| 1. |
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
- Jarebrant, Caroline, et al.
(författare)
-
Development of a tool for integrating Value Stream Mapping and ergonomics in healthcare - A Nordic Multicenter study.
- 2014
-
Ingår i: The 7th Nordic Working Life Conference. Book of Abstracts and Programme. - 9789198119558 ; , s. 123-124
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To present the most recent draft Nordic version of the ErgoVSM tool for healthcare and some contextual factors influencing the intended impact of the tool. Material and Methods: The ErgoVSM tool is tested at 7 wards on 4 different hospitals in Denmark, Iceland and Sweden. The tests include assessment of tool usability and main factors facilitating or inhibiting the intended impact of the tool. On the basis of these trials a final version of the ErgoVSM is developed. The ErgoVSM tool: According to common VSM procedure the Current State is mapped (visualized) followed by a similar procedure regarding a wanted Future State. The Ergo-module includes assessments of physical exposures (posture, forces, variation, porosity) and psychosocial exposures (demands, control, variation, communication, porosity). It focuses task as well as values stream level. The exposures are assessed by ratings scales with verbally defined end points. The analysis includes discussion of solutions and establishment of an Action Plan needed to realize the wanted Future State. Main contextual factors influencing the intended impact of the tool seem to be previous Lean experience, management style, volume of competing projects and type of value stream analysed.
|
|
| 6. |
|
|
| 7. |
|
|
| 8. |
- Jarebrant, Caroline, et al.
(författare)
-
ERGONOVA Workbook. Ergonomic Value Stream Mapping in health care
- 2013
-
Bok (övrigt vetenskapligt/konstnärligt)abstract
- Preface to the present English edition: This edition has been translated and printed as part of the Nordic Multicenter Study "A Nordic work environment complement to Value Stream Mapping (VSM) for more sustainable patient flows at hospitals – A NOVO Multicenter study", funded by the Nordic Council of Ministers. The present prototype version of the Workbook is now evaluated at 14 hospital wards in Denmark, Iceland and Sweden. We aim to deliver a revised Workbook for intervention processes towards increased sustainability of patient flows based on our specific Nordic opportunities with our strong tradition of agreement between the parties (cf. ‘the Nordic Model’).Jörgen WinkelProject leader of the Nordic Multicenter StudyCaroline JarebrantProject leader of the Swedish project
|
|
| 9. |
- Jarebrant, Caroline, et al.
(författare)
-
Previous experiences of Value Stream Mapping (VSM) at the hospital units included in the Swedish part of the NOVO Multicenter Study
- 2012
-
Ingår i: Abstract book. 6th NOVO symposium. - 9789163723803
-
Konferensbidrag (refereegranskat)abstract
- Within the county councils of Sweden (hospitals, elderly care, etc.) two waves of introduction of Lean Production (Lean) have occurred. The first occurred during the 1990s and was unsuccessful mainly due to dramatic and negative impact on the employees (Härenstam et al, 1999). The 2nd wave started after the turn of the millennium. In 2011 about 80% of the county councils were running Lean projects (SKL, 2012). Now more emphasis was put on leadership and teamwork as well as knowledge on methodology. Successful projects creating e.g. more efficient patient flows are supposed to save time. A key issue is, however, that no general agreement seems to occur on how these saved resources should be reprioritized (cf. the “50/50-basis” in Denmark). Due to this, Lean projects are often perceived as “saving projects” where staff will eventually be phased out leading to further “work intensification”. VSM is a main Lean tool used to reduce waste in production flows. Our present case studies show differences between hospitals in Lean and VSM experiences. At one hospital Lean has been developed from "below" in the organization since 2004 through successive education (SkaS-guiden 2008). In our 2 cases from this hospital the initial steps of VSM were guided by internal Lean educated stakeholders. No resistance was met from any employee. However, the writing of action plans and the following actions were integrated in parallel rationalization processes. In contrast, our 2 other cases at another hospital had only been marginally influenced by Lean. The VSM processes were guided by an external Lean educated stakeholder (one of the authors). Especially one of the cases had significant difficulties in achieving consensus on an action plan including work environment issues. The required time for the VSM analyses became considerably prolonged, partly related to lack of Lean and VSM experience. Conclusions: The duration of the VSM process seems to depend on previous Lean experiences. Problems in the assessment of an action plan, an essential part in the VSM procedure, seems partly due to employee uncertainty regarding the consequences for the individual and parallel rationalization processes.
|
|
| 10. |
|
|
| 11. |
|
|
| 12. |
|
|
| 13. |
- Johansson Hanse, Jan, 1954, et al.
(författare)
-
Lean och arbetsmiljö inom sjukvården: Proaktivt förändringsarbete för hållbara arbetsprocesser inom vården
- 2013
-
Ingår i: FALF Abstracts. Arbetslivets föränderlighet. FALF 17-19 juni 2013, Stockholm. ; , s. 15-16
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Det övergripande syftet med projektet (som finansieras av AFA Försäkring) är att skapa bättre förutsättningar för att kombinera effektiva patientflöden och en god arbetsmiljö bland anställda inom sjukvården. Ett delsyfte är att utveckla ett ergonomiskt integrerat komplement till LEAN-verktyget värdeflödesanalys (VFA). Ett annat delsyfte är att studera vilka faktorer som har betydelse i selektionsprocessen av lösningsförslag. Inom Lean är VFA ett etablerat verktyg för att effektivisera flöden. När ett flöde kartläggs så är huvudsyftet att reducera icke värdeskapande aktiviteter, dvs. den tid/aktiviteter som inte tillför varan eller tjänsten något värde. Genom visualisering av olika arbetsuppgifter i flödet (med hjälp av post it-lappar) och dialog tar man sig från ett nuläge till ett önskat framtida läge. Vid VFA finns dock en risk för arbetsintensifiering och därmed en risk för försämrad fysisk och/eller psykosocial arbetsmiljö. Därför är verktyget ERGONOVA (ergonomisk värdeflödesanalys) framtaget som ett integrerat komplement till VFA. Med ERGONOVA beaktas arbetsmiljöaspekter i ett flöde. De arbetsmiljöaspekter som beaktas är fysisk belastning(arbetsställningar, lyft av föremål mm) och arbetsinnehåll (krav, kontroll, kommunikation). Här görs bedömningar på arbetsuppgiftsnivå, flödesnivå och jobbnivå. Utifrån en nulägeskarta för flödet identifieras problem/hinder för arbetets utförande och arbetsmiljöbrister. Analysprocessen resulterar i konkreta lösningsförslag och en preliminär handlingsplan vad gäller ett framtida flöde. Förslagen exponeras sedan på avdelningen, där alla medarbetare ges tillfälle att lämna synpunkter. Slutligen fastställs en handlingsplan med de aktiviteter och åtgärder som krävs för att förändringarna ska kunna genomföras och implementeringen påbörjas. Resultat från tre vårdenheter inom Västra Götalandsregionen visar att de anställda blir delaktiga i förändringsarbetet, där analys av arbetssätt blir i centrum. Fördelen med att använda post it-lappar (olika färger för olika yrkeskategorier) är att de anställda får arbetsuppgifter och flödet ”framför ögonen”. Därmed förskjuts fokus från person till arbetssätt och flöde. De preliminära resultaten visar att den anställde ofta får en bättre förståelse för vad de gör i ett flöde och vad andra yrkeskategorier gör. Ergonomisk värdeflödesanalys genererar en betydande idérikedom vad gäller förslag till förändringar. Resultaten indikerar att de anställda får en tvärfunktionell dialog där man diskuterar och föreslår förändringar som ofta leder till både ökad effektivitet och bättre arbetsmiljö.
|
|
| 14. |
- Winkel, Jörgen, 1946, et al.
(författare)
-
A Nordic work environment complement to Value Stream Mapping (VSM) for sustainable patient flows at hospitals – A NOVO Multicenter study
- 2012
-
Ingår i: Abstract book. 6th NOVO Symposium. - 9789163723803 ; , s. 57-
-
Konferensbidrag (refereegranskat)abstract
- The Nordic Council of Ministers (NCM) granted 2007-09 a project with the aim to establish and develop a Nordic Network for scientists regarding research on work environment and efficiency in the health care sector (‘the NOVO network’). The vision is a “Nordic Model for sustainable systems” in health care. A “Sustainable system” is here defined as the joint consideration of competitive performance and working conditions in a long-term perspective (Westgaard & Winkel, 2009, 2011). A preliminary project plan for a Nordic Multicenter project focusing a specific aspect of the vision was developed as part of the above mentioned NCM project. This was entitled: “A Nordic work environment complement to Value Stream Mapping (VSM) for sustainable patient flows at hospitals – A NOVO Multicenter study”.Development of production systems in healthcare is at present to an increasing extent based on Lean Production ideas. In the Lean terminology “value-adding work” (VAW) represents the portion of process time that employees spend on actions that create value as perceived by the customer (Liker 2004). The complementary part is “non-VAW” or “waste” as the general Lean term of non-value-adding activities.In healthcare VSM is a common Lean tool used to identify and minimize waste (Keyte & Locher, 2004). It is a participatory tool, i.e. those affected by this type of rationalization are performing the analyses and subsequently suggesting the interventions. Participation has been shown to be crucial to obtain ownership of the suggested interventions and thereby increase impact. In addition, VSM has been shown to be a powerful rationalization tool. However, the resulting interventions may imply physical work intensification and impaired psychosocial work environment if the proportion of VAW is increased and management issues are not properly considered. In the rationalization process both physical and psychosocial working conditions should therefore be integrated to obtain a competitive performance in a long term perspective. In practice, this is rarely done. Thus, health of the employees and system performance goals often end up on a collision course with short-term performance demands as the winner (e.g. Winkel & Westgaard 1996, Westgaard & Winkel 2011).
|
|
| 15. |
- Winkel, Jörgen, 1946, et al.
(författare)
-
Ergonomic Value stream Mapping (ErgoVSM) – potential for integrating work environment issues in a Lean rationalization process at two Swedish Hospitals
- 2013
-
Ingår i: 7th NOVO Symposium: A Nordic Model for Sustainable Systems in the Health Care Sector, Helsinki 25 – 26 November, 2013. - 2323-363X. - 9789523020580
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Lean is used in healthcare as a tool for business development and rationalization. Lean aims at contributing value from a holistic perspective including reduction of waste. Previous research indicates that this often creates work intensification with possible negative implications for the working environment (WE). WE considerations generally take a back seat on the rationalization process and are most often introduced later in a separate process. This paper reports findings from the Swedish part of a Nordic Multicenter Study where WE considerations have been integrated into a rationalization process based on Value Stream Mapping (VSM). ErgoVSM incorporates aspects of the physical and psychosocial WE into the VSM process. The abstract presents pros and cons for using ErgoVSM in relation to VSM at 2 wards at 2 different hospitals based on some of our preliminary data. Material and Methods: The case ward (“Ca”) used the ErgoVSM tool and the control ward (“Co”) the VSM tool. The resulting Action Plans were analyzed regarding number of suggested interventions and expected impact on performance (P) and WE. The expected WE impact was finally categorized according to impact at “Task”, “Work Content” and “Work Situation” (Westlander 1993). Two of the present researchers made these assessments independent of each other followed by a consensus procedure. Results: The Action Plan from Ca comprised 37 and Co 22 interventions. For both wards 65% of the interventions were expected to improve both P and WE. However, for Ca none of the interventions were expected to imply negative or no impact on WE, while this was 23% for Co. For Ca 16% of the interventions concerned Tasks, 46% Work Content and 38% Work Situation. The corresponding results for Co were 55%, 36% and 9% respectively. Conclusions: The Ca ward suggested more interventions, none of these with expected negative impact on WE and the suggestions were more often at a system rather than task level. The present preliminary data suggest that the ErgoVSM tool facilitate development of an Action Plan that may result in higher organizational sustainability compared with VSM.
|
|
| 16. |
- Winkel, Jörgen, 1946, et al.
(författare)
-
Factors facilitating and inhibiting Value Stream Mapping processes at hospital units in three Nordic countries - A Nordic Multicenter study
- 2014
-
Ingår i: O. Broberg, N. Fallentin, P. Hasle, P.L. Jensen, A. Kabel, M.E. Larsen, T.Weller (Editors). 11th International Symposium on Human Factors in Organisational Design and Management 46th Annual Nordic Ergonomics Society Conference. - 9788793130135
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- 1.Conceptual framework and Purpose In healthcare Value Stream Mapping (VSM) is a common Lean tool used to improve the efficiency of patient flows by identifying and minimizing waste (Keyte & Locher, 2004). It is a participatory tool, i.e. those affected by this type of rationalization are performing the analyses and subsequently suggesting appropriate interventions. Participation has been shown to be crucial to obtain ownership of the suggested interventions and thereby increase impact. VSM has been shown to be a powerful rationalization tool. However, the resulting interventions may imply physical work intensification and impaired psychosocial work environment. Due to this, Lean is often perceived as a “threat” by employees at hospitals (Härenstam et al 2000, personal communications). Physical and psychosocial working conditions should therefore be taken into account in the rationalization process to obtain sustainable solutions, i.e. solutions that allow for competitive performance and acceptable work environment in a long term perspective. On this background we have complemented the VSM tool by an ergonomic module assisting the users to consider also physical and psychosocial implications of the suggested interventions. This ErgoVSM tool is now evaluated in a Nordic Multicenter Study including Denmark, Iceland and Sweden (Winkel et al, 2012). The aim of this paper is to present observations that may indicate facilitating and inhibiting factors for the VSM process. 2.Methods Seven wards have used the ErgoVSM and seven the traditional VSM. Information was obtained by screening key hospital documents and interviewing participants in the VSM processes. 3.Results In Sweden one out of three wards using VSM decided not to fulfil the VSM process. On Iceland the only ward using VSM also decided not to fulfil their VSM process. The hospitals of the investigated wards using VSM in Sweden and Iceland had a strong primary focus on financial balance of the business according to key documents. Decisions on when and which value stream to analyse were made by management with little/no dialog with the employees. Work environment issues were not discussed as part of this. In addition, Iceland had a short experience of Lean, mainly based on support from McKinsey, an American global management consulting firm that focuses on solving issues of concern to senior management (http://en.wikipedia.org/wiki/McKinsey_%26_Company). Thus, they had no attention to the wellbeing to the employees and their work environment when introducing Lean. In general, the Icelandic Lean coaches had problems motivating the employees. However, they perceived a facilitated VSM process at the investigated ErgoVSM ward. Due to this, the main Lean coach decided to include work environment aspects in the VSM processes performed at other wards not part of the present Multicenter Study. Positive effects on those VSM processes were reported back to the researchers. In Denmark all three wards using VSM fulfilled their VSM process. This hospital had a long Lean experience. The main Lean coach reported process problems during their 3 initial years when using a top-down approach. Before the present project was initiated they had turned to a bottom-up initiation of the VSM processes. The Lean coach also expressed that work environment issues might be articulated as part of the VSM process. All seven wards using ErgoVSM in the 3 countries fulfilled the process. 4.Conclusion When using the Lean tool “Value Stream Mapping” it seems to be important not only to focus on efficiency but also on issues that are perceived important for the well-being of the individual employee. 5.Financial support The Nordic Council of Ministers and national grants. 6.References Härenstam A, Bejerot E, Johansson K, Leijon O, Schéele P. “Mager och god” eller ”Lean and mean”? Samband mellan organisationsförändringar och arbetsförhållanden. In: Barllöf K (Ed.) Smärtgränsen? En antologi om hälsokonsekvenser I magra organisationer. Rådet för arbetslivsforskning, pp 2000 Keyte, B., Locher, D., 2004. The Complete Lean Enterprise. Value Stream Mapping for Administrative and Office Processes. Productivity Press, New York. Winkel J, Birgisdóttir B D, Dudas K, Edwards K, Gunnarsdóttir S, Jarebrant C, Johansson Hanse J (2012). A Nordic work environment complement to Value Stream Mapping (VSM) for sustainable patient flows at hospitals – A NOVO Multicenter study. 6th NOVO Symposium: Sustainable Health Care: Continuous Improvement of Processes and Systems. Karolinska Institute, Stockholm Sweden. November 15-16, 2012, pp 58-59. ISBN: 978-91-637-2380-3
|
|
| 17. |
- Winkel, Jörgen, 1946, et al.
(författare)
-
Introduction of Lean/Value Stream Mapping at hospital units in three Nordic countries and expected impact on the working environment - A Nordic Multicenter study
- 2013
-
Ingår i: International HELIX Conference 2013.
-
Konferensbidrag (refereegranskat)abstract
- Conceptual framework and Purpose A recent review has documented mostly negative effects of rationalization on musculoskeletal and mental health and corresponding risk factors. This goes in particular for the healthcare sector (Westgaard & Winkel, 2011). Lean Practices are increasingly used in healthcare and Value Stream Mapping (VSM) seems to be a commonly used tool to identify and minimize waste (Keyte & Locher, 2004). The health impact of Lean varies considerably between investigations. This may to a large extend be due to differences in the operationalization of Lean (Brännmark et al, 2012). VSM is a participatory tool, i.e. those affected by this type of rationalization are performing the analyses and subsequently suggesting the interventions. Participation has been shown to be crucial to obtain ownership of the suggested interventions and thereby increased impact. On this background rationalizations based on VSM may offer a procedure that also includes working environment issues. In addition, workplaces in the Nordic countries seem to offer good opportunities for realizing a true participatory approach considering also working environment issues when rationalizing a value stream (Guðmundsson, 1993; Westgaard & Winkel, 2011). VSM has been shown to be a powerful rationalization tool in the elimination of non-value-adding tasks (non-VAT). Several studies show that non-VAT generally offer less risky physical and mental exposures (e.g. Kazmierczak et al, 2005; Østensvik et al, 2008; Palmerud et al, 2012; Jonker et al, 2013). According to this, non-VAT is usually named “the porosity of the working day” (Marx, 1867; Westgaard & Winkel, 2011; Winkel & Westgaard, 2001). Strong political demands to maximize efficiency in healthcare may thus potentially result in an excessive rationalization causing a too large reduction in porosity and thus too risky work intensification. In practice Lean is often perceived as a “threat” by employees at hospitals (Härenstam et al, 2000; many personal communications). In contrast, most Lean consultants generally describe Lean as an opportunity for improvements also in terms of the working environment (numerous personal communications). On this background an ergonomic complement to VSM, the ErgoVSM, has been developed based on existing scientific evidence and in close co-operation with Swedish industry and the healthcare sector (Jarebrant et al, 2013). The ErgoVSM also considers health issues, i.e. risk factors for musculoskeletal and mental health in addition to reduction of waste (Jarebrant et al, 2004; 2009). In this paper we present some preliminary data based on 1st line managers’ assessments of expected impact of action plans based on VSM and ErgoVSM. The presented data are retrieved from a larger NOVO Multicenter Study (Winkel et al, 2012). Design/Methodology Fourteen hospital wards in Denmark, Iceland and Sweden are investigated. Seven of these are using VSM and the remaining the ErgoVSM to improve the efficiency of their patient flows. Current and future states are assessed and action plans presented. 1st line managers are then interviewed and asked to assess expected impact of each suggested intervention in the action plan in terms of efficiency, treatment quality, physical and psychosocial working environment. So far five of the fourteen 1st line managers have been interviewed. Two of the wards have used the VSM tool and 3 the ErgoVSM tool. Results and Discussion All together 103 amendments for improved performance have been assessed in the five action plans. Eighty-one of these were assessed also to imply improvements in the working environment. Three suggestions were expected to imply a negative impact and four no impact on the working environment. Fifteen suggestions were not rated as they were decided not to be realized. Using VSM or ErgoVSM did not influence the assessment of expected impact of amendments in the action plan. The dominance of expected positive impact on the working environment of the amendments will be discussed in terms of potential bias and real opportunities. The Multicenter Study includes follow-up investigations of realized impact on the working environment as well as potential national differences between the three investigated countries (cf. Birna & Gunnarsdóttir, 2012; Edwards & Winkel, 2012; Jarebrant et al, 2012).
|
|
| 18. |
|
|
| 19. |
- Edwards, K, et al.
(författare)
-
Using Chronicle Workshop to quantify impact of context in case studies
- 2014
-
Ingår i: In: Kasper Edwards & Jørgen Winkel (Eds.) Abstract book, The 8th Novo symposium: Sustainable Health Care Production Systems, Copenhagen, November 6 - 7, 2014, Technical University of Denmark..
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)
|
|
| 20. |
- Fors, Andreas, 1977, et al.
(författare)
-
Effects of person-centred care after an event of acute coronary syndrome: Two-year follow-up of a randomised controlled trial
- 2017
-
Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 249, s. 42-47
-
Tidskriftsartikel (refereegranskat)abstract
- © 2017 The Authors. Aim: To assess the long-term effect of person-centred care (PCC) in patients with acute coronary syndrome (ACS). Method: Patients with ACS were randomly assigned to treatment as usual (control group) or an added PCC intervention for six months. The primary endpoint was a composite score of changes in general self-efficacy. ≥. five units, return to work or to a prior activity level and re-hospitalisation or death. Results: The composite score improved in the PCC intervention group (n = 94) at a two-year follow-up compared with the control group (n = 105) (18.1%, n = 17 vs. 10.5%, n = 11; P = 0.127). In the per-protocol analysis (n = 183) the improvement was significant in favour of the PCC intervention (n = 78) compared with usual care (n = 105) (21.8%, n = 17 vs. 10.5%, n = 11; P = 0.039). This effect was driven by the finding that more patients in the PCC group improved their general self-efficacy score. ≥. 5. units (32.2%, n = 19 vs. 17.3%, n = 14; P = 0.046). The composite score improvement was significantly higher in the PCC intervention group without post-secondary education (n = 33) in comparison with corresponding patients in the control group (n = 50) (30.3%, n = 10 vs. 10.0%, n = 5; P = 0.024). Conclusion: Implementation of PCC results in sustained improvements in health outcome in patients with ACS. PCC can be incorporated into conventional cardiac prevention programmes to improve equity in uptake and patient health outcomes. Trial registration: Swedish registry, Researchweb.org, ID NR 65791.
|
|
| 21. |
- Fors, Andreas, 1977, et al.
(författare)
-
Person-centred care after acute coronary syndrome, from hospital to primary care - A randomised controlled trial
- 2015
-
Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 187, s. 693-699
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: To evaluate if person-centred care can improve self-efficacy and facilitate return to work or prior activity level in patients after an event of acute coronary syndrome. METHOD: 199 patients with acute coronary syndrome <75years were randomly assigned to person-centred care intervention or treatment as usual and followed for 6months. In the intervention group a person-centred care process was added to treatment as usual, emphasising the patient as a partner in care. Care was co-created in collaboration between patients, physicians, registered nurses and other health care professionals and documented in a health plan. A team-based partnership across three health care levels included transparent knowledge about the disease and medical state to achieve agreed goals during recovery. Main outcome measure was a composite score of changes in general self-efficacy >/=5units, return to work or prior activity level and re-hospitalisation or death. RESULTS: The composite score showed that more patients (22.3%, n=21) improved in the intervention group at 6months compared to the control group (9.5%, n=10) (odds ratio, 2.7; 95% confidence interval: 1.2-6.2; P=0.015). The effect was driven by improved self-efficacy >/=5units in the intervention group. Overall general self-efficacy improved significantly more in the intervention group compared with the control group (P=0.026). There was no difference between groups on re-hospitalisation or death, return to work or prior activity level. CONCLUSION: A person-centred care approach emphasising the partnership between patients and health care professionals throughout the care chain improves general self-efficacy without causing worsening clinical events.
|
|
| 22. |
|
|
| 23. |
- Fors, Andreas, 1977, et al.
(författare)
-
Person-centred care improves self-efficacy to control symptoms after acute coronary syndrome: a randomized controlled trial.
- 2016
-
Ingår i: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. - : Oxford University Press (OUP). - 1873-1953. ; 15:2, s. 186-194
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Person-centred care (PCC) aims to engage patients as active partners in their care and treatment to improve the management of their illness. Self-efficacy is an important concept and outcome in PCC as it refers to a patient's belief in their capability to manage the events that affect their lives. Recovery after acute coronary syndrome (ACS) is demanding and a PCC approach may promote self-efficacy and thereby facilitate recovery. AIM: The purpose of this study was to evaluate whether a PCC intervention was able to improve self-efficacy after hospitalization for ACS. METHODS: In a randomized controlled trial, patients <75 years of age and hospitalized for ACS were assigned to either a usual care group or a PCC intervention group. Self-efficacy was assessed at baseline and up to six months after discharge using the Swedish Cardiac Self-Efficacy Scale (S-CSES), which consists of three dimensions: control symptoms, control illness and maintain functioning. RESULTS: In total, 177 patients were included in the study: 93 in the usual care group and 84 in the PCC group. At the one-month follow-up the PCC group had improved significantly more (p=0.049) on the control symptoms dimension (mean change 0.81; SD 3.5 versus mean change -0.20; SD 3.0). No difference between groups was seen at the six-month follow-up in any of the S-CSES dimensions. CONCLUSIONS: Our results indicate that PCC added to usual care promotes and hastens the development of patients' confidence in their ability to manage symptoms during recovery after ACS. This underlines the importance of initiating and establishing partnerships between patients and health care professionals as early as possible after ACS.
|
|
| 24. |
|
|
| 25. |
- Fors, Andreas, 1977, et al.
(författare)
-
The Cardiac Self-Efficacy scale, a useful tool to evaluate person-centred care.
- 2015
-
Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 14:6, s. 536-543
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Cardiac self-efficacy is a person's belief in his/her ability to manage the challenges posed by a coronary disease, and its role has been evaluated in several coronary populations using the Cardiac Self-Efficacy Scale (CSE Scale). Self-efficacy has an important role in person-centred care, however there is a lack of appropriate instruments that evaluate person-centred interventions.AIM:The purpose of this study was to validate the CSE Scale by examining its psychometric properties as a first step in evaluating a person-centred care intervention in persons with acute coronary syndrome (ACS).METHODS:The study sample consisted of 288 persons (72 women, 216 men) who completed the Swedish version of the CSE Scale two months after hospitalisation for an ACS event. Construct validity was psychometrically evaluated using confirmatory factor analysis. Additionally, convergent and discriminant validity were tested using correlation analyses.RESULTS:The results revealed that the CSE Scale was represented by three dimensions (control symptoms, control illness and maintain functioning). The analyses also showed that the CSE Scale is suitable for providing a total summary score that represents a global cardiac self-efficacy dimension. Evaluation of convergent and discriminant validity showed the expected correlations.CONCLUSION:The CSE Scale is a valid and reliable measure when evaluating self-efficacy in patients with ACS. It also seems to be a useful tool to promote person-centred care in clinical practice since it may offer useful guidance in the dialogue with the patient in the common creation of a personal health plan.
|
|
| 26. |
- Gellerstedt, Linda
(författare)
-
Nursing perspectives on patients' sleep during hospital care
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sleep is crucial for all humans in terms of health, daily functioning and well-being. Previous research has shown that sleep is considered a stressor for patients during hospital care. The general aim of this thesis was to explore and describe, from a nursing perspective, patients’ sleep and how sleep is addressed, promoted and assessed during hospital care.Methods: To cover the general aim of this thesis, various designs were chosen, and diverse methods of data collection were employed. In Study I, data were collected through qualitative interviews of ten consecutively recruited patients at an acute hospital. In Study II, data were collected through qualitative individual interviews and four focus groups, with a total of twenty-two registered nurses at four acute hospitals in an urban region. Study III was designed as a mixed method study and data were collected through twenty-one qualitative individual interviews as well as from program and course syllabuses and intended learning outcomes at three universities. Data from Studies I-II were analysed by qualitative content analysis with an inductive, latent approach. Data in Study III were analysed by qualitative content analysis with an inductive, manifest approach and collected documents were read word-for-word and scanned for the pre-set word, sleep. Study IV was a cross-sectional study and data were collected through a web-based survey. Acute hospitals in Sweden were subjected to stratified randomized sampling. Registered nurses, head nurses, nursing care developers and local training staff were included in the study. Data were analysed using descriptive statistics, and free-text answers were analysed by a thematic text analysis. Study V was performed as a non-experimental prospective study. Data from a group of twenty-five patients at two hospitals were collected by using the Richards-Campbell Sleep Questionnaire and actigraphy by Vivago® and were analysed with correlation and regression analysis.Findings: Patients’ sleep during hospital care is affected by several different factors and patients’ sleep is described as an important but undermanaged area. Limited knowledge and education within the area and insufficient support from the organization can be seen as barriers. Study III reveals that several student nurses lack evidence-based knowledge about sleep and sleep-promotion and consider themselves only to be prepared to address and promote sleep to a limited extent. Furthermore, the word, sleep, occurred explicitly only three times in two different learning outcomes at one of three included universities. Study IV shows that the area of sleep is not highlighted in a clinical context; for example, there is an absence of training days and education about sleep, only a few departments actively address patients’ sleep, and the use of sleep-assessment is non-existent. Study V shows a relationship between individual Vivago® graphs and patients’ self-assessed sleep, but a significant correlation for all patients between mean values for the two assessments was only obtained for one of the two included nights.Conclusions: This thesis indicates that sleep deprivation is common among patients during hospital care. Furthermore, education about patients’ sleep in the investigated nursing programs and in clinical practice seems to be deficient. Assessments with the Richards-Campbell Sleep Questionnaire and measurement with Vivago® capture different dimensions of sleep. In its present form, the RCSQ could have the potential to facilitate nursing actions to promote sleep amongst hospitalized patients in line with person-centred care. Furthermore, it is concluded that patients’ sleep during hospital care is an undermanaged and non-highlighted area. This thesis shows that there are several challenges for nurses, nursing managers and organizations at acute hospitals if better outcomes are to be achieved.
|
|
| 27. |
|
|
| 28. |
|
|
| 29. |
- Gyberg, Anna, et al.
(författare)
-
Framing healthcare professionals in written adverse events: A discourse analysis
- 2022
-
Ingår i: Nursing Inquiry. - : Wiley. - 1320-7881 .- 1440-1800. ; 29:3
-
Tidskriftsartikel (refereegranskat)abstract
- Healthcare professionals have a major responsibility to protect patients from harm. Despite vast efforts to decrease the number of adverse events, the progression of patient safety has internationally been acknowledged as slow. From a social construction perspective, it has been argued that the understanding of patient safety is contextual based on historical and structural rules, and that this meaning construction points out different directions of possible patient safety actions. By focusing on fact construction and its productive and limiting effect on how something can be understood, we explored the discourses about healthcare professionals in 29 written reports of adverse events as reported by patients, relatives, and healthcare professionals. Through the analysis, a discourse about the healthcare professionals as experts was found. The expert role most dominantly included an understanding that adverse events were identified through physical signs and that patient safety could be prevented by more strictly following routines and work procedures. We drew upon the conclusion that these regimes of truth brought power to the expert discourse, to the point that it became difficult for patients and relatives to engage in patient safety actions on their terms.
|
|
| 30. |
- Gyberg, Anna, et al.
(författare)
-
From identifying patient safety risks to reporting patient complaints: A grounded theory study on patients' hospital experiences
- 2024
-
Ingår i: Journal of Clinical Nursing. - 0962-1067 .- 1365-2702. ; In Press
-
Tidskriftsartikel (refereegranskat)abstract
- Aim : To explore how patients with hospital experience construct patient safety, from the identification of a patient safety risk to the decision to file a complaint. Background: Patients play an important role in the prevention of adverse events in hospitals, but the ability of patients to act and influence their own safety is still challenged by multiple factors. Understanding how patients perceive risk and act to prevent harm may shed light on how to enhance patients' opportunities to participate in patient safety. Design : The research design of this study is qualitative and exploratory. Methods: Twelve participants who had experienced Swedish hospital care were interviewed between June 2022 and July 2023. The method of analysis was constructivist grounded theory, focusing on social processes. The COREQ checklist for qualitative research was followed. Results : Four categories were constructed: (1) defining the boundary between one's own capacity and that of the hospital, (2) acting to minimize the impact on one's safety, (3) finding oneself in the hands of healthcare professionals and (4) exploring the boundaries between normality and abnormality of the situation. This process was captured in the core category of navigating the path of least suffering. This illustrated how the participants constructed meaning about patient safety risks and showed that they prevented multiple adverse events. Conclusions : Provided that participants were able to act independently, they avoided a multitude of adverse events. When they were dependent on healthcare professionals, their safety became more vulnerable. Failure to respond to the participants' concerns could lead to long-term suffering. Relevance to Clinical Practice : By responding immediately to patients' concerns about their safety, healthcare professionals can help prevent avoidable suffering and exhaustive searching for someone in the healthcare system who will take their needs seriously. Patient Contribution : A member check was performed with the help of one of the participants who read the findings to confirm familiarity.
|
|
| 31. |
- Gyberg, Anna, et al.
(författare)
-
Struggling for access to appropriate healthcare services: A qualitative content analysis of patient complaints
- 2023
-
Ingår i: Journal of Advanced Nursing. - 0309-2402 .- 1365-2648. ; 79:10, s. 3748-3759
-
Tidskriftsartikel (refereegranskat)abstract
- AimThis study aimed to describe circumstances concerning access for patients and relatives to take part in patient health and safety in a hospital setting. DesignThis study used a qualitative descriptive design and was conducted at a Swedish university hospital. MethodThe 79 complaints reported by patients and relatives included in this study were registered between January 2017 and June 2019. These complaints were classified as concerning access to healthcare services. Data were analysed using qualitative content analysis. ResultsThe overarching theme, struggling for access as a human being in the healthcare system, encompassed three themes describing patients' and relatives' needs. The three themes were (1) navigating through the healthcare organization, (2) making sense of self and what is going on and (3) being acknowledged as having needs. ConclusionPatients and relatives continuously participate in various ways in healthcare to promote health and prevent patient harm. Our findings contribute important knowledge about the meaning of access from a broad healthcare system perspective. Access was restricted in terms of appropriateness in how patients' needs were met. This restriction of access risked the deterioration of patient health and safety. ImpactPatients and relatives play an active part in patient health and safety, although their attempts are sometimes hindered. Restrictions in the appropriateness of access prevented patients and relatives from taking part in patient health and safety, which appeared to mean that they had to adapt and expend effort to the point that it negatively affected their health and everyday life. These findings concern all patients, relatives and healthcare professionals in hospital-associated settings. Patient or Public ContributionNo patient or public contribution.
|
|
| 32. |
- Gyberg, Anna, et al.
(författare)
-
Written reports of adverse events in acute care-A discourse analysis
- 2019
-
Ingår i: Nursing Inquiry. - : Wiley. - 1320-7881 .- 1440-1800. ; 26:4
-
Tidskriftsartikel (refereegranskat)abstract
- Adverse health care events are a global public health issue despite major efforts, and they have been acknowledged as a complex concern. The aim of this study was to explore the construction of unsafe care using accounts of adverse events concerning the patient, as reported by patients, relatives, and health care professionals. Twenty‐nine adverse events reported in an acute care setting in a Swedish university hospital were analyzed through discourse analysis, where the construction of what was considered to be real and true in the descriptions of unsafe care was analyzed. In the written reports about unsafe events, the patient was spoken of in three different ways: (a) the patient as a presentation of physical signs, (b) the patient as suffering and vulnerable, and (c) the patient as unpredictable. When the patient's voice was subordinate to physical signs, this was described as being something that conflicted with patient safety. The conclusion was that the patient's voice might be the only sign available in the early stages of adverse events. Therefore, it is crucial for health care professionals to give importance to the patient's voice to prevent patients from harm and not unilaterally act only upon abnormal physical signs.
|
|
| 33. |
- Ingadottir, B., et al.
(författare)
-
Patients are expecting to learn more: A longitudinal study of patients with heart failure undergoing device implantation
- 2020
-
Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 103:7, s. 1382-1389
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the educational expectations and experiences of patients with heart failure in relation to device implantation. Methods: In this longitudinal study, patients at six Swedish and Icelandic hospitals answered instruments about their knowledge expectations, before the device implantation, and about the knowledge they had received at two weeks, six months and 12 months after the procedure. Predictors for fulfillment of knowledge expectations were assessed with linear mixed model analysis. Results: Patients (N = 133, mean age 69.8 (±9.7) years, 80 % men) had high knowledge expectations, which for 83 % of them were unfulfilled. Predictors for fulfillment of knowledge expectations were access to knowledge from healthcare professionals (β 0.74, 95 % CI: 0.42–1.10), educational level (β −0.30, 95 % CI: −0.52 to −0.07) and knowledge expectations (β -1.03, 95 % CI: −1.30 to −0.80). Healthcare professionals were the main information source (89 %), 74 % of patients received written information, and 19 % had used the Internet. Conclusions: Patients receive less knowledge than they expect, and individual factors and communication with healthcare professionals are related to their experience. Face-to-face is the most common method of delivering education. Practice implications: Healthcare professionals should assess patients’ expectations for information and consider implementing more diversity in their educational practices. © 2020 Elsevier B.V.
|
|
| 34. |
- Jansson, Inger, 1964, et al.
(författare)
-
Documentation of person-centred health plans for patients with acute coronary syndrome.
- 2018
-
Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 17:2, s. 114-122
-
Tidskriftsartikel (refereegranskat)abstract
- Personalised care planning is argued for but there is a need to know more about what the plans actually contain.To describe the content of person-centred health, plans documented at three healthcare levels for patients with acute coronary syndrome.Patients with acute coronary syndrome aged under 75 years and admitted to two coronary care units at a university hospital were enrolled in the study. This retrospective descriptive study documented 89 person-centred health plans at three healthcare levels: hospital, outpatient and primary care. In total, 267 health plans were reviewed and a quantitative content analysis conducted. The health plans included commonly formulated goals, patients' own resources and support needed.The health plan goals were divided into three categories: lifestyle changes, illness management and relational activities. The most frequently reported goal for better health was increased physical activity, followed by social life/leisure activities and return to paid professional work. In order to reach the goals, patients identified three ways: own resources, family and social support and healthcare system, in total three categories. The most frequently reported own capability was self-motivation. Spouses and children were important sources of family and social support. The most frequently reported healthcare support was cardiac rehabilitation.In traditional care and treatment plans devised by health professionals, patient goals often comprise behavioural changes. When patients identify their own goals and resources with the help of professionals, they include maintaining social relations and being able to return to important activities such as work.
|
|
| 35. |
- Jarebrant, Caroline, et al.
(författare)
-
Ergonomic Value Stream Mapping (ErgoVSM). Tool and User Guide.
- 2016
-
Ingår i: Nordic Council of Ministers, ANP 2016:731. - : Nordic Council of Ministers. ; :APN 2016:731
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Recent years Lean Production (”Lean”) has become a prevalent rationalization strategy in healthcare to create more efficient value streams. Research shows that this often results in impaired Ergonomics, i.e. impaired work content and physical work load (“physical ergonomics”). A common Lean tool used to rationalize value streams in healthcare is Value Stream Mapping (VSM). An ergonomic “add-in module” Ergonomic Value Stream Mapping (ErgoVSM) – has therefore been developed to be used as an integrated part of VSM in the analysis of value streams in healthcare. ErgoVSM as well as VSM are participative tools. All occupational groups performing tasks directly related to the investigated value stream should be represented when using the tool. This Guide includes description of methods and assessment templates for physical ergonomics and work content. An initial version of ErgoVSM for manufacturing industry was developed in Sweden. Later, this was further developed for the health-care sector. This tool was then evaluated in a Nordic Multicenter Study by national projects in Sweden, Denmark and Iceland. The Nordic evaluation showed that using the ErgoVSM tool may result in more focus on ergonomics in the Action Plans compared to just using VSM. This is obtained without jeopardizing performance aspects. Based on the field experiences from the Nordic Multicentre Study I, the ErgoVSM tool was further developed, resulting in this present English version.
|
|
| 36. |
- Jarebrant, Caroline, et al.
(författare)
-
Framtidens VårdArbete. Proaktivt förändringsarbete för hållbart arbetsliv
- 2014
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Projektets övergripande hypotes utgår från att riskfaktorer för mental och fysisk ohälsa kan minskas, genom att arbetsmiljöarbetet integreras i utvecklings- och effektiviseringsarbetet. Verktyget Ergonomisk VärdeFlödesAnalys (ErgoVFA) har vidareutvecklats för att stödja förändringsprocessen. Tre vårdenheter arbetade med ErgoVFA (värdeflödesanalys med arbetsmiljöperspektiv) och två använde traditionell värdeflödesanalys (VFA). Ett gemensamt tillvägagångssätt tillämpades men där förändringsprocessen utgick från respektive vårdenhets behov och förutsättningar. Handlingsplanerna (central del i processen) innehöll mellan åtta och 39 förändringsförslag. Handlingsplanerna tyder på att ErgoVFA genererar fler förslag än traditionell VFA. Effektivitet beaktas i lika omfattning. ErgoVFA tenderar att i högre grad fokusera den psykosociala arbetsmiljön. När endast patientkvalitet prioriteras, noteras risker för försämringar i arbetsmiljön. Resultaten tyder på att ErgoVFA jämfört med VFA medför effekter på förändringsarbetet som skulle kunna leda till högre grad av organisatorisk hållbarhet. Beträffande upplevd förändring under projekttiden visade resultaten att ErgoVFA-enheterna upplevde den ”psykosociala arbetsmiljön” som signifikant bättre jämfört med VFA-enheterna. I projektet framkommer att ErgoVFA skapar engagemang och ger möjlighet till helhetslösningar. En arena för kommunikation skapas, där kontinuitet i analysarbetet över tid möjliggörs. ErgoVFA har vidareutvecklats där arbetsgången förtydligats och verktyget som ett processinstrument betonas. I vidareutvecklingen har förenkling av handledningstext och bedömningsmallar eftersträvats.
|
|
| 37. |
- Johansson Hanse, Jan, 1954, et al.
(författare)
-
Leader-Member Exchange (LMX) and Psychosocial Factors at Work Among Healthcare Professionals
- 2014
-
Ingår i: Journal of Nursing and Care. - : OMICS Publishing Group. - 2167-1168. ; 3:5
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: The study aims to examine the associations between leader–member exchange (LMX) and psychosocial factors at work. Methods: A questionnaire-based cross-sectional study was undertaken at four units in two not-for-profit hospitals in southwestern Sweden. The study sample included 240 employees. Results: Significant correlations were found between LMX items and most of the psychosocial domains and dimensions. The strongest correlations were found between the LMX item affect and rewards/recognition, role clarity and predictability, and the LMX item loyalty and rewards/recognition. In sum, high-quality LMX was associated with good psychosocial work conditions experienced by the employees. Conclusions: The results support possible ways for managers and employees to strengthen their relationships and this may in turn lead to more sustainable systems in health care.
|
|
| 38. |
- Johansson Hanse, Jan, 1954, et al.
(författare)
-
Optimering av handlingsplaner för utveckling av hållbara arbetsprocesser inom vården
- 2014
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Det övergripande syftet med projektet var att skapa bättre förutsättningar för att kombinera effektiva flöden och en god arbetsmiljö bland anställda inom sjukvården. I projektet studerades vad som har betydelse i selektionsprocessen av lösningsförslag fram till handlingsplan vid användning av Ergonomisk VärdeFlödesAnalys (ErgoVFA), dvs. värdeflödesanalys med integrerat arbetsmiljöperspektiv. Tre vårdenheter ingick i projektet. Tillvägagångssättet vid vårdenheterna var att identifiera ett flöde i sin verksamhet, genomföra analys av det valda flödet med hjälp av ErgoVFA, ta fram lösningsförslag och upprätta en handlingsplan och implementera. Datainsamling skedde med hjälp av intervjuer med vårdenhetschefer och analysgrupper. Syftet med intervjuerna var att få en förståelse för val av flöde, problemidentifiering samt eventuella selektionsmekanismer från lösningsförslag fram till handlingsplan. Dessutom ställdes intervjufrågor utifrån ledarskapsteorin ”servant leadership” när det gäller dialogen och samspelet mellan vårdenhetschefen och medarbetarna under förändringsprocessen. Resultaten indikerar, när det gäller den initiala selektionsprocessen av lösningsförslag, att det är viktigt att det finns en öppenhet och delaktighet på vårdenheten där ledningen uppmuntrar sina medarbetare att komma med nya idéer (”empowerment”). När det gäller faktorer som har betydelse för hur goda idéer på bästa möjliga sätt når fram till handlingsplanen visar resultaten att det är viktigt med en förankring hos ledningen. Med ErgoVFA visualiseras problem för olika yrkeskategorier och på så vis skapas transparens i organisationen. Resultat från vårdenheterna vittnar också om betydelsen av att ha en långsiktig vision (”stewardship”) för att medarbetarnas idéer ska nå fram till handlingsplaner.
|
|
| 39. |
- Johansson Hanse, Jan, 1954, et al.
(författare)
-
The impact of servant leadership dimensions on leader–member exchange among health care professionals
- 2016
-
Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 24:2, s. 228-234
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of the current study was to investigate the impact of servant leadership dimensions on leader–member exchange (LMX) among health-care professionals. Background: Leadership support and the quality of the dyadic relationship between the leader and the employee are essential regarding the work environment and turnover intentions in health care. Method: A questionnaire-based cross-sectional study was undertaken at four hospital units in Sweden. The study sample included 240 employees. Results: Significant bivariate correlations were found between all servant leadership dimensions and LMX. The strongest correlations were found between ‘humility’ and LMX (r = 0.69, P < 0.001), and ‘empowerment’ and LMX (r = 0.67, P < 0.001). The hierarchical regression analyses indicated that ‘empowerment’, ‘humility’ and ‘stewardship’ explained about 55% of the variance in LMX. Conclusion: In our study servant leadership dimensions were strongly related to LMX. Implications for nursing management: The results identify specific servant leadership dimensions that are likely to be useful for developing a stronger exchange relationship between the leader (e.g. nursing manager) and individual subordinates in health care.
|
|
| 40. |
- Oxelmark, Lena, et al.
(författare)
-
Patients prefer clinical handover at the bedside; Nurses do not: Evidence from a Discrete Choice Experiment
- 2020
-
Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489. ; 105:May
-
Tidskriftsartikel (refereegranskat)abstract
- Background Shift-to-shift bedside handover is advocated as a patient-centred approach, yet its enactment is challenging. Objectives To describe and compare the preferences of both patients and nurses in the implementation of bedside handover in a Swedish University Hospital. Design A discrete choice experiment (DCE) survey. Settings University setting, four medical wards in two hospitals. Participants Adult medical patients (n=218) and registered nurses (n=101) Methods The survey was administered by an electronic tablet-assisted face-to-face survey. Respondents made repeated choices between two hypothetical bedside handover alternatives and a third alternative of ‘handover away from the bedside’. Handover alternatives were described according to six attributes: invitation to participate, number of nurses present at the handover, family member, carer or trusted friend (of the patient) allowed to be present, level of (patient) involvement, what information related to your (patient) care is discussed. Choice data were analysed using a mixed logit model. Results A total of 1308 (patients) and 909 (nurses) choice observations were included in the preference models. Patients showed a strong preference for handover at the bedside compared to nurses. Nurses generally preferred handover away from the bedside. Patients perceived their level of involvement in handover as highly important, being able to speak, hear what was said being the most important characteristic, closely followed by being invited to participate and asked questions as well as being heard. Nurses considered patients being invited to participate most important, followed by level of involvement. Different options for handing over sensitive information were not perceived of importance by patients or nurses. There was substantial variation at the individual level across both patients and nurses for where and how handover is delivered. Conclusions In this study, patients strongly preferred handover at the bedside, while the nurses considered patients to be invited to participate to be the most important preference but generally preferred handover to take place away from the bedside, all else equal. When implementing bedside handover in a Swedish context this must be considered, although participation is a prerequisite for bedside handover. Differences between patients and nurses’ preferences could jeopardize future introduction of bedside handover in Swedish health care, and might explain why bedside handover is still not very common in hospital wards.
|
|
| 41. |
- Oxelmark, Lena, et al.
(författare)
-
Registered Nurses' experiences of patient participation in hospital care: Supporting and hindering factors patient participation in care
- 2018
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 32:2, s. 612-621
-
Tidskriftsartikel (refereegranskat)abstract
- © 2017 Nordic College of Caring Science. Background: Promoting patient participation in care is an international priority identified by the World Health Organization and various national bodies around the world and an important aspect of person-centred care. Aim: The aim of this study was to describe Registered Nurses' experiences with patient participation in nursing care including their barriers and facilitators for participation. Method: The study setting was a University Hospital in Sweden. Interviews were conducted with twenty Registered Nurses working at medical wards in 2013. Thematic data analysis was used to analyse the transcribed interview data. Results: Twenty nurses from four wards in two hospitals were included. Five themes emerged from the analysis including listening to the patient, engaging the patient, relinquishing some responsibility, sharing power and partnering with patients. The core theme 'partnering with patients' was enacted when nurses listened to and engaged patients and when they relinquished responsibility and shared power with patients. In addition, hindering and facilitating factors to participation were identified, such as patients wanted to take on a passive role, lack of teamwork which participants understood would enhance interprofessional understanding and improve patient safety. Patient participation was hindered by medical jargon during the ward round, there was a risk of staff talking over patients' heads but sometimes inevitable having conversations at the patient's bedside. However, nurses preferred important decisions to be made away from bedside. Conclusions: It all came down to partnering with the patient and participants described how they made an effort to respect the patients' view and accept patient as a part of the care team. Identified hindering factors for participation were lack of teamwork, patients' taking on passive roles and communication during ward rounds having conversations at the patient's bedside. Nurses wished for a change but lacked strategies on how. Nurses preferred important decisions to be made away from bedside.
|
|
| 42. |
- Ringdal, Mona, 1955, et al.
(författare)
-
Patient preferences for participation in patient care and safety activities in hospitals
- 2017
-
Ingår i: Bmc Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 16
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Active patient participation is a patient safety priority for health care. Yet, patients and their preferences are less understood. The aim of the study was to explore hospitalised patients' preferences on participation in their care and safety activities in Sweden. Methods: Exploratory qualitative study. Data were collected over a four-month period in 2013 and 2014. Semi-structured interviews were conducted with 20 patients who were admitted to one of four medical wards at a university hospital in Sweden. Data were analysed using thematic analysis. Results: Nine men and eleven women, whose median age was 72 years (range 22-89), were included in the study. Five themes emerged with the thematic analysis: endorsing participation; understanding enables participation; enacting patient safety by participation; impediments to participation; and the significance of participation. This study demonstrated that patients wanted to be active participants in their care and safety activities by having a voice and being a part of the decision-making process, sharing information and possessing knowledge about their conditions. These factors were all enablers for patient participation. However, a number of barriers hampered participation, such as power imbalances, lack of patient acuity and patient uncertainty. Patients' participation in care and patient safety activities seemed to determine whether patients were feeling safe or ignored. Conclusion: This study contributes to the existing literature with fundamental evidence of patients' willingness to participate in care and safety activities. Promoting patient participation begins by understanding the patients' unique preferences and needs for care, establishing a good relationship and paying attention to each patient's ability to participate despite their illness.
|
|
| 43. |
|
|
| 44. |
- Rosengren, Kristina, et al.
(författare)
-
Characteristic of person-centered care as documented in medical records at a medical department – a mixed methods.
- 2019
-
Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 8:2, s. 7-13
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Few studies describe characteristics of content of person-centrered care (PCC) in hospital care. Therefore, this study aim to describe and compare documentation in medical records regarding content of PCC for two diagnostic groups; Chronic Obstructive Pulmonary Disease (COPD) and Chronic Heart Failure (CHF) at a medical department in a hospital in Sweden.Methods: Documentation within medical records (n = 121) regarding content of PCC (patient resources, responsibility, i.e. partnership) were analysed by a mixed methods.Results: The results describe documented healthcare activities (medical records) among patients (COPD1 = 88; CHF2 = 33) treated at medical wards practicing PCC (n = 69, 391/302) and traditional medical wards (n = 52, 491/32). The study showed limited documentation in all medical records regardless of care; however, patients with CHF have higher documentation regarding content of PCC compare to COPD in 6 (symptoms, home situation, objectives, caring activities, patients resources, continuing care) out of 7 areas (planning processes).Conclusions: To improve healthcare with limited resources, there is need to switch mind-sets from what (diagnosis) to who (resources) using all evidence (expert=scientific to expert=lived experiences) by collecting narratives to facilitate mutual health plans (partnership). This change in healthcare organisation facilitates by transformative and shared leadership to improve teamwork (health professionals, patient, relative) in partnership with all involved.
|
|
| 45. |
- Ulin, Kerstin, 1963, et al.
(författare)
-
Flip focus and emphasise patient resources in person-centred care over the telephone-A retrospective descriptive study
- 2023
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 37:3, s. 797-804
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: The study aim was to describe the content of person-centred health plans, formulated via telephone conversations between registered nurses and patients with chronic obstructive pulmonary disease and/or chronic heart failure. Method: Patients who had been hospitalised due to worsening chronic obstructive pulmonary disease and/or chronic heart failure were enrolled. After hospital discharge, the patients received a person-centred telephone support where a health plan was co-created with registered nurses who had received training in the theory and practice of person-centred care. A retrospective descriptive review of 95 health plans using content analysis was conducted. Results: The health plan content revealed personal resources such as optimism and motivation in patients with chronic obstructive pulmonary disease and/or chronic heart failure. Although patients reported severe dyspnoea symptoms, the most common goals were to engage in physical activity and to be able to manage social life and leisure activities. Additionally, the health plans illustrated that patients were capable of using their own interventions to reach their goals rather than accessing municipal and health care support. Conclusion: The focus on listening, that person-centred telephone care affords, promotes the patient's own goals, interventions, and resources, which can be used to tailor support and engage the patient as an active partner in their care. The flipped focus from patient to person highlights the person's own resources, which in turn may contribute to a reduced need for hospital care.
|
|
| 46. |
|
|
| 47. |
|
|
| 48. |
|
|
| 49. |
- Ulin, Kerstin, 1963, et al.
(författare)
-
What Is Known About the Benefits of Patient-Centered Care in Patients with Heart Failure.
- 2015
-
Ingår i: Current heart failure reports. - : Springer Science and Business Media LLC. - 1546-9549 .- 1546-9530. ; 12:6, s. 350-359
-
Tidskriftsartikel (refereegranskat)abstract
- Treatment for chronic heart failure (CHF) has improved, and symptom burden has been identified as an important treatment goal. Because patient-centered care may ease the burden, we need to know its benefits for patients with CHF, hence this systematic literature review. We found that one benefit of person-centered care is an increase in quality of life in patients with CHF. Improvements were found in self-care, physical and mental status, health care costs, general uncertainty regarding illness and recovery, patient dignity, treatment, and systems of care. Improvements also were observed in symptom burden, self-efficacy, and quality of life. These findings indicate that person-centered care is a powerful approach to current and future health care. However, because an appropriate tool to measure person-centered care does not yet exist, it will be a challenge to determine whether the goal has been reached from a long-term and patient perspective.
|
|
| 50. |
- Wallström, Sara, 1982, et al.
(författare)
-
Cohort study of healthcare use, costs and diagnoses from onset to 6 months after discharge for takotsubo syndrome in Sweden.
- 2019
-
Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 9:2
-
Tidskriftsartikel (refereegranskat)abstract
- Little is known about the economic impact of takotsubo syndrome (TS) for patients and the health system after initial discharge from hospital. Therefore, the aim of this study was to describe the healthcare resource use and calculate direct healthcare costs for TS, from hospitalisation to 6months after discharge, and explore the distribution of costs between TS and other diagnoses among patients with TS.Cohort study investigating direct healthcare costs from hospitalisation, open specialised outpatient and primary care. Healthcare resource use during 6months after diagnosis with TS was collected for 58 consecutive patients from the Regional Patient Register. Incidence-based direct healthcare costs, in 2015 values, were calculated using diagnosis-related group weights and unit costs from national statistics on healthcare costs.The mean length of hospital stay was 10.2 days, index 6.4 and re-admissions 3.8 days. The mean number of follow-up encounters per patient was 15.6, of which two-thirds was specialised outpatient and one-third was primary care. This resulted in an average cost of €10 360. Of this, costs of €8026 (77.5%) occurred during encounters for which at least one of the registered conditions was cardiovascular. Costs differed little according to background characteristics.This study shows that patients utilise hospital, specialised outpatient and primary care after discharge for TS. Most direct healthcare costs relate to cardiac diagnoses. Patients with TS would probably benefit from a supportive follow-up programme after discharge from hospital.
|
|
