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- Avallin, Therese, 1982-
(författare)
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Achieving person-centred pain management for the patient with acute abdominal pain : Guided by the Fundamentals of Care framework
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to explore how to achieve and measure person-centred pain management (PCPM) for the patient with acute abdominal pain (AAP) in acute surgical care. The Fundamentals of Care (FoC) framework guides all studies.The methods: In Study I, focused ethnography is used with 92h of participant observations (n=34) at the emergency department (n=1) and surgical wards (n=2), including 261 patient–provider interactions. In Study II, case study is used for secondary analysis of 20 observations from Study I. In Study III, a questionnaire is developed in a systematic process to measure PCPM, performed by combining; a validated questionnaire, theoretical and empirical evidence. The questionnaire is tested by question appraisal, theoretical experts (n=2), patients (n=5) and providers (n=5), and thereafter by patients (n=100) at surgical wards (n=4). In Study IV, a qualitative systematic review is performed with a synthesis by thematic analysis, to test and refine a model for PCPM from Study I. The synthesis includes 15 qualitative studies representing patients (n=495) and/or nurses (n=259) from n= 3 emergency departments and n=17 hospital wards in n=9 countries. The patients are ≥ 18 years old, with AAP (Studies I-IV), or acute pain from surgery (Study IV). The results confirms that the patient still suffer from unmanaged pain in acute surgical care, and presents actions on behalf of the patient and provider, and contextual factors including the organizational culture, to achieve and measure PCPM. The studies presents a model for PCPM from the patient perspective (Study I), patient-provider communications contributing to meeting fundamental care needs (Study II), an initially feasible and valid questionnaire to measure PCPM (Study III), and a tested and refined model for PCPM from the patient and nurse perspective (Study IV). Conclusion: This thesis presents scientific evidence providing an in-depth understanding of what is important for successful pain management from the patient’s and nurses’ perspectives, how these parts are interconnected, and how they can be achieved and measured. The results also show the feasible role of communication in meeting the patient’s fundamental care needs. This evidence is suggested to be tested and evaluated in clinical practice to perform PCPM, relieving the patient from pain.
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| 2. |
- Wallin, Lars
(författare)
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Knowledge Utilisation in Swedish Neonatal Nursing : Studies on Guideline Implementation, Change Processes and Contextual Factors
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to study the implementation of guidelines, change processes and contextual variables from the perspective of improvements and neonatal nursing care’s endeavours to be more evidenced-based. Because health care is exposed to extensive change pressure and because the impact of effectiveness research on clinical practice is limited, it becomes urgent to understand how knowledge utilisation initiatives can be facilitated.Three studies involved managers and nurses at all neonatal units in Sweden. Two of these studies also included nurses from other healthcare organisations. The fourth study included all staff at four neonatal units. The study designs used were cross-sectional, comparative and prospective longitudinal surveys; questionnaires were used as data collection tools in all four studies.Evaluation of the utilisation of the neonatal nursing guidelines showed that the guidelines were known to the nurse managers and used at most of the units, though to varying degrees and in different ways. Fifteen months after guideline dissemination, 8 of 35 units had changed practice, of which 2 units had completed the implementation process of a guideline. Involvement in the preceding guideline project facilitated the completion of improvement projects compared with participation in training courses for quality improvement (QI) only. There was no difference between these two groups on long-standing involvement in improvement work. Nurses who continued QI work over a 4-year period were more active in seeking research and implementing research findings in clinical practice than those who ceased the improvement work. The QI-sustainable nurses reported better contextual support for research-related activities. In a separate study staff perceptions of organisational factors appeared stable over the course of one year at the aggregated level. Improvements in skills development and participatory management predicted higher overall organisational and staff well-being. The findings emphasize the importance of including both individual and organisational factors in the strategic planning for evidence-based nursing. Plans have to be long-term and consider that change is a slow process. Leadership commitment is essential and there are clear benefits in developing a learning and professional supportive environment as well as of involving staff in organisational decision making.
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