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  • 1. Angsmo, Ewa
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Florin, Jan
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Midböe, Lars
    Nilsson, Gunilla
    Fogelberg-Dahm, Marie
    Ehnfors, Margareta
    Björvell, Catrin
    Wärn-Hede, Gunnel
    Östlinder, Gerthrud
    Nursing informatics in Sweden: the agenda for the future2009In: Connecting Health and Humans - Proceedings of NI2009, Helsinki, 2009, Vol. 146, p. 866-867Conference paper (Other academic)
    Abstract [en]

    With the purpose of getting an overview of the current research and development in information systems and terminology for nursing practice and outline strategies for the future, an initiative for a workshop was taken at the national level in Sweden by the Section for Nursing Informatics, the Society of Nursing and the Association of Health Professionals in 2007. For the workshop around 30 nurses were invited, representing clinical practice, education, and research. The workshop resulted in recommendations for future strategies to support the development of nursing informatics in Sweden.

  • 2. Asplund, Kjell
    et al.
    Castrén, Maaret
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Farrokhnia, Nasim
    Göransson, Katarina
    Jonsson, Håkan
    Lind, Lars
    Oredsson, Sven
    Rognes, Jon
    SBU om "lean": Processorienterat arbetssätt på akuten ger kortare ledtider2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 17Article in journal (Other academic)
  • 3. Asplund, Kjell
    et al.
    Castrén, Maaret
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Farrokhnia, Nasim
    Göransson, Katarina
    Jonsson, Håkan
    Lind, Lars
    Oredsson, Sven
    Rognes, Jon
    Triage och flödesprocesser på akutmottagning2010Book (Other academic)
  • 4.
    Berg, L
    et al.
    Department of Medicine Solna, Karolinska Institutet, Solna, Sweden ; Department of Emergency Medicine, Karolinska University Hospital, Solna, Sweden.
    Källberg, Ann-Sofie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet; Department of Emergency Medicine, Falun Hospital.
    Göransson, K
    Department of Medicine Solna, Karolinska Institutet, Solna, Sweden ; Department of Emergency Medicine, Karolinska University Hospital, Solna, Sweden.
    Östergren, J
    Department of Medicine Solna, Karolinska Institutet, Solna, Sweden ; Department of Emergency Medicine, Karolinska University Hospital, Solna, Sweden.
    Florin, Jan
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Interruptions in emergency department work: an observational and interview study2013In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 22, no 8, p. 656-663Article in journal (Refereed)
    Abstract [en]

    Objectiv.e Frequent interruptions are assumed to have a negative effect on healthcare clinicians’ working memory that could result in risk for errors and hence threatening patient safety. The aim of this study was to explore interruptions occurring during common activities of clinicians working in emergency departments.

    Method. Totally 18 clinicians, licensed practical nurses, registered nurses and medical doctors, at two Swedish emergency departments were observed during clinical work for 2 h each. A semistructured interview was conducted directly after the observation to explore their perceptions of interruptions. Data were analysed using non-parametric statistics, and by quantitative and qualitative content analysis.

    Results. The interruption rate was 5.1 interruptions per hour. Most often the clinicians were exposed to interruptions during activities involving information exchange. Calculated as percentages of categorised performed activities, preparation of medication was the most interrupted activity (28.6%). Face-to-face interaction with a colleague was the most common way to be interrupted (51%). Most common places for interruptions to occur were the nurses’ and doctors’ stations (68%). Medical doctors were the profession interrupted most often and were more often recipients of interruptions induced by others than causing self-interruptions. Most (87%) of the interrupted activities were resumed. Clinicians often did not regard interruptions negatively. Negative perceptions were more likely when the interruptions were considered unnecessary or when they disturbed the work processes.

    Conclusions. Clinicians were exposed to interruptions most often during information exchange. Relative to its occurrence, preparation of medication was the most common activity to be interrupted, which might increase risk for errors. Interruptions seemed to be perceived as something negative when related to disturbed work processes.

  • 5. Berg, Lena
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Florin, Jan
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Östergren, Jan
    Göransson, Katarina
    An observational study of activities and multitasking performed by clinicians in two Swedish emergency departments2012In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 19, no 4, p. 246-251Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore the type and frequency of activities and multitasking performed by emergency department clinicians.

    Methods: Eighteen clinicians (licensed practical nurses, registered nurses and medical doctors), six from each occupational group, at two Swedish emergency departments were followed in their clinical work for 2 h each to observe all their activities and multitasking practices. Data were analysed using qualitative and quantitative content analysis.

    Results: Fifteen categories of activities could be identified based on 1882 observed activities during the 36 h of observation. The most common activity was information exchange, which was most often performed face-to-face. This activity represented 42.1% of the total number of observed activities. Information exchange was also the most common activity to be multitasked. Registered nurses performed most activities and their activities were multitasked more than the other clinicians. The nurses’ and doctors’ offices were the most common locations for multitasking in the emergency department.

    Conclusion: This study provides new knowledge regarding the activities conducted by clinicians in the emergency department. The most frequent activity was information exchange, which was the activity most often performed by the clinicians when multitasking occurred. Differences between clinicians were found for activities performed and multitasked, with registered nurses showing the highest frequencies for both.

  • 6. Berg, Lena
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Florin, Jan
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Östergren, Jan
    Göransson, Katarina
    Avbrott på akutmottagning2011In: 6:e nationella konferensen om patientsäkerhet, Stockholm, 2011Conference paper (Refereed)
  • 7. Berg, Lena
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Florin, Jan
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Östergren, Jan
    Göransson, Katarina
    Multitasking and interruptions of emergency department clinicians' activities2011In: College of Emergency Nursing Australasia International Conference, Adelaide, Australia, 2011Conference paper (Refereed)
  • 8. Berg, Lena
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Florin, Jan
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Östergren, Jan
    Göransson, Katarina
    The presence of emergency department crowding at a Swedish University hospital.: A longitudinal study using two crowding indicators as measures.2018Conference paper (Refereed)
  • 9.
    Berg, Lena
    et al.
    Akutkliniken Karolinska Universitetssjukhuset Solna ; Institutionen för Medicin Solna, Karolinska Institutet.
    Källberg, Ann-Sofie
    kutkliniken, Falu Lasarett ; Institutionen för Medicin Solna, Karolinska Institutet.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Florin, Jan
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Östergren, Jan
    Karolinska institutet.
    Göransson, Katarina
    Karolinska institutet.
    Avbrott och störning i arbetet för akutmottagningspersonal - är det någon skillnad?2014Conference paper (Refereed)
  • 10.
    Berg, Lena
    et al.
    Karolinska institutet.
    Källberg, Ann-Sofie
    Karolinska institutet.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Florin, Jan
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Östergren, Jan
    Karolinska institutet.
    Göransson, Katarina
    Karolinska institutet.
    Interruptions and disturbances in emergency department work assignments2014Conference paper (Refereed)
  • 11. Berg, Lena M
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Florin, Jan
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karonlinska institutet.
    Östergren, Jan
    Discacciati, Andrea
    Göransson, Katarina E
    Associations between crowding and ten-day mortality among patients allocated lower triage acuity levels without need of acute hospital care on departure from the emergency department2019In: Annals of Emergency Medicine, ISSN 0196-0644, E-ISSN 1097-6760, Vol. 74, no 3, p. 345-356Article in journal (Refereed)
    Abstract [en]

    STUDY OBJECTIVE: We describe the association between emergency department (ED) crowding and 10-day mortality for patients triaged to lower acuity levels at ED arrival and without need of acute hospital care on ED departure.

    METHODS: This was a registry study based on ED visits with all patients aged 18 years or older, with triage acuity levels 3 to 5, and without need of acute hospital care on ED departure during 2009 to 2016 (n=705,699). The sample was divided into patients surviving (n=705,076) or dying (n=623) within 10 days. Variables concerning patient characteristics and measures of ED crowding (mean length of stay and ED occupancy ratio) were extracted from the hospital's electronic health records. ED length of stay per ED visit was estimated by the average length of stay for all patients who presented to the ED during the same day and shift and with the same acuity level. The 10-day mortality after ED discharge was used as the outcome measure. Multivariable logistic regression analyses were conducted.

    RESULTS: The 10-day mortality rate was 0.09% (n=623). The event group had larger proportions of patients aged 80 years or older (51.4% versus 7.7%) and triaged with acuity level 3 (63.3% versus 35.6%), and greater comorbidity (age-combined Charlson comorbidity index median interquartile range 6 versus 0). We observed an increased 10-day mortality for patients with a mean ED length of stay greater than or equal to 8 hours versus less than 2 hours (adjusted odds ratio 5.86; 95% confidence interval [CI] 2.15 to 15.94) and for elevated ED occupancy ratio. Adjusted odds ratios for ED occupancy ratio quartiles 2, 3, and 4 versus quartile 1 were 1.48 (95% CI 1.14 to 1.92), 1.63 (95% CI 1.24 to 2.14), and 1.53 (95% CI 1.15 to 2.03), respectively.

    CONCLUSION: Patients assigned to lower triage acuity levels when arriving to the ED and without need of acute hospital care on departure from the ED had higher 10-day mortality when the mean ED length of stay exceeded 8 hours and when ED occupancy ratio increased.

  • 12. Berg, Lena M
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Florin, Jan
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Östergren, Jan
    Göransson, Katarina E
    Significant changes in emergency department length of stay and case mix over eight years at a large Swedish University Hospital2019In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 43, p. 50-55Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Describe the longitudinal development of crowding and patient/emergency department (ED) characteristics at a Swedish University Hospital.

    METHODS: A retrospective longitudinal registry study based on all ED visits with adult patients during 2009-2016 (N = 1,063,806). Patient characteristics and measures of ED crowding (ED occupancy ratio, length-of-stay [LOS], patients/clinician's ratios) were extracted from the hospital's electronic health record. Non-parametric analyses were conducted.

    RESULTS: The proportion of unstable patients (triage level 1-2) increased while the proportion of admitted patients decreased. All crowding variables were stable, except for LOS, which increased by 9 min/visit/year (95% CI: 8.8-9.1). LOS for visits by patients ≥ 80 years increased more compared to those 18-79 (248 min vs. 190 min, p < 0.001). Unstable patients increased their median LOS compared to stable patients (triage level 3-5). LOS for discharged patients increased with an average of 7.7 min/year (95% CI: 7.5-7.9) compared to 15.5 min/year (95% CI: 15.2-15.8) for those being admitted.

    CONCLUSION: Fewer admissions, despite an increase of unstable patients, is likely related to lack of in-hospital beds and contributes to ED crowding. The increase in median ED LOS, especially for patients in the subgroups unstable, ≥80 years and admitted to in-hospital care reflects this problem.

  • 13. Berg, Lena M
    et al.
    Florin, Jan
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Östergren, Jan
    Djärv, Therese
    Göransson, Katarina E
    Reasons for interrupting colleagues during emergency department work: a qualitative study2016In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 29, no SI, p. 21-26Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Emergency department team members frequently need to interact with each other, a circumstance causing multiple interruptions. However, information is lacking about the motives underlying these interruptions and this study aimed to explore clinicians' reasons to interrupt colleagues during emergency department work.

    METHOD: Semi-structured interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. The interviews were analyzed inductively using content analysis.

    RESULTS: The working conditions to some extent sustained the clinicians' need to interrupt, for example different routines. Another reason to interrupt was to improve the initiator's work process, such as when the initiators perceived that the interruption had high clinical relevance. The third reason concerns the desire to influence the work process of colleagues in order to prevent mistakes and provide information for the person being interrupted to improve patient care.

    CONCLUSION: The three identified categories for why emergency department clinicians interrupt their colleagues were related to working conditions and a wish to improve/influence the work processes for both initiators and recipients. Several of the reasons given for interrupting colleagues were done in order to improve patient care. Interruptions perceived as negative to the recipient were mostly related to the working conditions.

  • 14. Berg, Lena M
    et al.
    Källberg, Ann-Sofie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Department of Medicine Solna, Karolinska Institutet; Department of Emergency Medicine, Falun Hospital.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Florin, Jan
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Östergren, Jan
    Djärv, Therese
    Brixey, Juliana J
    Göransson, Katarina E
    Factors influencing clinicians' perceptions of interruptions as disturbing or non-disturbing: a qualitative study2016In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 27, p. 11-16Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Emergency departments consist of multiple systems requiring interaction with one another while still being able to operate independently, creating frequent interruptions in the clinical workflow. Most research on interruptions in health care settings has focused on the relationship between interruptions and negative outcomes. However, there are indications that not all interruptions are negatively perceived by those being interrupted. Therefore, this study aimed to explore factors that influence when a clinician perceives interruptions as non-disturbing or disturbing in an emergency department context.

    METHOD: Explorative design based on interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. Data were analyzed using qualitative content analysis.

    RESULT: Factors influencing whether emergency department clinicians perceived interruptions as non-disturbing or disturbing were identified: clinician's constitution, external factors of influence and the nature of the interrupted task. The clinicians' perceptions were related to a complex of attributes inherent in these three factors at the time of the interruption. Thus, the same type of interruption could be perceived as either non-disturbing or disturbing contingent on the surrounding circumstances in which the event occurred.

    CONCLUSION: Emergency department clinicians' perceptions of interruptions as non-disturbing or disturbing were related to the character of identified influencing factors.

  • 15. Bjurbo, Camilla
    et al.
    Eriksson, Ulrika
    Källberg, Ann-Sofie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Muntlin Athlin, Åsa
    Early identification of frail older patients by using the FRESH-instrument in the emergency department: a pilot study2018Conference paper (Refereed)
  • 16. Bostrom, Anne-Marie
    et al.
    Rudman, Ann
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Gustavsson, Jens Petter
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Huddinge, Sweden.
    Factors associated with evidence-based practice among registered nurses in Sweden: a national cross-sectional study2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, article id 165Article in journal (Refereed)
    Abstract [en]

    Background: Evidence-based practice (EBP) is emphasized to increase the quality of care and patient safety. EBP is often described as a process consisting of distinct activities including, formulating questions, searching for information, compiling the appraised information, implementing evidence, and evaluating the resulting practice. To increase registered nurses' (RNs') practice of EBP, variables associated with such activities need to be explored. The aim of the study was to examine individual and organizational factors associated with EBP activities among RNs 2 years post graduation.

    Methods: A cross-sectional design based on a national sample of RNs was used. Data were collected in 2007 from a cohort of RNs, included in the Swedish Longitudinal Analyses of Nursing Education/Employment study. The sample consisted of 1256 RNs (response rate 76%). Of these 987 RNs worked in healthcare at the time of the data collection. Data was self-reported and collected through annual postal surveys. EBP activities were measured using six single items along with instruments measuring individual and work-related variables. Data were analyzed using logistic regression models.

    Results: Associated factors were identified for all six EBP activities. Capability beliefs regarding EBP was a significant factor for all six activities (OR = 2.6 - 7.3). Working in the care of older people was associated with a high extent of practicing four activities (OR = 1.7 - 2.2). Supportive leadership and high collective efficacy were associated with practicing three activities (OR = 1.4 - 2.0).

    Conclusions: To be successful in enhancing EBP among newly graduated RNs, strategies need to incorporate both individually and organizationally directed factors.

  • 17. Boström, Anne-Marie
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Gustavsson, Petter
    Wallin, Lars
    Registered nurses' application of evidence based practice - A national survey2010In: The 2010 Knowledge Utilization Colloquium, Halifax, Kanada, 2010Conference paper (Refereed)
  • 18. Boström, Anne-Marie
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Gustavsson, Petter
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet.
    Registered nurses' application of evidence based practice: a national survey2009In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 6, p. 1159-1163Article in journal (Refereed)
    Abstract [en]

    Background. Evidence-based practice (EBP) is a worldwide approach to improving health care. There is, however, a shortage of studies examining whether or not newly graduated health care professionals are actually applying EBP in their daily work.

    Objectives. To examine the application of EBP in clinical practice by registered nurses (RNs) 2 years post graduation and to explore whether the application of EBP differed with regard to the clinical settings where RNs were working.

    Method. A cross-sectional design using a national sample. Data were collected in 2007 from 987 RNs (response rate 76%). Six items measuring respondents' self-reported extent of applying EBP were used.

    Results. Of the 987 RNs, 19% formulated questions and performed searches in data bases, 56% used other information sources, 31% appraised the literature, 30% participated in practice development and 34% participated in evaluating clinical practice. A greater proportion of the RNs working in elder care applied EBP compared with the RNs working in hospitals, psychiatric care and primary care.

    Conclusions. The RNs applied the components of EBP to a rather low extent 2 years post graduation despite EBP being an important objective in Swedish health care and educational programmes since the 1990s. These findings support other studies reporting the implementation of EBP in organizations as a complex and often slow process. The differences in the RNs extent of applying EBP in relation to their workplace indicate that contextual factors and the role of the RN in the organization are of importance for getting EBP into practice.

  • 19. Carlsson, E
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Ehnfors, M
    Long term experiences of living with eating difficulties after stroke2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, p. 825-834Article in journal (Refereed)
  • 20. Carlsson, E
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Ehnfors, M
    Long-term experiences of living with eating difficulties after stroke2004In: The Tenth Annual Qualitative Health Research Conference, Banff, Alberta, Canada, 2004Conference paper (Other academic)
  • 21. Carlsson, Eva
    et al.
    Ehnfors, Margareta
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Multidisciplinary recording and continuity of care for stroke patients with eating difficulties2010In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 24, no 3, p. 298-310Article in journal (Refereed)
    Abstract [en]

    Eating difficulties after stroke are common and can, in addition to being a risk for serious medical complications, impair functional capability, social life and self-image. Stroke unit care entails systematic multidisciplinary teamwork and continuity of care. The purpose of this study was to describe (i) multidisciplinary stroke care as represented in patient records for patients with eating difficulties, and (ii) the written information that was transferred from hospital to elderly care. Data from 59 patient records were analysed with descriptive statistics and by categorization of phrases. Signs of multidisciplinary collaboration to manage eating problems were scarce in the records. While two notes from physiotherapists were found, nurses contributed with 78% of all notes (n=358). Screening of swallowing and body weight was documented for most patients, whereas data on nutritional status and eating were largely lacking. The majority of notes represented patients' handling of food in the mouth, swallowing and lack of energy. Care plans were unstructured and few contained steps for managing eating. Discharge summaries held poor information on care related to eating difficulties. The language of all professionals was mostly unspecific. However, notes from speech-language therapists were comprehensive and entailed information on follow-up and patient participation.

  • 22.
    Carlsson, Eva
    et al.
    Örebro University, School of Health and Medical Sciences. Dept Qual & Patient Safety, Lindesberg Hosp, Lindesberg, Sweden.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences. Dept Hlth & Social Sci, Hogskolan Dalarna, Falun, Sweden.
    Multidisciplinary recording and continuity of care for stroke patients with eating difficulties2010In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 24, no 3, p. 298-310Article in journal (Refereed)
    Abstract [en]

    Eating difficulties after stroke are common and can, in addition to being a risk for serious medical complications, impair functional capability, social life and self-image. Stroke unit care entails systematic multidisciplinary teamwork and continuity of care. The purpose of this study was to describe (i) multidisciplinary stroke care as represented in patient records for patients with eating difficulties, and (ii) the written information that was transferred from hospital to elderly care. Data from 59 patient records were analysed with descriptive statistics and by categorization of phrases. Signs of multidisciplinary collaboration to manage eating problems were scarce in the records. While two notes from physiotherapists were found, nurses contributed with 78% of all notes (n = 358). Screening of swallowing and body weight was documented for most patients, whereas data on nutritional status and eating were largely lacking. The majority of notes represented patients' handling of food in the mouth, swallowing and lack of energy. Care plans were unstructured and few contained steps for managing eating. Discharge summaries held poor information on care related to eating difficulties. The language of all professionals was mostly unspecific. However, notes from speech-language therapists were comprehensive and entailed information on follow-up and patient participation

  • 23.
    Carlsson, Eva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eldh, Ann Catrine
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Accuracy and continuity in discharge information for patients with eating difficulties after stroke2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 1-2, p. 21-31Article in journal (Refereed)
    Abstract [en]

    Aims: To describe the accuracy and continuity of discharge information for patients with eating difficulties after stroke.

    Design: Prospective, descriptive.

    Methods: The study investigated a sample of 15 triads, each including one patient with stroke along with his patient record and discharge summary and two nursing staff in the municipal care to whom the patient was discharged. Data were collected by observations of patients' eating, record audits and interviews with nurses. Data were analysed using content analysis and descriptive statistics.

    Results: Accuracy of recorded information on patients' eating difficulties and informational continuity were poor, as was accuracy in the transferred information according to nursing staff's perceptions. All patients were at risk of undernutrition and in too poor a state to receive rehabilitation. Nevertheless, patients' eating difficulties were described in a vague and unspecific language in the patient records. Co-ordinated care planning and management continuity related to eating difficulties were largely lacking in the documentation. Despite their important role in caring for patients with eating difficulties, little information on eating difficulties seemed to reach licensed practical nurses in the municipalities.

    Conclusions: Comprehensiveness in the documentation of eating difficulties and accuracy of transferred information were poor based on record audits and as perceived by the municipal nursing staff. Although all patients were at risk of undernutrition, had multiple eating difficulties and were in too poor a state for rehabilitation, explicit care plans for nutritional problems were lacking.

    Relevance to clinical practice: Lack of accuracy and continuity in discharge information on eating difficulties may increase risk of undernutrition and related complications for patients in continuous stroke care. Therefore, the discharge process must be based on comprehensive and accurate documentation.

  • 24. Carlsson, Eva
    et al.
    Ehnfors, Margareta
    Eldh, Ann Catrine
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet, Örebro university.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Accuracy and continuity in discharge information for patients wtih eating difficulties after stroke2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 2, p. 21-31Article in journal (Refereed)
    Abstract [en]

    Aims. To describe the accuracy and continuity of discharge information for patients with eating difficulties after stroke. Design. Prospective, descriptive. 

    Methods. The study investigated a sample of 15 triads, each including one patient with stroke along with his patient record and discharge summary and two nursing staff in the municipal care to whom the patient was discharged. Data were collected by observations of patients' eating, record audits and interviews with nurses. Data were analysed using content analysis and descriptive statistics. 

    Results. Accuracy of recorded information on patients' eating difficulties and informational continuity were poor, as was accuracy in the transferred information according to nursing staff's perceptions. All patients were at risk of undernutrition and in too poor a state to receive rehabilitation. Nevertheless, patients' eating difficulties were described in a vague and unspecific language in the patient records. Co-ordinated care planning and management continuity related to eating difficulties were largely lacking in the documentation. Despite their important role in caring for patients with eating difficulties, little information on eating difficulties seemed to reach licensed practical nurses in the municipalities. 

    Conclusions. Comprehensiveness in the documentation of eating difficulties and accuracy of transferred information were poor based on record audits and as perceived by the municipal nursing staff. Although all patients were at risk of undernutrition, had multiple eating difficulties and were in too poor a state for rehabilitation, explicit care plans for nutritional problems were lacking. Relevance to clinical practice. Lack of accuracy and continuity in discharge information on eating difficulties may increase risk of undernutrition and related complications for patients in continuous stroke care. Therefore, the discharge process must be based on comprehensive and accurate documentation.

  • 25.
    Carlsson, Eva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Sciences, Örebro University Hospital, Örebro, Sweden.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eldh, Ann Catrine
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Information transfer and continuity of care for stroke patients with eating difficulties from the perspectives of nursing staff in Swedish elderly care2012In: Nursing informatics ... : proceedings of the ... International Congress on Nursing Informatics, 2012, p. 61-64Conference paper (Refereed)
    Abstract [en]

    Continuity of care is a key issue in the care for elderly people, for example, those having experienced stroke, particularly with regards to informational and managerial continuity based on patient record data. The study aim was to explore municipal nursing staff's (n=30) perceptions of discharge information provided to them for stroke patients with eating difficulties. Structured interviews were used and data were analysed by content analysis and descriptive statistics. Results showed that nursing staff perceived informational continuity and accuracy of information on patients' eating difficulties as poor and that little information on eating difficulties reached licensed practical nurses, who instead relied on their own assessments of patients' eating ability. Co-ordinated care planning and management continuity were largely lacking, increasing the risk for undernutrition and related complications for the patients.

  • 26.
    Carlsson, Eva
    et al.
    Örebro University, Department of Health Sciences.
    Ehrenberg, Anna
    Örebro University, Department of Health Sciences.
    Ehnfors, Margareta
    Örebro University, Department of Health Sciences.
    Stroke and eating difficulties: long-term experiences2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 7, p. 825-834Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous studies have shown that eating difficulties after stroke are common and often associated with communication problems. These difficulties, however, have mainly been studied from a professional perspective. Although numerous aspects of dysfunction have been identified, little knowledge exists about the experiences of living with eating difficulties. AIM: To explore how people affected by stroke experience living with eating difficulties, during a prolonged period. DESIGN: Explorative, qualitative case study. METHODS: Repeated interviews and participant observations with three persons 1.5-2 years after their last stroke. Data were analysed using qualitative analysis. RESULTS: Eating difficulties after stroke were experienced as Striving to live a normal life, with the subthemes Abandoned to learn on one's own, Experiences of losses and Feeling dependent. The process of getting back to a life that resembled life before the stroke was experienced as long-lasting and hard work. The informants felt that they were abandoned to manage eating training on their own. The informants experienced a loss of functional eating ability and the ability to perform activities related to food and meals. Feelings of dependence were experienced in mealtime situations. CONCLUSION: Living with eating difficulties after stroke is a complex phenomenon. The informants felt abandoned because of lack of support from the nursing staff. They were left on their own to deal with the difficult process of adjusting to a new way of eating and losses regarding mealtime activities. The combination of repeated interviews and participant observations seemed to be an approach that should be tested in larger studies. RELEVANCE TO CLINICAL PRACTICE: This case study indicates a need for nurses to develop and use evidence-based guidelines for eating training during the continuum of care. Nurses need to assess patient's habits and desires related to eating, and to adjust environment according to patient preferences.

  • 27. Carlsson, Eva
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Ehnfors, Margareta
    Stroke patients with eating difficulties – findings from an audit of multi-disciplinary patient records2007In: 6th European Conference of the Association for Common European Nursing Diagnoses, Interventions and Outcomes (ACENDIO), Amsterdam, Netherlands, 2007Conference paper (Refereed)
  • 28. Carlsson, Eva
    et al.
    Eldh, Ann Catrine
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ehnfors, Margareta
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Information transfer and continuity of care for stroke patients with eating difficulties from the perspective of nursing staff in Swedish elderly care2012In: AMIA proceedings, Montreal, Kanada, 2012Conference paper (Refereed)
  • 29.
    Carlsson, Eva
    et al.
    Örebro University, Department of Health Sciences.
    Paterson, Barbara L.
    Scott-Findlay, Shannon
    Ehnfors, Margareta
    Örebro University, Department of Health Sciences.
    Ehrenberg, Anna
    Örebro University, Department of Health Sciences.
    Methodological Issues in Interviews Involving people with Communication Impairments After acquired Brain Damage2007In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 17, no 10, p. 1361-1371Article in journal (Refereed)
    Abstract [en]

    Qualitative research has made a significant contribution to the body of knowledge related to how people experience living with various chronic diseases and disabilities, however, the voices of certain vulnerable populations, particularly those with impairments that affect their ability to communicate, are commonly absent. In recent years, a few researchers have attempted to explore the most effective ways to ensure that the voices of people with communication impairments from acquired brain damages can be captured in qualitative research interviews, yet several methodological issues related to including this population in qualitative research remained unexamined. In this article, the authors draw on insights derived from their research on the experiences of adult survivors of stroke and traumatic brain injury to describe methodological issues related to sampling, informed consent, and fatigue in participant and researcher while also making some recommendations for conducting qualitative interviews with these populations.

  • 30. Dahlin Ivanoff, Synneve
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ekdahl, Anne
    Eklund Grönberg, Annika
    Oredsson, Sven
    Sjöstrand, Fredrik
    Stavenow, Lars
    Wisten, Aase
    Akutvården måste klara också sköra åldringar2014In: Dagens Nyheter, ISSN 1101-2447, no 2014-01-03Article in journal (Other (popular science, discussion, etc.))
  • 31. Ehnfors, M
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Kvalitetsindikatorer för omvårdnadsdokumentation i patientjournalen2009In: Kvalitetsindikatorer för omvårdnad / [ed] Idvall, E, Stockholm: Svensk sjuksköterskeförening och Gothia , 2009, p. 45-58Chapter in book (Other academic)
  • 32. Ehnfors, M
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Florin, Jan
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Applicability of the International Classification of Nursing Practice (ICNP®) in the Areas of Nutrition and Skin Care.2003In: International Journal of Nursing Terminology and Classification, ISSN  2047-3095, Vol. 14(1), p. 5-18Article in journal (Refereed)
  • 33. Ehnfors, M
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Nikula, R
    Nursing Informatics in Europe: some examples2006In: Essentials of Nursing Informatics / [ed] Saba, KV; McCormick, KA, McGraw-Hill , 2006, p. 621-628Chapter in book (Other academic)
  • 34. Ehnfors, M
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Thorell-Ekstrand, I
    Sweden: The VIPS model: Development, validation and experience of its use2003In: Naming nursing. Proceedings of the first ACENDIO Ireland/UK conference, Swansea, Wales, 2003, p. 139-150Conference paper (Refereed)
  • 35. Ehnfors, M
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Thorell-Ekstrand, I
    The VIPS-model: Development, validation and experience of its use2003In: Naming Nursing / [ed] Clark, J, Bern: Verlag Hans Huber , 2003, p. 139-150Chapter in book (Other academic)
  • 36. Ehnfors, M
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Thorell-Ekstrand, I
    VIPS modelis pacientu aprupes dokumentesana2004Book (Other academic)
  • 37.
    Ehnfors, Margareta
    et al.
    Örebro University, School of Health and Medical Sciences.
    Angermo, Lilly Marit
    Rikshospitalet University Hospital, Centre for Shared Decision Making and Nursing Research, Oslo, Norway.
    Berring, Lene
    Gentofte University Hospital, Copenhagen, Denmark.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences. Department of Health and Social Sciences, Dalarna University, Falun.
    Lindhardt, Tove
    Dept of Health Sciences, Lund University, Lund.
    Rotegard, Ann Kristin
    Rikshospitalet University Hospital, Centre for Shared Decision Making and Nursing Research, Oslo, Norway.
    Thorell-Ekstrand, Ingrid
    Örebro University, School of Health and Medical Sciences.
    Mapping VIPS concepts for nursing interventions to the ISO reference terminology model for nursing actions: A collaborative Scandinavian analysis2006In: Consumer-Centered Computer-Suppported Care for Healthy People, Amsterdam, Netherlands: IOS Press, 2006, Vol. 122, p. 401-5Conference paper (Refereed)
    Abstract [en]

    The aims of this study were to analyze the coherence between the concepts for nursing interventions in the Swedish VIPS model for nursing recording and the ISO Reference Terminology Model for Nursing Actions and to identify areas in the two models for further development. Seven Scandinavian experts analyzed the VIPS model's concepts for nursing interventions using prototypical examples of nursing actions, involving 233 units of analyses, and collaborated in mapping the two models. All nursing interventions in the VIPS model comprise actions and targets, but a few lack explicit expressions of means. In most cases, the recipient of care is implicit. Expressions for the aim of an action are absent from the ISO model. By this mapping we identified areas for future development of the VIPS model and the experience from nursing terminology work in Scandinavia can contribute to the international standardization efforts.

  • 38. Ehnfors, Margareta
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Development of electronic health records to support nursing care in Sweden2010In: Nursing and informatics for the 21th century: An international look at practice, education and EHR trends. / [ed] Weaver, CA; White Delaney, C; Weber, P; Carr, RL, Chicago, USA: The Healthcare Information and Management Systems Society , 2010, p. 404-411Chapter in book (Other academic)
  • 39. Ehnfors, Margareta
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Kvalitetsindikatorer för omvårdnadsdokumentation i patientjournalen.2007In: Kvalitetsindikatorer inom omvårdnad / [ed] Idvall, Ewa, Stockholm: Svensk sjuksköterskeförening SSF och Gothia. , 2007, p. 30-44Chapter in book (Other academic)
  • 40. Ehnfors, Margareta
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Thorell-Ekstrand, Ingrid
    Nye VIPS-boken: Velvaere, integritet, profylakse, sikkerhet2015Book (Other academic)
  • 41.
    Ehnfors, Margareta
    et al.
    Örebro University, Department of Nursing and Caring Sciences. Swedish Society of Nursing, Stockholm.
    Florin, Jan
    Örebro University, Department of Nursing and Caring Sciences. Dalarna University, Falun.
    Ehrenberg, Anna
    Örebro University, Department of Nursing and Caring Sciences. Dalarna University, Falun.
    Applicability of the International Classification of Nursing Practice (ICNP) in the areas of nutrition and skin care2003In: International Journal of Nursing Terminologies and Classifications, ISSN 2047-3087, E-ISSN 2047-3095, Vol. 14, no 1, p. 5-18Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate completeness, granularity, multiple axial content, and clinical utility of the beta version of the ICNP in the context of standardized nursing care planning in a clinical setting.

    Methods: An 35-bed acute care ward for infectious diseases at a Swedish university hospital was selected for clinical testing. A convenience sample of 56 patient records with data on nutrition and skin care was analyzed and mapped to the ICNP.

    Findings: Using the ICNP terminology, 59%-62% of the record content describing nursing phenomena and 30%-44% of the nursing interventions in the areas of nutrition and skin care could be expressed satisfactorily. For about a quarter of the content describing nursing phenomena and interventions, no corresponding ICNP term was found.

    Conclusions: The ICNP needs to be further developed to allow representation of the entire range of nursing care. Terms need to be developed to express patient participation and preferences, normal conditions, qualitative dimensions and characteristics, nonhuman focus, and duration.

    Practice implications: The practical usefulness of the ICNP needs further testing before conclusions about its clinical benefits can be determined.

  • 42.
    Ehnfors, Margareta
    et al.
    Örebro University, Department of Nursing and Caring Sciences. Department of Social Medicine, Uppsala University, Uppsala.
    Thorell-Ekstrand, Ingrid
    Department of Nursing Research, Karolinska Hospital; College of Health and Caring Sciences, Stockholm.
    Ehrenberg, Anna
    Department of Planning and Development, Falun Hospital, Falun.
    Towards basic nursing information in patient records1991In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 11, no 3-4, p. 12-31Article, review/survey (Refereed)
    Abstract [en]

    Four key concepts for good nursing care and a list of key words for nursing documentation in patient records were established and to some extent tried in clinical practice in Sweden. The method consisted of the following steps: extensive literature review, review of nursing records, development of a list of key words on two levels, a first level corresponding to the nursing process, and a second level consisting of subdivisions for possible use in practice, use and assessment in clinical practice by nurses and students, expert panel judgement and refinement of the key words including an examination of semantic accuracy of the Swedish key words by an expert in Nordic languages. The proposed key words are presented both in English and Swedish and explanations, comments and references are given. The version of key words presented here is subject to further testing for possible modifications.

  • 43.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Can we make better use of patient records to learn about outcomes?2003In: Occupational Therapy in Psychiatry Conference, Alberta Hospital, Edmonton, Canada, 2003Conference paper (Other academic)
  • 44.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Förhållandet mellan profession och huvudområde i sjuksköterskeutbildningen på grund- och avancerad nivå.2009In: Omvårdnad som akademiskt ämne / [ed] Östlinder, Gerthrud; Söderberg, Siv; Öhlén, Joakim, Stockholm: Svensk Sjuksköterskeförening , 2009, p. 79-81Chapter in book (Other academic)
  • 45.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Vad är evidensbaserad omvårdnad?2012In: Sammanfattningar (abstrakt) : Avancerad omvårdnad i ett mångkulturellt samhälle, Örebro 22 – 23 Mars 2012: Lust & kunskap: Sjuksköterskedagarna 2012, Örebro: Svensk Sjuksköterskeförening , 2012Conference paper (Refereed)
  • 46. Ehrenberg, Anna
    et al.
    Angsmo, Ewa
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Florin, Jan
    Fogelberg-Dahm, Marie
    Liljequist, David
    Midboe, Lars
    Nilsson, Gunilla
    Wärn-Hede, Gunnel
    Östlinder, Gerthrud
    Nursing informatics in Sweden: the agenda for the future2009In: Connecting health and humans / [ed] Kaija Saranto, Patricia Flatley Brennan, Hyeoun-Ae Park, Marianne Tallberg, Anneli Ensio, Australian Computer Society , 2009, Vol. 146, p. 866-867Conference paper (Other academic)
    Abstract [en]

    With the purpose of getting an overview of the current research and development in information systems and terminology for nursing practice and outline strategies for the future, an initiative for a workshop was taken at the national level in Sweden by the Section for Nursing Informatics, the Society of Nursing and the Association of Health Professionals in 2007. For the workshop around 30 nurses were invited, representing clinical practice, education, and research. The workshop resulted in recommendations for future strategies to support the development of nursing informatics in Sweden. © 2009 The authors and IOS Press. All rights reserved.

  • 47.
    Ehrenberg, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Berg, Lena
    Källberg, Ann-Sofie
    Göransson, Katarina
    Östergren, Jan
    Florin, Jan
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hur uppfattar personal på akutmottagningar avbrott i arbetet?2013Conference paper (Refereed)
  • 48.
    Ehrenberg, Anna
    et al.
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Birgersson, C
    Nursing Documentation of Leg Ulcers. Adherence to Clinical Guidelines in a Swedish Primary Health Care District.2003In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 3Article in journal (Refereed)
  • 49.
    Ehrenberg, Anna
    et al.
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Carlsson, Eva
    Paterson, Barbara
    Scott-Findlay, Shannon
    Ehnfors, Margareta
    Methodological issues in interviews involving people with communication impairments after aquired brain damage.2007In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 17, no 10, p. 1361-1371Article in journal (Refereed)
  • 50.
    Ehrenberg, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Carlström, Eric
    Sjuksköterskebristen kan inte lösas med lägre kompetens2017In: Dagens Medicin, ISSN 1104-7488Article in journal (Other (popular science, discussion, etc.))
12345 1 - 50 of 221
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