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- Bergerum, Carolina, 1967-, et al.
(författare)
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Patient involvement in quality improvement - a 'tug of war' or a dialogue in a learning process to improve healthcare?
- 2020
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Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Co-production and co-design approaches to quality improvement (QI) efforts are gaining momentum in healthcare. Yet, these approaches can be challenging, not least when it comes to patient involvement. The aim of this study was to examine what might influence QI efforts in which patients are involved, as experienced by the patients and the healthcare professionals involved.METHODS: This study involved a qualitative design inspired by the constructivist grounded theory. In one mid-sized Swedish hospital's patient process organisation, data was collected from six QI teams that involved patients in their QI efforts, addressing care paths for patients with transient, chronic and/or multiple parallel diagnoses. Field notes were collected from participant observations during 53 QI team meetings in three of the six patient processes. Individual, semi-structured interviews were conducted with 12 patients and 12 healthcare professionals in all the six QI teams.RESULTS: Patients were involved in QI efforts in different ways. In three of the QI teams, patient representatives attended team meetings regularly. One team consulted patient representatives on a single occasion, one team collected patient preferences structurally from individual interviews with patients, and one team combined interviews and a workshop with patients. The patients' and healthcare professionals' expressions of what might influence the QI efforts involving patients were similar in several ways. QI team members emphasized the importance of organisational structure and culture. Furthermore, they expressed a desire for ongoing interaction between patients and healthcare professionals in healthcare QI.CONCLUSIONS: QI team members recognised continuous dialogue and collective thinking by the sharing of experiences and preferences between patients and healthcare professionals as essential for achieving better matches between healthcare resources and patient needs in their QI efforts. Significant structural and cultural aspects of performing QI in complex hospital organisations were considered to be obstructions to progress. Therefore, to sustain learning and behaviour change through QI efforts at the team level, a deeper understanding of how structural and cultural aspects of QI promote or prevent success appears essential.
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| 2. |
- Bisholt, Birgitta, 1963-, et al.
(författare)
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Nursing students' assessment of the learning environment in different clinical settings
- 2014
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Ingår i: Nurse Education in Practice. - : Elsevier. - 1471-5953 .- 1873-5223. ; 14:3, s. 304-310
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Nursing students perform their clinical practice in different types of clinical settings. The clinical learning environment is important for students to be able to achieve desired learning outcomes. Knowledge is lacking about the learning environment in different clinical settings.AIM: The aim was to compare the learning environment in different clinical settings from the perspective of the nursing students.DESIGN: A cross-sectional study with comparative design was conducted.METHOD: Data was collected from 185 nursing students at three universities by means of a questionnaire involving the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) evaluation scale. An open-ended question was added in order to ascertain reasons for dissatisfaction with the clinical placement.RESULTS: The nursing students' satisfaction with the placement did not differ between clinical settings. However, those with clinical placement in hospital departments agreed more strongly that sufficient meaningful learning situations occurred and that learning situations were multi-dimensional. Some students reported that the character of the clinical setting made it difficult to achieve the learning objectives.CONCLUSION: In the planning of the clinical placement, attention must be paid to whether the setting offers the student a meaningful learning situation where the appropriate learning outcome may be achieved.
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| 6. |
- Blomberg, Karin, 1970-, et al.
(författare)
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Swedish nursing students' experience of stress during clinical practice in relation to clinical setting characteristics and the organisation of the clinical education
- 2014
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Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell Publishing Ltd.. - 0962-1067 .- 1365-2702. ; 23:15-16, s. 2264-2271
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education. BACKGROUND: Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference. DESIGN: A cross-sectional study with evaluative design. METHODS: Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included. RESULTS: Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis. CONCLUSIONS: The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation. RELEVANCE TO CLINICAL PRACTICE: It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support.
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| 7. |
- Blomberg, Karin, 1970-, et al.
(författare)
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Work stress among newly graduated nurses in relation to workplace and clinical group supervision
- 2016
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Ingår i: Journal of Nursing Management. - : Wiley-Blackwell Publishing Ltd.. - 0966-0429 .- 1365-2834. ; 24:1, s. 80-87
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to investigate occupational stress among newly graduated nurses in relation to the workplace and clinicla group supervision. Being a newly graduated nurse is particulary stressful. Whar remains unclear is wehter teh workplace and clinical group supervision affect the stress. A cross-sectional comperative study was performed. Data were collected by means of a numerical scale measuring occupational stress, questions about workplace and clinicla group supervision. One hundred and thirteen nusres were included in the study. Conclusions: Newly graduated nurses experience great strss and need support. Nusrse participating in clinical group supervision reported significantly less stress.
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| 8. |
- Dellve, Lotta, 1965, et al.
(författare)
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Ledarskap i äldreomsorgen: Att leda integrerat värdeskapande i en röra av värden och förutsättningar
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Det övergripande syftet med denna rapport är att beskriva chefers etiska värderingar, dilemman och organisatoriska förutsättningar för att bedriva ett värdebaserat ledarskap i såväl kommunal som privat äldreomsorg. Det empiriska materialet består av en omfattande enkätstudie till nästan 500 studerande inom ramen för den nationella ledarutbildningen för chefer inom äldreomsorgen vid Högskolan i Borås under perioden 2013 till 2015. Utbildningen gavs på uppdrag av Socialstyrelsen och omfattade 30 högskolepoäng med två års studier på kvartsfart. Samtliga studerande var yrkesverksamma som chefer och ledare inom kommunal eller privat äldreomsorg i södra Sverige. Metoder som använts i bearbetning och analys av materialet är deskriptiva, jämförande och analytiska med regressionsmodeller och SEM-analys. Resultatet visar på att cheferna – oavsett utbildningsbakgrund, värderade följande etiska värden högst: att inte skada, respekt för individen och rätten till konfidentialitet. Värdedilemman i chefsarbetet är dock vanligt och sammanlänkat med andra utmaningar i arbetet, särskilt med utmaningar som rör hantering över organisationsnivåer (buffertproblem och containerproblem) och av olika ansvarsområden (logikkonflikter). Inom privat verksamhet skattade de medverkande cheferna värdekonflikter och andra utmaningar i lägre grad än chefer inom kommunal verksamhet. De flesta chefer var nöjda med hur de kunde fullfölja sitt ansvar för utveckling av verksamheten avseende värdegrund, kvalitet, processer, dagligt arbete, brukarmedverkan, brukarsäkerhet och arbetsmiljö. De flesta skattade också att de arbetade i mycket hög grad med strukturering och utveckling av dessa frågor. Stödresurser minskade upplevelsen av värdekonflikter, men det fanns skillnad i betydelsen relaterat till chefers grundprofession. Det organisatoriska stödet var också tydligare för chefer inom privat verksamhet. Organiserade stödresurser hade stor betydelse för hållbart integrerat och värdeskapande ledarskap samt för aktiva ledningsstrategier. Även sambandet mellan hållbart ledarskap och aktiva ledarstrategier modererades av grundprofession, där sambandet var moderat negativt för chefer med social grundutbildning. Det tycks således finnas ett utbildningsbehov bland äldreomsorgens chefer och behov av ett utvecklat stöd från arbets- givaren då det varierar avseende omfattning, inriktning och nivå mellan kommunal och privat verksamhet. Sammanfattningsvis har chefer i äldreomsorgen många olika värden, på olika nivåer och utifrån olika perspektiv att förhålla sig till i sitt ledarskap. Att hantera och utveckla förståelse för dessa är utmanande i chefskapet och värdedilemman är vanliga. Majoriteten av cheferna i denna studie beskriver dock generellt en aktiv och god hantering och organisering av dessa. Konstateras att en integrerad förståelse och hantering, samt goda organisatoriska stödresurser tycks bidra till mer hållbart och värdeskapande ledarskap.
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| 9. |
- Fallman, Sara L., et al.
(författare)
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Har organisatoriska förutsättningar och ledarskapsstrategier betydelse för att främja låg sjukfrånvaro inom hälso- och sjukvården?
- 2020
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Ingår i: Socialmedicinsk Tidskrift. - 0037-833X. ; 97:1
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Tidskriftsartikel (refereegranskat)abstract
- Studien syftar till att undersöka om det finns gemensamma organisatoriska förutsättningar och ledarskapsstrategier som kännetecknar enheter inom hälso- och sjukvården som har låg sjukfrånvaro. För att undersöka detta intervjuades första linjens chefer, ansvarig för enheten. Urvalet gjordes utifrån enheternas sjukfrånvaro under åren 2013-2016. Data analyserades med kvalitativ innehållsanalys. Resultatet visar att dessa chefer arbetar under en del organisatoriska krav som de upplever som försvårande. De lyckas trots det att skapa förutsättningar för låg sjukfrånvaro och gör det genom ett aktivt ledarskap som har fokus på medarbetarna. De hade tydliga strategier för att förebygga och hantera sjukfrånvaro och de var lyhörda och flexibla inför medarbetarnas önskemål om att lägga tillrätta sin arbetssituation. Den övergripande slutsatsen är att de intervjuade cheferna tycks vara i en position där de kan påverka medarbetarnas arbetssituation och i slutändan deras sjukfrånvaro. En god idé för överordnad ledning verkar vara att stötta chefer i ett aktivt arbete att stärka förutsättningar för medarbetare samt att öka chefers inflytande över frågor som rör lokala arbetsförhållanden.
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| 10. |
- Fallman, Sara L., et al.
(författare)
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Managerial approaches for maintaining low levels of sick leave: A qualitative study
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The aim of this study was to identify first line managers’ approaches for maintaining low levels of sick leave among health care employees.Introduction: One challenge in health care is the high level of sick leave among employees. High work demands and conflicting pressures characterize the work situation of both employees and first line managers, with potential negative effects on work-related health.Method: First line managers at units with low and/or decreasing sick leave were interviewed. Thematic content analysis was used to analyze the data.Results: The managers took a holistic approach in meeting their employees’ broader needs and they were balancing high organizational demands through insubordination. To keep sick leave rate low, they created possibilities for the employees to influence their own working life through a present, visible and trustful leadership.Conclusion: Managers responsible for units with low sick leave had a holistic approach in their focus on their employees, and prioritized needs of their employees before organizational demands from top-management.Implications for nursing management: First line managers in health care can have impact on sick leave among their employees. They are in a position to create good working conditions for their employees, despite pressure from their superiors.
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