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- Burström, Lena, et al.
(författare)
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The patient safety culture as perceived by staff at two different emergency departments before and after introducing a flow-oriented working model with team triage and lean principles : A repeated cross-sectional study
- 2014
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patient safety is of the utmost importance in health care. The patient safety culture in an institution has great impact on patient safety. To enhance patient safety and to design strategies to reduce medical injuries, there is a current focus on measuring the patient safety culture. The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety. Methods: A repeated cross-sectional design, using the Hospital Survey On Patient Safety Culture questionnaire before and after a quality improvement project in two emergency departments at a county hospital and a university hospital. The questionnaire was developed to obtain a better understanding of the patient safety culture of an entire hospital or of specific departments. The Swedish version has 51 questions and 15 dimensions. Results: At the county hospital, a difference between baseline and follow-up was observed in three dimensions. For two of these dimensions, Team-work within hospital and Communication openness, a higher score was measured at the follow-up. At the university hospital, a higher score was measured at follow-up for the two dimensions Team-work across hospital units and Team-work within hospital. Conclusion: The result showed changes in the self-estimated patient safety culture, mainly regarding team-work and communication openness. Most of the improvements at follow-up were seen by physicians, and mainly at the county hospital.
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| 4. |
- Ekelund, Ulf, et al.
(författare)
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Patient throughput times and inflow patterns in Swedish emergency departments. A basis for ANSWER, A National SWedish Emergency Registry
- 2011
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Quality improvement initiatives in emergency medicine (EM) often suffer from a lack of benchmarking data on the quality of care. The objectives of this study were twofold: 1. To assess the feasibility of collecting benchmarking data from different Swedish emergency departments (EDs) and 2. To evaluate patient throughput times and inflow patterns. Method: We compared patient inflow patterns, total lengths of patient stay (LOS) and times to first physician at six Swedish university hospital EDs in 2009. Study data were retrieved from the hospitals' computerized information systems during single on-site visits to each participating hospital. Results: All EDs provided throughput times and patient presentation data without significant problems. In all EDs, Monday was the busiest day and the fewest patients presented on Saturday. All EDs had a large increase in patient inflow before noon with a slow decline over the rest of the 24 h, and this peak and decline was especially pronounced in elderly patients. The average LOS was 4 h of which 2 h was spent waiting for the first physician. These throughput times showed a considerable diurnal variation in all EDs, with the longest times occurring 6-7 am and in the late afternoon. Conclusion: These results demonstrate the feasibility of collecting benchmarking data on quality of care targets within Swedish EM, and form the basis for ANSWER, A National SWedish Emergency Registry.
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- Källestedt, M. -LS., et al.
(författare)
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When caring becomes an art - how clinical gaze are perceived to be developed
- 2023
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : NLM (Medline). - 1748-2623 .- 1748-2631. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This qualitative study describes nurses' experiences and perceptions of how they develop the clinical gaze. METHODS: This qualitative study used an inductive approach and content analysis to assess the experiences of newly graduated nurses, nurse managers, and nursing teachers. Nineteen interviews were conducted. To achieve credibility, the study followed the guidelines of the Consolidated Criteria for Reporting Qualitative research (COREQ). RESULTS: Two themes emerged: nurses' personal abilities and the learning culture. Learning culture was considered the foundation of the development of the clinical gaze. The clinical gaze was found to be developed in relationships with patients and when learning together with colleagues, in which the opportunities for reflection are central. To develop the clinical gaze, structures for learning activities, such as reflection, communication exercises, and simulation, are needed so that they become a natural part of daily work. This can also be achieved through supervision and skills training both at university and in a care context. CONCLUSIONS: Prerequisites for the development of the clinical gaze include physical presence with the patient combined with learning activities such as conscious reflection with others in a safe learning culture.
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| 14. |
- Letterstål, Anna, et al.
(författare)
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Nursing Faculties' Perceptions of Integrating Theory and Practice to Develop Professional Competence
- 2022
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Ingår i: Journal of Nursing Education. - : SLACK, Inc.. - 0148-4834 .- 1938-2421. ; 61:5, s. 236-241
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Tidskriftsartikel (refereegranskat)abstract
- Background: Nursing faculties??? perceptions influence nursing education. This article describes how nursing faculty perceive nursing students??? development of professional competence by integrating theory and practice, and by examining how this context influences this integration. Method: With a phenomenographic approach, interviews were conducted with nine participants and analyzed into qualitatively different categories of description. Results: The integration of theoretical and practical knowledge is perceived as a challenge or as naturally intertwined in the entire education, focusing mainly on individual prerequisites for learning. Perceptions of a common mission create coherence for students. Evident learning structures are needed, and there is a perceived discrepancy between nurses??? competence and expectations in health care. Conclusion: If the theory and practice gap could be perceived as a driving force for continuous learning, it could become an incentive for closer collaboration by creating structures for competence development that include individuals, teams, and organizations. [J Nurs Educ. 2022;61(5):236-241.]
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| 15. |
- Letterstål, Anna
(författare)
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Nya kvalitetsregister
- 2008
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 19. |
- Letterstål, Anna, et al.
(författare)
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Patients' experience of open repair of abdominal aortic aneurysm : preoperative information, hospital care and recovery
- 2010
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 19:21-22, s. 3112-3122
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. The aim was to elucidate patients' lived experience of the care pathway of going through open surgery for abdominal aortic aneurysm. Background. Open surgical treatment has a great impact on patients' health-related quality of life both before and after treatment. The transition from being independent and asymptomatic to dependent on nursing care can be difficult. To facilitate this process and provide high-quality care, patients' needs must be better understood. Design. An exploratory descriptive design was chosen to describe and understand patients' lived experience. Method. Audio-taped interviews were performed three months postoperatively, covering the care pathway before and after surgery. Interviews were analysed with qualitative content analysis. Results. The informants made a transition from becoming aware of the deadly risk associated with abdominal aortic aneurysm to gradually understanding the physical and emotional impact of the surgical procedure during the recovery process. The experience of not understanding fully the risks of undergoing surgery or its consequences on daily life made the informants unprepared for complications and limitations during the recovery period. Many concerns emerged, with a need for more dialogue and opportunities to understand their own care than those provided by the health care staff. Conclusions. To facilitate the transition process, health care staff should consider patients' unpreparedness for the physical and emotional impact that can follow diagnosis and treatment for abdominal aortic aneurysm and recognise the need for dialogue to enhance participation during recovery. Relevance to clinical practice. Throughout the care pathway, patients' need for information and for opportunities to reflect on bodily and emotional reactions to the diagnosis and treatment of abdominal aortic aneurysm should be recognised by nurses and physicians to support patients getting realistic expectations of the consequences of treatment and facilitate participation in decisions concerning care and medical treatment.
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| 21. |
- Letterstål, Anna, et al.
(författare)
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Postoperative mobilization of patients with abdominal aortic aneurysm
- 2004
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 48:6, s. 560-568
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Tidskriftsartikel (refereegranskat)abstract
- Aim. This paper reports on a study which aimed to evaluate the effects of structured written preoperative information on patients’ postoperative psychological and physical wellbeing after surgery for abdominal aortic aneurysm (AAA).Background. The possible benefits of current booklets written by professionals on postoperative psychological and physical wellbeing in patients with AAA are unknown. Previous studies have shown that preoperative information has a favourable effect on both mood state and physical mobilization.Method. Fifty-two patients admitted for elective repair of AAA were selected consecutively and randomized to receive only verbal (control group), or verbal and written information in booklet form (experimental group). The booklet contained procedural and sensory information about the disease and its treatment. Two questionnaires were used to establish whether the booklet had any effect on perceived health, psychological and physical wellbeing postoperatively.Results. The two groups were similar regarding their perceived health but differed significantly regarding psychological wellbeing pre- and postoperatively. Patients in the experimental group were significantly sadder both pre- and postoperatively compared with those in the control group. Both groups were similar in postoperative physical wellbeing.Conclusion. This group of patients often has asymptomatic disease, with a short interval between diagnosis and major surgery. When patients receive an information booklet during this period, this seems to cause more worries than anticipated. Hence, a more supportive educational programme might benefit this patient group, both pre- and postoperatively.
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| 25. |
- Letterstål, Anna
(författare)
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Risk attitude and patients’ experience with treatment of abdominal aortic aneurysm and severe claudication
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to investigate the effect of information on well-being after open surgical repair (OR) of abdominal aortic aneurysm (AAA) and to explore the experience of the care pathway of OR from the patients perspective as well as to describe risk attitude and preference for treatment of AAA and severe intermittent claudication (IC). The effect of information was assessed during the first week after returning to the surgical ward using a study-specific questionnaire in patients with AAA randomized to receive either additional written information (EG) or best practice (CG). The experience of the care pathway was investigated in patients with AAA three months after going through OR using in-depth interview. Risk attitude and preference for treatment was evaluated in a general population sample stratified in four age groups facing a hypothetical scenario of going through OR, in patients scheduled for AAA treatment as well as in patients with severe IC before and six months after treatment using time trade off (TTO), standard gamble (SG) questions and a derived TTO value. Health related quality of life as well as cost-effectiveness was also evaluated in patients with severe IC. Preoperative written information did not have beneficial effects on postoperative recovery in patients with AAA. The EG reported a significantly worse psychological well-being during the first three days after returning from ICU. Otherwise there were no significant differences between the EG and CG in physical or psychological well being. The experience of the care pathway of OR describe patients awareness of having a deadly disease, feeling no option to decline surgery and the physical and emotional impact of OR which is difficult to cope with. During the care pathway there was a need for information and dialogue not fully met by the health care staff. Not understanding the risk and implications with surgery resulted in being unprepared for the long recovery period. A hypothetical situation of having AAA and facing OR was tested in otherwise healthy persons showing that the oldest age group was not prepared to take a deadly risk with treatment or trade off years to live their remaining life without the risk of rupture, to the same extent as reported by the three younger age groups. A decreased HRQL and functional ability in patients with severe IC influences risk attitude and preference for treatment, showing that the patients were prepared to accept a considerable treatment risk and shorten their remaining life to be free from their symptoms. Clinical parameters, HRQL and walking ability improved considerably after revascularization. Revascularization could also be considered cost-effective. In conclusion, patients with AAA seem to need better structured information and a possibility for a dialogue with the health care staff during the care pathway. The physical and emotional impact of OR has to be assessed to meet patients need. Preference for treatment should be considered individually, with special attention to the reluctance of taking a risk with OR seen in the very elderly and to patients with severe IC willing to take considerable risks with treatment.
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