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- Andersson, Inger S
(författare)
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Utveckling av metoder för mätning av vårdkvalitet : Med inriktning mot omvårdnad
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present thesis has its roots in the need to measure and evaluate quality of care, especially in times when resources allocated to health- and medical care are being limited. This is of concern for many groups in society, but perhaps mOst of all for patients, hospital staff and politicians.The main purpose of the thesis was to develop methods for measuring quality of care within nursing.The thesis has been organised in three main parts, the first of which deals with the principal concepts in this research,in addition to research and develop- ment in existing instruments for measuring quality of care. The second part contains the empirical study and its results. Finally, the third part deals with the development of variables for methods of measurement based on the empirical study: it also looks ahead, at visions and viewpoints governing future research and development work.Data collection was carried out by means of a thematic interview, and by measuring attitudes to quality of care on a modified attitude scale based on Osgood's semantic differential. The interview group comprised 128 people; 25 patients and 25 staff members at a local hospital, 25 patients and 27 staff members at a health centre, and 26 county council politicians. The interview material was analysed inductively using qualitative and quantitative content analysis. On analysing the three themes which dealt with the interviewees' perception of health, quality of life as a result of care received, the quality of selfcare as well as care goals, literature studies were added which dealt with the above-mentioned phenomena.The result of the interview study, and the literature studies included in the analysis phase, can be stated in brief, that the main focus in the perception of quality of care held by the patients, the staff and the politicians was on 1) the quality of the staff, with an emphasis on the characteristics and skills of the staff, 2) quality in implementing care, involving care measures of an affective nature and the quality of the patient- staff relationship, and 3) the patient-related quality of results, consisting of such changes in the patient's health status as a cure or a change in health; cognitively oriented results like better knowledge about one's condition; wellbeing as a result of care; satisfaction with the care and treatment provided, and with the staff.The result of the attitudes survey was that politicians were the most positive towards the quality of the care provided, while the personal at the health centre were the least positive. Of the various professional categories interviewed, physicians were the most positive. Other staff comprising paramedical groups were the least positive.Further groups of variables have been generated from the data collected and from the literature studies in order to extend the evaluation of the quality of nursing care. All of the variable groups developed in the present thesis have been named and grouped together in a system called the KISAAL system, after the initials of the author. The different groups of variables can be related to each other to facilitate a total assessment of the quality of nursing care, and its management.
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| 3. |
- Lundgren, Anna
(författare)
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Perifer intravenös infart i klinisk rutin : Utveckling av omvårdnadsrutiner för att minska risken för komplikationer
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim was to study the way nurses plan, take care of and document a peripheral intravenous cannula (PIV) line related to complications, and to give a basis for quality assurance in surgery and internal medicine wards. The methods used were examination of patients' records, interview of patients and nurses, and observation of the cannula and its insertion area. An analysis of risk factors was also performed. The sample included 300 patients with 501 inserted peripheral cannulae, as well as nurses. The patients were followed from the day of insertion until the day the insertion area and the vein were free from symptoms.A significantly higher frequency of thrombophlebitis and severe long-term problems were found in patients treated by nurses without special training than among those with (p<0.001 ). The complication risks increased after long time in situ and were especially high when hypertonic drugs, solutions, or anticoagulants were given. Complications could exist up to six months. The care and handling decreased with time in situ and the cannulae were not always removed or documented. The intention was that a cannula should be inserted less than three days, but nurses were aware that the PIV remained in situ longer. Bad routines and neglected areas were said to be the reasons. Discomfort reported by the patients could be directly referred to technical mistakes or/and bad routines. When asked what governed the work with PI Vs the most decisive factors in the case of PIV were said to be knowledge 86%, experience 83%, and routine 32%. Educated nurses performed more satisfactory care and handling. No significant difference could be found between the nurses· years of experience and care and handling of PIV.A gap was shown between nursing research and nurses practice. The findings were not in accordance with, or based on, well-tried experience or scientific performance and diverges from "good knowledge" and '"good care". Reflection over current routines should be of value. One example of a good routine to reduce infections is daily change of the cannula. The conclusion is that the nurse has to be technically and theoretically acquainted with the subject.Nursing care demands special competence and relevant knowledge to enable nurses to assess and give satisfactory care in relation to patients" needs. Good nursing care should include prevention of pain and discomfort, be planned and implemented in a secure way, and also follow research and development in this area so that new knowledge and experience can be brought into the profession.
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