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Melin-Johansson, ChristinaORCID iD iconorcid.org/0000-0001-9623-5813
Alternative names
Publications (10 of 52) Show all publications
Schenell, R., Österlind, J., Browall, M., Melin-Johansson, C., Lundh Hagelin, C. & Hjorth, E. (2023). Teaching to prepare undergraduate nursing students for palliative care: Nurse educators’ perspectives. BMC Nursing, 22, Article ID 338.
Open this publication in new window or tab >>Teaching to prepare undergraduate nursing students for palliative care: Nurse educators’ perspectives
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2023 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, ISSN 1472-6955, Vol. 22, article id 338Article in journal (Refereed) Published
Abstract [en]

Background Education in palliative care for undergraduate nursing students is important for the competence of general nurses. Newly graduated nurses have reported challenges in coping with their own emotions when encountering dying persons. They express a wish for more education before they graduate, particularly in psychosocial and existential areas, such as having difficult conversations and supporting grieving persons. Despite awareness of the importance of palliative care education for nurses, there is a lack of knowledge on how to effectively convey this knowledge to students. The aim of the present study was to explore how teaching to prepare undergraduate nursing students for palliative care practice is conducted in Sweden.

Methods Educators from 22 Bachelor of Science nursing programmes in Sweden were interviewed about how they conducted palliative care education, with a focus on teaching situations that have been successful or less successful. The interviews were transcribed and analysed using qualitative inductive content analysis.

Results Educators described that they play a crucial role in preparing undergraduate nursing students to face death and dying and to care for persons at the end of life. In the main theme, “Transforming person-centred palliative care into student-centred education”, educators described how they incorporated the person-centred palliative approach into their teaching. Educators used a dynamic style of teaching where they let the students’ stories form the basis in a co-constructed learning process. The educators trusted the students to be active partners in their own learning but at the same time they were prepared to use their expert knowledge and guide the students when necessary. Discussion and reflection in small groups was described as being essential for the students to achieve a deeper understanding of palliative care and to process personal emotions related to encountering dying and grieving individuals.

Conclusions This study suggests that palliative care education for undergraduate nursing students benefits from teaching in smaller groups with room for discussion and reflection. Furthermore, gains are described relating to educators taking the role of facilitators rather than traditional lecturers, being flexible and ready to address students’ emotions. Educators also draw on their experiences as palliative care nurses in their teaching practices.

Place, publisher, year, edition, pages
Springer Nature, 2023
Keywords
Nurse education, Teaching approach, Student-centred education, Pedagogy, Palliative care, End of life care
National Category
Nursing Learning
Research subject
The Individual in the Welfare Society, Palliative Care
Identifiers
urn:nbn:se:esh:diva-10443 (URN)10.1186/s12912-023-01493-5 (DOI)37759221 (PubMedID)
Available from: 2023-10-15 Created: 2023-10-15 Last updated: 2023-10-16Bibliographically approved
Melin-Johansson, C., Sveen, J., Lövgren, M. & Udo, C. (2022). A third of dying patients do not have end-of-life discussions with a physician: A nationwide registry study. Palliative & Supportive Care, 20(3), 357-362
Open this publication in new window or tab >>A third of dying patients do not have end-of-life discussions with a physician: A nationwide registry study
2022 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 20, no 3, p. 357-362Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of the study was to explore the proportion of adult patients and next-of-kin who had end-of-life (EOL) discussions and associated factors.

METHOD: A retrospective nationwide registry study was reported with data from the Swedish Register of Palliative Care. All patients in Sweden in hospitals, nursing homes, own homes, community, and palliative care units during 2015-2017 and their next-of-kin were included. Data were reported to the register by healthcare staff, based on diseased patients' records regarding their last days of life, and were voluntary. Descriptive statistics illustrated the proportion of patients/next-of-kin who had EOL discussions and logistic regressions were used to examine associated factors.

RESULTS: About half of the patients (46%) did have an EOL discussion, but a third (32%) did not. Associated factors of those who did not have an EOL discussion were dementia (48.5%) or stroke (47.5%), older age (38.4%), being female (33.6%), being cared for in a nursing home (41.3%), or hospital (40.3%), having lost decision-making ability months before death (58.9%), and not having a documented decision to shift to EOL care (82.7%). Younger patients diagnosed with cancer and cared for at a palliative unit were more likely to have EOL discussions. The regression analysis showed similar results for next-of-kin.

SIGNIFICANCE OF RESULTS: The result shows that not all patients with palliative care needs have equal access to EOL discussions, despite efforts at a national level and the recognized benefits of timely communication about the EOL care. Further efforts must be made to achieve EOL discussions for all patients.

Keywords
Communication, End of life, Older people, Palliative care, Quality indicators, Register study
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-9020 (URN)10.1017/S1478951521000973 (DOI)000778901000001 ()34158146 (PubMedID)
Available from: 2021-06-28 Created: 2021-06-28 Last updated: 2022-12-01Bibliographically approved
Rönnberg, L., Nilsson, U., Hellzén, O. & Melin-Johansson, C. (2022). Beyond the monitors: Anaesthesiologists' experiences of the process of extubation. Scandinavian Journal of Caring Sciences, 36(4), 988-996
Open this publication in new window or tab >>Beyond the monitors: Anaesthesiologists' experiences of the process of extubation
2022 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 36, no 4, p. 988-996Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although extubation is a high-risk phase associated with risk of severe complications for patients undergoing general anaesthesia, there is a lack of research about this phenomenon from the perspective of anaesthesiologists' experiences of the process of extubation in the anaesthesia setting.

AIM: To describe Swedish anaesthesiologists' experiences of the extubation process in the anaesthesia setting.

METHODS: A qualitative descriptive design study with individual semi-structured interviews was conducted in three hospitals in Sweden with a total of 17 anaesthesiologists. A qualitative manifest content analysis method was used to analyse the data.

RESULTS: The anaesthesiologists' experiences were described in two categories: To assemble sensibilities, where the anaesthesiologists are receptive to inputs, create tailored plans, are guided by emotions and experiences, and sense the atmosphere in the process of extubation; and To stay focused, where they understand the importance of preparation and being prepared, and of being calm and strategic, and of needing to trust the registered nurse anaesthetist in the process of extubation.

CONCLUSIONS: Decision-making regarding the process of extubation does not rely solely on monitoring signs; rather, the anaesthesiologists described how, by looking beyond the monitors and by being receptive to inputs from the patient and other professionals, their experience and intuition guides them through the process of extubation.

Keywords
Anaesthesia setting, Anaesthesiologist, Content analysis, Decision making, Extubation process, Operating room, Qualitative, Teamwork
National Category
Nursing Anesthesiology and Intensive Care Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:esh:diva-8870 (URN)10.1111/scs.12996 (DOI)000652752800001 ()34021616 (PubMedID)
Available from: 2021-05-31 Created: 2021-05-31 Last updated: 2022-11-21Bibliographically approved
Ozanne, A., Henoch, I., Öhlén, J., Jakobsson Larsson, B. & Melin-Johansson, C. (2022). Impact of an education program to facilitate nurses' discussions of existential issues in neurological care. Palliative & Supportive Care, 20(5), 630-636
Open this publication in new window or tab >>Impact of an education program to facilitate nurses' discussions of existential issues in neurological care
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2022 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 20, no 5, p. 630-636Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Discussing existential issues is integral to caring for people with acute, progressive, or life-limiting neurological illness, but there is a lack of research examining how nurses approach existential issues with this patient group and their family members. The purpose was to examine the experiential impact of an educational program for nurses designed to facilitate discussions of existential issues with patients and family members in neurological wards.

METHOD: Nurses in inpatient and outpatient care at a neurological clinic in Sweden were invited to participate in an education program about discussing existential issues with patients and their family members as related to neurological conditions. The evaluation of the program and of the nurses' view of discussing existential issues was conducted through focus groups before and after participation. The data were analyzed by qualitative content analysis.

RESULTS: The program gave nurses a deeper understanding of existential issues and how to manage these conversations with patients and their family members. Both internal and external barriers remained after education, with nurses experiencing insecurity and fear, and a sense of being inhibited by the environment. However, they were more aware of the barriers after the education, and it was easier to find strategies to manage the conversations. They demonstrated support for each other in the team both before and after participating in the program.

SIGNIFICANCE OF RESULTS: The educational program gave nurses strategies for discussing existential issues with patients and family members. The knowledge that internal and external barriers impede communication should compel organizations to work on making conditions more conducive, for example, by supporting nurses to learn strategies to more easily manage conversations about existential issues and by reviewing the physical environment and the context in which they are conducted.

Keywords
Education, Existential, Neurology, Nursing, Spirituality
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-9451 (URN)10.1017/S1478951521001620 (DOI)000763766500001 ()35236538 (PubMedID)
Available from: 2022-04-19 Created: 2022-04-19 Last updated: 2022-10-10Bibliographically approved
Rönnberg, L., Melin-Johansson, C., Hellzén, O., Nilsson, U. & Häggström, M. (2022). Safeguarding the patient: a grounded theory study of registered nurse anesthetists' main concerns in the process of extubation in the anesthesia setting. BMC Nursing, 21(1), Article ID 56.
Open this publication in new window or tab >>Safeguarding the patient: a grounded theory study of registered nurse anesthetists' main concerns in the process of extubation in the anesthesia setting
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2022 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 21, no 1, article id 56Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The process of extubation is complex as it takes place in the technical and challenging environment of the operating room. The extubation is related to complications of varying severity and a critical moment for the patient, who is in a vulnerable condition when emerging from anesthesia. Registered Nurse Anesthetists (RNAs) in Sweden have specialist training and performs extubations independently or in collaboration with an anesthesiologist.

AIM: To obtain a deeper understanding of Registered Nurse Anesthetists' main concerns and how they resolve these in the process of extubation when caring for a patient during general anesthesia.

PARTICIPANTS: A total of 17 RNAs, eight male and nine female, were included in the study. Twelve RNAs in the first step of data collection (I); and five RNAs the second step of data collection (II).

METHOD: A classic grounded theory approach with a qualitative design was used for this study.

FINDINGS: The RNAs' main concern in the process of extubation were Safeguarding the patient in a highly technological environment, which the solved by Maintaining adaptability. Facilitators as well as challenges affected how the RNAs solved their main concern and represented the categories: 'Having a back-up plan', 'Getting into the right frame of mind', 'Evaluating the patient's reactions', 'Using one's own experience', 'Dealing with uncertainty', 'Pressure from others', and 'Being interrupted'. The theory, Safeguarding the patient in the process of extubation, emerged.

CONCLUSION: To be able to safeguard the patient in a highly technological environment, the RNAs must oscillate between facilitators and challenges. By maintaining adaptability, the RNAs resolved the difficulties of oscillating, indicating a need for finding a balance between maintaining attentiveness on what is important to keep the patient safe in the process of extubation and all of the disturbances present in the OR.

Keywords
Anesthesia, Anesthetic nursing, Extubation, Grounded theory, Registered nurse anesthetist, Safeguarding
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-9452 (URN)10.1186/s12912-022-00817-1 (DOI)000766555500001 ()35264171 (PubMedID)
Available from: 2022-04-19 Created: 2022-04-19 Last updated: 2022-04-19Bibliographically approved
Lundh Hagelin, C., Melin-Johansson, C., Ek, K., Henoch, I., Österlind, J. & Browall, M. (2022). Teaching about death and dying: A national mixed‐methods survey of palliative care education provision in Swedish undergraduate nursing programmes. Scandinavian Journal of Caring Sciences, 36(2), 545-557
Open this publication in new window or tab >>Teaching about death and dying: A national mixed‐methods survey of palliative care education provision in Swedish undergraduate nursing programmes
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2022 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 36, no 2, p. 545-557Article in journal (Refereed) Published
Abstract [en]

Background: In coming decades, the number of people affected by illnesses who need palliative care will rise worldwide. Registered Nurses are in a central position in providing this care, and education is one of the necessary components for meeting coming requirements. However, there is a lack of knowledge about palliative care in undergraduate nursing education curricula, including the extent of the education provided and the related pedagogical methods.

Aim: The aim was to investigate the extent, content and pedagogical methods used and to explore lecturers’ experiences of being responsible for teaching and learning about palliative care for undergraduate nursing students on nursing programmes at Swedish universities.

Setting: All 24 universities responsible for providing undergraduate nursing education in Sweden participated.

Participants: One lecturer with in-depth knowledge about palliative care or end-of-life care education participated in the quantitative (n = 24) and qualitative (n = 22) parts of the study.

Method: A mixed-method research study with an explorative design was used. Descriptive statistics were used to analyse quantitative data, and content analysis for qualitative, with both also analysed integratively.

Results: Few undergraduate nursing programmes included a specific course about palliative care in their curricula, however, all universities incorporated education about palliative care in some way. Most of the palliative care education was theoretical, and lecturers used a variety of pedagogical strategies and their own professional and personal experience to support students to understand the palliative care approach. Topics such as life and death were difficult to both learn and teach about.

Conclusions: There is a need for substantial education about palliative care. Lecturers strive on their own to develop students’ understanding and increase the extent of palliative care education with innovative teaching strategies, but must compete with other topics. Palliative care teaching must be prioritised, not only by the universities, but also by the national authority.

Keywords
Death and dying, Palliative care, Qualitative approaches, Quantitative approaches, Undergraduate nurse education
National Category
Nursing Educational Sciences
Identifiers
urn:nbn:se:esh:diva-9330 (URN)10.1111/scs.13061 (DOI)000736112500001 ()34962307 (PubMedID)
Available from: 2021-12-28 Created: 2021-12-28 Last updated: 2023-01-03Bibliographically approved
Browall, M., Pakpour, A. H., Melin-Johansson, C., Lundh Hagelin, C., Österlind, J. & Henoch, I. (2021). Development and Psychometric Evaluation of a New Short Version of the Swedish Frommelt Attitudes Toward Care of the Dying Scale. Cancer Nursing, 44(4), 305-313
Open this publication in new window or tab >>Development and Psychometric Evaluation of a New Short Version of the Swedish Frommelt Attitudes Toward Care of the Dying Scale
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2021 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 44, no 4, p. 305-313Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Frommelt Attitudes Toward Care of the Dying (FATCOD) is widely used as a measure of attitudes toward care of dying patients. However, poor factor structure and item redundancy have been reported across the literature.

OBJECTIVE: A short version of the questionnaire is needed, to facilitate effective assessments of the attitudes of those caring for dying patients. The purpose of this study was to develop a FATCOD-Short Form and to secure its psychometric properties.

INTERVENTIONS/METHODS: Data gathered from 1000 nurses in previous studies were pooled and reanalyzed. Principal components analysis and confirmatory factor analysis were utilized to assess the factor structure of the FATCOD-30. A Rasch model was used to evaluate the measurement functioning of the scale.

RESULTS: Of the original 30 items, 9 items of FATCOD were chosen for retention in the short form based on the principal components analysis, floor or ceiling effects, interitem correlations, and item-total correlation. All 9 items had good internal reliability. Both confirmatory factor analysis and Rasch analysis supported the unidimensionality of the FATCOD-Short Form.

CONCLUSIONS: The 9-item FATCOD-Short Form demonstrates evidence of acceptable validity and reliability to identify nurses' attitudes toward caring for dying persons because of its brevity and comprehensive content.

IMPLICATIONS FOR PRACTICE: When changing curricula in nursing education or implementing new procedures in nursing practice, it is important to have valid instruments to evaluate the results of the change. Such instruments should not be too lengthy or complicated. FATCOD-Short Form is a brief and valid instrument that can be easily used.

Keywords
Instrument, Measuring attitudes toward care of dying patients, Psychometrics, Short-form process, Nurses attitudes, Medical-students, Palliative care, Form B, Cancer, Death, Intervention, Patient
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-7995 (URN)10.1097/NCC.0000000000000794 (DOI)000669245600015 ()32000177 (PubMedID)
Available from: 2020-02-19 Created: 2020-02-19 Last updated: 2023-01-26Bibliographically approved
Fristedt, S., Grynne, A., Melin-Johansson, C., Henoch, I., Lundh Hagelin, C. & Browall, M. (2021). Registered nurses and undergraduate nursing students' attitudes to performing end-of-life care. Nurse Education Today, 98, Article ID 104772.
Open this publication in new window or tab >>Registered nurses and undergraduate nursing students' attitudes to performing end-of-life care
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2021 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 98, article id 104772Article in journal (Refereed) Published
Abstract [en]

Registered Nurses (RNs) are in the immediate position to provide End-of-life (EOL) care and counselling for patients and families in various settings. However, EOL-care often creates feelings of uncertainty and inadequacy linked to inexperience, lack of education, and attitude. To identify and describe factors associated with RNs' attitudes towards EOL-care, and to identify whether and how these attitudes differ from undergraduate nursing students' (UNSs) attitudes, a descriptive and comparative, quantitative study was performed. The FATCOD-instrument, focusing on attitude towards EOL-care, was used and the results analysed with descriptive and nonparametric statistics. In total, 287 RNs in 14 different specialist programmes, and 124 UNSs participated. A statistically significant difference (p = 0.032) was found in attitude towards EOL-care based on clinical experience. RNs in "Acute Care" and "Paediatric & Psychiatry Care" specialist programmes had a less positive attitude towards EOL-care (compared to RNs in other specialist programmes), while RNs attending the Palliative Care programme had the most positive attitudes. RNs and UNSs' scores differed statistically significantly in 17 out of 30 FATCOD variables. Finally, the results imply that there is a need for greater emphasis on further continuing education within EOL care for RNs working in all types of clinical specialities to encourage RNs talking about death and to enhance attitudes towards EOL care.

Keywords
Clinical experience, Education, Nursing, Palliative care
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-8602 (URN)10.1016/j.nedt.2021.104772 (DOI)000752141400007 ()33497992 (PubMedID)
Available from: 2021-02-04 Created: 2021-02-04 Last updated: 2023-01-26Bibliographically approved
Høgsnes, L., Norbergh, K.-G. & Melin-Johansson, C. (2019). “Being in Between”: Nurses' Experiences When Caring for Individuals With Dementia and Encountering Family Caregivers' Existential Life Situations. Research in Gerontological Nursing, 12(2), 91-98
Open this publication in new window or tab >>“Being in Between”: Nurses' Experiences When Caring for Individuals With Dementia and Encountering Family Caregivers' Existential Life Situations
2019 (English)In: Research in Gerontological Nursing, ISSN 1940-4921, E-ISSN 1938-2464, Vol. 12, no 2, p. 91-98Article in journal (Refereed) Published
Abstract [en]

The focus of the current study was to explore nursing home staff's understanding and how they approach family caregivers' existential life situations when caring for individuals with dementia. A qualitative interview study was conducted with 20 nursing staff in two nursing homes in northern Sweden. Face-to-face interviews were analyzed using interpretive content analysis. One overarching theme with three themes and nine subthemes comprised the findings. The themes describe how nursing staff were “in between” when they cared for individuals with dementia and encountered family caregivers' existential life situations. Nurses acted as advocates and safeguarded family caregivers via dialogues and interactions. Nurses were supporters and by “being in between” they eased family caregivers' feelings of powerlessness in relation to dying and death. “Being in between” may give nurses a deeper understanding of family caregivers' existential needs, thus increasing family caregivers' well-being.

National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-7432 (URN)10.3928/19404921-20190207-01 (DOI)
Available from: 2019-04-17 Created: 2019-04-17 Last updated: 2020-09-30Bibliographically approved
Melin-Johansson, T. (2019). Egna val och frihetens baksidor (1ed.). In: Gunilla Silfverberg (Ed.), Utsatthet och ansvar: Flickan med svavelstickorna i vår tid (pp. 118-123). Stockholm: Appell Förlag
Open this publication in new window or tab >>Egna val och frihetens baksidor
2019 (Swedish)In: Utsatthet och ansvar: Flickan med svavelstickorna i vår tid / [ed] Gunilla Silfverberg, Stockholm: Appell Förlag , 2019, 1, p. 118-123Chapter in book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Appell Förlag, 2019 Edition: 1
Keywords
Existentiell smärta, Förluster, Livskvalitet, Obotlig sjukdom, Palliativ vård, Stöd och hjälp, Total smärta
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-7729 (URN)9789198496055 (ISBN)
Available from: 2019-08-28 Created: 2019-08-28 Last updated: 2020-06-03Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-9623-5813

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