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  • 1.
    Emilsson, Maria
    et al.
    University West, Department of Health Sciences, Section for nursing - graduate level.
    Karlsson, Christina
    University West, Department of Health Sciences, Section for nursing - undergraduate level.
    Svensson, Ann
    University West, School of Business, Economics and IT, Divison of Informatics.
    Experiences of using surveillance cameras as a monitoring solution at nursing homes: The eldercare personnel's perspectives.2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 144Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As the number of older people increases, so does the need for care. However, the workforce in eldercare cannot increase at the rate required to match the needs. Welfare technologies, such as surveillance cameras, can replace physical visits and be used at night to monitor older people in order to keep them safe, while not disturbing their sleep. The aim of the paper is to analyze obstacles and opportunities associated with implementation and use of surveillance cameras at nursing homes from the perspectives of the practitioners who use the technology, their working environment and the conditions of the older people with cognitive impairment who live in nursing homes.

    METHODS: Individual semi-structured interviews were conducted with the eldercare personnel at nursing homes to understand their experiences of implementation and use of surveillance cameras. The transcribed interviews were analyzed using qualitative content analysis. The consolidated criteria for reporting qualitative research (COREQ) was used as a guidance tool.

    RESULTS: The results show that the eldercare personnel experienced lack of adequate information, education and support related to using surveillance cameras. Several benefits are highlighted, such as better working environment and that the residents were not unnecessarily disturbed at night. However, the results also show that it is important to clarify that surveillance cameras cannot replace the human presence.

    CONCLUSIONS: The conclusions from this study are the importance of prerequisites for implementation, and that using surveillance cameras contributed to improvements in the working environment at night and created possibilities to maintain security and integrity for older people living in nursing homes.

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  • 2.
    Hansson, Malin
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Dencker, Anna
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Lundgren, Ingela
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Carlsson, Ing-Marie
    Department of Health and Nursing, School of Health and Welfare.
    Eriksson, Monica
    University West, Department of Health Sciences, Section for health promotion and care sciences.
    Hensing, Gunnel
    School of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg.
    Job satisfaction in midwives and its association with organisational and psychosocial factors at work: a nation-wide, cross-sectional study2022In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, p. 1-10, article id 436Article in journal (Refereed)
    Abstract [en]

    BackgroundMidwives report a challenging work environment globally, with high levels of burnout, insufficient work resources and low job satisfaction. The primary objective of this study was to identify factors in the organisational and psychosocial work environment associated with midwives’ job satisfaction. A secondary objective was to identify differences in how midwives assess the organisational and psychosocial work environment compared to Swedish benchmarks.

    MethodsThis nation-wide, cross-sectional web survey study analysed midwives’ assessment of their organisational and psychosocial work environment using the COPSOQ III instrument. A multivariable, bi-directional, stepwise linear regression was used to identify association with job satisfaction (N = 1747, 99.6% women). A conventional minimal important score difference (MID ± 5 as a noticeable difference with clinical importance) were used to compare midwives’ results with Swedish benchmarks.

    ResultsA multivariable regression model with 13 scales explained the variance in job satisfaction (R2 = .65). Five scales, possibilities for development, quality of work, role conflict, burnout and recognition, explained most of the variance in midwives’ job satisfaction (R2 = .63) and had β values ranging from .23 to .10. Midwives had adverse MID compared to Swedish benchmarks with higher difference in mean values regarding quantitative demands (8.3), work pace (6.0) emotional demand (20.6), role conflicts (7.9) and burnout (8.3). In addition, lower organisational justice (-6.4), self-rated health (-8.8), influence (-13.2) and recognition at work (-5.8). However, variation and meaning of work showed a beneficial difference in mean values with 7.9 and 13.7 respectively.

    ConclusionsMidwives reported high levels of meaningfulness in their work, and meaningfulness was associated with job satisfaction. However, midwives also reported adversely high demands and a lack of influence and recognition at work and in addition, high role conflict and burnout compared to Swedish benchmarks. The lack of organisational resources are modifiable factors that can be taken into account when structural changes are made regarding organisation of care, management and resource allocation. Midwives are necessary to a high quality sexual, reproductive and perinatal health care. Future studies are needed to investigate if job satisfaction can be improved through professional recognition and development, and if this can reduce turnover in midwives.

  • 3.
    Hansson, Malin
    et al.
    Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, P O Box 457, 405 30, Gothenburg, SE, Sweden.
    Lundgren, Ingela
    Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, P O Box 457, 405 30, Gothenburg, SE, Sweden.
    Hensing, Gunnel
    Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Dencker, Anna
    Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, P O Box 457, 405 30, Gothenburg, SE, Sweden.
    Eriksson, Monica
    University West, Department of Health Sciences, Section for health promotion and care sciences.
    Carlsson, Ing-Marie
    Department of Health and Nursing, School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Professional courage to create a pathway within midwives’ fields of work: a grounded theory study2021In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, no 1, article id 312Article in journal (Refereed)
    Abstract [en]

    The theory of salutogenesis focuses on resources for health and health-promoting processes. In the context of midwives’ work, this is not well described despite the importance for occupational health and the intention to remain in the profession. In order to promote a healthy workplace, it is necessary to consider the facilitating conditions that contribute to a sustainable working life. Therefore, the aim of this study was to explore health-promoting facilitative conditions in the work situation on labour wards according to midwives.

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  • 4.
    Persson, Josefine
    et al.
    Göteborgs Universitet.
    Ferraz-Nunes, José
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics.
    Karlberg, Ingvar
    Göteborgs universitet.
    Economic burden of stroke in a large county in Sweden2012In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 12, no 341, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Stroke remains to be a major burden of disease, often causing death or physical impairment or disability. This paper estimates the economic burden of stroke in a large county of 1.5 million inhabitants in western Sweden. Methods: The economic burden of stroke was estimated from a societal perspective with an incidence approach. Data were collected from clinical registries and 3,074 patients were included. In the cost calculations, both direct and indirect costs were estimated and were based on costs for 12 months after a first-ever stroke. Results: The total excess costs in the first 12 months after the first-ever stroke for a population of 1.5 million was 629 million SEK (€69 million). Men consumed more acute care in hospitals, whereas women consumed more rehabilitation and long-term care provided by the municipalities. Younger patients brought a significantly higher burden on society compared with older patients due to the loss of productivity and the increased use of resources in health care. Conclusions: The results of this cost-of-illness study were based on an improved calculation process in a number of fields and are consistent with previous studies. In essence, 50% of costs for stroke care fall on acute care hospital, 40% on rehabilitation and long-time care and informal care and productivity loss explains 10% of total cost for the stroke disease. The result of this study can be used for further development of the methods for economic analyses as well as for analysis of improvements and investments in health care.

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    Economic burden of stroke
  • 5.
    Rosenbäck, Ritva Gisela
    et al.
    University West, Department of Engineering Science, Division of Production Systems.
    Svensson, Ann
    University West, School of Business, Economics and IT, Divison of Informatics.
    Resilience in keeping the balance between demand and capacity in the COVID-19 pandemic, a case study at a Swedish middle-sized hospital.2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 202Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In pandemics, it is critical to find a balance between healthcare demand, and capacity, taking into consideration the demands of the patients affected by the pandemic, as well as other patients (in elective or emergency care). The purpose of this paper is to suggest conceptual models for the capacity requirements at the emergency department, the inpatient care, and intensive care unit as well as a model for building staff capacity in pandemics.

    METHODS: This paper is based on a qualitative single case study at a middle-sized hospital in Sweden. The primary data are collected from 27 interviewees and inductively analyzed.

    RESULTS: The interviewees described a large difference between the immediate catastrophe scenario described in the emergency plan (which they had trained for), and the reality during the COVID-19 pandemic. The pandemic had a much slower onset and lasted longer compared to, for example, an accident, and the healthcare demand fluctuated with the societal infection. The emergency department and inpatient care could create surge capacity by reducing elective care. Lower inflow of other emergency patients also helped to create surge capacity. The number of intensive care beds increased by 350% at the case hospital. At the same time, the capacity of the employees decreased due to infection, exhaustion, and fear. The study contributes to knowledge of conceptional models and key factors affecting the balance between demand and capacity.

    CONCLUSION: The framework suggests conceptual models for balancing surge capacity during a pandemic Health care practitioners need to provide assumptions of the key factors to find the balance between the demand and capacity corresponding to the reality and maintain the delivery of high-quality healthcare services.

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  • 6.
    Samuelson, Sarah
    et al.
    University West, School of Business, Economics and IT, Divison of Informatics. Region Västra Götaland, Research, Education, Development & Innovation (REDI), Primary Health Care (SWE); General Practice, Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg (SWE).
    Pennbrant, Sandra
    University West, Department of Health Sciences, Section for nursing - undergraduate level.
    Svensson, Ann
    University West, School of Business, Economics and IT, Divison of Informatics.
    Svenningsson, Irene
    Region Västra Götaland, Research, Education, Development & Innovation (REDI), Primary Health Care (SWE); General Practice, Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg (SWE).
    Standing together at the helm: how employees experience employee-driven innovation in primary car2024In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, no 1, article id 655Article in journal (Refereed)
    Abstract [en]

    Primary care needs to find strategies to deal with today’s societal challenges and continue to deliver efficient and high-quality care. Employee-driven innovation is increasingly gaining ground as an accessible pathway to developing successful and sustainable organisations. This type of innovation is characterised by employees being engaged in the innovation process, based on a bottom-up approach. This qualitative study explores employees’ experiences of employee-driven innovation at a primary care centre in Sweden. Data are collected by focus group interviews and analysed by inductive qualitative content analysis. The result is presented with the overarching theme “Standing together at the helm” followed by three categories: “Motivating factors for practising employee-driven innovation”, “Challenges in practising employee-driven innovation” and “Benefits of employee-driven innovation”, including nine subcategories. The study found that employee-driven innovation fosters organisational innovation, empowers employees, and enhances adaptability at personal and organisational levels. This enables individual and collective learning, and facilitates the shaping, development, and adaptation of working methods to meet internal and external requirements. However, new employees encountered difficulty grasping the concept of employee-driven innovation and recognising its long-term advantages. Additionally, the demanding and task-focused environment within primary care posed challenges in sustaining efforts in innovation work. The employees also experienced a lack of external support to drive and implement some innovative ideas.

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  • 7.
    Sparud-Lundin, Carina
    et al.
    University of Gothenburg, Institute of Health and Care Sciences, The Sahlgrenska Academy, Box 457, SE- 405 30, Gothenburg, Sweden.
    Berghammer, Malin
    University West, Department of Health Sciences, Section for nursing - graduate level. University of Gothenburg, Centre for Person-Centred Care (GPCC), Box 457, SE- 405 30, Gothenburg, Sweden..
    Moons, Philip
    University of Gothenburg, Institute of Health and Care Sciences, The Sahlgrenska Academy, Box 457, SE- 405 30, Gothenburg, Sweden..
    Bratt, Ewa-Lena
    University of Gothenburg, Institute of Health and Care Sciences, The Sahlgrenska Academy, Box 457, SE- 405 30, Gothenburg, Sweden..
    Health care providers' attitudes towards transfer and transition in young persons with long term illness: a web-based survey2017In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 17, no 1, article id 260Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Transition programs in health care for young persons with special health care needs aim to maximize lifelong functioning. Exploring health care professionals' perspective may increase the possibility of successful implementation of transition programs. The aim was to survey health care professionals' attitudes towards components and barriers on transition and transfer in young people with long-term medical conditions with special health care needs.

    METHODS: A cross-sectional web-based survey was sent by e-mail to 529 physicians and nurses in Swedish pediatric and adult outpatient clinics. Response rate was 38% (n = 201). The survey consisted of 59 questions regarding different aspects of components and barriers on transition and transfer. Descriptive statistics were computed to summarize demographic data and categorized responses. The Chi square test was used for comparison between proportions of categories.

    RESULTS: Most respondents agreed on the destinations of care for adolescents within their specialty. Age and psychosocial aspects such as maturity and family situations were considered the most important initiators for transfer. Joint meeting with the patient (82%); presence of a transition coordinator (76%) and a written individualized transfer plan (55%) were reported as important transition components. Pediatric care professionals found the absence of a transition coordinator to be more of a transition barrier than adult care professionals (p = 0.018) and also a more important transfer component (p = 0.017). Other barriers were lack of funding (45%) and limited clinical space (19%). Transition programs were more common in university hospitals than in regional hospitals (12% vs 2%, p = <0.001) as well as having a transition coordinator (12% vs 3%, p = 0.004).

    CONCLUSION: The findings highlight a willingness to work on new transition strategies and provide direction for improvement, taking local transition components as well as potential barriers into consideration when implementing future transition programs. Some differences in attitudes towards transitional care remain among pediatric and adult care professionals.

  • 8.
    Suutari, Anne-Marie
    et al.
    The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping (SWE); Department of Internal Medicine and Geriatrics, the Highland Hospital (Höglandssjukhuset), Region Jönköping County, Eksjö (SWE).
    Thor, Johan
    The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping (SWE).
    Nordin, Annika
    The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping (SWE).
    Areskoug Josefsson, Kristina
    University West, Department of Health Sciences, Section for health promotion and care sciences. The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping (SWE)Department of Behavioral Science, Oslo Metropolitan University, Oslo (NOR).
    Improving heart failure care with an Experience-Based Co-Design approach: what matters to persons with heart failure and their family members?2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, p. 1-17, article id 294Article in journal (Refereed)
    Abstract [en]

    Background

    Heart failure is a chronic heart condition. Persons with heart failure often have limited physical capabil‑ity, cognitive impairments, and low health literacy. These challenges can be barriers to healthcare service co-design with family members and professionals. Experience-Based Co-Design is a participatory healthcare quality improve‑ment approach drawing on patients’, family members’ and professionals’ experiences to improve healthcare. The over‑all aim of this study was to use Experience-Based Co-Design to identify experiences of heart failure and its care in a Swedish cardiac care setting, and to understand how these experiences can translate into heart failure care improve‑ments for persons with heart failure and their families.

    Methods

    A convenience sample of 17 persons with heart failure and four family members participated in this single case study as a part of an improvement initiative within cardiac care. In line with Experienced-Based Co-Design meth‑odology, feld notes from observations of healthcare consultations, individual interviews and meeting minutes from stakeholders’ feedback events, were used to gather participants’ experiences of heart failure and its care. Refexive thematic analysis was used to develop themes from data.

    Results

    Twelve service touchpoints, organized within fve overarching themes emerged. The themes told a story about persons with heart failure and family members struggling in everyday life due to a poor quality of life, lack of support networks, and difculties understanding and applying information about heart failure and its care. To be recognized by professionals was reported to be a key to good quality care. Opportunities to be involved in healthcare varied, Further, participants’ experiences translated into proposed changes to heart failure care such as improved information about heart failure, continuity of care, improved relations, and communication, and being invited to be involved in healthcare.

    Conclusions

    Our study fndings ofer knowledge about experiences of life with heart failure and its care, trans‑lated into heart failure service touchpoints. Further research is warranted to explore how these touchpoints can be addressed to improve life and care for persons with heart failure and other chronic conditions

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  • 9.
    Van Bulck, Liesbet
    et al.
    KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium (BEL); Research Foundation Flanders (FWO), Brussels, Belgium (BEL).
    Goossens, Eva
    KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium (BEL); Research Foundation Flanders (FWO), Brussels, Belgium; University of Antwerp,Division of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, Antwerp, Belgium (BEL).
    Luyckx, Koen
    KU Leuven - University of Leuven, School Psychology and Child and Adolescent Development,Leuven, Belgium (BEL); University of the Free State, UNIBS, Bloemfontein, South Africa (ZAF).
    Apers, Silke
    KU Leuven - University of Leuven, KU Leuven Department of Public Health and Primary Care, Leuven, Belgium (BEL).
    Oechslin, Erwin
    Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada (CAN).
    Thomet, Corina
    University of Bern, Center for Congenital Heart Disease, Inselspital - Bern University Hospital, Bern, Switzerland (CHE).
    Budts, Werner
    Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium (BEL); KU Leuven - University of Leuven, KU Leuven Department of Cardiovascular Sciences, Leuven, Belgium (BEL).
    Enomoto, Junko
    Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan (JPN).
    Sluman, Maayke A
    Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands (NLD).
    Lu, Chun-Wei
    National Taiwan University Children’s Hospital, Adult Congenital Heart Center, Taiwan (TWN).
    Jackson, Jamie L
    Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA (USA).
    Khairy, Paul
    Université de Montréal, Adult Congenital Heart Center, Montreal Heart Institute, Montreal, Canada (CAN).
    Cook, Stephen C
    Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA (USA).
    Chidambarathanu, Shanthi
    Pediatric Cardiology, Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation), Chennai, India (IND).
    Alday, Luis
    Division of Cardiology, Hospital de Niños, Córdoba, Argentina (ARG).
    Eriksen, Katrine
    Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway (NOR).
    Dellborg, Mikael
    Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden; University of Gothenburg, Centre for Person-Centred Care (GPCC), Gothenburg, Sweden.
    Berghammer, Malin
    University West, Department of Health Sciences, Section for nursing - graduate level. University of Gothenburg, Centre for Person-Centred Care (GPCC), Gothenburg, Sweden.
    Johansson, Bengt
    Umeå University, Department of Public Health and Clinical Medicine, Umeå, Sweden.
    Mackie, Andrew S
    University of Alberta, Division of Cardiology, Stollery Children's Hospital, Edmonton, Canada (CAN).
    Menahem, Samuel
    Monash University, Monash Heart, Monash Medical Centre, Melbourne, Australia (AUS).
    Caruana, Maryanne
    Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta (MLT).
    Veldtman, Gruschen
    Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA (USA).
    Soufi, Alexandra
    Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France (FRA).
    Fernandes, Susan M
    Adult Congenital Heart Program at Stanford, Lucile Packard Children’s Hospital and Stanford Health Care, USA (USA).
    White, Kamila S
    Washington University, Adult Congenital Heart Disease Center ; University of Missouri, Barnes Jewish Heart & Vascular Center, Saint Louis, Missouri USA (USA).
    Callus, Edward
    Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy (ITA); Università degli Studi di Milano, Department of Biomedical Sciences for Health, Milan, Italy (ITA).
    Kutty, Shelby
    University of Nebraska Medical Center, Adult Congenital Heart Disease Center, Children's Hospital and Medical Center, Omaha, NE, USA (USA).
    Moons, Philip
    KU Leuven - University of Leuven, KU Leuven Department of Public Health and Primary Care, Leuven, Belgium (BEL); Centre for Person-Centred Care (GPCC), Gothenburg, Sweden; University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden; University of Cape Town, Department of Paediatrics and Child Health, Cape Town, South Africa (ZAF).
    Healthcare system inputs and patient-reported outcomes: a study in adults with congenital heart defect from 15 countries2020In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 20, no 1, article id 496Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The relationship between healthcare system inputs (e.g., human resources and infrastructure) and mortality has been extensively studied. However, the association between healthcare system inputs and patient-reported outcomes remains unclear. Hence, we explored the predictive value of human resources and infrastructures of the countries' healthcare system on patient-reported outcomes in adults with congenital heart disease.

    METHODS: This cross-sectional study included 3588 patients with congenital heart disease (median age = 31y; IQR = 16.0; 52% women; 26% simple, 49% moderate, and 25% complex defects) from 15 countries. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviors, and quality of life. The assessed inputs of the healthcare system were: (i) human resources (i.e., density of physicians and nurses, both per 1000 people) and (ii) infrastructure (i.e., density of hospital beds per 10,000 people). Univariable, multivariable, and sensitivity analyses using general linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences.

    RESULTS: Sensitivity analyses showed that higher density of physicians was significantly associated with better self-reported physical and mental health, less psychological distress, and better quality of life. A greater number of nurses was significantly associated with better self-reported physical health, less psychological distress, and less risky health behavior. No associations between a higher density of hospital beds and patient-reported outcomes were observed.

    CONCLUSIONS: This explorative study suggests that density of human resources for health, measured on country level, are associated with patient-reported outcomes in adults with congenital heart disease. More research needs to be conducted before firm conclusions about the relationships observed can be drawn.

    TRIAL REGISTRATION: ClinicalTrials.gov: NCT02150603. Registered 30 May 2014.

  • 10.
    Vestgarden, Lisbeth Alnes
    et al.
    Department of Health Sciences in Aalesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Box 1517, Aalesund 6025 (NOR).
    Dahlborg, Elisabeth
    University West, Department of Health Sciences, Section for nursing - graduate level.
    Strunck, Jeanne
    Department of Culture and Learning, Faculty of Social Sciences and Humanities, Aalborg University, Kroghstraede 3, Aalborg 9220 (DNK).
    Aasen, Elin Margrethe
    Department of Health Sciences in Aalesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Box 1517, Aalesund 6025 (NOR).
    Nurses' discursive construction of older adult immigrant patients in hospitals2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 586Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The immigrant population across Europe is ageing rapidly. Nurses will likely encounter an increasing number of patients who are older adult immigrants. Moreover, access to and equal provision of healthcare is a key issue for several European countries. The relationship between nurses and patients is asymmetrical with unequal power relations; however, the way nurses construct the patient through language and discourse can help maintain or change the balance of power. Unequal power relations can affect access and be a hindrance to equal healthcare delivery. Hence, the aim of this study is to explore how older adult immigrants are discursively constructed as patients by nurses.

    METHODS: An exploratory qualitative design was used. Data were collected through in-depth interviews with a purposive sample of eight nurses from two hospitals. The nurses' narratives were analysed using critical discourse analysis (CDA) as described by Fairclough.

    RESULTS: The analysis identified an overarching, stable, and dominant discursive practice; 'The discourse of the other', with three interdiscursive practices: (1) 'The discourse on the immigrant patient versus an ideal patient'; (2) 'The expert discourse'; and (3) 'The discourse of adaption'. Older immigrant adults were constructed as 'othered' patients, they were different, alienated, and 'they' were not like 'us'.

    CONCLUSION: The way nurses construct older adult immigrants as patients can be an obstacle to equitable health care. The discursive practice indicates a social practice in which paternalism overrides the patient's autonomy and generalization is more prevalent than a person-centred approach. Furthermore, the discursive practice points to a social practice wherein the nurses' norms form the basis for normal; normality is presumed and desirable. Older adult immigrants do not conform to these norms; hence, they are constructed as 'othered', have limited agency, and may be considered rather powerless as patients. However, there are some examples of negotiated power relations where more power is transferred to the patient. The discourse of adaptation refers to a social practice in which nurses challenge their own existing norms to best adapt a caring relationship to the patient's wishes.

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  • 11.
    Åhs, Jill W.
    et al.
    Department of Health Sciences, Swedish Red Cross University, Huddinge (SWE).
    Ranheim, Albertine
    Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institute, Huddinge (SWE).
    Eriksson, Henrik
    University West, Department of Health Sciences, Section for nursing - graduate level.
    Mazaheri, Monir
    Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institute, Huddinge (SWE), 4 Department of Nursing Science, Sophiahemmet University, Stockholm (SWE).
    Encountering suffering in digital care: a qualitative study of providers’ experiences in telemental health care2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, p. 1-8, article id 418Article in journal (Refereed)
    Abstract [en]

    Background

    Encountering patients who are suffering is common in health care, and particularly when providing mental health care. Telehealth technologies are increasingly used to provide mental health care, yet little is known about the experiences of providers when encountering patients who are suffering within remote care. The present study explored health care providers’ lived experiences of encountering patient suffering during telemental health care.

    Methods

    A qualitative phenomenological approach was used to uncover participants’ experiences. In-depth interviews were conducted with a purposive sample of physicians, psychologists, and therapists who used telemental health in varied clinical practices in Sweden. Data were analyzed using descriptive phenomenology.

    Results

    Telehealth care with patients who were suffering was experienced by providers as loose connections, both literally in compromised functioning of the technology and figuratively in a compromised ability connecting emotionally with patients. Providers’ lived experiences were explicated into the following aspects: insecurity in digital practice, inaccessibility of the armamentarium, and conviction in the value of telehealth care. Interpersonal connection between patient and provider is necessary. Worry and guilt arose for providers with fears that technology would not work, patient status was deteriorated, or the care needed could not be delivered. Providers overcame barriers in telehealth encounters, and expressed they perceived that patients appreciated the care received, and through it found relief.

    Conclusions

    This study brings an understanding of experiences in providing telemental care for patients who are suffering. Providers experience challenges in connecting with patients, and in accessing tools needed to enable reaching the goals of the caring encounter. Efforts to ensure functioning of technology, comfort with its use, and accessibility of tools might be some accommodations to support providers for successful and rewarding telehealth care encounters.

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