ulcers.

  • 11.
    Ek, Anna-Christina
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Lindgren, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Nursing Science.
    Boken om trycksår, en kunskapssammanställning1997Book (Other academic)
  • 12.
    Ek, Anna-Christina
    et al.
    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.
    Näringstillståndets betydelse för utveckling och läkninga av trycksår.2003In: Incitament, ISSN 1103-503X, Vol. 1, p. 76-78Article in journal (Other academic)
  • 13.
    Ek, Anna-Christina
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindgren, Margareta
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Melhus, Åsa
    Klinisk bakteriologi, Uppsala Universitet.
    Silverförband vid behandling av kroniska sår2010Report (Other academic)
  • 14.
    Ek, Anna-Christina
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Nordström, Gun
    Lindgren, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Kvalitetsindikatorer för patienter med eller med risk för trycksår.2001In: Kvalitetsindikatorer inom omvårdnad. / [ed] Ewa Idvall, Linköping: Linköpings universitet , 2001, p. 11-28Chapter in book (Other academic)
  • 15.
    Hagblad, J.
    et al.
    Mälardalen University.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Kaisdotter Andersson, A.
    Mälardalen University.
    Bergstrand, Sara
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindgren, Margareta
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Folke, M.
    Mälardalen University.
    Linden, M.
    Mälardalen University.
    A technique based on laser Doppler flowmetry and photoplethysmography for simultaneously monitoring blood flow at different tissue depths2010In: Medical and Biological Engineering and Computing, ISSN 0140-0118, Vol. 48, no 5, p. 415-422Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to validate a non-invasive optical probe for simultaneous blood flow measurement at different vascular depths combining three photoplethysmography (PPG) channels and laser Doppler flowmeter (LDF). Wavelengths of the PPG were near-infrared 810 nm with source-to-detector separation of 10 and 25 mm, and green 560 nm with source-to-detector separation of 4 mm. The probe is intended for clinical studies of pressure ulcer aetiology. The probe was placed over the trapezius muscle, and depths from the skin to the trapezius muscle were measured using ultrasound and varied between 3.8 and 23 mm in the 11 subjects included. A provocation procedure inducing a local enhancement of blood flow in the trapezius muscle was used. Blood flows at rest and post-exercise were compared. It can be concluded that this probe is useful as a tool for discriminating between blood flows at different vascular tissue depths. The vascular depths reached for the different channels in this study were at least 23 mm for the near-infrared PPG channel (source-to-detector separation 25 mm), 10-15 mm for the near-infrared PPG channel (separation 10 mm), and shallower than 4 mm for both the green PPG channel (separation 4 mm) and LDF.

  • 16.
    Hagblad, Jimmie
    et al.
    Mälardalen University.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Kaisdotter Andersson, Annika
    Mälardalen University.
    Bergstrand, Sara
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindgren, Margareta
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Folke, Mia
    Mälardalen University.
    Lindén, Maria
    Mälardalen University.
    Simultan registrering av blodflöde på flera djup2009Conference paper (Refereed)
  • 17.
    Harle, Karolina
    et al.
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Hallböök, Olof
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Experience of living with an enterocutaneous fistula2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 15-16, p. 2175-2183Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. The purpose of this study was to describe patients experiences of living with an enterocutaneous fistula. Background. An enterocutaneous fistula is a complex and serious illness that usually occurs as a complication from surgery or spontaneously as a result of an underlying disease. The illness is demanding both physically and mentally and causes substantial medical and nursing problems for the afflicted individual. Design. A descriptive design with a qualitative approach. Methods. In-depth interviews were performed with nine participants who had experiences of living with an enterocutaneous fistula. The analysis was conducted using descriptive phenomenology according to Giorgi. Results. The essence of this study was that living with an enterocutaneous fistula is about handling an illness that causes several limitations in daily life and the following five themes emerged from the data: restrictions in daily life, approaches to illness, emotions, dependence and need of support. A constant fear of leakage from the fistula appliance, being dependent on intravenous fluids and being dependent on health care professionals caused isolation and social restriction. Conclusions. The participants had many strategies for handling their illness. By being well trained, engaged and having a positive and understanding approach, health care professionals can encourage hope, motivation and self-care. This can lead to decreased dependence and help the patient to better handle their illness. Relevance to clinical practice. The competence of health care professionals is essential in the care of patients with an enterocutaneous fistula.

  • 18.
    Hellman, Eva
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Radiographers' perceptions of patients care needs during a computed tomography examination2014In: Journal of Radiology Nursing, ISSN 1546-0843, Vol. 33, no 4, p. 206-213Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe the radiographers' perceptions of the patient care that is needed by the latter undergoing a computed tomography (CT) examination. The study was conducted using phenomenography methodology. Eight female and four male radiographers were interviewed at three radiology departments in central Sweden. The radiographers highlighted that the patients' need for information regarding the whole examination was important for them to understand the procedure. The radiographers' perception was that the time required for a CT examination needs to be adjusted so that there is sufficient time for individualized patient care, while at the same time taking into account the patient's age and illness. There was also a need for the examination to be carried out by a knowledgeable professional radiographer. In conclusion, this study shows that patients are in need of good communication, information, physical/psychological care, and individualized adapted examination time. Radiographers' knowledge and ability to understand patients' needs have a significant impact if patients are involved in their examination.

  • 19.
    Jonsson, A.
    et al.
    Department of Computer Science and Electronics, Mälardalen University, Västerås, Sweden.
    Linden, M.
    Lindén, M., Department of Computer Science and Electronics, Mälardalen University, Västerås, Sweden.
    Lindgren, Margareta
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Malmqvist, Lars-Åke
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Backlund, Y.
    Bäcklund, Y., Department of Computer Science and Electronics, Mälardalen University, Västerås, Sweden.
    Evaluation of antidecubitus mattresses2005In: Medical and Biological Engineering and Computing, ISSN 0140-0118, E-ISSN 1741-0444, Vol. 43, no 5, p. 541-547Article, review/survey (Refereed)
    Abstract [en]

    Pressure sores are a current problem in hospitals and care of the elderly, leading to protracted hospital stays and a high care burden. The trauma for the patients is severe, and the cost of pressure sore prevention and treatment, is considerable. Antidecubitus mattresses are used for prevention and in treatment, but they also contribute to the cost of treating pressure sores. The problem highlighted in the review is that the mattresses' effectiveness in preventing and treating pressure sores has not been sufficiently evaluated. When antidecubitus mattresses are evaluated, it is often only with regard to aspects of the interface pressure and the mattresses' ability to redistribute the pressure. The review points out the important observation that, to be able to evaluate the efficacy of the antidecubitus mattress, the mattress's effect on tissue viability needs to be studied. The parameters that ought to be considered when evaluating a support surface are: interface pressure, pressure and blood flow distribution, temperature and humidity in the skin-support surface interface. The authors propose that the effect on tissue viability of external loading can be assessed by simultaneous measurement of the interface pressure and tissue perfusion. © IFMBE: 2005.

  • 20.
    Jonsson, Annika
    et al.
    Mälardalen uiniversity.
    Lindgren, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Lindén, Maria
    Mälardalen university.
    Skin temperature effects on skin blood flow at areas prone to pressure sore development2005In: 13th Nordic Baltic Conference Biomedical Engineering and Medical Physics,2005, 2005Conference paper (Other academic)
    Abstract [en]

       

  • 21.
    Karlsson, Matilda
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Jarnhed-Andersson, Ingmarie
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Tarpila, Erkki
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Dressing the split-thickness skin graft donor site: a randomized clinical trial2014In: Advances in Skin & Wound Care, ISSN 1527-7941, E-ISSN 1538-8654, Vol. 27, no 1, p. 20-25Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The primary objective of this study was to compareAquacel (ConvaTec, Skillman, New Jersey), Allevyn (Smith &Nephew, St Petersburg, Florida), and Mediskin I (Mo¨ lnlycke, HealthCare AB, Gothenburg, Sweden) in the treatment of split-thicknessskin graft donor sites.

    DESIGN: This study was performed as a prospective randomized,3-arm, clinical study.

    SETTING: A clinical study performed at a hand and plastic surgerydepartment with burn unit.

    PARTICIPANTS: The study included 67 adults with a total of73 donor sites, which were on the thigh, not reharvested, andranged between 30- and 400-cm2 area.

    INTERVENTIONS: Subjects were randomly assigned to treatmentwith Aquacel, Allevyn, or Mediskin I.

    MAIN OUTCOME MEASURES: The donor site was assessed onpostoperative days 3, 14, and 21 for healing, infection, pain,impact on everyday life, ease of use, and cost.

    MAIN RESULTS: The obtained results demonstrate significantlyfaster re-epithelialization for patients treated with Aquacel orMediskin I compared with Allevyn. Regarding infections, therewere no significant differences between the groups. Patientswearing Aquacel experienced significantly less pain changing thedressing and less impact on everyday life than the patientswearing Allevyn. Aquacel was shown to be significantly easier forthe caregiver to use than Allevyn and Mediskin I. There is asignificant difference in cost of treatment between the dressings,whereas Mediskin I is the most expensive.

    CONCLUSION: The authors’ results support the use of Aquacel in thetreatment of split-thickness skin graft donor sites. Aquacel has alow cost per unit, is user friendly, gives short healing time, andminimizes patient discomfort.

     

  • 22.
    Krantz, Ann-Margret
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Lindgren, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Riskfactors for pressure sore among newly operated patients, a prospective study1999In: 8th Annual Meeting of th European Tissue Repair Society,1999, 1999Conference paper (Other academic)
    Abstract [en]

      

  • 23.
    Källman, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Bergstrand, Sara
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Different lying positions and their effects on tissue blood flow and skin temperature in older adult patients2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 1, p. 133-144Article in journal (Refereed)
    Abstract [en]

    Aim. To report a study to compare the effects of different lying positions on tissue blood flow and skin temperature in older adult patients. This article reports the evaluation of study design and procedures. Background. To reduce risk of pressure ulcers, repositioning of immobile patients is a standard nursing practice; however, research into how different lying positions effect tissue microcirculation is limited. Design. Descriptive comparative design. Methods. From MarchOctober 2010, 20 inpatients, aged 65 years or older, were included in the study. Tissue blood flow and skin temperature were measured over bony prominences and in gluteus muscle in four supine and two lateral positions. Results. The blood flow over the bony prominence areas was most influenced in the superficial skin and especially in the 30 degrees lateral position, where the blood flow decreased significantly in comparison with the supine positions. There were significant individual differences in blood flow responses, but no common trend was identified among the patients considered at risk for pressure ulcer development. The study procedure worked well and was feasible to perform in an inpatient population. Conclusion. The lying positions seem to influence the tissue blood flow over the bony prominences in different ways in older adult inpatients, but further study is needed to confirm the results and to make recommendations to clinical practice. The study procedure worked well, although some minor adjustments with regard to heat accumulation will be made in future studies.

  • 24.
    Källman, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Bergstrand, Sara
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Nursing staff induced repositionings and immobile patients' spontaneous movements in nursing care.2016In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 13, no 6, p. 1168-1175Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate nursing staff induced repositionings and the patients' spontaneous movements during the day and night among older immobile patients in nursing care. Furthermore, the aim was to identify factors associated with the nursing staff induced repositionings and the patients' spontaneous movement frequency. An observational cross-sectional design was used. Spontaneous movements among patients (n = 52) were registered continuously using the MovinSense monitoring system. The nursing staff documented each time they repositioned the patient. Patients spontaneous movements were compared with nursing staff induced repositionings. There were large variations in the patients' spontaneous repositioning frequency during both days and nights, which shows that, although immobilised, some patients frequently reposition themselves. Analgesics were positively related to the movement frequency and psycholeptics were negatively related. The nursing staff more often repositioned the patients who were assessed as high risk than those assessed as low risk, but the patients' spontaneous movement frequency was not correlated to the risk score. This may be important when planning repositioning schedules. A monitoring system may be useful in decision making with regard to planning repositioning and positions used in the prevention of pressure ulcers among elderly immobile patients.

  • 25.
    Källman, Ulrika
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science.
    Bergstrand, Sara
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Engström, Maria
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology in Linköping.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Pressure ulcer prevention: The effect of different lying positions on tissue blood flow, temperature and interface pressure in elderly patients - an ongoing study2010In: Pressure ulcer prevention: The effect of different lying positions on tissue blood flow, temperature and interface pressure in elderly patients, 2010Conference paper (Refereed)
  • 26.
    Källman, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Bergstrand, Sara
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Sacral pressure-induced blood flow responses at different tissue depths during one hour supine bedrest in nursing home residents2015Manuscript (preprint) (Other academic)
    Abstract [en]

    Background. Pressure induced vasodilation (PIV) protects the skin from pressure induced ischemia. PIV responses at individual level during a long-term measurement period have not previously been described in an elderly population in a clinically relevant situation.

    Aim. To describe individual PIV responses in a nursing home resident population for 1-hour periods of bed rest.

    Method. From May 2011 to August 2012, blood flow at three tissue depths was measured for one hour over the sacrum in 0° supine position and 30° supine tilt position in 25 individuals aged 65 years or older while lying on a pressure redistributing mattress. Measurements were made using the non-invasive optical techniques Laser Doppler Flowmetry (LDF) and photoplethysmography. The individuals were divided into a PIV group and a non-PIV group based upon the LDF data.

    Results. In the PIV group, the blood flow in almost all cases increased immediately and remained over baseline for the entire 60 minutes of loading in both positions, while the blood flow decreased immediately and remained below baseline in the non-PIV group. These blood flow patterns were also seen in deeper tissue layers although a PIV response was most common in the underlying tissue in both groups.

    Conclusion. The cutaneous blood flow response among the nursing home residents was distinct, appeared early and remained during the one hour of loading in both the PIV and non-PIV group. The non-PIV group may be more vulnerable to pressure and thus may be at risk for pressure ulcer development. More research is needed in order to verify the results.

  • 27.
    Källman, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Södra Älvsborgs Sjukhus, Borås, Sweden .
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Bergstrand, Sara
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Cristina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    The Effects of Different Lying Positions on Interface Pressure, Skin Temperature, and Tissue Blood Flow in Nursing Home Residents2015In: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 17, no 2, p. 142-151Article in journal (Refereed)
    Abstract [en]

    Background: Although repositioning is considered an important intervention to prevent pressure ulcers, tissue response during loading in different lying positions has not been adequately explored.

    Aim: To compare the effects of different lying positions on interface pressure, skin temperature, and tissue blood flow in nursing home residents.

    Method: From May 2011 to August 2012, interface pressure, skin temperature, and blood flow at three tissue depths were measured for 1 hr over the sacrum in 30 supine tilt and 0 supine positions and over the trochanter major in 30lateral and 90lateral positions in 25 residents aged 65 years or older. Measurement of interface pressure was accomplished using a pneumatic pressure transmitter connected to a digital manometer, skin temperature using a temperature sensor, and blood flow using photoplethysmography and laser Doppler flowmetry.

    Results: Interface pressure was significantly higher in the 0supine and 90lateral positions than in 30supine tilt and 30 lateral positions. The mean skin temperature increased from baseline in all positions. Blood flow was significantly higher in the 30 supine tilt position compared to the other positions. A hyperemic response in the post pressure period was seen at almost all tissue depths and positions.

    Conclusion: The 30supine tilt position generated less interface pressure and allowed greater tissue perfusion, suggesting that this position is the most beneficial.

  • 28.
    Källman, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Predictive validity of 4 risk assessment scales for prediction of pressure ulcer development in a hospital setting2014In: Advances in Skin & Wound Care, ISSN 1527-7941, E-ISSN 1538-8654, Vol. 27, no 2, p. 70-76Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    The aims of this study were to examine and compare the predictive validity of 4 risk assessment scales used for the prediction of pressure ulcer (PrU) development and to identify risk factors.

    DESIGN:

    Cross-sectional descriptive study.

    SETTING:

    A general hospital in Sweden.

    PARTICIPANTS:

    Patients (all aged ≥18 years) admitted to medical, surgical, orthopedic, oncology, and rehabilitation wards. Of 412 patients available, a total of 346 patients participated in the study.

    METHOD:

    Data were collected using the Swedish version of the European Pressure Ulcer Advisory Panel minimum data set as well as the Norton, Modified Norton, Braden, and Risk Assessment Pressure Sore (Ulcer) (RAPS) scales. The predictive validity was estimated by measuring sensitivity, specificity, positive predictive value, and negative predictive value. Multiple logistic regression analysis was used to determine risk factors associated with PrUs.

    RESULTS:

    The RAPS scale reached best balance between sensitivity and specificity at the recommended cutoff level of ≤29, followed by the Braden scale and the Norton scale at recommended cutoff levels ≤18 versus ≤16, respectively. The modified Norton scale also reached an acceptable balance between sensitivity and specificity but at the cutoff level of ≤23, which is a higher cutoff level than recommended. General physical condition, physical activity, moisture, friction, and shear emerged as significant risk factors.

    CONCLUSIONS:

    The results support that the recommended cutoff levels of the RAPS, Norton, and Braden scales are valid in a general hospital setting. However, the recommended cutoff level of the modified Norton scale (≤20) has to be increased when used in this care context.

  • 29.
    Lidman, Disa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    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.
    Lindgren, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Trycksår - Decubitalsår2005In: Bokkapitel i Svårläkta sår - Vårdprogram för Sydöstra sjukvårdsdistriktet / [ed] Landstinget i Jönköpings län,Landstinget i Kalmar län och Landstinget i Östergötland, Linköping: LiÖ , 2005, p. 50-61Chapter in book (Other academic)
  • 30.
    Lindgren, Margareta
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Pressure sores: risk assessment and prevention2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aims of this thesis were to study the prevalence, incidence, prevention and treatment of pressure sores, to further develop a risk assessment scale, and test the reliability and validity of this scale, to identify risk factors for pressure sore development, and to study skin blood flow in non-blanchable erythema areas as compared to undamaged skin.

    Criteria used for pressure sore assessment were persistent discoloration i.e. non-blanchable erythema, epithelial damage, and damage to the full thickness of the skin either without or with a deep cavity. The prevalence study was based on interviews, with 55 registered nurses, about 1173 patients. A Risk Assessment Pressure Sore scale, i.e. the RAPS scale consisting of twelve variables: general physical condition, activity, mobility, moisture, food intake, fluid intake, sensory perception, :fiiction and shear, skin type, bodily constitution, body temperature and serum albumin, was developed. In total 530 patients were assessed with the RAPS scale within 24 hours of admission, thereafter once a week for a maximum of twelve weeks. To estimate equivalence, 10 pairs of nurses assessed a total of 116 patients. A total of 19 blood flow measurements, in 5 patients were performed, using a Laser Doppler perfusion imager.

    The prevalence of pressure sores among 1173 patients was 3.75% and the incidence among 530 patients was 11.75%. The most frequently preventive and treatment measures used were related to pressure relief. After the test of internal consistency, two variables were excluded from the RAPS scale, namely bodily constitution and skin type. The Cronbach's alpha coefficient was 0.83. The factor analyses gave three factors, termed mobility, physical condition and nutrition, with a total variance explained of 65.1%. The intraclass correlation between raters was 0.83. Sensitivity was 75% and specificity 70% among patients on medical wards and corresponding values for patients on infection wards were 80% and 69.7%, respectively. In the multiple logistic regression analyses mobility, length of hospitalisation, age, surgical treatment and weight were identified as risk factors for pressure sore development. The blood flow distribution profiles for areas with non-blanchable erythema and those for undamaged skin were found to be different. As the area of non-blanchable erythema decreased, the blood flow distribution profiles gradually became more homogeneous.

    In conclusion, pressure sores are still a problem in nursing care. The RAPS scale is a reliable scale for predicting pressure sore development. The validity is especially good for patients on medical wards and infection wards. The results indicate that the scale may be useful in clinical practice. Mobility is a major risk factor and undergoing surgical treatment increases the risk of developing pressure sores. There are differences between blood flow in areas of non-blanchable erythema as compared to undamaged skin. The skin blood flow seems to increase in relation to the size of the non-blanchable erythema.

    List of papers
    1. Pressure sore prevalence within a public health services area
    Open this publication in new window or tab >>Pressure sore prevalence within a public health services area
    2000 (English)In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 6, no 6, p. 333-337Article in journal (Refereed) Published
    Abstract [en]

    Pressure sores are a great problem for patients, staff and society. The aim of this study was to examine the prevalence, treatment and prevention of pressure sores in a public health service area in Sweden. Criteria used for pressure sore assessment were persistent discoloration, epithelial damage and damage to the full thickness of the skin, without or with a cavity. The data were collected during 2 weeks in April 1995 from 1173 inpatients. The pressure-sore prevalence rate was 3.75%; 44 patients had a total of 68 sores. Men were as prone to developing pressure sores as women. The most frequently reported preventive measures were antidecubitus mattresses and turning schedules. Relief from pressure and occlusive dressings were the most common treatment measures. There was no statistical difference in pressure-sore prevalence when compared with a similar study from 1980. Patients were, however, older in 1995.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-24810 (URN)10.1046/j.1440-172x.2000.00236.x (DOI)7079 (Local ID)7079 (Archive number)7079 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    2. A risk assessment scale for the prediction of pressure sore development: reliability and validity
    Open this publication in new window or tab >>A risk assessment scale for the prediction of pressure sore development: reliability and validity
    2002 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 38, no 2, p. 190-199Article in journal (Refereed) Published
    Abstract [en]

    Background. The ability to assess the risk of a patient developing pressure sores is a major issue in pressure sore prevention. Risk assessment scales should be valid, reliable and easy to use in clinical practice.

    Aim.  To develop further a risk assessment scale, for predicting pressure sore development and, in addition, to present the validity and reliability of this scale.

    Methods. The risk assessment pressure sore (RAPS) scale, includes 12 variables, five from the re-modified Norton scale, three from the Braden scale and three from other research results. Five hundred and thirty patients without pressure sores on admission were included in the study and assessed over a maximum period of 12 weeks. Internal consistency was examined by item analysis and equivalence by interrater reliability. To estimate equivalence, 10 pairs of nurses assessed a total of 116 patients. The underlying dimensions of the scale were examined by factor analysis. The predictive validity was examined by determination of sensitivity, specificity and predictive value.

    Results.  Two variables were excluded as a result of low item–item and item–total correlations. The average percentage of agreement and the intraclass correlation between raters were 70% and 0·83, respectively. The factor analysis gave three factors, with a total variance explained of 65·1%. Sensitivity, specificity and predictive value were high among patients at medical and infection wards.

    Conclusions.  The RAPS scale is a reliable scale for predicting pressure sore development. The validity is especially good for patients undergoing treatment in medical wards and wards for infectious diseases. This indicates that the RAPS scale may be useful in clinical practice for these groups of patients. For patients undergoing surgical treatment, further analysis will be performed.

    Keywords
    pressure sore, risk assessment, prevention, validity, reliability, instrument development
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-24809 (URN)10.1046/j.1365-2648.2002.02163.x (DOI)7076 (Local ID)7076 (Archive number)7076 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    3. Immobility – a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study
    Open this publication in new window or tab >>Immobility – a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study
    2004 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 18, no 1, p. 57-64Article in journal (Refereed) Published
    Abstract [en]

    Objective : To identify risk factors associated with pressure ulcer development among adult hospitalized medical and surgical patients.

    Design : A prospective comparative study including 530 adult patients from medical and surgical wards. Registered Nurses made the data collection on admission and once a week for up to 12 weeks. The risk assessment scale used was the Risk Assessment Pressure Sore (RAPS) scale, including the following variables; general physical condition, activity, mobility, moisture, food intake, fluid intake, sensory perception, friction and shear, body temperature and serum albumin.

    Results : Sixty-two (11.7%) patients developed 85 pressure ulcers. The most common pressure ulcer was that of nonblanchable erythema. Patients who developed pressure ulcers were significantly older, hospitalized for a longer time, had lower scores on the total RAPS scale, had lower weight and lower diastolic blood pressure than nonpressure ulcer patients did. In the multiple logistic regression analyses using variables included in the RAPS scale immobility emerged as a strong risk factor. When adding remaining significant variables in the analyses, mobility, time of hospitalization, age, surgical treatment and weight were found to be risk factors for pressure ulcer development.

    Conclusion : It is confirmed that immobility is a risk factor of major importance for pressure ulcer development among adult hospitalized patients. The results also indicate that the RAPS scale may be useful for prediction of pressure ulcer development in clinical practice.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-22027 (URN)10.1046/j.0283-9318.2003.00250.x (DOI)1063 (Local ID)1063 (Archive number)1063 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    4. Altered skin blood perfusion in areas with non blanchable erythema: an explorative study
    Open this publication in new window or tab >>Altered skin blood perfusion in areas with non blanchable erythema: an explorative study
    2006 (English)In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 3, no 3, p. 215-223Article in journal (Refereed) Published
    Abstract [en]

    Non blanchable erythema, i.e. stage I pressure ulcer, is common in patients in acute and geriatric care and in nursing homes. Research has shown that this type of lesions is prone to develop into more severe pressure ulcers. The peripheral skin blood perfusion is of major importance for the development of pressure ulcers. The aim of this study was to explore the peripheral skin blood perfusion over time, in areas with non blanchable erythema and in corresponding undamaged areas on the opposite side of the body. A total of 19 measurements were performed, over time, using a laser Doppler perfusion imager. The blood flow distribution profiles over areas with non blanchable erythema and undamaged skin were found to be different. As the area of the non blanchable erythema decreased, the blood perfusion distribution profiles gradually became more heterogeneous; an area of high blood perfusion in the centre of the lesions was seen and the perfusion successively decreased closer to the edge. These results indicate that there are differences in blood perfusion between skin areas of non blanchable erythema and undamaged skin. The results also indicate that the visible redness in areas with non blanchable erythema is related to altered blood perfusion. The skin blood perfusion also seems to increase in relation to the size of the non blanchable erythema.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-34928 (URN)10.1111/j.1742-481X.2006.00238.x (DOI)24111 (Local ID)24111 (Archive number)24111 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
  • 31.
    Lindgren, Margareta
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Andersson, Inger S
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    The Karen instruments for measuring quality of nursing care: construct validity and internal consistency.2011In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 23, no 3, p. 292-301Article in journal (Refereed)
    Abstract [en]

    Background Valid and reliable instruments for measuring the quality of care are needed for evaluation and improvement of nursing care. Previously developed and evaluated instruments, the Karen-patient and the Karen-personnel based on Donabedian's Structure–Process–Outcome triad (S–P–O triad) had promising content validity, discriminative power and internal consistency.

    Objective The objective of this study was to further develop the instruments with regard to construct validity and internal consistency.

    Design and Settings This prospective study was carried out in medical and surgical wards at a hospital in Sweden. A total of 95 patients and 120 personnel were included.

    Methods The instruments were tested for construct validity by performing factor analyses in two steps and for internal consistency using Cronbach's alpha coefficient.

    Results The first confirmatory factor analyses, with a pre-determined three-factor solution did not load well according to the S–P–O triad, but the second exploratory factor analysis with a six-factor solution appeared to be more coherent and the distribution of variables seemed to be logical. The reliability, i.e. internal consistency, was good in both factor analyses.

    Conclusions The Karen-patient and the Karen-personnel instruments have achieved acceptable levels of construct validity. The internal consistency of the instruments is good. This indicates that the instruments may be suitable to use in clinical practice for measuring the quality of nursing care.

  • 32.
    Lindgren, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Andersson, Inger S
    The Karen instruments for measuring quality of nursing care. Item analysis2008In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 28, no 89, p. 14-18Article in journal (Refereed)
  • 33.
    Lindgren, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Kjellman, Britt-Marie
    University hospital, Linköping.
    Thorfinn, Johan
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Prevention of hypothermia and pressure ulcers during and after surgery2007In: A celebration event for Med dr h c professor Afaf I Meleis and twenty yeras of Nursing Science,2007, 2007Conference paper (Other academic)
    Abstract [en]

      

  • 34.
    Lindgren, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Krantz, Ann-Margret
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Risk factors associated with pressure sore development among hospitalized patients2004In: 12th Biennial Conference of the Workgroup of European Nurse Researchers,2004, 2004Conference paper (Other academic)
  • 35.
    Lindgren, Margareta
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Malmqvist, Lars-Åke
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Altered skin blood perfusion in areas with non blanchable erythema: an explorative study2006In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 3, no 3, p. 215-223Article in journal (Refereed)
    Abstract [en]

    Non blanchable erythema, i.e. stage I pressure ulcer, is common in patients in acute and geriatric care and in nursing homes. Research has shown that this type of lesions is prone to develop into more severe pressure ulcers. The peripheral skin blood perfusion is of major importance for the development of pressure ulcers. The aim of this study was to explore the peripheral skin blood perfusion over time, in areas with non blanchable erythema and in corresponding undamaged areas on the opposite side of the body. A total of 19 measurements were performed, over time, using a laser Doppler perfusion imager. The blood flow distribution profiles over areas with non blanchable erythema and undamaged skin were found to be different. As the area of the non blanchable erythema decreased, the blood perfusion distribution profiles gradually became more heterogeneous; an area of high blood perfusion in the centre of the lesions was seen and the perfusion successively decreased closer to the edge. These results indicate that there are differences in blood perfusion between skin areas of non blanchable erythema and undamaged skin. The results also indicate that the visible redness in areas with non blanchable erythema is related to altered blood perfusion. The skin blood perfusion also seems to increase in relation to the size of the non blanchable erythema.

  • 36.
    Lindgren, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Silén, Carlotte
    Learning plan as a tool for self-directed learning in clinical practice1999In: Pedagogisk konferens,1999, 1999Conference paper (Other academic)
  • 37.
    Lindgren, Margareta
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Pressure sore prevalence within a public health services area2000In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 6, no 6, p. 333-337Article in journal (Refereed)
    Abstract [en]

    Pressure sores are a great problem for patients, staff and society. The aim of this study was to examine the prevalence, treatment and prevention of pressure sores in a public health service area in Sweden. Criteria used for pressure sore assessment were persistent discoloration, epithelial damage and damage to the full thickness of the skin, without or with a cavity. The data were collected during 2 weeks in April 1995 from 1173 inpatients. The pressure-sore prevalence rate was 3.75%; 44 patients had a total of 68 sores. Men were as prone to developing pressure sores as women. The most frequently reported preventive measures were antidecubitus mattresses and turning schedules. Relief from pressure and occlusive dressings were the most common treatment measures. There was no statistical difference in pressure-sore prevalence when compared with a similar study from 1980. Patients were, however, older in 1995.

  • 38.
    Lindgren, Margareta
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Fredrikson, Mats
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Immobility – a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study2004In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 18, no 1, p. 57-64Article in journal (Refereed)
    Abstract [en]

    Objective : To identify risk factors associated with pressure ulcer development among adult hospitalized medical and surgical patients.

    Design : A prospective comparative study including 530 adult patients from medical and surgical wards. Registered Nurses made the data collection on admission and once a week for up to 12 weeks. The risk assessment scale used was the Risk Assessment Pressure Sore (RAPS) scale, including the following variables; general physical condition, activity, mobility, moisture, food intake, fluid intake, sensory perception, friction and shear, body temperature and serum albumin.

    Results : Sixty-two (11.7%) patients developed 85 pressure ulcers. The most common pressure ulcer was that of nonblanchable erythema. Patients who developed pressure ulcers were significantly older, hospitalized for a longer time, had lower scores on the total RAPS scale, had lower weight and lower diastolic blood pressure than nonpressure ulcer patients did. In the multiple logistic regression analyses using variables included in the RAPS scale immobility emerged as a strong risk factor. When adding remaining significant variables in the analyses, mobility, time of hospitalization, age, surgical treatment and weight were found to be risk factors for pressure ulcer development.

    Conclusion : It is confirmed that immobility is a risk factor of major importance for pressure ulcer development among adult hospitalized patients. The results also indicate that the RAPS scale may be useful for prediction of pressure ulcer development in clinical practice.

  • 39.
    Lindgren, Margareta
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Krantz, Ann-Margret
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    A risk assessment scale for the prediction of pressure sore development: reliability and validity2002In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 38, no 2, p. 190-199Article in journal (Refereed)
    Abstract [en]

    Background. The ability to assess the risk of a patient developing pressure sores is a major issue in pressure sore prevention. Risk assessment scales should be valid, reliable and easy to use in clinical practice.

    Aim.  To develop further a risk assessment scale, for predicting pressure sore development and, in addition, to present the validity and reliability of this scale.

    Methods. The risk assessment pressure sore (RAPS) scale, includes 12 variables, five from the re-modified Norton scale, three from the Braden scale and three from other research results. Five hundred and thirty patients without pressure sores on admission were included in the study and assessed over a maximum period of 12 weeks. Internal consistency was examined by item analysis and equivalence by interrater reliability. To estimate equivalence, 10 pairs of nurses assessed a total of 116 patients. The underlying dimensions of the scale were examined by factor analysis. The predictive validity was examined by determination of sensitivity, specificity and predictive value.

    Results.  Two variables were excluded as a result of low item–item and item–total correlations. The average percentage of agreement and the intraclass correlation between raters were 70% and 0·83, respectively. The factor analysis gave three factors, with a total variance explained of 65·1%. Sensitivity, specificity and predictive value were high among patients at medical and infection wards.

    Conclusions.  The RAPS scale is a reliable scale for predicting pressure sore development. The validity is especially good for patients undergoing treatment in medical wards and wards for infectious diseases. This indicates that the RAPS scale may be useful in clinical practice for these groups of patients. For patients undergoing surgical treatment, further analysis will be performed.

  • 40.
    Lindgren, Margareta
    et al.
    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.
    Krantz, Ann-Margret
    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.
    Pressure ulcer risk factors in patients undergoing surgery2005In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 50, no 6, p. 605-612Article in journal (Refereed)
    Abstract [en]

    Aim. This paper reports a study to identify risk factors associated with pressure ulcer development among a mixed group of adult patients undergoing surgery. Background. Few studies have been carried out with patients undergoing surgery to assess the risk of pressure ulcer development, and so there is a little knowledge of the risk factors for this group. However, studies among non-surgical patients have shown that nutritional predictors such as low serum albumin level and low body mass index (BMI) are of great importance. An additional predictive factor may be low blood pressure. It is important to study these predictors further among patients undergoing surgery, using techniques such as multiple regression techniques, designed to identify the most important predictors for pressure ulcer development. Methods. A prospective comparative study was carried out in 1996-1998 with 286 adult patients undergoing surgical treatment. The data were collected from patient records by Registered Nurses preoperatively, for seven days postoperatively and thereafter once a week for up to 12 weeks. Perioperative data were also collected. The Risk Assessment Pressure Sore Scale was used, and data were collected on general physical condition, activity, mobility, moisture, food intake, fluid intake, sensory perception, friction and shear, body temperature and serum albumin. Results. Forty-one (14.3%) patients developed pressure ulcers during the observation period. The most common type was non-blanchable erythema. Those who developed pressure ulcers were significantly older, weighed less, and had a lower BMI and serum albumin. More women than men developed pressure ulcers. Risk factors identified in multiple stepwise regression analyses were female gender, American Society of Anaesthesiologists (ASA) status or New York Heart Association (NYHA) status and food-intake. Conclusion. Special attention, with regard to risk of pressure ulcer development, should be paid to patients undergoing surgery who have low ASA or NYHA scores, low food intake and/or are women. © 2005 Blackwell Publishing Ltd.

  • 41.
    Strand, Tillan
    et al.
    Östergötlands Läns Landsting, Sinnescentrum, Department of Neurosurgery UHL. Östergötlands Läns Landsting.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Knowledge, attitudes and barriers towards prevention of pressure ulcers in intensive care units: A descriptive cross-sectional study2010In: Intensive & Critical Care Nursing, ISSN 0964-3397, Vol. 26, no 6, p. 335-342Article in journal (Refereed)
    Abstract [en]

    Pressure ulcer incidence varies between 1 and 56% in intensive care and prevention is an important quest for nursing staff. Critically ill patients that develop pressure ulcers suffer from increased morbidity and mortality and also requires prolonged intensive care.

    AIM: The aim of this study was to investigate registered nurses' and enrolled nurses' (1) attitudes, (2) knowledge and (3) perceived barriers and opportunities towards pressure ulcer prevention, in an ICU setting. These are important aspects in the Theory of Planned Behaviour, a conceptual framework when trying to predict, understand and change specific behaviours.

    METHOD: The study is descriptive. Questionnaires were distributed to registered nurses and enrolled nurses in four ICUs in a Swedish hospital.

    RESULTS: The mean score regarding attitude was 34 ± 4. Correct categorisation of pressure ulcers was made by 46.8% of nursing staff with enrolled nurses having significantly less correct categorisation (p=0.019). Pressure relief (97.3%) and nutritional support (36.1%) were the most frequently reported preventive measures. Reported barriers were lack of time (57.8%) and severely ill patients (28.9%); opportunities were knowledge (38%) and access to pressure relieving equipment (35.5%).

    CONCLUSION: This study highlights areas where measures can be made to facilitate pressure ulcer prevention in intensive care units, such as raising knowledge and making pressure ulcer prevention a part of daily care.

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