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  • 1.
    Fjordkvist, Erika
    et al.
    Orebro Univ, Sweden.
    Eldh, Ann Catrine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Winberg, Madeleine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Joelsson-Alm, Eva
    Karolinska Inst, Sweden.
    Halleberg Nyman, Maria
    Orebro Univ, Sweden; Univ Hlth Care Res Ctr, Sweden.
    First-line managers' experience of guideline implementation during the COVID-19 pandemic2024In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed)
    Abstract [en]

    Aim(s)To explore first-line managers' experience of guideline implementation in orthopaedic care during the COVID-19 pandemic.DesignA descriptive, qualitative study.MethodsSemi-structured interviews with 30 first-line nursing and rehabilitation managers in orthopaedic healthcare at university, regional and local hospitals. The interviews were analysed by thematic analysis.ResultsFirst-line managers described the implementation of guidelines related to the pandemic as different from everyday knowledge translation, with a swifter uptake and time freed from routine meetings in order to support staff in adoption and adherence. The urgent need to address the crisis facilitated guideline implementation, even though there were specific pandemic-related barriers such as staffing and communication issues. An overarching theme, Hanging on to guidelines for dear life, is substantiated by three themes: Adapting to facilitate change, Anchoring safety through guidelines and Embracing COVID guidelines.ConclusionA health crisis such as the COVID-19 pandemic can generate enabling elements for guideline implementation in healthcare, despite prevailing or new hindering components. The experience of guideline implementation during the COVID-19 pandemic can improve understanding of context aspects that can benefit organizations in everyday translation of evidence into practice.Implications for the Profession and/or Patient CareRecognizing what enabled guideline implementation in a health crisis can help first-line managers to identify local enabling context elements and processes. This can facilitate future guideline implementation.ImpactDuring the COVID-19 pandemic, the healthcare context and staff's motivation for guideline recognition and adoption changed. Resources and ways to bridge barriers in guideline implementation emerged, although specific challenges arose. Nursing managers can draw on experiences from the COVID-19 pandemic to support implementation of new evidence-based practices in the future.Reporting MethodThis study adheres to the EQUATOR guidelines by using Standards for Reporting Qualitative Research (SRQR). No Patient or Public Contribution.Reporting MethodThis study adheres to the EQUATOR guidelines by using Standards for Reporting Qualitative Research (SRQR). No Patient or Public Contribution.

  • 2. Order onlineBuy this publication >>
    Winberg, Madeleine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Evidensbaserad blåsövervakning vid ortopedisk vård: Patienters erfarenheter och personals följsamhet till riskbedömning vid höftkirurgi2023Licentiate thesis, comprehensive summary (Other academic)
    Abstract [sv]

    Background: Hip surgery, a common healthcare procedure in Sweden and worldwide, is like other surgical procedures associated with risks of complications, such as urinary retention. Urinary retention is prompted by several factors experienced by the orthopaedic patient, such as pain, bed rest, medication (opioids, anaesthesia) and intravenous treatment with fluids. To prevent urinary retention or other voiding complications, there are evidence-based guidelines, supporting safe clinical care and averting unnecessary care injuries. Prior studies indicate that these guidelines are neither fully known nor used by orthopaedic staff, but bladder distension is still one of the most common adverse events in Swedish orthopaedic care. This licentiate thesis represents two studies, constituted by baseline data from 17 orthopaedic units in the Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation (OPTION) trial.   

    Aim: The overall aim was to explore patients’ experiences of bladder care and voiding issues due to hip surgery and to evaluate staffs’ adherence to risk assessment for urinary retention according to evidence-based guide-lines.  

    Design and method: Study I had a descriptive design and data was analysed using inductive content analysis. Study II was an observational study analysed with descriptive and comparative statistics, and logistic regressions.  

    Findings: Patients experienced that bladder care and monitoring seemed important, although the reason was not fully explained to them, nor the related risk between hip surgery and urinary retention. Those experiencing bladder issues postoperatively managed and sought care on their own, not associating such events with their hip surgery. The bladder issues were described as negatively affecting daily life.  

    Documentation in medical records (n=1382) indicated low adherence to recommended risk assessment for urinary retention (23.4%), and performed assessment was significantly associated with acute surgery or being treated at an academic hospital. Acute patients experienced urinary retention or other bladder issues more frequently, and among those patients completing a survey (n=447), 11.9% reported increased bladder issues after surgery.  

    Conclusions: With a lack of communication with patients about bladder care, and limited adherence to risk assessment for urinary retention, further efforts to reinforce guideline implementation are needed. This should include a more patient-centred approach in the attempts to provide better, safer and more equal care. 

    List of papers
    1. Patients experiences of urinary retention and bladder care-A qualitative study in orthopaedic care
    Open this publication in new window or tab >>Patients experiences of urinary retention and bladder care-A qualitative study in orthopaedic care
    Show others...
    2023 (English)In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 50, article id 101034Article in journal (Refereed) Published
    Abstract [en]

    Background: Urinary retention is a common complication associated with hip surgery. There are easily available, evidence-based clinical practice guidelines pre-scribing how to prevent both urinary retention and other voiding issues, by means of bladder monitoring and risk assessments. A detected lack of adherence to such guidelines increases risks for unnecessary suffering among patients but a greater understanding of patients experiences can benefit tailored interventions to address quality and safety gaps in orthopaedic nursing and rehabilitation.Purpose: The aim was to describe patients experiences of urinary retention, bladder issues, and bladder care in orthopaedic care due to hip surgery.Method: This was a qualitative study with a descriptive design: content analysis with an inductive approach was applied to interviews (n = 32) and survey free-text responses (n = 122) across 17 orthopaedic units in Sweden.Results: The patients had received no or limited details for the recurrent bladder care interventions (such as bladder scans and prompted voiding) while at the hospital. They relied on the staff for safe procedures but were left to themselves to manage and comprehend prevailing bladder issues. Despite the patients ex-periences of bladder issues or the risk of urinary retention postoperatively, the link to hip surgery remained unknown to the patients, leaving them searching for self -management strategies and further care.Conclusions: Patients perspectives on bladder care, urinary retention and bladder issues can serve as a means for increased understanding of procedures and issues, reinforcing improved implementation of guidelines, including person-centred information. Safer bladder procedures imply further patient engagement, highlighted in guidelines.

    Place, publisher, year, edition, pages
    ELSEVIER SCI LTD, 2023
    National Category
    Nursing
    Identifiers
    urn:nbn:se:liu:diva-196690 (URN)10.1016/j.ijotn.2023.101034 (DOI)001037809900001 ()37437464 (PubMedID)
    Available from: 2023-08-18 Created: 2023-08-18 Last updated: 2024-05-03
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  • 3.
    Winberg, Madeleine
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Nyman, Maria Halleberg
    Orebro Univ, Sweden.
    Fjordkvist, Erika
    Orebro Univ, Sweden.
    Joelsson-Alm, Eva
    Karolinska Inst, Sweden.
    Eldh, Ann Catrine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Patients experiences of urinary retention and bladder care-A qualitative study in orthopaedic care2023In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 50, article id 101034Article in journal (Refereed)
    Abstract [en]

    Background: Urinary retention is a common complication associated with hip surgery. There are easily available, evidence-based clinical practice guidelines pre-scribing how to prevent both urinary retention and other voiding issues, by means of bladder monitoring and risk assessments. A detected lack of adherence to such guidelines increases risks for unnecessary suffering among patients but a greater understanding of patients experiences can benefit tailored interventions to address quality and safety gaps in orthopaedic nursing and rehabilitation.Purpose: The aim was to describe patients experiences of urinary retention, bladder issues, and bladder care in orthopaedic care due to hip surgery.Method: This was a qualitative study with a descriptive design: content analysis with an inductive approach was applied to interviews (n = 32) and survey free-text responses (n = 122) across 17 orthopaedic units in Sweden.Results: The patients had received no or limited details for the recurrent bladder care interventions (such as bladder scans and prompted voiding) while at the hospital. They relied on the staff for safe procedures but were left to themselves to manage and comprehend prevailing bladder issues. Despite the patients ex-periences of bladder issues or the risk of urinary retention postoperatively, the link to hip surgery remained unknown to the patients, leaving them searching for self -management strategies and further care.Conclusions: Patients perspectives on bladder care, urinary retention and bladder issues can serve as a means for increased understanding of procedures and issues, reinforcing improved implementation of guidelines, including person-centred information. Safer bladder procedures imply further patient engagement, highlighted in guidelines.

    Download full text (pdf)
    fulltext
  • 4.
    Winberg, Madeleine
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Biomedical and Clinical Sciences.
    Turesson, Christina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Biomedical and Clinical Sciences.
    Patients perspectives of collagenase injection or needle fasciotomy and rehabilitation for Dupuytren disease, including hand function and occupational performance2023In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 45, no 6, p. 986-996Article in journal (Refereed)
    Abstract [en]

    Purpose To describe patients perspectives of collagenase injection or needle fasciotomy for Dupuytren disease (DD) including hand therapy, and their view of hand function and occupational performance. Materials and methods Interviews were performed with twelve patients who had undergone non-surgical treatment and rehabilitation for DD. Data was analysed using a problem-driven content analysis using the model of Patient Evaluation Process as a theoretical framework. Results The participants previous experiences influenced their expectations of the upcoming treatment and they needed information to be prepared for treatment. Treatment and rehabilitation had a positive impact on daily life and were regarded as effective and simple with quick recovery. However, there could be remaining issues with tenderness or stiffness. The participants expressed their belief in rehabilitation and how their own efforts could contribute to an improved result. Despite concerns about future recurrence participants described increased knowledge and sense of control regarding future needs. Conclusion Undergoing a non-surgical treatment and rehabilitation process for DD was regarded as quick and easy and can meet the need for improved hand function and occupational performance. Taking responsibility for ones own rehabilitation was considered to influence the outcome positively. The theoretical framework optimally supported the exploration of participants perspective.

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