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- Bergerum, Carolina, 1967-
(författare)
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Patient and public involvement in hospital quality improvement interventions : the mechanisms, monitoring and management
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation focuses on the mechanisms, monitoring and management of patient and public involvement in hospital quality improvement (QI) interventions. Findings from a literature review generated an initial programme theory (PT) on active patient involvement in healthcare QI interventions (Paper 1). Empirical studies were also undertaken in order to describe what was actually happening in the hospital QI teams and what patients and professionals experience influence their joint involvement (Paper 2), and to compare hospital leaders’ and managers’ experiences of managing QI interventions involving patients and the public (Paper 3). Finally, it was studied how patient-reported measures stimulate patient involvement in QI interventions in practice (Paper 4). The research had a qualitative design. The approach was descriptive and comparative, and the studies were carried out prospectively. Data were collected in two hospital organisations in Sweden and in one hospital organisation in the Netherlands. Data collection methods were a literature search (Paper 1), interviews and field observations (Paper 2 and 3) and data collection meetings (Paper 4). Altogether, 93 team meetings and meetings between the team leaders and management were attended and a total of 20 days of study visits with different forms of meetings were made. Twelve patients, 12 healthcare professionals and 17 and 8 hospital leaders and managers, respectively, participated in the interviews and data collection meetings. Realist synthesis was used to formulate the initial PT (Paper 1). Constructivist grounded theory was used to analyse and describe what was happening in the QI teams and how it was experienced by the team members (Paper 2). To compare hospital leaders’ and managers’ different, contextual meanings in Sweden and the Netherlands, the reflexive thematic analysis informed by critical realism was used (Paper 3). To order, manage and map data from 31 examples of local QI interventions associated to patient-reported measures, the framework method was used (Paper 4). The results formulate a generic PT on the mechanisms, monitoring and management perspectives of co-produced QI interventions in hospital services where patients and the public are involved. The PT provides a hypothesis on the various mechanisms at play and outcomes obtained at the different levels of hospital organisations in the process. It is argued that focus should be on experiences, interaction, relationships and dialogue, integration of context, and the matching of hospital resources to patient and public demands and needs. Subsequently, the outcome will be the resources and reasoning interplay resulting in actions and processes, experiences and knowledge, ‘product’ benefits, emotions, judgements and motivations. Monitoring constitutes an important feedback loop to enable such learnings. The PT aligns the perspectives of the clinical microsystem, improvement science and the service-dominant logic, and has a potential to explain how patient and public involvement in QI interventions might work.
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| 2. |
- Darcy, Laura, et al.
(författare)
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Health and functioning in the everyday lives of young children with cancer : documenting with the International Classification of Functioning, Disability and Health – Children and Youth (ICF-CY)
- 2014
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Ingår i: Child Care Health and Development. - : Wiley-Blackwell Publishing Ltd.. - 0305-1862 .- 1365-2214.
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Tidskriftsartikel (refereegranskat)abstract
- Background Health care focus is shifting for children from surviving childhood cancer to living with it on a daily basis. There is a need to document health and function in the everyday lives of young children with cancer using the multidimensional framework and language of the International Classification of Functioning, Disability and Health – Children and Youth (ICF-CY). Aims The aims of this study were (1) to document health and functioning in the everyday lives of young children with cancer using ICF-CY codes and (2) to identify a comprehensive code set that can aid clinical assessment. Method Interviews with children diagnosed with cancer and their parents, were transcribed, reviewed for content and coded to the ICF-CY using linking procedures. Results A comprehensive code set (n = 70) for childhood cancer was identified. The majority of content identified to codes was related to activity and participation describing social relations with family, peers and professionals, preschool attendance and play, as well as issues related to support and independence. Conclusions The ICF-CY can be used to document the nature and range of characteristics and consequences of cancer experienced by children. The identified comprehensive code set could be helpful to health care professionals, parents and teachers in assessing and supporting young children’s health and everyday life through the cancer trajectory. The comprehensive code set could be developed as a clinical assessment tool for those caring for young children with cancer. The universal language of the ICF-CY means that the utility of a clinical assessment tool based on identified codes can have wide reaching effects for the care of young children with cancer.
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| 3. |
- Friberg, Febe, et al.
(författare)
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Context and Methodological Decontextualisation in Nursing Research with Examples from Phenomenography
- 2000
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell Publishing Ltd.. - 0283-9318 .- 1471-6712. ; 14:1, s. 37-43
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Tidskriftsartikel (refereegranskat)abstract
- In both human science and nursing research the concept of context is important. However, context can be understood in different ways. The aim of this article is to elucidate, discuss and problematize context, decontextualization and recontextualization in some health care-related phenomenographical studies. A further aim is to problematize the concet of context in a wider perspective of human complex ohenomena which characterize nursing research demand a broad contextual understanding. Both the local or immediate experiences of the phenomen of interest as well as the socio-cultural discourse. A balance between openness and pliability t the phenomenon is suggested. Reflection is considered an important tool in this process. Within phenomenography, the interest i s directed towards conceptions of certain aspects of the worlds. Thus, context in a wider sense is given a subordinate role. Accordingly, phenomenography is considered to have limited applicability in nursing research when complex phenomena are to be studied.
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| 4. |
- Nydén, K, et al.
(författare)
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Unsatisfied basic needs of older people in emergency care environments : obstacles to an active role in decision making
- 2003
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Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell Publishing Ltd.. - 0962-1067 .- 1365-2702. ; 12:2, s. 268-274
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Tidskriftsartikel (refereegranskat)abstract
- Little attention is paid in Emergency Care Units (ECUs) in Sweden to the special needs of older people. The aim of this study was thus to analyse older people's basic needs in the emergency care environment. The study was carried out with a life-world interpretative approach, and the theoretical framework for interpretation was Abraham Maslow's theory of motivation and personality. Seven informants aged between 65 and 88 years, with various experiences of being patients with urgent as well as non-urgent health-related problems, were interviewed about their experiences of ECU care. Their basic needs at the lower levels of Maslow's hierarchy were well-represented in the data. Higher needs, such as desire to know and understand, appeared to be totally neglected. Safety needs dominated the whole situation. Our conclusion is that standards of care must be developed in Sweden to make older patients feel safer and more secure in ECUs. Furthermore, the principles of nursing care for older patients need to be defined in order to encourage them to take an active part in their own health process.
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| 5. |
- Nyström, Maria, et al.
(författare)
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Being a non-urgent patient at an ECU : a strive to maintain personal integrity
- 2003
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Ingår i: Accident and Emergency Nursing. - : Churchill Livingstone. - 0965-2302 .- 1532-9267. ; 11:1, s. 22-26
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to analyse and describe experiences of being a non-urgent patient in an ECU (emergency care unit). Eleven non-urgent patients were interviewed. The research approach was inductive and interpretative. Seven tentative interpretations and an interpreted whole, i.e., an existential interpretation, revealed that the informants tried to be ‘good’ patients by not demanding much attention from nursing personnel, in an attempt to maintain good relations with the nurses in order to be assured of a positive reception. As health related problems jeopardise personal integrity, patients cannot afford the risk of being looked upon as inappropriate clients in the ECU.
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| 6. |
- Nyström, Maria, et al.
(författare)
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Music : Artistic Performance or a Therapeutic Tool. A Study on Differences.
- 2011
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Ingår i: International Journal of Music Education. - : Sage Publications Ltd.. - 0255-7614 .- 1744-795X. ; 29:3, s. 229-240
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to analyze and describe how musicians who are also music therapy students separate music as artistic performance from music as a therapeutic tool. The data consist of 18 written reflections from music therapy students that were analyzed according to a phenomenographic method. The findings are presented as four qualitatively-separated perceptions that describe differences in the purpose, symbolic value, professional competence and perceived reception of music. The underlying meaning is discussed as a difference between intuition and reflection.
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| 8. |
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| 9. |
- Petersson, Gunnar, et al.
(författare)
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Music Therapy as a Caring Intervention : musicians’ learning of a new competence.
- 2011
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Ingår i: International Journal of Music Education. - : Sage Publications Ltd. - 0255-7614 .- 1744-795X. ; 29:1, s. 3-14
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Tidskriftsartikel (refereegranskat)abstract
- The question of competence in providing music therapy has rarely been the focus of interest in empirical research, as most music therapy research aims at measuring outcomes. Therefore, the aim of this study is to analyse and describe musicians’ learning processes when they study music therapy as a caring intervention. An initial presumption is that musicians are highly qualified to take advantage of the potential of music but need to become familiar with the caring perspective. Ten freelance musicians participated in an education programme with music therapy anchored in a lifeworld-oriented caring science model. They were interviewed about their learning experiences. The data was analysed according to a phenomenographic method. The musicians’ understanding of their learning music therapy is described in terms of four qualitative categories: conversion, openness, reflection and practice. Learning as a continuous process is discussed in relation to pedagogic theories about tacit knowledge and ‘learning by doing’.
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| 10. |
- Wolmesjö, Maria
(författare)
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Ledningsfunktion i omvandling : Om förändringar av yrkesrollen för första linjens chefer inom den kommunala äldre- och handikappomsorgen
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During the 1990s many of the local authorities have been forced to reduce expenditure on the care of the elderly and people with disabilities, and many organisational changes have been carried out. New problems and their solutions are often related to leadership and management. This dissertation deals with three trends in the development of the organisation: The first trend is a market orientation, one example of which is the attempt to increase effectiveness and efficiency by utilising a purchaser/provider model in the organisation. Here the needs assessment model is studied. The second trend is the response to the pressed situation due to heavy workloads that staff members and their managers express, exemplified by self-managing work teams and a year-based working hour system. Here called flexible work organisations. The third trend focused in this dissertation is the decentralisation of social services. It is connected to increased demands on involvement in, and participation from those who use the services, i.e. the elderly and people with disabilities. The aim of this dissertation is to shed light on how politicians and managers view, experience and describe management and leadership in three types of local authority organisations. The focus is on the demands on managers and how the working conditions for managers are described in the different organisations. The material includes three different empirical methods. The first is a questionnaire to politicians and local authority officials, mainly managers at different levels in the care of the elderly and persons with disabilities. The second method consists of qualitative interviews with politicians and managers. The third method involved a document study of local authority documents, e.g. official guidelines, plans and evaluations. The method of analysis, a ?qualified content analysis? is inspired by discourse analysis and focuses on a comparison between the different local authorities, between politicians and managers and between women and men. This dissertation shows that the organisational changes brought about unexpected consequenses for management and that the demands differ between politicians and managers and between different organisations. Politicians and higher-level management expect the managers to manage the organisation, and employees expect them to lead. The solution seems to be a high level of competence, but which competence is needed? There are two different ideals for leadership. One is associated with focus on effectiveness and efficiency and the other associated with focus on communication. The dissertation highlights the conditions of a management, which is currently being pushed further down in the organisation. The dilemma of leadership ? being a manager or a leader will not disappear. Somewhere in the organisation the perspective of effectiveness and efficiency and the perspective of communication have to meet. It might be seen as a dilemma that will not go away ? only be placed in different levels in the organisation.
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