| 1. |
- Andregard, Anna-Carin, et al.
(author)
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The tortuous journey of introducing the Nurse Practitioner as a new member of the healthcare team : a meta-synthesis
- 2015
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In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 29:1, s. 3-14
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Research review (peer-reviewed)abstract
- The aim of this study was to explore the obstacles to and the opportunities for achieving optimal interprofessional team collaboration with the introduction of the nurse practitioner (NP). A team approach can contribute importantly to sustainable and safe patient care, and NPs have been added to the healthcare team in many countries. Following the international trend towards the development of the acute care NP, the role has recently been initiated in surgical care in Sweden. The introduction of an advanced nursing role into existing organisations raises questions about how the role will be developed and what its effects will be on collaboration between the different professions. We conducted a systematic review of qualitative studies using the meta-ethnographic approach developed by Noblit and Hare. Literature in the field of nursing was searched on PubMed and CINAHL, and empirical qualitative studies from outpatient and inpatient care in seven countries were included. The studies were appraised according to national guidelines and templates and were analysed and synthesised according to the meta-ethnographic approach. A total of 26 studies were included in the synthesis. The analysis revealed four themes: (i) a threat to professional boundaries, (ii) a resource for the team, (iii) the quest for autonomy and control, and (iv) necessary properties of a developing interprofessional collaboration. Based on these themes, the synthesis was created and presented as a metaphorical journey. The implementation of a new nursing role in a traditional healthcare team is a complex process influenced by many factors and can be described as a tortuous journey towards a partially unknown destination. The synthesised obstacles and opportunities drawn from international studies may help healthcare organisations and new NPs prepare for, and optimise, the implementation of a new nursing role.
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| 2. |
- Athlin, Åsa Muntlin, et al.
(author)
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Lack of existing guidelines for a large group of patients in Sweden : a national survey across the acute surgical care delivery chain
- 2017
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In: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 23:1, s. 89-95
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Journal article (peer-reviewed)abstract
- Rationale, aims and objectivesEvidence-informed healthcare is the fundament for prac-tice, whereby guidelines based on the best available evidence should assist health profes-sionals in managing patients. Patients seeking care for acute abdominal pain form acommon group in acute care settings worldwide, for whom decision-making and timelytreatment are of paramount importance. There is ambiguity about the existence, use andcontent of guidelines for patients with acute abdomen. The objective was to describe andcompare guidelines and management of patients with acute abdomen in different settingsacross the acute care delivery chain in Sweden.MethodA national cross-sectional design was used. Twenty-nine ambulance stations, 17emergency departments and 33 surgical wards covering all six Swedish health regions wereincluded, and 23 guidelines were quality appraised using the validated Appraisal of Guide-lines for Research & Evaluation II tool.ResultsThere is a lack of guidelines in use for the management of this large group of pa-tients between and within different healthcare areas across the acute care delivery chain.The quality appraisal identified that several guidelines were of poor quality, especiallythe in-hospital ones. Further, range orders for analgesics are common in the ambulance ser-vices and the surgical wards, but are seldom present in the emergency departments. Also,education in pain management is more common in the ambulance services. Thesefindingsare noteworthy as, hypothetically, the same patient could be treated in three different waysduring the same care episode.ConclusionsThere is an urgent need to develop high-quality evidence-based clinicalguidelines for this patient group, with the entire care process in focus
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| 3. |
- Avallin, Therese, 1982-
(author)
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Achieving person-centred pain management for the patient with acute abdominal pain : Guided by the Fundamentals of Care framework
- 2022
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of this thesis is to explore how to achieve and measure person-centred pain management (PCPM) for the patient with acute abdominal pain (AAP) in acute surgical care. The Fundamentals of Care (FoC) framework guides all studies.The methods: In Study I, focused ethnography is used with 92h of participant observations (n=34) at the emergency department (n=1) and surgical wards (n=2), including 261 patient–provider interactions. In Study II, case study is used for secondary analysis of 20 observations from Study I. In Study III, a questionnaire is developed in a systematic process to measure PCPM, performed by combining; a validated questionnaire, theoretical and empirical evidence. The questionnaire is tested by question appraisal, theoretical experts (n=2), patients (n=5) and providers (n=5), and thereafter by patients (n=100) at surgical wards (n=4). In Study IV, a qualitative systematic review is performed with a synthesis by thematic analysis, to test and refine a model for PCPM from Study I. The synthesis includes 15 qualitative studies representing patients (n=495) and/or nurses (n=259) from n= 3 emergency departments and n=17 hospital wards in n=9 countries. The patients are ≥ 18 years old, with AAP (Studies I-IV), or acute pain from surgery (Study IV). The results confirms that the patient still suffer from unmanaged pain in acute surgical care, and presents actions on behalf of the patient and provider, and contextual factors including the organizational culture, to achieve and measure PCPM. The studies presents a model for PCPM from the patient perspective (Study I), patient-provider communications contributing to meeting fundamental care needs (Study II), an initially feasible and valid questionnaire to measure PCPM (Study III), and a tested and refined model for PCPM from the patient and nurse perspective (Study IV). Conclusion: This thesis presents scientific evidence providing an in-depth understanding of what is important for successful pain management from the patient’s and nurses’ perspectives, how these parts are interconnected, and how they can be achieved and measured. The results also show the feasible role of communication in meeting the patient’s fundamental care needs. This evidence is suggested to be tested and evaluated in clinical practice to perform PCPM, relieving the patient from pain.
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| 4. |
- Avallin, Therese, et al.
(author)
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Measuring person-centred pain management : Development of a questionnaire using the Fundamentals of Care framework
- 2023
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In: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 79:10, s. 3923-3934
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Journal article (peer-reviewed)abstract
- Aim: To develop and test a questionnaire using the Fundamentals of Care framework to measure person-centred pain management.Design: Cross-sectional exploratory descriptive design.Methods: Development in three phases: (a) literature search for questionnaires measuring person-centred pain management, (b) seven-step process developing items using thematic analysis, (c) initial feasibility and validity testing. Theoretical and empirical evidence was used, including the 'Strategic and Clinical Quality Indicators in Postoperative Pain management' questionnaire, the Fundamentals of Care framework and person-centredness principles. Theoretical experts (n = 2) reviewed the questionnaire, further evaluated by providers (n = 5) and patients (n = 5) using a think-aloud process, and by additional questions in the questionnaire answered by n = 100 patients. The questionnaire was tested February to March 2021, at four surgical wards in a university hospital.Results: The evaluation showed initial support for feasibility and validity, and the questionnaire was found to represent and be sensitive to capture the patients' experiences of person-centred pain management and being easy to answer. The 100 patients with acute abdominal pain who answered the questionnaire (aged 18-89 years, 46 women and 54 men), identified missing elements of fundamental care in their pain management, indicating that the questionnaire is sensitive to capture specific areas for improvement.Conclusion: This first attempt at transforming the essential components of person-centred pain management into measurable items in a questionnaire was found promising. The questionnaire is suggested to be further tested for psychometric properties and patient benefit to provide clinical guidance in acute surgical care to meet the patient care need of pain management.Implications for the profession and/or patient care: The developed questionnaire addresses the need of nurses and nursing leaders to evaluate the delivery of person-centred pain management in acute surgical care, to relieve the patient from pain.Patient or public contribution: Patients and providers were involved in testing the questionnaire.
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| 5. |
- Avallin, Therese, et al.
(author)
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Person-centred pain management for the patient with acute abdominal pain : An ethnography informed by the Fundamentals of Care framework
- 2018
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In: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 74:11, s. 2596-2609
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Journal article (peer-reviewed)abstract
- Aims: To explore and describe the impact of the organizational culture on and the patient-practitioner patterns of actions that contributes to or detract from successful pain management for the patient with acute abdominal pain (AAP) across the acute care pathway.Background: Although pain management is a recognized human right, unmanaged pain continues to cause suffering and prolong hospital care. Unanswered questions about how to successfully manage pain relate to both organizational culture and individual practitioners' performance.Design: Focused ethnography, applying the Developmental Research Sequence and the Fundamentals of Care framework.Methods: Participant observation and informal interviews (92hr) were performed at one emergency department (ED) and two surgical wards at a University Hospital during April-November 2015. Data include 261 interactions between patients, aged 18years seeking care for AAP at the ED and admitted to a surgical ward (N=31; aged 20-90years; 14 men, 17 women; 9 with communicative disabilities) and healthcare practitioners (N=198).Results: The observations revealed an organizational culture with considerable impact on how well pain was managed. Well-managed pain presupposed the patient and practitioners to connect in a holistic pain management including a trustful relationship, communication to share knowledge and individualized analgesics.Conclusions: Person-centred pain management requires an organization where patients and practitioners share their knowledge of pain and pain management as true partners. Leaders and practitioners should make small behavioural changes to enable the crucial positive experience of pain management.
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| 6. |
- Avallin, Therese, et al.
(author)
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Testing a model for person-centred pain management : A systematic review and synthesis guided by the Fundamentals of Care framework
- 2023
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In: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 32:19-20, s. 6811-6832
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Journal article (peer-reviewed)abstract
- AimsTo test a model for person-centred pain management using qualitative evidence in the literature and refine it based on the results.DesignA qualitative systematic review with thematic synthesis using the Fundamentals of Care framework.Methods and Data SourcesA literature search in February 2021 in six scientific databases: CINAHL, PsycInfo, Pubmed, Scopus, Social Science Premium Collection and Web of Science, reported using ENTREQ and PRISMA. Quality assessment was performed for the individual studies. Thematic analysis and the GRADE-CERQual approach were used in the synthesis including the assessment of confidence in the evidence.ResultsThe model was tested against the evidence in 15 studies appraised with moderate or high quality and found represented in the literature but needed to be expanded. A refined model with a moderate/high confidence level of evidence presents elements to be used in a holistic care process; The nurse is guided to establish a trusting relationship with the patient and enable communication to identify and meet pain management needs using pharmacological and non-pharmacological management. Nurse leaders are guided to support this process by providing the right contextual conditions.ConclusionsThe strengths of the confidence level in the refined model, and that it is represented from the nurse and patient perspectives in nursing research across countries and cultures, support our recommendation for empirical evaluation.Implications for the Profession and/or Patient CareThe model links the knowledge of pain management elements from individual studies together into actions to be performed in clinical practice. It also outlines the organizational support needed to make this happen. Nurses and nursing leaders are suggested to test the model to implement person-centred pain management in clinical practice.Patient or Public ContributionNo patient or public contribution.ImpactWhat Problem Did the Study Address? There is a need to transfer available evidence of person-centred pain management into practice to relieve the patient from pain. What Were the Main Findings? Person-centred pain management is of high priority for patients and nurses around the world and can be performed in a holistic care process including patient–nurse trust and communication, supported by contextual conditions to deliver timely pharmacological and non-pharmacological pain management addressing the patient's physical, psychosocial and relational care needs. Where and on Whom will the Research Have an Impact? The model is to be tested and evaluated in clinical practice to guide the providers to relieve the patient from pain.Reporting MethodRelevant EQUATOR guidelines were used to report the study: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.
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| 7. |
- Avallin, Therese, et al.
(author)
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Using communication to manage missed care : A case study applying the Fundamentals of Care framework
- 2020
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In: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 28:8, s. 2091-2102
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Journal article (peer-reviewed)abstract
- AimTo explore, through the patient's perspective, how patient–provider communication is linked to missed nursing care vs. meeting patients’ fundamental care needs.BackgroundMissed nursing care causes severe consequences for patients. Person-centred fundamental care, in which communication is central, provides an approach to manage this challenge. However, the specific patient–provider communications linked to care outcomes are unknown.MethodsCase study using secondary analysis of observations and interviews. A purposeful sample of 20 patients with acute abdominal pain collected using ethnographic methodology at one emergency department and two surgical wards. The Fundamentals of Care framework guided the analysis.ResultsCommunications that included the patient as an equal member of the care team were observed to make a difference between adequate and missed nursing care. Four categories were identified: interpersonal respect, humanized context of care, available and accessible communication channels, and mutual holistic understanding of the care needs and care plan.ConclusionCommunication can be an essential tool to avoid missed nursing care and address the critical need for nursing managers to restore the fundamentals of care.Implications for Nursing ManagementNursing managers can use this new knowledge of communication to facilitate person-centred fundamental care and thereby avoid missed nursing care.
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| 8. |
- Bernhoff, Karin, et al.
(author)
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Patient Experiences of Life Years After Severe Civilian Lower Extremity Trauma With Vascular Injury
- 2016
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In: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 52:5, s. 690-695
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Severe lower limb trauma with arterial injury is often devastating for the individual. Many studies describe how to manage these injuries when they occur. Short-term functional outcome is quite well described, but the patients are often young, and their suffering is physical, mental, and social from a lifelong perspective. The aim of this study was to report patient experiences of their lives several years after their accidents, and to explore mechanisms of how to improve management.METHOD: The Swedvasc registry was searched for participants from 1987 to 2011, living in the region of Uppsala, Sweden. Some amputated participants were added from the Walking Rehabilitation Center. There were five reconstructed patients with an intact limb, and three with amputations. In depth interviews were conducted and systematically analyzed, using A Giorgi's descriptive phenomenological method.RESULTS: Eight patients participated, five with reconstructed and three with amputated limbs. Life affecting functional impairments were described by all patients. The patients undergoing amputation had received more structured follow up and support through the Walking Rehabilitation Center. The satisfaction with the cosmetic result was poorer than expected. All patients had developed strategies of how to cope with their impairments and stated they now lived "normal lives."CONCLUSIONS: Despite substantial physical, psychological, and cosmetic impairments years after severe lower limb trauma, the participants described life as "normal" and mainly satisfactory. Transition to the new situation could have been facilitated by more frequent and continuous follow up after discharge from hospital, in particular among the non-amputated patients who tend to be lost to follow up. Findings also indicate that family members have to be acknowledged, strengthened, and supported.
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| 9. |
- Donnelly, Frank, et al.
(author)
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The management of patients with acute abdominal pain in the emergency department : A qualitative study of nurse perceptions
- 2019
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In: AUSTRALASIAN EMERGENCY CARE. - : ELSEVIER SCI LTD. - 2588-994X. ; 22:2, s. 97-102
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Journal article (peer-reviewed)abstract
- Background: Acute abdominal pain is a common reason for presentation to the emergency department. Understanding the role of nurses involved in management of acute abdominal pain is important for improving patient care and outcomes. The aim of this study was to understand the perceptions of emergency nurses in the management of acute abdominal pain. Methods: Using a qualitative design, a purposeful sample (n=9) of experienced registered nurses was recruited from the emergency department of a large tertiary public hospital in South Australia. Semi-structured interviews, informed by literature describing the management of acute abdominal pain, were used to identify the perceptions of emergency nurses when caring for patients with acute abdominal pain. Results: Thematic analysis of interviews identified four themes: Centrality of Diagnosis; Busyness and Patient Management; Systems Issues; and Communication Challenges. Of the four themes, the Centrality of Diagnosis was especially important to the nurses' sense of contribution to patient care. Care was also affected by the busyness of the environment, the systems and processes in place to manage patients and communication in the emergency department. Conclusions: The management of patients with acute abdominal pain is influenced by how nurses participate in the diagnostic process. Nurses identified their role in this process and described how this role impacted their delivery of fundamental care. Further studies of the nursing contribution to diagnosis, communication, and the systems that affect care delivery in the emergency department are required.
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| 10. |
- Drott, Jenny, et al.
(author)
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Factors related to a successful professional development for specialist nurses in surgical care: a cross-sectional study
- 2023
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In: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 22:1
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Journal article (peer-reviewed)abstract
- BackgroundA high level of competence among staff is necessary for providing patient-safe surgical care. Knowledge regarding what factors contribute to the professional development of specialist nurses in surgical care and why they choose to remain in the workplace despite high work requirements is needed. To investigate and describe the organizational and social work environment of specialist nurses in surgical care as part of studying factors that impact on professional development.MethodThis was a cross-sectional study with a strategic convenience sampling procedure that recruited 73 specialist nurses in surgical care in Sweden between October to December 2021. The study was guided by STROBE Statement and checklist of cross-sectional studies. The validated Copenhagen Psychosocial Questionnaire was used, and additional demographic data. Descriptive statistics were performed and the comparison to the population benchmarks was presented as the mean with a 95% confidence interval. To study potential differences among the demographic and professional characteristics, pairwise t tests were used with Bonferroni adjustment for multiple comparisons with a significance level of 5%.ResultsFive domains were identified as factors related to success, as they received higher scores in relation to population benchmarks: quality of leadership, variation of work, meaning of work and work engagement as well as job insecurity. There was also a significant association between a having a manager with low nursing education and job insecurity (p = 0.021).ConclusionsQuality of leadership is important for the professional development of specialist nurses in surgical care. Strategic work seems to include managers with a higher nursing education level to prevent insecure professional working conditions.
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