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  • 1.
    Aronsson, Patrik
    et al.
    Department Pharmacology, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Booth, Shirley
    Department Pedagogical, Curricular and Professional Studies, Faculty of Education, University of Gothenburg, Gothenburg, Sweden; School of Education, University of the Witwatersrand, Johannesburg, South Africa.
    Hägg, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pharmacology.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Zetterqvist, Ann
    Department Pedagogical, Curricular and Professional Studies, Faculty of Education, University of Gothenburg, Gothenburg, Sweden.
    Tobin, Gunnar
    Department Pharmacology, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Reis, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    The understanding of core pharmacological concepts among health care students in their final semester2015In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 15, no 1, article id 235Article in journal (Refereed)
    Abstract [en]

    Background

    The overall aim of the study was to explore health care students´ understanding of core concepts in pharmacology.

    Method

    An interview study was conducted among twelve students in their final semester of the medical program (n = 4), the nursing program (n = 4), and the specialist nursing program in primary health care (n  = 4) from two Swedish universities. The participants were individually presented with two pharmacological clinically relevant written patient cases, which they were to analyze and propose a solution to. Participants were allowed to use the Swedish national drug formulary. Immediately thereafter the students were interviewed about their assessments. The interviews were audio-recorded and transcribed verbatim. A thematic analysis was used to identify units of meaning in each interview. The units were organized into three clusters: pharmacodynamics, pharmacokinetics, and drug interactions. Subsequent procedure consisted of scoring the quality of students´ understanding of core concepts. Non-parametric statistics were employed.

    Results

    The study participants were in general able to define pharmacological concepts, but showed less ability to discuss the meaning of the concepts in depth and to implement these in a clinical context. The participants found it easier to grasp concepts related to pharmacodynamics than pharmacokinetics and drug interactions.

    Conclusion

    These results indicate that education aiming to prepare future health care professionals for understanding of more complex pharmacological reasoning and decision-making needs to be more focused and effective.

  • 2.
    Bengtsson, Ulrika
    et al.
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien Göteborg, Centrum för personcentrerad vård, Göteborgs universitet.
    Kasperowski, Dick
    Institutionen för filosofi, lingvistik och vetenskapsteori, Göteborgs Universitet.
    Ring, Lena
    Centrum för forsknings- och bioetik, Uppsala Universitet, Läkemedelsverket, Uppsala.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien Göteborg, Centrum för personcentrerad vård, Göteborgs Universitet.
    Developing an interactive mobile phone self-report system for self-management of hypertension. Part 1: Patient and professional perspectives2014In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 23, no 5, p. 288-295Article in journal (Refereed)
    Abstract [en]

    Low adherence remains a struggle in hypertension management, despite improvement efforts. Presuming that increased patient participation is a possible approach, we collaborated with patients and healthcare professionals to design a self-report system to support self-management. The study aimed to explore and describe relevant aspects of hypertension and hypertension treatment, for use in the development of an interactive mobile phone self-report system. It further aimed to suggest which clinical measures, lifestyle measures, symptoms and side-effects of treatment would be meaningful to include in such a system. Five focus group interviews were performed with 15 patients and 12 healthcare professionals, and data was analysed using thematic analysis. Patients suggested trust, a good relationship with caregivers, and well-being as important aspects of hypertension self-management. Furthermore, they regarded blood pressure, dizziness, stress, headache and tiredness as important outcomes to include. Patients sought to understand interconnections between symptoms and variations in blood pressure, whilst healthcare professionals doubted patients’ ability to do so. Healthcare professionals emphasized accessibility, clear and consistent counselling, complication prevention and educational efforts. The study presents aspects of importance for follow-up to understand the interplay between blood pressure and daily life experiences for patients with hypertension.

  • 3.
    Bengtsson, Ulrika
    et al.
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Kjellgren, Karin
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Hallberg, Inger
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Aspects of hypertension - a multi-perspective approach on the way towards adherence and self-management2012Conference paper (Other academic)
    Abstract [en]

    Hypertension is a long lasting condition for which a poor adherence to therapy becomes a substantial threat to the individual and public health. Major efforts have been made to explore reasons for poor adherence but few successful interventions have been designed. There is a need for effective strategies tailored for the unique needs of persons with hypertension. We set out to explore and describe relevant aspects of hypertension and hypertension treatment, from the perspective of persons with hypertension and health care providers. Focus group interviews were performed with 12 persons with hypertension and 15 health care providers and analysed according to thematic analysis. Persons with hypertension perceived trust, relationship to providers, well-being and prevention of complications as important aspects of hypertension care. Further they sought to understand the interplay between symptoms and variation of blood pressure. The providers emphasised accessibility, clear and consistent counselling, prevention of complications and educational efforts but doubted patients’ ability to be participating partners in care. The study presents aspects that persons with hypertension and health care providers deem important in hypertension self-management. Our findings provide input for future outcome measures and may increase the understanding of hypertension and treatment from a person-centred perspective.

  • 4.
    Bengtsson, Ulrika
    et al.
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska Akademin, Göteborgs universitet; Centrum för personcentrerad vård (GPCC), Sahlgrenska Akademin, Göteborgs universitet.
    Kjellgren, Karin
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska Akademin, Göteborgs universitet; Centrum för personcentrerad vård (GPCC), Sahlgrenska Akademin, Göteborgs universitet.
    Hallberg, Inger
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska Akademin, Göteborgs universitet; Centrum för personcentrerad vård (GPCC), Sahlgrenska Akademin, Göteborgs universitet.
    Lindwall, Magnus
    Centrum för personcentrerad vård (GPCC), Sahlgrenska Akademin, Göteborgs universitet; Institutionen för kost- och idrottsvetenskap, Psykologiska institutionen, Göteborgs universitet.
    Taft, Charles
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska Akademin, Göteborgs universitet; Centrum för personcentrerad vård (GPCC), Sahlgrenska Akademin, Göteborgs universitet.
    Improved blood pressure control using an interactive mobile phone support system2016In: The Journal of Clinical Hypertension, ISSN 1524-6175, E-ISSN 1751-7176, Vol. 18, no 2, p. 101-108Article in journal (Refereed)
    Abstract [en]

    This explorative, longitudinal study evaluated the effect of the daily use of a mobile phone-based self-management support system for hypertension in reducing blood pressure (BP) among 50 primary care patients with hypertension over 8 weeks. The self-management system comprises modules for (1) self-reports of BP, pulse, lifestyle, symptoms, and well-being; (2) delivery of reminders and encouragements; and (3) graphical feedback of self-reports. Daily use of the support system significantly reduced BP (systolic BP -7 mm Hg, diastolic BP -4.9 mm Hg) between baseline and week 8, with daily improvements leveling off as the study progressed. Three homogenous subsets of patients were identified who, despite different initial BP levels, showed similar decreases in BP during the study, indicating that patients benefited irrespective of baseline BP. In showing significant reductions in BP, our results suggest that the self-management support system may be a useful tool in clinical practice to help patients self-manage their hypertension.

  • 5.
    Bengtsson, Ulrika
    et al.
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien Göteborg, Centrum för personcentrerad vård, Göteborgs universitet.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien Göteborg, Centrum för personcentrerad vård, Göteborgs universitet.
    Höfer, Stefan
    Innsbruck Medical University, Department of medical psychology, Innsbruck, Austria.
    Taft, Charles
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien Göteborg.
    Ring, Lena
    Centrum för forsknings- & bioetik, Uppsala Universitet, Läkemedelsverket, Uppsala.
    Developing an interactive mobile phone self-report system for self-management of hypertension. Part 2: Content validity and usability2014In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 23, no 5, p. 296-306Article in journal (Refereed)
    Abstract [en]

    Self-management support tools using technology may improve adherence to hypertension treatment. There is a need for user-friendly tools facilitating patients’ understanding of the interconnections between blood pressure, wellbeing and lifestyle. This study aimed to examine comprehension, comprehensiveness and relevance of items, and further to evaluate the usability and reliability of an interactive hypertension-specific mobile phone self-report system. Areas important in supporting self-management and candidate items were derived from five focus group interviews with patients and healthcare professionals (n = 27), supplemented by a literature review. Items and response formats were drafted to meet specifications for mobile phone administration and were integrated into a mobile phone data-capture system. Content validity and usability were assessed iteratively in four rounds of cognitive interviews with patients (n = 21) and healthcare professionals (n = 4). Reliability was examined using a test–retest. Focus group analyses yielded six areas covered by 16 items. The cognitive interviews showed satisfactory item comprehension, relevance and coverage; however, one item was added. The mobile phone self-report system was reliable and perceived easy to use. The mobile phone self-report system appears efficiently to capture information relevant in patients’ self-management of hypertension. Future studies need to evaluate the effectiveness of this tool in improving self-management of hypertension in clinical practice.

  • 6.
    Bengtsson, Ulrika
    et al.
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien, Göteborg.
    Kjellgren, Karina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien, Göteborg.
    Hallberg, Inger
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien, Göteborg.
    Lindwall, Magnus
    Institutionen för kost- och idrottsvetenskap, Göteborgs Universitet.
    Taft, Charles
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien Göteborg.
    Blood pressure decrease with a mobile phone-based system to support self-management2014Conference paper (Other academic)
  • 7.
    Bengtsson, Ulrika
    et al.
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Ring, Lena
    Uppsala universitet.
    Hallberg, Inger
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Kjellgren, Karin
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Development of a mobile phone self-report system for persons with hypertension: focus group interviews with patients and providers2013Conference paper (Other academic)
  • 8.
    Bengtsson, Ulrika
    et al.
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Ring, Lena
    Uppsala universitet.
    Kjellgren, Karin
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Hallberg, Inger
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Development of a mobile phone self-report system for persons with hypertension: focus group interviews with patients and providers2013Conference paper (Other academic)
    Abstract [en]

    Introduction: Hypertension is a risk factor for cardiovascular disease for which poor adherence to therapy becomes a substantial threat to health. Major efforts have been made to explore reasons for poor adherence but few successful interventions have been designed. There is a need for effective strategies designed to facilitate an increased understanding for the complexity of hypertension and treatment by strengthening of patient participation as well as patient empowerment. Purpose / Methods: The aim of this study was to explore and describe relevant aspects of hypertension and hypertension treatment, from the perspective of persons with hypertension and health care providers. Focus group interviews were performed with 15 persons with hypertension and 12 health care providers and analysed according to thematic analysis. Results: Persons with hypertension perceived trust, relationship to providers, well-being and prevention of complications as important aspects of hypertension care. Further they sought to understand the interplay between symptoms and variation of blood pressure. The providers emphasised accessibility, clear and consistent counselling, prevention of complications and educational efforts but doubted patients’ ability to be participating partners in care. Conclusion: The study presents aspects that persons with hypertension and health care providers deem important in hypertension management. Our finding provides input for future outcome measures, such as self-reports and may serve as a foundation for the development of a self-report system for persons with hypertension. They may further facilitate patient empowerment by increasing the understanding of hypertension and its’ treatment, from a person-centred perspective.

  • 9.
    Berg, Katarina
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Postoperative recovery from the perspective of day surgery patients: A phenomenographic study2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 12, p. 1630-1638Article in journal (Refereed)
    Abstract [en]

    Background: Today, many patients undergo surgical procedures in a day surgery setting. The shift from inpatient care to care at the patient’s own home following discharge places various demands on patients and their families during the recovery process. There is a need for knowledge of how the postoperative recovery process is perceived, as research indicates a lack of support for patients managing recovery at home.

    Objectives: To explore day surgery patients’ perceptions of postoperative recovery.

    Design: A qualitative design with a phenomenographic approach was used.

    Methods and settings: Semi-structured interviews with 31 patients undergoing an orthopaedic, general or urologic day surgical procedure were carried out face-to-face at the patients’ homes, 11-37 days post-discharge. Patients were recruited from two day surgery settings: one private unit and one unit associated with a local county hospital.

    Results: The patients perceived postoperative recovery as comprising internal and external prerequisites and implied changes in ordinary life with varying levels of support. The organization at the day surgery unit, with its advantages and disadvantages, was perceived as having an impact on the subsequent recovery trajectory. The results are demonstrated in three descriptive categories: ‘Conditions for recovery at home’, The rollback to ordinary life’ and ‘Being a cog in a flow of care’.

    Conclusions: Postoperative recovery following day surgery implies, from the patients’ perspective, a migration from being a recipient of care at the day surgery unit to playing an active role, with extensive responsibility at home. To manage self-care confidently, postdischarge patients require knowledge and understanding of what constitutes the normal range in recovery following their specific surgical procedure.

  • 10.
    Berg, Katarina
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Postoperative recovery and its association with health-related quality of life among day surgery patientsManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between postoperative recovery and health-related quality of life 30 days after discharge. A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale and the Quality of Recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between postoperative recovery and health-related quality of life.

    Results: Postoperative recovery improved from day 1 to 14 in all surgical groups (p<0.001). The orthopaedic patients had lower postoperative recovery on day 14 compared to the general and the gynaecological patients (p<0.001). Health-related quality of life was lower among orthopaedic patients (p<0.001), even if significant improvements over time were seen in all groups. Recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p<0.05).

    Conclusion: Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life.

  • 11.
    Berg, Katarina
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Postoperative recovery and its association with health-related quality of life among day surgery patients2012In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 11, no 24Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first Postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe Postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between Postoperative recovery and healthrelated quality of life 30 days after discharge.

    METHODS: A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery recovery scale and the quality of recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate Postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between Postoperative recovery and health-related quality of life.

    RESULTS: Postoperative recovery improved from day 1 to 14 in all surgical groups (p<0.001). The orthopaedic patients had lower Postoperative recovery on day 14 compared to the general and the gynaecological patients (p<0.001). health-related quality of life was lower among orthopaedic patients (p<0.001), even if significant improvements over time were seen in all groups. recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p<0.05).

    CONCLUSION: Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life.

  • 12.
    Berglund, Helene
    et al.
    Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Vårdalinstitutet, The Swedish Institute for Health Sciences, Lund, Sweden.
    Blomberg, Staffan
    Department of Social Work, Lund University, Lund, Sweden; Vårdalinstitutet, The Swedish Institute for Health Sciences, Lund, Sweden.
    Dunér, Anna
    Department of Social Work, University of Gothenburg, Gothenburg, Sweden; Vårdalinstitutet, The Swedish Institute for Health Sciences, Lund, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Organizing integrated care for older persons: strategies in Sweden during the past decade2015In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 29, no 1, p. 128-151Article in journal (Refereed)
    Abstract [en]

    Purpose - The purpose of this paper is to describe and analyse ways of organizing integrated care for older persons in Sweden during the past decade. Design/methodology/approach - The data consist of 62 cases of development work, described in official reports. A meta-analysis of cases was performed, including content analysis of each case. A theoretical framework comprising different forms of integration (co-ordination, contracting, co-operation and collaboration) was applied. Findings - Co-operation was common and collaboration, including multiprofessional teamwork, was rare in the cases. Contracting can be questioned as being a form of integration, and the introduction of consumer choice models appeared problematic in inter-organization integration. Goals stated in the cases concerned steering and designing care, rather than outcome specifications for older persons. Explicit goals to improve integration in itself could imply that the organizations adapt to strong normative expectations in society. Trends over the decade comprised development of local health care systems, introduction of consumer choice models and contracting out. Research limitations/implications - Most cases were projects, but others comprised evaluations of regular organization of integrated care. These evaluations were often written normatively, but constituted the conditions for practice and were important study contributions. Practical implications - Guiding clinical practice to be aware of importance of setting follow-up goals. Social implications - Awareness of the risk that special funds may impede sustainable strategies development. Originality/value - A theoretical framework of forms of integration was applied to several different strategies, which had been carried out mostly in practice. The study contributes to understanding of how different strategies have been developed and applied to organize integrated care, and highlights some relationships between integration theory and practice.

  • 13.
    Berglund, Helene
    et al.
    Sahlgrenska Academy at the University of Gothenburg, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Duner, Anna
    University of Gothenburg, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Blomberg, Staffan
    Lund University, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Care planning at home: a way to increase the influence of older people?2012In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 12Article in journal (Refereed)
    Abstract [en]

    Introduction: Care-planning meetings represent a common method of needs assessment and decision-making practices in elderly care. Older peoples influence is an important and required aspect of these practices. This studys objective was to describe and analyse older peoples influence on care-planning meetings at home and in hospital. Methods: Ten care-planning meetings were audio-recorded in the older peoples homes and nine were recorded in hospital. The study is part of a project including a comprehensive continuum-of-care model. A qualitative content analysis was performed. Results: Care-planning meetings at home appeared to enable older peoples involvement in the discussions. Fewer people participated in the meetings at home and there was less parallel talking. Unrelated to the place of the care-planning meeting, the older people were able to influence concerns relating to the amount of care/service and the choice of provider. However, they were not able to influence the way the help should be provided or organised. Conclusion: Planning care at home indicated an increase in involvement on the part of the older people, but this does not appear to be enough to obtain any real influence. Our findings call for attention to be paid to older peoples opportunities to receive care and services according to their individual needs and their potential for influencing their day-to-day provision of care and service.

  • 14.
    Berglund, Helene
    et al.
    Sahlgrenska Academy at the University of Gothenburg, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Dunér, Anna
    University of Gothenburg, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Blomberg, Staffan
    Lund University, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Care planning at home: a way to increase the influence of older people?2014Conference paper (Refereed)
  • 15.
    Berglund, Helene
    et al.
    University of Gothenburg, Sweden; Swedish Institute Health Science, Sweden.
    Hasson, Henna
    Swedish Institute Health Science, Sweden; Karolinska Institute, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. University of Gothenburg, Sweden.
    Wilhelmson, Katarina
    Swedish Institute Health Science, Sweden; University of Gothenburg, Sweden.
    Effects of a continuum of care intervention on frail older persons life satisfaction: a randomized controlled study2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 7-8, p. 1079-1090Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: The aim of this study was to analyse effects of a comprehensive continuum of care (intervention group) on frail older persons life satisfaction, as compared to those receiving usual care (control group). The intervention included geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care-planning meetings in older persons own homes. Background: Improvements in older persons subjective well-being have been shown in studies including care planning and coordination by a case manager. However, effects of more complex continuum of care interventions on frail older persons life satisfaction are not well explored. DesignRandomised controlled study. Methods: The validated LiSat-11 scale was used in face-to-face interviews to assess older persons life satisfaction at baseline and at three, six and 12 months after the baseline. The odds ratio for improving or maintaining satisfaction was compared for intervention and control groups from baseline to three-month, three- to six-month as well as six- to 12-month follow-ups. Results: Older persons who received the intervention were more likely to improve or maintain satisfaction than those who received usual care, between 6 and 12 month follow-ups, for satisfaction regarding functional capacity, psychological health and financial situation. Conclusions: A comprehensive continuum of care intervention comprising several components had a positive effect on frail older persons satisfaction with functional capacity, psychological health and financial situation. Relevance to clinical practice: Frail older persons represent a great proportion of the persons in need of support from the health care system. Health care professionals need to consider continuum of care interventions impact on life satisfaction. As life satisfaction is an essential part of older persons well-being, we propose that policy makers and managers promote comprehensive continuum of care solutions.

  • 16.
    Berglund, Helene
    et al.
    Sahlgrenska Academy at the University of Gothenburg, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Dunér, Anna
    (University of Gothenburg, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Organizing integrated care for older persons: strategies in Sweden2014Conference paper (Other academic)
  • 17.
    Berglund, Helene
    et al.
    University of Gothenburg, Sweden .
    Wilhelmson, Katarina
    Swedish Institute Health Science, Sweden .
    Blomberg, Staffan
    Swedish Institute Health Science, Sweden .
    Duner, Anna
    Swedish Institute Health Science, Sweden .
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. University of Gothenburg, Sweden .
    Hasson, Henna
    Swedish Institute Health Science, Sweden .
    Older people's views of quality of care: a randomised controlled study of continuum of care2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 19-20, p. 2934-2944Article in journal (Refereed)
    Abstract [en]

    Aims and objectives To analyse frail older peoples views of quality of care when receiving a comprehensive continuum of care intervention, compared with those of people receiving the usual care (control group). The intervention included early geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care-planning meetings in older peoples own homes. less thanbrgreater than less thanbrgreater thanBackground Prior studies indicate that tailored/individualised care planning conducted by a case manager/coordinator often led to greater satisfaction with care planning among older people. However, there is no obvious evidence of any effects of continuum of care interventions on older peoples views of quality of care. less thanbrgreater than less thanbrgreater thanDesign Randomised controlled study. less thanbrgreater than less thanbrgreater thanMethods Items based on a validated questionnaire were used in face-to-face interviews to assess older peoples views of quality of care at three, six and 12months after baseline. less thanbrgreater than less thanbrgreater thanResults Older people receiving a comprehensive continuum of care intervention perceived higher quality of care on items about care planning (p0005), compared with those receiving the usual care. In addition, they had increased knowledge of whom to contact about care/service, after three and 12months (pandlt;003). less thanbrgreater than less thanbrgreater thanConclusions The study gives evidence of the advantages of a combination of components such as organising care-planning meetings in older peoples own homes, case management and interprofessional teamwork. less thanbrgreater than less thanbrgreater thanRelevance to clinical practice The results have implications for policymakers, managers and professionals in the area of health and social care for older people to meet individual needs of frail older people.

  • 18.
    Brink, Eva
    et al.
    Inst. of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg; Centre for Person-Centred Care, University of Gothenburg; Dept of Nursing, Health and Culture, University West, Trollhättan.
    Alsén, Pia
    Dept of Nursing, Health and Culture, University West, Trollhättan.
    Herlitz, Johan
    School of Health Sciences, University of Borås; Inst. of Medicine, Sahlgrenska University Hospital, Gothenburg.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Cliffordson, Christina
    Dept of Nursing, Health and Culture, University West, Trollhättan.
    General self-efficiacy and health-related quality of life after myocardial infarction2012In: Psychology, Health & Medicine, ISSN 1354-8506, E-ISSN 1465-3966, Vol. 17, no 3, p. 346-355Article in journal (Refereed)
    Abstract [en]

    Fatigue after myocardial infarction (MI) has been found to be distressing. A person's self-efficacy will influence his/her health behavior and plays an active role in tackling illness consequences. This study investigated associations between fatigue, disturbed sleep, general self-efficacy, and health-related quality of life (HRQoL) in a sample of 145 respondents admitted to hospital for MI two years earlier. The aim was to identify the predictive value of general self-efficacy and to elucidate mediating factors between self-efficacy and HRQoL. General self-efficacy measured four months after MI was positively related to HRQoL after two years. In tests of indirect effects, fatigue meditated the effects between self-efficacy and the physical and the mental dimension of HRQoL, respectively. The indirect effect of disturbed sleep went through that of fatigue. To conclude, patients who suffer from post-MI fatigue may need support aimed at helping them increase their self-efficacy as well as helping them adapt to sleep hygiene principles and cope with fatigue, both of which will have positive influences on HRQoL.

  • 19.
    Drevenhorn, E.
    et al.
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Bengtson, A
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Allen, J.
    Johns Hopkins University School of Nursing, Baltimore, MD, USA.
    Säljö, R.
    Göteborg University, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy at Göteborg University, Sweden.
    A content analysis of patient centredness in hypertension care after consultation training for nurses2007In: The Internet Journal of Advanced Nursing Practice, ISSN 1523-6064, Vol. 8, no 2Article in journal (Refereed)
    Abstract [en]

    Lifestyle changes are important when it comes to reducing the risk factors for cardiovascular complications. There is evidence that these changes are more successful if counselling is conducted in a patient-centred way. The purpose was to analyse how nurses used patient-centred counselling with hypertensive patients after video-recorded consultation training. Nineteen nurses from nurse-led clinics in hypertension care at Swedish health centres participated in residential counselling. Two audio-recordings with hypertensive patients in regular practice were made before and after the training and analysed with the emphasis on patient centredness. Weighing up the pros and cons, the identification of beliefs about treatment and negotiations about the reasons for and where to begin behavioural change increased. A slight increase in reflections and pauses was observed. Expansive and provocative questions and the identification of goals or goal-setting were used sparsely. As a result of the training, the nurses gave individually-adapted information more frequently.

  • 20.
    Drevenhorn, E.
    et al.
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Bengtson, A.
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Allen, J.
    John Hopkins University School of Nursing, Baltimore, MD, USA .
    Säljö, R.
    Göteborg University, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Counselling on lifestyle factors in hypertension care after training on the stages of change model2007In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, no 6, p. 46-53Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    In assisting the nurse's counselling on lifestyle changes in hypertension care a behaviour model can be used.

    AIM:

    To analyse the effects of nurses' training on the use of the stages of change model when counselling hypertensive patients to perform lifestyle changes.

    METHODS:

    As part of a randomised, controlled trial, 19 nurses belonging to the intervention group took part in video-recorded consultation training with simulated patients. To evaluate the training, the nurses audio-recorded their consultations with two patients before and after the intervention. Analysis focused on the areas of non-pharmacological treatment and the nurses' attention to the patients' readiness for change.

    RESULTS:

    Patient participation in the consultations increased after the training. The importance of non-pharmacological treatment was mentioned more frequently for all areas of lifestyle behaviour, exercise, smoking, alcohol consumption, food and stress, and the nurses acquired a more distinct structure for their consultations. The mean length of the recorded consultations increased from 18 min to 20.5 min. All the criteria for fulfillment of attention to patient's readiness to change were met in nine consultations before the training and in seven after it. After the training, attention was paid to support more frequently than before in the action and maintenance stages and a great deal of information was provided.

  • 21.
    Drevenhorn, E
    et al.
    Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet.
    Bengtson, A
    Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet.
    Kjellgren, Karin
    Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet.
    Evaluation of consultation training in hypertension care2009In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 8, no 5, p. 349-354Article in journal (Refereed)
    Abstract [en]

    Background: Nurses in hypertension care play an important role in minimising the risk factors for cardiovascular diseases, but this care can be improved.

    Aim: To evaluate the content of nurses' consultations with hypertensive patients before and after consultation training.

    Methods: Nineteen nurses from a randomised study of nurse-led hypertension clinics at health centres received three days of residential training in patient-centred counselling and cardiovascular prevention. To assess the result, two consultations with hypertensive patients in clinical practice before and after the training were audio-recorded. Content analysis was used for the analysis.

    Results: Diet and exercise were the most frequent topics in the consultations both before and after the training. Discussions about alcohol and the patient's responsibility for treatment increased after the training. The time spent talking about various issues, other health problems, history and appointment scheduling decreased in the consultations after the training.

    Conclusion: After the consultation training, the nurses succeeded in emphasising important issues for risk factor control to a greater extent.

  • 22.
    Drevenhorn, E.
    et al.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Bengtson, A.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Outcomes following a programme for lifestyle changes with people with hypertension2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 7b, p. 144-151Article in journal (Refereed)
    Abstract [en]

    AIM:

    The purpose of the study was to explore the effects of using a structured nursing intervention programme in hypertension care.

    BACKGROUND:

    Counselling on lifestyle changes to address hypertension helps patients reduce risk factors such as smoking, high alcohol consumption, overweight, dyslipidemia, negative stress and physical inactivity.

    DESIGN:

    The study was performed as a pre-test-post-test study.

    METHODS:

    All 177 patients diagnosed with hypertension visiting a health centre in Southern Sweden were invited to be counselled by a public health nurse about hypertension, cardiovascular risk factors and non-pharmacological treatment with 15 months follow up.

    RESULTS:

    One hundred patients participated in the study. Systolic blood pressure decreased overall (p < 0.01), three patients with high alcohol consumption were identified, two smokers stopped smoking, two new diabetics were discovered, physical activity increased (p = 0.035) and one-third of the patients changed their medication.

    CONCLUSION:

    The level of exercise increased and a reduction in systolic blood pressure and in women's weight were the most obvious results of this intervention study. The study elucidates the challenge of executing health behaviour changes.

    RELEVANCE TO CLINICAL PRACTICE:

    Counselling following a hypertension programme gives hypertensive patients a chance to execute lifestyle changes and have their medication adjusted to achieve goals for blood pressure control. Further prospective studies in this area, with well-defined intervention approaches and several years of follow up, are necessary.

  • 23.
    Drevenhorn, Eva
    et al.
    Lund University, Sweden.
    Bengtson, Ann
    University of Gothenburg, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. University of Gothenburg, Sweden.
    To be motivated or only comply - patients views of hypertension care after consultation training for nurses2015In: Health Education Journal, ISSN 0017-8969, E-ISSN 1748-8176, Vol. 74, no 1, p. 28-36Article in journal (Refereed)
    Abstract [en]

    Objective: This paper reports on patients perspectives on the nurse management of hypertension following consultation training, elicited as part of a randomised controlled study. Method: Telephone interviews were conducted with 16 patients in an intervention group (IG) and eight patients in a control group (CG), 3 years after nurses consultation training in primary health care. By means of a 3-day course, nurses were educated in patient centredness, Motivational Interviewing, the Stages of Change model, guidelines for cardiovascular prevention, lifestyle changes and pharmacological treatment. In addition, they took part in video-recorded consultation training with simulated patients. A specially designed educational booklet was developed for patients in the IG. Results: Of the 16 patients in the IG, 13 reported that their views and former experiences were taken into account and all eight patients in the CG reported the same. Patients in the IG reported that the nurse listened and they had been guided and motivated to perform lifestyle changes. The booklet in the IG was reported to have been read several times, but a few patients did not remember receiving it. There were more informed thoughts about how to manage lifestyle in the IG. Patients in the CG were less detailed in their descriptions. Conclusion: Patients in both IG and CG reported to have made efforts to change lifestyle, and patients in the IG reported that they had been coached and motivated by their nurses to do so.

  • 24.
    Drevenhorn, Eva
    et al.
    Lund University, Sweden .
    Bengtson, Ann
    University of Gothenburg, Sweden .
    Nilsson, Peter M
    Lund University, Sweden .
    Nyberg, Per
    Lund University, Sweden .
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Consultation training of nurses for cardiovascular prevention - A randomized study of 2 years duration2012In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 21, no 5, p. 293-299Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to increase patients adherence to the treatment of hypertension through the consultation training of nurses. Thirty-three nurses were included in the study. In the intervention group (IG), 19 nurses took part in a 3-day residential training course on the Stages of Change model, Motivational Interviewing and guidelines for cardiovascular prevention, and recruited 153 patients. Sixteen nurses in the control group (CG) recruited 59 patients. A decrease in systolic and diastolic blood pressure and total cholesterol was noticed in both groups over the 2 years. Heart rate (p = 0.027), body mass index (p = 0.019), weight (p = 0.0001), waist (p = 0.041), low-density lipoprotein-cholesterol (p = 0.0001), the waist-hip ratio (p = 0.024), and perceived stress (p = 0.001) decreased to any great extent only in the IG. After 2 years, 52.6% of the patients in the IG (p = 0.13) reached the target of andlt;= 140/90 mmHg in blood pressure compared with 39.2% in the CG. For self-reported physical activity, there was a significant (p = 0.021) difference between the groups. The beneficial effects of the consultation training on patients weight parameters, physical activity, perceived stress and the proportion of patients who achieved blood pressure control emphasize consultation training and the use of behavioural models in motivating patients to adhere to treatment.

  • 25.
    Drevenhorn, Eva
    et al.
    Lund University, Sweden.
    Bengtson, Ann
    University of Gothenburg, Sweden.
    Nyberg, Per
    Lund University, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. University of Gothenburg, Sweden.
    Assessment of hypertensive patients self-care agency after counseling training of nurses2015In: Journal of the American Association of Nurse Practitioners, ISSN 2327-6886, E-ISSN 2327-6924, Vol. 27, no 11, p. 624-630Article in journal (Refereed)
    Abstract [en]

    PurposeThe aim of the study was to assess hypertensive patients self-care agency and any correlation with the patients lifestyle changes and the nurses degree of patient centeredness after counseling training. Data sourcesNurses in the intervention group (IG; n = 19) working at nurse-led clinics at health centers were trained in patient centeredness (motivational interviewing) and the stages of change model and included 137 patients. Nurses in the control group (CG; n = 14) included 51 patients. The Exercise of Self-Care Agency (ESCA) instrument was used. There was a significant difference from baseline to the 2-year follow-up in the ESCA score (IG, p = .0001). An increase in ESCA score was correlated with an increased level of physical activity after 2 years (IG, p = .0001; CG, p = .040). ConclusionsThe counseling training gave an increase in the patients self-care agency scores, which was significantly correlated with increased physical activity. Implications for practiceIn clinical practice it is important for nurses to be patient centered in their counseling to affect patients self-care agency in a positive direction.

  • 26.
    Drevenhorn, Eva
    et al.
    Institutionen för hälsovetenskaper, Lunds Universitet.
    Bengtson, Ann
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien, Göteborgs Universitet.
    Nyberg, Per
    Institutionen för hälsovetenskaper, Lunds Universitet.
    Kjellgren, Karin I.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien, Göteborgs Universitet.
    Effects on hypertensive patients' satisfaction with information about their medication after nurses' consultation training2014In: Pragmatic and Observational Research, ISSN 1179-7266, Vol. 5, p. 35-41Article in journal (Refereed)
    Abstract [en]

    Background: There is a well-known problem in hypertension care with patients' adherence to treatment. Patients who score high in answering the instrument Satisfaction with Information about Medicine Scale are reported to have greater adherence to their medication.

    Aim: To explore how hypertensive patients' satisfaction with information about their medicines was affected by nurses' education in Motivational Interviewing.

    Material and methods: The Stages of Change model and Motivational Interviewing was the theoretical base for consultation training for nurses. Nineteen nurses attended 3 days of video-recorded consultation training with simulated patients. They were updated in hypertensive medication and were trained in motivating patients to improve their self-management as well as adherence to lifestyle changes and medication. The satisfaction with information instrument identifies patients' satisfaction with information about the action and usage of medication as well as potential problems with it. The instrument was used to assess how well the needs of individual patients for medicine information were met at baseline and 2 years after the training. The 19 trained nurses in the intervention group worked with 137 patients, and a control group of 16 nurses, who gave normal care, worked with 51 patients.

    Results: There was a difference between the intervention and control group in total score (P=0.028) 2 years after the intervention. Patients in the intervention group perceived higher satisfaction with the action and usage of their medication (P=0.001) and a lower degree of potential problems with their medication (P=0.001). Patients in the control group also perceived a lower degree of potential problems with their medication (P=0.028).

    Conclusion: We suggest that consultation training for nurses with the aim of motivating patients to be more self-directed in their self-care improves satisfaction with information about medication.

  • 27.
    Drott, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Fomichov, Victoria
    Region Östergötland, Center for Business support and Development, Department of Health and Care Development.
    Starkhammar, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Kjellgren, Karin I.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Oxaliplatin-Induced Neurotoxic Side Effects and Their Impact on Daily Activities2019In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804Article in journal (Refereed)
    Abstract [en]

    Background: Oxaliplatin (OXA) is frequently used in the treatment of patients with colorectal cancer, and OXA-induced neurotoxic side effects are common. Reports on real-time patient-reported neurotoxic side effects and impact on the patient's daily activities are sparse in existing studies. Objective: The aim of this study was to identify and assess patient-reported OXA-induced neurotoxic side effects and their impact on the patient's daily activities, during and after chemotherapy. Methods: In a multicenter prospective longitudinal study, 46 chemo-naïve patients with colorectal cancer treated with postoperative adjuvant OXA-based chemotherapy were monitored during treatment and at 3-, 6-, 9-, and 12-month follow-ups. Patients were recruited from September 2013 to June 2016. In total, 370 Oxaliplatin-Associated Neurotoxicity Questionnaire responses were available for analysis. A mobile phone-based system was used to receive real-time assessments. Results: All patients reported neurotoxic side effects and impact on daily activities during treatment. The side effects changed in character and body location over time and had an impact on the daily activities. Conclusions: The high prevalence of OXA-induced neurotoxic side effects significantly interfered with the patients' daily activities. We found significant differences between baseline data and follow-up time points for neurotoxicity, and the patients had not returned to baseline after 1 year. Implications for Practice: The real-time assessment using mobile phone technology seems to be a valuable tool for monitoring patient-reported neurotoxicity and interventions for tailored care. Effectively identifying neurotoxicity and its impact on the patient's daily activities is important in supportive cancer care.

  • 28.
    Drott, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Starkhammar, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    The trajectory of neurotoxic side effects' impact on daily life: a qualitative study2016In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 8, p. 3455-3461Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    The purpose of this study was to explore the experiences of oxaliplatin-induced neurotoxic side effects among patients with colorectal cancer (CRC) and how these side effects influenced their daily lives over time.

    METHODS:

    To assess neurotoxic side effects, ten patients were repeatedly interviewed. The patients were recruited from two hospitals in south of Sweden, had stage II-III CRC, and had been treated with adjuvant oxaliplatin postoperatively, from November 2013 to October 2015. They had received FOLFOX and XELOX, with a mean total dose of 791 mg oxaliplatin. After completed chemotherapy, at 3, 6, and 12 months into the post-treatment phase, 25 interviews were conducted and thematic analysis was used according to Braun and Clarke.

    RESULTS:

    Oxaliplatin-induced neurotoxicity affects patients in several ways in the long term. Four themes were identified: Expectation of cure, Dubiety, Normalization, and Learn to live with neurotoxicity. The findings of this study describe the trajectory of neurotoxicity and its impact on these patients' life situation. The findings confirmed that neurotoxicity is multi-faceted and that the experience of it changes over time.

    CONCLUSION:

    The desire to survive stimulates adaptations and strategies to manage daily life, and patients learn to live with the neurotoxic side effects. This study provides evidence that these patients need individual attention and support during the trajectory of neurotoxic side effects. Current care provision is inadequate due to a lack of knowledge of the ways in which neurotoxicity impacts the patient's daily life. This study provides insights that could be used to develop a more person-centered care.

  • 29.
    Drott, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Starkhammar, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Kjellgren, Karin I.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Neurotoxic Side Effects Early in the Oxaliplatin Treatment Period in Patients With Colorectal Cancer2018In: Oncology Nursing Forum, ISSN 0190-535X, E-ISSN 1538-0688, Vol. 45, no 6, p. 690-697Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To identify and describe experiences of patients with colorectal cancer (CRC) who have neurotoxic side effects early in the oxaliplatin treatment period, and how neurotoxicity affects their daily lives.

    PARTICIPANTS & SETTING: 10 patients with stage II-III CRC were included. All were treated with adjuvant oxaliplatin postoperatively and assessed neurotoxicity via a platform-independent mobile phone-based system. Patients were recruited from two hospitals in southern Sweden from November 2013 to August 2014.

    METHODOLOGIC APPROACH: Qualitative interview study conducted through open-ended, face-to-face, qualitative interviews. Thematic analysis was used.

    FINDINGS: A main theme was identified.

    IMPLICATIONS FOR NURSING: Nurses have an obligation to communicate the importance of early detection of neurotoxicity. Mobile phone technology seems to be a valuable tool for monitoring patient-reported neurotoxicity to improve communication and supportive care.

  • 30.
    Drott, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Vilhelmsson, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Experiences with a self-reported mobile phone-based system among patients with colorectal cancer: a qualitative study2016In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 4, no 2, p. 182-190, article id e66Article in journal (Refereed)
    Abstract [en]

    Background: In cancer care, mobile phone-based systems are becoming more widely used in the assessment, monitoring, and management of side effects.

    Objective: To explore the experiences of patients with colorectal cancer on using a mobile phone-based system for reporting neurotoxic side effects.

    Methods: Eleven patients were interviewed (ages 44-68 years). A semistructured interview guide was used to perform telephone interviews. The interviews were transcribed verbatim and analyzed with qualitative content analysis.

    Results: The patients' experiences of using a mobile phone-based system were identified and constructed as: “being involved,” “pacing oneself,” and “managing the questions.” “Being involved” refers to their individual feelings. Patients were participating in their own care by being observant of the side effects they were experiencing. They were aware that the answers they gave were monitored in real time and taken into account by health care professionals when planning further treatment. “Pacing oneself” describes how the patients can have an impact on the time and place they choose to answer the questions. Answering the questionnaire was easy, and despite the substantial number of questions, it was quickly completed. “Managing the questions” pointed out that the patients needed to be observant because of the construction of the questions. They could not routinely answer all the questions. Patients understood that side effects can vary during the cycles of treatment and need to be assessed repeatedly during treatment.

    Conclusions: This mobile phone-based system reinforced the patients’ feeling of involvement in their own care. The patients were comfortable with the technology and appreciated that the system was not time consuming.

  • 31.
    Ekman, I.
    et al.
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Schaufelberger, M.
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Swedberg, K.
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Granger, B. B.
    Duke School of Nursing, Durham, North Carolina, USA.
    Standard medication information is not enough: poor concordance of patient and nurse perceptions2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 60, no 2, p. 181-186Article in journal (Refereed)
    Abstract [en]

    AIM:

    This paper is a report of a study to describe patient and nurse perceptions of patient satisfaction with information about the medicines at two heart failure clinics after medication up-titration and information-giving.

    BACKGROUND:

    Chronic heart failure is a major cause of hospitalization. Poor adherence to medications increases mortality and heart failure-related hospitalizations. To achieve mutual goal-setting (concordance) regarding medication-taking behaviours, health providers need to understand patient information needs regarding the prescribed medicines.

    METHODS:

    A convenience sample of 56 patients with chronic heart failure referred for an up-titration of medicines and information-giving about the condition and treatment completed the Satisfaction about Information about Medicines Scale at their first and last visits. Nurses completed the same questionnaire after each patient's final visit, assessing the patient's need for further information. The data were collected between 2002 and 2004.

    RESULTS:

    Patient scores indicated statistically significantly more satisfaction with their information at the final visit compared with the first visit (P = 0.005). However, at the programme conclusion, nurses (n = 7) rated patients to be appropriately informed while patients reported a persistent need for further information (P = 0.011).

    CONCLUSION:

    Further research should evaluate more advanced pedagogical strategies such as how to address patients' expectations about the effect of medicines when actual effects of the treatment are related to mortality and morbidity at the population level and may not result directly in symptom relief at an individual level.

  • 32.
    Ekman, Inger
    et al.
    University of Gothenburg.
    Swedberg, Karl
    University of Gothenburg.
    Taft, Charles
    University of Gothenburg.
    Lindseth, Anders
    University of Gothenburg.
    Norberg, Astrid
    University of Gothenburg.
    Brink, Eva
    University of Gothenburg.
    Carlsson, Jane
    University of Gothenburg.
    Dahlin-Ivanoff, Synneve
    University of Gothenburg.
    Johansson, Inga-Lill
    University of Gothenburg.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Liden, Eva
    University of Gothenburg.
    Ohlen, Joakim
    University of Gothenburg.
    Olsson, Lars-Eric
    University of Gothenburg.
    Rosen, Henrik
    University of Gothenburg.
    Rydmark, Martin
    University of Gothenburg.
    Stibrant Sunnerhagen, Katharina
    University of Gothenburg.
    Person-centered care - Ready for prime time2011In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 4, p. 248-251Article in journal (Refereed)
    Abstract [en]

    Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness.

  • 33.
    Hallberg, Inger
    et al.
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Bengtsson, Ulrika
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Kjellgren, Karin
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Patientmedverkan i behandling av högt blodtryck med hjälp av mobiltelefon2012Conference paper (Other academic)
  • 34.
    Hallberg, Inger
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden.
    Ranerup, Agneta
    Univ Gothenburg, Sweden.
    Bengtsson, Ulrika
    Univ Gothenburg, Sweden; Univ Gothenburg, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden; Univ Gothenburg, Sweden.
    Experiences, expectations and challenges of an interactive mobile phone-based system to support self-management of hypertension: patients and professionals perspectives2018In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 12, p. 467-476Article in journal (Refereed)
    Abstract [en]

    Background: A well-controlled blood pressure (BP) reduces cardiovascular complications. Patient participation in care using technology may improve the current situation of only 13.8% of adults diagnosed with hypertension worldwide having their BP under control. Objective: The objective of this study was to explore patients and professionals experiences of and expectations for an interactive mobile phone-based system to support self-management of hypertension. Methods: The self-management system consists of: 1) a mobile phone platform for self-reports, motivational messages and reminders; 2) a device for measuring BP and 3) graphical feedback of self-reports. Patients diagnosed with high BP (n=20) and their treating professionals (n=7) participated in semi-structured interviews, after 8 weeks use of the system in clinical practice. Data were analyzed thematically. Results: The self-reporting of BP, symptoms, medication use, medication side effects, lifestyle and well-being was perceived to offer insight into how daily life activities influenced BP and helped motivate a healthy lifestyle. Taking increased responsibility as a patient, by understanding factors affecting ones well-being, was reported as an enabling factor for a more effective care. Based on the experiences, some challenges were mentioned: for adoption of the system into clinical practice, professionals educational role should be extended and there should be a reorganization of care to fully benefit from technology. The patients and professionals gave examples of further improvements to the system, for example, related to the visualization of graphs from self-reports and an integration of the system into the general technical infrastructure. These challenges are important on the path to accomplishing adoption. Conclusion: The potential of a more autonomous, knowledgeable and active patient, through use of the interactive mobile system would improve outcomes of hypertension treatment, which has been desired for decades. Documentation and visualization of patients self-reports and the possibilities to communicate these with professionals may be a significant resource for person-centered care.

  • 35.
    Hallberg, Inger
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ranerup, Agneta
    Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Applied IT, University of Gothenburg, Gothenburg, Sweden.
    Kjellgren, Karin I.
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Supporting the self-management of hypertension: Patients' experiences of using a mobile phone-based system2016In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 30, no 2, p. 141-146Article in journal (Refereed)
    Abstract [en]

    Globally, hypertension is poorly controlled and its treatment consists mainly of preventive behavior, adherence to treatment and risk-factor management. The aim of this study was to explore patients’ experiences of an interactive mobile phone-based system designed to support the self-management of hypertension. Forty-nine patients were interviewed about their experiences of using the self-management system for 8 weeks regarding: (i) daily answers on self-report questions concerning lifestyle, well-being, symptoms, medication intake and side effects; (ii) results of home blood-pressure measurements; (iii) reminders and motivational messages; and (iv) access to a web-based platform for visualization of the self-reports. The audio-recorded interviews were analyzed using qualitative thematic analysis. The patients considered the self-management system relevant for the follow-up of hypertension and found it easy to use, but some provided insight into issues for improvement. They felt that using the system offered benefits, for example, increasing their participation during follow-up consultations; they further perceived that it helped them gain understanding of the interplay between blood pressure and daily life, which resulted in increased motivation to follow treatment. Increased awareness of the importance of adhering to prescribed treatment may be a way to minimize the cardiovascular risks of hypertension.

  • 36.
    Hallberg, Inger
    et al.
    Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet, Centrum för personcentrerad vård, Sahlgrenska akademin, Göteborgs Universitet.
    Taft, Charles
    Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet, Centrum för personcentrerad vård, Sahlgrenska akademin, Göteborgs Universitet.
    Ranerup, Agneta
    Avdelningen för informatik, Göteborgs Universitet, Centrum för personcentrerad vård, Sahlgrenska akademin, Göteborgs Universitet.
    Bengtsson, Ulrika
    Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet, Centrum för personcentrerad vård, Sahlgrenska akademin, Göteborgs Universitet.
    Hoffman, Mikael
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Stiftelsen NEPI, Linköping .
    Höfer, Stefan
    Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria.
    Kasperowski, Dick
    Institutionen för filosofi, lingvistik och vetenskapsteori, Göteborgs Universitet.
    Mäkitalo, Åsa
    Institutionen för pedagogik, kommunikation och lärande, Göteborgs Universitet.
    Lundin, Mona
    Institutionen för pedagogik, kommunikation och lärande, Göteborgs Universitet.
    Ring, Lena
    Centrum för forsknings- och bioetik, Uppsala Universitet, Enheten för läkemedelsanvändning, Läkemedelsverket, Uppsala.
    Rosenqvist, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Kjellgren, Karin I
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet, Centrum för personcentrerad vård, Sahlgrenska akademin, Göteborgs Universitet.
    Phases in development of an interactive mobile phone-based system to support self-management of hypertension2014In: Integrated Blood Pressure Control, ISSN 1178-7104, E-ISSN 1178-7104, Vol. 7, p. 19-28Article in journal (Refereed)
    Abstract [en]

    Hypertension is a significant risk factor for heart disease and stroke worldwide. Effective treatment regimens exist; however, treatment adherence rates are poor (30%–50%). Improving self-management may be a way to increase adherence to treatment. The purpose of this paper is to describe the phases in the development and preliminary evaluation of an interactive mobile phone-based system aimed at supporting patients in self-managing their hypertension. A person-centered and participatory framework emphasizing patient involvement was used. An interdisciplinary group of researchers, patients with hypertension, and health care professionals who were specialized in hypertension care designed and developed a set of questions and motivational messages for use in an interactive mobile phone-based system. Guided by the US Food and Drug Administration framework for the development of patient-reported outcome measures, the development and evaluation process comprised three major development phases (1, defining; 2, adjusting; 3, confirming the conceptual framework and delivery system) and two evaluation and refinement phases (4, collecting, analyzing, interpreting data; 5, evaluating the self-management system in clinical practice). Evaluation of new mobile health systems in a structured manner is important to understand how various factors affect the development process from both a technical and human perspective. Forthcoming analyses will evaluate the effectiveness and utility of the mobile phone-based system in supporting the self-management of hypertension.

  • 37.
    Hendry, G
    et al.
    University of Sydney, Australia.
    Kinnersley, P.
    University of Cardiff, UK.
    Kjellgren, Karin
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Langendyk, V.
    University of Sydney, Australia.
    Hyde, S.J.
    University of Sydney, Australia.
    Students' attitudes toward the patient-doctor relationship in a graduate-entry, problem-based medical program - a qualitative study2006In: Focus on Health Professional Education, ISSN 1442-1100, Vol. 7, no 3, p. 2-29Article in journal (Refereed)
    Abstract [en]

    Context and objectives:

    Doctors and student doctors develop attitudes to the patient-doctor relationship that range from patient-centred to doctor-centred. Patient-centred attitudes and approaches lead to increased patient satisfaction and improved health outcomes. In some circumstances the proportion of students with patient-centred attitudes may decline as students progress through their medical program.

    Method:

    We conducted qualitative research on the determinants of attitudes to the patient-doctor relationship in students from Years 1 to 4 of a graduate-entry, problem-based medical program.

    Results:

    Themes identified for the determinants of students’ attitudes to the patient-doctor relationship included personal values, experiences as patients, personal experiences with patients and experiences of doctors interacting with patients in the clinical setting during the medical program. Students’ attitudes are both positively and negatively influenced by experiences with patients and experiences with doctors’ interactions with patients, and negatively influenced by perceived time constraints.

    Conclusion:

    Students attitudes to the patient-doctor relationship are determined by a variety of influences throughout their medical program. To counter negative influences, medical schools may need to focus on improving the quality of practising doctors’ patient-centred role-modelling through selection and teacher training.

  • 38.
    Hoffmann, Mikael
    et al.
    Linköping University, Department of Medicine and Care, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
    Hammar, Mats
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Kjellgren, Karin
    Linköping University, Faculty of Health Sciences. The Sahlgrenska Academy at Göteborg University, Sweden.
    Lindh-Åstrand, Lotta
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Ahlner, Johan
    National Board of Forensic Medicine, Linköping, Sweden.
    Risk communication in consultations about hormone therapy in the menopause: concordance in risk assessment and framing due to the context2006In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 9, no 5, p. 347-354Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    It is important for the physician and the patient to have a mutual understanding of the possible consequences of different treatment alternatives in order to achieve a partnership in decision-making.

    OBJECTIVE:

    The aim of this study was to explore to which degree first-time consultations for discussion of climacteric discomfort achieved shared understanding of the risks and benefits associated with hormone therapy in the menopausal transition.

    METHODS:

    Analysis of structure and content of transcribed consultations (n = 20), and follow-up interviews of the women (n = 19 pairs of consultations and interviews), from first-time visits for discussion of climacteric discomfort and/or HT with five physicians at three different outpatient clinics of gynecology in Sweden.

    RESULTS:

    Four distinctively different interpretations of risk, depending on whether or not benefits were discussed in the same context, emerged from the analysis. On average, five advantages (range 0-11) and two (0-3) disadvantages were mentioned during the consultations. In the interviews, the women expressed on average four advantages (0-7) and one disadvantage (0-3). There were major variations between advantages and disadvantages expressed in the consultation and the following interview.

    CONCLUSION:

    Even though the consultations scored high in patient involvement, the information in most consultations was not structured in a way that made it possible to achieve a shared or an informed decision-taking.

  • 39.
    Hoffmann, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
    Linell, Per
    Linköping University, Department of Culture and Communication. Linköping University, Faculty of Arts and Sciences.
    Lindh-Åstrand, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Kjellgren, Karin I.
    Faculty of Health and Caring Sciences, Institute of Nursing, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    Risk talk: rhetorical strategies in consultations on hormone replacement therap2005In: Health, Risk and Society, ISSN 1369-8575, E-ISSN 1469-8331, Vol. 5, no 2, p. 139-154Article in journal (Refereed)
    Abstract [en]

    When analysing risk discussions in medical settings it is important to consider the specific activity type. In this qualitative study 20 first-time consultations by healthy women regarding hormone replacement therapy (HRT) in the menopause the risk discussion is asymmetrical with the doctors dominating. Despite being set up as a specific opportunity for women in the menopause to discuss problems and risks, it comes forth as a decision-making activity in a traditional medical setting. The consultations fulfil to a high extent the demands for informed decision making, but the risk discussions are recontextualised into a cost-benefit discourse with a typical implicit quantitative bias. The doctors use several different rhetorical strategies such as positive introduction of HRT, embedding drawbacks in positive introductions and/or exits thereby diminishing them. The word risk is avoided to a considerable extent and the term 'drawbacks' is used instead. The most obvious strategy is to move from the woman's symptoms to aspects of prevention, thus changing the discussion from the menopause and different strategies to cope with menopausal problems into a medically oriented discussion of pharmacological treatment alternatives. The 'change of life' in these talks is entirely conceptualised within a 'medical model'.

  • 40.
    Hultberg, J.
    et al.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Plos, K.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Hendry, G.
    University of Sydney, Australia .
    Kjellgren, Karin
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Scaffolding students' transition to higher education: parallel introductory courses for students and teachers2008In: Journal of Further and Higher Education, ISSN 0309-877X, E-ISSN 0013-1326, Vol. 32, no 1, p. 47-57Article in journal (Refereed)
    Abstract [en]

    The aim of this article was to outline the basis for an introductory course to higher education focusing on students' approaches to learning and the role of teaching in higher education. The framework is a discussion on contemporary literature on approaches to learning. In the article experiences are also reported of developing and implementing an introductory course at the Sahlgrenska Academy, Göteborg University, Sweden. This was made within the LearnAble project, which was a two‐tier approach in which students were given an introductory course to higher education parallel with a course in pedagogy in higher education for teachers. The courses were evaluated with different instruments, which is also to some extent accounted for. The transition from upper secondary school to studies in higher education is discussed, as is the importance of a scholarship of teaching in the context of the courses mentioned above. In this article the authors argue that a well‐planned and stimulating introduction to higher education could be a natural part of the transition process, which can help students develop better prerequisites to manage their studies in higher education.

  • 41.
    Janson Fagring, A.
    et al.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Lappas, G.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Welin, C.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Manhem, K.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Rosengren, A.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Twenty-year trends in incidence and 1-year mortality in Swedish patients hospitalised with non-AMI chest pain. Data from 1987-2006 from the Swedish hospital and death registries2010In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 96, no 13, p. 1043-1049Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To study trends for 20 years in incidence and 1-year mortality in hospitalised patients who received a diagnosis of either angina or unexplained chest pain (UCP) in Sweden.

    DESIGN AND SETTING:

    Register study of all patients aged 25-84 years identified from the Swedish National Hospital Discharge Register who were hospitalised with a first-time diagnosis of UCP or angina pectoris during 1987 to 2006.

    PARTICIPANTS:

    A total of 378 454 patients, 235 855 with UCP and 142 599 with angina.

    MAIN OUTCOME MEASURES:

    1-Year mortality and standardised mortality ratios (SMRs).

    RESULTS:

    From the period 1987-1991 to 2002-2006, the observed 1-year mortality rate in men and women with UCP aged 25-74 years decreased from 2.19% to 1.45% and from 1.85% to 0.91%, respectively. SMRs decreased from 1.67 (95% CI 1.39 to 1.95) and 1.63 (1.27 to 2.00) to 1.09 (0.96 to 1.23) and 0.88 (0.75 to 1.00). Corresponding decreases in 1-year mortality for a discharge diagnosis of angina were from 6.50% to 2.49% in men and from 4.80% to 1.68% in women, with SMRs decreasing from 2.69 (2.33-3.05) and 2.59 (2.06-3.12) to 1.09 (0.93-1.25) and 1.05 (0.81-1.29), respectively. Similar changes occurred in patients aged 75-84 years. Only men with UCP aged 75-84 years still retained a slightly increased mortality (SMR 1.14 (1.01-1.28)).

    CONCLUSIONS:

    The prognosis of patients admitted with chest pain in which acute myocardial infarction has been ruled out has improved for the past 20 years, such that the 1-year mortality of these patients is now similar to that in the general population.

  • 42.
    Jansson Fagring, A.
    et al.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Gaston-Johansson, F.
    John Hopkins University, School of Nursing, Baltimore, USA .
    Kjellgren, Karin
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Welin, C.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Unexplained chest pain in relation to psychosocial factors and health-related quality of life in men and women2007In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 6, no 4, p. 329-336Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Unexplained chest pain is a frequent and increasingly common complaint among patients admitted to Emergency Departments. Previous studies have defined unexplained chest pain as non-cardiac or non-coronary artery disease, i.e. patients with other organic causes explaining the chest pain could be included. To increase the knowledge of unexplained chest pain, this study only includes patients without any known explanation for their chest pain.

    AIM:

    To analyze gender differences regarding pain characteristics, psychosocial factors and health-related quality of life among patients diagnosed unexplained chest pain.

    METHODS AND RESULTS:

    The results are based on 179 patients (101 men, 78 women) between 16 and 69 years old (mean age 45.3) consecutively admitted to Emergency Department. Pain characteristics were assessed by Pain-O-Meter. Social relationships, depression, anxiety, and health-related quality of life were measured by a self-administered questionnaire. There were no gender differences regarding chest pain intensity; however women described their pain as burning (p<0.01) and frightening (p<0.03) more often than men. Men reported less depression (p<0.01) and less trait anxiety (p=0.01) than women. Chest pain intensity did not significantly impact health-related quality of life except physical functioning in men (p=0.05).

    CONCLUSION:

    Gender differences were few. Chest pain intensity did not significantly impact health-related quality of life.

  • 43.
    Jansson Fagring, A.
    et al.
    IThe Sahlgrenska Academy, Göteborg University, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Rosengren, A.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Lissner, L.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Manhem, K.
    Sahlgrenska University Hospital/Mölndal, Göteborg, Sweden .
    Welin, C.
    Sahlgrenska University Hospital/Mölndal, Göteborg, Sweden .
    Depression, anxiety, stress, social interaction and health-related quality of life in men and women with unexplained chest pain2008In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 8, p. 165-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Unexplained chest pain (UCP) is a common reason for emergency hospital admission and generates considerable health-care costs for society. Even though prior research indicates that psychological problems and impaired quality of life are common among UCP patients, there is lack of knowledge comparing UCP patients with a reference group from the general population. The aim of this study was to analyse differences between men and women with UCP and a reference group in terms of psychosocial factors as depression, anxiety, stress, social interaction and health-related quality of life (HRQOL).

    METHODS:

    A self-administered questionnaire about psychosocial factors was completed by 127 men and 104 women with acute UCP admitted consecutively to the Emergency Department (ED) or as in-patients on a medical ward. A reference group from the general population, 490 men and 579 women, participants in the INTERGENE study and free of clinical heart disease, were selected.

    RESULTS:

    The UCP patients were more likely to be immigrants, have a sedentary lifestyle, report stress at work and have symptoms of depression and trait-anxiety compared with the reference group. After adjustment for differences in age, smoking, hypertension and diabetes, these factors were still significantly more common among patients with UCP. In a stepwise multivariate model with mutual adjustment for psychosocial factors, being an immigrant was associated with a more than twofold risk in both sexes. Stress at work was associated with an almost fourfold increase in risk among men, whereas there was no independent impact for women. In contrast, depression only emerged as an independent risk factor in women. Trait-anxiety and a low level of social interaction were not independently associated with risk in either men or women. Patients with UCP were two to five times more likely to have low scores for HRQOL.

    CONCLUSION:

    Both men and women with UCP had higher depression scores than referents, but an independent association was only found in women. Among men, perceived stress at work emerged as the only psychosocial variable significantly associated with UCP

  • 44.
    Jerlock, M.
    et al.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Gaston-Johansson, F.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Welin, C.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Coping strategies, stress, physical activity and sleep in patients with unexplained chest pain2006In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 5, no 7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The number of patients suffering from unexplained chest pain (UCP) is increasing. Intervention programmes are needed to reduce the chest pain and suffering experienced by these patients and effective preventive strategies are also required to reduce the incidence of these symptoms. The aim of this study was to describe general coping strategies in patients with UCP and examine the relationships between coping strategies, negative life events, sleep problems, physical activity, stress and chest pain intensity.

    METHOD:

    The sample consisted of 179 patients younger than 70 years of age, who were evaluated for chest pain at the emergency department daytime Monday through Friday and judged by a physician to have no organic cause for their chest pain. The study had a cross-sectional design.

    RESULTS:

    Emotive coping was related to chest pain intensity (r = 0.17, p = 0.02). Women used emotive coping to a greater extent than did men (p = 0.05). In the multivariate analysis was shown that physical activity decreased emotive coping (OR 0.13, p < 0.0001) while sex, age, sleep, mental strain at work and negative life events increased emotive coping. Twenty-seven percent of the patients had sleep problems 8 to 14 nights per month or more. Permanent stress at work during the last year was reported by 18% of the patients and stress at home by 7%. Thirty-five percent of the patients were worried often or almost all the time about being rushed at work and 23% were worried about being unable to keep up with their workload. Concerning total life events, 20% reported that a close relative had had a serious illness and 27% had reasons to be worried about a close relative.

    CONCLUSION:

    Our results indicated that patients with more intense UCP more often apply emotive coping in dealing with their pain. Given that emotive coping was also found to be related to disturbed sleep, negative life events, mental strain at work and physical activity, it may be of value to help these patients to both verbalise their emotions and to become cognizant of the influence of such factors on their pain experience.

  • 45.
    Jerlock, M.
    et al.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Gaston-Johansson, F.
    Johns Hopkins University, School of Nursing, Baltimore, MD, USA.
    Lissner, L.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Manhem, K.
    Sahlgrenska University Hospital/Östra, Gothenburg; Sweden.
    Rosengren, A.
    Sahlgrenska University Hospital/Östra, Gothenburg; Sweden.
    Welin, C.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Psychosocial profile in men and women with unexplained chest pain2008In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 264, no 3, p. 265-274Article in journal (Refereed)
    Abstract [en]

    Objective.  The aim of this study was to compare men and women with unexplained chest pain (UCP) to a randomly selected population sample free of clinical heart disease with regard to sleep problems, mental strain at work, stress at home, negative life events and health-related quality of life (HRQOL).

    Design and subjects.  The study was conducted at a university hospital in Sweden including 231 patients aged 25–69 without any organic cause for chest pain. As a reference group, 1069 participants, were recruited from the INTERGENE population-based study.

    Results.  Patients with UCP had more sleep problems (OR = 1.8, P < 0.0001), were almost three times more worried about stress at work (OR = 2.9, P < 0.0001), or had more stress at home (OR = 2.8, P < 0.0001), and were twice as likely to have negative life events (OR = 2.1, P < 0.0001). Women, but not men, with UCP, had a higher prevalence of cardiovascular risk factors (obesity, smoking, diabetes and hypertension) compared with references. With regard to HRQOL, UCP patients scored significantly lower than references in all dimensions of the SF-36.

    Conclusions.  In comparison with a healthy reference group, patients with UCP reported more sleep problems, mental strain at work, stress at home and negative life events and had lower health-related quality of life. Aside from immigration the strongest independent psychosocial factors were mental strain at work and negative life events last year in men and stress at home in women.

  • 46.
    Journath, G.
    et al.
    Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
    Hellénius, M-L
    Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
    Manhem, K.
    Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Nilsson, P. M.
    Lund University, University Hospital, Malmö, Sweden.
    Association of physician's sex with risk factor control in treated hypertensive patients from Swedish primary healthcare2008In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 26, no 10, p. 2050-2056Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To study the association of physician's sex with blood pressure, lipid control, and cardiovascular risk factors in treated hypertensive men and women, stratified for the sex of their physician.

    METHODS:

    In a cross-sectional survey of hypertensive patients, 264 primary care physicians (PCPs), 187 men and 77 women from across Sweden, recruited 6537 treated hypertensive patients (48% men) during 2002-2005, consecutively collected from medical records and registered on a web-based form connected to a central database. Patients were included consecutively in the same order as they visited the healthcare centre.

    RESULTS:

    Hypertensive women more often reached target systolic/diastolic blood pressure levels (<140/90 mmHg) when treated by female PCPs than when they were treated by male PCPs (32 vs. 24%, P < 0.001). This difference remained when comparing female and male physicians' nondiabetic female patients. Both male and female patients had better control of total cholesterol and low-density lipoprotein cholesterol levels when treated by female PCPs than when treated by male PCPs (total cholesterol <5 mmol/l: women 30 vs. 24%, P < 0.001; men 42 vs. 34%, P < 0.001; low-density lipoprotein cholesterol <3 mmol/l: women 39 vs. 33%, P < 0.01; men 41 vs. 35%, P < 0.05). Female PCPs had a higher proportion of treated hypertensive patients with diabetes than did male PCPs but male PCPs had a higher prevalence of treated hypertensive men with microalbuminuria compared with female PCPs.

    CONCLUSION:

    Female physicians appeared more often to reach the treatment goal for blood pressure in female patients and cholesterol levels in all patients than did male physicians.

  • 47.
    Kiessling, Tina
    et al.
    Västra Götalandsregionen.
    Kjellgren, Karin
    Institutionen för Omvårdnad, Göteborgs Universitet.
    Patients' experiences of participation in care2004In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 24, p. 31-37Article in journal (Refereed)
    Abstract [en]

    Patients have a legal right to participate in their care and in the decision-making affecting their care in most Western countries. However, this is not only a matter of legal right. According to previous research, treatment outcome may be improved if patients experience greater participation. The aim of this Swedish study was to describe how patients experience their participation in the care, and factors that have an influence on their participation. A phenomenological approach was used and data was collected by interviews with eight inpatients at a surgical ward. The interviews were audio-taped and transcribed verbatim. Through analysis, meaning units were organized into themes and the essence was formulated. The experience of participation was expressed in following themes: a need of dialogue, continuity in contact with the staff and control. The essence of participation was the desire of a continuous dialogue with the caregiver, with the aim of exchanging information. Lack of time, as the patient experienced it, among the caregivers reduced the possibility to keep the dialogue. The need of control could force the patient to participate in the care situation.

  • 48.
    Kjellgren, Karin
    et al.
    Linköping University, Faculty of Health Sciences.
    Ahlner, JohanLinköping University, Department of Medicine and Care, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.Dahlgren, Lars-OveLinköping University, Department of Behavioural Sciences, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.Haglund, LenaLinköping University, Department of Neuroscience and Locomotion, Occupational Therapy. Linköping University, Faculty of Health Sciences.
    Problembaserad inlärning: Erfarenheter från Hälsouniversitetet1993Collection (editor) (Other academic)
  • 49.
    Kjellgren, Karin
    et al.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Hendry, G.
    University of Western Sydney, Australia.
    Hultberg, J
    University of Gothenburg, Sweden.
    Plos, K.
    University of Gothenburg, Sweden.
    Rydmark, M.
    University of Gothenburg, Sweden.
    Tobin, G.
    University of Gothenburg, Sweden.
    Säljö, R.
    University of Gothenburg, Sweden.
    Learning to learn and learning to teach - Introduction to studies in higher education2008In: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 30, no 8, p. e239-e245Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    How students are introduced to their studies will affect the quality of learning. This project deals with tools for lifelong learning to increase students' awareness of learning how to learn. In parallel to an introductory course for students, a course for teachers was given with a focus on tutoring students.

    AIMS:

    To evaluate an interprofessional transition course for first-year health science students, the LearnAble project, and a teachers' course aiming to support students to be successful in their learning.

    METHOD:

    The project was followed up by a computer-based course evaluation, reflective journals, the Learning Process Questionnaire and the Approaches to Teaching Inventory. The questionnaires were distributed before and after the courses. Teachers (n = 31) and students (n = 270) in two courses from different health educations participated.

    RESULTS:

    Students' approaches to the course and to learning could be described as technical/reproductive, seeking for an identity or as reflective/transformative. The evaluation indicates that a deep approach to the studies among the students was related to higher age and female gender. Teachers with earlier pedagogical education supported students more in the attempts to question their own understanding.

    CONCLUSION:

    The most obvious result was the positive impact of being a tutor for a group of students in parallel to studying pedagogy.

     

  • 50.
    Kjellgren, Karin
    et al.
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Welin, Charharina
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Danielson, Ella
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Evaluation of doctoral nursing programs - A review and a strategy for follow up2005In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 25, no 4, p. 316-325Article in journal (Refereed)
    Abstract [en]

    Enhancing and assuring the quality of doctoral nursing programs is currently of major concern to promote growth in quality and quantity of research in nursing. The aims of the paper were to review the literature about evaluation of higher education with focus on doctoral programs in nursing, and to present a strategy to evaluate a doctoral nursing program. A search of literature in relevant databases was done using the keywords doctoral program, evaluation, nursing, program evaluation and higher education. From the review it is concluded that more systematic evaluations are necessary to guide the development of quality in nursing. Attention must be given to the curricula, competence in the faculty, the research activity and to the students' involvement in courses and research. Therefore, a strategy for evaluation should be ongoing, flexible, systematic and comprehensive. It should involve students, graduates, employers and faculty members in evaluation, include process and outcome data and give possibility for comparison to internal and external standards. The strategy developed aims to facilitate ongoing and future improvement of the doctoral nursing program. This process is dependent on a methodological pluralism of evaluation to detect what is of most weight for growth in the process of research and education.

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