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  • 1.
    Hedman, Ann-Marie
    et al.
    Neurotec Department, Division of Gerontological Caring Science, Karolinska Institutet, Stockholm, Sweden.
    Ljunggren, Gunnar
    Neurotec Department, Karolinska Institutet, Stockholm, Sweden.
    Grafström, Margareta
    Mälardalen University, Department of Caring Science, Eskilstuna, Sweden.
    Strömberg, Lars
    Division of Orthopaedics, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Dementia, delirium and other comorbid conditions in acute hip fracture care: Traditions, attitudes and local policies rather than actual state guide diagnose making?2005In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 25, no 4, p. 25-29Article in journal (Refereed)
    Abstract [en]

    In the elderly, hip fracture is a common disease. Previous studies show that more than half of these patients has a co-existing dementia and/or delirium diagnose. We found a cognitive disorder diagnose code registered in only 11% of 14,993 hip fracture patients, 65 years or older, in Stockholm, Sweden during 1994–1999. Although most common in the clinical setting, acute confusional state (delirium) was hardly ever diagnose-coded (1%). Furthermore, the share of dementia/delirium registrations ranged from 6 to 17% between hospitals and within a single hospital from 1 to 20 %. The lack of pattern in diagnosis coding became even more evident in the patients who were transferred from acute care to geriatric rehabilitation – it was unusual that the diagnosis was given at both specialities. Also regarding secondary diagnoses on the whole, large differences on hospital level was found (range 0.4 – 2.2/patient). The over all impression of the findings was that recording of comorbid conditions in acute somatic care depends on other factors than the patient’s actual state such as traditions, attitudes and local policies (or the lack thereof). In conclusion, significant conditions crucial for planning, treatment and prognosis in the hip fracture population are virtually invisible in this administrative database.

  • 2.
    Paillard-Borg, Stéphanie
    et al.
    Red Cross University College of Nursing.
    Strömberg, Lars
    Red Cross University College of Nursing.
    The importance of reciprocity for female caregivers in a super-aged society: a qualitative journalistic approach2014In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 35, no 11-12, p. 1367-1379Article in journal (Refereed)
  • 3.
    Rydholm Hedman, Ann-Marie
    et al.
    Red Cross University College of Nursing.
    Heikkilä, Kristina
    Grafström, Margareta
    Strömberg, Lars
    Red Cross University College of Nursing.
    Hip fractures and cognitive state: patient outcomes and proxies’ perceptions of the rehabilitation period2008In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 3, no 3, p. 178-186Article in journal (Refereed)
    Abstract [en]

    Background.  Numerous studies are available on hip fracture and rehabilitation outcomes, some mention dementia but very few from a family/proxy perspective.

    Aim.  To investigate whether cognitive state influences the hip fracture patients’ rehabilitation outcomes as well as the proxies’ perceptions of the 6-month rehabilitation period.

    Design.  A survey with structured and unstructured questions. Statistics and content analysis.

    Methods.  The questionnaire was sent to 40 proxies of hip fracture patients with and without cognitive impairment, 32 replied. Statistics and content analysis were used to analyse the data.

    Results.  In the cognitively impaired group, physical function decreased (P = 0.0241) as well as locomotion (P = 0.0005) compared to pre-fracture. This group mainly participated in rehabilitation sessions in institutions (P = 0.0001) and their main support came from nursing staff. The cognitively impaired group assessed the rehabilitation period as being of a much lower quality than the cognitively intact group (P = 0.0048). In the impaired group, hindrances to rehabilitation were low level of staffing, and lack of access to rehabilitation resources such as physiotherapists.

    Conclusions and relevance for clinical practice.  Hip fracture patients are a dichotomous group and cognition is decisive for physical and social outcomes as well as type of rehabilitation support.

  • 4. Rydholm Hedman, Ann-Marie
    et al.
    Strömberg, Lars
    Grafström, M.
    Heikkilä, K.
    Significant others ‘experiences of the hip fracture recovery period of older patients with and without cognitive impairment2009Conference paper (Refereed)
  • 5.
    Rydholm Hedman, Ann-Marie
    et al.
    Red Cross University College of Nursing. Division of Nursing, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm.
    Strömberg, Lars
    Red Cross University College of Nursing. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm.
    Grafström, Margareta
    Division of Nursing, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm.
    Heikkilä, Kristina
    Linnaeus University, School of Health and Caring Sciences, Växjö.
    Hip fracture patients’ cognitive state affects family members’ experiences: a diary study of the hip fracture recovery2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 3, p. 451-458Article in journal (Refereed)
    Abstract [en]

    Background:  Many patients with hip fractures suffer from dementia disease, which has shown to affect the outcome of recovery strongly, as well as care and treatment. As most hip fracture patients are discharged home early after surgery, caregiving often falls on family members – spouses, daughters, sons, or even neighbours become informal carers.

    Aim:  To explore how hip fracture patients’ cognitive state affect family members’ experiences during the recovery period.

    Methods:  Eleven diaries written by family members’ of hip fracture patients were analysed by means of qualitative content analysis.

    Findings:  The analysis generated two main categories with four categories. The first main category was; ‘Being a family member of a cognitively impaired patient’ with the categories ‘Dissatisfaction with lack of support’ and ‘Emotional distress due to the patient’s suffering’. The second main category was ‘Being a family member of a cognitively intact patient’ with the categories ‘Satisfaction with a relative’s successful recovery’ and ‘Strain due to their caring responsibilities’. Being a family member of a patient with cognitive impairment and a hip fracture meant being solely responsible for protecting the interests of the patient; in regard to care, rehabilitation and resources. The family members were also burdened with feelings of powerlessness and sadness due to the patients’ suffering. On the contrary, family members of cognitively intact hip fracture patients had positive experiences. The family members expressed pleasure from seeing their close ones make progress. However, when the healing process was delayed this led to strain on the family members.

    Conclusions:  The findings suggest the hip fracture patient’s cognitive state is more decisive than the hip fracture itself for the family members’ experiences.

  • 6.
    Strömberg, Lars
    Red Cross University College of Nursing.
    Omvårdnad av patienter med ortopediska sjukdomar2012In: Omvårdnad vid kirurgiska sjukdomar / [ed] Lillemor Lindwall, Lund: Studentlitteratur AB, 2012, 1, p. 113-128Chapter in book (Other academic)
  • 7.
    von Vogelsang, Ann-Christin
    et al.
    Karolinska Instsitutet / Karolinska Univ Hospital.
    Milton, Camilla
    Danderyd Hospital.
    Ericsson, Ingrid
    Handen Geriatrics, Praktikertjänst NÄRA.
    Strömberg, Lars
    The Swedish Red Cross University College, Department of Nursing and Care.
    'Wouldn't it be easier if you continued to be a guy?' - a qualitative interview study of transsexual persons' experiences of encounters with healthcare professionals2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 23-24, p. 3577-3588Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To describe transsexual persons' experiences of encounters with healthcare professionals during the sex reassignment process. Background. Transsexual persons are individuals who use varying means to alter their natal sex via hormones and/or surgery. Transsexual persons may experience stigma, which increases the risk of psychological distress. Mistreatments by healthcare professionals are common. Qualitative studies addressing transsexual persons' experiences of healthcare are scarce. Design. Qualitative descriptive design. Methods. A Swedish non-clinical convenience sample was used, consisting of six persons who had been diagnosed as transsexual, gone through sex reassignment surgery or were at the time of the interview awaiting surgery. Semi-structured interviews were undertaken, and data were analysed using manifest qualitative content analysis. Results. Three categories and 15 subcategories were identified. The encounters were perceived as good when healthcare professionals showed respect and preserved the transsexual person's integrity, acted in a professional manner and were responsive and built trust and confidence. However, the participants experienced that healthcare professionals varied in their level of knowledge, exploited their position of power, withheld information, expressed gender stereotypical attitudes and often used the wrong name. They felt vulnerable by having a condescending view of themselves, and they could not choose not to be transsexual. They felt dependent on healthcare professionals, and that the external demands were high. Conclusions. Transsexual persons are in a vulnerable position during the sex reassignment surgery process. The encounters in healthcare could be negatively affected if healthcare professionals show inadequate knowledge, exploit their position of power or express gender stereotypical attitudes. A good encounter is characterised by preserved integrity, respect, responsiveness and trust. Relevance to clinical practice. Improved education on transgender issues in nursing and medical education is warranted. Healthcare professionals should be aware of how their attitudes and their level of knowledge affect the care given during the sex reassignment surgery process.

  • 8.
    Åling, Maria
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Nilsson, Evelina R
    European Medicines Agency.
    Garpstål, Björn
    Capio S:t Görans Sjukhus.
    Strömberg, Lars
    The Swedish Red Cross University College, Department of Health Sciences.
    Nursing Diagnoses Panorama in a Swedish Forensic Psychiatric Setting Using NANDA-International Taxonomy2018In: Journal of Forensic Nursing, ISSN 1939-3938, E-ISSN 1556-3693, Vol. 14, no 3, p. 141-147Article in journal (Refereed)
    Abstract [en]

    More than 1,000 Swedish hospital beds are occupied by patients in forensic psychiatric settings; their average length of hospitalization is 3-7 years. In this context, nursing diagnoses could be extremely useful to make nursing care structured, measurable, and internationally comparable. The study aimed to describe nursing diagnoses in a Swedish forensic psychiatric setting.

    METHODS: Data were collected from electronic patient records of 55 patients in a medium-secure forensic psychiatric setting in Sweden. Anonymized data were entered into a database where entries were transformed into figures. Descriptive statistics were used, and frequencies, means, and percentages were calculated. The variables employed were characteristics and related factors, according to NANDA-International (NANDA-I) and International Statistical Classification of Dieseases and Related Heatlh Problems, 10th Revision (ICD-10), diagnoses.

    RESULTS: The patients had between 1 and 13 NANDA-I diagnoses each. Forty-one of the 55 patients had psychosis as the primary ICD-10 code. The identified nursing diagnoses described the patients' status upon arrival in the forensic psychiatric setting. Of the 55 patients, entries in the patient records describing 300 signs and symptoms (i.e., characteristics and related factors) were found. From these signs and symptoms, 371 entries that fit NANDA-I diagnoses were identified, representing 20 different NANDA-I diagnoses.

    CONCLUSION: NANDA-I diagnoses individualize patient care, making care person centered. NANDA-I is used all over the world and has the potential to make nursing care structured, measurable, and internationally comparable.

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