| 1. |
- 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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| 2. |
- 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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| 3. |
- Crilly, Julia, et al.
(författare)
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Factors predictive of hospital admission for children via emergency departments in Australia and Sweden: an observational cross-sectional study
- 2024
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Ingår i: BMC Health Services Research. - : Springer Nature. - 1472-6963. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Identifying factors predictive of hospital admission can be useful to prospectively inform bed management and patient flow strategies and decrease emergency department (ED) crowding. It is largely unknown if admission rate or factors predictive of admission vary based on the population to which the ED served (i.e., children only, or both adults and children). This study aimed to describe the profile and identify factors predictive of hospital admission for children who presented to four EDs in Australia and one ED in Sweden.Methods: A multi-site observational cross-sectional study using routinely collected data pertaining to ED presentations made by children < 18 years of age between July 1, 2011 and October 31, 2012. Univariate and multivariate analysis were undertaken to determine factors predictive of hospital admission.Results: Of the 151,647 ED presentations made during the study period, 22% resulted in hospital admission. Admission rate varied by site; the children's EDs in Australia had higher admission rates (South Australia: 26%, Queensland: 23%) than the mixed (adult and children's) EDs (South Australia: 13%, Queensland: 17%, Sweden: 18%). Factors most predictive of hospital admission for children, after controlling for triage category, included hospital type (children's only) adjusted odds ratio (aOR):2.3 (95%CI: 2.2-2.4), arrival by ambulance aOR:2.8 (95%CI: 2.7-2.9), referral from primary health aOR:1.5 (95%CI: 1.4-1.6) and presentation with a respiratory or gastrointestinal condition (aOR:2.6, 95%CI: 2.5-2.8 and aOR:1.5, 95%CI: 1.4-1.6, respectively). Predictors were similar when each site was considered separately.Conclusions: Although the characteristics of children varied by site, factors predictive of hospital admission were mostly similar. The awareness of these factors predicting the need for hospital admission can support the development of clinical pathways.
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| 4. |
- Kitson, Alison L., et al.
(författare)
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‘No more heroes’ : The ILC Oxford Statement on fundamental care in times of crises
- 2023
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 79:3, s. 922-932
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Forskningsöversikt (refereegranskat)abstract
- AimTo outline the International Learning Collaborative (ILC) Oxford Statement, explicating our commitment to ensuring health and care systems are equipped to meet patients' fundamental care needs during times of unprecedented crisis. Design/MethodDiscussion paper. The content was developed via a co-design process with participants during the ILC's international conference. Key ArgumentsWe, the ILC, outline what we do and do not want to see within our health and care systems when faced with the challenges of caring for patients during global pandemics and other crises. Specifically, we want fundamental care delivery to be seen as the minimum standard rather than the exception across our health and care systems. We want nursing leaders to call out and stand up for the importance of building fundamental care into systems, processes and funding priorities. We do not want to see the voices of nursing leaders quashed or minimized in favour of other agendas. In turn, what we want to see is greater recognition of fundamental care work and greater respect for the people who do it. We expect nurses to have a 'seat at the table' where the key health and care decisions that impact patients and staff are made. ConclusionTo achieve our goals we must (1) ensure that fundamental care is embedded in all health and care systems, at all levels; (2) build on and strengthen the leadership skills of the nursing workforce by clearly advocating for person-centred fundamental care; (3) co-design systems that care for and support our staff's well-being and which foster collective resilience rather than overly rely on individual resilience; (4) improve the science and methodologies around reporting and measuring fundamental care to show the positive impact of this care delivery and (5) leverage the COVID pandemic crisis as an opportunity for transformational change in fundamental care delivery.
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| 5. |
- Muntlin Athlin, Åsa, Docent, 1971-, et al.
(författare)
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Bedside nurses' perspective on the fundamentals of care framework and its application in clinical practice. : A multi-site focus group interview study
- 2023
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Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 145, s. 104526-104526
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Tidskriftsartikel (refereegranskat)abstract
- Background: A changing nursing workforce and an increase in demands for care together with more complex care, raise arguments that leading and guiding nursing practice is more challenging than ever. Therefore, nurses need to have a shared agenda and a common language to show the importance of nursing care and the consequences of not addressing this in an appropriate way. In response to this the Fundamentals of Care framework was developed to also contribute to the delivery of person-centred care in an integrated way. However, to gain acceptance and applicability we need to ensure the framework's relevance to clinical practice from bedside nurses' perspectives.Objective: To describe bedside nurses' perspectives on the Fundamentals of Care framework and how it can be applied in clinical practice.Design: A descriptive qualitative design informed by the Fundamentals of Care framework.Setting(s): The study was undertaken at seven hospitals in Sweden, Denmark and the Netherlands during 2019.ParticipantsA total sample of 53 registered nurses working at the bedside participated.Participants: had a wide variety of clinical experience and represented a range of different nursing practice areas.Methods: Twelve focus group interviews were used to collect data and analysed with a deductive content analysis approach.Results: Bedside nurses perceived that the Fundamentals of Care framework was adequate, easy to understand and recognised as representative for the core of nursing care. The definition for fundamental care covered many aspects of nursing care, but was also perceived as too general and too idealistic in relation to the registered nurses' work. The participants recognised the elements within the framework, but appeared not to be using this to articulate their practice. Three main categories emerged for implications for clinical practice; guiding reflection on one's work; ensuring person-centred fundamental care and reinforcing nursing leadership.Conclusions: The Fundamentals of Care framework is perceived by bedside nurses as a modern framework describing the core of nursing. The framework was recognised as having clinical relevance and provides bedside nurses with a common language to articulate the complexity of nursing practice. This knowledge is crucial for bedside nurses both in clinical practice and in leadership roles to be able to speak up for the need to integrate all dimensions of care to achieve person-centred fundamental care. Various activities for reflection, person-centred care and leadership to apply the framework in clinical practice were presented, together with minor suggestions for development of the framework.Tweetable abstract: Bedside nurses recognise their clinical practice within the Fundamentals of Care framework, showing the core of modern nursing.
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| 6. |
- Muntlin, Åsa, 1971-
(författare)
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Identifying and Improving Quality of Care at an Emergency Department : Patient and healthcare professional perspectives
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patients in the emergency department are not always satisfied with the care received and the nursing care in the emergency department is sometimes described as instrumental and non-holistic. Structured quality improvement work and evidence-based practice are needed. Aim: The overall aim was to emphasize general patients in the emergency department to enhance the knowledge on how they perceive the quality of care and how the care could be improved through collaboration with the healthcare professionals. Methods: Four studies, with quantitative and qualitative designs, were conducted in a Swedish emergency department. Two hundred patients answered a questionnaire, after which 22 healthcare professionals comprising five focus groups were interviewed, and finally 200 patients were included in an intervention study. Results: The following five areas for improvement were identified: “information, respect and empathy”, “pain relief”, “nutrition”, “waiting time” and “general atmosphere”. Of these areas, the healthcare professionals prioritized “information, respect and empathy”, “waiting time” and “pain relief” to be highlighted in the quality improvement work. Although goals and suggestions for changes were stated, barriers to quality improvement at different levels in the health care were detected. The results of the intervention study showed that structured nursing assessment of the patients’ abdominal status and nurse-initiated intravenous opioid analgesic could increase frequency of analgesic and reduce time to analgesic in the emergency department. Patients perceived lower pain intensity and improved quality of care in pain management. Conclusions: An uncomplicated nursing intervention, related to pain management, based on the results from a patient questionnaire and interviews with healthcare professionals, can improve the care process and pain management in the emergency department, as well as patients’ perceptions of the quality of care in pain management. To succeed with continuous quality improvement work, barriers to change should be addressed.
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| 7. |
- Pavedahl, Veronica, 1980-, et al.
(författare)
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Fundamentals of care in the emergency room – An ethnographic observational study
- 2021
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Ingår i: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 58
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a strong biomedical focus within emergency care. However, while failure to meet patients’ fundamental care needs has severe consequences for the patient, there is limited knowledge on how nursing care is provided in emergency rooms and the related implications for patients. Aim: This study aims to explore how fundamental care needs of critically ill patients are met in emergency rooms. Methods: Non-participant observations at an emergency department in Sweden included 108 observations and field notes (150 h). Data were analysed using descriptive statistics. Results: Observations showed that registered nurses (RN) identified patients’ fundamental care needs and provided nursing care. However, the RNs’ focus on the patient decreased over time. When the RN communicated with the patient, the patients’ physical needs were met to a greater extent. The organisational structure and physical environment of emergency rooms limit RNs’ ability to meet patients’ fundamental care needs. Conclusion: Not all patients had their fundamental care needs optimally met. This study highlights the importance of RNs working in an integrated manner; an RN working bedside is crucial for establishing a patient–nurse relationship to meet the patient's physical, psychosocial, and relational needs.
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| 8. |
- Pavedahl, Veronica, 1980-, et al.
(författare)
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Prioritizing and meeting life-threateningly ill patients' fundamental care needs in the emergency room : An interview study with registered nurses
- 2022
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 78:7, s. 2165-2174
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Tidskriftsartikel (refereegranskat)abstract
- Aim To explore how registered nurses in the emergency room describe their work approach and prerequisites for meeting life-threateningly ill patients' care needs from the perspective of a person-centred fundamental care framework. Design A descriptive, qualitative interview study. Method Individual interviews were carried out with 14 registered nurses with experience of working in an emergency room in Sweden, during 2019. Data were analysed using thematic analysis, according to Braun and Clarke. The COREQ checklist was used for reporting the findings. Results Three themes were identified: Task-oriented nursing care based on structured guidelines and checklists; Fundamental care not being promoted or prioritized in the emergency room; and The organization and responsibilities for providing person-centred fundamental care are unclear. Results showed that registered nurses structure their work approach based on prevailing organizational prerequisites as well as personal ones. Meeting patients' fundamental care needs was not always prioritized; their physical needs were met to a greater extent than their relational and psychosocial needs. Registered nurses did not prioritize fundamental care when the organization did not. Conclusion From the registered nurses' perspective, they structured their work based on the prevailing conditions for meeting patients' fundamental care needs. The organizational structure does not clearly state that fundamental care should be performed in the emergency room, and the registered nurses' work approach there for meeting patients' fundamental care needs is not adapted to provide patients with person-centred care. Impact To date, little is known about registered nurses' work approach and prerequisites in meeting life-threateningly ill patients' fundamental care needs in the emergency room. Our findings indicate that the organizational structure is pivotal in supporting registered nurses to provide person-centred fundamental care. The knowledge from this study can be used in emergency care settings to facilitate person-centred fundamental care and thereby avoid fundamental care being missed.
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| 9. |
- 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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| 10. |
- Amritzer, Maria A, et al.
(författare)
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Nursing staff ratio and skill mix in Swedish emergency departments : A national cross-sectional benchmark study.
- 2021
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 29:8, s. 2594-2602
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe ratio and skill mix for nursing staff in Swedish emergency departments over a specific 24-hour period.BACKGROUND: The link between number of patients per nursing staff and missed nursing care is well described within the in-hospital setting, showing association with negative outcomes such as increased mortality. Potential association within the emergency department setting is still unexplored.METHOD: A national descriptive cross-sectional benchmark study.RESULTS: The majority (n=54; 89%) of Swedish emergency departments participated. The patients-per-registered nurse ratio varied between the shifts, from 0.3 patients to 8.8 patients (mean 3.2). The variation of patients per licensed practical nurse varied, from 1.5 to 23.5 patients (mean 5.0). The average skill mix was constant at around 60% registered nurses and 40% licensed practical nurses.CONCLUSION: The varying ratios for patient per registered nurse and licensed practical nurse in Swedish emergency departments is noteworthy. Furthermore, the patient flow and nursing staff numbers did not match one another, resulting in higher nursing staff ratios during the evening shift.IMPLICATIONS FOR NURSING MANAGEMENT: Findings can be used to improve rosters in relation to crowding, to manage the challenging recruitment and retention situation for nursing staff and to improve patient safety.
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