| 1. |
- Skogevall, Sofia, 1979-
(författare)
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Telephone nurses’ work with persons calling healthcare services frequently
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Telephone nursing constitutes a significant part of total healthcare and is increasing in society. Often it entails the care-seeking person’s first contact with healthcare and can be crucial for the whole episode of healthcare for the individual person. In every telephone healthcare context, there are persons who call repeatedly, commonly referred to as frequent callers. The definition of the term frequent caller however varies across studies. The frequent calling can affect the telephone nurses working environment and thereby the healthcare for frequent callers and other callers as well. It is a challenge for the healthcare system and telephone nurses to help these callers in an already stressful call-center environment with high time-pressure and limited time for each call. There is limited research on frequent callers, and the existing research has been conducted in different healthcare contexts. Frequent callers seem to be a vulnerable group with a larger need to call healthcare services. Therefore, the overall aim of this thesis is to describe telephone nurses work with frequent callers to telephone nursing services and how frequent callers can be helped. To gather and integrate the existing research an integrative review was conducted on frequent callers in different healthcare contexts, Study I. The results showed that frequent callers are a heterogeneous group with complex healthcare needs and mental ill-health. The suggestions for helping frequent callers were individual strategies and cooperation among health services.To investigate how telephone nurses perceive to handle frequent caller calls, in Study II a survey was conducted at Sweden’s national telephone nursing service, 1177. The survey was answered by 199 telephone nurses at 11 sites. The answers were analyzed with content analysis and summative analysis. The results showed that telephone nurses sometimes feel hopelessness in helping frequent callers. They were also afraid of missing something urgent in the calls with frequent callers. Suggestions for handling frequent caller calls was a common strategy at the workplace and to truly listen to frequent callers when they call. Further, to find out about parameters considered relevant for telephone nurses working environment in the task of answering frequent caller calls, three parameters were added to the survey: stress, self-efficacy, and empathy. The answers were analyzed statistically with correlation analysis, analysis of variance, and multiple regression analysis. The results revealed that telephone nurses who were already stressed perceived higher levels of stress in relation to frequent caller calls. Self-efficacy worked as a significant mediator for the other parameters and was correlated with lower stress and higher empathy. Telephone nurses who had worked for more than 30 years had lower empathy that those who had worked shorter than 30 years. There have been few interventions conducted of frequent callers and therefore in Study IV a case study was performed where an intervention project with frequent callers at an emergency medical dispatch center was followed and analyzed. The project nurse gathered data from the frequent callers’ medical records. To describe the intervention that aimed to optimize healthcare for frequent callers from a person-centered perspective, an interview was carried out with the project nurse and one caller from the project. The results showed that the most common cause for calling was anxiety. The frequent callers had overall tough life-situations. When individual nurse strategies were realized in the project, most of the callers stopped calling or the calls decreased.Conclusions are that to help frequent callers it is suggested to work person-centered and individualize the healthcare nurse strategies. Cooperation within the current healthcare service as well as with other healthcare services is crucial.
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| 2. |
- Ahlstedt, Carina, et al.
(författare)
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Flourishing at work : Nurses' motivation through daily communication - An ethnographic approach
- 2020
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Ingår i: Nursing and Health Sciences. - Australia : John Wiley & Sons. - 1441-0745 .- 1442-2018. ; 22:4, s. 1169-1176
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Tidskriftsartikel (refereegranskat)abstract
- Shortage and turnover of registered nurses are worldwide challenges, and work motiva-tion is one factor in retaining staff in the healthcare sector. The aim of this study was toexplore registered nurses' motivation expressed in daily communication, using the basicneeds in self-determination theory as a framework. A secondary analysis of ethno-graphic data, collected through participant observations, informal interviews duringobservations, and individual interviews, was used. A total sample of all registered nursesemployed at a hospital unit in Sweden (n = 10) participated. The data were analyzed the-matically through the lens of the basic needs in self-determination theory: autonomy,competence, and relatedness. Self-regulation of learning, the possibilities to discuss work-related challenges with colleagues, and having registered nurses lead dialogues with phy-sicians were factors connected to autonomy. Having a registered nurse and physiciansolve problems together was a factor connected to competence.Asenseofbelongingand security in a permissive climate between registered nurses was co nnected to relat-edness. This paper has implications for increased awareness of the three basic motiva-tional needs, which could be used in the development of attractive workplaces
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| 3. |
- Ernesäter, Annica, 1970-
(författare)
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National Telephone Advice Nursing in Sweden : Patient Safety and Communication
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to investigate patient safety and communication within national telephone advice nursing (SHD) in Sweden. Four empirical studies with different perspectives were conducted. The aim of Study I was to describe telenurses’ experiences of working with computerized decision support systems and how such systems could influence their work. The telenurses described a duality of perceptions: the CDSS both supported and inhibited their work. Study II aimed at describing medical errors that had led to an incident report within the context of SHD. Incident reports sent to and from the SHD during 2007 were collected. The results showed that telenurses have limited possibilities to refer callers to the appropriate level of care, and that other healthcare providers reported that telenurses had made an incorrect assessment regarding callers’ need for care. Study III aimed at describing the actual communication between telenurses and callers expecting a higher level of care than recommended by telenurses, and at investigating relationships within the communication between telenurses and callers. The results showed that telenurses were more prone to use closed-ended questions and did not follow up on callers’ understanding of the advice given. There was also a statistically significant positive relationship between callers’ expressions of Concern and telenurses’ expressions of Criticism, and also between utterances of Criticism between the parties. The aim of Study IV was to describe the characteristics of all malpractice claims following telephone calls to SHD, including the identified causes, the healthcare providers’ measures, and the actual communication between the telenurses and callers. The results showed that among the cases, 13 of 33 patients died and 12 were admitted to intensive care. The National Board of Health and Welfare’s (NBHW) investigations most commonly reported communication failure as the cause of the malpractice claims. The measures reported by SHD most commonly involved discussion in work groups and education of staff. Communication analysis showed a positive correlation between the callers’ expressions of Concern and the telenurses’ expressions of Reassurance. The results also showed communication patterns similar to those found in Study III. Hence, telenurses’ communicative strategies are not in line with the “dialogue process” they are educated in and could be regarded as a threat to patient safety.In conclusion, the importance of high quality communication is undoubted within telephone advice nursing, and specific training and supervision in communication for telenurses might contribute to improving their communicative competence as well as patient safety. Adapting the CDSS into encourage telenurses to explore callers’ reasons for calling and to follow up on understanding might facilitate patient safety. Organizations also need to take a system-wide approach when addressing patient safety issues and ensure that telenurses are given the resources they need to fulfill their work.
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| 4. |
- Pavedahl, Veronica, 1980-
(författare)
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Person-centered fundamental care in the emergency room : Patient and registered nurse perspectives
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients who suffer from life-threatening illness or injury – experiencing conditions such as cardiac arrest, breathing problems, or trauma – are cared for at designated emergency rooms within the emergency department. In the emergency room, the registered nurse is responsible for those who are exposed and vulnerable and have complex needs. In these rooms, the biomedical focus may reinforce a culture that values the medical-technical aspects of nursing. Meeting patients’ fundamental care needs, such as respect, information, and toileting, in a person-centered way seems challenging in emergency rooms. When care is not provided correctly, the consequences for the patient’s health can be serious, for instance resulting in physical complications in the form of pressure injuries from breathing masks and spine boards or psychological complications such as worry, anxiety, or post-traumatic stress syndrome. Little is known about how person-centered fundamental care is made visible and valued both for and by patients in emergency rooms. In this thesis the understanding of fundamental care is guided by the Fundamentals of Care framework, in order to maintain an optimal person-centered care that considers the patient’s fundamental care needs with a holistic view of the patient. The overall aim of this thesis is to explore how person-centered fundamental care needs are met for life-threateningly ill patients in emergency rooms, from both patient and registered nurse perspectives.Study I explored how fundamental care needs of life-threateningly ill or injured patients were met by observing the daily activities of registered nurses in the emergency room, through 108 observations. The results showed that registered nurses were initially engaged and active in meeting patients’ needs, but that this decreased over the duration of the care. Registered nurses met the patients’ physical needs to a greater extent than their psychosocial and relational ones. The environment affected the registered nurses’ ability to meet the patients’ fundamental care needs.To describe fundamental care needs in the emergency room, based on life-threateningly ill patients’ experiences, an interview study (Study II) was conducted with 15 persons who had been cared for in an emergency room. The interviews were analyzed using deductive content analysis based on the Fundamentals of Care framework. The results showed that relationship, timely and personalized information, and existential needs were identified as essential fundamental care needs, which were not (or only partly) met. The physical environment limited patients in having their fundamental care needs met, and they adopted a “patient role” to avoid adding to healthcare professionals’ stress.Study III described registered nurses’ work approach and prerequisites for meeting life-threateningly ill patients’ care needs from the perspective of a person-centered fundamental care framework, through 14 interviews. The results revealed that registered nurses structure their work approach in meeting patients’ fundamental care needs based on prevailing organizational and personal prerequisites.In Study IV the content of guidelines governing the registered nurses’ work in the emergency room was investigated. The results revealed that the registered nurses’ work in Swedish emergency rooms was guided by an instrumental and task-oriented approach to care. The guidelines lacked guidance in providing for patients’ fundamental care needs, and did not support the registered nurses in conducting holistic, comprehensive patient assessments and interventions.The organizational prerequisites contribute to a task-oriented and instrumental way of working, and patients are not having their fundamental care needs fully met. Fundamental care is not being promoted or prioritized, as the organization and responsibilities for providing person-centered fundamental care are unclear, unspecified, and lacking in direction for how it is to be performed – neither the organization nor the culture supports the registered nurses’ work and profession.
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| 5. |
- Ahlstedt, Carina, 1969-, et al.
(författare)
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What makes registered nurses remain in work? : An ethnographic study
- 2019
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Ingår i: International Journal of Nursing Studies. - : Elsevier Ltd. - 0020-7489 .- 1873-491X. ; 89, s. 32-38
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Tidskriftsartikel (refereegranskat)abstract
- Background: Registered nurses’ work-related stress, dissatisfaction and burnout are some of the problems in the healthcare and that negatively affect healthcare quality and patient care. A prerequisite for sustained high quality at work is that the registered nurses are motivated. High motivation has been proved to lead to better working results. The theory of inner work life describes the dynamic interplay between a person's perceptions, emotions and motivation and the three key factors for a good working life: nourishment, progress and catalysts. Objectives: The aim of the study was to explore registered nurses’ workday events in relation to inner work life theory, to better understand what influences registered nurses to remain in work. Design: A qualitative explorative study with an ethnographic approach. Methods: Participant observation over four months; in total 56 h with 479 events and 58 informal interviews during observation; all registered nurses employed at the unit (n = 10) were included. In addition, individual interviews were conducted after the observation period (n = 9). The dataset was analysed using thematic analysis and in the final step of the analysis the categories were reflected in relation to the three key factors in theory of inner work life. Results: Nourishment in a registered nurse context describes the work motivation created by the interpersonal support between colleagues. It was important to registered nurses that physicians and colleagues respected and trusted their knowledge in the daily work, and that they felt comfortable asking questions and supporting each other. Progress in the context of registered nurses’ work motivation was the feeling of moving forward with a mix of small wins and the perception of solving more complex challenges in daily work. It was also fundamental to the registered nurses’ development through new knowledge and learning during daily work. Catalysts, actions that directly facilitate the work, were highlighted as the possibility to work independently along with the opportunity to work together with other registered nurses. Conclusion: This study has a number of implications for future work and research on creating an attractive workplace for registered nurses. Working independently, with colleagues from the same profession, integrated with learning, visible progress, and receiving feedback from the work itself, contribute to work motivation.
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| 6. |
- Bjuresäter, Kaisa, 1970-
(författare)
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Home enteral tube feeding - from patients’, relatives’ and nurses’ perspectives
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Changes in the health-care system during the past decades have led to an increased transfer of health care to the home environment which also concerns patients treated with home enteral tube feeding (HETF). Research is scarce about how HETF care is functioning. Therefore, the overall aim with this thesis was to describe and explore HETF care and treatment from patients', relatives' and nurses' perspectives. Three qualitative and one quantitative study were used. The findings showed that the HETF treatment and care had a great impact on daily life for both patients and their relatives and implied many practical, emotional and social problems in their daily life, which they strived to manage. Side effects were common and the patients' reported low HRQL and general health. The amount and quality of received guidance and support from the health care, not least before discharge, turned out to have impact on the patients' and the relatives' daily life and how they could manage their situation. Lack of guidance and support meant insecurity, worries and distress. Cooperation in the care trajectory was found to be decisive for how well the care was running. Nurses' knowledge about tube feeding and discharge planning procedures, their commitment to the patients' care, as well as clarity regarding responsibility of HETF care were factors of crucial importance on how the cooperation worked, and the quality of the HETF care. This thesis shows the need of improvements regarding the care of HETF patients and their relatives.
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| 7. |
- Edelbring, Samuel, PhD, Docent, 1969-, et al.
(författare)
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Person-Centeredness in Clinical Reasoning of Interprofessional Stroke Teams
- 2023
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Ingår i: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 109:Suppl., s. 70-70
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Although person-centered care is prioritized in healthcare, challenges remain before such care is integrated in everyday communication and practice. One way to strengthen person-centered care is that health professionals’ clinical reasoning (i.e., assessment and management) is pervaded by patient participation and individualized to patient needs. Interprofessional team meetings, focusing on goals and management planning, is an opportunityt o improve person-centeredness. However, there is a lack of understanding of how person-centeredness is created in the clinical reasoning of teams. This study aims to explore how clinical reasoning is performed from a person-centered perspective in team meetings with patients with stroke and next of kin.Methods: Explorative qualitative design employing a thematic analysis of audio recorded communication at three team meetings. In total, three patients, two next of kin, and 15 professionals representing eight health professions, participated in the meetings.Findings: Four themes and eight subthemes were established: a) Emphasizing the patient’s resources; b) Struggling to find a common understanding, including subthemes: Unite the person’s narrative, the relative’s view, and the expertise of the interprofessional team, missed opportunities to clarify patient needs and wishes, and active listening and receptiveness; c) Balancing the patient’s goals and professionals’ goals, including subthemes: Shared goals, the professionals’ view of appropriate goals, and the professionals’ assessment governs achievement of goals; d) Ambiguity in decisions about the management plan, including subthemes: Initiating shared decision making and lack of clarity and consensus.Discussion: This study reveals how the patient, next of kin and team contribute to shared understanding of the patient’s problem. Goals were guided by the patient’s and professionals’ expertise. To improve person-centeredness in clinical reasoning, the team need to further put the patient’s personal goals and perception of goal-achievement in the forefront as well as improve communication skills to catch patient needs and facilitate shared decisions.
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| 8. |
- Elvén, Maria, 1973-, et al.
(författare)
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A tension between surrendering and being involved : An interview study on person-centeredness in clinical reasoning in the acute stroke setting
- 2023
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Ingår i: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 112
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore how stroke survivors experience and prefer to participate in clinical reasoning processes in the acute phase of stroke care.METHODS: An explorative qualitative design was used. Individual interviews were conducted with 11 stroke survivors in the acute phase of care and analyzed using reflexive thematic analysis.RESULTS: The analysis identified five themes: What's going on with me?; Being a recipient of care and treatment; The need to be supported to participate; To be seen and strengthened; and Collaboration and joint understanding.CONCLUSION: Stroke survivors experience many attributes of person-centeredness in the acute phase of care but, according to their stories, their participation in clinical reasoning can be further supported. The tension between surrendering and the desire to be more actively involved in the care needs to be considered to facilitate participation in clinical reasoning.PRACTICE IMPLICATIONS: Stroke survivors' participation in clinical reasoning in the acute phase can be facilitated by health professionals noticing signs prompting a shift towards increased willingness to participate. Furthermore, health professionals need to take an active role, sharing their expertise and inviting the stroke survivors to share their perspective. The findings can contribute to further develop person-centered care in acute settings.
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| 9. |
- Elvén, Maria, 1973-, et al.
(författare)
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Reasoning about reasoning : using recall to unveil clinical reasoning in stroke rehabilitation teams
- 2024
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The study objective was to investigate how health care providers in stroke teams reason about their clinical reasoning process in collaboration with the patient and next of kin.Materials and methods: An explorative qualitative design using stimulated recall was employed. Audio-recordings from three rehabilitation dialogs were used as prompts in interviews with the involved staff about their clinical reasoning. A thematic analysis approach was employed.Results: A main finding was the apparent friction between profession-centered and person-centered clinical reasoning, which was salient in the data. Five themes were identified: the importance of different perspectives for a rich picture and well-informed decisions; shared understanding in analysis and decision-making - good intentions but difficult to achieve; the health care providers' expertise directs the dialog; the context's impact on the rehabilitation dialog; and insights about missed opportunities to grasp the patient perspective and arrive at decisions.Conclusions: Interprofessional stroke teams consider clinical reasoning as a process valuing patient and next of kin perspectives; however, their professional expertise risks preventing individual needs from surfacing. There is a discrepancy between professionals' intentions for person-centeredness and how clinical reasoning plays out. Stimulated recall can unveil person-centered practice and enhance professionals' awareness of their clinical reasoning.
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| 10. |
- Fredriksson, Mio, et al.
(författare)
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Caesarean section on maternal request : a qualitative study of conflicts related to shared decision-making and person-centred care in Sweden
- 2024
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Ingår i: Reproductive Health. - : BioMed Central (BMC). - 1742-4755. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundToday, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals' perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making.MethodsA qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription.ResultsIn the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman's current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman's sense of security (an uncomplicated decision-making process).ConclusionsThe complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals' reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context. Person-centered care is today a widespread approach, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). This study examines Swedish health professionals' views on CSMR. Interviews with 12 health professionals reveal conflicts between CSMR and key aspects of person-centered care, in particular shared decision-making. While professionals acknowledge women's autonomy, they question CSMR without medical need. Concerns include for example treatment quality and patient safety, and avoiding treatments that harm others. The Swedish context, balancing collective solutions with individualized care, complicates decision-making. Unlike countries with more private healthcare, where CSMR support might be higher, Swedish health professionals emphasize shared decision-making despite viewing the mode of delivery as primarily a professional decision. This study sheds light on the challenges in integrating CSMR into person-centered care frameworks.
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