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Edfeldt K, Jangland E, Larsson Ingwall L, Wistedt SM, Gunnarsson AK, Fröjd C. Oral health and oral care in patients in a surgical context: A quantitative study comparing patients' and nurses' assessments. J Clin Nurs 2024; 33:2201-2208. [PMID: 38093514 DOI: 10.1111/jocn.16961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024]
Abstract
AIMS To investigate fundamental care delivery regarding oral care in a surgical context, and to compare patients' self-reported oral health with registered nurse assessments. DESIGN A descriptive and comparative study, with a consecutive selection. METHODS A patient oral health rating tool, including questions about performed oral care, was distributed to patients (n = 50), at four surgical wards in Sweden. The response rate was 72%. Oral health status was assessed by a registered nurse using the Revised Oral Assessment Guide (ROAG), and a comparison between patient and registered nurse assessment was performed by calculating Cohen's kappa coefficient and percentage agreement. RESULTS Patients (38%) reported severe oral symptoms, mostly dry lips and not an adequate amount of saliva, and 80% were not offered help with oral care. ROAG assessments revealed that 74% had problems with oral health. Almost half of the patients (48%) needed assistance with oral care but only 10% received help. Registered nurses assessed the patient's oral health as worse than the patient's self-assessment did. CONCLUSION There are deficiencies in fundamental care delivery regarding oral care in a surgical care context. Oral health assessments need to be performed by registered nurses. Routines for systematic oral assessments and for oral care need to be implemented by nurse managers to ensure that patients' fundamental care needs are fulfilled. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Oral health assessments need to be performed regularly by registered nurses since it is insufficient that patients self-assess their oral health. Nurse managers need to provide and implement routines for nurse assessments and oral care in surgical care contexts. IMPACT There are deficiencies in patients' oral health and oral care, and registered nurses need to perform oral health assessments. Nurse managers need to implement routines for registered nurse assessments and oral care. PATIENT CONTRIBUTION Patients admitted to a surgical ward were included in the study after being screened for inclusion criteria. After participants signed informed consent, they filled in a questionnaire about oral health and oral care, and a registered nurse performed an oral health assessment. REPORTING METHOD This study was carried out according to the STROBE checklist.
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Affiliation(s)
- Katarina Edfeldt
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Linn Larsson Ingwall
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Sandra-Marie Wistedt
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Anna-Karin Gunnarsson
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Camilla Fröjd
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
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Edfeldt K, Nyholm L, Jangland E, Gunnarsson AK, Fröjd C, Hauffman A. Missed nursing care in surgical care- a hazard to patient safety: a quantitative study within the inCHARGE programme. BMC Nurs 2024; 23:233. [PMID: 38584285 PMCID: PMC10999080 DOI: 10.1186/s12912-024-01877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Missed nursing care occurs globally, and the consequences are severe for the patients when fundamental care needs are not fulfilled, nor delivered in a person-centred way. This study aimed to investigate the occurrence and cause of missed nursing care, and the relationship between registered nurses' and nursing assistants' perceptions of missed nursing care, in a surgical care context. METHODS A quantitative study was performed using the MISSCARE survey, measuring missed nursing care and associated reasons, in three surgical wards with registered nurses and nursing assistants as the participants (n = 118), during May-November in 2022. The MISSCARE survey also covers background data such as job satisfaction and intention to leave. The survey was distributed paper-based and the response rate was 88%. RESULTS Aspects of nursing care rated to be missed the most were 'attending interdisciplinary care conferences', 'turning patient every 2 h', 'ambulation 3 times per day or as ordered', and 'mouth care'. Differences between registered nurse and nursing assistant ratings were detected for eight out of 24 items, where registered nurses rated more missed nursing care. The uppermost reasons for missed nursing care were 'inadequate number of staff' and 'unexpected rise in patient volume and/or acuity on the unit'. Registered nurses and nursing assistants rated differently regarding six of 17 items. Almost every fourth staff member (24.6%, n = 29) had the intention to leave within a year in the present department. CONCLUSIONS The occurrence of missed nursing care is frequent in the surgical context, and in combination with a high number of staff members intending to leave their employment, poses a hazard to patient safety. Registered nurses, holding higher educational levels, reported more missed care compared with the nursing assistants. The main reason for missed nursing care was an inadequate number of staff. These findings support a warranted investment in nursing within the organisation. The results can be used to form strategies and interventions, to reduce nurse attrition and optimise competence utilisation, and to achieve safe person-centered fundamental care.
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Affiliation(s)
- Katarina Edfeldt
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.
| | - Lena Nyholm
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Eva Jangland
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Anna-Karin Gunnarsson
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Camilla Fröjd
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Anna Hauffman
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
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Nyholm L, Gunningberg L, Jangland E. Is this to be another project that fizzles out? Using the i-PARIHS framework to evaluate implementation of a mentoring programme. J Adv Nurs 2024. [PMID: 38174632 DOI: 10.1111/jan.16041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
It is well-known that the implementation of evidence into clinical practice is complex and challenging. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework conceptualizes successful implementation of evidence into practice. As the implementation of the mentoring programme proved to be a challenge, it seemed valuable to retrospectively study the implementation process using a framework like the i-PARIHS. AIM The aim of this study was to evaluate implementation of a multifaceted mentoring programme for bedside nurses using the i-PARIHS framework, to identify factors that influenced the implementation. DESIGN A secondary analysis of qualitative data using the i-PARIHS framework as the theoretical lens. METHOD A directed content analysis was performed, driven theoretically by the i-PARIHS framework. The analysis focused separately on (a) characteristics of the innovation and (b) successful and hindering factors in the implementation process. RESULTS The results showed that successful factors influencing implementation of the mentoring programme included supportive and actively involved formal leaders and supervisors at the unit level. A major hindering factor was lack of resources in the form of personnel, time and money. A lack of facilitators, particularly experienced facilitators, throughout the organization hindered implementation. The i-PARIHS framework offered a structured how-to guide to identify factors that influenced the implementation process. CONCLUSION Implementation of the mentoring programme was a challenge for the organization. Investment into implementation should continue, with a more structured facilitation process. A structured and prioritized management system, including supportive leadership at the unit level, should be established by the hospital board. IMPLICATIONS FOR THE PROFESSION There is a need for experienced facilitators throughout the organization. This is crucial to achieve sustainability in the mentoring programme and ensure that the large investments of staff resources and money do not fizzle out. IMPACT What problem did the study address? Implementing a mentoring programme for nurses in a large university hospital proved to be a challenge. Therefore, it seemed valuable to retrospectively study the implementation process using a framework like the i-PARIHS. What were the main findings? A lack of facilitators, particularly experienced facilitators, throughout the organization hindered the implementation. The i-PARIHS framework offered a structured how-to guide to identify factors that influenced the implementation process. Where and on whom will the research have an impact? Our findings are important for leaders on all levels in a hospital setting, including the hospital board, heads of departments and nurse managers. REPORTING METHOD Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups is used. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Lena Nyholm
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
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Avallin T, Muntlin Å, Kitson A, Jangland E. Testing a model for person-centred pain management: A systematic review and synthesis guided by the Fundamentals of Care framework. J Clin Nurs 2023; 32:6811-6831. [PMID: 37245067 DOI: 10.1111/jocn.16770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/25/2023] [Accepted: 05/12/2023] [Indexed: 05/29/2023]
Abstract
AIMS To test a model for person-centred pain management using qualitative evidence in the literature and refine it based on the results. DESIGN A qualitative systematic review with thematic synthesis using the Fundamentals of Care framework. METHODS AND DATA SOURCES A 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. RESULTS The 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. CONCLUSIONS The 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 CARE The 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 CONTRIBUTION No patient or public contribution. IMPACT What 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 METHOD Relevant EQUATOR guidelines were used to report the study: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.
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Affiliation(s)
- Therese Avallin
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Åsa Muntlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Public Health and Caring Sciences/Health Services Research, Uppsala University, Uppsala, Sweden
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Eva Jangland
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
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Avallin T, Jangland E, Kitson A, Muntlin Å. Measuring person-centred pain management: Development of a questionnaire using the fundamentals of care framework. J Adv Nurs 2023; 79:3923-3934. [PMID: 37209376 DOI: 10.1111/jan.15697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 03/21/2023] [Accepted: 04/23/2023] [Indexed: 05/22/2023]
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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Affiliation(s)
- Therese Avallin
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Åsa Muntlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Haakseth L, Öster C, Wanhainen A, Mani K, Jangland E. Patients' health and quality of life after complex endovascular aortic repair: A prospective cohort study. J Vasc Nurs 2023; 41:132-143. [PMID: 37684091 DOI: 10.1016/j.jvn.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 09/10/2023]
Abstract
RATIONALE Complex endovascular aortic repair often involves multiple major procedures over time with a high risk of complications and little time for recovery. This exposes patients to great stress, both physically and mentally, with potentially long-lasting effects. There is limited knowledge about these effects and who is most at risk - information on this could help vascular nurses and other healthcare professionals anticipate and meet care needs. AIM To investigate the health and quality of life effects of complex endovascular aortic repair, in relation to patients' demographic and health characteristics. DESIGN A prospective cohort study. METHODS Patients undergoing elective complex endovascular aortic repair were consecutively recruited from one university hospital during one year (n=25). Self-report questionnaires on health disability (WHODAS 2.0), quality of life (WHOQoL-BREF) and symptoms of anxiety and depression (HADS) were filled out preoperatively and repeated one and six months postoperatively. Prospective changes in health and quality of life, and associations with patient demographics and preoperative health characteristics, were assessed. Ethical approval was obtained prior to study performance. RESULTS Overall, patients had significantly greater health disability at one month (WHODAS 2.0 score median 31.5, range 1.1-63.0) than preoperatively (median 13.6, range 0.0-41.3) (n=22, p=.017); the majority had recovered at six months (median 11.4, range 3.3-58.7) (n=18, p=.042). No significant effects were seen in quality of life and symptoms of anxiety and depression (p>.05). However, the participants showed heterogeneity, with certain individuals not recovered at six months (n=8). Factors associated with worse six-month outcomes were being female, age < 70 years, postoperative complications, and history of anxiety or depression. CONCLUSIONS Complex endovascular aortic repair have limited long-term negative effects on patients' health and quality of life. However, some patients are not recovered at six months postoperatively, which could be explained by individual characteristics. To improve recovery outcomes, vascular nurses and other health care professionals should be aware of the possible recovery trajectories and factors associated with impaired recovery, and use them to anticipate and meet the patients' individual care needs.
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Affiliation(s)
- Linda Haakseth
- Department of Surgical Sciences, Nursing, Uppsala University, Entrance 15, Uppsala University Hospital, Uppsala 75185, Sweden.
| | - Caisa Öster
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing, Uppsala University, Entrance 15, Uppsala University Hospital, Uppsala 75185, Sweden
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Muntlin Å, Jangland E, Laugesen B, Voldbjerg SL, Gunningberg L, Greenway K, Merriman C, Grønkjær M, Heinen M, Huisman-de Waal G. Bedside nurses' perspective on the Fundamentals of Care framework and its application in clinical practice: A multi-site focus group interview study. Int J Nurs Stud 2023; 145:104526. [PMID: 37390582 DOI: 10.1016/j.ijnurstu.2023.104526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND A changing nursing workforce and an increase in demands for care together with more complex care, raise arguments that leading and guiding nursing practice is more challenging than ever. Therefore, nurses need to have a shared agenda and a common language to show the importance of nursing care and the consequences of not addressing this in an appropriate way. In response to this the Fundamentals of Care framework was developed to also contribute to the delivery of person-centred care in an integrated way. However, to gain acceptance and applicability we need to ensure the framework's relevance to clinical practice from bedside nurses' perspectives. OBJECTIVE To describe bedside nurses' perspectives on the Fundamentals of Care framework and how it can be applied in clinical practice. DESIGN A descriptive qualitative design informed by the Fundamentals of Care framework. SETTING(S) The study was undertaken at seven hospitals in Sweden, Denmark and the Netherlands during 2019. PARTICIPANTS A total sample of 53 registered nurses working at the bedside participated. Participants had a wide variety of clinical experience and represented a range of different nursing practice areas. METHODS Twelve focus group interviews were used to collect data and analysed with a deductive content analysis approach. RESULTS Bedside nurses perceived that the Fundamentals of Care framework was adequate, easy to understand and recognised as representative for the core of nursing care. The definition for fundamental care covered many aspects of nursing care, but was also perceived as too general and too idealistic in relation to the registered nurses' work. The participants recognised the elements within the framework, but appeared not to be using this to articulate their practice. Three main categories emerged for implications for clinical practice; guiding reflection on one's work; ensuring person-centred fundamental care and reinforcing nursing leadership. CONCLUSIONS The Fundamentals of Care framework is perceived by bedside nurses as a modern framework describing the core of nursing. The framework was recognised as having clinical relevance and provides bedside nurses with a common language to articulate the complexity of nursing practice. This knowledge is crucial for bedside nurses both in clinical practice and in leadership roles to be able to speak up for the need to integrate all dimensions of care to achieve person-centred fundamental care. Various activities for reflection, person-centred care and leadership to apply the framework in clinical practice were presented, together with minor suggestions for development of the framework. TWEETABLE ABSTRACT Bedside nurses recognise their clinical practice within the Fundamentals of Care framework, showing the core of modern nursing.
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Affiliation(s)
- Åsa Muntlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences/Clinical Epidemiology, Uppsala University, Uppsala, Sweden; College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Brit Laugesen
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Centre for Clinical Guidelines, Aalborg University, Denmark
| | - Siri Lygum Voldbjerg
- Clinical Nursing Research Unit, Aalborg University Hospital, Department of Clinical Medicine, Aalborg University, Denmark; School of Nursing, University College Nordjylland, Denmark
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Kathleen Greenway
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, England, United Kingdom of Great Britain and Northern Ireland.
| | - Clair Merriman
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, England, United Kingdom of Great Britain and Northern Ireland.
| | - Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Department of Clinical Medicine, Aalborg University, Denmark
| | - Maud Heinen
- Radboud University Medical Center, Radboud Institute for Healthcare Sciences, IQ Health, Nijmegen, the Netherlands.
| | - Getty Huisman-de Waal
- Radboud University Medical Center, Radboud Institute for Healthcare Sciences, IQ Health, Nijmegen, the Netherlands.
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Hult A, Lundgren E, Fröjd C, Lindam A, Jangland E. Patient complaints about communication in cancer care settings: Hidden between the lines. Patient Educ Couns 2023; 114:107838. [PMID: 37295042 DOI: 10.1016/j.pec.2023.107838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/16/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate patient complaints in cancer care settings reported to patient advisory committees (PACs) and describe the frequency and content of communication failures across all reports. METHODS Content analysis, with a summative approach, was applied to cancer care complaints (2016-2020) by 692 patients to PACs in one Swedish healthcare region. RESULTS More than half the patients reported communication failures. Patients reported not receiving proper information, not being listened to, and being treated disrespectfully or impersonally. Communication failures occurred in different stages of the patients' cancer care, from diagnostic workup to end-of-life. Compared with the results of the PACs, communication failures were underreported, and were often combined with complaints in other categories. CONCLUSIONS Communication failures are hidden "between the lines" and do not appear clearly in existing reporting systems. Healthcare must utilize the knowledge conveyed by patient complaints and create conditions and environments that support healthcare providers in delivering person-centered care. PRACTICE IMPLICATION A summary picture of patients' complaints in Swedish cancer care is provided. These results could be used to further improve the patient complaint system. Above all, the results could serve as a "wake-up call" about the importance of communication and a valuable resource in improving cancer care.
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Affiliation(s)
- Anna Hult
- Department of Surgical Sciences (EL), Nursing Research (AH, CL, EJ), Uppsala University, Uppsala, Sweden.
| | - Ewa Lundgren
- Department of Surgical Sciences (EL), Nursing Research (AH, CL, EJ), Uppsala University, Uppsala, Sweden
| | - Camilla Fröjd
- Department of Surgical Sciences (EL), Nursing Research (AH, CL, EJ), Uppsala University, Uppsala, Sweden
| | - Anna Lindam
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development, Östersund Hospital, Umeå University, Umeå, Sweden
| | - Eva Jangland
- Department of Surgical Sciences (EL), Nursing Research (AH, CL, EJ), Uppsala University, Uppsala, Sweden
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Drott J, Engström M, Jangland E, Fomichov V, Malmström M, Jakobsson J. Factors related to a successful professional development for specialist nurses in surgical care: a cross-sectional study. BMC Nurs 2023; 22:79. [PMID: 36949475 PMCID: PMC10031911 DOI: 10.1186/s12912-023-01258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/20/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND A 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. METHOD This 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%. RESULTS Five 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). CONCLUSIONS Quality 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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Affiliation(s)
- Jenny Drott
- Division of Nursing Science, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Department of Surgery, Linköping University Hospital, Linköping, Sweden.
| | - My Engström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery Sahlgrenska, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Victoria Fomichov
- Unit for Public Health and Statistics, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Marlene Malmström
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Surgery and Gastroenterology, Skåne University Hospital, Malmö, Sweden
| | - Jenny Jakobsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Jangland E, Gunnarsson AK, Hauffman A, Edfeldt K, Nyholm L, Fröjd C. Effective learning activity to facilitate post-graduate nursing students' utilization of nursing theories - Using the fundamentals of care framework. J Adv Nurs 2023; 79:1082-1093. [PMID: 35352387 DOI: 10.1111/jan.15238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/28/2022] [Accepted: 03/15/2022] [Indexed: 12/29/2022]
Abstract
AIMS To explore how postgraduate nursing students used the Fundamentals of Care framework in a written assignment based on a clinical situation, and describe their learning process in using the framework. DESIGN A qualitative descriptive study design applying the Fundamentals of Care framework. METHODS Postgraduate nursing students' theoretical written assignments (n = 35) based on self-experienced clinical cases were included. The data were collected in 2021 in five specialties in a postgraduate nursing programme in Sweden. The data were analysed using content analysis. RESULTS Applying the framework to a self-experienced clinical case illuminated the importance of nurse-patient relationships and clarified the meaning of person-centred care. The students assessed the framework as easy-to-use bedside as a guide to providing nursing care. By using the framework, the students were aided in reasoning about the fundamental values of care such as ethics, equality in healthcare and patient rights. When students reflected on their learning process, they stated that the assignment taught them how to use the framework, as well as paving the way for finding and applying other theories of nursing. CONCLUSION Learning activities with an opportunity to practice analysing nursing care guided by a theory, combined with a self-evaluating element, are conducive to deepening students' learning and improving their ability to use theories in clinical practice. IMPACT The framework illuminated the importance of the nurse-patient relationship in nursing care to the students and made them recognize and value the clinical use of theories. It is the responsibility of leaders in nurse education and healthcare to provide the next generation of specialist nurses-future nursing leaders-with regular opportunities to analyse nursing care through theories and frameworks. Nurses call for continuous learning on theories; leaders in nurse education and healthcare must meet these needs.
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Affiliation(s)
- Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Anna Hauffman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Katarina Edfeldt
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Nyholm
- Department of Neuroscience, neurosurgery, Uppsala University, Uppsala, Sweden
| | - Camilla Fröjd
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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11
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Muntlin Å, Jangland E. Translation and cultural adaptation of the fundamentals of care framework: Are we there yet? J Adv Nurs 2023; 79:1107-1118. [PMID: 35867344 DOI: 10.1111/jan.15383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 06/10/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Abstract
AIM This paper aims to explore and describe the translation and cultural adaptation of the Fundamentals of Care framework to a Swedish context, and highlight the need for a translated version. DESIGN An exploratory, descriptive approach was adopted. METHODS A structured forward-backward translation process and cultural adaptation were used, considering situation and recipient as recommended for such process. Data such as literature and documents were collected during 2019-2021. The authors took systematic steps in collaboration with a strategic sample of experts: professional language service providers, clinicians, educators and a linguist. RESULTS The framework was mainly translated verbatim. A few fundamental care elements were adjusted to the Swedish language, context and clinical practice. Also, this work clarified the relational elements to be coherently seen as nursing actions. Addressing the need for a translated version was illustrated in activities in research, education and clinical practice. CONCLUSION This paper highlights the importance of translating the Fundamentals of Care framework into a country's native language to gain acceptance and application there. Sharing the framework's translated version impacts nursing science, generating a consistent language in the development and conducting of research for the comparison and transferability or generalizability of findings. Together with a cultural adaptation, the translated framework can support and guide researchers, educators and nursing leaders in articulating fundamental nursing care for enacting change. By disseminating the first Swedish version of the framework we encourage a global discussion and sharing of examples of translation and cultural adaptation by others. IMPACT The framework's English version has limitations in various context. This paper shows a systematic translation and cultural adaptation process of the framework. We proclaim that this is necessary for nursing leaders and nurses to be able to apply it in guiding nursing practice and leading change.
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Affiliation(s)
- Åsa Muntlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences/Clinical Epidemiology, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University, Entrance 15, Uppsala University Hospital, Uppsala, Sweden
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12
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Kitson AL, Conroy T, Jeffs L, Carr D, Huisman-Dewaal GJ, Muntlin A, Jangland E, Grønkjaer M, Parr J. 'No more heroes': The ILC Oxford Statement on fundamental care in times of crises. J Adv Nurs 2023; 79:922-932. [PMID: 36523232 DOI: 10.1111/jan.15533] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
AIM To outline the International Learning Collaborative (ILC) Oxford Statement, explicating our commitment to ensuring health and care systems are equipped to meet patients' fundamental care needs during times of unprecedented crisis. DESIGN/METHOD Discussion paper. The content was developed via a co-design process with participants during the ILC's international conference. KEY ARGUMENTS We, the ILC, outline what we do and do not want to see within our health and care systems when faced with the challenges of caring for patients during global pandemics and other crises. Specifically, we want fundamental care delivery to be seen as the minimum standard rather than the exception across our health and care systems. We want nursing leaders to call out and stand up for the importance of building fundamental care into systems, processes and funding priorities. We do not want to see the voices of nursing leaders quashed or minimized in favour of other agendas. In turn, what we want to see is greater recognition of fundamental care work and greater respect for the people who do it. We expect nurses to have a 'seat at the table' where the key health and care decisions that impact patients and staff are made. CONCLUSION To achieve our goals we must (1) ensure that fundamental care is embedded in all health and care systems, at all levels; (2) build on and strengthen the leadership skills of the nursing workforce by clearly advocating for person-centred fundamental care; (3) co-design systems that care for and support our staff's well-being and which foster collective resilience rather than overly rely on individual resilience; (4) improve the science and methodologies around reporting and measuring fundamental care to show the positive impact of this care delivery and (5) leverage the COVID pandemic crisis as an opportunity for transformational change in fundamental care delivery.
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Affiliation(s)
- Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Lianne Jeffs
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Devin Carr
- Maine Medical Center, Portland, Maine, USA
| | - Getty J Huisman-Dewaal
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Asa Muntlin
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden.,Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Mette Grønkjaer
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg, Denmark
| | - Jenny Parr
- Counties Manukau District Health Board, Auckland, New Zealand
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13
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Jakobsson J, Jangland E, Engström M, Malmström M, Drott J. Work conditions influencing professional development of specialist nurses in surgical care explored using the Job Demand-Resources theory: A qualitative study. J Adv Nurs 2023. [PMID: 36843299 DOI: 10.1111/jan.15618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/12/2023] [Accepted: 02/10/2023] [Indexed: 02/28/2023]
Abstract
AIM The aim of the study was to explore the work conditions that influence the opportunities for professional development of specialist nurses in surgical care. DESIGN A qualitative descriptive design was used. METHODS With a purposeful sampling procedure, 14 specialist nurses in surgical care were included. Four focus-group interviews were conducted during November to December 2021 and deductively analysed using the Job Demand-Resource theory as a guiding framework. Reporting adheres to COREQ guidelines. FINDINGS Work conditions that were identified as job demands and that inhibited nurses' opportunities for professional development were mainly found at an organizational and leadership level. Primarily, those conditions included role ambiguity and time constraints caused by uncompensated nursing shortages that restricted the nurses from exercising their role. Such conditions could also discourage other nurses from further education. Job demands were seen as largely compensated for by work conditions identified as job resources and located mainly at an individual level, for example finding the work interesting and multifaceted. Most prominent was the participants' inner motivation to work with surgical patients and to continue to develop themselves and other nurses professionally. CONCLUSIONS A prerequisite for professional development is that the specialist role is clearly defined in collaboration with representatives from the nursing profession and universities. Hence, hospital organizations need to reflect on how to utilize the competence. Also, it is important that nurse leaders promote the specialist nurses' motivation by supporting them in the exercise of their role. IMPACT Findings from this study revealed work conditions that need to be acknowledged during hospital organizations' endeavours to maintain and enhance nursing competence. PATIENT OR PUBLIC CONTRIBUTION Patient or public contribution was not applicable since the study focused on specialist nurses' working conditions.
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Affiliation(s)
- Jenny Jakobsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - My Engström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Surgery Sahlgrenska, Gothenburg, Sweden
| | - Marlene Malmström
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Surgery and Gastroenterology, Skåne University Hospital, Malmö/Lund, Sweden
| | - Jenny Drott
- Division of Nursing Science, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Surgery, Linköping University Hospital, Linköping, Sweden
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14
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Jangland E, Gunningberg L, Nyholm L. A mentoring programme to meet newly graduated nurses' needs and give senior nurses a new career opportunity: A multiple-case study. Nurse Educ Pract 2021; 57:103233. [PMID: 34678635 DOI: 10.1016/j.nepr.2021.103233] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
AIM To evaluate the implementation of a multifaceted mentoring programme in a large university hospital and describe its value from the perspectives of newly graduated nurses, experienced nurses and the hospital organisation. BACKGROUND Healthcare organisations need long-term competence-planning strategies to retain nurses, prevent their premature departure from the profession and use their competencies. This paper reports a mentoring programme focused on supporting newly graduated nurse' transition to practice and senior nurses' professional development as supervisors. DESIGN A multiple-case study. METHODS We performed 35 interviews with nurses, supervisors and nurse managers in the five units that implemented the programme, mapped the programme at the hospital level and extracted the nurses' working hours. The interviews were analysed thematically using the theoretical lens of the head-heart-hand model to interpret the results. RESULTS Of 46 units in the hospital, 14 had implemented one or several of the components in the mentoring programme. The programme corresponded to the newly graduated nurses' needs, gave senior nurses a new career opportunity and contributed to an attractive workplace. The main theme, Giving new nurses confidence, experienced nurses a positive challenge and the organisation an opportunity to learn, reflects the value of the programme's supervisory model to new and experienced nurses and to the organisation as a whole. CONCLUSION The mentoring programme appeared to be a promising way to smooth the transition for newly graduated nurses. The experienced supervising nurses were key to the success of this complex programme, supporting the new nurses at the bedside and being available to respond to their questions and reflections. Embedding the supervisors in the units' daily practice was necessary to the success of the different parts of the programme. Despite the strategic and well-designed implementation of this mentoring programme aimed to solve the everyday challenge of nurse shortages in the hospital, it was a challenge to implement it fully in all the units studied.
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Affiliation(s)
- Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Entrance 15, SE-751 85 Uppsala, Sweden.
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, SE-751 85 Uppsala, Sweden.
| | - Lena Nyholm
- Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala University Hospital, Entrance 85, SE-751 85 Uppsala, Sweden.
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15
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Hult A, Lundgren E, Jangland E. Patient representatives: Crucial members of health-care working groups facing an uncertain role and conflicting expectations. A qualitative study. Health Expect 2021; 24:1197-1206. [PMID: 33949054 PMCID: PMC8369119 DOI: 10.1111/hex.13249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patient representatives (PRs) have been involved for decades in health-care development, and their participation is increasingly sought in health-care working groups (HCWGs) on every level. However, information on how the role could be further developed and teamwork improved remains sparse. OBJECTIVE To explore the role of patient representatives in clinical practice guideline (CPG) monitoring groups, to describe their contributions and identify possibilities of improvement. DESIGN Qualitative design using semi-structured interviews analysed by content analysis. SETTING AND PARTICIPANTS Interviews were conducted with 11 PRs, 13 registered nurses, and 9 physicians, all members of national committees monitoring CPGs for cancer in Sweden. RESULTS Most participants considered the PR role important but mentioned several problems. PRs' contributions were hampered by uncertainties about their role, the low expectations of other group members and their sense that their contributions were often disregarded. Some professionals questioned whether PRs were truly representative and said some topics could not be discussed with PRs present. CONCLUSION This study highlights the fundamental problems that remain to be solved despite the long involvement of PRs in HCWGs. Even though the PR role and teamwork differed between the groups, most PRs need to be empowered to be actively involved in the teamwork and have their engagement and knowledge fully utilized. Enhancing teamwork through clarifying roles and expectations could lead to more inclusive and equal teams able to work more effectively towards the goal of improving health care. PATIENT OR PUBLIC CONTRIBUTION PRs were information givers in data collection.
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Affiliation(s)
- Anna Hult
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ewa Lundgren
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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16
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Tegelberg A, Muntlin Å, Juhlin C, Jangland E. Engagement under difficult conditions: Caring for patients with acute abdominal pain across the acute-care chain: A qualitative study. Int Emerg Nurs 2020; 52:100910. [PMID: 32827935 DOI: 10.1016/j.ienj.2020.100910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/08/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies report that patients with acute abdominal pain do not always receive optimal care and can experience poor pain management, safety failures, and emotional harm. Deeper understanding of how health professionals experience care delivery is needed to improve care to patients with acute abdominal pain. AIM To explore, from the perspective of registered nurses and physicians, how care is provided for patients with acute abdominal pain in the acute care chain, and to identify barriers that they describe in the delivery of care. METHOD Registered nurses and physicians (n = 19) working in ambulance services, emergency departments, and surgical departments at five hospitals in Sweden were interviewed. A content analysis was performed. RESULTS Five categories were identified; interaction: a decisive moment, competence and resources: not always available, guidelines: limited use, medical care: a main focus, and feedback and collaboration: limited across acute care chain. CONCLUSION This study adds new insights relating to how health professionals reflect on patient needs and obstacles to satisfying them. To deliver high quality care and meet patients' fundamental needs, there is a need of general guidelines and close collaboration in the acute care chain.
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Affiliation(s)
- Alexander Tegelberg
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Sweden.
| | - Åsa Muntlin
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Sweden; Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences/Clinical Epidemiology, Uppsala University, Uppsala, Sweden; Adelaide Nursing School, University of Adelaide, Adelaide, Australia.
| | - Claes Juhlin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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17
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Avallin T, Muntlin Athlin Å, Björck M, Jangland E. Using communication to manage missed care: A case study applying the Fundamentals of Care framework. J Nurs Manag 2020; 28:2091-2102. [PMID: 31985109 DOI: 10.1111/jonm.12963] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
Abstract
AIM To explore, through the patient's perspective, how patient-provider communication is linked to missed nursing care vs. meeting patients' fundamental care needs. BACKGROUND Missed 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. METHODS Case 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. RESULTS Communications 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. CONCLUSION Communication 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 MANAGEMENT Nursing managers can use this new knowledge of communication to facilitate person-centred fundamental care and thereby avoid missed nursing care.
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Affiliation(s)
- Therese Avallin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Åsa Muntlin Athlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences/Clinical Epidemiology, Uppsala University, Uppsala, Sweden.,Department of Public Health and Caring Sciences/Health Services Research, Uppsala University, Uppsala, Sweden.,Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Martin Björck
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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18
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Lyttkens L, Wanhainen A, Svensjö S, Hultgren R, Björck M, Jangland E. Systematic Review and Meta-Analysis of Health Related Quality of Life and Reported Experiences in Patients With Abdominal Aortic Aneurysm Under Ultrasound Surveillance. Eur J Vasc Endovasc Surg 2020; 59:420-427. [DOI: 10.1016/j.ejvs.2019.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/03/2019] [Accepted: 07/15/2019] [Indexed: 12/21/2022]
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19
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Haakseth L, Björck M, Wanhainen A, Jangland E. Patients’ Experiences of Recovery After Staged Aortic Repair: A Phenomenological Study. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Lyttkens L, Wanhainen A, Svensjö S, Hultgren R, Björk M, Jangland E. Patients’ Experience of Living with a Small Abdominal Aortic Aneurysm and its Effect on Health Related Quality of Life While Being Under Surveillance: A Systematic Review and Synthesis. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Haakseth L, Wanhainen A, Björck M, Jangland E. Understanding patients’ experiences of recovery after staged complex aortic repair: A phenomenological study. J Adv Nurs 2019; 75:2834-2844. [DOI: 10.1111/jan.14103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/04/2019] [Accepted: 04/07/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Linda Haakseth
- Department of Surgical Sciences Uppsala University Uppsala Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences Uppsala University Uppsala Sweden
| | - Martin Björck
- Department of Surgical Sciences Uppsala University Uppsala Sweden
| | - Eva Jangland
- Department of Surgical Sciences Uppsala University Uppsala Sweden
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22
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Tegelberg A, Jangland E, Juhlin C, Muntlin Athlin Å. Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain. J Clin Nurs 2019; 28:3641-3650. [PMID: 31190406 DOI: 10.1111/jocn.14962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/13/2019] [Accepted: 05/26/2019] [Indexed: 01/30/2023]
Abstract
AIM AND OBJECTIVES To describe managers' perspectives on the care of patients with acute abdominal pain and explore how they influence the care. BACKGROUND Patients with acute abdominal pain form a common group of patients who often report poor pain management. Managers are key actors in ensuring that patients receive high-quality care. This stresses the need to deepen the understanding of their perspectives on these patients, in order to provide high-quality fundamental care across the acute care chain. DESIGN Qualitative descriptive semi-structured interview study, with an inductive approach. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used. METHODS Individual interviews were conducted with managers (n = 17) from ambulance services, emergency departments and surgical departments at four hospitals in Sweden, representing managers at the micro- and macrolevels across the acute care chain. RESULTS The patient group was described as a challenging heterogeneous group, with a focus on medical care, shaped by clinical practice guidelines, for which others were responsible. Managers with a physician background expressed that nursing care was important for the outcome of the care, while managers with a nursing background focused solely on the medical care. Additionally, the managers described that they affected the care by providing resources and serving as role models. CONCLUSIONS The solely medical perspective is worrying. By being a stakeholder, the managers' responsibility should be to highlight the patient perspective in the care and promote and support all health professionals in redesigning the care, where achieving higher quality both in nursing and in medical care for patients with acute abdominal pain becomes a shared goal. RELEVANCE TO CLINICAL PRACTICE Managers should use their leadership to bridge the gap between medicine and nursing care by highlighting patients' need for fundamental care, and to support health professionals in providing evidence-based and high-quality care.
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Affiliation(s)
- Alexander Tegelberg
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.,Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Claes Juhlin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Åsa Muntlin Athlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences/Clinical Epidemiology, Department of Public Health and Caring Sciences/Health Services Research, Uppsala University, Uppsala, Sweden.,Adelaide Nursing School, University of Adelaide, Adelaide, South Australia, Australia
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23
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Karlsson A, Lindeborg P, Gunningberg L, Jangland E. Evidence‐based nursing—How is it understood by bedside nurses? A phenomenographic study in surgical settings. J Nurs Manag 2019; 27:1216-1223. [DOI: 10.1111/jonm.12802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/30/2019] [Accepted: 05/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Lena Gunningberg
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
| | - Eva Jangland
- Department of Surgical Sciences Uppsala University Uppsala Sweden
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24
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Donnelly F, Feo R, Jangland E, Muntlin Athlin Å. The management of patients with acute abdominal pain in the emergency department: A qualitative study of nurse perceptions. Australas Emerg Care 2019; 22:97-102. [PMID: 31056349 DOI: 10.1016/j.auec.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 11/18/2022]
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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Affiliation(s)
- Frank Donnelly
- Adelaide Nursing School, Faculty of Health and Medical Sciences, Level 4, Adelaide Health & Medical Sciences Building, Cnr North Terrace & George Street, Adelaide, SA 5005, Australia.
| | - Rebecca Feo
- College of Nursing & Health Sciences, Flinders University,Sturt Road, Bedford Park, South Australia 5042, GPO Box 2100, Adelaide, SA 5001, Australia.
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
| | - Åsa Muntlin Athlin
- Adelaide Nursing School, Faculty of Health and Medical Sciences, Level 4, Adelaide Health & Medical Sciences Building, Cnr North Terrace & George Street, Adelaide, SA 5005, Australia; Department of Emergency Care and Internal Medicine, Entrance 40, Level 3 (contact address: 5th floor), Uppsala University Hospital, 751 85 Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Sweden.
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Abstract
PURPOSE Globally, acute abdominal pain (AAP) is one of the most common reasons for emergency admissions, yet little is known about how this patient group experiences the delivery of fundamental care across the acute care delivery chain. The purpose of this paper is to describe how patients with AAP experienced fundamental care across their acute care presentation, and to explicate the health professional behaviours, reported by patients, that contributed to their positive experiences. DESIGN/METHODOLOGY/APPROACH A qualitative descriptive study, using repeated reflective interviews, was analysed thematically ( n=10 patients). FINDINGS Two themes were identified: developing genuine, caring relationships with health professionals and being informed about one's care. Patients reported that health professionals established genuine professional-patient relationships despite the busy care environment but perceived this environment as impeding information-provision. Patients were typically accepting of a lack of information, whereas poor professional-patient relationships were seen as inexcusable. PRACTICAL IMPLICATIONS To provide positive fundamental care experiences for patients with AAP, health professionals should establish caring relationships with patients, such as by using humour, being attentive, and acknowledging patients' physical pain and emotional distress; and should inform patients about their care, including allowing patients to ask questions and taking time to answer those questions. ORIGINALITY/VALUE This is the first Australian study to explore the experiences of patients with AAP across the acute care delivery chain, using a novel method of repeated interviews, and to demonstrate how fundamental care can be delivered, in clinical practice, to ensure positive patient experiences.
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Affiliation(s)
- Rebecca Feo
- Adelaide Nursing School, University of Adelaide , Adelaide, Australia
- College of Nursing and Health Sciences, Flinders University , Adelaide, Australia
| | - Frank Donnelly
- Adelaide Nursing School, University of Adelaide , Adelaide, Australia
| | - Åsa Muntlin Athlin
- Department of Medical Sciences, Uppsala University , Uppsala, Sweden
- Department of Public Health and Caring Sciences/Health Services Research, Uppsala University , Uppsala, Sweden
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital , Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University , Uppsala, Sweden
- Uppsala University Hospital , Uppsala, Sweden
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Avallin T, Muntlin Athlin Å, Elgaard Sørensen E, Kitson A, Björck M, Jangland E. Front Cover. J Adv Nurs 2018. [DOI: 10.1111/jan.13872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Avallin T, Muntlin Athlin Å, Elgaard Sørensen E, Kitson A, Björck M, Jangland E. Person-centred pain management for the patient with acute abdominal pain: An ethnography informed by the Fundamentals of Care framework. J Adv Nurs 2018; 74:2596-2609. [DOI: 10.1111/jan.13739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/03/2018] [Accepted: 06/01/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Therese Avallin
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - Åsa Muntlin Athlin
- Department of Emergency Care and Internal Medicine; Uppsala University Hospital; Uppsala Sweden
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
- Department of Public Health and Caring Sciences/Health Services Research; Uppsala University; Uppsala Sweden
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
| | - Alison Kitson
- College of Nursing and Health Sciences Flinders University; Adelaide SA Australia
| | - Martin Björck
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - Eva Jangland
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
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Jangland E, Mirza N, Conroy T, Merriman C, Suzui E, Nishimura A, Ewens A. Nursing students' understanding of the Fundamentals of Care: A cross-sectional study in five countries. J Clin Nurs 2018. [PMID: 29526052 DOI: 10.1111/jocn.14352] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVE To explore the accuracy with which nursing students can identify the fundamentals of care. BACKGROUND A challenge facing nursing is ensuring the fundamentals of care are provided with compassion and in a timely manner. How students perceive the importance of the fundamentals of care may be influenced by the content and delivery of their nursing curriculum. As the fundamentals of care play a vital role in ensuring patient safety and quality care, it is important to examine how nursing students identify these care needs. DESIGN Cross-sectional descriptive design. METHODS A total of 398 nursing students (pre- and postregistration) from universities in Sweden, England, Japan, Canada and Australia participated. The Fundamentals of Care Framework guided this study. A questionnaire containing three care scenarios was developed and validated. Study participants identified the fundamentals of care for each of the scenarios. All responses were rated and analysed using ANOVA. RESULTS The data illustrate certain fundamentals of care were identified more frequently, including communication and education; comfort and elimination, whilst respecting choice, privacy and dignity were less frequently identified. The ability to identify all the correct care needs was low overall across the pre- and postregistration nursing programmes in the five universities. Significant differences in the number of correctly identified care needs between some of the groups were identified. CONCLUSIONS Nursing students are not correctly identifying all a patient's fundamental care needs when presented with different care scenarios. Students more frequently identifying physical care needs and less frequently psychosocial and relational needs. The findings suggest educators may need to emphasise and integrate all three dimensions. RELEVANCE TO CLINICAL PRACTICE To promote students' ability to identify the integrated nature of the fundamentals of care, practising clinicians and nurse educators need to role model and incorporate all the fundamental care needs for their patients.
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Affiliation(s)
- Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Noeman Mirza
- School of Nursing, Thompson Rivers University, Kamloops, BC, Canada
| | - Tiffany Conroy
- Adelaide Nursing School, University of Adelaide, Adelaide, South Australia, Australia
| | - Clair Merriman
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Emiko Suzui
- New Department Preparatory Office, Otemae University, Kobe, Japan
| | - Akiko Nishimura
- Department of Nursing School of Nursing, Hyogo University of Health Sciences, Kobe, Japan
| | - Ann Ewens
- Centre of Excellence in Healthcare Education, Staffordshire University, Stoke-on-Trent, UK
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Feo R, Conroy T, Jangland E, Muntlin Athlin Å, Brovall M, Parr J, Blomberg K, Kitson A. Towards a standardised definition for fundamental care: A modified Delphi study. J Clin Nurs 2018; 27:2285-2299. [DOI: 10.1111/jocn.14247] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Rebecca Feo
- Adelaide Nursing School; University of Adelaide; Adelaide SA Australia
| | - Tiffany Conroy
- Adelaide Nursing School; University of Adelaide; Adelaide SA Australia
| | - Eva Jangland
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
- Department of Surgery; Uppsala University Hospital; Uppsala Sweden
| | - Åsa Muntlin Athlin
- Department of Medical Sciences; Uppsala University; Uppsala University Hospital; Uppsala Sweden
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Maria Brovall
- School of Health and Education; University of Skövde; Skövde Sweden
| | - Jenny Parr
- Counties Manukau District Health Board; Auckland New Zealand
- Auckland University of Technology; Auckland New Zealand
| | - Karin Blomberg
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - Alison Kitson
- Adelaide Nursing School; University of Adelaide; Adelaide SA Australia
- College of Nursing and Health Sciences; Flinders University; Adelaide SA Australia
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Jangland E, Teodorsson T, Molander K, Muntlin Athlin Å. Inadequate environment, resources and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework. J Clin Nurs 2017; 27:2311-2321. [DOI: 10.1111/jocn.14095] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Eva Jangland
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | | | - Karin Molander
- Department of Surgery; Sundsvall Hospital; Sundsvall Sweden
| | - Åsa Muntlin Athlin
- Department of Emergency Care and Internal Medicine; Uppsala University Hospital; Uppsala Sweden
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
- Department of Public Health and Caring Sciences/Health Services Research; Uppsala University; Uppsala Sweden
- Adelaide Nursing School; University of Adelaide; Adelaide SA Australia
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31
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Kvarnström S, Jangland E, Dahlgren MA. Introducing the nurse practitioner into the surgical ward: an ethnographic study of interprofessional teamwork practice. Scand J Caring Sci 2017; 32:765-771. [DOI: 10.1111/scs.12507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 06/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Susanne Kvarnström
- Region Östergötland; Linköping Sweden
- Department of Medicine and Health Sciences; Linköping University; Linköping Sweden
- Jönköping Academy for Improvement of Health and Welfare; Jönköping University; Jönköping Sweden
| | - Eva Jangland
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
- Department of Surgery; Uppsala University Hospital; Uppsala Sweden
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Jangland E, Gunningberg L. Improving patient participation in a challenging context: a 2-year evaluation study of an implementation project. J Nurs Manag 2017; 25:266-275. [PMID: 28164406 DOI: 10.1111/jonm.12459] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 11/29/2022]
Abstract
AIM To evaluate an implementation project on patient participation. BACKGROUND Patient participation is one of the cornerstones of person-centred care. A previous intervention study resulted in improved patient participation in a surgical department in a large university hospital in Sweden. A subsequent implementation project was guided by the PARiSH framework and included several strategies over 2 years. METHOD Patients (n = 198) in five units completed a questionnaire and nurse managers (n = 5) were interviewed. RESULTS Although the long-term implementation project did not improve patient participation in the units, the nurse managers described a changing culture in which staff grew to accept patients' involvement in their own care. Several barriers to change and sustainability were acknowledged. CONCLUSIONS Improving patient participation in a busy environment is challenging. The framework was useful in the different steps of the project. In the future, the interrelationship of the core elements needs to be analysed in an ongoing and deeper way to allow both prediction and prevention of barriers to improvement. IMPLICATIONS FOR NURSING MANAGEMENT A dedicated leadership together with skilled facilitators should encourage and support staff to reflect on their attitudes and ways of working to increase person-centred care.
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Affiliation(s)
- Eva Jangland
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.,Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University Hospital, Uppsala, Sweden.,Quality Department, Uppsala University Hospital, Uppsala, Sweden
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Muntlin Athlin Å, Juhlin C, Jangland E. Lack of existing guidelines for a large group of patients in Sweden: a national survey across the acute surgical care delivery chain. J Eval Clin Pract 2017; 23:89-95. [PMID: 27491471 DOI: 10.1111/jep.12607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 12/12/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Evidence-informed healthcare is the fundament for practice, whereby guidelines based on the best available evidence should assist health professionals in managing patients. Patients seeking care for acute abdominal pain form a common group in acute care settings worldwide, for whom decision-making and timely treatment are of paramount importance. There is ambiguity about the existence, use and content of guidelines for patients with acute abdomen. The objective was to describe and compare guidelines and management of patients with acute abdomen in different settings across the acute care delivery chain in Sweden. METHOD A national cross-sectional design was used. Twenty-nine ambulance stations, 17 emergency departments and 33 surgical wards covering all six Swedish health regions were included, and 23 guidelines were quality appraised using the validated Appraisal of Guidelines for Research & Evaluation II tool. RESULTS There is a lack of guidelines in use for the management of this large group of patients between and within different healthcare areas across the acute care delivery chain. The quality appraisal identified that several guidelines were of poor quality, especially the in-hospital ones. Further, range orders for analgesics are common in the ambulance services and the surgical wards, but are seldom present in the emergency departments. Also, education in pain management is more common in the ambulance services. These findings are noteworthy as, hypothetically, the same patient could be treated in three different ways during the same care episode. CONCLUSIONS There is an urgent need to develop high-quality evidence-based clinical guidelines for this patient group, with the entire care process in focus.
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Affiliation(s)
- Åsa Muntlin Athlin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.,School of Nursing, University of Adelaide, Adelaide, Australia
| | - Claes Juhlin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
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Leo Swenne C, Jangland E, Arakelian E. Patients' experiences of their everyday life 14 months after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy - a qualitative follow-up study. Scand J Caring Sci 2017; 31:904-913. [PMID: 28124449 DOI: 10.1111/scs.12412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 11/07/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with peritoneal carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have a long recovery process. AIM To describe patients' experiences of their everyday lives after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. METHOD A follow-up study with a qualitative, descriptive design. Data were collected by individual, in-depth telephone interviews with 16 patients who had been treated for peritoneal carcinomatosis 14 months earlier at a university hospital in Sweden. The interviews were performed between May and June 2013 and analysed using systematic text condensation. RESULTS Five themes were identified: (i) finding one's new self and relating to the new situation; (ii) the disease making its presence felt through bodily complications or mental fatigue; (iii) worrying about the return of the disease and passing it on to one's children; (iv) experiencing difficulties contacting various care facilities, not having a clear plan for ongoing rehabilitation; and (v) the need for online support through the Internet and counselling for both patients and their family members. CONCLUSIONS Despite bodily complications, mental fatigue and worries about the return of the disease, the patient's everyday life was focused on finding his/her new self and adapting to the new circumstances. Difficulties in contacting care facilities and the lack of an ongoing medical and nursing rehabilitation plan called for a need for network support for patients and their families. CLINICAL RELEVANCE After advanced surgery, patients require a continuous medical and nursing rehabilitation plan, and a platform of support such as meetings via social media and Internet which would connect former patients and their families with future patients and their family members. A contact nurse with specific expertise should design an individual rehabilitation plan and continuously identify the individual needs for long-term support.
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Affiliation(s)
- Christine Leo Swenne
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Erebouni Arakelian
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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35
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Jangland E, Yngman Uhlin P, Arakelian E. Between two roles – Experiences of newly trained nurse practitioners in surgical care in Sweden: A qualitative study using repeated interviews. Nurse Educ Pract 2016; 21:93-99. [DOI: 10.1016/j.nepr.2016.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/23/2016] [Accepted: 10/12/2016] [Indexed: 11/30/2022]
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Bernhoff K, Björck M, Larsson J, Jangland E. Patient Experiences of Life Years After Severe Civilian Lower Extremity Trauma With Vascular Injury. Eur J Vasc Endovasc Surg 2016; 52:690-695. [PMID: 27637376 DOI: 10.1016/j.ejvs.2016.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/17/2016] [Indexed: 10/21/2022]
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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Affiliation(s)
- K Bernhoff
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - M Björck
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - J Larsson
- Health Services Research, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - E Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Jangland E, Nyberg B, Yngman-Uhlin P. ‘It's a matter of patient safety’: understanding challenges in everyday clinical practice for achieving good care on the surgical ward - a qualitative study. Scand J Caring Sci 2016; 31:323-331. [DOI: 10.1111/scs.12350] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 03/12/2016] [Indexed: 01/30/2023]
Affiliation(s)
- Eva Jangland
- Department of Surgical Sciences; Uppsala University and Department of Surgery; Uppsala University Hospital; Uppsala Sweden
| | - Berit Nyberg
- Department of Surgery; Uppsala University Hospital; Uppsala Sweden
| | - Pia Yngman-Uhlin
- Research & Development Unit in Local Health Care and Department of Medicine and Health Sciences; Linköping University; Linköping Sweden
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Jangland E, Kitson A, Muntlin Athlin Å. Patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode: a multi-stage qualitative case study. J Adv Nurs 2016; 72:791-801. [DOI: 10.1111/jan.12880] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Eva Jangland
- Department of Surgical Sciences; Uppsala University; Sweden
- Department of Surgery; Uppsala University Hospital; Sweden
| | - Alison Kitson
- School of Nursing; University of Adelaide; South Australia Australia
- Central Adelaide Local Health Network; Australia Green Templeton College; Adelaide South Australia Australia
- University of Oxford; UK
| | - Åsa Muntlin Athlin
- School of Nursing; University of Adelaide; South Australia Australia
- Department of Medical Sciences and Department of Public Health and Caring Sciences; Uppsala University; Sweden
- Department of Emergency Care; Uppsala University Hospital; Sweden
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Yngman-Uhlin P, Klingvall E, Wilhelmsson M, Jangland E. Obstacles and opportunities for achieving good care on the surgical ward: nurse and surgeon perspective. J Nurs Manag 2015; 24:492-9. [DOI: 10.1111/jonm.12349] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Pia Yngman-Uhlin
- Research & Development Unit in Local Health Care, and Department of Medicine and Health Sciences; Linköping University; Linköping Sweden
| | - Emma Klingvall
- Department of Surgery and Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - Maria Wilhelmsson
- Department of Surgery and Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - Eva Jangland
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
- Department of Surgery; Uppsala University Hospital; Uppsala Sweden
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Andregård AC, Jangland E. The tortuous journey of introducing the nurse practitioner as a new member of the healthcare team: a meta-synthesis. Scand J Caring Sci 2014; 29:3-14. [PMID: 24580718 DOI: 10.1111/scs.12120] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 01/27/2014] [Indexed: 11/29/2022]
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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Affiliation(s)
- Anna-Carin Andregård
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
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Jangland E, Carlsson M, Lundgren E, Gunningberg L. The impact of an intervention to improve patient participation in a surgical care unit: a quasi-experimental study. Int J Nurs Stud 2011; 49:528-38. [PMID: 22104043 DOI: 10.1016/j.ijnurstu.2011.10.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 09/14/2011] [Accepted: 10/26/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Organizational changes in surgical care are requiring patients to become more responsible for their own care, both before and after surgery, and also during recovery. Involving patients in their care is vital to improving quality of care and patient safety. OBJECTIVE The aim of this study was to investigate the impact of the 'Tell-us' card on patients' perceptions of quality of care, with a specific focus on patient participation. Another aim was to evaluate the use of the Tell-us card from the patients' perspective. DESIGN A quasi-experimental design with an intervention group and control groups was used. The patient's self-written Tell-us card was introduced as the intervention. SETTING The study was conducted in two surgical care units at a Swedish university hospital. PARTICIPANTS A consecutive sample of patients admitted from the waiting list and from the emergency department was included (n=310). The inclusion criteria were surgical patients with a hospital stay of at least one day. Patients who were younger than 18 years, not able to speak or write in Swedish, or unable or unwilling to give informed consent to participate were excluded. METHODS Quality of care was assessed using the questionnaire 'Quality from the Patient's Perspective'. The patients included in the intervention group were asked to write what was most important for them during the day or just before discharge on patient-written Tell-us cards. RESULTS The use of the Tell-us card resulted in significant improvements (5 out of 17 items) in patients' abilities to participate in decisions about their nursing and medical care. The patients found the Tell-us card more useful in their interaction with registered nurses and assistant nurses than with physicians. CONCLUSIONS The use of the Tell-us card improved patients' participation in some areas of nursing and medical care in the surgical care units. The Tell-us card is an uncomplicated and inexpensive tool that could be an important step towards improved patient participation in the surgical care unit. More research is needed to evaluate the use of the Tell-us card in different hospital units and over a longer period of time.
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Affiliation(s)
- Eva Jangland
- Department of Surgical Sciences, Uppsala University, Entrance 70, SE-751 85 Uppsala, Sweden.
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Jangland E, Larsson J, Gunningberg L. Surgical nurses’ different understandings of their interactions with patients: a phenomenographic study. Scand J Caring Sci 2010; 25:533-41. [DOI: 10.1111/j.1471-6712.2010.00860.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jangland E, Gunningberg L, Carlsson M. Patients' and relatives' complaints about encounters and communication in health care: evidence for quality improvement. Patient Educ Couns 2009; 75:199-204. [PMID: 19038522 DOI: 10.1016/j.pec.2008.10.007] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Revised: 10/07/2008] [Accepted: 10/09/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The aim of this study was to describe patients' and relatives' complaints to the local Patients' Advisory Committee about their encounters and communication in health care. METHODS Complaints (n=105) regarding patients' and relatives' dissatisfaction with communication and encounters in health care, registered at a local Patients' Advisory Committee between 2002 and 2004, were included. The texts were analysed using content analysis. RESULTS Three categories were identified: "Not receiving information or being given the option to participate", "Not being met in a professional manner" and "Not receiving nursing or practical support". Insufficient information, insufficient respect and insufficient empathy were described as the most common reasons for a negative professional encounter. CONCLUSION Patients and relatives experienced unnecessary anxiety and reduced confidence in health care after negative professional encounters. PRACTICE IMPLICATIONS The complaints reported to the Patients' Advisory Committee could be used more effectively in health care and be regarded as important evidence when working with quality improvement. To systematically use patient stories, such as those obtained in this report, as a reflective tool in education and supervision could be one way to improve communication and bring new understanding about the patient's perspective in health care.
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Affiliation(s)
- Eva Jangland
- Department of Surgery, University Hospital, Uppsala, Sweden.
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