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  • 1.
    Eklund, Anna Josse
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Sjuksköterskor som patienters företrädare: Med huvudsakligt fokus på företrädarskap för äldre patienter i kommunal hälso- och sjukvård2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim was to study nurses’ and managers’ attitudes towards micro social patient advocacy (I) and factors related to patient advocacy (II, III) with the main focus being on advocacy in the care of older patients in community health care together with psychometric testing of the instrument 'Attitudes toward Patient Advocacy Scale-Attitudes toward MIcrosocial Advocacy' (IV).

    Methods: A quantiative cross-sectional study and a qualitative study were carried out. Nurses (n=207) and managers (n=23) in community health care responded to a questionnaire about patient advocacy, nursing competence, personal traits, quality of care and organisational climate (I, II, IV). Nurses' (n=18) perceptions of influencers of patient advocacy was studied in a phenomenographic study (III).

    The results showed that nurses and managers reported positive attitudes to patient advocacy (I, II), especially for patients unable to speak for themselves (I). Two areas of nursing competence (Performing the nursing process, Supervision and cooperation) and a dimension of quality of care of older patients were positively associated with attitudes towards patient advocacy (II). Two organisational dimensions were, negatively (dynamism) respectively positively (playfulness), associated with attitudes towards patient advocacy. The nurses' perceptions of influencers of patient advocacy consist of three hierarchically related levels: The nurse's character traits, The nurse’s bond with the patient and The organisational conditions (III). The Swedish version of APAS-AMIA consists of 33 items in a four-factor structure (APAS-AMIA/SE): Support patients’ beliefs and decision-making, Safeguard patients' health care, Support patients to communicate their wishes and Respect patients’ wishes not to participate in decisions regarding care (IV).

    Conclusions: Maintaining the continuing professional competence of nurses is important, and is ensuring the organisational prerequisites to enable nurses' advocacy for patients.

  • 2.
    Eklund, Anna Josse
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Jossebo, Marie
    Karlskoga lasarett, Örebro läns landsting.
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Karlskoga Hospital, Sweden.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Norway.
    Petzäll, Kerstin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Norway.
    Swedish nurses’ perceptions of influencers on patient advocacy – a phenomenographic study2014In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 21, no 6, p. 673-683Article in journal (Refereed)
    Abstract [en]

    Background: A limited number of studies have shown that patient advocacy can be influenced by both facilitators and barriers which can encourage and discourage nurses to act as patient advocates. Objective: This study’s aim was to describe Swedish nurses’ perceptions of influencers on patient advocacy.

    Research design and context: Interviews with 18 registered nurses from different Swedish clinical contexts were analysed using the phenomenographic method.

    Ethical considerations: Ethical revisions were made in accordance with national legislation and guidelines by committees for research ethics at Karlstad University. Findings: Three levels of hierarchically related influencers on patient advocacy were found in the descriptive categories. The fundamental influencer, the nurse’s character traits, was described in the perceptions that advocacy is influenced by nurse’s having a moral compass, having control over the care situation, being protective and feeling secure as a nurse. The second most vital influencer, the nurse’s bond with the patient, was expressed in the perceptions of knowing the patient and feeling empathy for the patient. The third level of influencers, the organisational conditions, was described in the perceptions that the organisational structures and organisational culture influence patient advocacy.

    Discussion: The results correspond with findings from earlier research but add an understanding that influencers on patient advocacy exist at three hierarchically related levels. Conclusion: The nurse’s character traits are the fundamental influencer to patient advocacy, but in order to be comfortable and secure when advocating for patients, nurses also need to be familiar with both the patient and the situation. A supposition could be that all influencers interact, which needs to be further addressed in future studies.

  • 3.
    Eklund, Anna Josse
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Petzäll, Kerstin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Räty, Lena
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Patient Advocacy in Community Care of Older Patients: Psychometric testing of the Swedish version of Attitudes towards Patient Advocacy Scale (APAS) and registered nurses and nurse managers attitudes towards patient advocacy2010Conference paper (Refereed)
  • 4.
    Eklund, Anna Josse
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Petzäll, Kerstin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Räty, Lena
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Sjuksköterskans advokatskap för patienter inom kommunal vård2010Conference paper (Other (popular science, discussion, etc.))
  • 5.
    Eklund, Anna Josse
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Petzäll, Kerstin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Räty, Lena
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Sjuksköterskans advokatskap för patienter inom kommunal vård2011Conference paper (Other (popular science, discussion, etc.))
  • 6.
    Eklund, Anna Josse
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Petzäll, Kerstin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Swedish registered nurses attitudes towards patient advocacy and individual influencing factors2011Conference paper (Refereed)
    Abstract [en]

    INTRODUCTIONPatient advocacy can be considered as a vital part of the registered nurses (RNs) profession. The RN advocates for the patients when she/he speaks or acts on behalf of the patients, support and protects the patients when they themselves cannot. According to Bu and Jezewski´s1 theory (2007) patient advocacy consists of three core attributes; safeguarding the patients autonomy, acting on behalf of patients and championing social justice in provision of health care. Factors on an individual and an organisational level can influence patient advocacy. Individual factors described in the literature are the RNs nursing competence, educational level and her/ his personality.AIMSThe aims of the study was to describe registered nurses (RNs) attitudes toward patient advocacy and to explore individual factors influencing attitudes toward patient advocacy in the context of community care of older patients.METHODSThe cross sectional study was carried out in 16 communities in a region of Sweden, between March and September in 2009. Mailed questionnaires were used to collect data and a total of 226 RNs participated in the study (rr=52 %). Besides demographics, the questionnaire consisted of the instruments the APAS2 (to measure RNs attitudes towards patient advocacy), the AssCe3 (to measure the RNs self assessed nursing competence) and the SIMP4 (to measure personality traits). Descriptive statistics and multiple regression analysis were used to analyze data.RESULTSThe RNs showed positive attitudes towards patient advocacy. Nursing competence proved to be an influencing factor to attitudes towards patient in the regression model. The model explained 18.4 % of the variance in attitudes toward patient advocacy.CONCLUSIONThe results from this study can contribute to the available knowledge about patient advocacy since new insights about influencing factors have been added. The vital results from this study are that RNs in a community context showed a positive attitude towards patient advocacy and that attitudes towards patient advocacy were influenced by the RNs nursing competence but not by their nursing experience, educational level or personality traits. The results can contribute to the knowledge about patient advocacy but further research regarding patient advocacy and influencing factors is needed.REFERENCES1. Bu X. & Jezewski MA. Developing a mid-range theory of patient advocacy through concept analysis. J Adv Nur 2007; 57(1): 101-110.2. Bu X. & Wu Y.B. Development and Psychometric Evaluation of the Instrument: Attitude Toward Patient Advocacy. Res Nurs Health 2008; 31(1): 63- 75.3. Löfmark A. & Thorell-Ekstrand I. An assessment form for clinical nursing education: a Delphi study. J Adv Nurs 2004; 48(3): 291-298.4. Woods S.A. & Hampson S.E. Measuring the Big Five with Single Items using a Bipolar Response Scale. Eur J Pers. 2005; 19: 373-390.

  • 7.
    Eklund, Anna Josse
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Petzäll, Kerstin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Cross-cultural validation and psychometric testing of the Swedish version of the microsocial section of the Attitudes toward Patient Advocacy Scale2012In: The International Journal of Person Centered Medicine, ISSN 2043-7730, E-ISSN 2043-7749, Vol. 2, no 3, p. 473-481Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives: Patient advocacy can be defined as a process for maintaining and monitoring patients’ rights, values and best interests. To measure attitudes toward patient advocacy, Bu and Wu (2008) developed the Attitudes toward Patient Advocacy Scale (APAS), which required further testing and refining in different contexts. This two-phased study aimed to: (1) translate and cross-culturally validate the APAS section for microsocial patient advocacy (AMIA) in accordance with the Swedish context and (2) test the instrument’s psychometric properties in the community care of older patients.

    Methods and results: The first phase consisted of back-translation and cultural validation of the APAS-AMIA in accordance with the Swedish context and resulted in a 39-item Swedish version of the APAS-AMIA. In the second phase, data were collected using the 39-item APAS-AMIA in 2009 from a sample of 230 registered nurses and nurse managers covering 16 communities. Subsequently, psychometric testing was conducted with exploratory factor analysis and reliability analysis in a final sample of 201 RNs. The exploratory factor analysis revealed a 4-factor structure, explaining 52.1% of the total scale variance in a 33-item instrument called the APAS-AMIA/SE. The Cronbach’s alpha for the APAS-AMIA/SE was 0.92 and varied between 0.82 and 0.88 for the factors.

    Conclusion: When the APAS-AMIA/SE semantic and conceptual equivalence to the APAS-AMIA, its distinct factor structure, internal consistency values and theoretical attachment are all added together, the conclusion is that the APAS-AMIA/SE is an acceptably reliable and valid instrument.

  • 8.
    Eklund, Anna Josse
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Petzäll, Kerstin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Swedish registered nurses’ and nurse managers’ attitudes towards patient advocacy in community care of older patients2013In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 21, no 5, p. 753-761Article in journal (Refereed)
    Abstract [en]

    Aim To describe and compare registered nurses’ (RNs) and nurse managers’ (NMs) attitudes towards patient advocacy in the community care of older patients.

    Background RNs may act as patients’ advocates in the care of older patients. NMs should support patient advocacy in order to make the best care available to patients.

    Method A modified Attitudes towards Patient Advocacy Scale was used to collect data from 207 RNs and 23 NMs in the Swedish community care of older patients. The response rate was 52%. Descriptive and inferential statistics were used.

    Results Both RNs and NMs showed positive attitudes towards patient advocacy. They were more positive towards patient advocacy for patients unable to help themselves than for competent patients.

    Conclusions This study showed that RNs and NMs did not differ in their attitudes towards patient advocacy. This result is consistent with the idea of giving the neediest and vulnerable patients greater care.

    Implications for Nursing Management It is important for NMs to clarify their own and RNs attitudes towards patient advocacy as disparities may affect cooperation between the groups. Any effects on cooperation may, by extension, affect the quality of care.

  • 9.
    Eklund, Anna Josse
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Norway.
    Petzäll, Kerstin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Norway.
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. City Council Värmland.
    Individual and organisational factors influencing registered nurses' attitudes towards patient advocacy in Swedish community health care of elders2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 486-495Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to describe and explore individual and organisational factors potentially influencing registered nurses' (RNs) attitudes towards patient advocacy. Methods and Sample: In a quantitative cross-sectional study, data were collected from 226 RNs in community health care of elders. A questionnaire was used to measure a number of factors including attitudes towards patient advocacy, nursing competence, personality traits, individual preferences regarding the quality of health care and working climate. A multiple regression analysis was performed. Results: The results showed that individual factors of nursing competence and individual preferences of the quality of health care, as well as organisational factors of the working climate, explained 26.2% of the variance in the RNs' attitudes towards patient advocacy. Conclusions: Although the mentioned individual factors may be intertwined, the conclusion is that both individual and organisational factors influenced RNs' attitudes towards patient advocacy. The results do not verify that nursing experience, workplace experience, educational level or personality traits influence the RNs' attitudes towards patient advocacy. The proportion of explained variance indicates that additional factors also influence attitudes towards patient advocacy, and more research is needed to shed further light on these factors.

  • 10.
    Sundler, A. J.
    et al.
    University of Borås, Sweden.
    Blomberg, K.
    Örebro universitet.
    Bisholt, Birgitta
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Eklund, Anna Josse
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Windahl, J.
    Örebro universitet.
    Larsson, Maria
    Experiences of supervision during clinical education among specialised nursing students in Sweden: A cross-sectional study2019In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 79, p. 20-24Article in journal (Refereed)
    Abstract [en]

    Background: The importance of the clinical learning environment in nurse education has gained increasing attention over the last decades. However, there is a lack of research on the learning environment, its significance and meaning in specialist nurse education. Objective: The objectives of the study were to investigate specialised nursing students' experiences of supervision during clinical practice and to compare students who were satisfied with the supervision with those who were dissatisfied with respect to a)organisation of supervision and number of preceptors, as well as time allocated by preceptors for b)supervision, c)reflection, d)discussion of intended learning outcomes, and e)assessments of students' performance by preceptors. Design: This study used a cross-sectional design. Sample and settings: A convenience sample of specialised nursing students was derived from five Swedish universities in the years 2016 and 2017. Methods: Data were collected using a questionnaire. Statistical analyses and a qualitative conventional content analysis were performed. Results: While almost all specialised nursing students reported that there had been time for discussion on their performance assessment, almost half of the students reported not getting time for supervision, or time for reflections and discussions on intended learning outcomes with the preceptor. Students reporting having time allocated for supervision by preceptors were found to be more satisfied with supervision. It was described as important that the preceptor(s)acknowledged the students previous work experiences. Even though being a registered nurse, reflections and feedback were described as valuable for the students learning. Several preceptors were described as positive allowing a broader picture and different views regarding working as a specialist nurse. Conclusions: This study indicates that supervision, in terms of discussions and reflections, of specialised nursing students is significant for learning experiences and satisfaction during clinical placement.

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