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  • 1.
    Westin, Emma
    et al.
    Linnaeus Univ, Sweden; Dept Pediat, Sweden.
    Gustafsson, Ingrid L.
    Linnaeus Univ, Sweden; Univ Coll Boras, Sweden.
    Svensson, Anders
    Linnaeus Univ, Sweden; Dept Ambulance Serv, Sweden.
    Sund-Levander, Märtha
    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 Neurosurgery.
    Elmqvist, Carina
    Linnaeus Univ, Sweden; Res, Sweden.
    Advising parents when their child has a fever: a phenomenographic analysis of nurses' perceptions when working at a telephone helpline, at primary care or at a paediatric emergency department in Sweden2024In: BMJ Open, E-ISSN 2044-6055, Vol. 14, no 1, article id e074823Article in journal (Refereed)
    Abstract [en]

    Objectives To describe nurses' perceptions of advising parents when their child has a fever.Design/method Inductive, descriptive study with a qualitative, phenomenographic approach.Participants and setting A purposive sampling was used. To be included, the 24 online interviewed nurses had to have experience advising parents of febrile children between birth and 5 years of age. They were recruited from three different parts of the healthcare system from four regions in the south of Sweden.Results The nurses described advising parents when their child has a fever as four different kinds of balancing acts: balancing between the parents' story and objective assessment, balancing between listening and teaching, balancing between self-confidence and trust in the expert, and balancing between independence and having someone by one's side.Conclusions Giving advice to parents when their child has a fever is a process where the nurse needs to listen, assess and give advice based on the situation. This requires a correct assessment that depends on the parents' story. Creating a trusting relationship is perceived as necessary for parents to assimilate the advice that is provided. What dominates are the nurses' perceptions of the inner qualities required to achieve a balance in the process, for example, the importance of experience and security in their professional role, while it is also necessary to get support from colleagues.

  • 2.
    Gustafsson, B. M.
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Department of Child and Adolescent Psychiatry in Linköping. Hogland Hosp, Sweden.
    Sund-Levander, Märtha
    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 Neurosurgery.
    Parents experiences of investigations and interventions by Child Healthcare, Child and Adolescent Psychiatry and Child and Youth Habilitation2024In: Children's health care, ISSN 0273-9615, E-ISSN 1532-6888, Vol. 53, no 1, p. 1-22Article in journal (Refereed)
    Abstract [en]

    This study examines parents experiences of support, investigation and treatment from child healthcare/psychiatry and habilitation in children with ESSENCE symptoms (neurodevelopmental symptoms). Data were collected through focus interviews, with 13 parents. A conventional qualitative analysis revealed four main categories: confidence, information, competence and collaboration, affecting parents. While waiting for an investigation parents experience anxiety, frustration, lack of information and confidence and doubts about their parenting ability, which also affects the child. The categories were interpreted using Bronfenbrenners bioecological model to illustrate the effects on the familys interaction with the context. Parents demand a greater insight and participation in the ongoing process and improved collaboration between the various professionals

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  • 3.
    Gustafsson, Berit
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Department of Child and Adolescent Psychiatry in Linköping. Hogland Hosp Eksjo, Sweden.
    Sund-Levander, Märtha
    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 Neurosurgery.
    Preschool teachers' assessments of behavioural problems, impact on daily life, and engagement in children with neurodevelopmental symptoms: A Swedish comparative, intervention study2024In: European Journal of Education, ISSN 0141-8211, E-ISSN 1465-3435Article in journal (Refereed)
    Abstract [en]

    The interprofessional, interagency model PLUSS offers education for preschool teachers on how to detect and support preschool children with neurodevelopmental symptoms. A total of 119 preschool teachers used the Strengths and Difficulties Questionnaire (SDQ) to assess behavioural problems and the Children's Engagement Questionnaire (CEQ) to evaluate engagement and social interaction in 119 preschool children, before and after their PLUSS education. After education, the preschool teachers rated fewer behavioural problems (total SDQ p < .001) and increased engagement and social interactions (CEQ p < .001). In conclusion, the PLUSS preschool teachers' education and screening with the SDQ and the CEQ facilitate assessment of behavioural problems, engagement and social interaction in preschool children. Increased understanding of neurodevelopmental symptoms seems to influence how preschool teachers manage a child's behaviour, which indirectly changes the child's engagement and social interactions for the better. The preschool teachers expressed perceived needs, especially to learn how to deal with a child's emotions and behavioural regulation, and their interactions with other children.

  • 4.
    Tingström, Pia
    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.
    Karlsson, Nadine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Faculty of Medicine and Health Sciences.
    Sund-Levander, Märtha
    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 Neurosurgery.
    The value of fever assessment in addition to the Early Detection Infection Scale (EDIS). A validation study in nursing home residents in Sweden2023In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 23, no 1, article id 585Article in journal (Refereed)
    Abstract [en]

    Background In order to improve detection of suspected infections in frail elderly there is an urgent need for development of decision support tools, that can be used in the daily work of all healthcare professionals for assessing non-specific and specific changes. The aim was to study non-specific signs and symptoms and fever temperature for early detection of ongoing infection in frail elderly, and how these correlates to provide the instrument, the Early Detection Infection Scale (EDIS), which is used to assess changes in health condition in frail elderly. Methods This was an explorative, prospective cohort study, including 45 nursing home residents, 76 to 99 years, in Sweden. Nursing assistants measured morning ear body temperature twice a week and used the EDIS to assess individual health condition daily for six months. The outcome comprised events of suspected infection, compiled from nursing and medical patient records. Factor analysis and multivariate logistic regression analysis were performed to analyse data. Results Fifteen residents were diagnosed with at least one infection during the six-month follow-up and 189 observations related to 72 events of suspected infection were recorded. The first factor analysis revealed that the components, change in cognitive and physical function, general signs and symptoms of illness, increased tenderness, change in eye expression and food intake and change in emotions explained 61% of the variance. The second factor analysis, adding temperature assessed as fever to > 1.0 degrees C from individual normal, resulted in change in physical function and food intake, confusion and signs and symptoms from respiratory and urinary tract, general signs and symptoms of illness and fever and increased tenderness, explaining 59% of the variance. In the first regression analysis, increased tenderness and change in eye expression and food intake, and in the second change in physical function and food intake, general signs and symptoms of illness and fever (> 1.0 degrees C from individual normal) and increased tenderness were significantly associated with increased risk for ongoing infection. Conclusion No items in the EDIS should be removed at present, and assessment of fever as > 1.0 degrees C from individual normal is a valuable addition. The EDIS has the potential to make it easier for first line caregivers to systematically assess changes in health condition in fragile elderly people and helps observations to be communicated in a standardised way throughout the care process. The EDIS thus contributes to ensuring that the decisions not being taken at the wrong level of care.

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  • 5.
    Geijer, Sebastian
    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, ANOPIVA US.
    Sund-Levander, Märtha
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Hjelm, Carina
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Ågren, Susanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Tidig upptäckt av allvarlig vårdrelaterad infektion – Erfarenheter från sjukvårdspersonal på kirurgisk- och intensivvårdsavdelning2023Conference paper (Other academic)
  • 6.
    Edvardsson, Maria
    et al.
    Region Östergötland, Primary Care Center, Primary Health Care Center Finspång. Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences.
    Sund-Levander, Märtha
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Milberg, Anna
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Advanced Home Care in Norrköping. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine.
    Ernerudh, Jan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Wressle, Ewa
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics. Linköping University, Department of Health, Medicine and Caring Sciences.
    Marcusson, Jan
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine.
    Grodzinsky, Ewa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences.
    Classification of ≥80-year-old individuals into healthy, moderately healthy, and frail based on different frailty scores affects the interpretation of laboratory results2022In: Asian Journal of Medical Sciences, ISSN 2467-9100, E-ISSN 2091-0576, Vol. 13, no 9, p. 63-71Article in journal (Refereed)
    Abstract [en]

    Background: Interpretation laboratory analyses are crucial when assessing the patient’s condition. Reference intervals from apparently healthy and disease-free individuals may cause problems when outcomes from elderly patients with chronic diseases and on medications are being interpreted. Elderly individuals are a heterogeneous group ranging from individuals managing their daily life independently to individuals with diseases and impairment, in need of nursing care around the clock, that is, frail; a term widely used although there is no consensus on the definition.

    Aims and Objectives: The aim of the study was to study the effect of classification of elderly into healthy, moderately healthy, and frail, based on activities of daily living (ADL) and Mini-Mental State Examination (MMSE) or frailty index (FI), on the interpretation of outcomes regarding: Albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, and gamma-glutamyltransferase (γ-GT) levels.

    Materials and Methods: Individuals ≥80 years (n=568) were classified either on ADL and MMSE or number of deficits, (FI).

    Results: Individuals classified as frail based on FI had lower mean levels for ALT, creatinine and γ-GT than individuals classified based on ADL and MMSE (P<0.05).

    Conclusion: The model to define health status to some extent affected laboratory analyte levels in ≥80 years old, classified as healthy, moderately healthy, and frail based on ADL and MMSE versus FI.

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  • 7.
    Masot, Olga
    et al.
    Univ Lleida, Spain.
    Cox, Anna
    Univ Surrey, England.
    Mold, Freda
    Univ Surrey, England.
    Sund-Levander, Märtha
    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 Neurosurgery.
    Tingström, Pia
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Christelle Boersema, Geertien
    Univ South Africa, South Africa.
    Botigue, Teresa
    Univ Lleida, Spain.
    Daltrey, Julie
    Univ Auckland, New Zealand.
    Hughes, Karen
    Univ Surrey, England.
    Mayhorn, Christopher B.
    North Carolina State Univ, NC 27695 USA.
    Montgomery, Amy
    Univ Wollongong, Australia.
    Mullan, Judy
    Univ Wollongong, Australia.
    Carey, Nicola
    Univ Highlands & Isl, Scotland.
    Decision support-tools for early detection of infection in older people (aged> 65 years): a scoping review2022In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 22, no 1, article id 552Article, review/survey (Refereed)
    Abstract [en]

    Background Infection is more frequent, and serious in people aged &gt; 65 as they experience non-specific signs and symptoms delaying diagnosis and prompt treatment. Monitoring signs and symptoms using decision support tools (DST) is one approach that could help improve early detection ensuring timely treatment and effective care. Objective To identify and analyse decision support tools available to support detection of infection in older people (&gt; 65 years). Methods A scoping review of the literature 2010-2021 following Arksey and OMalley (2005) framework and PRISMA-ScR guidelines. A search of MEDLINE, Cochrane, EMBASE, PubMed, CINAHL, Scopus and PsycINFO using terms to identify decision support tools for detection of infection in people &gt; 65 years was conducted, supplemented with manual searches. Results Seventeen papers, reporting varying stages of development of different DSTs were analysed. DSTs largely focussed on specific types of infection i.e. urine, respiratory, sepsis and were frequently hospital based (n = 9) for use by physicians. Four DSTs had been developed in nursing homes and one a care home, two of which explored detection of non- specific infection. Conclusions DSTs provide an opportunity to ensure a consistent approach to early detection of infection supporting prompt action and treatment, thus avoiding emergency hospital admissions. A lack of consideration regarding their implementation in practice means that any attempt to create an optimal validated and tested DST for infection detection will be impeded. This absence may ultimately affect the ability of the workforce to provide more effective and timely care, particularly during the current covid-19 pandemic.

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  • 8.
    Toros, Andrew
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology.
    Karlsson, Nadine
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Nilsson, Martin
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Sund-Levander, Märta
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Use of temperature changes and pro-inflammatory biomarkers to diagnose bacterial infections in patients with severe cerebral trauma2022In: Journal of Neurocritical Care, E-ISSN 2508-1349, Vol. 15, no 1, p. 21-31Article in journal (Refereed)
    Abstract [en]

    BackgroundIn patients undergoing neurosurgeries, inflammation and infection are strongly related; however, inflammation can be present without infection. Midregional proadrenomedullin (MR-proADM) is a relatively new sepsis biomarker that is rarely used clinically. Recently, the concept of DiffTemp was introduced, that is, a >1°C rise from individual normal temperature accompanied by malaise, as a more accurate definition of temperature assessed as fever. The aim of the present study was to examine the importance of C-reactive protein (CRP), white blood cells, procalcitonin, and MR-proADM levels and DiffTemp.MethodsThis prospective, comparative study had a quantitative approach. Forty-two patients, aged >18 years and presenting with severe cerebral trauma were included from a neurosurgical intensive care unit. The outcome variable was infection; group 0, no infection (n=11); group 1, suspected infection (n=15); and, group 2, confirmed infection (n=16). Group assignments were performed using biomarkers, medical records, bacterial cultures, and International Classification of Diseases-10, and by the clinical assessment of criteria for nosocomial infections by a neurosurgeon.ResultsOn comparing groups 1 and 2, MR-proADM and DiffTemp were associated with a higher risk of confirmed infection (odds ratio, 5.41 and 17.14, respectively). Additionally, DiffTemp had a 90.9% specificity in patients with no infection and a 93.8% sensitivity in patients with confirmed infections. CRP and procalcitonin levels were not associated with an increased risk of confirmed infection.ConclusionIncreased levels of MR-proADM were associated with a higher risk of confirmed infection. DiffTemp was associated with a higher risk of having a confirmed infection.

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  • 9.
    Sund-Levander, Märtha
    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 Neurosurgery.
    Tingström, Pia
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Complicated versus complexity: when an old woman and her daughter meet the health care system2020In: BMC Women's Health, E-ISSN 1472-6874, Vol. 20, no 1, article id 230Article in journal (Refereed)
    Abstract [en]

    Background Detecting infection in frail elderly is a challenge due to lack of specific signs and symptoms. We highlight the complex situation when an elderly woman with urinary tract infection (UTI) and her daughter meet the highly qualified health care system. The aim was to describe and analyze the process when an elderly individual with an acute infection encounters the healthcare system.MethodsA descriptive, retrospective Single Case Study design with a qualitative approach was used. Data from interviews with the old women and her daughter, medical record data and different regulatory documents were gathered and analysed with a qualitative content analysis. In a second step, the results were interpreted with concepts from the complexity theory. Complexity theory has been used as a conceptual framework for analysis or a framework for interpretation. In this study we are using the theory for interpretation by comparing the results with the complexity theory, which is explored in the discussion. Results The latent content analysis of the daughters story is interpreted as though she perceives the situation as causing a life crisis and a threat to her mothers entire existence. The old women herself does not take part in what is happening, though after returning to home she is trying to understand her behaviour and what has happened. The health care tries different diagnoses and treatment according to standardized care plans without success. When urinary tract infection is finally diagnosed and treated successfully, the old women recovers quickly. Conclusion The healthcare system should embrace the complexity in the encounter with an elderly individual. However, we found that the immediate reaction from the healthcare system is to handle the patients problem as complicated by complexity reduction. Shortcomings are that elderly patients with multiple disorders are difficult to evaluate and triage "correctly" for later placement in the appropriate continuum of care, although the findings of this case study also imply that with time the system instead took on an approach of absorption of complexity.

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  • 10.
    Hellqvist, Carina
    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, Neurologiska kliniken i Linköping.
    Berterö, Carina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Hagell, Peter
    The PRO‐CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden.
    Dizdar, Nil
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Neurologiska kliniken i Linköping.
    Sund-Levander, Märtha
    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 Neurosurgery.
    Effects of self-management education for persons with Parkinson's disease and their care partners: A qualitative observational study in clinical care2020In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 22, no 3, p. 741-748Article in journal (Refereed)
    Abstract [en]

    Persons with Parkinson's disease and their care partners want support from healthcare to develop the skills to handle everyday life with disease. Earlier findings indicate that participants of the self‐management program Swedish National Parkinson School experience several benefits of the program. The purpose of this qualitative observational study was to explore if participants had implemented the strategies of self‐monitoring included in the program, and use them to communicate health care status and needs in clinical encounters. Data was collected 3–15 months after participation in the program and analysed using constant comparative analysis. Three categories were evident: “Self‐observation in everyday life”, “Self‐care activities to promote health” and “Managing emotional impact of Parkinson's Disease”. Categories were linked together in a core category that highlight the use of self‐management strategies described by participants during clinical encounters. Results confirmed that persons with Parkinson's disease and care partners use the techniques of self‐observation in their everyday lives. Observations of effects in clinical care can be a valuable approach to evaluate the outcomes educational interventions and their benefits for individuals and health care.

    This article is protected by copyright. All rights reserved.

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  • 11.
    Carey, N.
    et al.
    Univ Surrey, England.
    Alkhamees, Nouf
    Princess Noura Bint Abdul Rahman Univ, Saudi Arabia.
    Cox, Anna
    Univ Surrey, England.
    Sund-Levander, Märtha
    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 Neurosurgery.
    Tingström, Pia
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Mold, Freda
    Univ Surrey, England.
    Exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes in England and Sweden: a survey protocol2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 10, article id e038390Article in journal (Refereed)
    Abstract [en]

    Introduction In order to avoid unnecessary hospital admission and associated complications, there is an urgent need to improve the early detection of infection in nursing home residents. Monitoring signs and symptoms with checklists or aids called decision support tools may help nursing home staff to detect infection in residents, particularly during the current COVID-19 pandemic. We plan to conduct a survey exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes in England and Sweden. Methods and analysis An international cross-sectional descriptive survey, using a pretested questionnaire, will be used to explore nurses, care workers and managers views and experiences of how infections are detected and managed in practice in nursing homes. Data will be analysed descriptively and univariate associations between personal and organisational factors explored. This will help identify important factors related to awareness, knowledge, attitudes, belief and skills likely to affect future implementation of a decision support tool for the early detection of infection in nursing home residents. Ethics and dissemination This study was approved using the self-certification process at the University of Surrey and Linkoping University ethics committee (Approval 2018/514-32) in 2018. Study findings will be disseminated through community/stakeholder/service user engagement events in each country, publication in academic peer-reviewed journals and conference presentations. A LAY summary will be provided to participants who indicate they would like to receive this information. This is the first stage of a plan of work to revise and evaluate the Early Detection of Infection Scale (EDIS) tool and its effect on managing infections and reducing unplanned hospital admissions in nursing home residents. Implementation of the EDIS tool may have important implications for the healthcare economy; this will be explored in cost-benefit analyses as the work progresses.

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  • 12.
    Hellqvist, Carina
    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, Neurologiska kliniken i Linköping.
    Berterö, Carina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Dizdar (Segrell), Nil
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Neurologiska kliniken i Linköping.
    Sund-Levander, Märtha
    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 Neurosurgery.
    Hagell, Peter
    Kristianstad Univ, Sweden.
    Self-Management Education for Persons with Parkinsons Disease and Their Care Partners: A Quasi-Experimental Case-Control Study in Clinical Practice2020In: Parkinson's Disease, ISSN 2090-8083, E-ISSN 2042-0080, Vol. 2020, article id 6920943Article in journal (Refereed)
    Abstract [en]

    Background. Parkinsons disease is a neurodegenerative condition with both physical and mental consequences that affect many aspects of everyday life. Persons with Parkinsons disease and their care partners want guidance from healthcare services in order to develop skills to adjust to life with a long-term condition. The Swedish National Parkinson School is a dyadic self-management programme to support both persons with Parkinsons disease and care partners. Objective. To assess the outcomes of the Swedish National Parkinson School as reported by participants. Design. A quasi-experimental case-control study in clinical care using self-reported questionnaires. Participants. Swedish National Parkinson School was offered by health care professionals working in clinical care. Participants in the programme were also asked to participate in the study. A matched control group was recruited for a comparison of findings. In total, 92 persons with Parkinsons disease and 55 care partners were included. Settings. Five Swedish geriatric and neurologic outpatient clinics. Method. Data were collected during 2015-2017, before and after participation in the National Parkinson School or before and after seven weeks of standard care. Outcomes were assessed using generic and Parkinsons specific questionnaires. Descriptive statistics were used to describe baseline characteristics. Mann-Whitney U and Chi(2) tests were used to test for between-group differences and within-group differences were tested by the Wilcoxon signed-ranks test. Results. Improvements regarding health status, constructive attitudes and approaches, and skill and technique acquisition were found after the intervention among persons with Parkinsons disease. No changes were found among care partners. Conclusion. The findings indicate that the Swedish National Parkinson School may improve health status and self-management among persons with Parkinsons disease, but further studies are needed to better understand the effects of the programme.

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  • 13.
    Edvardsson, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Finspång, Health care Center Finspång.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Milberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Advanced Home Care in Norrköping.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Division of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Sweden.
    Elevated levels of CRP and IL-8 are related to reduce survival time: 1-year follow-up measurements of different analytes in frail elderly nursing home residents2019In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 79, no 5, p. 288-292Article in journal (Refereed)
    Abstract [en]

    There are only few studies with specific focus on predictors of survival in nursing home residents (NHRs). The aim was to study whether 1-year changes in complete blood count (including hemoglobin, red blood cells, erythrocyte volume fraction, mean corpuscular volume, mean corpuscular hemoglobin concentration, white blood cells count and platelet count), C-reactive protein and interleukin-1 beta (IL-1 beta), IL-1Ra, IL-6, IL-8 and IL-10, are associated with 8-year survival in elderly NHRs, aged amp;gt;= 80 years. Complete blood count, C-reactive protein and interleukins were measured at baseline, after 6 and 12 months from 167 NHRs aged 80-101 years, mean age 88 +/- 4.5 years, 75% of whom were women. Dates of death were collected from the National Death Register 8 years after baseline. Levels of hemoglobin, red blood cells and mean corpuscular hemoglobin concentration were lower after 1-year, but higher for mean corpuscular volume and IL-1 beta, compared to baseline or 6 month follow-up. In the Cox regression model with a time-dependent covariate, raised levels of C-reactive protein and IL-8 were associated with reduced survival time. Elevated levels of C-reactive protein and IL-8 during 1-year follow-up were related to reduce lengths of survival in elderly NHRs.

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  • 14.
    Kidd, Tara
    et al.
    Liverpool John Moores Univ, England.
    Mold, Freda
    Univ Surrey, England.
    Jones, Claire
    Univ Surrey, England.
    Ream, Emma
    Univ Surrey, England.
    Grosvenor, Wendy
    Univ Surrey, England.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Carey, Nicola
    Univ Surrey, England.
    What are the most effective interventions to improve physical performance in pre-frail and frail adults? A systematic review of randomised control trials2019In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, article id 184Article, review/survey (Refereed)
    Abstract [en]

    BackgroundWith life expectancy continuing to rise in the United Kingdom there is an increasing public health focus on the maintenance of physical independence among all older adults. Identifying interventions that improve physical outcomes in pre-frail and frail older adults is imperative.MethodsA systematic review of the literature 2000 to 2017 following PRISMA guidelines and registered with PROSPERO (no. CRD42016045325).ResultsTen RCT trials fulfilled selection criteria and quality appraisal. The study quality was moderate to good. Interventions included physical activity; nutrition, physical activity combined with nutrition. Interventions that incorporated one or more physical activity components significantly improved physical outcomes in pre-frail and/or frail older adults.ConclusionsPhysical activity interventions are key to maintaining independence in pre-frail and frail older adults. A lack of consensus regarding the definition of frailty, and an absence of core measures to assess this means any attempt to create an optimal intervention will be impeded. This absence may ultimately impact on the ability of older and frail adults to live well and for longer in the community.

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  • 15.
    Edvardsson, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Finspång, Health care Center Finspång.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Milberg, Anna
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Center of Palliative Care.
    Wressle, Ewa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Marcusson, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Division of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Sweden.
    Differences in levels of albumin, ALT, AST, gamma-GT and creatinine in frail, moderately healthy and healthy elderly individuals2018In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 56, no 3, p. 471-478Article in journal (Refereed)
    Abstract [en]

    Background: Reference intervals are widely used as decision tools, providing the physician with information about whether the analyte values indicate ongoing disease process. Reference intervals are generally based on individuals without diagnosed diseases or use of medication, which often excludes elderly. The aim of the study was to assess levels of albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine and gamma-glutamyl transferase (gamma-GT) in frail, moderately healthy and healthy elderly indivuduals. Methods: Blood samples were collected from individuals amp;gt; 80 years old, nursing home residents, in the Elderly in Linkoping Screening Assessment and Nordic Reference Interval Project, a total of 569 individuals. They were divided into three cohorts: frail, moderately healthy and healthy, depending on cognitive and physical function. Albumin, ALT, AST, creatinine and gamma-GT were analyzed using routine methods. Results: Linear regression predicted factors for 34% of the variance in albumin were activities of daily living (ADL), gender, stroke and cancer. ADLs, gender and weight explained 15% of changes in ALT. For AST levels, ADLs, cancer and analgesics explained 5% of changes. Kidney disease, gender, Mini Mental State Examination (MMSE) and chronic obstructive pulmonary disease explained 25% of the variation in creatinine levels and MMSE explained three per cent of gamma-GT variation. Conclusions: Because a group of people are at the same age, they should not be assessed the same way. To interpret results of laboratory tests in elderly is a complex task, where reference intervals are one part, but far from the only one, to take into consideration.

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  • 16.
    Sund Levander, Märta Helena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Fever or not fever - that's the question: A cohort study of simultaneously measured rectal and ear temperatures in febrile patients with suspected infection2018In: Clinical Nursing Studies, ISSN 2324-7940, E-ISSN 2324-7959, Vol. 6, no 2, p. 47-54Article in journal (Refereed)
    Abstract [en]

    Objective: To study how ear and rectal body temperatures relate to each other over time in febrile patients.

    Methods: Descriptive cohort study with repeated measurements. The setting was a Unit for Infectious Diseases at a county hospital in Sweden. Patients, ≥ 18 years, admitted for suspected infection and with a rectal or ear temperature of ≥ 37.5°C were invited. 16 females and 24 men, 19 to 94 years were included. Ear and rectal temperature was measured simultaneously every two hours for one day.

    Results: Mean rectal temperature was higher, compared to both ear sites. Ninety-five percent of the differences between the rectal and ear sites were within 0.6°C to 1.1°C. Changes in rectal temperature were smaller and slower than in ear temperature, especially when patients were given temperature-lowering drugs.

    Conclusions: Adjustments from one temperature site to another is a risk of diagnostic error affecting clinical decision-making. Ear temperature reacts faster than the rectal site to body temperature changes and antipyretics, and is therefore more reliable in the assessment of the patient’s condition. Traditional paradigm for temperature measurement and assessment needs to be replaced with evidence-based science to improve patient safety.

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  • 17.
    Hellqvist, Carina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    Dizdar Segrell, Nil
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    Hagell, Peter
    Kristianstad Univ, Sweden.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Improving self-management for persons with Parkinsons disease through education focusing on management of daily life: Patients and relatives experience of the Swedish National Parkinson School2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 19-20, p. 3719-3728Article in journal (Refereed)
    Abstract [en]

    Aims and objectiveTo identify and describe experiences valuable formanaging daily life after participation in the NPS self-management intervention. The second part was to explore the applicability of the Self- and family management framework by Grey and colleagues for persons with Parkinsons Disease and their relatives. BackgroundThe impact of PD is evident on the lives of both patients and relatives. The National Parkinson School (NPS) is a Swedish self-management programme designed for patients and relatives, aiming at teaching strategies helpful for the ability of self-management, in order to promote life satisfaction. DesignQualitative explorative with inductive and deductive analysis. MethodsFive group discussions with NPS participants were audio-recorded. Verbatim transcriptions were analysed inductively with thematic analysis according to Braun and Clarke, and the findings were then applied deductively to the existing model for patients with chronic disease. ResultsThrough the first step of inductive analysis, three themes capturing the meaning, value and experience of being a participant at the NPS were identified: exchanging experiences and feeling support, adjustment and acceptance of PD for managing daily life and promoting life satisfaction. The deductive analysis applied the inductive findings to the Self- and family management framework of chronically ill to explore the fit to persons with PD and relatives attending the NPS programme. ConclusionsThe NPS programme is a promising approach for helping persons with PD and their relatives to achieve better self-management of disease and improved life satisfaction. Further evaluations of programme outcomes in clinical practice are warranted. Relevance of clinical practiceSelf-management programmes like the NPS is a promising approach in facilitating a positive mindset and outlook on life and gain knowledge to understand, adapt and handle chronic disease, such as PD, better.

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  • 18.
    Westin, Emma
    et al.
    Växjö Cent Hosp, Sweden.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Parents Experiences of Their Children Suffering Febrile Seizures2018In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 38, p. 68-73Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore parents experiences of their child suffering febrile seizures. Design and Method: Seven mothers and four fathers with experience of one or several febrile seizures in their children were interviewed. A qualitative content analysis with an inductive approach was performed. Result: Five themes emerged; emotional experiences, in terms of anxiety and fear, and need for control, need for support, need for acknowledgement and need for comfort. Professional assurance and support from healthcare staff was considered important to help parents handle the situation. Conclusion: Febrile seizure caused anxiety due to parents lack of comprehension about the event and how to act during the seizure. Practice Implications: The pediatric nurse plays an important role in gaining the trust of and supporting parents whose children have suffered febrile seizures. They can alleviate concerns that arise, and also generate assured and well informed parents, who are better prepared to deal with recurrent febrile seizures. (c) 2017 Elsevier Inc. All rights reserved.

  • 19.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. National Board Forens Med, Linkoping, Sweden.
    Variation in Normal Ear Temperature2017In: The American journal of surgery, ISSN 0002-9629, E-ISSN 1538-2990, Vol. 354, no 4, p. 370-378Article in journal (Refereed)
    Abstract [en]

    Background: Variation in baseline ear temperature, taken in the unadjusted mode, has yet to be established in different age groups. Because normal body temperatures show large variations, the same may be expected for increased temperatures in fever. The aims were to study variations in normothermic body temperatures measured with an ear thermometer and to determine differences between actual and perceived body temperature during a febrile episode (referred to as difftemp) in apparently healthy children and adults. Methods: Ear temperature was measured once in 2,006 individuals (61.7% females): 683 children aged 2 and 4 years, 492 adolescents aged 10-18 years, 685 adults aged 19-65 years and 146 elderly aged 66-89 years. Difftemp was estimated as the difference between the individuals ear body temperature, measured in the present study, and the respondents reported temperature when feverish. Results: Mean ear temperature was 36.4 +/- 0.6 degrees C overall and in the child and adult groups. In adolescents, it was 36.5 +/- 0.5 degrees C, and in elderly, 36.1 +/- 0.5 degrees C. Temperature in men was 36.3 +/- 0.6 degrees C, and in women, 36.5 +/- 0.5 degrees C. Difftemp was 1.1 +/- 0.7 degrees C in adolescents, 1.5 +/- 0.7 degrees C in children and adults, and 1.6 +/- 0.7 degrees C in those amp;gt; 65 years. Conclusions: Ear body temperature is lower than traditionally reported and differs with age and sex. An individual difftemp of 1.0-1.5 degrees C along with malaise might indicate fever.

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  • 20.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Milberg, Anna
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Center of Palliative Care. Region Östergötland, Local Health Care Services in East Östergötland, Department of Advanced Home Care in Norrköping.
    Rodhe, Nils
    Uppsala University, Sweden.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Differences in predictors of 5-year survival over a 10-year period in two cohorts of elderly nursing home residents in Sweden2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 4, p. 714-720Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to compare 5-year survival in two included cohorts (from year 2000 and year 2007) of 249 nursing home residents (NHR) in this retrospective, comparative study. Methods: The cohorts were compared regarding chronic diseases, medication, physical/cognitive/nutritional status, body mass index, body temperature and 5-year mortality. Factors correlated with 5-year survival were determined using Cox regression analysis. Results: In average, cohort 2007 survived 31 +/- 16 months and cohort 2000, 38 +/- 13 months, p amp;lt; 0.001. Dementia, ageing and circulatory failure were more common as cause of death 2007, while stroke, chronic obstructive pulmonary disease (COPD) and pneumonia were less common, compared with 2000. NHR belonging to cohort 2007 were significantly older when admitted to nursing homes (NH), more dependent in activities of daily living (ADL), had dementia, stroke, autoimmune disease and treatment with antidepressants, while malnutrition and treatment with paracetamol were more common 2000. In 2000, medication with antidepressants, the presence of stroke and diabetes, irrespective of gender, and in women cardiovascular disease, two to threefold significantly increased survival, while autoimmune disease, influenza vaccination and dependency in ADL decreased survival. In 2007, maintaining BMI, irrespective of gender, and autoimmune disease and COPD in women significantly increased survival, while malnutrition, influenza vaccination, dependency in ADL and medication with sedatives/tranquillisers or paracetamol severely reduced survival. Conclusions: The present results indicate a trend that individuals are older and frailer when admitted to NH and that survival time after admission has been shortened. Hence, the need of daily support and care has increased, irrespective of housing. Also, predictors of survival, possible to influence, have changed.

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  • 21.
    Vackerberg, Nicoline
    et al.
    Jonköping University, Sweden.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Thor, Johan
    Jonköping University, Sweden.
    What Is Best for Esther? Building Improvement Coaching Capacity With and for Users in Health and Social Care-A Case Study2016In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 25, no 1, p. 53-60Article in journal (Refereed)
    Abstract [en]

    While coaching and customer involvement can enhance the improvement of health and social care, many organizations struggle to develop their improvement capability; it is unclear how best to accomplish this. We examined one attempt at training improvement coaches. The program, set in the Esther Network for integrated care in rural Jonkoping County, Sweden, included eight 1-day sessions spanning 7 months in 2011. A senior citizen joined the faculty in all training sessions. Aiming to discern which elements in the program were essential for assuming the role of improvement coach, we used a case-study design with a qualitative approach. Our focus group interviews included 17 informants: 11 coaches, 3 faculty members, and 3 senior citizens. We performed manifest content analysis of the interview data. Creating will, ideas, execution, and sustainability emerged as crucial elements. These elements were promoted by customer focusembodied by the senior citizen trainershared values and a solution-focused approach, by the supportive coach network and by participants expanded systems understanding. These elements emerged as more important than specific improvement tools and are worth considering also elsewhere when seeking to develop improvement capability in health and social care organizations.

  • 22.
    Grodzinsky, Ewa
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Assessment of Fever: Physiology, Immunology and Measurement in Clinical Practice2015 (ed. 1)Book (Other academic)
    Abstract [en]

    When we say that someone has a fever, what do we really mean? Most people only take their temperature when they have a fever, and with good reason: fever is part of a larger response in the body.

    Assessment of Fever, a problem-based learning (PBL) textbook, uses inter-professional discussions of scenarios from clinical practice to examine the question of body temperature. The authors start by examining the historical perspective and go on to consider technical measurement accuracy and thermoregulation from a physiological and immunological perspective. They address evaluations of body temperature and inflammatory activity in various conditions. They end by discussing how evidence-based knowledge can inform clinical practice, looking at different scenarios in the shape of case histories and realistic situations from clinical practice. These clinical scenarios are pertinent both in an inter-professional perspective in clinical practice and in the advanced education of health-care professionals, research scientists, and technicians. Each chapter concludes with a number of reflections and additional questions that the reader will be able to answer using the material presented in the book.

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  • 23.
    Edvardsson, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Finspång, Primary Health Care in Finspång.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine. Linköping University, Faculty of Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Grodzinsky, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Rättsmedicinalverket, Linköping, Sweden.
    Clinical use of conventional reference intervals in the frail elderly2015In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, no 2, p. 229-235Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives

    Reference intervals provided by the laboratory are commonly established by measuring samples from apparently healthy subjects in the ages 18–65 years, excluding elderly individuals with chronic diseases and medication. The aim of our study was to establish whether current reference intervals for immune parameters and chemical biomarkers are valid for older individuals including those with chronic diseases, so-called frail elderly.

    Methods

    Data from our cohort of 138 non-infected nursing home residents (NHR), mean age 86.8 years, range 80–98, were compared with raw data, as basis for the development of reference intervals, obtained from reference populations, like blood donors (IgA, IgG, IgM, C3 and C4) and from the Nordic Reference Interval Project (NORIP) (alanine aminotransferase, albumin, aspartate aminotransferase, creatinine, gamma-glutamyl transferase, lactate dehydrogenase, phosphate, sodium and urea). Immune parameters were measured by nephelometry and in NORIP the measurements were performed by means of different routine methods, in more than 100 laboratories.

    Results

    Only nine individuals (7%) of NHR were found to be free from chronic disease. C3, C4 (P < 0.001) and IgG levels (P < 0.05) were higher, while IgM levels (P < 0.001) were lower in NHR compared with reference blood donors. Levels of alanine aminotransferase, phosphate (P < 0.001), albumin (P < 0.05) and sodium (P < 0.01) were lower while creatinine and urea levels were higher (P < 0.001) in NHR compared with NORIP subjects.

    Conclusion

    Comparing laboratory results from elderly people with conventional reference intervals can be misleading or even dangerous, as normal conditions may appear pathological, or vice versa and thus lead to unnecessary or even harmful treatment.

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  • 24.
    Veronese, N.
    et al.
    Department of Medicine - DIMED, Geriatrics section, University of Padova, Padova, Italy.
    Cereda, E.
    Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
    Solmi, M
    Department of Neurosciences, University of Padova, Padova, Italy.
    Fowler, S.A.
    Becker Medical Library, Washington University, St Louis, MO, USA.
    Manzato, E
    Department of Medicine - DIMED, Geriatrics section, University of Padova, Padova, Italy; National Research Council, Institute of Neuroscience, Padova, Italy.
    Maggi, S
    National Research Council, Institute of Neuroscience, Padova, Italy.
    Manu, P
    The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA; Hofstra North Shore LIJ School of Medicine, Hemstead, New York, USA; The Feinstein Institute for Medical Research, Manhasset, New York, USA; Albert Einstein College of Medicine, Bronx, New York, USA.
    Abe, E
    Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan.
    Hayashi, K
    Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan.
    Allard, J.P.
    Toronto General Hospital, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada.
    Arendt, B.M.
    Toronto General Hospital, University Health Network, Toronto, Canada.
    Beck, A
    Research Unit for Nutrition (EFFECT), Herlev University Hospital, Herlev, Denmark.
    Chan, M
    Department of Geriatric Medicine, Tan Tock Seng Hospital, Jalan, Tan Tock Seng, Singapore.
    Audrey, Y.J.P.
    Department of Geriatric Medicine, Tan Tock Seng Hospital, Jalan, Tan Tock Seng, Singapore.
    Lin, W-Y
    Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
    Hsu, H-S
    Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
    Lin, C-C
    Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
    Diekmann, R
    Institute for Biomedicine of Aging, Friedrich-Alexander Universität Erlangen-Nurnberg, Nurnberg, Germany.
    Kimyagarov, S
    The Gilad Geriatric Center, Ramat-Gan, Israel.
    Miller, M
    Nutrition and Dietetics, Flinders University, Adelaide, Australia.
    Cameron, I.D.
    Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia.
    Pitkälä, K.H.
    Unit of Primary Health Care, Department of General Practice, Helsinki University Central Hospital, Helsinki, Finland.
    Lee, J
    The S.H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
    Woo, J
    The S.H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
    Nakamura, K
    Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
    Smiley, D
    Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
    Umpierrez, G
    Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
    Rondanelli, M
    Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, University of Pavia, Pavia, Italy.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Valentini, L
    Section of Dietetics, Department of Agriculture and Food Sciences, University of Applied Sciences, Neubrandenburg, Germany.
    Schindler, K
    Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Italy.
    Törmä, J
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Volpato, S
    Department of Medical Sciences, University of Ferrara, Ferrar, Italy.
    Zuliani, G
    Department of Medical Sciences, University of Ferrara, Ferrar, Italy.
    Wong, M
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
    Lok, K
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
    Kane, J.M.
    The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA; Hofstra North Shore LIJ School of Medicine, Hemstead, New York, USA; The Feinstein Institute for Medical Research, Manhasset, New York, USA; Albert Einstein College of Medicine, Bronx, New York, USA.
    Sergi, G
    Department of Medicine - DIMED, Geriatrics section, University of Padova, Padova, Italy.
    Correll, C.U.
    The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA; Hofstra North Shore LIJ School of Medicine, Hemstead, New York, USA; The Feinstein Institute for Medical Research, Manhasset, New York, USA; Albert Einstein College of Medicine, Bronx, New York, USA.
    Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects2015In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 16, no 11, p. 1001-1015Article, review/survey (Refereed)
    Abstract [en]

    Body mass index (BMI) and mortality in old adults from the general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (<18.5, 18.5–24.9, 25–29.9, ≥30 kg/m2), the most adjusted hazard ratios (HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow-up were meta-analysed. Compared with normal weight, all-cause mortality HRs were 1.41 (95% CI = 1.26–1.58) for underweight, 0.85 (95% CI = 0.73–0.99) for overweight and 0.74 (95% CI = 0.57–0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections (HR = 1.65 [95% CI = 1.13–2.40]). RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than in normal-weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting.

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  • 25.
    Allemann, Hanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Sund-Levander, Märta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Nurses' actions in response to nursing assistants' observations of signs and symptoms of infections among nursing home residents2015In: Nursing Open, ISSN 2054-1058, Vol. 2, no 3, p. 97-104Article in journal (Refereed)
    Abstract [en]

    Aims

    To describe what nurses do during episodes of suspected infection in elderly nursing home residents and if these actions are linked to who is initiating an episode and whether the episode is considered an infection or not.

    Design

    Prospective descriptive study. Data were collected in 2008–2010.

    Methods

    Summarized and categorized documentation by nursing assistants and nurses was used for summative content analysis.

    Results

    Nurses' actions seem to be related to who initiated the episode and if the episodes are categorized as ‘non-infection’, ‘possible infection’ or ‘infection’. Actions could be ‘observation’, ‘screenings’, ‘engaged in waiting’, ‘follow-ups’, ‘nurse-prescribed actions’, ‘diagnosing’, ‘contacting the physician’, ‘carrying out an action prescribed by the physician’, ‘contacting an ambulance or arranging an emergency visit to the hospital’ and ‘prescribing screening’. As NAs often initiate episodes of suspected infection by observing changed conditions, it seems important to include the NA in the decision-making process as these observations could detect possible early signs and symptoms of infections.

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  • 26.
    Tingström, Pia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Milberg, Anna
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Advanced Home Care in Norrköping. Region Östergötland, Local Health Care Services in East Östergötland, Center of Palliative Care.
    Rodhe, N.
    Uppsala University, Sweden.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Nursing assistants: "He seems to be ill" - a reason for nurses to take action: validation of the Early Detection Scale of Infection (EDIS)2015In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, no 122Article in journal (Refereed)
    Abstract [en]

    Background: Signs and symptoms of infection in frail elderly are atypical, causing delay in diagnosis and treatment. To improve communication between healthcare staff of signs and symptoms of infection we developed an instrument, using qualitative data from observations by nursing assistants when they suspected infection. The aim of this study was to assess the validity of nursing assistants observations by developing and testing the instrument for early detection of infection in elderly nursing home residents. Methods: The early detection of infection (EDIS) instrument was based on data from focus interviews with nursing assistants. Over one year the nursing assistants used EDIS to document episodes of suspected early signs and symptoms of infection in 204 nursing home residents. Two physicians classified documented episodes as "no infection", "possible infection", and "infection". The content validity of the 13 items of the EDIS was established to explore the relationships between the items. The construct validity was used to explore the relationship between the items and the presence or absence of infection. The predictive value of the developed model was evaluated by the percentage of correct classifications of the observed cases. Generalized linear model (ordinal multinomial distribution and logit link) was used. Results: Of the 388 events of suspected infection, 20 % were assessed as no infection, 31 % as possible infection and 49 % as infection. Content validity analysis showed that 12/13 of the items correlated significantly with at least one other statement. The range in number of significant inter-correlations was from 0 ("pain") to 8 ("general signs and symptoms of illness"). The construct validity showed that the items "temperature", "respiratory symptoms" and "general signs and symptoms of illness" were significantly related to "infection", and these were also selected in the model-building. These items predicted correct alternative responses in 61 % of the cases. Conclusion: The validation of EDIS suggests that the observation of "general signs and symptoms of illness", made by nursing assistants should be taken seriously in detecting early infection in frail elderly. Also, the statement "He/She is not as usual" should lead to follow-up.

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  • 27.
    Sund-Levander, Märta
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    The Challenge of Infections in Frail Elderly: The Story of Mr. Nilsson2015In: Clinical Medical Reviews and Case Reports, ISSN 2378-3656, Vol. 2, no 9Article in journal (Refereed)
    Abstract [en]

    Signs and symptoms of infection in Nursing Home Residents (NHR) are often atypical with a lack of specific ones, causing a delay in diagnosis and treatment. The complexity of detecting infections in NHR can be explained by difficulties in understanding and interpreting non-specific signs and symptoms and co-existing chronic diseases that blur the clinical picture. The case of Mr. Nilsson illustrates the process from the first signs and symptoms of infection to diagnosis in an elderly person with severe cognitive decline and physical impairment. What we can learn from this case is to reflect on changed behavior from habitual status and/or non-specific symptoms as possible suspected infection, and to consider a rise from individual baseline temperature, so called DiffTemp™, instead of traditional decided cut-off values for fever.

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  • 28.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Jönköping County Council, Sweden.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Assessment of body temperature measurement options2013In: British Journal of Nursing, ISSN 0966-0461, E-ISSN 2052-2819, Vol. 22, no 16, p. 942-950Article in journal (Refereed)
    Abstract [en]

    Assessment of body temperature is important for decisions in nursing care, medical diagnosis, treatment and the need of laboratory tests. The definition of normal body temperature as 37°C was established in the middle of the 19th century. Since then the technical design and the accuracy of thermometers has been much improved. Knowledge of physical influence on the individual body temperature, such as thermoregulation and hormones, are still not taken into consideration in body temperature assessment. It is time for a change; the unadjusted mode should be used, without adjusting to another site and the same site of measurement should be used as far as possible. Peripheral sites, such as the axillary and the forehead site, are not recommended as an assessment of core body temperature in adults. Frail elderly individuals might have a low normal body temperature and therefore be at risk of being assessed as non-febrile. As the ear site is close to the hypothalamus and quickly responds to changes in the set point temperature, it is a preferable and recommendable site for measurement of body temperature.

  • 29.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. FoU-enheten, Höglandssjukhuset, Eksjö, Sweden.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Clinical decision-making process for early nonspecific signs of infection in institutionalised elderly persons: experience of nursing assistants2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 1, p. 27-35Article in journal (Refereed)
    Abstract [en]

    Aim: To illuminate nursing assistants experiences of the clinical decision-making process when they suspect that a resident has an infection and how their process relates to other professions.

    Background: The assessment of possible infection in elderly individuals is difficult and contributes to a delayed diagnosis and treatment, worsening the goal of good care. Recently we explored that nursing assistants have a keen observational ability to detect early signs and symptoms that might help to confirm suspected infections early on. To our knowledge there are no published papers exploring how nursing assistants take part in the clinical decision-making process.

    Design: Explorative, qualitative study.

    Setting: Community care for elderly people.

    Participants: Twenty-one nursing assistants, 2261years.

    Methods: Focus groups with verbatim transcription. The interviews were subjected to qualitative content analysis for manifest and latent content with no preconceived categories.

    Findings: The findings are described as a decision-making model consisting of assessing why a resident feels unwell, divided into recognition and formulation and strategies for gathering and evaluating information, influenced by personal experiences and preconceptions and external support system and, secondly, as taking action, consisting of reason for choice of action and action, influenced by feedback from the nurse and physician.

    Conclusion: Nursing assistants assessment is based on knowing the resident, personal experiences and ideas about ageing. Nurses and physicians response to the nursing assistants observations had a great impact on the latters further action. A true inter-professional partnership in the clinical decision-making process would enhance the possibility to detect suspected infection early on, and thereby minimize the risk of delayed diagnosis and treatment and hence unnecessary suffering for the individual.

    Relevance to clinical practice: In order to improve the clinical evaluation of the individual, and thereby optimise patient safety, it is important to involve nursing assistants in the decision-making process.

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  • 30.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Genauigkeit beim Fiebermessen. Was ist normale Körpertemperatur?2013In: CNE.fortbildung. Certified Nursing Education, Vol. 3, p. 8-11Article in journal (Refereed)
  • 31.
    Johansson, Rose-Marie
    et al.
    Jönköping University, Sweden.
    Malmvall, Bo-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Andersson-Gäre, Boel
    Futurum – The Academy of Healthcare, County Council, Jönköping and Jönköping University, Sweden.
    Larsson, Bruno
    County Hospital Ryhov, Jönköping, Sweden.
    Erlandsson, Ingrid
    County Hospital Ryhov, Jönköping, Sweden.
    Sund-Levander, Märta
    Höglandssjukhuset, Eksjö, Sweden.
    Rensfelt, Gunhild
    County Hospital Ryhov, Jönköping, Sweden.
    Mölstad, Sigvard
    Futurum, Sweden .
    Christensson, Lennart
    Jönköping University, Sweden.
    Guidelines for preventing urinary retention and bladder damage during hospital care2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 3-4, p. 347-355Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES:

    To develop evidence-based guidelines for adult patients in order to prevent urinary retention and to minimise bladder damage and urinary tract infection.

    BACKGROUND:

    Urinary retention causing bladder damage is a well known complication in patients during hospital care. The most common treatment for urinary retention is an indwelling urinary catheter, which causes 80% of hospital-acquired urinary tract infections. Appropriate use of bladder ultrasonography can reduce the rate of bladder damage as well as the need to use an indwelling urinary catheter. It can also lead to a decrease in the rate of urinary tract infections, a lower risk of spread of multiresistant Gram-negative bacteria, and lower hospital costs.

    DESIGN:

    An expert group was established, and a literature review was performed.

    METHODS:

    On the basis of literature findings and consensus in the expert group, guidelines for clinical situations were constructed.

    RESULTS:

    The main points of the guidelines are the following: identification of risk factors for urinary retention, managing patients at risk of urinary retention, strategies for patients with urinary retention and patient documentation and information.

    CONCLUSION:

    Using literature review and consensus technique based on a multiprofessional group of experts, evidence-based guidelines have been developed. Although consensus was reached, there are parts of the guidelines where the knowledge is weak.

    RELEVANCE TO CLINICAL PRACTICE:

    These guidelines are designed to be easy to use in clinical work and could be an important step towards minimising bladder damage and hospital-acquired urinary tract infections and their serious consequences, such as bacteraemia and the spread of multidrug-resistant bacteria in hospitals.

  • 32.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Hitzfe- und Kälteempfindlichkeit. Körpertemperatur bei älteren Menschen2013In: CNE.fortbildung. Certified Nursing Education, Vol. 3, p. 12-16Article in journal (Refereed)
  • 33.
    Sund-Levander, Märtha
    et al.
    Högland Hospital, Eksjö, Sweden.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Accuracy when assessing and evaluating body temperature in clinical practice: Time for a change2012Conference paper (Other academic)
  • 34.
    Sund-Levander, Märtha
    et al.
    Högland Hospital, Eksjö, Sweden.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Accuracy when assessing and evaluating body temperature in clinical practice: Time for a change2012In: Thermology International, ISSN 1560-604X, Vol. 22 Appendix 1, no 3, p. 25-32Article, review/survey (Other academic)
  • 35.
    Sund-Levander, Märtha
    Futurum/Akademin för hälsa och vård, Landstinget i Jönköpings län.
    Feber eller inte feber - det är frågan2012Conference paper (Other academic)
  • 36.
    Sund-Levander, Märtha
    Futurum/Akademin för hälsa och vård, Landstinget i Jönköpings län.
    Infektioner hos multisjuka äldre - varför missar vi dem?2012Conference paper (Other academic)
  • 37.
    Sund-Levander, Märtha
    et al.
    FoU enheten, Höglandssjukhuset, Eksjö.
    Areskoug-Josefsson, Kristina
    Värnamo sjukhus.
    Josephson, Iréne
    Länssjukhuset Ryhov, Jönköping.
    Öberg, Ulrika
    Länssjukhuset Ryhov, Jönköping.
    Kammerlind, Ann-Sofi
    Länssjukhuset Ryhov, Jönköping.
    Hinder och möjligheter för evidensbaserad vård inom Landstinget i Jönköpings län - en enkätstudie2011Report (Other academic)
  • 38.
    Sund-Levander, Märtha
    et al.
    Futurum/Akademin för hälsa och vård, Landstinget i Jönköpings län.
    Areskoug-Josefsson, Kristina
    Värnamo sjukhus.
    Josephson, Iréne
    Länssjukhuset Ryhov, Jönköping.
    Öberg, Ulrika
    Länssjukhuset Ryhov, Jönköping.
    Kammerlind, Ann-Sofi
    Länssjukhuset Ryhov, Jönköping.
    Hinder och möjligheter för evidensbaserad vård inom Landstinget i Jönköpings län. En enkätstudie2011Conference paper (Other academic)
  • 39.
    Sund-Levander, Märtha
    FoU-enheten, Höglandssjukhuset, Eksjö, Sweden.
    Time for a change to assess and evaluate body temperature in clinical practice2011Conference paper (Other academic)
  • 40.
    Sund-Levander, Märtha
    FoU-enheten, Höglandssjukhuset, Eksjö, Sweden.
    Time for a change to assess and evaluate body temperature in clinical practice - Part I2011Conference paper (Other academic)
  • 41.
    Sund-Levander, Märtha
    FoU-enheten, Höglandssjukhuset, Eksjö, Sweden.
    Time for a change to assess and evaluate body temperature in clinical practice Part II: Implications for clinical practice2011Conference paper (Other academic)
  • 42.
    Sund-Levander, Märtha
    et al.
    Futurum/Akademin för hälsa och vård, Landstinget i Jönköpings län.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Clinical decision making process of early nonspecific signs of infection in institutionalized elderly persons: experience of nursing assistants2010Conference paper (Other academic)
  • 43.
    Sund-Levander, Märtha
    et al.
    FoU-enheten, Höglandssjukhuset, Eksjö, Sweden.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Clinical decision-making process for early nonspecific signs of infection in institutionalised elderly persons: experience of nursing assistants2010Conference paper (Other academic)
  • 44.
    Tingström, Pia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Sund-Levander, Märtha
    Futurum/Akademin för hälsa och vård, Landstinget i Jönköpings län.
    Signs and symptoms of infection in nursing-home residents: perceptions of nursing assistants2010Conference paper (Other academic)
  • 45. Edvardsson, M
    et al.
    Sund-Levander, Märtha
    Futurum/Akademin för hälsa och vård, Landstinget i Jönköpings län.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    The number of erythrocytes and their middle cells2010Conference paper (Other academic)
  • 46.
    Sund-Levander, Märtha
    et al.
    Futurum/Akademin för hälsa och vård, Landstinget i Jönköpings län.
    Grodzinsky, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Edvardsson, M
    The use of blood composition parameters to detect infection in elderly residentszinsky: A challenge2010Conference paper (Other academic)
  • 47.
    Sund-Levander, Märtha
    et al.
    Höglandssjukhuset, Eksjö, Sweden.
    Grodzinsky, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    What is the evidence base for the assessment and evaluation of body temperature?2010In: Nursing Times, ISSN 0029-6589, Vol. 106, no 1, p. 10-13Article in journal (Refereed)
    Abstract [en]

    Measurement and management of body temperature is often based on traditionand personal ideas and beliefs rather than evidence based knowledge. This article summarises the literature to provide a guide to evidence based assessment and evaluation of body temperature in clinical practice.

  • 48.
    Tingström, Pia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Milberg, Anna
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Advanced Home Care in Linköping.
    Sund-Levander, Märtha
    Högland Hospital Eksjö, Sweden.
    Early nonspecific signs and symptoms of infection in institutionalized elderly persons:: perceptions of nursing assistants2009Conference paper (Other academic)
  • 49.
    Sund-Levander, Märtha
    Höglandssjukhuset, Eksjö.
    Kroppstemperatur2009In: Omvårdnadens grunder. Hälsa och ohälsa / [ed] Edberg AK & Wijk H, Lund: Studentlitteratur, 2009Chapter in book (Other academic)
  • 50.
    Sund-Levander, Märtha
    et al.
    FoU-enheten, Höglandssjukhuset, Eksjö, Sweden.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Time for a change to assess and evaluate body temperature in clinical practice2009In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 15, no 4, p. 241-249Article, review/survey (Other academic)
    Abstract [en]

    The definition of normal body temperature as 37°C still is considered the norm worldwide, but in practice there is a widespread confusion of the evaluation of body temperature, especially in elderly individuals. In this paper, we discuss the relevance of normal body temperature as 37°C and consequences in clinical practice. Our conclusion is that body temperature should be evaluated in relation to the individual variability and that the best approach is to use the same site, and an unadjusted mode without adjustments to other sites. If the baseline value is not known, it is important to notice that frail elderly individuals are at risk of a low body temperature. In addition, what should be regarded as fever is closely related to what is considered as normal body temperature. That is, as normal body temperature shows individual variations, it is reasonable that the same should hold true for the febrile range.

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