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- Bååthe, Fredrik, 1968, et al.
(författare)
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Physician experiences of patient-centered and team-based ward rounding – an interview based case-study
- 2014
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Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 3:6, s. 127-142
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Tidskriftsartikel (refereegranskat)abstract
- Background: Rounding has long traditions within hospital-based healthcare, as a way to organize the ward-based part of the care and cure process. Despite an increased emphasis on patient participation, there has been limited research exploring physician experiences of actually applying these principles to the ward round. Aim: To explore physician experiences after changing to a patient-centered and team-based ward round, in an internal medicine department at a Swedish mid-size hospital. Methods: Qualitative exploratory case-study. Semi-structured interviews with 13 physicians (six consultants, three residents, four interns) have been carried out. All interviews have been transcribed and analyzed by qualitative method. Results: The traditional relationship of superiority and subordination, embodied by the patient lying down in bed and the physician standing over the bed, was one essential change in the new ward round. Physicians experienced that less hierarchical relationships with patients, combined with working in a multi-professional team, contributed to betterinformed clinical decisions, fewer follow-up questions from patients, and increased professional fulfilment. However, physicians also experienced that their autonomy was being reduced, and there was uneasiness about exposing potential knowledge gaps in front of others. Conclusions: This qualitative study of physician experiences finds that patient-centered and team-based ward rounds is a fertile development journey forward. Also important to notice are the seemingly new and paradoxical findings that despite the introduction of the “right” ward round structure, negative experiences emerged as unwanted side effects to the positive experiences reported. It could be beneficial for leaders in healthcare (both managers and physicians) to consider these results to facilitate future ward round initiatives.
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| 2. |
- Bååthe, Fredrik, 1968, et al.
(författare)
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Uncovering paradoxes from physicians' experiences of patient-centered ward-round.
- 2016
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Ingår i: Leadership in health services (Bradford, England). - 1751-1887. ; 29:2, s. 168-84
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The purpose of this paper is to uncover paradoxes emerging from physicians' experiences of a patient-centered and team-based ward round, in an internal medicine department. Design/methodology/approach Abductive reasoning relates empirical material to complex responsive processes theory in a dialectical process to further understandings. Findings This paper found the response from physicians, to a patient-centered and team-based ward round, related to whether the new demands challenged or confirmed individual physician's professional identity. Two empirically divergent perspectives on enacting the role of physician during ward round emerged: We-perspective and I-perspective, based on where the physician's professional identity was centered. Physicians with more of a We-perspective experienced challenges with the new round, while physicians with more of an I-perspective experienced alignment with their professional identity and embraced the new round. When identity is challenged, anxiety is aroused, and if anxiety is not catered to, then resistance is likely to follow and changes are likely to be hampered. Practical implications For change processes affecting physicians' professional identity, it is important for managers and change leaders to acknowledge paradox and find a balance between new knowledge that needs to be learnt and who the physician is becoming in this new procedure. Originality/value This paper provides increased understanding about how physicians' professional identity is interacting with a patient-centered ward round. It adds to the knowledge about developing health care in line with recent societal requests and with sustainable physician engagement.
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| 3. |
- Edling, C., et al.
(författare)
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Long-term follow up of workers exposed to solvents
- 1990
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Ingår i: British journal of industrial medicine. - 0007-1072. ; 47:2, s. 75-82
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Tidskriftsartikel (refereegranskat)abstract
- Long term occupational exposure to organic solvents may cause adverse effects to the central nervous system. This collaborative study between six Swedish departments of occupational medicine examines the overall prognosis in terms of working capacity, symptoms, and psychometric test performance for individuals occupationally exposed to organic solvents. After re-analyses of the data from an initial clinical investigation of 111 men, the subjects were divided into two subgroups: one group of 65 with symptoms but no impairment on the tests and one group of 46 with toxic encephalopathy (symptoms and test impairment). At least five years after the initial examination the subjects were asked to attend a re-examination that included a structured medical interview and a psychometric investigation. The results indicate that effects on the central nervous system persist even when exposure has ceased. In the group of 46 more men had stopped working and were receiving sickness or early retirement pensions. This group also had reduced activity levels with regard to everyday life, leisure activities, and education or training and more neuropsychiatric symptoms. There was no support for the view that a solvent induced toxic encephalopathy is a progressive disease comparable with presenile dementia such as Alzheimer's disease or Pick's disease. If a worker was removed from exposure when he presented symptoms without signs of impairment in intellectual function recovery was seen in most cases.
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| 6. |
- Ahlborg, Gunnar, 1948
(författare)
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Occupational and environmental medicine in Sweden
- 2000
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Ingår i: International Archives of Occupational and Environmental Health. - 0340-0131. ; 73:1, s. 1-6
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Tidskriftsartikel (refereegranskat)abstract
- Great changes have taken place in the fields of occupational and environmental medicine in Sweden during the past decade. Unemployment, work stress, and indoor climate problems have become increasingly common. Chemical exposures in industry and serious work accidents have continued to decrease. State subsidies to occupational health services have been withdrawn and the legislation concerning, for example, occupational diseases has been changed in order to decrease state expenditure. Research has focused on, for instance, ergonomic and psycho-social factors, electromagnetic fields and exposures causing allergy. There is a growing awareness of the need for more emphasis on prevention, which should act in favour of both hospital-based occupational and environmental medicine and the occupational health services sector.
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| 7. |
- Ahlborg, Gunnar, 1948
(författare)
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Physical work load and pregnancy outcome
- 1995
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Ingår i: Journal of Occupational and Environmental Medicine. - 1076-2752. ; 37:8, s. 941-4
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Forskningsöversikt (refereegranskat)abstract
- Pronounced physical exertion may influence intraabdominal pressure and uterine blood flow, hormonal balance, and nutritional status, all of which are important determinants of embryonic and fetal development and survival. Most of the epidemiologic evidence of reproductive effects from occupational physical activity concerns gestational age/premature birth, birth weight/intrauterine growth retardation, and spontaneous abortion. Strenuous work, especially when involving long hours of standing and walking, seems to increase the risk of preterm delivery. The effect on intrauterine growth and spontaneous abortion risk is less clear. As a single factor, heavy lifting has in most circumstances not been associated with a significantly increased risk of these outcomes. In general, heavy work duties should be avoided, and enough rest periods assured, especially in late pregnancy.
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| 8. |
- Ahlborg, Gunnar, 1948, et al.
(författare)
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Reproductive effects of chemical exposures in health professions
- 1995
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Ingår i: Journal of Occupational and Environmental Medicine. - 1076-2752. ; 37:8, s. 957-61
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Forskningsöversikt (refereegranskat)abstract
- Numerous chemical substances are handled by persons working in the health care sector. At exposure levels that may occur in the occupational setting, some of these substances are potentially harmful to the reproductive processes. Among the potentially harmful substances are anesthetic gases, antineoplastic agents, and sterilants. The epidemiological evidence of increased risks for adverse reproductive effects (eg, subfertility, spontaneous abortions, congenital defects) from such exposure is not unequivocal. However, due to the toxic potential, exposures should be kept at a minimum, and this may be especially important for workers who are pregnant or are planning to achieve pregnancy.
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| 9. |
- Ahlborg, Gunnar, 1948, et al.
(författare)
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Shift work, nitrous oxide exposure and subfertility among Swedish midwives
- 1996
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Ingår i: International Journal of Epidemiology. - 0300-5771. ; 25:4, s. 783-90
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Shift work and nitrous oxide exposure have both been suspected of having adverse influence on the reproductive performance of health workers. Time to pregnancy has been suggested as a sensitive measure of fecundity in occupationally exposed groups. We investigated the effects of shift work and nitrous oxide exposure on the fertility of Swedish midwives. METHODS: A questionnaire was mailed to all members of the Swedish Midwives Association who were born 1940 or thereafter, 3985 in all. Eighty-four per cent responded. Detailed information on the number of menstrual cycles required to achieve pregnancy and the working conditions during that period were obtained concerning the most recent, planned pregnancy occurring after 1983. The per cycle probability of becoming pregnant was calculated for each exposure category, and the relation to the unexposed was expressed as fecundability ratios. RESULTS: Midwives who worked two-shift, three-shift rotas, or only nights had reduced fertility compared to those working in the day time. The fecundability ratios were 0.78 (95% confidence interval [CI]: 0.65-0.94), 0.77 (95% CI: 0.60-0.98), and 0.82 (95% CI: 0.64-1.03), respectively, after adjustment for covariates. No effect of nitrous oxide exposure was noted except in the small group reporting that they assisted at more than 30 deliveries per month when nitrous oxide was used (fecundability ratio = 0.64; 95% CI: 0.44-0.95). CONCLUSION: Shift work and frequent, high occupational exposure to nitrous oxide may have a negative influence on the ability of women to become pregnant.
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| 10. |
- Ahlborg, Gunnar, 1948, et al.
(författare)
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Tobacco smoke exposure and pregnancy outcome among working women. A prospective study at prenatal care centers in Orebro County, Sweden
- 1991
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Ingår i: Am J Epidemiol. - 0002-9262. ; 133:4, s. 338-47
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Tidskriftsartikel (refereegranskat)abstract
- Among 4,687 women undergoing prenatal care in Orebro County, Sweden, from October 1980 to June 1983, 678 nonsmokers reported passive exposure to tobacco smoke. Of these women, 267 had been passively exposed at work, and the risk ratio (RR) for intrauterine death (spontaneous abortion or stillbirth) among these pregnancies was increased to 1.53 (95% confidence interval (CI) 0.98-2.38) compared with pregnancies of unexposed working women. This could not be explained by age, previous spontaneous abortion, educational level, planning of pregnancy, or alcohol use. The effect was confined to first-trimester fetal loss (adjusted RR = 2.16, 95% CI 1.23-3.81), while active smoking was associated with intrauterine death after the first trimester. Passive exposure in the workplace was weakly associated with preterm birth (less than 37 weeks) but not with low birth weight (less than 2,500 g) among full-term livebirths. Active smoking clearly increased the risk of both of these outcomes. However, passive exposure in the home only did not seem to affect pregnancy outcome. The lack of quantitative exposure data points to the need for more research before passive exposure to tobacco smoke can be regarded as an established hazard to fetal development and survival.
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