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  • 1.
    Törnqvist, Tove
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Lindh, Annika
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Jensen, Catrine Buck
    Centre for Faculty Development, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway.
    Iversen, Anita
    Centre for Faculty Development, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway.
    Tingström, Pia
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health.
    Are the stars aligned? Healthcare students’ conditions for negotiating tasks and competencies during interprofessional clinical placement2023In: BMC Medical Education, E-ISSN 1472-6920, Vol. 23, no 1, article id 648Article in journal (Refereed)
    Abstract [en]

    BackgroundHealthcare students must learn to collaborate across professional boundaries so they can make use of each other’s knowledge and competencies in a way that benefits the patient. One aspect of interprofessional collaboration implies negotiating what needs to be done and by whom. Research, focused on the conditions under which students perform this negotiation when they are working together during interprofessional clinical placement, needs to be further developed. The study therefore aimed to explore students’ negotiation of tasks and competencies when students are working together as an interprofessional team during clinical placement.

    MethodsThe study was designed as a focused ethnographic observational study. Two Nordic sites where final-year healthcare students perform clinical interprofessional education were included. Data consists of fieldnotes, together with informal conversations, group, and focus group interviews. In total, 160 h of participating observations and 3 h of interviews are included in the study. The analysis was informed by the theory on communities of practice.

    ResultsStudents relate to intersecting communities of practice when they negotiate what they should do to help a patient and who should do it. When the different communities of practice align, they support students in coming to an agreement. However, these communities of practice sometimes pulled the students in different directions, and negotiations were sometimes interrupted or stranded. On those occasions, observations show how the interprofessional learning practice conflicted with either clinical practice or one of the student’s profession-specific practices. Conditions that had an impact on whether or not communities of practice aligned when students negotiated these situations proved to be ‘having time to negotiate or not’, as well as ‘feeling safe or not’.

    ConclusionsFinal-year healthcare students can negotiate who in the team has the competence suited for a specific task. However, they must adapt their negotiations to different communities of practice being enacted at the same time. Educators need to be attentive to this and make an effort to ensure that students benefit from these intersecting communities of practice, both when they align and when they are in conflict. 

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  • 2.
    Andreae, Christina
    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. Uppsala Univ, Sweden.
    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.
    Nilsson, Staffan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Operations management PVC.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Med Ctr Utrecht, Netherlands.
    Karlsson, Nadine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Kärner Köhler, Anita
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Does problem-based learning improve patient empowerment and cardiac risk factors in patients with coronary heart disease in a Swedish primary care setting? A long-term prospective, randomised, parallel single randomised trial (COR-PRIM)2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 2, article id e065230Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate long-term effects of a 1-year problem-based learning (PBL) on self-management and cardiac risk factors in patients with coronary heart disease (CHD).Design A prospective, randomised, parallel single centre trial.Settings Primary care settings in Sweden.Participants 157 patients with stable CHD completed the study. Subjects with reading and writing impairments, mental illness or expected survival less than 1 year were excluded.Intervention Participants were randomised and assigned to receive either PBL (intervention) or home-sent patient information (control group). In this study, participants were followed up at baseline, 1, 3 and 5 years.Primary and secondary outcomes Primary outcome was patient empowerment (Swedish Coronary Empowerment Scale, SWE-CES) and secondary outcomes General Self-Efficacy Scale (GSES), self-rated health status (EQ-VAS), high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), weight and smoking. Outcomes were adjusted for sociodemographic factors.Results The PBL intervention group resulted in a significant improved change in SWE-CES over the 5-year period (mean (M), 39.39; 95% CI 37.88 to 40.89) compared with the baseline (M 36.54; 95% CI 35.40 to 37.66). PBL intervention group increased HDL-C level (M 1.39; 95% CI 1.28 to 1.50) compared with baseline (M 1.24; 95% CI 1.15 to 1.33) and for EQ-VAS (M 77.33; 95% CI 73.21 to 81.45) compared with baseline (M 68.13; 95% CI 63.66 to 72.59) while these outcomes remained unchanged in the control group. There were no significant differences in BMI, weight or scores on GSES, neither between nor within groups over time. The overall proportion of smokers was significantly higher in the control group than in the experimental group.Conclusion One-year PBL intervention had positive effect on patient empowerment, health status and HDL-C at a 5-year follow-up compared with the control group. PBL education aiming to improve patient empowerment in cardiac rehabilitation should account for sociodemographic factors.

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  • 3.
    Törnqvist, Tove
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Lindh, Annika
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Tingström, Pia
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health.
    Sharing knowledge: Final-year healthcare students working together at an interprofessional training ward2023In: Journal of Interprofessional Education & Practice, ISSN 2405-4526, Vol. 33, article id 100670Article in journal (Refereed)
    Abstract [en]

    Background

    Healthcare students must learn how to collaborate with colleagues from different professional backgrounds and organisational units. Research has showed what students themselves think they gain from interprofessional education. Less is known about what knowledge students share when doing interprofessional education.

    Purpose

    This paper aims to study students’ knowledge sharing when working together as an interprofessional team at an interprofessional training ward.

    Method

    The study was conducted using a focused ethnographic approach. Field observations were carried out at two different interprofessional training wards. Fieldnotes, drawings and informal interviews constitute data. Data was analysed iteratively with ‘practice architectures’ as theoretical lens.

    Discussion/conclusion

    We found that students share knowledge in different ways during ward rounds, at the student team room and during the reflection session. The ward rounds are more formal and structured; at the student team room, things are buzzing; and the reflection session is weary.

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  • 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.
    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 > 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 (> 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 > 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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  • 6.
    Törnqvist, Tove
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Lindh, Annika
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Students’ Interprofessional Collaboration in Clinical Practice: Ways of Organizing the Patient Encounter2022In: Professions & Professionalism, ISSN 1893-1049, E-ISSN 1893-1049, Vol. 11, no 3Article in journal (Refereed)
    Abstract [en]

    As health care increases its focus on collaborative practice, universities must provide students with opportunities to learn how to collaborate with different professions and translate this knowledge into practice, known as interprofessional education. Simultaneously, researchers struggle to understand the full complexity of interprofessional education and must therefore conduct multiple-site studies, employ observational work, and apply theory throughout the research process.This paper draws on focused ethnographic fieldwork at two different sites focusing on how students organize collaboration during interprofessional clinical placements. Findings indicate that the way students organize their collaboration is intertwined with how patients were introduced during handovers and involved mobilizing knowledge as “betwixt and between” familiar student practices and unfamiliar clinical practices. Findings also show how authentic situations, artifacts and spatial features supported students to mobilize collaboration.

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  • 7.
    Lindh, Annika
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Hammar, Mats
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Dahlberg, Johanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Interprofessional student teams focus on staff issues while learning about quality improvement2021In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 35, no 4, p. 552-557Article in journal (Refereed)
    Abstract [en]

    There is a well-known gap between what we know and what we do within healthcare service processes. Models that facilitate quality improvement (QI) have seen used to eliminate these gaps. Knowledge and competence in QI work are necessary for every professional within the healthcare system and are ideally learned through interprofessional collaboration and introduced during undergraduate studies. To meet these competence needs, Linkoping University, Sweden, in collaboration with the main healthcare provider in the region, implemented a 2-week interprofessional QI learning module, which is mandatory for all undergraduate healthcare students. Ideas for practice-based QI projects were introduced to all the students who studied theory in the relevant domains of QI while working on these projects. A content analysis of students written reports was conducted to investigate the focus of the projects. The analysis showed that most projects (65%) concerned staff-related issues, while 35% had patient perspectives. This distribution changed over time, increasing the number of patient centered projects.

  • 8.
    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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  • 9.
    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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  • 10.
    Kärner Köhler, Anita
    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.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Nilsson, Staffan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Vikbolandet. Primary Hlth Care Ctr Vikbolandet, Sweden.
    The effect of problem-based learning after coronary heart disease - a randomised study in primary health care (COR-PRIM)2020In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 20, no 1, article id 370Article in journal (Refereed)
    Abstract [en]

    BackgroundCardiac rehabilitation is effective after coronary heart disease (CHD). However, risk factors remain, and patients report fear for recurrence during recovery. Problem-based learning is a pedagogical method, where patients work self-directed in small groups with problem solving of real-life situations to manage CHD risk factors and self-care. We aimed to demonstrate the better effectiveness of problem-based learning over home-sent patient information for evaluating long-term effects of patient empowerment and self-care in patients with CHD. Hypothesis tested: One year of problem-based learning improves patients empowerment- and self-efficacy, to change self-care compared to 1 year of standardised home-sent patient information after CHD.MethodsPatients (N =157) from rural and urban areas in Sweden between 2011 and 2015 (78% male; age.688.5years) with CHD verified by percutaneous coronary intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and CABG+PCI or myocardial infarction (29.9%) were randomly assigned to problem-based learning (experimental group; n=79) or home-sent patient information (controls; n=78). The problem-based learning intervention consisted of patient education in primary care by nurses tutoring groups of 6-9 patients on 13 occasions over 1 year. Controls received home-sent patient information on 11 occasions during the study year.ResultsAt one-year follow-up, the primary outcome, patient empowerment, did not significantly differ between the experimental group and controls. We found no significant differences between the groups regarding the secondary outcomes e.g. self-efficacy, although we found significant differences for body mass index (BMI) [-0.17 (SD 1.5) vs. 0.50 (SD 1.6), P=0.033], body weight [-0.83 (SD) 4.45 vs. 1.14kg (SD 4.85), P=0.026] and HDL cholesterol [0.1 (SD 0.7) vs. 0.0mmol/L (SD 0.3), P=0.038] favouring the experimental group compared to controls.ConclusionsThe problem-based learning- and the home-sent patient information interventions had similar results regarding patient empowerment, self-efficacy, and well-being. However, problem-based learning exhibited significant effects on weight loss, BMI, and HDL cholesterol levels, indicating that this intervention positively affected risk factors compared to the home-sent patient information.Trial registration NCT01462799 (February 2020).

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  • 11.
    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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  • 12.
    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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  • 13.
    Kärner Köhler, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, 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.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Vikbolandet.
    Patient empowerment and general self-efficacy in patients with coronary heart disease: a cross-sectional study2018In: BMC Family Practice, E-ISSN 1471-2296, Vol. 19, article id 76Article in journal (Refereed)
    Abstract [en]

    Background

    In managing a life with coronary heart disease and the possibility of planning and following a rehabilitation plan, patients’ empowerment and self-efficacy are considered important. However, currently there is limited data on levels of empowerment among patients with coronary heart disease, and demographic and clinical characteristics associated with patient empowerment are not known.

    The purpose of this study was to assess the level of patient empowerment and general self-efficacy in patients six to 12 months after the cardiac event. We also aimed to explore the relationship between patient empowerment, general self-efficacy and other related factors such as quality of life and demographic variables.

    Methods

    A sample of 157 cardiac patients (78% male; age 68 ± 8.5 years) was recruited from a Swedish hospital. Patient empowerment was assessed using the SWE-CES-10. Additional data was collected on general self-efficacy and well-being (EQ5D and Ladder of Life). Demographic and clinical variables were collected from medical records and interviews.

    Results

    The mean levels of patient empowerment and general self-efficacy on a 0–4 scale were 3.69 (±0.54) and 3.13 (±0.52) respectively, and the relationship between patient empowerment and general self-efficacy was weak (r = 0.38). In a simple linear regression, patient empowerment and general self-efficacy were significantly correlated with marital status, current self-rated health and future well-being. Multiple linear regressions on patient empowerment (Model 1) and general self-efficacy (Model 2) showed an independent significant association between patient empowerment and current self-rated health. General self-efficacy was not independently associated with any of the variables.

    Conclusions

    Patients with a diagnosis of coronary heart disease reported high levels of empowerment and general self-efficacy at six to 12 months after the event. Clinical and demographic variables were not independently associated with empowerment or low general self-efficacy. Patient empowerment and general self-efficacy were not mutually interchangeable, and therefore both need to be measured when planning for secondary prevention in primary health care.

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  • 14.
    Andersson, Sten-Ove
    et al.
    Linnaeus University, Sweden; Swedish Armed Forces, V Frölunda, Sweden.
    Lundberg, Lars
    Försvarsmakten, Centrum för Försvarsmedicin, Sweden;Borås University, Sweden.
    Jonsson, Anders
    Borås University, Sweden.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Doctors' and nurses' perceptions of military pre-hospital emergency care - When training becomes reality2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 32, p. 70-77Article, review/survey (Refereed)
    Abstract [en]

    The aim of this study was to identify physicians' and nurses' perceptions of military pre-hospital emergency care before and after an international mission. A qualitative empirical study with a phenomenographic approach was used. The results after pre-deployment traing can be categorised as 1) learning about military medicine and 2) taking care of the casualty. The results after an international mission can be categorised as 1) collaborating with others 2) providing general health care and 3) improving competence in military medicine. The results indicate that the training should be developed in order to optimise pre-deployment training for physicians and nurses. This may result in increased safety for the provider of care, while at the same time minimising suffering and enhancing the possibility of survival of the injured.

  • 15.
    Kärner Köhler, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Vikbolandet.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, 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.
    Health beliefs about lifestyle habits differ between patients and spouses 1 year after a cardiac event – a qualitative analysis based on the Health Belief Model2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 2, p. 332-341Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Spousal concordance on risk factors and lifestyle habits exists and can partly be explained by patients' and spouses' health beliefs and underuse of cardiac rehabilitation. However, there have been very few qualitative comparisons of health beliefs between patients and spouses after a cardiac event.

    AIM:

    To examine and qualitatively compare the health beliefs of patients with coronary heart disease and their spouses about lifestyle habits, 1 year after the cardiac event.

    DESIGN:

    Explorative and descriptive.

    METHOD:

    Semi-structured focus group interviews were conducted with patients (n = 14) 1 year after a cardiac event, as well as individual interviews with spouses (n = 8). The transcriptions underwent a deductive qualitative content analysis, within the framework of the Health Belief Model.

    FINDINGS:

    Patients' and spouses' health beliefs about lifestyle habits qualitatively differed in most predetermined main analytical categories of the Health Belief Model. The patients relied more on their own capacity and the healthcare system than on collaboration with their spouses who instead emphasised the importance of mutual activities to establish lifestyle habits. The spouses therefore experienced problems with different family preferences compared to the patients' wishes. Moreover, only patients believed supervised exercise was beneficial for risk reduction of coronary heart disease and they related barriers for medication to a self-healing body and a meaningless life without relatives and old habits. Patients and spouses agreed that despite the severity of illness, life was captured and that normalisation to a life as usual was possible.

    CONCLUSION:

    The patients' and spouses' qualitatively different health beliefs regarding health-related behaviours imply a new approach. Nurses and associated professionals need to follow-up patients' and spouses' in primary health care to support them in a tailored way, for example in problem-based sessions. Recognition and understanding of their different views and otherness could lead to compromises and goals to work with.

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  • 16.
    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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  • 17.
    Andersson, Sten-Ove
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden.
    Lundberg, Lars
    Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden/Borås University, School of Health Sciences,Borås Sweden.
    Jonsson, Anders
    Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden/Borås University, School of Health Sciences,Borås Sweden.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Fixing the Wounded or Keeping Lead in the Air: Tactical Officers’ Views of Emergency Care on the Battlefield2015In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 180, no 2, p. 224-229Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify tactical officers’ views of pre-hospital emergency care in the field before an international mission. A qualitative study with a phenomenographic approach based on interviews was used. The result of this study is a set of descriptive categories on a collective level, showing the variation in how the tactical officers perceived the phenomenon of emergency care in the battlefield. The result can be viewed as (1) noncombat oriented including being able to do one’s specialist task, being able to talk with local people and being able to give first aid, (2) combat oriented including soldiers’ skills and roles in the unit, being able to act in the unit and being able to lead the care of  injured These findings are important for officers’ preparation for international missions. The interaction between military and medical knowledge on-site care should be developed between the tactical officer and the medical personnel in order to minimize suffering and to enhance the possibility for survival of the casualty.

  • 18.
    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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  • 19.
    Andersson, Sten-Ove
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden.
    Lundberg, Lars
    Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden/Borås University, School of Health Sciences,Borås Sweden.
    Jonsson, Anders
    Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden/Borås University, School of Health Sciences,Borås Sweden.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Doctors’ and Nurses’ Perceptions of Military Pre-hospital Emergency Care2014Manuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study was to identify physicians’ and nurses’ perceptions of military prehospital emergency care before and after an international mission. A qualitative empirical study with a phenomenographic approach was used. The aim is to identify the area of knowledge, pre-hospital care in a military environment, in terms of expressions from doctors and nurses focussing on the variation in how learning of pre-hospital care is perceived. The result of the study is a set of descriptive categories on a collective level, showing the variation in how doctors and nurses perceived the phenomenon of military pre-hospital emergency care. The results after predeployment training can be categorized as (1) to learn military medicine, (2) to take care of the casualty and (3) to have safety awareness. The results after an international mission can be categorized as (1) to collaborate with others, (2) to deliver general health care, and (3) to improve competence in military medicine. Possible implications of the results from the present study are the following; (I) better conditions for doctors and nurses to provide appropriate military medical care by clarification and better understanding of professions in the mission area (doctors, nurses, officers), since they may have different goals for their actions, (II) to pay attention to all aspects of military health care during predeployment training, including general health care in the mission area, (III) to implement new knowledge in military medicine in the predeployment training, and (IV) to train for the reality all doctors and nurses are about to meet. These results indicate  that the training should be developed in order to optimize the prepare physicians and nurses for international assignments. This may result in increased safety for the provider of care, while at the same time minimizing suffering and enhancing the possibility of survival of the injured.

  • 20.
    Grönlund, V.
    et al.
    Östergötlands Läns Landsting, Local Health Care Services in Finspång, Primary Health Care in Finspång. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Rudenas, A.
    Östergötlands Läns Landsting, Local Health Care Services in Finspång, Primary Health Care in Finspång. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Appel, M.
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland.
    Ednarsson, T.
    Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Primary Health Care in Norrköping.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Kärner Köhler, Anita
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Problem-based learning after Coronary artery disease - how do patients experience it?2014Conference paper (Other academic)
  • 21.
    Hjelmfors, Lisa
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Problem-based learning used in the context of cardiac rehabilitation: different scenes and different roles2014In: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 36, no 2, p. 218-232Article in journal (Refereed)
    Abstract [en]

    Several studies show that how patients have difficulties in changing lifestyle even though such changes are essential because they are suffering from a life-threatening disease. Coronary artery disease (CAD) patients met 13 times during a year and used problem-based learning (PBL) to improve their empowerment and self-efficacy in making lifestyle changes. District nurses functioned as tutors, helping patients to formulate issues and to state self-care goals. To identify and describe the enactment of PBL, an ethnographic approach was used, including, for example, participant observations and interviews, all derived from six sessions of the education programme. Five different enactments were found, metaphorically expressed as: ‘The study circle’, ‘The classroom’, ‘The expert consultation’, ‘The therapy session’ and ‘The coffee party’. The education programme did not always function as it was supposed to according to the model, but perhaps this should not be seen as a failure of the pedagogical intervention since these enactments as a whole seem to be a way for the patients to be able to make healthy lifestyle changes. The metaphors can broaden the understanding of what can happen when implementing problem-based learning in health care practice.

  • 22.
    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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  • 23.
    Arvidsson, Susann
    et al.
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Arvidsson, Barbro
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Sweden.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Effects of a self-care promoting problem-based learning programme in people with rheumatic diseases: a randomized controlled study2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 7, p. 1500-1514Article in journal (Refereed)
    Abstract [en]

    Aim

    To evaluate the effects of a self-care promoting problem-based learning programme for people with rheumatic diseases in terms of health-related quality of life, empowerment, and self-care ability.

    Background

    Individuals with rheumatoid arthritis express a great need for education and support in adapting to the disease, but the average qualities of studies about patient education interventions are not high. There is no evidence of long-term benefits of patient education.

    Design

    Randomized controlled trial.

    Methods

    A randomized controlled design was selected with test at baseline, 1-week and 6-month post-interventions after completed the 1-year programme. The tests consisted of validity and reliability tested instruments. The participants were randomly assigned in spring 2009 to either the experimental group (n = 54) or the control group (n = 148). The programme was running alongside the standard care the participants received at a rheumatology unit. Parametric and non-parametric tests were used in the analyses.

    Results

    The participants in the experimental group had statistically significant stronger empowerment after participation in the self-care promoting problem-based learning programme compared with the control group, at the 6-month post-intervention. Approximately, two-thirds of the participants in the experimental group stated that they had implemented lifestyle changes due to the programme.

    Conclusion

    The self-care promoting problem-based learning programme enabled people with rheumatic diseases to improve their empowerment compared with the control group. It is important to continue to develop problem-based learning in patient education to find the very best way to use this pedagogical method in rheumatology care.

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  • 24.
    Andersson, Sten-Ove
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden.
    Lundberg, Lars
    Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden.
    Jonsson, Anders
    Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Interaction, action, and reflection: how medics learn medical care in the Swedish armed forces2013In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 178, no 8, p. 861-866Article in journal (Refereed)
    Abstract [en]

    The objective of this study is to examine how medics within the Swedish Armed Forces perceive their learning outcome following military prehospital training. A qualitative study with a phenomenographic approach was used to investigate how leaming is perceived among military medics. At meta level, the results can be viewed as an interaction, i.e., being able to collaborate in the medical platoon, including the ability to interact within the group and being able to lead; an action, i.e., being able to assess and treat casualties, including the ability to communicate with the casualty, to prioritize, and to be able to act; and a reflection, i.e., having confidence in one's own ability in first aid, including being prepared and feeling confident. Interaction during the period of education is important for learning. Action, being able to act in the field, is based on a drill in which the subject progresses from simple to complex procedures. Reflection, leaming to help others, is important for confidence, which in turn creates preparedness, thereby making the knowledge meaningful.

  • 25.
    Grönlund, V.
    et al.
    Östergötlands Läns Landsting, Local Health Care Services in Finspång, Primary Health Care in Finspång. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Carlsson, A.
    Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    The desire for a good life - patients beliefs of self-care after a coronary event2013Conference paper (Other academic)
    Abstract [en]

         

    Introduction: After a first coronary event there is an increased risk for a recurrent event. Despite that risk, 1/5 of the patients continue to smoke, 1/3 is obese and more than half of the patients have elevated blood pressure and total cholesterol. Secondary preventive self-care activities are needed to improve outcomes and the belief of patients plays a vital role in changing behavior.                         

    Aim: To examine patients’ beliefs of self-care 6-12 months after a coronary event.                         

    Method: The study design was qualitative. Twenty-five patients, including 10 women, mean age 65 years with stable coronary artery disease participated in four focus group interviews. Data were taped, transcribed and analyzed according to the conventional content analysis.                         

    Findings: Patients’ belief of self-care is influenced by their desire of a good life even though life seems fragile. Patients try to live up to the standard of health care prescription and advices. However, these achievements require behavior change and conscious boundaries, which are challenged by various obstacles such as fear of, overstrain and stress. Physical activity is considered as both a source to well-being and a necessity, but patients are uncertain and afraid for overstraining. A healthy diet is seen as important but the advices given are sometimes contradictory and create confusion. Medication is found important but not at the cost of all the side-effects. Patients also report that in order to believe in their ability and to be responsible for self-care, support from health care providers is expected. But at the same time the invaluable support and information is often not provided, creating uncertainty.                         

    Discussion: The study highlights the patients’ perspective of self-care and what they view as important in self-care after an event of coronary artery disease. The patients’ expectations on health services comprise information, support and continuous follow-up. This is necessary to facilitate the patient’s responsibility for their own care.                         

    Conclusion: Patients’ beliefs about the concept of self-care after an event of coronary artery disease are multifaceted and voluminous compared to the health care definition. The findings of the study challenge health care policies approach to self-care. There is a need to reconsider and assess what and how secondary preventive patient education should be performed after an event of coronary artery disease.  

                        

  • 26.
    Sjögren, Elaine
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Uhlin, Lars
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ragnemalm, Eva L
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, The Institute of Technology.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Medical Pedagogics. Linköping University, Faculty of Health Sciences.
    Academics reflections on the use of eportfolio documentation of pedagogical skills: a pilot study2012In: The quality of higher education, ISSN 1822-1645, Vol. 9, p. 98-119Article in journal (Other academic)
  • 27.
    Kärner, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, East County Primary Health Care.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Wodlin, Peter
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Hjelmfors, Lisa
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    The effect of problem-based learning in patient education after an event of CORONARY heart disease - a randomised study in PRIMARY health care: design and methodology of the COR-PRIM study2012In: BMC Family Practice, E-ISSN 1471-2296, Vol. 13, no 110Article in journal (Refereed)
    Abstract [en]

    Background

    Even though there is convincing evidence that self-care, such as regular exercise         and/or stopping smoking, alters the outcomes after an event of coronary heart disease         (CHD), risk factors remain. Outcomes can improve if core components of secondary prevention         programmes are structurally and pedagogically applied using adult learning principles         e.g. problem-based learning (PBL). Until now, most education programs for patients         with CHD have not been based on such principles. The basic aim is to discover whether         PBL provided in primary health care (PHC) has long-term effects on empowerment and         self-care after an event of CHD.     

    Methods/Design

    A randomised controlled study is planned for patients with CHD. The primary outcome         is empowerment to reach self-care goals. Data collection will be performed at baseline         at hospital and after one, three and five years in PHC using quantitative and qualitative         methodologies involving questionnaires, medical assessments, interviews, diaries and         observations. Randomisation of 165 patients will take place when they are stable in         their cardiac condition and have optimised cardiac medication that has not substantially         changed during the last month. All patients will receive conventional care from their         general practitioner and other care providers. The intervention consists of a patient         education program in PHC by trained district nurses (tutors) who will apply PBL to         groups of 6–9 patients meeting on 13 occasions for two hours over one year. Patients         in the control group will not attend a PBL group but will receive home-sent patient         information on 11 occasions during the year.     

    Discussion

    We expect that the 1-year PBL-patient education will improve patients’ beliefs, self-efficacy         and empowerment to achieve self-care goals significantly more than one year of standardised         home-sent patient information. The assumption is that PBL will reduce cardiovascular         events in the long-term and will also be cost-effective compared to controls. Further,         the knowledge obtained from this study may contribute to improving patients’ ability         to handle self-care, and furthermore, may reduce the number of patients having subsequent         CHD events in Sweden.

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  • 28.
    Kärner, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    P161 Poster COR-PRIM: Longitudinal Study on PBL in Self-Care after CVD Preliminary Results from a Pilot Study2011Conference paper (Other academic)
  • 29.
    Martha, Sund-Levander
    et al.
    Hoegland Hospital, Eksjo, Sweden .
    Tingström, Pia
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Clinical decision making of signs of infection in elderly persons: experience of nursing assistants in JOURNAL OF CLINICAL NURSING, vol 19, issue , pp 125-1252010In: JOURNAL OF CLINICAL NURSING, Blackwell Publishing Ltd , 2010, Vol. 19, p. 125-125Conference paper (Refereed)
    Abstract [en]

    n/a

  • 30.
    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)
  • 31.
    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)
  • 32.
    Kärner, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Dahl, Lena
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Asklund, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    COR-PRIM: Patient education after coronary disease - Long-term evaluation in primary care2010Conference paper (Other academic)
  • 33.
    Tingström, Pia
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Milberg, Anna
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, LAH Linköping. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Centre of Competence in Palliative Care.
    Sund-Levander, Martha
    Hoegland Hospital.
    Early nonspecific signs and symptoms of infection in institutionalized elderly persons: perceptions of nursing assistants2010In: SCANDINAVIAN JOURNAL OF CARING SCIENCES, ISSN 0283-9318, Vol. 24, no 1, p. 24-31Article in journal (Refereed)
    Abstract [en]

    Aim: To explore early nonspecific signs and symptoms of infection in elderly institutionalized individuals as described by nursing assistants. Background: Nonspecific signs and symptoms and lack of specific ones are common in connection with infection in institutionalized elderly persons and contribute to a delayed diagnosis and treatment. In clinical care, the nurse makes notes on the individual status of the patient on a daily basis and decides whether to contact the physician or not. However, in Sweden nursing assistants provide most of the daily care and therefore have many opportunities to observe subtle changes that may be early signs of infection. Method: Data were collected in 2006 from focus interviews with 21 female nursing assistants. The interviews were verbatim transcripted and analysed with qualitative content analysis for manifest content with no preconceived categories. Findings: Nursing assistants descriptions of nonspecific signs and symptoms of infection comprised two exclusive categories. Is not as usual described general signs and symptoms of discomfort related to possible infection, such as discomfort, unrestrained behaviour, aggressiveness, restlessness, confusion, tiredness and feebleness, and decreased eating. Seems to be ill was more distinctly related to signs and symptoms of established infection in general terms of fever and pain or more specifically related to pneumonia, urinary tract infection, skin infection, cold and eye infection. Conclusion: Nursing assistants have a keen observational ability to detect early signs that might help to confirm suspected infections in elderly nursing home residents early on. Whether or not the cited categories are actual early signs and symptoms of infectious disease needs to be further investigated.

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  • 34.
    Dahlberg, Johanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Berglund, Ebba
    Östergötlands Läns Landsting.
    Interprofessionella studentgruppers medverkan i kliniskt förbättringsarbete2010Conference paper (Other (popular science, discussion, etc.))
    Abstract [sv]

    I Östergötland samverkar Hälsouniversitetet och Landstinget i ett utvecklingsprojekt kring förbättringskunskap. Syftet är att studenterna under grundutbildningen ska tillägna sig kunskaper om kvalitets- och förbättringsarbete samtidigt som de inspirerar och bidrar till det kliniska förbättringsarbetet i landstingets verksamheter.

     

    Hälsouniversitet skapar därför ett curriculum kring förbättringskunskap som i huvudsak är förlagt till dem interprofessionella utbildningsmomenten, sammanlagt 12 veckor. I steg 1 gör studenterna ett personligt förbättringsarbete. Detta är förlagt till termin 1. Mot slutet av utbildningarna kommer studenterna att samlas i interprofessionella basgrupper och delta i kliniska förbättringsarbeten. I tredje steget planeras ett kontinuerligt förbättringsarbete under den verksamhetsförlagda praktiken på Klinisk undervisningsavdelning (KUA), där de olika studentteamen jobbar med ett projekt som sträcker sig över en eller flera terminer.

     

    Formerna för studenternas deltagande i kliniska förbättringsarbeten, steg 2, har provats under tre terminer, med sammanlagt 19 basgrupper (19x8 studenter). Studenterna har bland annat engagerats i:

     

    • Förbättrad vårdprocess för Astma-patienter och      ”mångsökare”
    • Hänvisning av patienter från sjuksköterska till sjukgymnast
    • Studie kring användning av britspapper
    • Undersökning av följsamheten till dokumentationsrutiner      vid läkemedelsordinationer i landstingets elektroniska patientjournal
    • Utskrivningssamtal från kirurgiska kliniken

     

    Studenternas erfarenheter har utvärderats. Studenterna har blivit väl mottagna och lärandet hos studenterna har ökat, såväl avseende interprofessionell kompetens som kring förbättringsarbete i vården. Vårdverksamheterna redovisar positiva resultat, ”över förväntan bra”.

     

    Förutom att studenterna får utbildning i förbättringskunskap krävs motsvarande kompetensökning hos lärare inom akademien såväl som hos personal i landstinget. Därför genomförs gemensamma utbildningar av basgruppshandledare och kontaktpersoner inom landstinget, för att på så sätt stödja organisationernas lärande.

     

    Höstterminen 2010 kommer 30-35 grupper av studenter, i interprofessionella team, att delta i kliniskt förbättringsarbete.

  • 35.
    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)
  • 36.
    Sund-Levander, Martha
    et al.
    Hoegland Hospital, Eksjo, Sweden .
    Tingström, Pia
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Milberg, Anna
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, LAH Linköping. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Centre of Competence in Palliative Care.
    Signs and symptoms of infection in nursing-home residents: perceptions of nursing assistants in JOURNAL OF CLINICAL NURSING, vol 19, issue , pp 101-1012010In: JOURNAL OF CLINICAL NURSING, Blackwell Publishing Ltd , 2010, Vol. 19, p. 101-101Conference paper (Refereed)
    Abstract [en]

    n/a

  • 37.
    Dahlberg, Johanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Berglund, Ebba
    Östergötlands Läns Landsting.
    Student groups in Continuous Quality Improvement work in clinical setting2010Conference paper (Other (popular science, discussion, etc.))
    Abstract [en]

    The Faculty of Health Sciences (FHS), Linköping University, Sweden, has introduced Continuous Quality Improvement (CQI) to all its undergraduate programs in close collaboration with the County Council of Ostergotland (CCO). To be powerful, improvement of quality and safety (IQS) should be performed by all involved health professionals and patients in cooperation. Since the mid-80ies, all students have been engaged in educational modules within their undergraduate programs aiming at the development of inter-professional competence. We suggest that inter-professional competence is one of the key elements for working with CQI in healthcare.

    At the FHS, all curricula are based on Problem-Based Learning (PBL). The procedure for CQI-work has great similarities to the process for PBL. Hence, CQI and PBL reinforce the way individuals identify and solve problems in addition to needs of learning.

    Since 2008, students from all our undergraduate programs learn CQI-methodology during their first semester in individual projects, as part of the curricula for inter-professional learning. The partnership with the CCO now offere opportunities to include practice of CQI in clinical settings. In close collaboration with the staff from primary health care centers or clinical wards, inter-professional student groups identifiy areas of quality and safety improvement and suggest interventions that are evaluated. For example; i) use of search-terms in a web-based medical record system, ii) accessibility to acute care, or iii) reception of frequent visitors in primary health care. The suggested interventions and conclusions were well received, discussed and developed at the clinics.

  • 38.
    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)
  • 39.
    Tingström, Pia
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Ekelund, U.
    Department of Physical Education and Health, Örebro University, Örebro, Sweden and MRC Epidemiology Unit, Cambridge, United Kingdom.
    Kamwendo, Kitty
    Department of Caring Sciences, Örebro University, Örebro, Sweden.
    Bergdahl, Björn
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Effects of a problem-based learning rehabilitation program on physical activity in patients with coronary artery disease2006In: Journal of Cardiopulmonary Rehabilitation (JCR), ISSN 0883-9212, E-ISSN 1539-0691, Vol. 26, no 1, p. 32-38Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate the effects of a problem-based learning (PBL) rehabilitation program on physical activity.

    METHODS: We randomized 207 consecutive patients younger than 70 years, with a recent event of coronary artery disease (CAD), to a PBL group (n = 104) or a control group (n = 103). In addition to standard treatment, the PBL patients participated in a 1-year program with 13 sessions in small groups, where learning needs and behavior change were focused upon. Physical activity was assessed by means of interviews with all patients and by an activity monitor in 69 patients at pretest and in 175 after 1 year.

    RESULTS: Only small differences between groups were found at posttest. Interview data revealed significantly less activity at low-intensity level in the control group, whereas the activity monitor showed no significant differences. No changes were found in total physical activity during the year within the 2 groups. The self-reported physical activity indicating a level of brisk walking was markedly higher than that measured by the activity monitor, the latter indicating that only 35% of the patients achieved a 10-minute period of continued physical activity per day on an adequate level.

    CONCLUSIONS: Our PBL program had no important impact on the physical activity pattern of patients with CAD. The activity monitor is a feasible way of measuring physical activity in these patients, indicating a lower level of physical activity than interview data.

  • 40.
    Tingström, Pia
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Kamwendo, Kitty
    Department of Caring Sciences, Örebro University, Örebro, Sweden.
    Bergdahl, Björn
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Effects of a problem-based learning rehabilitation programme on quality of life in patients with coronary artery disease2005In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 4, no 4, p. 324-330Article in journal (Refereed)
    Abstract [en]

    Background: The aim of cardiac rehabilitation (CR) is not only physical improvement but also increased quality of life (QoL). A CR programme based upon problem based learning (PBL) philosophy was developed, to achieve and apply new knowledge related to coronary artery disease (CAD). The aim of this paper was to evaluate the impact of the PBL programme on QoL.

    Methods: 207 consecutive patients < 70 years of age with a recent event of CAD were randomised to a PBL group (n = 104) or a control group (n = 103). In addition to standard treatment, the PBL patients participated in 13 group sessions during 1 year, where individual learning needs and behavioural changes were focused upon. QoL was measured by the Ladder of Life, Self-Rated Health (SRH), SF 36, and Cardiac Health Profile (CHP).

    Results: Significant differences between the groups, favouring the PBL patients, were found by global instruments: more optimistic expectations of the future QoL and a better general condition. No differences were found by SRH, SF 36 or subscales of CHP, but QoL increased in both groups during the year.

    Conclusions: The main outcome was that QoL improved in both groups with some effects favouring the PBL programme.

  • 41.
    Kärner, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Bergdahl, Björn
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Incentives for lifestyle changes in patients with coronary heart disease2005In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 51, no 3, p. 261-275Article in journal (Refereed)
    Abstract [en]

    Aim. This paper reports a study exploring how patients in the rehabilitation phase of coronary heart disease experience facilitating and constraining factors related to lifestyle changes of importance for wellbeing and prognosis.

    Background. Lifestyle change is important but complex during rehabilitation after a myocardial infarction or angina pectoris. The intentions to perform behaviours and to experience control over facilitators and constraints are important determinants of behaviour.

    Methods. A total of 113 consecutive patients below 70 years of age (84 men and 29 women) were interviewed within 6 weeks of a cardiac event and again after 1 year. Interview transcriptions and notes taken by hand were qualitatively analysed using the phenomenographic framework. The distribution of statements among the categories identified was quantitatively analysed. The data were collected in 1998–2000.

    Findings. Four main categories portrayed patients' experiences of facilitating or constraining incentives for lifestyle changes. 'Somatic incentives' featured bodily signals indicating improvements/illness. 'Social/practical incentives' involved shared concerns, changed conditions including support/demand from social network, and work/social security issues. Practical incentives concerned external environmental factors in the patients' concrete context. 'Cognitive incentives' were characterized by active decisions and appropriated knowledge, passive compliance with limited insights, and routines/habits. 'Affective incentives' comprised fear of and reluctance in the face of lifestyle changes/disease, lessened self-esteem, and inability to resist temptations. Cognitive incentives mostly facilitated physical exercise and drug treatment. Social/practical incentives facilitated physical exercise and diet change. Physical exercise and diet changes were mainly constrained by somatic, social, and affective incentives.

    Conclusion. The results illustrate important incentives that should be considered in contacts with patients and their families to improve the prospects of positively affecting co-operation with suggested treatment and lifestyle changes.

  • 42.
    Tingström, Pia
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Problem-based learning in the rehabilitation of patients with coronary artery disease2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and aims: A well-informed patient is a prerequisite for adherence to lifestyle changes and drug treatments, which improve prognosis of CAD. Problem-based learning (PBL) is in line with principles of adult learning. The aim was to develop and evaluate a PBL rehabilitation programme for coronary artery disease (CAD) patients.

    The PBL model: In the PBL programme, 6-9 patients and a tutor met ftrst at 9 (I), and after revision at 13 (III and IV) sessions during a one year period. Learning needs related to CAD, its treatment, psychosocial issues, and behavioural changes were focused upon.

    Subjects and methods: To validate the PBL programme, six tutors were interviewed, seven PBL groups were videotaped, and 44 other patients answered a questionnaire (I). To evaluate the validity of the MTI/CSA activity monitor, as a means of measuring physical activity intensity, 34 patients walked on a treadmill at three different speeds. Indirect calorimetry was used to determine energy expenditure (EE) (11). In order to evaluate the effects of the PBL programme (III and IV), 207 patients (55% of all eligible), were randomised to the PBL programme (n=104) or to a control group (n=103). All patients received standard therapy. Physical activity was measured by interview and by the activity monitor, and quality of life by the Ladder of Life, Self-rated Health, Cardiac Health Profile, and SF-36. All measurements were performed before randomisation and at the end of the programme.

    Results: The PBL-model could be incorporated into the clinical routine with a high participation rate. Initial problems with the tutor role and the structured problem-solving process in the group-work were revealed, which led to revision of the model. PBL stimulated participants to search actively for knowledge, while remaining to fmd demands adequate and being positive about the education. According to self-reports, lifestyle changes had been performed (I). The MTI/CSA activity monitor was a valid tool for quantifying both amount and intensity of physical activity during walking (II). The PBL programme did not affect physical activity. No increase in activity was found in any of the groups over the one year period Activity, as measured by the activity monitor, was lower than recommended in guidelines for secondary prevention (III). On the contrary, self-reports indicated higher and adequate physical activity. The PBL programme seemed to have positive effects on quality of life, as measured by global instruments. No effects were found on health-related or disease specific aspects of quality of life (IV).

    Conclusion: The PBL programme was feasible to run in clinical practice. Education of tutors was crucial and required time. The programme stimulated participants to become active learners. The PBL model had no effects on physical activity, but some effects on global quality of life. Physical activity remained unchanged and low in both groups, as measured by the activity monitor, which was a useful and reliable tool, while self-reports seemed to overestimate performed physical activity. Quality of life improved in both groups over the year. More data are needed to evaluate the usefulness of the PBL-model.

    List of papers
    1. Validation and feasibility of problem-based learning in rehabilitation of patients with coronary artery disease
    Open this publication in new window or tab >>Validation and feasibility of problem-based learning in rehabilitation of patients with coronary artery disease
    2002 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 47, no 4, p. 337-345Article in journal (Refereed) Published
    Abstract [en]

    A patient education programme applying problem-based learning (PBL) was developed for patients with coronary artery disease (CAD). Groups with 6–8 patients and a tutor from the rehabilitation team met nine times for 1.5 h each. The feasibility and validity of the model was evaluated using patient questionnaires, interviews with tutors and video observations of tutorials. The participants were active (69% of all input) and discussions of acquired knowledge and lifestyle changes took place in all groups. A total of 89% of the patients reported implementation of lifestyle changes and over 90% rated their learning and overall experience of the programme as acceptable or high and the demands as acceptable. Shortcomings were the limited use of some of the steps in the problem-solving process and tutors’ difficulties in adapting to their new role; their answering of questions was higher than planned (35% of their total input). The programme was feasible in clinical routine.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26807 (URN)10.1016/S0738-3991(02)00007-1 (DOI)11416 (Local ID)11416 (Archive number)11416 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    2. The validity of the Computer Science and Applications activity monitor for use in coronary artery disease patients during level walking
    Open this publication in new window or tab >>The validity of the Computer Science and Applications activity monitor for use in coronary artery disease patients during level walking
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    2002 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 22, no 4, p. 248-253Article in journal (Refereed) Published
    Abstract [en]

    The principal aim of the present study was to examine the validity of the Computer Science and Applications (CSA) activity monitor during level walking in coronary artery disease (CAD) patients. As a secondary aim, we evaluated the usefulness of two previously published energy expenditure (EE) prediction equations. Thirty-four subjects (29 men and five women), all with diagnosed CAD, volunteered to participate. Oxygen uptake (VO2) was measured by indirect calorimetry during walking on a motorized treadmill at three different speeds (3·2, 4·8 and 6·4 km h−1). Physical activity was measured simultaneously using the CSA activity monitor, secured directly to the skin on the lower back (i.e. lumbar vertebrae 4–5) with an elastic belt. The mean (±SD) activity counts were 1208 ± 429, 3258 ± 753 and 5351 ± 876 counts min−1, at the three speeds, respectively (P<0·001). Activity counts were significantly correlated to speed (r=0·92; P<0·001), VO2 (ml kg−1 min−1; r=0·87; P<0·001) and EE (kcal min−1; r=0·85, P<0·001). A stepwise linear regression analysis showed that activity counts and body weight together explained 75% of the variation in EE. Predicted EE from previously published equations differed significantly when used in this group of CAD patients. In conclusion, the CSA activity monitor is a valid instrument for assessing the intensity of physical activity during treadmill walking in CAD patients. Energy expenditure can be predicted from body weight and activity counts.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-24803 (URN)10.1046/j.1475-097X.2002.00426.x (DOI)7070 (Local ID)7070 (Archive number)7070 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    3. Effects of a problem-based learning rehabilitation program on physical activity in patients with coronary artery disease
    Open this publication in new window or tab >>Effects of a problem-based learning rehabilitation program on physical activity in patients with coronary artery disease
    2006 (English)In: Journal of Cardiopulmonary Rehabilitation (JCR), ISSN 0883-9212, E-ISSN 1539-0691, Vol. 26, no 1, p. 32-38Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: To evaluate the effects of a problem-based learning (PBL) rehabilitation program on physical activity.

    METHODS: We randomized 207 consecutive patients younger than 70 years, with a recent event of coronary artery disease (CAD), to a PBL group (n = 104) or a control group (n = 103). In addition to standard treatment, the PBL patients participated in a 1-year program with 13 sessions in small groups, where learning needs and behavior change were focused upon. Physical activity was assessed by means of interviews with all patients and by an activity monitor in 69 patients at pretest and in 175 after 1 year.

    RESULTS: Only small differences between groups were found at posttest. Interview data revealed significantly less activity at low-intensity level in the control group, whereas the activity monitor showed no significant differences. No changes were found in total physical activity during the year within the 2 groups. The self-reported physical activity indicating a level of brisk walking was markedly higher than that measured by the activity monitor, the latter indicating that only 35% of the patients achieved a 10-minute period of continued physical activity per day on an adequate level.

    CONCLUSIONS: Our PBL program had no important impact on the physical activity pattern of patients with CAD. The activity monitor is a feasible way of measuring physical activity in these patients, indicating a lower level of physical activity than interview data.

    Keywords
    Cardiac rehabilitation, Coronary artery disease, Physical activity, Problem-based learning
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-50323 (URN)10.1097/00008483-200601000-00007 (DOI)
    Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12Bibliographically approved
    4. Effects of a problem-based learning rehabilitation programme on quality of life in patients with coronary artery disease
    Open this publication in new window or tab >>Effects of a problem-based learning rehabilitation programme on quality of life in patients with coronary artery disease
    2005 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 4, no 4, p. 324-330Article in journal (Refereed) Published
    Abstract [en]

    Background: The aim of cardiac rehabilitation (CR) is not only physical improvement but also increased quality of life (QoL). A CR programme based upon problem based learning (PBL) philosophy was developed, to achieve and apply new knowledge related to coronary artery disease (CAD). The aim of this paper was to evaluate the impact of the PBL programme on QoL.

    Methods: 207 consecutive patients < 70 years of age with a recent event of CAD were randomised to a PBL group (n = 104) or a control group (n = 103). In addition to standard treatment, the PBL patients participated in 13 group sessions during 1 year, where individual learning needs and behavioural changes were focused upon. QoL was measured by the Ladder of Life, Self-Rated Health (SRH), SF 36, and Cardiac Health Profile (CHP).

    Results: Significant differences between the groups, favouring the PBL patients, were found by global instruments: more optimistic expectations of the future QoL and a better general condition. No differences were found by SRH, SF 36 or subscales of CHP, but QoL increased in both groups during the year.

    Conclusions: The main outcome was that QoL improved in both groups with some effects favouring the PBL programme.

    Keywords
    Coronary artery disease, Cardiac rehabilitation, Problem-based learning, Quality of life
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-31058 (URN)10.1016/j.ejcnurse.2005.04.008 (DOI)16778 (Local ID)16778 (Archive number)16778 (OAI)
    Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
  • 43. Kamwendo, K
    et al.
    Tingström, Pia
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine.
    Bergdahl, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Svensson, E
    Effect of problem-based learning on stages of change for exercise behaviour in patients with coronary artery disease2004In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 9, p. 24-32Article in journal (Refereed)
  • 44.
    Ekelund, Ulf
    et al.
    Unit of Preventive Nutrition, Department of Medical Nutrition / Biosciences, Karolinska Institutet, Stockholm, Sweden and Department of Physical Education and Health, Örebro University, Örebro, Sweden.
    Tingström, Pia
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Kamwendo, Kitty
    Department of Caring Sciences, Örebro University, Örebro, Sweden.
    Krantz, Monica
    Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Sjöström, Michael
    Unit of Preventive Nutrition, Department of Medical Nutrition / Biosciences, Karolinska Institutet, Stockholm, Sweden.
    Bergdahl, Björn
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    The validity of the Computer Science and Applications activity monitor for use in coronary artery disease patients during level walking2002In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 22, no 4, p. 248-253Article in journal (Refereed)
    Abstract [en]

    The principal aim of the present study was to examine the validity of the Computer Science and Applications (CSA) activity monitor during level walking in coronary artery disease (CAD) patients. As a secondary aim, we evaluated the usefulness of two previously published energy expenditure (EE) prediction equations. Thirty-four subjects (29 men and five women), all with diagnosed CAD, volunteered to participate. Oxygen uptake (VO2) was measured by indirect calorimetry during walking on a motorized treadmill at three different speeds (3·2, 4·8 and 6·4 km h−1). Physical activity was measured simultaneously using the CSA activity monitor, secured directly to the skin on the lower back (i.e. lumbar vertebrae 4–5) with an elastic belt. The mean (±SD) activity counts were 1208 ± 429, 3258 ± 753 and 5351 ± 876 counts min−1, at the three speeds, respectively (P<0·001). Activity counts were significantly correlated to speed (r=0·92; P<0·001), VO2 (ml kg−1 min−1; r=0·87; P<0·001) and EE (kcal min−1; r=0·85, P<0·001). A stepwise linear regression analysis showed that activity counts and body weight together explained 75% of the variation in EE. Predicted EE from previously published equations differed significantly when used in this group of CAD patients. In conclusion, the CSA activity monitor is a valid instrument for assessing the intensity of physical activity during treadmill walking in CAD patients. Energy expenditure can be predicted from body weight and activity counts.

  • 45.
    Tingström, Pia
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Kamwendo, Kitty
    Department of Caring Sciences, Örebro University, Örebro, Sweden.
    Göransson, Anne
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Bergdahl, Björn
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Validation and feasibility of problem-based learning in rehabilitation of patients with coronary artery disease2002In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 47, no 4, p. 337-345Article in journal (Refereed)
    Abstract [en]

    A patient education programme applying problem-based learning (PBL) was developed for patients with coronary artery disease (CAD). Groups with 6–8 patients and a tutor from the rehabilitation team met nine times for 1.5 h each. The feasibility and validity of the model was evaluated using patient questionnaires, interviews with tutors and video observations of tutorials. The participants were active (69% of all input) and discussions of acquired knowledge and lifestyle changes took place in all groups. A total of 89% of the patients reported implementation of lifestyle changes and over 90% rated their learning and overall experience of the programme as acceptable or high and the demands as acceptable. Shortcomings were the limited use of some of the steps in the problem-solving process and tutors’ difficulties in adapting to their new role; their answering of questions was higher than planned (35% of their total input). The programme was feasible in clinical routine.

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