| 1. |
- Dannapfel, Petra, 1978-, et al.
(författare)
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Education to Increase Skills in Research Methods among Clinicians in Health Care
- 2017
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Ingår i: Journal of Health & Medical Informatics. - Los Angeles, United States : Omics Publishing Group. - 2157-7420. ; 8:4
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionThe aim of this study was to evaluate participants’ and managers’ experience of the design and content of an education programme. The Knowledge to Action (KTA) framework was applied to identify the steps of knowledge creation and action in the education programme.MethodsData were collected from 18 participants representing two groups: participants in the intervention and supervisors and managers. Two focus groups took place: two with participants in the intervention (4 and 3 in each) and one with eleven managers.ResultsAll steps in the KTA framework were identified and discussed from several aspects. The importance of selecting projects that were relevant and added value in their clinics was mentioned by all participants. The participants also mentioned that after the education, they had further understanding and increased skills in how to be active and perform continuous improvement projects. The step in the KTA process regarding how to adapt knowledge to local context was not discussed explicitly by the participants or managers.DiscussionEducation in research methods and performing improvement projects to develop the clinic creates a more positive attitude to working with continuous improvement. The participant’s self-esteem and knowledge increased regarding how to work with improvements. It is important to have the manager’s support to perform a project. Emphasis was on knowledge inquiry and synthesis and presenting the results with or without possible solutions. The participants and managers talked about barriers and knowledge use more generally and at an organizational level. This means that the participants did not gain the last bit of nowledge needed to put the action into practice. This implies that the problem regarding lack of implementation skills in health care might remain.
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| 2. |
- Hallgren Elfgren, Ing-Marie, et al.
(författare)
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Swedish Diabetes Register, a tool for quality development in primary health care
- 2013
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Ingår i: Primary Health Care Research and Development. - : Cambridge University Press. - 1463-4236 .- 1477-1128. ; 14:3, s. 250-257
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Tidskriftsartikel (refereegranskat)abstract
- Introduction In Sweden, quality indicators in health care have been the basis for developing National Quality Registers. The Swedish National Diabetes Register (NDR) – one of the largest diabetes registers globally – was introduced in primary health care (PHC) in the county of Östergötland by an implementation project, 2002–2005.Aim The aim of the present paper was to investigate, by using the results of the NDR, whether the registration led to sustained outcomes of medical results of diabetes care in PHC in the county during the period 2005–2009.Method HbA1c, blood pressure (BP), albuminuria and low-density lipoprotein-cholesterol were registered online in the NDR. In 2005 and 2006, goal achievement for HbA1c was measured and compared between PHC centres (PHCC) within the county. In 2007, achievements to national goals were compared between the PHCCs within the county and with those Swedish counties that had attained a sufficiently high registration rate. In 2008 and 2009, the average county results were compared with the corresponding national average measurements for all 21 Swedish counties combined.Result In 2005, a clear improvement trend for HbA1c and BP was shown within the county. In 2007–2009, goal achievements in the county studied were slightly better than the other counties measured and the country as a whole in almost every comparison.Discussion The present study has shown association between medical results and registration in the NDR. As the project was primarily a quality improvement work, the results have continuously influenced the development of diabetes care. Both the health professions and the county council now have – in the NDR – an effective and rapid method for evaluation and follow-up of diabetes care. The systematic documentation, followed by comparisons and analyses, create ideas for care improvements.
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| 3. |
- Hallgren Elfgren, Ing-Marie, et al.
(författare)
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The process of implementation of the diabetes register in Primary Health Care
- 2012
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 24:4, s. 419-424
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Tidskriftsartikel (refereegranskat)abstract
- Quality problem or issue According to Swedish law, all health care units must have a system for quality improvement. The aim of this study was to follow an implementation process of a uniform routine for quality control of diabetes care in Primary Health Care in one county. Initial assessment Primary Health Care had a decentralized organization and patients with type 2 diabetes were served at 42 different Primary Health Care Centres. Choice of solution As the Swedish Diabetes Register (National Diabetes Register, NDR) holds the most important quality indicators, implementation of the NDR registration at all centres was chosen to be the best way to follow up quality in diabetes care. Implementation The process of implementing the NDR went through different phases and the main way to encourage commitment to the process was to reward performance in a progressively more differentiated way. Evaluation During the implementation process (2001–05) there was an increasing rate of registration. When the programme ceased, the registration rate had reached a level of 75%, which has remained stable and was still in 2010 one of the highest rates in Sweden. Lessons learned Important factors for success were the initiative taken by the profession itself and strong support from the leaders of the county council. It was also important to let the process develop gradually in order to get all staff involved. Among the outcomes was an increase in computer use in clinical practice among the diabetes nurse specialists and a structured way of encouraging the patients' participation in self-care.
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| 4. |
- Hallgren Elfgren, Ing-Marie, et al.
(författare)
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The Swedish National Diabetes Register in clinical practice and evaluation in primary health care
- 2016
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Ingår i: Primary Health Care Research and Development. - : CAMBRIDGE UNIV PRESS. - 1463-4236 .- 1477-1128. ; 17:6, s. 549-558
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this project is to describe the use of the Swedish National Diabetes Register (NDR) in clinical practice in a Swedish county and to specifically monitor the diabetes care routines at two separate primary health-care centres (PHCC) with a special focus on older patients. Background: According to Swedish law, all health-care units have to maintain a system for quality evaluation and improvement. As the NDR holds the most important quality indicators, implementation of the NDR in primary care was carried out by an implementation project in 2002-2005. Methods: Initially, a digital questionnaire about NDR routines was sent to all PHCC. Statistics about hemoglobin adult 1c (HbA1c) and blood pressure (BP) was presented for the diabetes teams at two centres who were also interviewed. The responses became the basis for a focus group interview with both teams together, with data subject to content analysis. Findings: The study showed that reporting to the NDR has become a compulsory routine in primary care. The diabetes nurse specialist was responsible for the practical management of the register and used the NDR for continuous monitoring of the patients. Most centres used the NDRs statistics for evaluation and analyses annually. The diabetes nurse adapted the visits to the patients wishes and general condition. Only in terms of target values for HbA1c and BP did they accept slightly higher values for the older patients. Since the NDR was implemented, the registration rate has remained at 75% and has not increased. The reason given was that patients with diabetes living in nursing homes are checked up by the municipal nurse who does not use the NDR. However, the risk of omitting older patients in the NDR could be considerably decreased if data could be transferred from the electronic patient record.
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| 5. |
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| 6. |
- Jansson, Inger, et al.
(författare)
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Implementation of evidence-based practice by standardized care plans : A study protocol
- 2013
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Ingår i: Open Journal of Nursing. - Irvine : Scientific Research Publishing. - 2162-5336 .- 2162-5344. ; 3:8A, s. 51-57
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patient records should both transfer and create knowledge about patients and their health care. A standardized care plan could be a way to implement evidence-based care directly in practice and improve the documentation in patient records. The aim of this study is to investigate and compare the development and implementation process of a standardized care plan in hospital and primary health care. A further aim is to evaluate the effects on the quality of documentation and the care given in two contexts. Methods and Analysis: Realistic evaluation will be used as a framework to investigate the implementation process. According to this framework, possible contexts, mechanisms, and outcomes in the study will be considered. The study will be performed in two contexts: an orthopedic clinic and primary health care centers. In both contexts, the two key mechanisms will be the same: the implementation process will be driven by internal facilitators (practitioners at the units) and the process will be guided by the Rules and Regulations for interoperability in the Health and Social Care specification, “National information structure for standardized care plans”. Two outcomes of the study will be studied: to investigate the development and implementation process by an evaluation of fidelity and to evaluate how a standardized care plan affects the quality of documentation and the use of evidence-based care. Discussion: Implementation of the SCP will probably meet the same resistance as implementation of guidelines. Documentation of care is an important but resource-consuming requirement in health care, a more standardized method of documenting is requested by health professionals. This project can provide insight into the complex process of developing and implement an SCP in different contexts, which will be useful in further implementation processes.
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| 7. |
- Linderholm, Märit, et al.
(författare)
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Self-rated health, lifestyle habits and risk assessment in 75-year-old persons attending preventive clinic visits with a nurse in primary health care : a cross-sectional study
- 2019
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Ingår i: Primary Health Care Research and Development. - : CAMBRIDGE UNIV PRESS. - 1463-4236 .- 1477-1128. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe self-rated health in relation to lifestyle and illnesses and to identify risk factors for ill health such as pressure ulcers, falls and malnutrition among 75-year-old participants in a new clinical routine involving health assessment followed by tailored one-to-one health promotion at preventive clinic visits to a nurse at primary health care centres (PHCC). Background: There is a rapidly growing ageing population worldwide. It is central to health policy to promote active and healthy ageing. Preventive clinic visits to a nurse in primary health care were introduced as a new clinical intervention in a region in Sweden to improve the quality of health for the older adults. Design: A quantitative cross-sectional population-based study. Methods: The sample consisted of 306 individuals in six primary health care centres in Sweden aged 75 years who attended preventive clinic visits to a nurse. Data were collected from March 2014 to May 2015 during structured conversations with a nurse based on self-administered questionnaires, clinical examinations, risk assessments and after the clinic visit existing register data were collected by the researcher. Findings: Participants experienced good self-rated health despite being overweight and having chronic illnesses. Daily exercise such as walking and housework was more common than aerobic physical training. The majority had no problems with mobility but reported anxiety, pain and discomfort and had increased risk of falls. Conclusion: It is important to encourage the older adults to live actively and independently for as long as possible. The healthy older adults may benefit from the clinical intervention described here to support the individual's ability to maintain control over their health. Such supportive assessments might help the healthy older adult to achieve active ageing, reducing morbidity and preventing functional decline.
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| 8. |
- Malmgren, Malin, et al.
(författare)
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Patients with hip fracture : Experiences of participation in care
- 2014
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Ingår i: International Journal of Orthopaedic and Trauma Nursing. - London : Elsevier. - 1878-1241 .- 1878-1292. ; 18:3, s. 143-150
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Tidskriftsartikel (refereegranskat)abstract
- Health care staff are obliged to help patients participate in their care. Previous research has shown that information and relationships with staff are important factors for patients to feel involved. The aim of the study was to describe patients' experiences of participation during hospitalization for hip fracture. Eleven patients being treated for hip fracture were included and data were collected using interviews. Analysis of the data was carried out through qualitative content analysis. The results illustrate that the experiences of participation are governed by the patient's personal circumstances, needs and wishes and are affected by how responsive the staff are to these. Patients' experience of participation is also affected by having to adapt to the health care organization and structure. To pursue individualized care, staff need to start from patient preferences and it is a challenge to adapt care to both the individual and the organization. By paying attention to patient preferences, the staff have a greater opportunity to implement changes in health care that will benefit a large patient population. This can lead to patients gaining better functional capacity and quality of life. © 2013 Elsevier Ltd.
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| 9. |
- Törnqvist, Jeanette, et al.
(författare)
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Double documentation in electronic health records
- 2016
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Ingår i: Nordic Journal of Nursing Research. - : SAGE Publications. - 2057-1585 .- 2057-1593. ; 36:2, s. 88-94
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Tidskriftsartikel (refereegranskat)abstract
- Documentation in the patient record must be systematic and rigorous. However, each health care profession documents parts of the electronic health record (EHR) separately. This system can lead to double documentation. The aim of the study was to describe the amount of double documentation in health records for in-patients. A retrospective descriptive review of 30 records for in-patients diagnosed with hip fracture was conducted. Double documentation occurred on all records reviewed during the stay in hospital and in or between all professions reviewed. In total, 822 instances of double documentation were found. The EHRs available today are not designed to monitor processes. Instead, they follow each health profession, which can lead to double documentation. It would be desirable to develop an EHR from a process perspective and not a record per profession.
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| 10. |
- Törnvall, Eva, et al.
(författare)
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Advancing nursing documentation an intervention study using[X]patients with leg ulcer as an example
- 2009
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Ingår i: International Journal of Medical Informatics. - : Elsevier BV. - 1386-5056 .- 1872-8243. ; 78:9, s. 605-617
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim was to implement and evaluate a standardised nursing record, using patients with leg ulcer as an example, regarding the content of the nursing record and district nurses experiences of documentation. Method: This was a prospective, stratified and randomised intervention study, with one intervention group and one control group. A standardised nursing wound care record was designed and implemented in the electronic patient record in the intervention group for a period of 3 months. Pre- and post-intervention audits of nursing records [n = 102 and n = 92, respectively] were carried out and 126 district nurses answered questionnaires pre-intervention and 83 post-intervention. Result: The standardised nursing wound care record led to more informative, comprehensive and knowledge-intensive documentation according to the audit and district nurses opinions. Furthermore, the district nurses self-reported knowledge of nursing documentation increased in the intervention group. When the standardised nursing wound care record was not used, the documentation was mostly incomplete with a lack of nursing relevance. There were no differences in the district nurses experiences of documentation in general between the two groups. Conclusion: Using the standardised nursing wound care record improved nursing documentation meeting legal demands, which should increase the safety of patient. There was however a discrepancy between the nurses stated knowledge and how they carried out the documentation. Regular in-service training together with use of evidence based standardised nursing records, as a link to clinical reasoning about nursing care, could be ways effecting change.
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| 11. |
- Törnvall, Eva, 1956-
(författare)
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Carrying out Electronic Nursing Documentation : Use and Development in Primary Health Care
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Communication of care is essential in the multidisciplinary health care system and the patient record is an important tool for communication. The electronic patient record was introduced to facilitate the documentation of care, as well as the communication and evaluation of care. District nurses met the patient independently of other caregivers at the surgery or in the patient’s home. Documentation by district nurses is assumed to contribute to the view of the patient so that safe care can be carried out in primary health care.This thesis investigates and analyses the electronic nursing documentation in primary health care with emphasis on the content, district nurses’ experiences of documentation and how the information in the documentation was used. A further aim was to implement and evaluate the effect on standardised nursing documentation, using patients with leg ulcer as an example.A sample of 239 district nurses, 430 general practitioners and 74 care unit managers answered questionnaires about the nursing documentation and the use of it. One hundred and nine nursing records were audited. Quantitative and qualitative methods were used for data analysis.Documentation by district nurses lacked clear nursing status, judgment (nursing diagnosis) and nursing goals. Legal requirements were not fulfilled. Medical facts were carefully documented while relevant issues to nursing occurred only seldom. District nurses stated that they were satisfied with their documentation but were in need of education. The focus of the in-service training for documentation was technical rather than involving nursing issues.Fifty-eight per cent of the general practitioners read the nursing documentation always or often and found it valuable. They had problems, however, finding the information because of the unclear nursing status, the lack of district nurses’ judgement and the large quantity of notes regarding routine activities in district nurses’ documentation.The nursing documentation was used by 75 % of the care unit managers for evaluating resources and by 51 % for evaluating care. The categories ’prioritisation’, ’inadequate nursing records’, and ’lack of interest’, illustrate for what reasons the care unit mangers did not use the documentation for evaluation of care.In order to advance district nurses documentation, a standardised nursing wound care record was designed and implemented in nine primary health care centers, with a total of 83 district nurses. Eight primary health care centers were used as a control group, including 56 district nurses. A questionnaire was sent to the district nurses and 102 nursing records were audited before and after implementation. The standardised nursing record improves the descriptions of patient’s health history and status. Nursing diagnoses were more frequently used but were of low quality. Using the standardised nursing wound care record was experienced by the district nurses as being more timeconsuming but also more informative about the patient. Furthermore the knowledge in documentation increased among the district nurses in the intervention group.Improvement of nursing documentation is necessary in order to obtain documentation that fulfills legal requirements. The managers had a great responsibility to upgrade the documentation, which can be effected by continuing support. Documentation must be seen as a means of transferring information about the patient and of determining whether the best care has been given. A standardised documentation could increase the possibility to compare and determine the value of care. Strengthening the awareness of nursing among district nurses should involve strengthening the documentation, which ought to lead to safer care for the patient.
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| 12. |
- Törnvall, Eva, 1956-
(författare)
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Distriktsköterskans elektroniska omvårdnadsdokumentation för utvärdering av vård
- 2005
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Ingår i: Vårdstämman,2005. - Stockholm : Vårdförbundet.
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Konferensbidrag (refereegranskat)abstract
- Studie av distriktssköterskans omvårdnadsdokumentation gjord i tre landsting med hjälp av enkät och journalgranskning. Resultatet visade att distriktssköterskan dokumenterar främst utförda vårdåtgärder och omvårdnadsstatus. Användningen av omvårdnadsdokumentation för utvärdering av vård varierade mellan de olika landstingen från 43 - 100% av vårdcentralerna.
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| 13. |
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| 14. |
- Törnvall, Eva, et al.
(författare)
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Electronic nursing documentation in primary health care
- 2004
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 18:3, s. 310-317
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe and analyse nursing documentation based on an electronic patient record (EPR) system in primary health care (PHC) with emphasis on the nurses' opinions and what, according to the nursing process and the use of the keywords, the nurses documented. The study was performed in one county council in the south of Sweden and included 42 Primary Health Care Centres (PHCC). It consisted of a survey, an audit of nursing records with the Cat-ch-Ing instrument and calculation of frequencies of keywords used during a 1-year period. For the survey, district nurses received a postal questionnaire. The results from the survey indicated an overall positive tendency concerning the district nurses' opinions on documentation. Lack of in-service training in nursing documentation was noted and requested from the district nurses. All three parts of the study showed that the keywords nursing interventions and status were frequently used while nursing diagnosis and goal were infrequent. From the audit, it was noted that medical status and interventions appeared more often than nursing status. The study demonstrated limitations in the nursing documentation that inhibited the possibility of using it to evaluate the care given. In order to develop the nursing documentation, there is a need for support and education to strengthen the district nurses' professional identity. Involvement from the heads of the PHCC and the manufactures of the EPR system is necessary, in cooperation with the district nurses, to render the nursing documentation suitable for future use in the evaluation and development of care.
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| 15. |
- Törnvall, Eva, 1956-, et al.
(författare)
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Health-related quality in life in relation to mobility and fall risk in 85-year-old people: a population study in Sweden
- 2016
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Ingår i: Ageing & Society. - : Cambridge University Press. - 0144-686X .- 1469-1779. ; 36:9, s. 1982-1997
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Tidskriftsartikel (refereegranskat)abstract
- Optimal mobility is fundamental for healthy ageing and quality of life. This study is part of a cross-sectional population-based study of 85-year-old people residing in Linköping municipality, Sweden. The purpose was to describe 85-year-old peoples' health-related quality of life (HRQoL) in relation to mobility and fall risk while adjusting for gender and body mass index. Data collection included a postal questionnaire, a home visit and a reception visit. HRQoL was assessed with EQ-5D-3L, mobility with the Timed Up and Go test (TUG) and fall risk with the Downton Fall Risk Index (DFRI). All those who completed the DFRI, TUG and EQ-5D-3L were included in the present study (N = 327). Lower HRQoL was associated with longer time taken to complete TUG and higher fall risk in both genders but not with body mass index. Women had higher risk of falling, took a longer time to complete TUG and reported less physical activity compared with men. Health-care professionals should address mobility capacity and fall risk in order to maintain quality of life in elderly people. This is of utmost importance, especially for elderly women because impaired mobility, high risk of falling and occurrence of pain are common among women, and related to lower HRQoL.
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| 16. |
- Törnvall, Eva, 1956-
(författare)
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How nurses view and realize documentation in primary care
- 2005
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Ingår i: Documenting nursing care. Enhancing patient care through nursing documentation:new directions for novices and experts,2005. - Bern : Verlag Hans Huber. ; , s. 431-437
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Konferensbidrag (refereegranskat)abstract
- The aim of this study was to describe, analyses and compare nursing documentation in primary health care in three county councils. The study was performed in Sweden during 2002-2004. 346 district nurses answered a questionnaire and 52 nursing records were audited by the audit instrument Cat-ch-Ing. The result of the survey from all three county council indicates that nurses felt that the structured form, with keywords, for the nursing record facilitated the documentation, clinical decisions and evaluation of care. The audit showed that nursing intervention and nursing status was frequently documented bur the key words nursing diagnosis and nursing goal occurred rarely. Medical facts dominated the nursing documentation and notes of the diseases effect on the individual-s daily life existed rarely. The nursing record was more a checklist for done interventions than an informative source of nursing facts.
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| 17. |
- Törnvall, Eva, et al.
(författare)
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Impact of primary care management on nursing documentation
- 2007
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 15:6, s. 634-642
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim was to investigate whether perceptions of electronic nursing documentation and its performance differed because of primary health care management. Background: Success in leading people depends on the manager's personality, the context and the people who are led. Close proximity to clinical work, with manager and personnel sharing the same profession, promotes the authority to carry out changes. Methods: This study comprised a postal questionnaire to district nurses and an audit of nursing records from two primary health care organizations, one with a uniprofessional (nursing) organization, and one with multidisciplinary health care centres with general practitioners and/or another profession as managers. Results: Uniprofessional nurse management increased district nurses' positive perceptions of nursing documentation but did not affect documentation performance, which was inadequate regardless of management type. Conclusions: Positive perceptions of nursing documentation are bases for further development to a nursing documentation including a holistic view of the patient.
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| 18. |
- Törnvall, Eva, et al.
(författare)
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Nursing documentation for communicating and evaluating care
- 2008
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 17:16, s. 2116-2124
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To investigate the utility of electronic nursing documentation by exploring to what extent and for what purpose general practitioners use nursing documentation and to what extent and in which cases care unit managers use nursing documentation for quality development of care. Background: As health care includes multidisciplinary activities, communication about the care given is essential. To assure delivery of good and safe care, quality development is necessary. The main tool available for communication and quality development is the patient record. In many studies, nursing documentation has been found to be inadequate for this purpose. Design: This study had a cross-sectional descriptive design. Methods: Data were collected by postal questionnaires, one to the general practitioners (n = 544) and one to care unit managers (n = 82) in primary health care. Data were analysed by descriptive statistical and qualitative content analysis. Results: The general practitioners usually used the nursing record as the foremost source of information for treatment follow-up. The results, however, point out weaknesses and shortcomings in the nursing records, such as difficulties in finding important information because of a huge amount of routine notes. The care unit managers generally (74%) used the record for statistical purposes, while only half of them used it to evaluate care. Conclusion: Nursing records need more clarity and need to be more prominent regarding specific nursing information to fulfil their purpose of transferring information and to constitute a base for quality development of care. Relevance to clinical practice: The results of this study can provide a part of a basis upon which a multi-professional patient record could be developed and which could also function as an alarm to managers at different levels to prioritise the development of nursing documentation.
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| 19. |
- Törnvall, Eva, 1956-, et al.
(författare)
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Preliminary Evidence for the Usefulness of Standardized Nursing Terminologies in Different Fields of Application: A Literature Review.
- 2017
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Ingår i: International journal of nursing knowledge. - : John Wiley & Sons. - 2047-3087 .- 2047-3095. ; 28:2, s. 109-119
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Forskningsöversikt (refereegranskat)abstract
- PURPOSE:To examine the effects of using standardized terminologies in nursing.METHODS:A systematic literature research was conducted in June 2015 going back to January 2007. A modified narrative synthesis was used as the structure for the analysis.RESULTS:Twenty-three articles were included. Three themes were identified: enable evaluation of nursing-sensitive outcome indicators, enable calculation of resource consumption, and characterize nursing care.CONCLUSIONS:The studies included in the analysis described evidence for usefulness rather than effect. In all the studies, standardized nursing terminology was found to be essential for measuring, clarifying, and understanding nursing care.IMPLICATIONS FOR NURSING PRACTICE:The use of standardized terminologies could be advantageous. However, there are shortcomings in nursing documentation and the use of standardized nursing terminologies that obstruct evaluation of nursing care
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| 20. |
- Törnvall, Eva, 1956-, et al.
(författare)
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Quality of Nursing care from the perspective of patients with leg ulcers
- 2010
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Ingår i: Journal of Wound Care. - 0969-0700 .- 2052-2916. ; 19:9, s. 388-395
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate and analyse the quality of nursing care in a primary care setting from the perspective of patients with leg ulcers and determine the subjective importance that patients attach to various aspects of quality of care. • Method: All of the patients with leg ulcers at 15 primary care centres in the south east of Sweden were invited to participate.They were given the short version of the Quality from the Patient's Perspective questionnaire (QPP) to fill in.This included a number of closed and open questions relating to their perceptions of the quality of their nursing care and the importance of this care to them. • Results: Overall, the patients in this study perceived that the quality of nursing care was high. However, important areas for improvement were revealed, including the need for an increase in patient-focused care, continuity of care and better pain relief. • Conclusion: To address the weak points highlighted by the study, we recommend that nurses explore patient perceptions of pain in greater detail and invite patients take a more active role in the management of their leg ulcers. • Conflict of interest: None.This study was funded by the county council of Östergötland and by Linköping University, Sweden. Objective: To investigate and analyse the quality of nursing care in a primary care setting from the perspective of patients with leg ulcers and determine the subjective importance that patients attach to various aspects of quality of care. Method: All of the patients with leg ulcers at 15 primary care centres in the south east of Sweden were invited to participate. They were given the short version of the Quality from Patient’s Perspective questionnaire (QPP) to fill in. This included a number of closed and open questions relating to their perceptions of the quality of their nursing care and the importance of this care to them. Results: Overall, the patients in this study perceived that the quality of nursing care was high. However, important areas for improvement were revealed, including the need for an increase in patient-focused care, continuity of care and better pain relief. Conclusion: To address the weak points highlighted by the study, we recommend that nurses explore patient perceptions of pain in greater detail and invite patients take a more active role in the management of their leg ulcers.
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| 21. |
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| 22. |
- Viktorsson, Lisa, 1984-
(författare)
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Health Care Utilization among Young Adults in Primary and Emergency Health Care : The Need for Support, the Capacity to Support, and the Communication in between
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Swedish health care has set an aim of working towards ‘a good and integrated care’ with focus on patient-centred care in an effort to strengthen patient autonomy and improve accessibility. Problems with accessibility in earlier research have been associated with non-urgent complaints, especially at emergency departments (EDs). In addition, the use of EDs for non-urgent complaints has been connected to difficulties getting an appointment at primary health care centres (PHCs). Among non-urgent health care visits, young adults (age 18-29 years) are overrepresented. When studying health care utilization, the significance of health literacy permeates its different compounds, as associated with health care utilization. The overall aim of this thesis was to gain a deeper understanding of young adults’ health care utilization within EDs and PHCs by describing and exploring their use of health care in relation to perceived needs and prerequisites. The design of this thesis was primarily explorative. Data collection was performed using interviews and observations with young adults visiting selected primary and emergency health care units, doing focus groups with health care personnel working at selected health care units, and by performing text analysis of online health information web sites. In addition, a retrospective and cross-sectional overview was designed using registry data and questionnaires to identify health care use in a Swedish context. Data were analysed using statistical analyses, grounded theory, and two kinds of content analyses. Results demonstrated that, in terms of doctor visits, young adults did not seek care to a greater extent than other age groups. As a young adult, the seeking of emergency care was characterized mainly by abdominal and chest pain, symptoms of short duration, and recommendations to seek care by a health care professional. Insufficient and/or problematic health literacy was found in more than one-third of the young adults seeking health care and was associated with anxiety about symptoms, lower reliance on health care, and seeking care for psychological symptoms. When exploring young adults’ health care utilization, the sense of being taken seriously emerged as their main concern. Further-more, the seeking of health care should be considered a process rather than isolated visits where external influences, clarity of symptoms, behavioural approaches, health care know-how, and enabling self-management were important factors in understanding health care utilization. For health care personnel, the question of non-urgent care among young adults was a question of the distribution of responsibility; young adults were considered to put too much responsibility on health care to get healthy. The young adults had great concerns, were unable to wait, demonstrated other needs for communication, and were influenced by external information. The perception of young adults’ health care utilization was also associated with difficulties within the health care set-ting. Contributing factors were that each health care unit was just a small part of an enormous health care system, having to deal with tough priorities and to work with different ethical dilemmas. Nonetheless, health care personnel felt comfortable meeting young adults based on experience, either their own or by asking others. When scrutinizing external influence, online health information was found to be foremost basic, helping the reader in narrowing down possible diagnoses. However, a modified dimension was also present, in which the reader had to balance alternatives, making it difficult for young adults to come to a decisive conclusion on what to do with symptoms. The findings from this thesis demonstrate that it is the interactions between young adults and health care that enable factors for future patient empowerment and for health literacy to emerge and develop, thereby enabling future self-care. By acknowledging young adults primarily as newcomers to adult health care in need of support rather than part of a relatively healthy group, seeking care for non-urgent problems could possibly alter alternative attitudes and prejudices. Emphasizing adjustments within each health care meeting has the chance to empower and still achieve the goal of effective health care.
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| 23. |
- Viktorsson, Lisa, et al.
(författare)
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Healthcare utilisation and health literacy among young adults seeking care in Sweden: findings from a cross-sectional and retrospective study with questionnaire and registry-based data
- 2019
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Ingår i: Primary Health Care Research and Development. - : CAMBRIDGE UNIV PRESS. - 1463-4236 .- 1477-1128. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The objective of this study was to examine young adults healthcare utilisation and its possible association with health literacy. Background: Many countries struggle with insufficient accessibility at emergency departments (EDs) and primary healthcare centres (PHCs). Young adults, aged 20-29 years old, account for a substantial number of unnecessary doctor visits where health literacy could be an explanatory factor. Method: This study incorporated a combined retrospective and cross-sectional study design with analysis of registry data, including all registered outpatient doctor visits between 2004 and 2014 (n = 1 086 432), and strategic sample questionnaire data (n = 207), focusing on socio-demographics, symptoms and information-seeking behaviour. Mean differences between first-year and last-year doctor visits for each age group were calculated using registry data. Fischers exact test was applied to questionnaire data to analyse group differences between ED and PHC visitors as well as between patients with sufficient health literacy and insufficient health literacy. Binary logistic regression was used to investigate covariation. Findings: Healthcare utilisation has increased among young adults during the past decade, however, not comparatively more than for other age groups. ED patients (n = 49) compared to PHC patients (n = 158) were more likely to seek treatment for gastrointestinal symptoms (P = 0.001), had shorter duration of symptoms (P = 0.001) and sought care more often on the recommendation of a healthcare professional (P = 0.001). Insufficient/problematic health literacy among young adults was associated with having lower reliance on the healthcare system (P = 0.03) and with a greater likelihood of seeking treatment for psychiatric symptoms (P = 0.002). Conclusion: Young adults do not account for the increase in healthcare utilisation during the last decade to a greater extent than other age groups. Young adults reliance on the healthcare system is associated with health literacy, an indicator potentially important for consideration when studying health literacy and its relationship to more effective use of healthcare services.
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| 24. |
- Viktorsson, Lisa, 1984-, et al.
(författare)
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Young adults' healthcare utilisation and healthcare needs : Perceptions and experiences of healthcare providers
- 2022
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Ingår i: Health Expectations. - : John Wiley & Sons. - 1369-6513 .- 1369-7625. ; 25:1, s. 245-253
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Health care in many countries entails long waiting times. Avoidable healthcare visits by young adults have been identified as one probable cause.OBJECTIVE: The aim of this study was to explore healthcare providers' experiences and opinions about young adults' healthcare utilisation in the first line of care.METHOD: This study used latent qualitative conventional content analysis with focus groups. Four healthcare units participated: two primary healthcare centres and two emergency departments. This study included 36 participants, with 4-7 participants in each group, and a total of 21 registered nurses and 15 doctors. All interviews followed an interview guide.RESULTS: Data were divided into eight categories, which all contained the implicit theme of distribution of responsibility between the healthcare provider and the healthcare user. Young adult healthcare consumers were considered to be highly influenced by external resources, often greatly concerned with small/vague symptoms they had difficulty explaining and unable to wait with. The healthcare provider's role was much perceived as being part of a healthcare structure-a large organisation with multiple units-and having to meet different priorities while also considering ethical dilemmas, though feeling supported by experience.CONCLUSION: Healthcare personnel view young adults as transferring too much of the responsibility of staying healthy to the healthcare system. The results of this study show that the discussion of young adults unnecessarily seeking health care includes an underlying discussion of scarcity of resources.PATIENT OR PUBLIC CONTRIBUTION: The conduct of this study is based on interviews with young adult patients about their experiences of seeking healthcare.
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| 25. |
- Viktorsson, Lisa, 1984-, et al.
(författare)
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Young adults' needs when seeking first-line healthcare : A grounded theory design
- 2022
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 17:2
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Tidskriftsartikel (refereegranskat)abstract
- Background Healthcare outpatient visits have increased in recent years, and young adults are often given as an explanatory factor for many avoidable visits. Objective The objective of this study was to explore how young adults perceive seeking first-line healthcare. Design and setting The study utilized a grounded theory design with data collection at primary healthcare centres and emergency departments in southeast Sweden. Method Data were collected during individual interviews and patient observations with subsequent interviews during the years 2017-2018. The analysis was performed using grounded theory. Results The main concern when young adults are seeking healthcare is that their worries are taken seriously. It is a four-part process: becoming aware of, verifying, communicating, and receiving an opinion about one's symptoms. The process includes external factors, clarity of symptoms, behavioural approaches, healthcare know-how, enabling self-management, and prior healthcare experience(s). When communicating symptoms, the clearer the symptoms, the less there needs to be communicated. When symptoms are unclear, the importance of different behavioural approaches and healthcare know-how increases. When receiving a medical opinion about symptoms, young adults want to learn how to self-manage their symptoms. Depending on previous healthcare experience, the healthcare visit can either harm or help the patient in their healthcare-seeking process. Conclusion This study reflects several insights in the healthcare-seeking process from a young adult perspective. Based on the results, we suggest that healthcare providers focus on the final step in the healthcare-seeking process when giving their medical opinion about symptoms. Having extra minutes to give support for future self-care regardless of diagnosis could increase positive healthcare experiences and increase future self-care among young adults.
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| 26. |
- Wressle, Ewa, et al.
(författare)
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Comprehensive geriatric assessment in Swedish acute geriatric settings
- 2019
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Ingår i: International Journal of Health Care Quality Assurance. - : EMERALD GROUP PUBLISHING LTD. - 0952-6862 .- 1758-6542. ; 32:4, s. 752-764
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Comprehensive geriatric assessment (CGA) is a widely used approach in geriatric care and involves multidisciplinary assessments focused on determining a frail elderly persons medical, psychological and functional capability to develop an integrated plan for treatment. The purpose of this paper is to describe and scrutinize the CGA implementation process at six acute geriatric departments in three county councils and to study the outcome by the documentation in the patient medical records, and the staff perceptions using CGA. Design/methodology/approach The paper describes the implementation process stages. Outcome measures were based on patient medical records reviews at baseline and follow-ups at year 1 and year 2. Staff perceptions of using CGA were gathered by a questionnaire at the second follow-up. Findings The implementation had not yet reached sustainability so the implementation process must continue. Results show that documentation on the different areas increased in year 1, as well as the use of standardized assessment tools. However, results from the reviews for year 2 showed some decrease. Staff considered CGA to have high value for the geriatric patient but pointed out the need for continuing education. Originality/value Successful strategies for this implementation were strong support from the managers, small seminars, CGA rounds, good introduction routines for new staff and the use of reminders such as pocket-sized focus cards. A high staff turnover occurred during the study, which probably had a significant negative impact on the results.
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| 27. |
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