Publications by authors named "Helle Wijk"

60 Publications

Patients' experiences of place and space after a relocation to evidence-based designed forensic psychiatric hospitals.

Int J Ment Health Nurs 2021 May 3. Epub 2021 May 3.

Institute of Health and Care Sciences at Gothenburg University, Göteborg, Sweden.

Forensic hospitals provide care for incarcerated patients who have committed a crime under the influence of serious mental illness. The care and (re)habilitation of the target group require highly competent staff and treatment strategies as well as purpose-built facilities that promote successful recovery. The aim of this study was to examine patients' experiences of place and space in new, purpose-built, evidence-based designed forensic psychiatric facilities in terms of supporting everydayness. A qualitative methodology was chosen. In total, 19 patients agreed to participate. Data were collected through photovoice (a combination of photographs and interviews) at three forensic hospitals, according to an evidence-based design and the concept of person-centred care in Sweden. The data were analysed through thematic content analysis. Four themes emerged from the data, revealing the patients' experiences of the new buildings: (i) having a private place, (ii) upholding one's sense of self, (iii) feelings of comfort and harmony, and (iv) remaining connected to one's life. The findings reveal that purpose-built environments can support everyday living and well-being and can create comfort. This is considered highly therapeutic by the patients. In conclusion, the findings of this study are of imperative importance in the design of health-promoting forensic hospitals.
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http://dx.doi.org/10.1111/inm.12871DOI Listing
May 2021

Literature review: Evidence-based health outcomes and perceptions of the built environment in pediatric hospital facilities.

J Pediatr Nurs 2021 Apr 16. Epub 2021 Apr 16.

Sahlgrenska University Hospital, Gothia Forum for Clinical Trials, Gothenburg, Sweden; Center for Ethics, Law, and Mental Health (CELAM), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Problem: The current knowledge of evidence-based design for adults is not always implemented when hospital buildings are designed. Scientific data are sparse on the effects of hospital design in pediatric settings on health outcomes in children, parents, and staff. The objective of this review is to determine the evidence-based impact of the built environment in pediatric hospital facilities on health outcomes in children, parents, and staff.

Eligibility Criteria: A systematic literature review was carried out on the electronic databases Cochrane Library, Embase, Medline and CINAHL from the period of 2008 to 2019. The review considered studies using either quantitative, qualitative, or mixed methodologies.

Sample: Out of 1414 reviewed articles the result is based on eight included articles.

Results: Two of these eight articles included health outcomes. The other six articles presented results on measures of perceptions and/or satisfaction for children, parents or staff with the built environment when transitioning to a new or renovated facility. These were generally higher for the new compared to the old facility.

Conclusions: Given the small number of studies addressing the question posed in this review, no firm conclusions can be drawn.

Implications: The review illustrates the need for more research in the pediatric setting assessing the evidence-based health outcomes of aspects of physical environmental design in pediatric hospitals or units in children, parents and staff.
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http://dx.doi.org/10.1016/j.pedn.2021.04.013DOI Listing
April 2021

The five aspect meal model as a conceptual framework for children with a gastrostomy tube in paediatric care.

Scand J Caring Sci 2021 Jan 29. Epub 2021 Jan 29.

Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Background: Cancer treatments may induce side effects and cause eating problems. A gastrostomy tube may be required in order to maintain and optimise the child's nutritional needs. Despite the use of a gastrostomy tube, it is important to maintain a natural and attractive mealtime for the child. The Five Aspect Meal Model is age neutral and originally designed to improve restaurant visits. Its five aspects conceptualise what is necessary to ensure a complete meal experience. To date, there is lack of knowledge to guided model development about mealtimes adapted to children and limited knowledge regarding mealtime experiences for children with a gastrostomy tube.

Aim: The aim was to investigate whether the Five Aspect Meal Model could be appropriate to be used for children with a gastrostomy tube in caring science and paediatric care.

Methods: The design followed steps retrieved from Renjith and colleagues. Seven interviews were performed with the Five Aspect Meal Model as a base in the interview guide. The transcripts were analysed by using a qualitative directed content analysis with a deductive approach, which finally passed into a more inductive one.

Findings: All aspects of the Five Aspect Meal Model were represented in the interviews. There were also experiences related to the gastrostomy tube and the mealtimes that did not fit into any of the five predetermined categories. As a result, the modified version was developed, an adapted prescribing practice model that includes seven aspects, whereof bodily discomfort and time for change and acceptance are specific to children with a gastrostomy tube.

Conclusion: Based on children and their parent's experiences, the Five Aspect Meal Model has been developed and adapted into a modified version, which includes seven aspects. The modified version seems to be appropriate to use within caring science and paediatric care.
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http://dx.doi.org/10.1111/scs.12957DOI Listing
January 2021

The impact of the physical environment for caregiving in ordinary housing: Experiences of staff in home- and health-care services.

Appl Ergon 2021 Apr 2;92:103352. Epub 2021 Jan 2.

Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden; Institute of Health and Care Sciences, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.

The strong driving forces for ageing in place demand sustainable solutions for the housing and care of older people and the health and safety of home- and health-care staff. The aim of the study was to elucidate staff experiences of providing home- and health-care to older people living in ordinary housing. This study was part of a larger project investigating the relation between home design and conditions for care in ordinary housing. The data were gathered through focus group interviews with staff in home- and health-care. Three main themes were found according to staff experiences of particular rooms' sizes and proportions, spatial configurations, and aspects to consider when designing new housing. This study contributes important knowledge about essential features of the physical environment for staff providing home- and health-care for older people in their own homes and to aid the development of functionally sustainable housing to minimise injuries to staff.
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http://dx.doi.org/10.1016/j.apergo.2020.103352DOI Listing
April 2021

What constitutes feeling safe at home? A qualitative interview study with frail older people receiving home care.

Nurs Open 2021 01 13;8(1):191-199. Epub 2020 Sep 13.

Institute of Health and Care Sciences at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.

Aim: To highlight experiences of what constitutes feeling safe at home among frail older people receiving home care.

Design: Qualitative descriptive study.

Methods: The sample consists of 12 individual recorded interviews with frail older people in their homes. Interviews were transcribed verbatim and analysed using qualitative content analysis. The data collection was performed in spring 2018.

Results: The analysis resulted in three categories: "Having a feeling of at-homeness'" describes the older people's surrounding environment and their efforts to maintain independence; "being able to influence" describes the importance for older people to shape their care by being in control and having an opportunity for self-determination in the context of home care; and "being able to trust staff" relates to expecting staff's knowledge and skills and to appreciating the staff's ability to create positive relations.
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http://dx.doi.org/10.1002/nop2.618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729533PMC
January 2021

Assessing the Supportiveness of Healthcare Environments' Light and Color: Development and Validation of the Light and Color Questionnaire (LCQ).

HERD 2021 Apr 28;14(2):130-144. Epub 2020 Nov 28.

Centre for Interprofessional Cooperation Within Emergency Care (CICE), Department of Health and Caring Sciences, 249958Linnaeus University, Växjö, Sweden.

Aim: The aim of this study was to develop and evaluate a self-report instrument measuring patients', family members', and staff's perceived support from light and color in the physical environment of an emergency department (ED)-the Light and Color Questionnaire (LCQ).

Background: The physical care environment is an important part of a comprehensive caring approach in all levels of care not only for patients but also for family members and staff. However, no existing self-report questionnaire assessing the extent to which light and color are perceived as being supportive in the physical care environment from the users' perspective was found.

Method: The LCQ was developed as part of a pre-post study in which an ED serving 125,000 people was refurbished and remodeled using evidence-based design. The LCQ consists of six items for light and five items for color and assesses awareness/orientation, safety/security, functional abilities, privacy, personal control, and stimulation. The study was carried out in four steps: constructions of items, assessment of face validity, data collection, and data analysis.

Result/conclusion: Psychometric evaluation of the two versions, LCQ-Patient/Family member and LCQ-Staff, showed satisfactory content and internal validity (>90%) and high internal consistency (Cronbach's coefficient α = .9) to support the use of the questionnaire for research and development purposes. Explorative factor analysis of a total of 600 questionnaire responses confirmed light and color as distinctive and independent dimensions creating perceptions of more or less supportiveness for respondents. The LCQ instrument may be useful for architects, administrators, and researchers of healthcare environments.
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http://dx.doi.org/10.1177/1937586720975209DOI Listing
April 2021

Space and place for health and care.

Int J Qual Stud Health Well-being 2020 Dec;15(sup1):1750263

Centre for Ethics, Law and Mental Health, Gothenburg University Hospital , Gothenburg, Sweden.

: This discussion paper aims to contribute to a greater understanding of the state of the art of research engaged with conceptual matters of space and place for health and care. : The authors, who represent a variety of academic disciplines, discuss and demonstrate the conceptual recognition of space and place in research in health and caring sciences building upon own work and experience. : To explore the concepts of space and place for health and care is a research pursuit of utmost importance, and should be made through transdisciplinary research collaborations, whereby spatial theories from various disciplines could be communicated to cultivate truly novel and well-informed research. Furthermore, engaging with relational and topological perceptions of space and place poses methodological challenges to overcome in future research on health and care. : We argue that there is a need for accelerating spatially informed research on health and care that is informed by current theories and perspectives on space and place, and transdisciplinary research collaborations are a means to achieving this.
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http://dx.doi.org/10.1080/17482631.2020.1750263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594871PMC
December 2020

A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings.

Geriatr Nurs 2021 Jan-Feb;42(1):213-224. Epub 2020 Aug 27.

Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

The Purpose: of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+).

Method: A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish.

Results: In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation.

Conclusion: Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context.
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http://dx.doi.org/10.1016/j.gerinurse.2020.08.004DOI Listing
August 2020

Healthcare practitioners' experiences of postoperative pain management in lumbar spine surgery care-A qualitative study.

J Clin Nurs 2020 May 10;29(9-10):1662-1672. Epub 2020 Mar 10.

Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.

Aims And Objective: To explore and describe healthcare practitioners' experiences of postoperative pain management to patients undergoing planned lumbar spine surgery by identifying the healthcare practitioners' behaviours, attitudes and strategies.

Background: Poorly managed postoperative pain continues to cause suffering and prolong hospital care and may affect individual and team practitioners' strategies and attitudes. The impact of these strategies and attitudes needs greater understanding.

Design: Descriptive qualitative study.

Methods: In-depth interviews were conducted at a university hospital in Sweden during January-March 2016 with 9 healthcare practitioners (ages: 29-61 years; gender: male 3 and female 6; professions: medical doctor 3, registered nurse 3 and physiotherapist 3; professional experience: 1.5 months to 25 years). The interviews were analysed using Braun and Clarke's thematic analysis. The study adhered to the Consolidated Criteria for Reporting Qualitative Research COREQ.

Results: The interviews revealed healthcare practitioners' attitudes and strategies. Three themes were identified: (a) Connecting with the person was recognised as the key component in postoperative pain management; (b) Professionalism: a balancing act, accentuated health care practitioners' duality in being both vulnerable and strong in delicate care situations; and (c) Collaboration: being constantly responsive, the necessity for healthcare practitioners to be constantly responsive to their environment.

Conclusions: The findings pinpoint the need for healthcare organisations to build structures enabling practitioners to deliver adequate pain management in acknowledging the practitioners' delicate situation when facing patients in pain.

Relevance To Clinical Practice: Given the global need for postoperative pain management, our findings have international relevance. Preconceived expectations on specific pain need to be depicted and postoperative pain taken seriously to protect the patient as well as the healthcare practitioners.
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http://dx.doi.org/10.1111/jocn.15230DOI Listing
May 2020

Effects of Birthing Room Design on Maternal and Neonate Outcomes: A Systematic Review.

HERD 2020 07 20;13(3):198-214. Epub 2020 Feb 20.

Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.

Aim: To summarize, categorize, and describe published research on how birthing room design influences maternal and neonate physical and emotional outcomes.

Background: The physical healthcare environment has significant effects on health and well-being. Research indicates that birthing environments can impact women during labor and birth. However, summaries of the effects of different environments around birth are scarce.

Methods: We conducted a systematic review, searching 10 databases in 2016 and 2017 for published research from their inception dates, on how birthing room design influences maternal and neonate physical and emotional outcomes, using a protocol agreed a priori. The quality of selected studies was assessed, and data were extracted independently by pairs of authors and described in a narrative analysis.

Results: In total, 3,373 records were identified and screened by title and abstract; 2,063 were excluded and the full text of 278 assessed for analysis. Another 241 were excluded, leaving 15 articles presenting qualitative and quantitative data from six different countries on four continents. The results of the analysis reveal four prominent physical themes in birthing rooms that positively influence on maternal and neonate physical and emotional outcomes: (1) means of distraction, comfort, and relaxation; (2) raising the birthing room temperature; (3) features of familiarity; and (4) diminishing a technocratic environment.

Conclusions: The evidence on how birthing environments affect outcomes of labor and birth is incomplete. There is a crucial need for more research in this field.
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http://dx.doi.org/10.1177/1937586720903689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364772PMC
July 2020

"We Are Here for You All the Way"-Patients' and Relatives' Experiences of Receiving Advanced Home Care.

Am J Hosp Palliat Care 2020 Sep 13;37(9):669-674. Epub 2020 Feb 13.

Institute of Caring Sciences and Health, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden.

Background: It is of great importance to understand how patients and their close relatives experience the pros and cons of advanced home care so as to further develop this quickly growing choice of care.

Objective: The aim of this study was to explore the experiences of receiving advanced home care among patients affected by life-threatening illness and their close relatives.

Design: The study was an interview study conducted with patients in their homes. Some patient interviews were conducted together with a close relative participating.

Setting/participants: Patients registered in advanced home care in 2017 were offered the opportunity to participate in the study. The selection criteria were that the patient was within grade 3 of the Eastern Cooperative Oncology Group's Performance Status, older than 18 years, able to orient to time and place, and not newly registered.

Analysis: The interviews were recorded and transcribed verbatim and analyzed with qualitative content analysis.

Results: A total of 11 interviews were conducted: 8 with patients and 1 or 2 close relatives together; and 3 with the patient alone. It resulted in 3 main categories: create a safe environment, see the person, and better to manage care at home.

Conclusion: The results of this study show that patients and close relatives perceived that advanced home care was a safe and secure form of caring during advanced as well as end-of-life care.
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http://dx.doi.org/10.1177/1049909120905259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361651PMC
September 2020

"If you don't behave, you're in real shit, you don't get outside the doors"-a phenomenological hermeneutic study of adolescents' lived experiences of the socio-spatial environment of involuntary institutional care.

Int J Qual Stud Health Well-being 2020 Dec;15(1):1726559

Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

In Sweden, according to law, adolescents with extensive psychosocial problems, substance abuse or criminal behaviour can be cared for in institutions. The two-fold aim of these institutions (to rehabilitate and incarcerate) puts special demands to their socio-spatial context.: To elucidate adolescents' lived experiences of the socio-spatial environment at special youth homes run by the Swedish National Board of Institutional Care (SiS) in Sweden.: Data collected through Photovoice and analysed employing a phenomenological hermeneutical method. Fourteen adolescents (age 15-19) were asked to photograph their environment, and this was followed up by in-depth interviews.: Two themes emerged from the material: and . The socio-spatial environment can be seen as an additional "other" that distances the adolescents and the staff from one another. Negotiating with their behaviour, the adolescents strive to present themselves as worthy of increased degrees of freedom and ultimately access to the desired outside life.: In an institutional setting dominated by a security and criminal justice logic, words appear to have less impact than the environment. The adolescents appear to understand themselves through the socio-spatial other, causing reinforced feelings of social exclusion.
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http://dx.doi.org/10.1080/17482631.2020.1726559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034456PMC
December 2020

Development of a Toileting and Containment Decision Support Tool.

J Wound Ostomy Continence Nurs 2020 Jan/Feb;47(1):54-64

Paul van Houten, MD, PhD, Zonnehuisgroep Amstelland, Amstelveen, The Netherlands.

A multidisciplinary international expert panel was convened to provide input for a proposed decision support tool. This tool will assist health care professionals who are not specialized in incontinence care to assess individuals with urinary and/or fecal incontinence and recommend appropriate person-centered management options for the home care and ambulatory community settings. A targeted literature review was complemented by a series of interviews with experts in continence management, followed by a practitioner survey and rounds of expert opinion. A set of factors for assessment were defined, along with questions created to identify and quantify the factors. In addition, a range of lifestyle intervention, toileting and containment strategies were identified that were appropriate for the decision support tool. Future steps required to progress this work to a functioning tool are described.
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http://dx.doi.org/10.1097/WON.0000000000000609DOI Listing
September 2020

The Influence of Evidence-Based Design on Staff Perceptions of a Supportive Environment for Person-Centered Care in Forensic Psychiatry.

J Forensic Nurs 2020 Jul/Sep;16(3):E23-E30

Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg.

This prospective longitudinal study aimed to examine the relocation of three forensic psychiatric hospitals in Sweden into new facilities. The research focused on the effects of the physical and psychosocial environment and other staff-related parameters on the delivery of person-centered care after relocation. In forensic psychiatry, most relocations to new environments are to support a person-centered approach and to promote patients' rehabilitation and reintegration into society. Hopefully, this is undertaken in accordance with an evidence-based design strategy allowing improvement in staff satisfaction and working conditions as well as their capacity to provide individualized care. All staff members working on the wards of the facilities in question were invited to participate in the study. Data were collected prospectively between 2010 and 2014, before and after relocation of the forensic psychiatric clinics to new buildings. Structured validated questionnaires were employed. Staff members' job satisfaction and perceptions of a person-centered physical and psychosocial environment increased after relocation and provide evidence that staff perceptions of ward atmosphere in forensic psychiatric clinics are susceptible to factors in the physical and psychosocial environment. The importance of always taking the environmental factors into consideration, to achieve greater staff well-being and capacity to accomplish goals in forensic psychiatry, is emphasized.
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http://dx.doi.org/10.1097/JFN.0000000000000261DOI Listing
February 2021

Beyond the definition of formal care: Informal care arrangements among older swedes who are not family.

Health Soc Care Community 2020 03 3;28(2):633-641. Epub 2019 Dec 3.

Institute of Health and Care Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.

This study explores care practices of older people outside formal care and without appealing to predefined relationships. We conducted interviews with 30 independent-living men and women aged 67-93 in three municipalities in Sweden. The interviews explored how they cared for themselves and other older people who were not family. Interviews were conducted between December 2017 and May 2018 and later transcribed and analysed using grounded theory. Our paper presents one of the first studies on informal care practices among older people that looks beyond the definition of formal care to understand how such care complements formal care services. The findings show that older people participate in several care arrangements to care for themselves as well as for others. The arrangements feature different types of mutuality and include distant relations to other older people and larger more or less formalised groups. The findings highlight the importance of looking beyond conceptualisations of care based on understandings of formal care and specific relationships as a frame for understanding informal care. To promote older people's health by cultivating and supporting older people's care for themselves and others, research and healthcare practitioners need to explore and acknowledge the significance and complexity of older people's everyday care practices.
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http://dx.doi.org/10.1111/hsc.12897DOI Listing
March 2020

Room4Birth - the effect of an adaptable birthing room on labour and birth outcomes for nulliparous women at term with spontaneous labour start: study protocol for a randomised controlled superiority trial in Sweden.

Trials 2019 Nov 19;20(1):629. Epub 2019 Nov 19.

School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D'Olier St, Dublin 2, Ireland.

Background: An important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden.

Methods/design: Following ethics approval, a study design was developed and tested for feasibility in a pilot study, which led to some important improvements for conducting the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour and who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centred approach and physical aspects (such as light, silencer, media installation offering programmed nature scenes with sound, bathtub, birth support tools) that are changeable according to a woman's wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding < 1000 ml); and a positive overall childbirth experience (7-10 on a scale of 1-10). To detect a difference in the composite score of 8% between the groups we need 1274 study participants (power of 80% with significance level 0.05). Secondary outcomes include: the four variables in the primary outcome; other physical outcomes of labour and birth; women's self-reported experiences (the birthing room, childbirth, fear of childbirth, health-related quality of life); and measurement of costs in relation to the hospital stay for mother and neonate. Additionally, an ethnographic study with participant observations will be conducted in both types of birthing rooms.

Discussion: The findings aim to guide the design of birthing rooms that contribute to optimal quality of hospital-based maternity care.

Trial Registration: ClinicalTrials.gov NCT03948815. Registered 13 May 2019-retrospectively registered.
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http://dx.doi.org/10.1186/s13063-019-3765-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6862754PMC
November 2019

Written reports of adverse events in acute care-A discourse analysis.

Nurs Inq 2019 10 27;26(4):e12298. Epub 2019 May 27.

Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Adverse health care events are a global public health issue despite major efforts, and they have been acknowledged as a complex concern. The aim of this study was to explore the construction of unsafe care using accounts of adverse events concerning the patient, as reported by patients, relatives, and health care professionals. Twenty-nine adverse events reported in an acute care setting in a Swedish university hospital were analyzed through discourse analysis, where the construction of what was considered to be real and true in the descriptions of unsafe care was analyzed. In the written reports about unsafe events, the patient was spoken of in three different ways: (a) the patient as a presentation of physical signs, (b) the patient as suffering and vulnerable, and (c) the patient as unpredictable. When the patient's voice was subordinate to physical signs, this was described as being something that conflicted with patient safety. The conclusion was that the patient's voice might be the only sign available in the early stages of adverse events. Therefore, it is crucial for health care professionals to give importance to the patient's voice to prevent patients from harm and not unilaterally act only upon abnormal physical signs.
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http://dx.doi.org/10.1111/nin.12298DOI Listing
October 2019

Evidence-Based Design Has a Sustainable Positive Effect on Patients' Perceptions of Quality of Care in Forensic Psychiatry: A 3-Year Follow-Up Study.

J Forensic Nurs 2019 Jan/Mar;15(1):60-68

Center for Ethics, Law, and Mental Health, Sahlgrenska Academy, University of Gothenburg.

This prospective longitudinal study aimed to assess the sustainable effect on patients' assessment of ward atmosphere and quality of care at three forensic psychiatric clinics relocated to new facilities built with the latest evidence-based healthcare environment design to support recovery. Baseline data were collected in the old facilities and during three follow-ups after relocation, between 2010 and 2016. Of 74 patients who gave informed consent to participate, 58 patients (100%) answered the questionnaires at baseline, with 25 patients (43%) completing them at Follow-up 1, 11 patients (19%) at Follow-up 2, and seven patients (12%) at Follow-up 3. This study provides evidence that the mean values of patients' perceptions of care quality in these forensic psychiatric facilities increased when moving to new buildings and were stable up to 3 years after relocation, which was statistically significant in the domain of secluded environment (p < 0.05). The sample size at Follow-up 3 was small, and thus the results are limited, which indicates that further research is needed to confirm the findings.
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http://dx.doi.org/10.1097/JFN.0000000000000226DOI Listing
March 2019

The meanings of place and space in forensic psychiatric care - A qualitative study reflecting patients' point of view.

Int J Ment Health Nurs 2019 Apr 7;28(2):516-526. Epub 2018 Dec 7.

Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.

The outcome of care for patients sentenced to forensic psychiatric care is of importance not only for the patient but also for society, in preventing new crimes. In recent years, a person-centered perspective is influencing the care, recognizing the design of the physical environment as a therapeutic resource. To capture the complexity of patients' experience of the physical environment, a qualitative approach is needed. The aim of this study was to investigate the meanings of the patient room as a place and space in forensic psychiatric in-patient care from the patients' perspective. An explorative qualitative design was chosen, data were collected by photovoice; a combination of photographs, taken by the patients, followed by interviews. Eleven (N = 11) patients were interviewed. The interviews were analysed by a thematic analysis method. Four themes emerged from the data revealing the meanings of the patient room as a place and space: (i) striving towards normality; (ii) being anchored and protected; (iii) being at-home and homeness; and (iv) being in communion and meaningfulness. The findings show that the physical environment has a say in patients' basic needs and a role in maintaining normality. Substandard reveals a lack of respect and dignity towards this patient group. Involving patients in the design process of new facilities can be a way to make progress.
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http://dx.doi.org/10.1111/inm.12557DOI Listing
April 2019

The caregiving phenomenon and caregiver participation in dementia.

Scand J Caring Sci 2019 Jun 29;33(2):255-265. Epub 2018 Nov 29.

Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden.

Background: Dementia presents barriers to the collaboration between individuals and the healthcare system. Caregivers perform multiple functions helping patients with basic and instrumental activities but also communicating and mediating the dyads' needs within the broader social group. Interventions focusing on caregivers show that caregiver burden can be reduced, improving patient outcomes in a cost-effective way, but the generalisation of these findings is limited by several factors such as low participation rates of caregivers in studies. There is a global push to increase patient participation in health care, but this can be difficult for patients with dementia. Caregiver participation has arisen as a substitute, but there is a lack of standardised definitions, goals and outcome measurement tools for this participation.

Methods: In 2015, the Swedish Association of Local Authorities and Regions commissioned a study on possibilities of increasing caregiver participation within the Swedish Dementia Registry (SveDem). This discussion paper updates and adapts that report, aiming to broadly summarise the caregiving phenomenon in order to provide a backdrop for clinicians seeking to understand the legal, ethical and practical considerations of caregiver participation in dementia. Relevant literature on caregiver participation is presented, and its definition, extent and practical implementation are discussed.

Discussion: The Swedish legal framework compels care providers to facilitate patient and caregiver participation in dementia and provides support to caregivers through the local level of government, but further work is needed to clarify and define the extension and form that this participation must take in clinical practice. Advanced directives are one step in extending patient participation to the period of advanced dementia.

Conclusion: Little research exists on caregiver participation. There is a need to develop a framework for caregiver and patient participation to determine the extent, type and form that such participation should take in health care, research and quality initiatives pertaining to persons with dementia.
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http://dx.doi.org/10.1111/scs.12627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432177PMC
June 2019

Person-Centered Incontinence Care in Residential Care Facilities for Older Adults With Cognitive Decline: Feasibility and Preliminary Effects on Quality of Life and Quality of Care.

J Gerontol Nurs 2018 Nov;44(11):10-19

The current study operationalized, assessed, and evaluated the feasibility and preliminary effects of implementing a person-centered approach to incontinence care for older adults with cognitive decline in residential care facilities (RCFs) in Sweden. Twenty health care workers were purposively sampled from two intervention RCFs. Process outcome was measured as number of assessments conducted for incontinence management. Impact outcome measures were quality of life, basal assessment of incontinence, incontinence actions taken, and personally chosen incontinence aids. A usual care control group RCF was matched by resident case-mix and geographic region. Introduction of a person-centered approach showed an increase in residents' quality of life in the intervention group compared to baseline and the control group. A positive effect was found on the number of urinary incontinence assessments conducted (p < 0.05). In addition, the number of person-centered caring actions (e.g., toilet assistance) was significantly higher during and 6 months after implementation of the person-centered approach. Implementing a person-centered approach in clinical practice focused on incontinence care, quality of care, and quality of life is supported for RCF residents. [Journal of Gerontological Nursing, 44(11), 10-19.].
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http://dx.doi.org/10.3928/00989134-20181010-04DOI Listing
November 2018

Influence of Color in a Lactation Room on Users' Affective Impressions and Preferences.

HERD 2019 04 10;12(2):55-70. Epub 2018 Sep 10.

3 Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Objective: The present study aims to examine the influence of environmental color hue in a lactation room at a health center on users' affective response and preference.

Background: Hospital design plays an important role in the emotional experience of patients. In this regard, many studies have attempted to find relationships between design variables and healthcare facilities users' response. Color has been frequently examined because it is always present in the environment and can be easily changed. However, most of the studies dealing with color-emotion relationships acquire users' affective response by questionnaires developed by experts which could lead to inaccurate results since nonexperts may misunderstand concepts set by experts and use nonimmersive images to simulate the environments to assess.

Methods: To overcome these limitations, a Kansei Engineering-based approach was proposed. In the first phase, users' specific affective factors for lactation rooms were determined using Semantic Differential. In the second phase, the influence of nine different color hues on users' affective factors was obtained. An immersive display system was used to visualize the room altering hues in an isolated and controlled way.

Results: (1) Six user's affective factors connected to the lactation rooms were discovered: safety, elegance, coziness, spaciousness, simplicity, and luminosity, of which coziness has the most impact on the assessment of the room. (2) Warm colors like orange and yellow tend to score highly for coziness which puts them in leading positions when users' assess lactation rooms.

Conclusions: Results provide recommendations for designers and show the advantages of using semantic differential and immersive displays to analyze user's affective response to environments.
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http://dx.doi.org/10.1177/1937586718796593DOI Listing
April 2019

Patients' Experiences of Pain Have an Impact on Their Pain Management Attitudes and Strategies.

Pain Manag Nurs 2018 10;19(5):464-473

Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.

Objectives: Postoperative pain remains undermanaged in orthopedic surgery. To identify areas of improvement for future structural changes in pain management, patients' experiences of pain and pain management when undergoing elective lumbar spine surgery were explored, using a qualitative method with focus group interviews.

Setting: The study setting was an orthopedic spine surgery department at a University Hospital in Sweden.

Methods: This study consisted of two focus group interviews with patients (n = 6/group, a total of 12 patients) who had undergone lumbar spine surgery 4 days to 5 weeks prior to the focus group interviews. The interviews were semi-structured, and the analysis was performed using qualitative content analysis.

Results: The main result of this study revealed that patients' experiences of pain influenced their attitudes and strategies for pain management. Three main categories emerged from the focus group interviews: I. Coping with pain while waiting for surgery; II. Using different pain-relieving strategies after surgery; and III. How organizational structures influence the pain experiences.

Conclusions: In conclusion the results from this study acknowledge that postoperative pain experiences and coping strategies after spine surgery are highly diverse and individual. This calls for staff having a more personalized approach to pain management in order to optimize pain relief, which was stressed as highly valued by the patients.
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http://dx.doi.org/10.1016/j.pmn.2018.02.067DOI Listing
October 2018

A manual-based phenomenological art therapy for individuals diagnosed with moderate to severe depression (PATd): A randomized controlled study.

Psychiatr Rehabil J 2018 Sep 14;41(3):169-182. Epub 2018 May 14.

Institute of Care and Health Science, Sahlgrenska Academy, University of Gothenburg.

Objective: This study investigated the effects of manual-based Phenomenological Art Therapy for individuals living with depression in addition to treatment as usual (PATd/TAU) compared with only treatment as usual (TAU) for individuals diagnosed with moderate to severe depression.

Method: 79 adults (men = 29.1%) were included in this randomized-controlled-trial (RCT), multicenter study in Sweden with an intention-to-treat design. Participants were randomized into either the PATd/TAU-group (n = 43) or TAU-group (n = 36). Data were collected at baseline and at end of treatment. The main outcomes were depression levels and self-esteem. Secondary outcomes were suicide ideation and sickness absence.

Results: The PATd/TAU-group showed a significant decrease of depression levels. The PATd/TAU-group returned to work to a higher degree than the TAU-group. Self-esteem significantly improved in both groups. Suicide ideation was unaffected.

Conclusion And Implications For Practice: Manual-based PATd works as expected, being an effective treatment, and contributes to recovery for individuals with moderate to severe depression. This outcome needs to be confirmed and its long-term effects examined in further studies. (PsycINFO Database Record
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http://dx.doi.org/10.1037/prj0000300DOI Listing
September 2018

Sustainability of a person-centered ward atmosphere and possibility to provide person-centered forensic psychiatric care after facility relocation.

J Forensic Leg Med 2018 May 11;56:108-113. Epub 2018 Apr 11.

Center for Ethics, Law, and Mental Health (CELAM), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address:

Objective: This longitudinal study aims to assess the sustainability of staff perceptions of ward atmosphere and their possibility to provide person-centered forensic psychiatric care after relocation to new hospitals that aimed to provide supportive work conditions for the staff to be able to perform care of high quality.

Methods: In this study we only present the result for the repeated measures, that is, only the individuals that performed both the questionnaires at baseline and at the three follow-ups. Data were collected prospectively between 2010 and 2016; before (baseline) and after relocation of the forensic psychiatric clinics to new buildings, i.e., after six months (follow-up 1), after one year (follow-up 2) and after two years (follow-up 3), respectively. Data were obtained by employing structured validated questionnaires.

Results: The main findings of this study display an improvement in the staff assessment of a person-centered atmosphere from baseline to follow-up 3 in the domains of safety, everydayness and community where safety was evaluated the highest. No sustainable significant changes were found concerning staff's assessment of the support for them to provide person-centered care.

Conclusion: The findings show sustainability of person-centered ward atmosphere in forensic psychiatric care according to staff's assessment after relocation from traditional health care facilities to evidence-based designed premises. In this study the increased staff perception of the possibility to provide person-centered care in the new facilities could not be revealed as sustainability over the two years of follow-up.
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http://dx.doi.org/10.1016/j.jflm.2018.04.006DOI Listing
May 2018

Is hospitalisation necessary? A survey of frail older persons with cognitive impairment transferred from nursing homes to the emergency department.

Scand J Caring Sci 2018 Sep 12;32(3):1138-1147. Epub 2018 Feb 12.

Institute of Health and Care Sciences, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.

Background: Providing care for frail older persons is complex and demanding, and the transfer of older persons with cognitive impairment to the emergency department is associated with a high risk of them developing complications.

Aim: To survey the most ill and frail older persons with cognitive impairment who were transferred from nursing homes to the emergency department, considering reasons for referral, symptoms and actions taken at the hospital.

Method: A retrospective descriptive survey, conducting a review of 588 referral notes and medical records, analysed and presented with descriptive statistics and visualised with typical case narratives.

Findings: The persons who were transferred to the emergency department were frail with complex symptomology. When reviewing the medical records in the light of criteria for avoidable hospitalisation, 75% of the patients could have been examined and treated at the nursing homes or in primary care.

Conclusion: Frail older persons with cognitive impairment, who are in need of end-of-life care, should be prevented from unnecessary hospitalisation. The majority of these transfers to the emergency department can be avoided if there is better planning beforehand, more specially trained nurses in elderly care in the municipalities, and more physicians making house calls.
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http://dx.doi.org/10.1111/scs.12559DOI Listing
September 2018

The association between the physical environment and the well-being of older people in residential care facilities: A multilevel analysis.

J Adv Nurs 2017 Dec 7;73(12):2942-2952. Epub 2017 Jul 7.

School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.

Aims: To investigate the associations between the quality of the physical environment and the psychological and social well-being of older people living in residential care facilities.

Background: Many older people in care facilities have cognitive and physical frailties and are at risk of experiencing low levels of well-being. High-quality physical environments can support older people as frailty increases and promote their well-being. Although the importance of the physical environment for residents' well-being is recognized, more research is needed.

Design: A cross-sectional survey of 20 care facilities from each of which 10 residents were sampled. As the individual resident data were nested in the facilities, a multilevel analysis was conducted.

Methods: Data were collected during 2013 and 2014. The care facilities were purposely sampled to ensure a high level of variation in their physical characteristics. Residents' demographic and health data were collected via medical records and interviews. Residents' well-being and perceived quality of care were assessed via questionnaires and interviews. Environmental quality was assessed with a structured observational instrument.

Results: Multilevel analysis indicated that cognitive support in the physical environment was associated with residents' social well-being, after controlling for independence and perceived care quality. However, no significant association was found between the physical environment and residents' psychological well-being.

Conclusion: Our study demonstrates the role of the physical environment for enhancing the social well-being of frail older people. Professionals and practitioners involved in the design of care facilities have a responsibility to ensure that such facilities meet high-quality specifications.
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http://dx.doi.org/10.1111/jan.13358DOI Listing
December 2017

Can incontinence be cured? A systematic review of cure rates.

BMC Med 2017 03 24;15(1):63. Epub 2017 Mar 24.

Department of Obstetrics & Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.

Background: Incontinence constitutes a major health problem affecting millions of people worldwide. The present study aims to assess cure rates from treating urinary (UI) or fecal incontinence (FI) and the number of people who may remain dependent on containment strategies.

Methods: Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and PEDro were searched from January 2005 to June 2015. Supplementary searches included conference abstracts and trials registers (2013-2015). Included studies had patients ≥ 18 years with UI or FI, reported treatment cure or success rates, had ≥ 50 patients treated with any intervention recognized in international guideline algorithms, a follow-up ≥ 3 months, and were published from 2005 onwards. Title and abstract screening, full paper screening, data extraction and risk-of-bias assessment were performed independently by two reviewers. Disagreements were resolved through discussion or referral to a third reviewer where necessary. A narrative summary of included studies is presented.

Results: Most evidence was found for UI: Surgical interventions for stress UI showed a median cure rate of 82.3% (interquartile range (IQR), 72-89.5%); people with urgency UI were mostly treated using medications (median cure rate for antimuscarinics = 49%; IQR, 35.6-58%). Pelvic floor muscle training and bulking agents showed lower cure rates for UI. Sacral neuromodulation for FI had a median cure rate of 38.6% (IQR, 35.6-40.6%).

Conclusions: Many individuals were not cured and hence may continue to rely on containment. No studies were found assessing success of containment strategies. There was a lack of data in the disabled and in those with neurological diseases, in the elderly and those with cognitive impairment. Surgical interventions were effective for stress UI. Other interventions for UI and FI showed lower cure rates. Many individuals are likely to be reliant on containment strategies.

Prospero Registration: PROSPERO registration number: CRD42015023763 .
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http://dx.doi.org/10.1186/s12916-017-0828-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364653PMC
March 2017

A systematic review of the psychometric properties of instruments for assessing the quality of the physical environment in healthcare.

J Adv Nurs 2017 Dec 5;73(12):2796-2816. Epub 2017 Apr 5.

School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.

Aim: To identify instruments measuring the quality of the physical healthcare environment, describe their psychometric properties.

Background: The physical healthcare environment is regarded as a quality factor for health care. To facilitate evidence-based design there is a need for valid and usable instruments that can evaluate the design of the healthcare environment.

Design: Systematic psychometric review.

Data Sources: A systematic literature search in Medline, CINAHL, Psychinfo, Avery index and reference lists of eligible papers (1990-2016).

Review Method: Consensus based standards for selection of health measurement instruments guidelines were used to evaluate psychometric data reported.

Results: Twenty-three instruments were included. Most of the instruments are intended for healthcare environments related to the care of older people. Many of the instruments were old, lacked strong, contemporary theoretical foundations, varied in the extent to which they had been used in empirical studies and in the degree to which their validity and reliability had been evaluated.

Conclusions: Although we found many instruments for measuring the quality of the physical healthcare environment, none met all of our criteria for robustness. Of the instruments, The Multiphasic environmental assessment procedure, The Professional environment assessment protocol and The therapeutic environment screening have been used and tested most frequently. The Perceived hospital quality indicators are user centred and combine aspects of the physical and social environment. The Sheffield care environment assessment matrix has potential as it is comprehensive developed using a theoretical framework that has the needs of older people at the centre. However, further psychometric and user-evaluation of the instrument is required.
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http://dx.doi.org/10.1111/jan.13281DOI Listing
December 2017

Health Care Professionals' Usage and Documentation of a Swedish Quality Registry Regarding Preventive Nutritional Care.

Qual Manag Health Care 2017 Jan/Mar;26(1):15-21

School of Health and Welfare, Institute of Gerontology and Department of Nursing (Dr Johansson), and School of Health and Welfare, Department of Nursing (Dr Christensson), Jönköping University, Jönköping, Sweden; and Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden (Dr Wijk).

Objectives: To describe health care staff members' usage and documentation in a Swedish quality registry focusing on a preventive care process regarding the risk area of malnutrition among persons with dementia. The preventive care process includes risk assessment, analysis of underlying causes, planning and performing interventions, as well as evaluating effects.

Methods: Data were collected from 2 Swedish quality registries, Senior Alert and the Swedish Dementia Register (Svedem). In total, 1929 people with dementia were assessed and 1432 registered as being at risk of malnutrition or malnourished.

Results: Performed nutritional interventions were registered in approximately 65% of cases. In more than 80% of registrations, the analyses of underlying causes were missing. Those who had registered underlying causes had significantly more interventions and the evaluation of the performed intervention was registered. The time between assessment and evaluation depended on care setting and ranged from 0 to 702 days.

Conclusions: Limitations in registration were noted; however, the register allows staff to focus on nutritional care and has resulted in many risk assessments. Rarely people were registered in all steps of the preventive care process. Large variances in when the performed interventions were evaluated makes it difficult to measure improvements.
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http://dx.doi.org/10.1097/QMH.0000000000000116DOI Listing
February 2018