1.
Magnusson, Carl, 1976, et al.
(författare)
The final assessment and its association with field assessment in patients who were transported by the emergency medical service
2018
Ingår i: Scandinavian Journal of Trauma Resuscitation & Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 26
Tidskriftsartikel (refereegranskat) abstract
BackgroundIn patients who call for the emergency medical service (EMS), there is a knowledge gap with regard to the final assessment after arriving at hospital and its association with field assessment.AimIn a representative population of patients who call for the EMS, to describe a) the final assessment at hospital discharge and b) the association between the assessment in the field and the assessment at hospital discharge.MethodsThirty randomly selected patients reached by a dispatched ambulance each month between 1 Jan and 31 Dec 2016 in one urban, one rural and one mixed ambulance organisation in Sweden took part in the study. The exclusion criteria were age<18years, dead on arrival, transport between health-care facilities and secondary missions. Each patient received a unique code based on the ICD code at hospital discharge and field assessment.ResultsIn all, 1080 patients took part in the study, of which 1076 (99.6%) had a field assessment code. A total of 894 patients (83%) were brought to a hospital and an ICD code (ICD-10-SE) was available in 814 patients (91% of these cases and 76% of all cases included in the study). According to these ICD codes, the most frequent conditions were infection (15%), trauma (15%) and vascular disease (9%). The most frequent body localisation of the condition was the thorax (24%), head (16%) and abdomen (13%). In 118 patients (14% of all ICD codes), the condition according to the ICD code was judged as time critical. Among these cases, field assessment was assessed as potentially appropriate in 75% and potentially inappropriate in 12%.ConclusionAmong patients reached by ambulance in Sweden, 83% were transported to hospital and, among them, 14% had a time-critical condition. In these cases, the majority were assessed in the field as potentially appropriate, but 12% had a potentially inappropriate field assessment. The consequences of these findings need to be further explored.
2.
Berg, Marie, 1955, et al.
(författare)
Room4Birth - the effect of an adaptable birthing room on labour and birth outcomes for nulliparous women at term with spontaneous labour start: study protocol for a randomised controlled superiority trial in Sweden
2019
Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215 .- 1745-6215. ; 20:1
Tidskriftsartikel (refereegranskat) abstract
BACKGROUND: An important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden. METHODS/DESIGN: Following ethics approval, a study design was developed and tested for feasibility in a pilot study, which led to some important improvements for conducting the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour and who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centred approach and physical aspects (such as light, silencer, media installation offering programmed nature scenes with sound, bathtub, birth support tools) that are changeable according to a woman's wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding < 1000 ml); and a positive overall childbirth experience (7-10 on a scale of 1-10). To detect a difference in the composite score of 8% between the groups we need 1274 study participants (power of 80% with significance level 0.05). Secondary outcomes include: the four variables in the primary outcome; other physical outcomes of labour and birth; women's self-reported experiences (the birthing room, childbirth, fear of childbirth, health-related quality of life); and measurement of costs in relation to the hospital stay for mother and neonate. Additionally, an ethnographic study with participant observations will be conducted in both types of birthing rooms. DISCUSSION: The findings aim to guide the design of birthing rooms that contribute to optimal quality of hospital-based maternity care. TRIAL REGISTRATION: ClinicalTrials.gov NCT03948815. Registered 13 May 2019-retrospectively registered.
3.
Bångsbo, Angela, PhD, 1968-, et al.
(författare)
Preconditions to implementation of an integrated care process programme
2021
Ingår i: Journal of Integrated Care. - : Emerald Group Publishing Limited. - 1476-9018.
Tidskriftsartikel (refereegranskat) abstract
PurposeThe purpose of this study was to investigate the preconditions of a full-scale implementation of an integrated care process programme for frail older people from the staff's understanding, commitment and ability to change their work procedures with comparisons over time and between organisations.Design/methodology/approachA repeated cross-sectional study was conducted in a hospital, municipal health and social care setting.FindingsStaff commitment decreased to the importance of a permanent municipal contact from baseline compared to the 12-months follow-up (p = 0.02) and the six- and 12-months follow-up (p = 0.05), to the information transfer from emergency department from the six- to the 12-months follow-up (p = 0.04), to discharge planning at the hospital at six- and 12-months follow-up (p = 0.04) and towards discharge planning at home from baseline to the six-month follow-up (p = 0.04). Significant differences occurred between the organisations about information transfer from the emergency department (p = 0.01) and discharge planning at home (p = 0.03). The hospital staff were the most committed.Practical implicationsThe results can guide the implementation of complex interventions in organisations with high-employee turnover and heavy workload.Originality/valueThe study design, allowing the comparison of implementation results over time and between organisations in a later phase, gives this study a unique perspective.
4.
Lindgren, Helena, 1965, et al.
(författare)
Taking the matter into one’s own hands –Women’s experiences of unassited homebirths in Sweden
2017
Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 11, s. 31-35
Tidskriftsartikel (refereegranskat) abstract
Objective: There are no national guidelines or financial support for planned homebirths in Sweden. Some women choose to give birth at home without the assistance of a midwife. The objective of this study was to describe eight women’s experience of unassisted planned homebirth in Sweden. Design: Women who had the experience of an unassisted planned home birth were interviewed. The material was analysed using a phenomenological approach. Results: The essential meaning of the phenomenon giving birth at home without the assistance of a midwife is understood as a conflict between, on one hand, inner responsibility, power and control and on the other hand insecurity in relation to the outside, to other people and to the social system. A wish to be cared for by a midwife is in conflict with the fear of not maintaining integrity and respect in this precious moment of birth. Conclusion: Some women may be more sensitive to attitudes and activities that are routinely performed during pregnancy and childbirth and therefore choose not to turn to any representatives of the medical system. The challenge should be to provide safe care to allwomen so that assistance from a midwife becomes a reality in all settings.
5.
Dellve, Lotta, et al.
(författare)
Ledarskap i vården : att möta media och undvika personfokuserade drev
2014
Rapport (övrigt vetenskapligt/konstnärligt) abstract
Frågor om kvalitet, tillgänglighet och effektivitet i vården engagerar många och debatteras ofta i media. Att möta media är idag vanligt för chefer i vården och en viktig del av chefsarbetet. I media kan dock ett komplext problem komma att förenklas till att tillskrivas den ansvarige chefen snarare än t.ex. politiska, ekonomiska och organisatoriska förhållanden och överväganden. Mediebevakningen och debatten kan innehålla mer av en personfokusering än saklig debatt om viktiga frågor. Studier om orsak, förlopp och konsekvenser för en sådan personfokusering har varit få. Under 2011–2013 genomfördes en rad studier som syftade till att få djupare kunskap om hur chefer påverkas av att bli personligt fokuserade i media, vad som kan göras för att förebygga att negativa situationer uppstår och vilket stöd som krävs för att möta intensivt och kritiskt mediafokus. Projektet finansierades av afa försäkring och ett syfte var också att ta fram ett kunskapsunderlag för beredskap och stöd inför, under och efter möte med media. Rapporten har författats av professor Lotta Dellve vid Högskolan i Borås och kth (projektledare), leg. psykolog och doktorand Maria Wramsten Wilmar vid Högskolan Borås, leg. psykolog Christian Jacobsson vid Psykologiska Institutionen Göteborgs Universitet och Gunnar Ahlborg jr, leg. överläkare och docent i arbetsmedicin samt chef för Institutet för Stressmedicin, Västra Götalandsregionen.
6.
Eriksson, Erik, 1977
(författare)
A Service Management Perspective on Healthcare Improvement: Integrating Social Context
2016
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The current dissertation argues that ideas from service research should be given a more prominent position in improving healthcare that is capable of managing current and future challenges. The integration and combination of intangible resources, such as knowledge and skills, constitute the service in this thesis; thus, service is conceived as a verb. A central notion in such conceptualization is value co-creation, implying that healthcare providers may only offer potential value, which is realized as real value by people in their broader lifeworlds. Consequently, the healthcare provider is often only one of many actors in the individual’s value-creation process – in which resources from a multiplicity of actors are integrated and combined. One challenge that is particularly addressed in this thesis is unsatisfying inhabitant/patient perceptions concerning how healthcare is executed. More specifically, this refers to interpersonal aspects, including interaction between inhabitant/patient and provider, access to adequate information, and prerequisites to actively participate in one’s own care. Another challenge addressed herein is disparities between groups in society. A mainstream service management perspective is deemed relevant in targeting the first challenge, with foci on the inhabitant’s/patient’s active role rather than the internal affairs of the organization; interaction rather than results; and providing a holistic view rather than treating healthcare in isolation. In order to face the second challenge of disparities between groups, I argue that it is necessary to explicitly integrate the social context, which is claimed to have been neglected in traditional service research. Such context includes not only a diversity of actors, but also societal structures that influence – and are influenced by – the healthcare meeting and thus the individual’s prerequisites to actively participate in her or his care. By adopting a moderate social constructionist position – which contrasts to the individualism characterized by mainstream service research – the focus of the thesis moves from singular to plural, from individual to groups in society. On one hand, in such a position, categorization of individuals into groups is not uncomplicated. On the other hand, healthcare improvements are enabled on a collective level. The constructionist position also permeates conceptions of knowledge: rather than an absolute “truth,” knowledge is about different perspectives. An extension of this reasoning is that healthcare needs to manage multiple perspectives to achieve improvement. Consequently, the purpose of this thesis is not to proclaim a service management perspective as a universal solution, but rather to enhance its position among a diversity of mutually complementing perspectives. The empirical material draws from three studies, discussed in five papers. The first study sought to increase knowledge of three groups’ perceptions on parenthood in a child health service context. The second study mainly addressed the reasons why men and women reported complaints in healthcare. The third study addressed how healthcare providers and community representatives could contribute to increased participation in a screening program in an area with a large number of foreign-born inhabitants. Cumulatively, the studies illuminate the potential of a service management perspective to improve healthcare, not least being the focus on the inhabitant’s/patient’s perceptions, but also their active role and the inclusion of actors in the individual’s broader lifeworld such as family members and the local community. In line with a service management perspective, the interactional aspects are argued to be important enablers for individuals to participate in healthcare. However, by integrating the social context, it is also revealed that interaction may also constitute a constrainer of possibilities for individuals or groups to be participative. A service perspective integrating social context also offers possibilities, not least by enriching the emerging field of improvement science. Through lifeworld-situated perceptions, in which groups’ perceptions beyond healthcare are identified, healthcare may be improved to better address group members’ needs given their broader life situations. Representative co-creation implies that a collective’s unique knowledge and skills are used productively in order to improve healthcare that manages diversified needs and expectations.
7.
Olsson, Erik, 1977
(författare)
Interpersonal complaints regarding cancer care through a gender lens
2016
Ingår i: International Journal of Health Care Quality Assurance. - 0952-6862 .- 1758-6542. ; 29:6, s. 687-702
Tidskriftsartikel (refereegranskat) abstract
Purpose– The purpose of this paper is to investigate healthcare customer complaints concerning interpersonal matters in cancer care.Design/methodology/approach– Complaints from cancer patients and their relatives (n=116) that dealt with interpersonal matters registered between 2009 and 2011 at four local Patients’ Advisory Committees in Western Sweden were sampled and analyzed using qualitative content analysis.Findings– Complaints concerned lack of information and consideration from healthcare providers. Lack of empathy and civility also caused dissatisfaction, the latter particularly for women. Relatives complained that they did not feel included in the care process or were not offered proper support. Most complaints by relatives were filed by a female relative and concerned a male patient.Research limitations/implications– Information about patient demographics other than gender could not be investigated due to database limitations. Hence, factors such as age, country of birth, and geographical residence were not included for analysis. In addition, neither the type nor stage of cancer among the sampled patients was able to be addressed.Practical implications– Patient complaints should not only be viewed as a post-consumption judgment, but also as a service interaction activity. This may require healthcare providers to enhance their interpersonal skills, allowing patients and relatives to provide feedback during service interaction to satisfactorily address dissatisfaction. Visualizing gender disparities may help healthcare providers prevent stereotypical encounters. In addition, the provider should be invited to participate in the customer’s value creating network, which may also include knowledge and skills from other sources, such as relatives.Originality/value– Value co-creation offers a different view on patient complaints. Incorporating social construction into value co-creation may reveal socially constructed disparities. The paper provides aggregated information on cancer patients’ and relatives’ complaints concerning interpersonal issues, which can increase knowledge about patient healthcare service perceptions.
8.
Nässén, Kristina, et al.
(författare)
Health care professionals' experiences of possibilities and constraints in caring for older adults living with long-term pain in community home care
2023
Ingår i: Journal of Aging Studies. - : Elsevier. - 0890-4065 .- 1879-193X. ; 65
Tidskriftsartikel (refereegranskat) abstract
Caring for a growing population of older adults with complex health problems in their homes is part of every-day work for many health care professionals in the world. This qualitative interview study explores the way health care professionals perceive possibilities and constraints when caring for older adults living with long-term pain in community home care in Sweden. The study aims to understand the relationship between health care professionals' subjective experiences and social structures such as the organization of care and shared norms and values in regard to their perceived space of action. Findings provide insight into how institutional structures such as organization and time, conflate with cultural notions, norms, and ideals, and how these enable and constrain health care professionals in their daily work but also create dilemmas. Findings suggest centering the meaning of structuring aspects in social organizations as a tool for reflection on priorities, improvement, and development in care settings.
9.
Bergh, Anne-Louise, et al.
(författare)
Registered nurses' perceptions of conditions for patient education - focusing on organisational, environmental and professional cooperation aspects
2012
Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 20:6, s. 758-770
Tidskriftsartikel (refereegranskat) abstract
Aim To describe nurses' perceptions of conditions for patient education, focusing on organisational, environmental and professional cooperation aspects, and to determine any differences between primary, municipal and hospital care. Background Although patient education is an important part of daily nursing practice, the conditions for this work are unclear and require clarification. Method A stratified random sample of 701 (83%) nurses working in primary, municipal and hospital care completed a 60-item questionnaire. The study is part of a larger project. The study items relating to organisation, environment and professional cooperation were analysed using descriptive statistics, non-parametric tests and content analysis. Results Conditions for patient education differ. Nurses in primary care had better conditions and more managerial support, for example in the allocation of undisturbed time. Conclusions Conditions related to organisation, environment and cooperation need to be developed further. In this process, managerial support is important, and nurses must ask for better conditions in order to carry through patient education. Implications for nursing management Managerial support for the development of visible patient education routines (e.g. allocation of time, place and guidelines) is required. One recommendation is to designate a person to oversee educational work.
10.
Caesar, Ulla, et al.
(författare)
A sense of being rejected : Patients’ lived experiences of cancelled knee or hip replacement surgery
2021
Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712.
Tidskriftsartikel (refereegranskat) abstract
BackgroundGrowing care queues, reduced access to care and cancelled surgery are realities for some patients being treated with total hip or knee replacement surgery in Sweden.Most of the patients on the waiting lists have experienced pain and limited motion for a varying period of time, with a negative effect on their everyday lives. Overbooked surgical schedules are already contributing to the lengthy waiting times, but, with the addition of cancellations, longer waiting times will increase still further and may affect patients’ well‐being.MethodsIn the present study, we aimed to illuminate the experience of having planned surgery cancelled, based on narratives from 10 participants. The interview transcriptions were analysed using a phenomenological hermeneutic approach.ResultsThe comprehensive analyses revealed that the participants described the agony of being deselected and the additional impression of being excluded. Metaphors of being damaged and feeling physical pain were used and the interpretations referred to the cancellations as unpleasant. Additionally, the important relationship and the trust between the health workers and the patient were negatively affected by the cancellation.ConclusionAfter the cancellation, the participants expressed being vulnerable and from their perspective the cancelled surgery affected them deeply; in fact, much more than the healthcare workers appeared to understand. Therefore, information around the cancellation must be given respectfully and with dignity, in a dialogue between the patient and the healthcare workers. Taken together, to enable an opportunity to be involved in the continued care. The cancellations should be seen as an interruption, in which the patients’ chance of living a pain‐free, active life is postponed.
