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  • 1.
    Reichenpfader, Ursula
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Wickström, Anette
    Linköpings universitet, Institutionen för tema, Tema Barn. Linköpings universitet, Filosofiska fakulteten.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Carlfjord, Siw
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Embedding hospital-based medication review: The conflictual and developmental potential of a practice2019Ingår i: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 33, nr 3, s. 339-352Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The purpose of this paper is to explore the embedding of hospital-based medication review attending to the conflictual and developmental nature of practice. Specifically, this paper examines manifestations of contradictions and how they play out in professional practices and local embedding processes.

    Design/methodology/approach: Using ethnographic methods, this paper employs the activity-theoretic notion of contradictions for analyzing the embedding of medication review. Data from participant observation (in total 290?h over 48 different workdays) and 31 semi-structured interviews with different healthcare professionals in two Swedish hospital-based settings (emergency department, department of surgery) are utilized.

    Findings: The conflictual and developmental potential related to three interrelated characteristics (contested, fragmented and distributed) of the activity object is shown. The contested nature is illustrated showing different conceptualizations, interests and positions both within and across different professional groups. The fragmented character of medication review is shown by tensions related to the appraisal of the utility of the newly introduced practice. Finally, the distributed character is exemplified through tensions between individual and collective responsibility when engaging in multi-site work. Overall, the need for ongoing ᅵrepairᅵ work is demonstrated.

    Originality/value: By using a practice-theoretical approach and ethnographic methods, this paper presents a novel perspective for studying local embedding processes. Following the day-to-day work of frontline clinicians captures the ongoing processes of embedding medication review and highlights the opportunities to learn from contradictions inherent in routine work practices.

  • 2.
    Gudmundsen, Anita C.
    et al.
    UiT Arctic Univ Norway, Norway.
    Norbye, Bente
    UiT Arctic Univ Norway, Norway.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Obstfelder, Aud
    UiT Arctic Univ Norway, Norway; NTNU Norwegian Univ Sci and Technol, Norway.
    Interprofessional student meetings in municipal health service-Mutual learning towards a Community of Practice in patient care2019Ingår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 33, nr 1, s. 93-101Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Mutual engagement is fundamental in interprofessional collaboration. This paper investigated how mutual engagement evolves in interprofessional student meetings when medical, nursing, occupational therapy and physiotherapy students shape their own collaboration and learning in patient care. We conducted a qualitative study with an ethnographic design. The data material consists of 200 hours of observations across nine student groups and two informal conversations with each student group during a two-week clinical placement in the period of 2014-2015. The interprofessional student meetings and the informal conversations were audio recorded, and field notes were prepared from our observations of the student activities. In the data analysis, we relied on an interpretative thematic analysis and used the sociocultural theory of learning as an interpretative framework. The analysis showed that mutuality evolved through three types of mutual engagement: facilitating interactions, actual interactions and clarifying further interactions. In conclusion, complex mutual engagement in patient care evolved and was maintained in interprofessional student meetings when the students had an explicit opportunity to shape their own interprofessional collaboration and learning. The students opportunity to shape the interprofessional collaborative practice in patient care themselves appeared to be a criterion for success.

  • 3.
    Boud, David
    et al.
    Deakin University, Geelong, Australia / University of Technology, Sydney, Australia / Middlesex University, London, UK.
    Nyström, Sofia
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap. Region Östergötland, Diagnostikcentrum, Klinisk immunologi och transfusionsmedicin.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Gustavsson, Johanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för klinisk kemi. Linköpings universitet, Medicinska fakulteten.
    Kelly, Michelle
    Curtin University, Perth, Australia.
    O’Keeffe, Dara
    Royal College of Surgeons in Ireland, Dublin, Ireland.
    Learning through observation2019Ingår i: Interprofessional Simulation in Health Care: Materiality, Embodiment, Interaction / [ed] Madeleine Abrandt Dahlgren, Hans Rystedt, Li Felländer-Tsai & Sofia Nyström, Cham: Springer, 2019, s. 115-137Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    This chapter has a particular focus on the observers’ role in simulation-based learning activities. Simulation-based learning is often organised so that participants rotates between active participation in the scenario and participation as observers. The research examples provided show that the conditions for learning are related to the locations where and the ways the observers are situated, and to how the instructions to the observers are formulated. Arguments are put forward that the observers’ role in simulation has unexploited potential for developing skills of noticing.

  • 4.
    Eikeland Husebø, Sissel
    et al.
    University of Stavanger, Stavanger, Norway.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Edelbring, Samuel
    Örebro University, Örebro, Sweden.
    Nordenström, Elin
    University of Gothenburg, Gothenburg, Sweden.
    Nordahl Amorøe, Torben
    University of Gothenburg, Gothenburg, Sweden.
    Rystedt, Hans
    University of Gothenburg, Gothenburg, Sweden.
    Dieckmann, Peter
    Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark, Copenhagen, Denmark / Department for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark / Department for Quality and Health Technology, University of Stavanger, Stavanger, Norway.
    Reflecting on Interprofessional Simulation2019Ingår i: Reflecting on Interprofessional Simulation: Materiality, Embodiment, Interaction / [ed] Madeleine Abrandt Dahlgren, Hans Rystedt, Li Felländer-Tsai and Sofia Nyström, Cham: Springer Publishing Company, 2019, s. 139-171Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    This chapter explores and discusses how models of debriefing can support interprofessional learning in simulation-based education activities. The role of video as a tool for feedback and reflection is described and the ways video can be integrated in the learning environment to optimize opportunities for learning.

  • 5.
    Abrandt Dahlgren, Madeleine
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Nordenström, Elin
    University of Gothenburg, Gothenburg, Sweden.
    Rooney, Donna
    University of TechnologySydneyAustralia.
    Rystedt, Hans
    University of Gothenburg, Gothenburg, Sweden.
    Video as a Tool for Researching Simulation Practices2019Ingår i: Video as a Tool for Researching Simulation Practices: Materiality, Embodiment, Interaction / [ed] Madeleine Abrandt Dahlgren, Hans Rystedt, Li Felländer-Tsai and Sofia Nyström, Cham: Springer Publishing Company, 2019, s. 31-55Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    This chapter provides examples of how arrangements for collection and analyses of video data were organized across different sites. The common approach to data collection builds on established methods for recording of audiovisual materials in the social sciences with a focus on interaction and learning. The chapter describes how arrangements for data collection across different sites were organised, and how video analysis can be used as a method for collaborative analysis of practices. One approach is entitled purposeful approach to collaborative data analysis. A second approach draws on video-based studies of situated action, and a third approach of analysis is the use of qualitatively different readings of the same data. One does not replace the other, but rather draws out different features.

  • 6.
    Wiggins, Sally
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Ekstedt, Mattias
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Magtarmmedicinska kliniken.
    Hammar Chiriac, Eva
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Larsson Torstensdotter, Gunvor
    Törnqvist, Tove
    Being a professional, or just being a student? A discursive analysis of video-recorded interprofessional learning tutorials in a medical faculty2018Konferensbidrag (Övrigt vetenskapligt)
  • 7.
    Edelbring, Samuel
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Karolinska Inst, Sweden.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Edstrom, Desiree Wiegleb
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Characteristics of two questionnaires used to assess interprofessional learning: psychometrics and expert panel evaluations2018Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 18, artikel-id 40Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Interprofessional learning activities are included in many curricula but are difficult to assess. For languages that are not widely spoken such as Swedish, few validated questionnaires exist that relate to interprofessional outcomes. Therefore, the aim was to examine two such questionnaires in relation to interprofessional competence domains. Methods: Psychometric characteristics, such as homogeneity of items and internal consistency, were assessed for the Swedish versions of the Jefferson Scale of Attitudes Towards Physician-Nurse Collaboration (JSAPNC) and the Readiness for Interprofessional Learning Scale (RIPLS). The questionnaires were distributed directly following IPL activities. Mokken scale analysis based on Loevingers coefficient for homogeneity and Cronbachs alpha were used to evaluate the scales. Two expert panels performed a qualitative analysis of items in relation to four internationally defined interprofessional competences. Results: In total, 88 and 84 responded to the JSAPNC and RIPLS questionnaires, respectively. Estimates of homogeneity were low for both the JSAPNC (H = 0.16) and the RIPLS (H = 0.21). Reliabilities were weak (0.62 and 0.66, respectively) for the total scales. The expert panels categorised 68% of items into similar competence domains. However, their discussion revealed ambiguous wordings and imbalances in the two questionnaires in relation to domains. Conclusion: Interprofessional competence domains are defined but few validated tools exist to assess them. Examined tools relating to interprofessional learning in Swedish do not qualify for assessing overarching IPL outcomes, and summed scores from these tools should be used with caution.

  • 8.
    Kvarnström, Susanne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionstyrelsen. Jonkoping Univ, Sweden.
    Jangland, Eva
    Uppsala Univ, Sweden; Uppsala Univ Hosp, Sweden.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Introducing the nurse practitioner into the surgical ward: an ethnographic study of interprofessional teamwork practice2018Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, nr 2, s. 765-771Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimThe first nurse practitioners in surgical care were introduced into Swedish surgical wards in 2014. Internationally, organisations that have adopted nurse practitioners into care teams are reported to have maintained or improved the quality of care. However, close qualitative descriptions of teamwork practice may add to existing knowledge of interprofessional collaboration when introducing nurse practitioners into new clinical areas. The aim was to report on an empirical study describing how interprofessional teamwork practice was enacted by nurse practitioners when introduced into surgical ward teams. Methods and resultsThe study had a qualitative, ethnographic research design, drawing on a sociomaterial conceptual framework. The study was based on 170 hours of ward-based participant observations of interprofessional teamwork practice that included nurse practitioners. Data were gathered from 2014 to 2015 across four surgical sites in Sweden, including 60 interprofessional rounds. The data were analysed with an iterative reflexive procedure involving inductive and theory-led approaches. The study was approved by a Swedish regional ethics committee (Ref. No.: 2014/229-31). The interprofessional teamwork practice enacted by the nurse practitioners that emerged from the analysis comprised a combination of the following characteristic role components: clinical leader, bridging team colleague and ever-present tutor. These role components were enacted at all the sites and were prominent during interprofessional teamwork practice. ConclusionThe participant nurse practitioners utilised the interprofessional teamwork practice arrangements to enact a role that may be described in terms of a quality guarantee, thereby contributing to the overall quality and care flow offered by the entire surgical ward team.

  • 9.
    Reichenpfader, Ursula
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Wickström, Anette
    Linköpings universitet, Institutionen för tema, Tema Barn. Linköpings universitet, Filosofiska fakulteten.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Carlfjord, Siw
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Medi(c)ation work in the emergency department: Making standardized practice work2018Ingår i: Professions & Professionalism, ISSN 1893-1049, E-ISSN 1893-1049, Vol. 8, nr 2, artikel-id e2298Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Medication review, the systematic examination of an individual patient’s medicines in order to improve medication therapy, has been advocated as an important patient safety measure. Despite widespread use, little is known about how medication review is conducted when implemented in routine health care. Drawing from an ethnographic case study in a Swedish emergency department and using a practice-based approach, we examine how medication review is practically accomplished and how knowledge is mobilized in everyday practice. We show how physicians construct and negotiate medication safety through situated practices and thereby generate knowledge through mundane activities. We illustrate the centrality of practitioners’ collective reflexive work when co-constructing meaning and argue here that practitioners’ local adaptations can serve as important prerequisites to make “standardized” practice function in everyday work. Organizations need to build a practical capacity to support practitioners’ work-based learning in messy and time-pressured  health care  settings.

  • 10.
    Lindh Falk, Annika
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten.
    Hult, Håkan
    Karolinska Inst, Sweden.
    Hammar, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Hopwood, Nick
    Univ Technol Sydney, Australia; Univ Stellenbosch, South Africa.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Nursing assistants mattersAn ethnographic study of knowledge sharing in interprofessional practice2018Ingår i: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 25, nr 2, artikel-id e12216Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Interprofessional collaboration involves some kind of knowledge sharing, which is essential and will be important in the future in regard to the opportunities and challenges in practices for delivering safe and effective health care. Nursing assistants are seldom mentioned as a group of health care workers that contribute to interprofessional collaboration in health care practice. The aim of this ethnographic study was to explore how the nursing assistants knowledge can be shared in a team on a spinal cord injury rehabilitation ward. Using a sociomaterial perspective on practice, we captured different aspects of interprofessional collaboration in health care. The findings reveal how knowledge was shared between professionals, depending on different kinds of practice architecture. These specific cultural-discursive, material-economic, and social-political arrangements enabled possibilities through which nursing assistants knowledge informed other practices, and others knowledge informed the practice of nursing assistants. By studying what health care professionals actually do and say in practice, we found that the nursing assistants could make a valuable contribution of knowledge to the team.

  • 11.
    Wiggins, Sally
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Ekstedt, Mattias
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Magtarmmedicinska kliniken.
    Hammar Chiriac, Eva
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Larsson Torstensdotter, Gunvor
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Törnqvist, Tove
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    On doing ‘being a student amongst other kinds of students’: Managing academic identities in an interprofessional tutorial group2018Konferensbidrag (Övrigt vetenskapligt)
  • 12.
    Reichenpfader, Ursula
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Wickström, Anette
    Linköpings universitet, Institutionen för tema, Tema Barn. Linköpings universitet, Filosofiska fakulteten.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Carlfjord, Siw
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Our surgeons want this to be short and simple: practices of in-hospital medication review as coordinated sociomaterial actions2018Ingår i: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 40, nr 3, s. 323-336Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Medication review, a systematic assessment of a patients medicines by a health care professional, is intended to prevent medication-related harms. A critical element of medication review concerns whether medication review is conducted in a coordinated way. This article draws from a case example of implementing medication review in two surgical wards of a Swedish regional hospital and aims to analyse how medication review is being accomplished with respect to the coordination of its actions. Using a practice-based ethnographic approach, we present several coordination mechanisms by illustrating how practices are connected to materials involved in medication review. Also, we show how common orientations, ends, and understandings expressed in different medication review practices contribute to the coordination of the practices. In conclusion, this article highlights the complexity of establishing and sustaining medication review as a coordinated practice in routine health care. By closely examining sociomaterial connections, this article sheds new light on the neglected issue of artefacts and arrangements in constituting and transforming a highly complex medication practice.

  • 13.
    Abrandt Dahlgren, Madeleine
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Gustavsson, Maria
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, HELIX Competence Centre.
    Fejes, Andreas
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Professional practice, education and learning: A sociomaterial perspective2018Ingår i: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 40, nr 3, s. 239-241Artikel i tidskrift (Övrigt vetenskapligt)
  • 14.
    Dahlberg, Johanna
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten.
    Nelson, Marie
    Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Blomberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Ten years of simulation-based shoulder dystocia training-impact on obstetric outcome, clinical management, staff confidence, and the pedagogical practice - a time series study2018Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, artikel-id 361Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To assess the impact of 10 years of simulation-based shoulder dystocia training on clinical outcomes, staff confidence, management, and to scrutinize the characteristics of the pedagogical practice of the simulation training. Methods: In 2008, a simulation-based team-training program (PROBE) was introduced at a medium sized delivery unit in Linkoping, Sweden. Data concerning maternal characteristics, management, and obstetric outcomes was compared between three groups; prePROBE (before PROBE was introduced, 2004-2007), early postPROBE (2008-2011) and late postPROBE (2012-2015). Staff responded to an electronic questionnaire, which included questions about self-confidence and perceived sense of security in acute obstetrical situations. Empirical data from the pedagogical practice was gathered through observational field notes of video-recordings of maternity care teams participating in simulation exercises and was further analyzed using collaborative video analysis. Results: The number of diagnosed shoulder dystocia increased from 0.9/1000 prePROBE to 1.8 and 2.5/1000 postPROBE. There were no differences in maternal characteristics between the groups. The rate of brachial plexus injuries in deliveries complicated with shoulder dystocia was 73% prePROBE compared to 17% in the late postPROBE group (p amp;gt; 0.05). The dominant maneuver to solve the shoulder dystocia changed from posterior arm extraction to internal rotation of the anterior shoulder between the pre and postPROBE groups. The staff questionnaire showed how the majority of the staff (48-62%) felt more confident when handling a shoulder dystocia after PROBE training. A model of facilitating relational reflection adopted seems to provide ways of keeping the collaboration and learning in the interprofessional team clearly focused. Conclusions: To introduce and sustain a shoulder dystocia training program for delivery staff improved clinical outcome. The impaired management and outcome of this rare, emergent and unexpectedly event might be explained by the learning effect in the debriefing model, clearly focused on the team and related to daily clinical practice.

  • 15.
    Nyström, Sofia
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Dahlberg, Johanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten.
    Edelbring, Samuel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Hult, Håkan
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Continuing professional development: pedagogical practices of interprofessional simulation in health care2017Ingår i: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 39, nr 3, s. 303-319Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The increasing complexity of health care practice makes continuing professional development (CPD) essential for health care professionals. Simulation-based training is a CPD activity that is often applied to improve interprofessional collaboration and the quality of care. The aim of this study is to explore simulation as a pedagogical practice for the CPD of health care professionals. Specifically, the study focuses on how a professional development activity, the simulation, is enacted to support interprofessional collaboration and learning. A practice theory perspective is used as the theoretical framework. In this, the professional practice is conceptualised as being embodied, relational and situated in sociomaterial arrangements. Ten introduction and reflection sessions following interprofessional full-scale manikin-based simulations with professionals were video-recorded. The recordings were analysed following a stepwise qualitative collaborative approach developed for the purpose. The key findings suggest that the professional competence activity is enacted and interconnected with and governed by historical traditions of institutional teaching practices as well as simulation practices. Despite the intentions of team and interprofessional training, the institutional teaching and simulation practices constrain and hinder the intended outcomes of professional development in interprofessional collaboration.

  • 16.
    Thörne, Karin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Jönköping University, Sweden.
    Andersson-Gare, Boel
    Jonköping University, Sweden.
    Hult, Håkan
    Karolinska Institute, Sweden.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Co-Producing Interprofessional Round Work: Designing Spaces for Patient Partnership2017Ingår i: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 26, nr 2, s. 70-82Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Within wide-ranging quality improvement agendas, patient involvement in health care is widely accepted as crucial. Ward rounds that include patients active participation are growing as an approach to involve patients, ensure safety, and improve quality. An emerging approach to studying quality improvement is to focus on "clinical microsystems," where patients, professionals, and information systems interact. This provides an opportunity to study ward rounds more deeply. A new model of conducting ward rounds implemented through quality improvement work was studied, using the theory of practice architectures as an analytical tool. Practice architecture focuses on the cultural-discursive, social-political, and material-economic conditions that shape what people do in their work. Practice architecture is a sociomaterial theoretical perspective that has the potential to change how we understand relationships between practice, learning, and change. In this study, we examine howchanges in practices are accomplished. The results show that practice architecture formed co-productive learning rounds, a possible model integrating quality improvement in daily work. This emerged in the interplay between patients through their " double participation" (as people and as information on screens), and groups of professionals in a ward round room. However, social interplay had to be renegotiated in order to accomplish the goals of all ward rounds.

  • 17.
    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
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Doctors' and nurses' perceptions of military pre-hospital emergency care - When training becomes reality2017Ingår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 32, s. 70-77Artikel, forskningsöversikt (Refereegranskat)
    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.

  • 18.
    OBrien, Bridget C.
    et al.
    University of Calif San Francisco, CA 94143 USA.
    Warren Little, Judith
    University of Calif Berkeley, CA 94720 USA.
    Wamsley, Maria
    University of Calif San Francisco, CA 94143 USA.
    Cook, Joseph G.
    University of Calif San Francisco, CA 94143 USA.
    Yuan, Patrick
    University of Calif San Francisco, CA 94143 USA.
    Rivera, Josette
    University of Calif San Francisco, CA 94143 USA.
    Cianciolo, Anna T.
    Southern Illinois University, IL 62794 USA.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Ng, Stella L.
    University of Toronto, Canada.
    Stillsmoking, Kristina L.
    University of Texas Rio Grande Valley, TX USA.
    Emergent is Authentic: A Sociomaterial Perspective on Simulation-Enhanced Interprofessional Education2017Ingår i: Teaching and learning in medicine, ISSN 1040-1334, E-ISSN 1532-8015, Vol. 29, nr 4, s. 363-367Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This Conversations Starter article presents a selected research abstract from the 2017 Association of American Medical Colleges Western Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of three experts who shared their thoughts stimulated by the study. The commentary explores the implications of sociomaterial perspectives for conceptualizing authenticity in the design and evaluation of simulation-enhanced interprofessional education.

  • 19.
    Rogers, Gary
    et al.
    School of Medicine and Health Institute for the Development of Education and Scholarship (Health IDEAS), Griffith University , Gold Coast , Australia..
    Thistlethwaite, Jill
    School of Communication, University of Technology , Sydney , Australia..
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Grymompre, Ruby
    College of Pharmacy, University of Manitoba , Manitoba , Canada..
    Moran, Monica
    School of Human Health and Social Sciences, Central Queensland University , Rockhampton , Australia..
    Samarasekera, Duepa
    Centre for Medical Education (CenMED), National University of Singapore , Singapore , Singapore.
    International consensus statement on the assessment of interprofessional learning outcomes.2017Ingår i: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 36, nr 4, s. 347-359Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Regulatory frameworks around the world mandate that health and social care professional education programs graduate practitioners who have the competence and capability to practice effectively in interprofessional collaborative teams. Academic institutions are responding by offering interprofessional education (IPE); however, there is as yet no consensus regarding optimal strategies for the assessment of interprofessional learning (IPL). The Program Committee for the 17th Ottawa Conference in Perth, Australia in March, 2016, invited IPE champions to debate and discuss the current status of the assessment of IPL. A draft statement from this workshop was further discussed at the global All Together Better Health VIII conference in Oxford, UK in September, 2016. The outcomes of these deliberations and a final round of electronic consultation informed the work of a core group of international IPE leaders to develop this document. The consensus statement we present here is the result of the synthesized views of experts and global colleagues. It outlines the challenges and difficulties but endorses a set of desired learning outcome categories and methods of assessment that can be adapted to individual contexts and resources. The points of consensus focus on pre-qualification (pre-licensure) health professional students but may be transferable into post-qualification arenas.

  • 20.
    Escher, Cecilia
    et al.
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
    Rystedt, Hans
    Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden.
    Creutzfeldt, Johan
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
    Meurling, Lisbet
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
    Nyström, Sofia
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Dahlberg, Johanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten.
    Edelbring, Samuel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Nordahl Amorøe, Torben
    Simulator Centre West, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hult, Håkan
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden.
    Felländer-Tsai, Li
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Method matters: impact of in-scenario instruction on simulation-based teamwork training2017Ingår i: Advances in Simulation, E-ISSN 2059-0628, Vol. 2, nr 25Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    The rationale for introducing full-scale patient simulators in training to improve patient safety is to recreate clinical situations in a realistic setting. Although high-fidelity simulators mimic a wide range of human features, simulators differ from the body of a sick patient. The gap between the simulator and the human body implies a need for facilitators to provide information to help participants understand scenarios. The authors aimed at describing different methods that facilitators in our dataset used to provide such extra scenario information and how the different methods to convey information affected how scenarios played out.

    Methods

    A descriptive qualitative study was conducted to examine the variation of methods to deliver extra scenario information to participants. A multistage approach was employed. The authors selected film clips from a shared database of 31 scenarios from three participating simulation centers. A multidisciplinary research team performed a collaborative analysis of representative film clips focusing on the interplay between participants, facilitators, and the physical environment. After that, the entire material was revisited to further examine and elaborate the initial findings.

    Results

    The material displayed four distinct methods for facilitators to convey information to participants in simulation-based teamwork training. The choice of method had impact on the participating teams regarding flow of work, pace, and team communication. Facilitators’ close access to the teams’ activities when present in the simulation suite, either embodied or disembodied in the simulation, facilitated the timing for providing information, which was critical for maintaining the flow of activities in the scenario. The mediation of information by a loudspeaker or an earpiece from the adjacent operator room could be disturbing for team communication.

    Conclusions

    In-scenario instruction is an essential component of simulation-based teamwork training that has been largely overlooked in previous research. The ways in which facilitators convey information about the simulated patient have the potential to shape the simulation activities and thereby serve different learning goals. Although immediate timing to maintain an adequate pace is necessary for professionals to engage in training of medical emergencies, novices may gain from a slower tempo to train complex clinical team tasks systematically.

  • 21.
    Lindh Falk, Annika
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Hopwood, Nick
    University of Technology, Sydney, Australia.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Unfolding Practices: A Sociomaterial View of Interprofessional Collaboration in Health Care2017Ingår i: Professions & Professionalism, ISSN 1893-1049, E-ISSN 1893-1049, Vol. 7, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Abstract: Knowledge sharing is an essential part of interprofessional practice and will be even more important in the future in regard to the opportunities and chal-lenges in practices for delivering safe and effective healthcare. The aim of this ethnographic study was to explore how professional knowledge can be shared in an interprofessional team at a spinal cord injury rehabilitation unit. A sociomaterial per-spective on practice was used to analyse the data, and by theorizing upon this, we captured different aspects of interprofessional collaboration in health care. The find-ings illuminate how knowledge emerges and is shared between professionals, and how it passes along as chain of actions between professionals, in various ways. The findings offer a novel perspective on how interprofessional collaboration as a prac-tice, involving ongoing learning, unfolds. This reveals the mechanisms by which different forms of expertise are mobilized between professions as health care work.

  • 22.
    Edelbring, Samuel
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Karolinska Institutet.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Bodies in Simulation: Exploring Sociomaterial Theory in Collaborative Video-Analysis2016Ingår i: Independent Session: What You See is What You Get? Comparing Techniques of Video as a Means of Data Collection and Analysis in Research on Interprofessional Simulation / [ed] Abrandt Dahlgren, M., Rystedt, H., Felländer-Tsai, L., 2016Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    The third presentation builds on practice theory. Practice theory views knowledge as being embodied and relational, intertwined with ethical reasoning and materiality. The findings show that the student teams relate to the manikin as a technical, medical and human body, and that interprofessional knowings and enactments emerge as a fluid movement between bodily positioning in synchrony, and bodily positioning out of synchrony, in relation to the sociomaterial arrangements. The findings are related to contemporary theorisations of practice comprising an integrated view of body and mind, and it is discussed how the findings can be used in simulation exercises to support participants’ learning in new ways.

  • 23.
    Nyström, Sofia
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Dahlberg, Johanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten.
    Edelbring, Samuel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Hult, Håkan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Debriefing practices in interprofessional simulation with students: A sociomaterial perspective2016Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, nr 148, s. 1-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The debriefing phase is an important feature of simulation activities for learning. This study applies a sociomaterial perspective on debriefing in interprofessional simulation with medical and nursing students. Sociomaterial perspectives are increasingly being used in order to understand professional practice and learning in new ways, conceptualising professional practice as being embodied, relational and situated in sociomaterial relations. The aim of the study is to explore how debriefing is carried out as a practice supporting students’ interprofessional learning.

    Methods: Eighteen debriefing sessions following interprofessional full-scale manikin-based simulation with nursing and medical students from two different universities were video-recorded and analysed collaboratively by a team of researchers, applying a structured scheme for constant comparative analysis.

    Results: The findings show how debriefing is intertwined with, and shaped by social and material relationships. Two patterns of enacting debriefing emerged. Debriefing as algorithm was enacted as a protocol-based, closed inquiry approach. Debriefing as laissez-faire was enacted as a loosely structured collegial conversation with an open inquiry approach.

    Conclusion: The findings indicate that neither an imposed structure of the debriefing, nor the lack of structure assured interprofessional collaboration to emerge as a salient topic for reflection, even though that was an explicit learning objective for the simulation. 

  • 24.
    Nyström, Sofia
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Dahlberg, Johanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten.
    Hult, Håkan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Enacting simulation: A sociomaterial perspective on students’ interprofessional collaboration2016Ingår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 30, nr 4, s. 441-447Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Full-scale simulation exercises are becoming more common as an educational feature of the under- graduate training of health professionals. This study explores how interprofessional collaboration is enacted by the participating students. Practice theory is used as the theoretical framework for a field study of two naturalistic educational settings, when medical and nursing students come together to practice in a simulated emergency situation, where a manikin is replacing the patient. Eighteen sessions of simulations were observed, and data were collected through standardised video recordings that were analysed collaboratively. To ensure transparency and scientific rigour, a stepwise constant comparative analysis was conducted, in which individual observations within and across single video recordings were compared, negotiated and eventually merged. The findings show that the student teams relate to the manikin as a technical, medical, and human body, and that interprofessional knowings and enactments emerge as a fluid movement between bodily positioning in synchrony and bodily positioning out of synchrony in relation to the sociomaterial arrangements. The findings are related to contemporary theorisations of practice comprising an integrated view of body and mind, and it is discussed how the findings can be used in simulation exercises to support participants’ learning in new ways. 

  • 25.
    Nyström, Sofia
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Dahlberg, Johanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten.
    Hult, Håkan
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Observing of interprofessional collaboration in simulation: A socio-material approach2016Ingår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 30, nr 6, s. 710-716Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Simulation exercises are becoming more common as an educational feature of the undergraduate training of health professionals. Not all students participate in these activities, but are assigned as observers of the actual simulation. This article presents a study that explored how social-material arrangements for observation of interprofessional collaboration in a simulated situation are enacted and how these observations are thematised and made relevant for learning. The empirical data consisted of 18 standardised video recordings of medical and nursing students observing their peer students simulate. Practice theory is used to show how observation is embodied, relational, and situated in social-material relations. The findings show two emerging ways of enacting observation—proximate observation and distant observation. The enactments are characterised by different socio-material arrangements concerning the location where the simulation took place and its material set-up as well as embodied “doings” and “relatings” between the observing students and instructors. The observing students are participating in a passive, normative position as an audience and as judges of what is correct professional behaviour.

  • 26.
    Abrandt Dahlgren, Madeleine
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Fenwick, Tara
    University of Stirling, Scotland.
    Hopwood, Nick
    University of Technology Sydney, Australia.
    Theorising simulation in higher education: difficulty for learners as an emergent phenomenon2016Ingår i: Teaching in Higher Education, ISSN 1356-2517, E-ISSN 1470-1294, Vol. 21, nr 6, s. 613-627Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Despite the widespread interest in using and researching simulation in higher education, little discussion has yet to address a key pedagogical concern: difficulty. A sociomaterial view of learning, explained in this paper, goes beyond cognitive considerations to highlight dimensions of material, situational, representational and relational difficulty confronted by students in experiential learning activities such as simulation. In this paper we explore these dimensions of difficulty through three contrasting scenarios of simulation education. The scenarios are drawn from studies conducted in three international contexts: Australia, Sweden and the UK, which illustrate diverse approaches to simulation and associated differences in the forms of difficulty being produced. For educators using simulation, the key implications are the importance of noting and understanding (1) the effects on students of interaction among multiple forms of difficulty; (2) the emergent and unpredictable nature of difficulty; and (3) the need to teach students strategies for managing emergent difficulty.

  • 27.
    Lindh Falk, Annika
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    Dahlberg, Johanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten.
    Ekstedt, Mattias
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Magtarmmedicinska kliniken.
    Heslyk, Annika
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Whiss, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Creating spaces for interprofessional learning: Strategic revision of a common IPL curriculum in undergraduate programs2015Ingår i: Interprofessional Education in Europe: Policy and Practice / [ed] Andre Vyt, Majda Pahor, Tiina Tervaskanto-Maentausta, Antwerpen: Garant Publishers Limited , 2015, s. 49-66Kapitel i bok, del av antologi (Refereegranskat)
  • 28.
    Andersson, Sten-Ove
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. 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
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Fixing the Wounded or Keeping Lead in the Air: Tactical Officers’ Views of Emergency Care on the Battlefield2015Ingår i: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 180, nr 2, s. 224-229Artikel i tidskrift (Refereegranskat)
    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.

  • 29.
    Lundvall, Lise-Lott
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Wirell, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    How do technical improvements change radiographers’ practice: a practice theory perspective2015Ingår i: Radiography, ISSN 1078-8174, E-ISSN 1532-2831, Vol. 21, nr 3, s. 231-235Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Technical improvements in medical imaging have led to the replacement of two-plane imaging techniques by multidimensional imaging. How this affects radiographers’ professional practice has not been investigated.

    Aim: To explore how technical development affects the relations between different actors and their actions in the practice of computed tomography.

    Method: A qualitative design was used with data collection by open interviews (n=8) and open observations (n=10) of radiographers during their work with computed tomography. Data was first analysed inductively, resulting in seven preliminary codes. The initial analysis was followed by a phase of abduction, in which the preliminary codes were interpreted theoretically through the lens of practice theory. This resulted in four final themes.

    Result: First theme: Changed materiality makes practical action easier. The actual image production has become practically easier. Second theme: New machines cause conflict between the structural arrangements of the work and the patient’s needs. The time required for the scanner to carry out image production is easy to foresee, but information about the patient’s individual status and needs is missing and this leads to difficulties in giving individual planned care. Third theme: Changing materiality prefigures learning. The different apparatus in use and the continuously changing methods of image production are coconstitutive of the practitioner’s activities and learning. Fourth theme: How the connections between different practices lead to moments of practical reasoning in the radiography process with CT. The practice of image production with computed tomography takes account of patient safety in relation to radiation doses and medical security risks. The different professions in CT practice are interconnected through common material objects such as computers and machines. However, the radiographers, who meet the patients, have to check the accuracy of the planned examination in relation to the clinical observed information about patient safety risks during the examination.

  • 30.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    I takt med framtiden: Utveckling av ett nytt interprofessionellt curriculum vid Hälsouniversitetet i Linköping2015Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Hälso- och sjukvårdsutbildningarnas ansvar att utbilda professionella som kan samarbetaoch förstå varandras kompetens, för att utföra och utveckla patientsäker vård, betonas alltmer i den globala debatten om framtidens hälso- och sjukvård. Modern professionsutbildning inom hälso- och sjukvården måste idag därför innehålla moment av god kvalitet där studenter lär med, av och om varandra för att utveckla interprofessionell kompetens. Hälsouniversitetet i Linköping är pionjär, både nationellt och internationellt, när det gäller interprofessionellt lärande tack vare satsningen på integrerade utbildningsmoment som funnits med sedan från starten 1986. Den här rapporten är en sammanställning av den interna process som har genomförts för att initiera ett pedagogiskt utvecklingsprojekt med avsikt att revidera och utveckla dessa gemensamma utbildningsmoment inriktade mot interprofessionellt lärande. Texten är upplagd kronologiskt och inleds med det direktiv som fakultetsledningen gav för att en utvald grupp lärare skulle kunna utarbeta ett förslag på hur de interprofessionella lärandemomenten vid Hälsouniversitetet skulle kunna förbättras. Härefter följer den rapport som utredningsgruppen lämnade, och som sedan skickades på remiss till olika intressenter. Rapporten följs av en sammanställning och bearbetning av de inkomna remissvaren och till sist följer fakultetsstyrelsens beslut om hur curriculum för interprofessionell utbildning inom Hälsouniversitetet ska utvecklas eller förändras. Det är vår förhoppning att dokumentationen av processen för att förnya fakultetens interprofessionella utbildning ska ge inspiration för fortsatt förändrings- och utvecklingsarbete både inom och utom Linköpings universitet.

  • 31.
    Ahn, Song-Ee
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Rimpiläinen, Sanna
    University of Gothenburg.
    Theodorsson, Annette
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurokirurgiska kliniken US.
    Fenwick, Tara
    University of Stirling.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Learning in Technology-Enhanced Medical Simulation:Locations and Knowings2015Ingår i: Professions & Professionalism, ISSN 1893-1049, E-ISSN 1893-1049, Vol. 5, nr 2, s. 1-12Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This qualitative study focuses on how knowings and learning take place in full-scale simulation training of medical and nursing students, by drawing upon actor-network theory (ANT). ANT situates materiality as a part of the social practic-es. Knowing and learning, according to ANT, are not simply cognitive or social phenomena, but are seen as emerging as effects of the relation between material assemblages and human actors being performed into being in particular locations. Data consists of observations of simulations performed by ten groups of students. The analysis focuses on the emerging knowings in the socio-material—arrangements of three locations involved in the simulation—the simulation room, the observation room and the reflection room. The findings indicate that medical knowing, affective knowing and communicative knowing are produced in different ways in the different locations and material arrangements of the simulation cycle.

  • 32.
    Fenwick, Tara
    et al.
    University of Stirling, Scotland.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Towards socio-material approaches in simulation-based education: lessons from complexity theory2015Ingår i: Medical Education, ISSN 0308-0110, E-ISSN 1365-2923, Vol. 49, nr 4, s. 359-367Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    ContextReview studies of simulation-based education (SBE) consistently point out that theory-driven research is lacking. The literature to date is dominated by discourses of fidelity and authenticity - creating the real - with a strong focus on the developing of clinical procedural skills. Little of this writing incorporates the theory and research proliferating in professional studies more broadly, which show how professional learning is embodied, relational and situated in social - material relations. A key concern for medical educators concerns how to better prepare students for the unpredictable and dynamic ambiguity of professional practice; this has stimulated the movement towards socio-material theories in education that address precisely this question. Objectives and MethodsAmong the various socio-material theories that are informing new developments in professional education, complexity theory has been of particular importance for medical educators interested in updating current practices. This paper outlines key elements of complexity theory, illustrated with examples from empirical study, to argue its particular relevance for improving SBE. ResultsComplexity theory can make visible important material dynamics, and their problematic consequences, that are not often noticed in simulated experiences in medical training. It also offers conceptual tools that can be put to practical use. This paper focuses on concepts of emergence, attunement, disturbance and experimentation. These suggest useful new approaches for designing simulated settings and scenarios, and for effective pedagogies before, during and following simulation sessions. ConclusionsSocio-material approaches such as complexity theory are spreading through research and practice in many aspects of professional education across disciplines. Here, we argue for the transformative potential of complexity theory in medical education using simulation as our focus. Complexity tools open questions about the socio-material contradictions inherent in SBE, draw attention to important material dynamics of emergence, and suggest practical educative ways to expand and deepen student learning. Discuss ideas arising from the article at discuss.

  • 33.
    Hopwood, Nick
    et al.
    University of Technology, Sydney, Australien.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Siwe, Karin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Developing professional responsibility in medicine: A sociomaterial curriculum2014Ingår i: Reconceptualising professional learning: sociomaterial knowledges, practices, and responsibilities / [ed] Tara Fenwick & Monika Nerland, London and New York: Routledge, 2014, s. 171-183Kapitel i bok, del av antologi (Övrigt vetenskapligt)
    Abstract [en]

    This book presents leading-edge perspectives and methodologies to address emerging issues o concern for professional learning in contemporary society. The conditions for professional practice and learning are changein dramatically in the wake of globalisation, new modes of knowledge production, new regulatory regiemes and increased economic-political pressures. A number of chllenges for professional learning emerge:

    • more practitioners becoming involved in interprofessional collaboration
    • devlopments in new technologies and virtual workworlds
    • emergence of transnational knowedge cultures and interrelated circuits of knowledge.

    The space and time relations in which professional practice and learning are mebedded are becoming more complext, as are the epistemic underpinnings om professional work. Together these shifts bring about intersections of professional knowledge and responsibilities that call for new conceptions of professional knowing. Exploring what the authors call sociomaterial perspectives on professional learning, they argue that theories that trace not just the social but also the material aspects of practice - tools, texts, bodies, devices - are useful for coming to terms with the challenges above. Reconceptualising professional learning develops these issues through specific contemporary cases focused on one of the book's three main themes: (1) professionals' knowing in practice, (2) professionals' work arrangements and technologies and (3) professional responsibility. Each chapter draws on innovative theory to highlight the sociomaterial webs through which professional learning may be reconceptualised. Authors are based in Australia, Canada, italy, Norway, Sweden and the USA as well as the UTK and their cases are based in a range of professional settings including medicine, teaching, nursing engineering, social services, the creative industries and more. 

    By presenting detailed accounts of these themes from a sociomaterial perspective, the book raises new questions and opens new methodological approaches. These can help make more visible what is often invisible in today's messy dynamics of professional learning, and pont to new ways of configuring educational support and policy for professionals.

  • 34.
    Andersson, Sten-Ove
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. 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
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Doctors’ and Nurses’ Perceptions of Military Pre-hospital Emergency Care2014Manuskript (preprint) (Övrigt vetenskapligt)
    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.

  • 35.
    Nyström, Sofia
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Håkan, Hult
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    From 'there' to 'here' to 'elsewhere: Enacting debriefing in interprofessional medical education simulation2014Ingår i: Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, ISSN 1559-2332, E-ISSN 1559-713X, Vol. 9, nr 6, s. 422-422, artikel-id Board #144Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Hypothesis:

    Simulation is gaining international interest as a way to arrange a safe environment for practicing clinical, communicative and interprofessional competence in professional education within health care. However, simulation was originally developed to support and train professionals. The application of medical simulation in interprofessional education for students is still underresearched and undertheorised (1). Recent research and theory argue that professional learning in simulation is embodied, relational, and situated in social-material relations (2,3). Research on how instructional design of simulation as an integrated part of professional curricula support student learning is needed (4), as well as research focusing on what the relevant characteristics of debriefing that lead to effective learning are (1). The aim of this study is to explore the enactment of debriefing as a support for learning in interprofessional medical education simulation.

    Methods:

    This paper draw on findings from a large research project conducted by research environments at Linköping University (LiU), Karolinska Institute (KI) and University of Gothenburg (GU), Sweden. The data have been collected by standardised video recordings of all phases in the simulation (briefing, simulation and debriefing phases). Totally 30 simulation sessions were video recorded, 10
 sessions by each research team. Out of these recordings, 13 simulation sessions were professional teams and 17 sessions were nursing and medical students simulating as a compulsory part of their education in the last semester before graduation. The student sessions are around 18 hours of recordings and altogether 106 students, 71 females and 35 males, participated in the simulation either as active participants in the simulation or as observers. 66 were nursing students and 40 were medical students. The research project has been ethically approved by Linköping University, Sweden (Dnr 2012/439-31).

    Results:

    A framework for the analysis of the video recordings was developed on the basis of socio-material theory, with a particular focus on interprofessional collaboration. Sayings, doings and relatings in the debriefing with regard to specific activities or events during the sequence of the scenario were noted through ethnographic field notes and selected segments were transcribed (5). A purposeful constant comparative qualitative analysis (6) was made in three steps comparing sequences of the scenario 1) within a single video recording 2) between different video recordings of the same scenario 3) between video recordings of different scenarios. The findings suggest that interprofessional learning in medical education simulation can become jeopardised in the debriefing. Three interrelated aspects of lacking support for learning were identified, a) debriefing as algorithm or as laisséz-faire, b) neglect of team performance as a topic for reflection, and c) time constraints.

    Conclusion:

    The results raise questions whether debriefing in medical simulation as modelled on training of qualified health professionals provides a useful framework applied in undergraduate education with students learning to become health professionals. The experiences of the simulation ‘there’ are intended to become re-contextualised in the debriefing ‘here’. Our findings indicate that the socio-material arrangements of the debriefing instead risk taking the students ‘elsewhere’.  Structure or lack of structure of the debriefing seem both to jeopardise the support of interprofessional learning or even overlook interprofessional collaboration as a topic for reflection. The time constraints of the complex logistics of arranging interprofessional simulation-based education as a regular curricular activity for large classes can potentially turn debriefing into a superficial exercise with little or no connection to the intended learning outcomes.

    REFERENCES

    1) Issenberg B. Ringsted C. Østergaard D. Dieckmann P. Setting a Research Agenda for Simulation-Based Healthcare Education. A Synthesis of the Outcome From an Utstein Style Meeting. Sim Healthcare 2011; 6:155–167.

    2) Nyström S. Dahlberg J. Hult H. Crossing locations of enacting and observing simulations: Ways of constructing interprofessional learning. Paper to be presented at the Second International ProPEL conference 'Professional Matters: Materialities and Virtualities of Professional Learning', University of Stirling, UK; 2014, 25-27 June.

    3) Schatzki T. The site of the social: A philosophical account of the constitution of social life and change. University Park: Pennsylvania State University Press; 2002.

    4) Motola I, Sullivan J, Issenberg S, Devine L, Chung H. Simulation in healthcare education: A best evidence practical guide. AMEE Guide No. 82. Medical Teacher [serial online]. October 1, 2013;35(10):e1511-e1530.

    5) Heath C. Hindmarsh J. Luff P. Video in qualitative research: analysing social interaction in everyday life. Los Angeles: SAGE; 2010.

    6) Boeije H. A Purposeful Approach to the Constant Comparative Method in the Analysis of Qualitative Interviews. Quality & Quantity 2002; 36:391–409.

  • 36.
    Abrandt Dahlgren, Madeleine
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Dyrdal Solbrekke, Tone
    Oslo universitet, Norway.
    Karseth, Berit
    Oslo Universitet, Norway.
    Nyström, Sofia
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    From university to professional practice: Students as journeymen between cultures of education and work2014Ingår i: International handbook of research in professional and practice-based learning, Volume 1 / [ed] Stephen Billett, Christian Harteis, Hans Gruber, Dordrecht: Springer Netherlands, 2014, 1, s. 461-484Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    The overarching research problem addressed in this chapter is the relationship between professional/higher education and professional work. The chapter will discuss the relevance of university education for professional practice with a particular focus on professional identity formation and formation of professional responsibility. We deiscuss how different professional programs and their traditions and culturs shape different curricula structures that have an impact on students professional identity formation and transition to work. We will also discuss ecperiences with and learning of professional responsibility in the web of commitments within educational settings and how new multiple expectations emerge and lead to new learning experiencies when entering work life. The argument of the chapter is based on the rationale and findings from an extensive international research program, conducted between 2001-2008.

  • 37.
    Hildebrand, Eric
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Sved, Catarina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet.
    Gottvall, Tomas
    Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Blomberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Janerot Sjöberg, Birgitta
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska högskolan.
    Impact of a standardized training program on midwive’s ability to assess fetal heart anatomy by ultrasound2014Ingår i: BMC Medical Imaging, ISSN 1471-2342, E-ISSN 1471-2342, Vol. 14, nr 20Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Studies of prenatal detection of congenital heart disease (CDH) in the UK, Italy, and Norway indicate that it should be possible to improve the prenatal detection rate of CDH in Sweden. These studies have shown that training programs, visualization of the outflow tracts and color-Doppler all can help to speed up and improve the detection rate and accuracy. We aimed to introduce a more accurate standardized fetal cardiac ultrasound screening protocol in Sweden.

    Methods: A novel pedagogical model for training midwives in standardized cardiac imaging was developed, a model using a think-aloud analysis during a pre- and post-course test and a subsequent group reflection. The self-estimated difficulties and knowledge gaps of four midwives were identified. A two-day course with mixed lectures, demonstrations and handson sessions was followed by a feedback session one month later consisting of an interview and check-up. The long-term effects were tested two years later.

    Results: At the post-course test the self-assessed uncertainty was lower than at the pre-course test. The qualitative evaluation showed that the color Doppler images were difficult to interpret, but the training seems to have enhanced the familiarity with the new technique. The ability to perform the method remained at the new level at follow-up both three months and two years later.

    Conclusions: Our results indicate that by implementing new imaging modalities and providing hands-on training, uncertainty can be reduced and time decreased, but they also show that continuous on-site training with clinical and technical back-up is important.

  • 38.
    Hjelmfors, Lisa
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Kärner, Anita
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Tingström, Pia
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Problem-based learning used in the context of cardiac rehabilitation: different scenes and different roles2014Ingår i: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 36, nr 2, s. 218-232Artikel i tidskrift (Refereegranskat)
    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.

  • 39.
    Lundvall, Lise-Lott
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Wirell, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Professionals' experiences of imaging in the radiography process – A phenomenological approach2014Ingår i: Radiography, ISSN 1078-8174, E-ISSN 1532-2831, Vol. 20, nr 1, s. 48-52Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction

    Previous studies on radiographers' professional work have shown that this practice covers both technology and patient care. How these two competence areas blend together in practice needs to be investigated. The professionals' experiences of their work have not been studied in depth, and there is a need to focus on their experiences of the main features of their practice.

    The aim

    To explore, from the perspective of the radiographer, the general tasks and responsibilities of their work.

    Method

    Data were generated through a combination of open interviews with radiographers and observations of their work with Computer Tomography (CT) and Magnetic Resonance Imaging (MRI). The interviews and observations were analysed using an interpretative phenomenological method.

    Result

    Radiographers' professional work with diagnostic imaging, in a Swedish context, can be viewed as a problem-solving process involving judgments and responsibility for obtaining images that can be used for diagnosis. The examination process comprises three phases; planning, producing the images, and evaluation. In the first phase the radiographer makes judgments on adapting the method to the individual patient, and the second phase involves responsibilities and practical skills for image production. In the third phase, the quality of the images is judged in relation to the actual patient and the imaging process itself.

    Conclusions

    Radiographers consider that the main features of their professional work are patient safety aspects and their knowledge and skills regarding how to produce images of optimal quality, in the actual circumstances of each examination.

  • 40.
    Bergseth, Brita
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Utbildningsvetenskap.
    Petocz, Peter
    Department of Statistics, Macquarie University, Sydney, Australia.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Ranking quality in higher education: guiding or misleading?2014Ingår i: Quality in Higher Education, ISSN 1353-8322, E-ISSN 1470-1081, Vol. 20, nr 3, s. 330-347Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The study examines two different models of measuring, assessing and ranking quality in higher education. Do different systems of quality assessment lead to equivalent conclusions about the quality of education? This comparative study is based on the rankings of 24 Swedish higher education institutions. Two ranking actors have independently assessed the quality of these institutions during the same year. The analysis focuses on the concepts of quality on which the rankings are based, the choice of quality indicators, as well as methods, data sources and assessors. Although both actors base their rankings on the same overarching definition of quality, their conclusions do not correspond. The statistical method applied in this review, Bland-Altman analysis, indicates no significant agreement between the qualitative and quantitative measurements of quality in higher education. On the contrary, in several cases there are remarkable differences.

  • 41.
    Thörne, Karin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Hult, Håkan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Andersson Gäre, Boel
    Jönköping University, Sweden.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    The Dynamics of Physicians’ Learning and Support of Others’ Learning2014Ingår i: Professions & Professionalism, ISSN 1893-1049, E-ISSN 1893-1049, Vol. 4, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Learning has been defined as a condition for improving the quality of healthcare practice. The focus of this paper is on physicians’ learning and their support of others’ learning in the context of Swedish healthcare. Data were generated through individual and focus group interviews and analyzed from a socio-material practice theory perspective. During their workday, physicians dynamically alternated between their own learning and their support of others’ learning in individual patient processes. Learning and learning support were interconnected with the versatile mobility of physicians across different contexts and their participation in multiple communities of collaboration and through tensions between responsibilities in healthcare. The findings illustrate how learning enactments are framed by the existing “practice architectures.” We argue that productive reflection on dimensions of learning enactments in practice can enhance physicians’ professional learning and improve professional practice.

  • 42.
    Avby, Gunilla
    et al.
    Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, Filosofiska fakulteten.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Ways of understanding evidence-based practice in social work: A qualitative study2014Ingår i: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, Vol. 44, nr 6, s. 1366-1383Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This qualitative, empirical study explores and describes the variation in how evidence-based practice (EBP) is understood in social work. A phenomenographic approach to design and analysis was applied. Fourteen semi-structured interviews were conducted with politicians, managers and executive staff in three social welfare offices in Sweden. The main findings suggest that there are qualitatively different ways in which EBP is understood, described in five categories: (i) fragmented; (ii) discursive; (iii) instrumental; (iv) multifaceted; and (v) critical. The outcome space is hierarchically structured with a logical relationship between the categories. However, the informants found it difficult to account for EBP, depending on what was expressed as deficient knowledge of EBP in the organisation, as well as ability to provide a seemly context for EBP. The results highlight the importance of acknowledging these differences in the organisation to compose a supportive atmosphere for EBP to thrive rather than merely assume the case of evidence-based social work. The categories can be utilised as stimuli for reflection in social work practice, and thereby provide the possibility to promote knowledge use and learning in the evolving evidence-based social work.

  • 43.
    Stenfors-Hayes, Terese
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Hult, Håkan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Hälsouniversitetet.
    A phenomenographic approach to research in medical education2013Ingår i: Medical Education, ISSN 0308-0110, E-ISSN 1365-2923, Vol. 47, nr 3, s. 261-270Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Context  Phenomenography is a qualitative approach to research which has revolutionised the way that researchers and teachers think about the processes and outcomes of learning in higher education. Phenomenography has also been used successfully in medical and health care research for the last 20 years. Phenomenography provides a lens through which to view certain types of research question. It also provides direction for how to empirically carry out the research.

    Methods  This paper introduces phenomenography as a viable qualitative approach for use in medical education research.

    Results  A phenomenographic study maps the qualitatively different ways in which people experience a phenomenon. This type of study can have an important impact on, for example, patient communication, clinical practice and health care education.

    Conclusion  We suggest that a phenomenographic approach can be used to explore many medical education research issues, and can facilitate more solid links between research and educational development and change.

  • 44.
    Andersson, Sten-Ove
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. 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
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Interaction, action, and reflection: how medics learn medical care in the Swedish armed forces2013Ingår i: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 178, nr 8, s. 861-866Artikel i tidskrift (Refereegranskat)
    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.

  • 45.
    Ahn, Song Ee
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Rimpilainen, Sanna
    University of Stirling, UK.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Fenwick, Tara
    University of Stirling, UK.
    Interprofessional training in technology-enhanced medical simulation: Locations and knowings2013Ingår i: Conference Programme Book: 8th International Conference on Researching Work and Learning 2013, 2013, s. 15-16Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    This paper take an actor-network theory perspective on the use of medical simulators in professional education as a means of training students in medical education and nursing in handling acute emergency situations in health care.  The main aim of the study is to investigate what activities are performed in what material arrangements in a full cycle of simulation, i.e  the briefing, the simulation in the emergency room, the observations in the control room and the debriefing and what knowing is produced as an effect of these arrangements.

     The use of simulators has become a common teaching strategy in medical education. An ageing population, declining financial resources and lack of trained health care personnel are global trends that call for changing the system of health care practice as well as for professional education in the sector.  To build more effective health services, professionals are required to work more collaboratively and in partnership with health care consumers (WHO 2008; 2010). Recently, leading medical experts have also criticised the training of health personnel for not adequately preparing for cooperation and inter-professional communication (Frenk et al, 2010). In health care, this concern situations demanding effective communication for making prompt decisions that are of critical importance in emergency situations. Training of students and professionals by means of full-scale simulators is a response to accommodate for these needs.  Education in simulation-based environments is seen to offer opportunities to address the needs for training interprofessional collaboration by focusing on communication, situation awareness, decision making and coping with stress (Arafeh et al 2010; Östergaard et al,2011). Cook et al has shown in a meta analysis of more than 600 research articles, that in comparison with no intervention, technology-enhanced simulation is consistently associated with large effects for outcomes of knowledge, skills, and behaviors but moderate effects for patient-related outcomes (Cook et al 2011). A majority of the studies are effect studies with quantitative designs. The authors argue that there is a need for rigorous, theory based qualitative studies in order to clarify how and when to effectively use technology enhanced simulations in the training of health care professionals.

     The present study draws upon Actor-network theory (Latour, 2005).  This perspective which situates materiality as a part of the social practices, provides theoretical tools for observation and discussion of the relation between the material assemblages and human actors. Observations of full-scale simulations of acute trauma handling in the emergency room with ten groups of medical and nursing students make up the data for analysis. Preliminary findings indicate that the different locations and material arrangements of the simulation cycle produce different kinds of knowing and learning than the intended curriculum objectives. The findings can contribute to the theoretical knowledge of how to design simulation-based medical education.

     

     

     

     

     

  • 46.
    Lindh Falk, Annika
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Hult, Håkan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Hammar, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Hopwood, Nick
    University of Technology Sydney, Australia .
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    One site fits all? A student ward as a learning practice for interprofessional development2013Ingår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 27, nr 6, s. 476-481Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Interprofessional training wards (IPTWs), aiming to enhance interprofessional collaboration, have been implemented in medical education and evaluated over the last decade. The Faculty of Health Sciences, Linkoping University has, in collaboration with the local health provider, arranged such training wards since 1996, involving students from the medical, nursing, physiotherapy, and occupational therapy programs. Working together across professional boundaries is seen as a necessity in the future to achieve sustainable and safe healthcare. Therefore, educators need to arrange learning contexts which enhance students interprofessional learning. This article shows aspects of how the arrangement of an IPTW can influence the students collaboration and learning. Data from open-ended questions from a questionnaire survey, during autumn term 2010 and spring term 2011 at an IPTW, was analyzed qualitatively using a theoretical framework of practice theory. The theoretical lens gave a picture of how architectures of the IPTW create a clash between the "expected" professional responsibilities and the "unexpected" responsibilities of caring work. Also revealed was how the proximity between students opens up contexts for negotiations and boundary work. The value of using a theoretical framework of professional learning in practice within the frames of healthcare education is discussed.

  • 47.
    Johannesson, Eva
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk pedagogik. Linköpings universitet, Hälsouniversitetet.
    Hult, Håkan
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk pedagogik. Linköpings universitet, Hälsouniversitetet.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk pedagogik. Linköpings universitet, Hälsouniversitetet.
    Simulating the real - manual clinical skills training: Conditions and practices of learning through simulation2013Ingår i: Realising exemplary practice-based education / [ed] Joy Higgs, Rotterdam, Nederländerna: Sense Publishers, 2013, s. 187-194Kapitel i bok, del av antologi (Övrigt vetenskapligt)
    Abstract [en]

    For educators, scholars, practitioners and researchers this book offers an opportunity to explore and engage with practice-based education theories and concepts in real life teaching spaces. It is a place to see theory embodied and situated within PBE practices. It is also an opportunity to see how educators and scholars from other disciplines are applying theory to understand teaching and learning in their particular area. This volume provides an opportunity for readers to deepen their understanding of practice-based education and broaden and critically appraise their strategies for engaging

  • 48.
    Österberg, Annika
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk pedagogik. Linköpings universitet, Hälsouniversitetet.
    Ways of experiencing participation and factors affecting the activity level after nonreconstructed anterior cruciate ligament injury: a qualitative study2013Ingår i: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 43, nr 3, s. 172-183Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN: Phenomenographic, cross-sectional. OBJECTIVES: To describe ways of experiencing participation in activities of individuals with a nonreconstructed anterior cruciate ligament injury and to describe the emotional aspects related to participation. Further, the objective was to explore factors affecting the activity level. BACKGROUND: The importance of assessing different factors (knee status, muscle performance, psychological factors, performance-based tests, and subjective rating of knee function) after an anterior cruciate ligament injury has been emphasized. However, the results of these assessments do not answer the question of how the individuals themselves experience their participation in activities. METHODS: Semi-structured interviews were conducted with 19 strategically selected informants (age range, 18-43 years) who had sustained an anterior cruciate ligament injury 18 to 67 months previously. A phenomenographic approach, which describes individuals' ways of experiencing a phenomenon, was used. RESULTS: Five qualitatively different categories were identified: (A) unconditioned participation, (B) participation as conditioned by risk appraisal, (C) participation as conditioned by experienced control of the knee, (D) participation as conditioned by experienced knee impairment, and (E) participation as conditioned by neglecting the knee injury. Within each category, 5 interrelated aspects were discerned: focus, level of performance, activities, strategies, and feelings. Categories A, C, and E reflected experiences of full participation, whereas categories B and D reflected experiences of modified participation. There were mostly positive feelings regarding participation. Negative feelings were expressed in category D. Factors affecting the activity level were grouped according to the framework of the International Classification of Functioning, Disability and Health and described as facilitating or hindering the activity level. Facilitating factors included regaining and maintaining physical function, regaining confidence in knee function, and learning/relearning movement patterns. Hindering factors included fear of injury/reinjury, uncontrollable giving way, and loss of motivation. CONCLUSION: With different strategies, most of the informants achieved a satisfactory activity level, despite impairments and decreased activity level. Both physical and psychological factors were described to affect the activity level, as well as time since injury.

  • 49.
    Sjögren, Elaine
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Uhlin, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Ragnemalm, Eva L
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Tekniska högskolan.
    Tingström, Pia
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk pedagogik. Linköpings universitet, Hälsouniversitetet.
    Academics reflections on the use of eportfolio documentation of pedagogical skills: a pilot study2012Ingår i: The quality of higher education, ISSN 1822-1645, Vol. 9, s. 98-119Artikel i tidskrift (Övrigt vetenskapligt)
  • 50.
    Grundberg, Åke
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Britt, Ebbeskog
    Karolinska Institutet, Stockholm, Sweden.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk pedagogik. Linköpings universitet, Hälsouniversitetet.
    Religa, Dorota
    Karolinska Institutet, Stockholm, Sweden.
    How community-dwelling seniors with multimorbidity conceive the concept of mental health and factors that may influence it: A phenomenographic study2012Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 7, s. 19716-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Multimorbidity, that is, the coexistence of chronic diseases, is associated with mental health issues among elderly people. In Sweden, seniors with multimorbidity often live at home and receive care from nursing aides and district nurses. The aim of this study was to describe the variation in how community-dwelling seniors with multimorbidity perceive the concept of mental health and what may influence it. Thirteen semi-structured interviews were analysed using a phenomenographic approach. Six qualitatively different ways of understanding the concept of mental health and factors that may influence it, reflecting key variations of meaning, were identified. The discerned categories were: mental health is dependent on desirable feelings and social contacts, mental health is dependent on undesirable feelings and social isolation, mental health is dependent on power of the mind and ability to control thoughts, mental health is dependent on powerlessness of the mind and inability to control thoughts, mental health is dependent on active behaviour and a healthy lifestyle, and mental health is dependent on passive behaviour and physical inactivity. According to the respondents' view, the concept of mental health can be defined as how an individual feels, thinks, and acts and also includes a positive as well as a negative aspect. Social contacts, physical activity, and optimism may improve mental health while social isolation, ageing, and chronic pain may worsen it. Findings highlight the importance of individually definitions of mental health and that community-dwelling seniors with multimorbidity may describe how multiple chronic conditions can affect their life situation. It is essential to organize the health care system to provide individual health promotion dialogues, and future research should address the prerequisites for conducting mental health promotion dialogues.

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