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  • 1.
    Bergh, Anne-Louise
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Göteborgs Universitet.
    Sjuksköterskors patientundervisande arbete: Ett otydligt fält2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The overall aim of this thesis is to explore, describe and critically assess conditions for nurses’ patient education work. This was carried out in two stages. In the first stage, the aim was to describe nurses’ experiences and perceptions of patient education work in relation to organisation, environment, professional cooperation and pedagogical competence, as well as describe differences between primary, municipal and hospital care. In the second stage, the aim was to identify discourses in the ways managers speak of the conditions for nurses’ patient education work in primary and hospital care.

    Methods: In studies I and II, a randomised selection of nurses (842) received a questionnaire of 47 items concerning factual experiences and perceptions patient education, and 13 background items. Questionnaires were returned by 83 % of the participants. The items concerned organisation, environment, professional cooperation (I), and pedagogical competence (II). Descriptive statistics, non-parametric tests and content analysis for open-ended items were used. In studies III and IV, data was collected from three focus group interviews with managers (n=10) in hospital care, and three focus groups interviews with managers (n=10) in primary care. An explorative, qualitative design with a social constructionist perspective was used. The data was analysed with a critical discourse analysis.

    Results: Nurses’ perceptions of conditions for patient education differ between healthcare settings, in favour of primary care (I, II). The nurses in primary care had better conditions and more managerial support, for example in the allocation of uninterrupted time (I). The primary care nurses had an advantage in relation to those in municipal or hospital care when it came to following research in patient education as well as how they perceived their own competences, pedagogical education and post graduate specialisations (II). Due to a heavy workload and a lack of time, the managers in hospital care could neither see the importance of their role as a supporter of the patient education provided by the nurses nor their role in the development of the nurses’ pedagogical competence. The managers used (mainly) organisational, financial, medical and legal discourses for explaining their failure to support the nurses’ providing patient education (III). The discursive practice in primary care comprised a discourse order of economic, medical, organisational and didactic discourses. The economic discourse was the predominant one, to which the organisation had to adjust. The medical discourse was self-evident and unquestioned. The managers initiated reorganisations, generally due to financial constraints. The nurses’ pedagogical competence development was unclear. Practicebased experiences of patient education were considered very important, whereas theoretical pedagogical knowledge was considered less important (IV).

    Conclusions: Nurses’ patient education work must be made visible and be given sufficient resources. In this process, support from their managers is considered vital. Managers’ support for nurses’ practical and theory-based pedagogical competence development needs to be strengthened.

  • 2.
    Bergh, Anne-Louise
    et al.
    University of Borås, School of Health Science.
    Johansson, Inger
    Persson, Eva
    University of Borås, School of Health Science.
    Karlsson, Jan
    Friberg, Febe
    Nurses’ Patient Education Questionnaire: development and validation process2015In: Journal of Research in Nursing, ISSN 1744-9871, Vol. 20, no 3, p. 181-200Article in journal (Refereed)
    Abstract [en]

    Abstract Conditions for nurses’ daily patient education work are unclear and require clarification. The aim was to develop and validate the Nurses’ Patient Education Questionnaire, a questionnaire that assesses nurses’ perceptions of appropriate conditions for patient education work: what nurses say they actually do and what they think about what they do. The questionnaire was developed from a literature review, resulting in the development of five domains. This was followed by ‘cognitive interviewing’ with 14 nurses and dialogue with 5 pedagogical experts. The five domains were identified as significant for assessing nurses’ beliefs and knowledge; education environment; health care organisation; interdisciplinary cooperation and collegial teamwork; and patient education activities. A content validity index was used for agreement of relevance and consensus of items by nurses (n¼10). The total number of items in the final questionnaire is 60, consisting of demographic items, what nurses report they do and perceptions about patient education in daily work. The questionnaire can be used by managers and nurses to identify possibilities and barriers to patient education in different care contexts.

  • 3.
    Bergh, Anne-Louise
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Friberg, Febe
    Persson, Eva
    Dahlborg Lyckhage, Elisabeth
    Perpetuating ‘New Public Management’ at the expense of nurses’ patient education: A discourse analysis2015In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 22, no 3, p. 190-201Article in journal (Refereed)
    Abstract [en]

    This study aimed to explore the conditions for nurses' daily patient education work by focusing on managers' way of speaking about the patient education provided by nurses in hospital care. An explorative, qualitative design with a social constructionist perspective was used. Data were collected from three focus group interviews and analysed by means of critical discourse analysis. Discursive practice can be explained by the ideology of hegemony. Due to a heavy workload and lack of time, managers could ‘see’ neither their role as a supporter of the patient education provided by nurses, nor their role in the development of nurses' pedagogical competence. They used organisational, financial, medical and legal reasons for explaining their failure to support nurses' provision of patient education. The organisational discourse was an umbrella term for ‘things’ such as cost-effectiveness, which were prioritised over patient education. There is a need to remove managerial barriers to the professional development of nurses' patient education. Managers should be responsible for ensuring and overseeing that nurses have the prerequisites necessary for providing patient education as well as for enabling continuous reflective dialogue and opportunities for learning in practice.

  • 4.
    Bergh, Anne-Louise
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Friberg, Febe
    University of Stavanger, Norway.
    Persson, Eva
    University of Lund, Sweden.
    Dahlborg Lyckhage, Elisabeth
    University of West, Trollhättan, Sweden.
    Registered Nurses’ Patient Education in Everyday Primary Care Practice:: Managers Discourses2015In: Global Qualitative Nursing Research., ISSN 2333-3936, Vol. 2Article in journal (Refereed)
    Abstract [en]

    Nurses’ patient education is important for building patients’ knowledge, understanding, and preparedness for self-management.

    The aim of this study was to explore the conditions for nurses’ patient education work by focusing on managers’ discourses

    about patient education provided by nurses. In 2012, data were derived from three focus group interviews with primary care

    managers. Critical discourse analysis was used to analyze the transcribed interviews. The discursive practice comprised a

    discourse order of economic, medical, organizational, and didactic discourses. The economic discourse was the predominant

    one to which the organization had to adjust. The medical discourse was self-evident and unquestioned. Managers reorganized

    patient education routines and structures, generally due to economic constraints. Nurses’ pedagogical competence

    development was unclear, and practice-based experiences of patient education were considered very important, whereas

    theoretical pedagogical knowledge was considered less important. Managers’ support for nurses’ practical- and theoreticalbased

    pedagogical competence development needs to be strengthened.

  • 5.
    Bergh, Anne-Louise
    et al.
    University of Borås, School of Health Science.
    Persson, Eva
    University of Borås, School of Health Science. Lund University, Lund, Sweden.
    Karlsson, Jan
    The Sahlgrenska Academy, University of Gothenburg, Örebro University Hospital.
    Friberg, Febe
    University of Stavanger, Stavanger, Norway.
    Registered nurses’ perceptions of conditions for patient education: focusing on aspects of competence.2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 523-536Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It is important to clarify nurses' perceptions of conditions for patient education in daily work as research findings are ambiguous. There is a gap between societal regulations on nurses' competence in accomplishment/achievement of patient education and research findings. AIM: The aim was to describe nurses' perceptions of conditions for patient education, focusing on aspects of competence. The aim was also to describe differences in conditions for nurses working in primary, municipal and hospital care. METHODS: The study is a cross-sectional survey and is part of a project about nurses' patient-education. A randomized selection of nurses (842) received a questionnaire comprising 47 items concerning factual experience and attitudes to patient education and 13 background items. Questionnaires were returned by 83% of participants. Descriptive statistics, non-parametric tests and content analysis for open-ended items were used. RESULTS: Nurses' perceptions of conditions for patient education differ between health-care settings. Primary care nurses are at an advantage in following research in patient education, perception of their own competence (prioritizing and knowing their mandate in patient teaching), pedagogical education and post graduate specializations. CONCLUSIONS: Nurses' patient education must be more visualized and appropriate conditions created at each workplace. In this change process, managers' support is considered vital.

  • 6. Friberg, Febe
    et al.
    Granum, Vigdis
    Bergh, Anne-Louise
    University of Borås, School of Health Science.
    Nurses’ patient-education work: conditional factors - an integrative review.2012In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 20, no 2, p. 170-186Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this review was to identify conditional factors for nurses' patient-education work and to identify foundational aspects of significance when designing studies on this patient-education work. BACKGROUND: A few reviews of nurses patient education work exist, published up to 30 years ago, spawning interest in performing a review of more recent studies. EVALUATION: A search of CINAHL, MEDLINE and ERIC was made for articles dating from 1998 to 2011. Thirty-two articles were selected and an integrative review was performed. KEY ISSUES: Conditional factors were identified and beliefs and knowledge, environment, organization, interdisciplinary cooperation, collegial teamwork and patient education activities. A model was developed to describe foundational aspects of significance when designing studies. CONCLUSIONS: The conditional factors are to be seen as either enabling or hindering the accomplishment of evidence-based patient education and the level of person centredness, patient safe care and ethics - something that has to be considered when designing studies. IMPLICATIONS FOR NURSING MANAGEMENT: More detailed studies are required to clarify the nature of patient education work and to create realistic conditions that enable the role to be fulfilled in everyday work. Such knowledge is of significance for nursing management in developing supportive activities for nurses.

  • 7.
    Bergh, Anne-Louise
    University of Borås, School of Health Science.
    Registered nurses’ perceptions of conditions for patient education: focusing on organizational, environmental and professional cooperation aspects.2012In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 20, no 6, p. 758-770Article in journal (Refereed)
    Abstract [en]

    AIM: To describe nurses' perceptions of conditions for patient education, focusing on organisational, environmental and professional cooperation aspects, and to determine any differences between primary, municipal and hospital care. BACKGROUND: Although patient education is an important part of daily nursing practice, the conditions for this work are unclear and require clarification. METHOD: A stratified random sample of 701 (83%) nurses working in primary, municipal and hospital care completed a 60-item questionnaire. The study is part of a larger project. The study items relating to organisation, environment and professional cooperation were analysed using descriptive statistics, non-parametric tests and content analysis. RESULTS: Conditions for patient education differ. Nurses in primary care had better conditions and more managerial support, for example in the allocation of undisturbed time. CONCLUSIONS: Conditions related to organisation, environment and cooperation need to be developed further. In this process, managerial support is important, and nurses must ask for better conditions in order to carry through patient education. IMPLICATIONS FOR NURSING MANAGEMENT: Managerial support for the development of visible patient education routines (e.g. allocation of time, place and guidelines) is required. One recommendation is to designate a person to oversee educational work.

  • 8.
    Bergh, Anne-Louise
    et al.
    University of Borås, School of Health Science.
    Bergh, Claes-Håkan
    Friberg, Febe
    How do nurses record pedagogical activities? An investigation of nurses’ documentation inpatients´ records in a cardiac rehabilitation unit for patients following coronary artery bypass surgery.2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 10, p. 1898-1907Article in journal (Refereed)
    Abstract [en]

    Aims. To describe the use of pedagogically related keywords and the content of notes connected to these keywords, as they appear in nursing records in a coronary artery bypass graft (CABG) surgery rehabilitation unit. Background. Nursing documentation is an important component of clinical practice and is regulated by law in Sweden. Studies have been carried out in order to evaluate the educational and rehabilitative needs of patients following CABG surgery but, as yet, no study has contained an in-depth evaluation of how nurses document pedagogical activities in the records of these patients. Methods. The records of 265 patients admitted to a rehabilitation unit following CABG surgery were analysed. The records were structured in accordance with the VIPS model. Using this model, pedagogically related keywords: communication, cognition/development and information/education were selected. The analysis of the data consisted of three parts: the frequency with which pedagogically related keywords are used, the content and the structure of the notes. Results. Apart from the term 'communication', pedagogically related keywords were seldom used. Communication appeared in all records describing limitations, although no explicit reference was made to pedagogical activities. The notes related to cognition/development were grouped into the following themes: nurses' actions, assessment of knowledge and provision of information, advice and instructions as well as patients' wishes and experiences. The themes related to information were the provision of information and advice in addition to relevant nursing actions. The structure of the documentation was simple. Conclusions. The documentation of pedagogical activities in nursing records was infrequent and inadequate. Relevance to clinical practice. The patients' need for knowledge and the nurses' teaching must be documented in the patient records so as to clearly reflect the frequency and quality of pedagogical activities.

  • 9.
    Berg, AL
    et al.
    University of Borås, School of Health Science.
    Bergh, CH
    Friberg, Febe
    How do nurses record pedagogical activities? Nurses' documentation in patient records in a cardiac rehabilitation unit for patients who have undergone coronary artery bypass surgery.2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 10, p. 1898-1907Article in journal (Refereed)
    Abstract [en]

    Aims. To describe the use of pedagogically related keywords and the content of notes connected to these keywords, as they appear in nursing records in a coronary artery bypass graft (CABG) surgery rehabilitation unit. Background. Nursing documentation is an important component of clinical practice and is regulated by law in Sweden. Studies have been carried out in order to evaluate the educational and rehabilitative needs of patients following CABG surgery but, as yet, no study has contained an in-depth evaluation of how nurses document pedagogical activities in the records of these patients. Methods. The records of 265 patients admitted to a rehabilitation unit following CABG surgery were analysed. The records were structured in accordance with the VIPS model. Using this model, pedagogically related keywords: communication, cognition/development and information/education were selected. The analysis of the data consisted of three parts: the frequency with which pedagogically related keywords are used, the content and the structure of the notes. Results. Apart from the term 'communication', pedagogically related keywords were seldom used. Communication appeared in all records describing limitations, although no explicit reference was made to pedagogical activities. The notes related to cognition/development were grouped into the following themes: nurses' actions, assessment of knowledge and provision of information, advice and instructions as well as patients' wishes and experiences. The themes related to information were the provision of information and advice in addition to relevant nursing actions. The structure of the documentation was simple. Conclusions. The documentation of pedagogical activities in nursing records was infrequent and inadequate. Relevance to clinical practice. The patients' need for knowledge and the nurses' teaching must be documented in the patient records so as to clearly reflect the frequency and quality of pedagogical activities.

  • 10. Friberg, Febe
    et al.
    Bergh, Anne-Louise
    University of Borås, School of Health Science.
    Lepp, M.
    In search in patient teaching in nursing documentation: an analysis of patient records in a medical ward in Sweden2006In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 15, no 12, p. 1550-1558Article in journal (Refereed)
    Abstract [en]

    Keywords:need for knowledge;nursing;nursing documentation;patient education;patient records;teaching intervention Aim.  The aim of this study was to identify terms and expressions indicating patients’ need for knowledge and understanding, as well as nurses’ teaching interventions, as documented in nursing records. Background.  Previous international studies have shown that nursing documentation is often deficient in terms of recording patient teaching. Methods.  Patient records (N = 35) were collected in a general medical ward in a hospital in Sweden. The data contain 206 days of nursing documentation. The records were analysed with regard to content and structure. Terms and expressions indicating patients’ need for knowledge and understanding and terms and expressions indicating nurses’ teaching activities were analysed. Results.  The results showed that patients’ need for knowledge is implicitly indicated by conceptions and experiences as well as questions. Furthermore, nurses’ implicit teaching interventions consist of information, motivating conversations, explanations, instructions and setting expectations. However, the content and structure of the pedagogical activities in the patient records are fragmented and vague. Relevance to clinical practice.  Efforts must be directed towards elaborating upon the above-mentioned terms and expressions as indications of patients’ need for knowledge and nurses’ teaching interventions. Moreover, these terms and expressions must be recognized and acknowledged.

  • 11.
    Bergh, Anne-Louise
    et al.
    University of Borås, School of Health Science.
    Persson, LO
    Attvall, Stig
    Psychometric properties of the Swedish version of the Well-Being Questionnaire in a sample of patients with diabetes type 1.2000In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 28, no 2, p. 137-145Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of the present investigation was to further test the psychometric properties of a Swedish version of the Well-Being Questionnaire (WBQ) in order to determine whether it could be suitable for measuring health-related quality of life among type 1 diabetic patients. METHODS: In total, 94 patients who fulfilled the inclusion criteria were selected for the study and of these 85% participated. Reliability was tested with Cronbach's alpha coefficient and the internal validity by means of principal component analysis and multitrait analysis. To test the external validity, comparisons were made with two other questionnaires, the Short form-36 and a Swedish Mood Adjective Check List. RESULTS: The results show that, above all, the Swedish version of the WBQ measures psychological well-being, and thus must also be complemented with scales that measure other consequences of the illness and/or treatment, i.e. physical symptoms. The questionnaire has low discriminatory validity between subscales, which casts doubt on the appropriateness of using the four subscales as separate measures. The two scales measuring anxiety and depression are not sensitive enough for use among type 1 diabetics without complications and high or normal levels of psychological well-being. CONCLUSIONS: The Well-Being Questionnaire alone does not give any more information about subjective health status among type 1 diabetic patients than, for example, the generic SF-36.

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