| 1. |
- 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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| 2. |
- Carlsson, Lars, et al.
(författare)
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General practitioners' perceptions of working with the certification of sickness absences following changes in the Swedish social security system : A qualitative focus-group study
- 2015
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many physicians in Sweden, as well as in other countries, find the matter of certification of sickness absence (COSA) particularly burdensome. The issuing of COSAs has also been perceived as a work-environment problem among physicians. Among general practitioners (GPs) are the highest proportion of physicians in Sweden who experience difficulties with COSA. Swedish authorities have created several initiatives, by changing the social security system, to improve the rehabilitation of people who are ill and decrease the number of days of sick leave used. The aim of this study was to describe how GPs in Sweden perceive their work with COSA after these changes. Methods: A descriptive design with a qualitative, inductive focus-group discussion (FGD) approach was used. Results: Four categories emerged from the analysis of FGDs with GPs in Sweden: 1) Physicians' difficulties in their professional role; 2) Collaboration with other professionals facilitates the COSA; 3) Physicians' approach in relation to the patient; 4) An easier COSA process. Conclusions: Swedish GPs still perceived COSA to be a burdensome task. However, system changes in recent years have facilitated work related to COSA. Cooperation with other professionals on COSA was perceived positively.
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| 3. |
- Coyne, I., et al.
(författare)
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Centeredness in Healthcare : A Concept Synthesis of Family-centered Care, Person-centered Care and Child-centered Care
- 2018
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Ingår i: Journal of Pediatric Nursing. - : W.B. Saunders. - 0882-5963 .- 1532-8449. ; 42, s. 45-56
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Tidskriftsartikel (refereegranskat)abstract
- Background: Increasingly within healthcare, different kind of ‘centeredness’ are used to denote the focus of care which can create confusion for practitioners. Methods: A concept analysis was undertaken to identify the antecedents, attributes and relationship between family-, person-, and child-centered care. PubMed and CINAHL were searched from 2012 to 2017 and thirty-five papers were reviewed. Results: Both person- and child-centered care are focused on individuals, a symmetric relationship and the tailoring of care to individual needs while family- centered care is focused on the family as a unit of which the child is included. Person-centered care focuses on an adult person with autonomy, while the focus in child-centered care is the individual child as an own actor with rights but still close to a family. Conclusion: It appears at a conceptual level that the concepts of centeredness contain both similarities and differences. Finding ways to structure nursing and focus the care that respects a person's dignity and humanity is essential in healthcare and should be a major goal of health policy and health systems worldwide. Implications: The identification of the antecedents and attributes embedded in the concepts may help raise professionals’ awareness of the different foci and how this will influence one's practice. There is a need to recognize strengths and weaknesses of the centeredness in different settings and environments. Furthermore, it is important to know which approach to apply within different situations so that quality care is enabled for every person, child and family.
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| 4. |
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| 5. |
- 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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| 6. |
- 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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| 7. |
- Ernesäter, Annica, 1970-, et al.
(författare)
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A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish Healthcare Direct : a case–control study
- 2014
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 4:10, s. e005961-
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. Setting: In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. Participants: A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. Results: Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. Conclusions: The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems.
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| 8. |
- Ernesäter, Annica, 1970-, et al.
(författare)
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Malpractice claims regarding calls to Swedish telephone advice nursing : what went wrong and why?
- 2012
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Ingår i: Journal of Telemedicine and Telecare. - London, United Kingdoms : Sage Publications. - 1357-633X .- 1758-1109. ; 18:7, s. 379-383
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Tidskriftsartikel (refereegranskat)abstract
- We analysed the characteristics of all malpractice claims arising out of telephone calls to Swedish Healthcare Direct (SHD) during 2003-2010 (n = 33). The National Board of Health and Welfare's (NBHW) investigations describing the causes of the malpractice claims and the healthcare providers' reported measures were analysed using Qualitative Content Analysis. The original telephone calls themselves, which had been recorded, were analysed using the Roter Interaction Analysis System (RIAS). Among the 33 cases, 13 patients died and 12 were admitted to intensive care. Failure to listen to the caller (n = 12) was the most common reason for malpractice claims, and work-group discussion (n = 13) was the most common measure taken to prevent future re-occurrence. Male patients (n = 19) were in the majority, and females (n = 24) were the most common callers. The most common symptoms were abdominal (n = 11) and chest pain (n = 6). Telenurses followed up on caller understanding in six calls, and mainly used closed-ended questions. Despite the severity of these malpractice claims, the measures taken mainly addressed active failure, rather than the latent conditions. Third-party communication should be regarded as a risk. When callers make repeated contacts, telenurses need to re-evaluate their need for care.
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| 9. |
- Ernesäter, Annica, et al.
(författare)
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Telephone nurses' communication and response to callers' concern : a mixed methods study
- 2016
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Ingår i: Applied Nursing Research. - : Elsevier BV. - 0897-1897 .- 1532-8201. ; 29, s. 116-121
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Tidskriftsartikel (refereegranskat)abstract
- AimsTo describe telephone nurses’ and callers’ communication, investigate relationships within the dyad and explore telephone nurses’ direct response to callers’ expressions of concernBackgroundTelephone nurses assessing callers’ need of care is a rapidly growing service. Callers with expectations regarding level of care are challenging.MethodRIAS-and content analysis was performed on a criterion sampling of calls (n=25) made by callers who received a recommendation from telephone nurses of a lower level of care than expected.ResultsTelephone nurses mainly ask close-ended questions, whilst open-ended questions are sparsely used. Relationships between callers’ expressions of Concern and telephone nurses responding with Disapprovalwere found. Telephone nurses mainly responded to concern with close-ended medical questions whilst exploration of callers’ reason for concern was sparse.ConclusionTelephone nurses’ reluctance to use open-ended questions and to follow up on callers’ understanding might be a threat to concordance, and a potential threat to patient safety.
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| 10. |
- Ewertsson, Mona, 1958-, et al.
(författare)
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Use of technical skills and medical devices among new registered nurses : A questionnaire study
- 2015
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Ingår i: Nurse Education Today. - : Churchill Livingstone. - 0260-6917 .- 1532-2793. ; 35:12, s. 1169-1174
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Tidskriftsartikel (refereegranskat)abstract
- Background: One comprehensive part of nursing practice is performing technical skills and handling of medical equipment. This might be challenging for new registered nurses (RNs) to do in patient-safe way.Objectives: The aim of this study was to describe and compare the extent to which new RNs perform various technical skills and handle medical devices in different settings, and to investigate their possibility for continued learning in this respect. A further aim was to describe their perceptions of incident reporting related to technical skills and medical devices.Design: A cross-sectional study with descriptive and comparative design.Participants: RNs who recently graduated from a nursing programme at three Swedish universities and had worked as a RN for up to 1year were included in the study (n=113, response rate 57%).Method: Data were collected by means of a postal questionnaire.Results: Half of the RNs reported that they performed several of the listed tasks every day or every week, regardless of workplace. These tasks were most frequently performed in surgical departments. The majority of the participants (76%) stated a need of continued practical training. However, less than half of them (48%) had access to a training environment. Several participants (43%) had been involved in incidents related to technical skills or medical devices, which were not always reported. Nearly a third of the participants (31%) did not use the existing guidelines when performing technical skills, and reflection on performance was uncommon.Conclusions: This study highlights the importance of shared responsibilities between nurse educators and health care employers to provide learning opportunities for new RNs in technical skills, to maintain patient safety. To increase the safety culture where nursing students and new RNs understand the importance of using evidence-based guidelines and taking a reflective approach in the performance of technical tasks is needed.
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