Publications by authors named "Ann-Christin Karlsson"

8 Publications

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Pressure ulcer risk assessment-registered nurses´ experiences of using PURPOSE T: A focus group study.

J Clin Nurs 2021 Jun 9. Epub 2021 Jun 9.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

Aim: To evaluate the clinical usability of PURPOSE T among registered nurses in Sweden.

Background: Pressure ulcers are an adverse event and a problem worldwide. Risk assessment is a cornerstone, and a first step in pressure ulcer prevention is to identify possible risk patients and/or pressure ulcers. There are many pressure ulcer risk assessment instruments; however, they are not updated and/or evidence-based. PURPOSE T has been psychometrically evaluated in the UK and in Sweden with good inter-rater and test-retest reliability, and convergent validity was reported as moderate.

Design: A descriptive study design with a qualitative approach.

Methods: A total of six focus group interviews with 29 registered nurses were conducted. They were recruited from May 2018 to November 2018 from a university hospital and two nursing homes in Sweden. Data analysis was performed as described by Krueger. The study adheres to the COREQ guidelines.

Results: Four categories were identified: "An efficient risk assessment instrument performed at the bedside," "Deeper understanding and awareness of risk factors," "Benefits compared to the Modified Norton Scale" and "Necessity of integration of PURPOSE T in the electronic health record and team collaboration."

Conclusion: The registered nurses acknowledged an overall positive perception of PURPOSE T´s clinical usability. Future research is needed to evaluate the feasibility of PURPOSE T.

Relevance To Clinical Practice: PURPOSE T has the potential to replace outdated pressure ulcers risk assessment instruments that are used today.
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http://dx.doi.org/10.1111/jocn.15901DOI Listing
June 2021

PURPOSE T in Swedish hospital wards and nursing homes: A psychometric evaluation of a new pressure ulcer risk assessment instrument.

J Clin Nurs 2020 Nov 19;29(21-22):4066-4075. Epub 2020 Aug 19.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

Aim: To evaluate the psychometric characteristics of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T); reliability (inter-rater and test-retest) and validity (convergent validity) in a Swedish context.

Background: Pressure ulcers are considered as an adverse event and are a problem in healthcare worldwide. The first step in pressure ulcer prevention is to identify patients that are at risk. PURPOSE T is a new pressure ulcer risk assessment instrument that was developed in the UK using "golden standard" instrument method.

Design: Observational, descriptive and comparative.

Methods: A total of 235 patients and 28 registered nurses were recruited (May 2018-November 2018) from six hospital wards at a university hospital and two community nursing homes in Sweden. Blinded (ward/nursing home nurses and expert nurses) PURPOSE T assessments and follow-up retests were undertaken. Cross-tabulation and kappa statistics were used to examine the reliability, and phi correlation was used to test the convergent validity. The study followed the STROBE guideline.

Results: The clinical evaluation showed "very good" (kappa) inter-rater and test-retest reliability for PURPOSE T assessment decision overall. The agreement of "at risk"/"not at risk" for both inter-rater and test-retest was also high, at least 95.5%. The convergent validity between PURPOSE T and other traditional assessment instruments was moderate.

Conclusion: The evaluation of PURPOSE T demonstrated good psychometric characteristics. Further research is needed to evaluate PURPOSE T's usability among registered nurses.

Relevance To Clinical Practice: There is a lack of evidence-based validated pressure ulcer risk assessment instruments for use in health care. According to our findings, the Swedish version of PURPOSE T could be used in hospitals and nursing homes to identify patients in risk or with pressure ulcers.
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http://dx.doi.org/10.1111/jocn.15433DOI Listing
November 2020

Information and Communication Technology Can Increase Patient Participation in Pressure Injury Prevention: A Qualitative Study in Older Orthopedic Patients.

J Wound Ostomy Continence Nurs 2019 Sep/Oct;46(5):383-389

Lisa Hultin, MSc, Department of Public Health and Caring Sciences, Uppsala University; and Uppsala University Hospital, Uppsala, Sweden. Ann-Christin Karlsson, PhD, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; and Region Gotland, Visby, Sweden. Margareta Öhrvall, PhD, Department of Public Health and Caring Sciences, Uppsala University; and Uppsala University Hospital, Uppsala, Sweden. Lena Gunningberg, PhD, Department of Public Health and Caring Sciences, Uppsala University; and Uppsala University Hospital, Uppsala, Sweden.

Purpose: The aim of this study was to assess the participatory capabilities of hospitalized older adults in response to the Continuous Bedside Pressure Mapping system placed on the beds to prevent pressure injuries.

Design: Descriptive study.

Subjects And Setting: A convenience sample of 31 orthopedic patients were recruited from an orthopedic rehabilitation unit at a university hospital in Uppsala, Sweden, that served patients aged 65 years and older.

Methods: Semistructured interviews were conducted between November 2016 and February 2017, audio-recorded, and transcribed verbatim. Data were analyzed using qualitative content analysis.

Result: The overall theme from 21 interviews was "A new way of understanding helped patients to recognize vulnerable pressure points and to take action in their own care" from which 2 categories, "awareness" and "action," emerged. The study showed that verbally adapted information combined with using information and communication technology increased most participants' knowledge and as they became aware of increased pressure, they started to take preventative action by changing position.

Conclusions: It is possible for older participants in a rehabilitation unit who had recent orthopedic surgery to understand and use new information and communication technology and should be invited to participate in pressure injury prevention.
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http://dx.doi.org/10.1097/WON.0000000000000568DOI Listing
March 2020

Registered nurses' perspectives of work satisfaction, patient safety and intention to stay - A double-edged sword.

J Nurs Manag 2019 Oct 31;27(7):1359-1365. Epub 2019 Jul 31.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

Aim: To describe job satisfaction in registered nurses (RNs), their intention to stay at their current workplace and in the profession and to explore patient safety in relation to these.

Background: Nurse turnover presents a serious challenge to health care that may be predicted by factors related to the work environment.

Method: Descriptive design with 25 qualitative interviews.

Results: Five categories were identified: RNs feel satisfied when providing person-centred care; RNs enjoy the variability of the nursing job, but want control; RNs feel frustrated when care is put on hold or left undone; RNs depend on team collaboration and the work environment to assure patient safety; intention to stay depends on the work environment and a chance for renewal.

Conclusion: Registered nurses' job satisfaction could be described as a double-edged sword. Although the profession is described as a positive challenge, work overload threatens both job satisfaction and patient safety.

Implications For Nursing Management: Our findings suggest that nursing leadership can increase RNs' intention to stay by meeting their needs for appreciation, a better work environment, competence development and professional career development.
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http://dx.doi.org/10.1111/jonm.12816DOI Listing
October 2019

Women's Experiences of Undergoing Total Knee Joint Replacement Surgery.

J Perianesth Nurs 2017 Apr 27;32(2):86-95. Epub 2016 Jul 27.

Purpose: The purpose of the study was to describe women's experiences of undergoing total knee joint replacement surgery.

Design: A qualitative approach was used.

Method: A content analysis of the text from interviews with five women was conducted.

Findings: The time before surgery was marked by the experience of constant pain, which affected the women negatively in their everyday lives. During surgery, the information provided by the staff gave each woman a sense of security; the women handed over responsibility to the staff and experienced a sensation of relief. The postoperative period was characterized by a feeling of joy when the surgery was over, although a rough and tedious rehabilitation phase then began. Challenges in everyday life were a factor for motivation and confidence, although postoperative pain was experienced as discouraging.

Conclusion: Support from health care staff is an important factor for coping with everyday life during the preoperative, perioperative and postoperative phases of undergoing knee joint replacement.
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http://dx.doi.org/10.1016/j.jopan.2015.11.009DOI Listing
April 2017

Patient-nurse anesthetist interaction during regional anesthesia and surgery based on video recordings.

J Perianesth Nurs 2013 Oct;28(5):260-70

Purpose: The purpose of this study was to interpret and describe the patient-nurse anesthetist (NA) interaction during regional anesthesia.

Design: Video recordings conducted during orthopedic surgery at a surgical clinic in Sweden formed the basis for the study, in which three patients and three NAs participated.

Methods: A hermeneutic analysis was conducted on the data.

Finding: The findings of the analysis demonstrated that the NA was in either "present" presence or "absent" presence in the awake patient's visual field during surgery. The NA's professional actions at times dominated the patient's existential being in the intraoperative situation. The findings conveyed insights about the patient-NA interaction that open up possibilities for nurses to understand and reflect upon their own practice in an expanded way.

Conclusions: Using video recordings for reflections enables development of professional skills that positively influence the care quality for patients during regional anesthesia.
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http://dx.doi.org/10.1016/j.jopan.2012.11.009DOI Listing
October 2013

Only a whisper away. A philosophical view of the awake patient's situation during regional anaesthetics and surgery.

Nurs Philos 2012 Oct;13(4):257-65

School of Health Science, Blekinge Institute of Technology, Karlskrona, Sweden.

In this study the awake patient's intraoperative situation and experiences during regional anaesthetics and surgery are reflected upon by using the work of the French philosopher Maurice Merleau-Ponty. Merleau-Ponty's phenomenological idea of the body as being at the centre of the world highlights the patient's embodied position and bestows significance onto the body as a whole, as a lived body. A case, based on the findings from a previous interview study, is presented as a contextual starting point where a patient goes from having a familiar body recognized as her own to having a partially anaesthetized body experienced as an unknown object. The intraoperative caring space is described in this context as the mutual ground where the awake patient and the nurse anaesthetist (NA) can interact to create meaning. The NA can act as the patient's bodily extension to bridge the gap between the patient's experiences and the situation. This calls for the NA's proximity and genuine presence in order to meet and understand the patient's awake experiences. Learning from the patient's situatedness gives information that is valuable for NAs to share with patients who are less experienced with this contextual situation. The challenge for the NA is not to perform routine-based care, but to acknowledge every patient's lifeworld and uniqueness thus enabling the patient to move easily along the mind-body-world continuum. The core of intraoperative care is to provide support and promote well-being of awake patients in the intraoperative environment. The use of a philosophical perspective is relevant for nurses who work in an intraoperative setting where patients undergo regional anaesthetics. This study shows how nursing research using phenomenological philosophy can help uncover new meanings known only to the patients living the experience.
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http://dx.doi.org/10.1111/j.1466-769X.2012.00538.xDOI Listing
October 2012

"Is that my leg?" patients' experiences of being awake during regional anesthesia and surgery.

J Perianesth Nurs 2012 Jun;27(3):155-64

School of Health Science, Blekinge Institute of Technology, Karlskrona, Sweden.

Most knee or hip replacement surgery is performed under regional anesthesia, when patients are awake. Previous research has primarily focused on patients' experiences during general anesthesia. The aim of this study was to uncover the meaning of being awake during regional anesthesia and surgery. Nine interviews with patients undergoing knee or hip replacement surgery comprise the data. The phenomenological analysis shows that being awake during surgery can be compared with walking a tightrope because of ambiguous feelings. Four interrelated constituents further elucidated the patients' experiences: balancing between proximity and distance in the operating theater, balancing between having control and being left out, my partly inaccessible body handled by others, and the significant role of the carer. Anesthesia providers and perioperative nurses need to understand the awake patients' intraoperative experiences to support and confirm them when they can no longer experience or have full access to their body.
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http://dx.doi.org/10.1016/j.jopan.2012.02.005DOI Listing
June 2012