| 1. |
- Bastholm Rahmner, Pia, et al.
(författare)
-
Whose job is it anyway? : Swedish general practitioners' perception of their responsibility for the patient's drug list.
- 2010
-
Ingår i: Annals of Family Medicine. - : Annals of Family Medicine. - 1544-1709 .- 1544-1717. ; 8:1, s. 40-46
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE Information about the patient's current drug list is a prerequisite for safe drug prescribing. The aim of this study was to explore general practitioners' (GPs) understandings of who is responsible for the patient's drug list so that drugs prescribed by different physicians do not interact negatively or even cause harm. The study also sought to clarify how this responsibility was managed. METHODS We conducted a descriptive qualitative study among 20 Swedish physicians. We recruited the informants purposively and captured their view on responsibility by semistructured interviews. Data were analyzed using a phenomenographic approach. RESULTS We found variation in understandings about who is responsible for the patient's drug list and, in particular, how the GPs use different strategies to manage this responsibility. Five categories emerged: (1) imposed responsibility, (2) responsible for own prescriptions, (3) responsible for all drugs, (4) different but shared responsibility, and (5) patient responsible for transferring drug information. The relation between categories is illustrated in an outcome space, which displays how the GPs reason in relation to managing drug lists. CONCLUSIONS The understanding of the GP's responsibility for the patient's drug list varied, which may be a threat to safe patient care. We propose that GPs are made aware of variations in understanding responsibility so that health care quality can be improved.
|
|
| 2. |
- Björck-Åkesson, Eva, 1952-, et al.
(författare)
-
The International Classification of Functioning, Disability and Health and the version for children and youth as a tool in child habilitation/early childhood intervention - feasibility and usefulness as a common language and frame of reference for practice
- 2010
-
Ingår i: Disability and Rehabilitation. - London : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 32:S1, s. S125-S138
-
Tidskriftsartikel (refereegranskat)abstract
- Early childhood intervention and habilitation services for children with disabilities operate on an interdisciplinary basis. It requires a common language between professionals, and a shared framework for intervention goals and intervention implementation. The International Classification of Functioning, Disability and Health (ICF) and the version for children and youth (ICF-CY) may serve as this common framework and language. This overview of studies implemented by our research group is based on three research questions: Do the ICF-CY conceptual model have a valid content and is it logically coherent when investigated empirically? Is the ICF-CY classification useful for documenting child characteristics in services? What difficulties and benefits are related to using ICF-CY model as a basis for intervention when it is implemented in services? A series of studies, undertaken by the CHILD researchers are analysed. The analysis is based on data sets from published studies or master theses. Results and conclusion show that the ICF-CY has a useful content and is logically coherent on model level. Professionals find it useful for documenting children's body functions and activities. Guidelines for separating activity and participation are needed. ICF-CY is a complex classification, implementing it in services is a long-term project.
|
|
| 3. |
- Ernesäter, Annica, et al.
(författare)
-
Incident reporting in nurse-led national telephone triage in Sweden : The reported errors reveal a pattern that needs to be broken
- 2010
-
Ingår i: Journal of Telemedicine and Telecare. - : SAGE Publications. - 1357-633X .- 1758-1109. ; 16:5, s. 243-247
-
Tidskriftsartikel (refereegranskat)abstract
- We conducted a retrospective study of incident reports concerning the national, nurse-led telephone triage system in Sweden. The Swedish Health Care Direct organization (SHD) is staffed by registered nurses who act as telenurses and triage the callers' need for care, using a computerized decision support system. Data were collected during 2007 from all county councils that participated in the SHD and were analysed using content analysis. Incident reports were then compared concerning differences in reported categories and who reported the errors. The 426 incident reports included 452 errors. Of the analysed incident reports, 41% concerned accessibility problems, 25% incorrect assessment, 15% routines/guidelines, 13% technical problems and 6% information and communication. The most frequent outgoing incident reports (i.e. sent from SHD to other health-care providers) concerned accessibility problems and the most frequently incoming reports (i.e. sent to SHD from other health-care providers) concerned incorrect assessment. There was a significant difference (P < 0.001) between outgoing and incoming reports regarding the main category. Telenurses have limited possibilities for referring the caller to their primary health-care provider or specialist, which may cause them to over-triage or under-triage the callers' need for care. This over-triage or under-triage may in turn cause other health-care providers to report incorrect assessment to SHD. The implications for practice are that poor accessibility is a matter that should be addressed and that the reasons for incorrect assessment should be explored.
|
|
| 4. |
- Hjelmblink, Finn, et al.
(författare)
-
Stroke patients' delay of emergency treatment
- 2010
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 24:2, s. 307-311
-
Tidskriftsartikel (refereegranskat)abstract
- Treatment of stroke victims with fibrinolysis should take place within a time limit of 3 hours. In spite of comprehensive endeavours to reduce hospital arrival time, too many patients still delay arrival beyond this time limit. This qualitative case study explored the meaning of acute stroke and treatment to four patients with more than 24-hour delayed arrival. The setting of the study was the catchment area of a university hospital. Semi-structured interviews were analysed through the empirical psychological, phenomenological method. An essence was found which was constituted by four themes. The essence of stroke symptoms and treatment was: 'Threatened control of bodily function, autonomy and integrity'. When the patients fell ill they acted as if nothing had happened. They treated their body like a defective device. In encounters with physicians they demanded to be met as a person by a person; otherwise they rejected both the physician and her or his prescriptions. They did not involve their near ones in decision-making. The conclusions were the following: Health care information about how to act in cases of early stroke symptoms may need to imbue people with an understanding of how early treatment of neurological symptoms and preserved control of life are intimately connected. Furthermore emergency care of acute stroke patients might need to take place in an organisation where patients are sure to be met by physicians as a person by a person.
|
|
| 5. |
- Holmström, Inger
(författare)
-
Diabetes Telehealth and Computerized Decision Support Systems : A Sound System with a Human Touch Is Needed
- 2010
-
Ingår i: Journal of Diabetes Science and Technology. - : SAGE Publications. - 1932-2968. ; 4:4, s. 1012-1015
-
Tidskriftsartikel (refereegranskat)abstract
- Telehealth holds the promise of improved consistency and fast and equal access to care, and will have great impact on future care. To enhance its quality and safety, computerized decision support systems (CDSS) have been launched. This commentary focuses specifically on the impact of telehealth and CDSS on diabetes patient management. Ideally, clinical information should be linked to evidence based recommendations and guidelines in the CDSS to provide tailored recommendations at the moment of care. However, technical support such as CDSS is not enough. The human touch is essential. A named healthcare provider with access to telehealth and CDSS seems to promise a way of providing both patient-centered and evidence-based care.
|
|
| 6. |
- Johansson, Ann-Christin, et al.
(författare)
-
A prospective study of cognitive behavioural factors as predictors of pain, disability and quality of life one year after lumbar disc surgery
- 2010
-
Ingår i: Disability and Rehabilitation. - Oxon, United Kingdom : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 32:7, s. 521-529
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The primary aim of this study was to analyse the predictive value of cognitive and behavioural factors, in relation to pain, disability and quality of life (QoL) one year after lumbar disc surgery.Method: The study design was prospective. Fifty-nine patients scheduled for first time lumbar disc surgery were included. Pain, disability, QoL, coping, fear avoidance beliefs, expected outcome and sick leave were assessed preoperatively and 12 months after surgery. Multiple backward stepwise logistic regression analyses were performed to study the contribution of the preoperatively measured independent behavioural/cognitive factors (coping, fear avoidance beliefs and assessed chance to return to work within 3 months) to the dependent variables pain, disability and quality of life at 12 months after surgery.Results: Low expectations on work return within 3 months after surgery was significantly predictive for residual leg pain, odds ratio (OR)¼8.2, back pain, OR¼9.7, disability, OR¼13.8 and sick leave, OR¼19.5. Low QoL, was best predicted by preoperatively high scores on fear avoidance beliefs OR¼6.6 and being a woman OR¼6.0. The regression model explained 26–40% of the variance in pain, disability, QoL and sick leave.Conclusions: Eliciting patients’ expectations on work return after surgery could contribute to early identification of those who run the risk of developing long-term disability and sick-leave.
|
|
| 7. |
- Kaminsky, Elenor, et al.
(författare)
-
Paediatric health calls to Swedish telenurses : a descriptive study of content and outcome
- 2010
-
Ingår i: Journal of Telemedicine and Telecare. - : SAGE Publications. - 1357-633X .- 1758-1109. ; 16:8, s. 454-457
-
Tidskriftsartikel (refereegranskat)abstract
- We collected data about telephone triage calls concerning children in Sweden. A sample of 110 paediatric calls were recorded. The transcribed data were analysed regarding word count, reasons for calling, results of calls, ages and gender of children, and gender of parents. The median call length was 4.4 min and the median child's age was 3.5 years. Mothers made 73% of calls, but mothers and fathers called to the same extent about daughters and sons, and regardless of age. The most common reasons for calls were ear problems, rash/wound or fever. In nearly half the calls, the telenurses provided self-care advice. Call length, word count or caller's part of word count did not differ according to gender of parents or children. However, mothers were more likely to receive self-care advice while fathers were more often referred to other health services by the telenurses. Telenurses might need to improve their gender competence, and more male telenurses in the service would potentially be beneficial to callers.
|
|
| 8. |
- Kjeldmand, Dorte, et al.
(författare)
-
Difficulties in Balint groups : a qualitative study of leaders' experiences
- 2010
-
Ingår i: British Journal of General Practice. - 0960-1643 .- 1478-5242. ; 60:580, s. 808-814
-
Tidskriftsartikel (refereegranskat)abstract
- Background Balint groups (BGs) are a means of enhancing competence in the physician-patient relationship and are also regarded as beneficial for GPs' mental health. However, voluntary BGs are still few, some members terminate their participation, and problems are reported in obligatory groups in residency programmes. This raises questions about possible negative aspects of BGs. Aim To examine difficulties in BGs as experienced by BG leaders. Design of study Qualitative study using interviews. Setting Eight BG leaders from five countries were interviewed. Method The interviews focused on the informants' experiences' of difficulties in their groups and were analysed with a systematic text-condensation method. Results Three categories of difficulties emerged from the analysis: 1) the individual physician having needs, vulnerabilities, and defences; 2) the group (including the leader) having problems of hidden agendas, rivalries, and frames; and 3) the surrounding environment defining the conditions of the group. BGs were found to fit into modern theories of small groups as complex systems. They are submitted to group dynamics that are sometimes malicious, and are exposed to often tough environmental conditions. Conclusion Professionally conducted BGs seem to be a gentle, efficient method to train physicians, but with limitations. Participation of a member demands psychological stability and an open mind. BGs need support from the leadership of healthcare organisations in order to exist.
|
|
| 9. |
- Letterstål, Anna, et al.
(författare)
-
Patients' experience of open repair of abdominal aortic aneurysm : preoperative information, hospital care and recovery
- 2010
-
Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 19:21-22, s. 3112-3122
-
Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. The aim was to elucidate patients' lived experience of the care pathway of going through open surgery for abdominal aortic aneurysm. Background. Open surgical treatment has a great impact on patients' health-related quality of life both before and after treatment. The transition from being independent and asymptomatic to dependent on nursing care can be difficult. To facilitate this process and provide high-quality care, patients' needs must be better understood. Design. An exploratory descriptive design was chosen to describe and understand patients' lived experience. Method. Audio-taped interviews were performed three months postoperatively, covering the care pathway before and after surgery. Interviews were analysed with qualitative content analysis. Results. The informants made a transition from becoming aware of the deadly risk associated with abdominal aortic aneurysm to gradually understanding the physical and emotional impact of the surgical procedure during the recovery process. The experience of not understanding fully the risks of undergoing surgery or its consequences on daily life made the informants unprepared for complications and limitations during the recovery period. Many concerns emerged, with a need for more dialogue and opportunities to understand their own care than those provided by the health care staff. Conclusions. To facilitate the transition process, health care staff should consider patients' unpreparedness for the physical and emotional impact that can follow diagnosis and treatment for abdominal aortic aneurysm and recognise the need for dialogue to enhance participation during recovery. Relevance to clinical practice. Throughout the care pathway, patients' need for information and for opportunities to reflect on bodily and emotional reactions to the diagnosis and treatment of abdominal aortic aneurysm should be recognised by nurses and physicians to support patients getting realistic expectations of the consequences of treatment and facilitate participation in decisions concerning care and medical treatment.
|
|
| 10. |
- Lillvist, Anne, et al.
(författare)
-
Preschool children in need of special support : prevalence of traditional disability categories and functional difficulties
- 2010
-
Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 99:1, s. 131-134
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate the prevalence of children who are in need of special support in the total population of children attending preschools (CA 1-6) in two Swedish counties, and the functional problems exhibited by the children in relation to demographical and environmental factors in the preschool context. Method: Survey distributed to (N = 1138) preschools in two Swedish counties. Results: The majority of children perceived by preschool teachers and in need of special support were undiagnosed children with functional difficulties related to speech, language and interaction with peers. Conclusion: Undiagnosed and diagnosed children share the same type of difficulties. Thus, in estimating the prevalence of children in need of special support in a preschool context, traditional disability categories capture only a small proportion of the children experiencing difficulties. Therefore, a functional approach in studies of children in need of special support is recommended.
|
|
