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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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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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Lantz ACH, Gunningberg L, Eriksson G, Eldh AC, Wenemark M, Pöder U. Evaluation of patient participation in relation to the implementation of a person-centered nursing shift handover. Worldviews Evid Based Nurs 2023; 20:330-338. [PMID: 37431567 DOI: 10.1111/wvn.12666] [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: 12/09/2022] [Revised: 05/28/2023] [Accepted: 05/28/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND It has been suggested that nursing shift-to-shift handover should be a more team-based dialogue with and for the patient rather than about a patient. AIM The aim of this study was to evaluate patient participation in relation to the implementation of the person-centered handover (PCH). METHOD A pretest-posttest design was used without a comparison group, including patients from nine units in a university hospital at pretest (n = 228) and after implementing PCH (posttest, n = 253) per the framework integrated-Promoting Action on Research Implementation in Health Services. The PCH is inspired by an Australian bedside handover model. The Patient Preferences for the Patient Participation tool was used to rate the preference for and experience of participation on 12 items, combined into three levels of preference-based participation (insufficient-fair-sufficient). RESULTS There were no differences regarding experience or preference-based participation between patients at pretest-posttest; however, posttest patients experienced participation in the item Reciprocal communication to a lesser extent than the pretest patients. Only 49% of the posttest group received PCH; of those not receiving PCH, some would have wanted PCH (27%), while some would have declined (24%). Patients receiving PCH had sufficient participation (82%), to a greater extent, regarding the item Sharing one's symptoms with staff than patients at pretest (72%). Patients receiving PCH also had sufficient participation, to a greater extent, than patients at posttest who did not receive, but would have wanted PCH, regarding four items: (1) sharing one's symptoms with staff, (2) reciprocal communication, (3) being told what was done, and (4) taking part in planning. LINKING EVIDENCE TO ACTION Most patients want to be present at PCH. Therefore, nurses should ask for the patients' preferences regarding PCH and act accordingly. Not inviting patients who want PCH could contribute to insufficient patient participation. Further studies are needed to capture what assistance nurses would want in identifying and acting in alignment with patient preferences.
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Affiliation(s)
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Ann Catrine Eldh
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marika Wenemark
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Unit of Public Health and Statistics, Region Östergötland, Linköping, Sweden
| | - Ulrika Pöder
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Falk‐Brynhildsen K, Raepsaet C, Wistrand C, Bååth C, Leo Swenne C, Gifford M, Gunningberg L, von Vogelsang A, Björn C, Beeckman D. Swedish translation, cultural adaptation and psychometric evaluation of the pressure ulcer knowledge assessment tool for use in the operating room. Int Wound J 2022; 20:1534-1543. [PMID: 36318882 PMCID: PMC10088857 DOI: 10.1111/iwj.14008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/11/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
Abstract
The aim of this study was to psychometrically evaluate the Swedish operating room version of PUKAT 2.0. In total, 284 Swedish operating room nurses completed the survey of whom 50 completed the retest. The item difficulty P-value of 14 items ranged between 0.38 and 0.96 (median 0.65). Three items were found to be too easy (0.90-0.96). The D-value of 14 items ranged between 0.00 and 0.42 (median 0.46). Three items had a D-value lower than 0.20 (0.11-0.16) and eight items scored higher than 0.40 (0.45-0.61). The quality of the response alternatives (a-value) ranged between 0.00 and 0.42. This showed that nurses with a master's degree had a higher knowledge than nurses with a professional degree (respectively 9.4/14 versus 8.6/14; t = -2.4, df = 199, P = 0.02). The ICC was 0.65 (95% CI 0.45-0.78). The ICCs for the domains varied from 0.12 (95% CI = -0.16-0.39) to 0.59 (95% CI = 0.38-0.75). Results indicated that 11 of the original items contributed to the overall validity. However, the low participation in the test-retest made the reliability of the instrument low. An extended evaluation with a larger sample should be considered in order to confirm aspects of the psychometric properties of this instrument.
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Affiliation(s)
- Karin Falk‐Brynhildsen
- Faculty of Medicine and Health, School of Health Sciences, Nursing Science Unit, Swedish Centre for Skin and Wound Research Örebro University Sweden
| | - Charlotte Raepsaet
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care Ghent University Belgium
| | - Camilla Wistrand
- University Health Care Research Centre, Faculty of Medicine and Health Örebro University Sweden
| | - Carina Bååth
- Department of Health Sciences, Faculty of Health, Science and Technology Karlstad University Karlstad Sweden
- Faculty of Health, Welfare and Organisation Östfold University College Fredrikstad Norway
| | | | - Mervyn Gifford
- Faculty of Medicine and Health, School of Health Sciences, Nursing Science Unit, Swedish Centre for Skin and Wound Research Örebro University Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences Uppsala University Sweden
| | - Ann‐Christin von Vogelsang
- Department of Neurosurgery Karolinska University Hospital Stockholm Sweden
- Department of Clinical Neuroscience Karolinska Institute Stockholm Sweden
| | - Catrine Björn
- Centre for Research & Development Uppsala University/Region Gävleborg Sweden
| | - Dimitri Beeckman
- Faculty of Medicine and Health, School of Health Sciences, Nursing Science Unit, Swedish Centre for Skin and Wound Research Örebro University Sweden
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care Ghent University Belgium
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Hultin L, Karlsson A, Löwenmark M, Coleman S, Gunningberg L. Feasibility of PURPOSE T in clinical practice and patient participation-A mixed-method study. Int Wound J 2022; 20:633-647. [PMID: 35859322 PMCID: PMC9927909 DOI: 10.1111/iwj.13904] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022] Open
Abstract
This study aimed to evaluate the feasibility of implementing an electronic version of PURPOSE T, a risk assessment instrument for pressure ulcers, in a Swedish hospital ward. A mixed-method was used. Nursing staff received training in PURPOSE T and a record review was performed (n = 30). PURPOSE T replaced the Modified Norton Scale, and after one month another record review was performed (n = 30). Individual interviews with patients (n = 15) and focus group interviews with nursing staff (n = 23) were performed after the implementation. The results of the record review and the focus group interviews showed good clinical feasibility of PURPOSE T. The record review showed that more patients were at risk of developing pressure ulcers and more nursing interventions were prescribed with PURPOSE T compared to the Modified Norton Scale. The focus group interviews showed that all nursing staff were satisfied with PURPOSE T. The instrument contributed to increased reflection and analysis as well as the opportunity for nursing staff to draw their own conclusions regarding patients´ risk status. The documentation encouraged the prescription of more preventive actions, and the nurses were more involved at bedside. However, almost all the patients expressed not receiving any information about pressure ulcers.
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Affiliation(s)
- Lisa Hultin
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden,Uppsala University HospitalUppsalaSweden
| | - Ann‐Christin Karlsson
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden,Region GotlandVisbySweden
| | - Malin Löwenmark
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden,Uppsala University HospitalUppsalaSweden
| | | | - Lena Gunningberg
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden,Uppsala University HospitalUppsalaSweden
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6
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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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Hultin L, Gunningberg L, Coleman S, Karlsson AC. Pressure ulcer risk assessment-registered nurses´ experiences of using PURPOSE T: A focus group study. J Clin Nurs 2021; 31:231-239. [PMID: 34109691 DOI: 10.1111/jocn.15901] [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: 03/12/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the clinical usability of PURPOSE T among registered nurses in Sweden. BACKGROUND Pressure ulcers are an adverse event and a problem worldwide. Risk assessment is a cornerstone, and a first step in pressure ulcer prevention is to identify possible risk patients and/or pressure ulcers. There are many pressure ulcer risk assessment instruments; however, they are not updated and/or evidence-based. PURPOSE T has been psychometrically evaluated in the UK and in Sweden with good inter-rater and test-retest reliability, and convergent validity was reported as moderate. DESIGN A descriptive study design with a qualitative approach. METHODS A total of six focus group interviews with 29 registered nurses were conducted. They were recruited from May 2018 to November 2018 from a university hospital and two nursing homes in Sweden. Data analysis was performed as described by Krueger. The study adheres to the COREQ guidelines. RESULTS Four categories were identified: "An efficient risk assessment instrument performed at the bedside," "Deeper understanding and awareness of risk factors," "Benefits compared to the Modified Norton Scale" and "Necessity of integration of PURPOSE T in the electronic health record and team collaboration." CONCLUSION The registered nurses acknowledged an overall positive perception of PURPOSE T´s clinical usability. Future research is needed to evaluate the feasibility of PURPOSE T. RELEVANCE TO CLINICAL PRACTICE PURPOSE T has the potential to replace outdated pressure ulcers risk assessment instruments that are used today.
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Affiliation(s)
- Lisa Hultin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Uppsala University Hospital, Uppsala, Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Uppsala University Hospital, Uppsala, Sweden
| | - Susanne Coleman
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Ann-Christin Karlsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Region Gotland, Visby, Sweden
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8
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Hultin L, Karlsson A, Öhrvall M, Coleman S, Gunningberg L. PURPOSE T in Swedish hospital wards and nursing homes: A psychometric evaluation of a new pressure ulcer risk assessment instrument. J Clin Nurs 2020; 29:4066-4075. [DOI: 10.1111/jocn.15433] [Citation(s) in RCA: 3] [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: 12/20/2019] [Revised: 06/24/2020] [Accepted: 07/15/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Lisa Hultin
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
- Uppsala University Hospital Uppsala Sweden
| | - Ann‐Christin Karlsson
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
- Region Gotland Visby Sweden
| | | | | | - Lena Gunningberg
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
- Uppsala University Hospital Uppsala Sweden
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Karlsson AC, Gunningberg L, Bäckström J, Pöder U. Registered nurses' perspectives of work satisfaction, patient safety and intention to stay - A double-edged sword. J Nurs Manag 2019; 27:1359-1365. [PMID: 31211908 DOI: 10.1111/jonm.12816] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 11/26/2018] [Revised: 05/15/2019] [Accepted: 06/13/2019] [Indexed: 12/01/2022]
Abstract
AIM To describe job satisfaction in registered nurses (RNs), their intention to stay at their current workplace and in the profession and to explore patient safety in relation to these. BACKGROUND Nurse turnover presents a serious challenge to health care that may be predicted by factors related to the work environment. METHOD Descriptive design with 25 qualitative interviews. RESULTS Five categories were identified: RNs feel satisfied when providing person-centred care; RNs enjoy the variability of the nursing job, but want control; RNs feel frustrated when care is put on hold or left undone; RNs depend on team collaboration and the work environment to assure patient safety; intention to stay depends on the work environment and a chance for renewal. CONCLUSION Registered nurses' job satisfaction could be described as a double-edged sword. Although the profession is described as a positive challenge, work overload threatens both job satisfaction and patient safety. IMPLICATIONS FOR NURSING MANAGEMENT Our findings suggest that nursing leadership can increase RNs' intention to stay by meeting their needs for appreciation, a better work environment, competence development and professional career development.
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Affiliation(s)
- Ann-Christin Karlsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Josefin Bäckström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Ulrika Pöder
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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10
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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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11
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Gunningberg L, Sving E, Hommel A, Ålenius C, Wiger P, Bååth C. Tracking pressure injuries as adverse events: National use of the Global Trigger Tool over a 4-year period. J Eval Clin Pract 2019; 25:21-27. [PMID: 30027549 DOI: 10.1111/jep.12996] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 05/04/2018] [Revised: 06/25/2018] [Accepted: 06/25/2018] [Indexed: 11/30/2022]
Abstract
AIM To examine the frequency, preventability, and consequences of hospital acquired pressure injuries in acute care hospitals over a 4-year period. METHOD A retrospective record review was performed using the Swedish version of the Global Trigger Tool (GTT). A total of 64 917 hospital admissions were reviewed. Data were collected between 2013 and 2016 from all 63 Swedish acute care hospitals. RESULTS The prevalence of pressure injuries (category 2-4) was 1%. Older patients, "satellite patients", and patients with acute admissions had more pressure injuries. Most pressure injuries (91%) were determined to be preventable. The mean extended length of hospital stay was 15.8 days for patients who developed pressure injuries during hospitalization. CONCLUSION The GTT provides a useful and complementary national perspective on hospital acquired pressure injuries across hospitals, informing health care providers on safety priorities to reduce patient harm. Clinical leaders can use information on the preventability and the consequences of pressure injuries, as well as evidence-based arguments for improving the health care organization.
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Affiliation(s)
- Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Eva Sving
- Department of Public Health and Caring Sciences, Uppsala University and Region Gävleborg, Gävle, Sweden
| | | | - Carina Ålenius
- The Swedish Association of Local Authorities and Regions, Stockholm, Sweden
| | - Per Wiger
- The Swedish Association of Local Authorities and Regions, Stockholm, Sweden
| | - Carina Bååth
- Department of Health Sciences, Karlstad University and County Council of Värmland, Sweden
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12
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Affiliation(s)
- Maria Carlsson
- Senior Lecturer, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Gunningberg
- Clinical Professor, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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13
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Gunningberg L, Bååth C, Sving E. Staff's perceptions of a pressure mapping system to prevent pressure injuries in a hospital ward: A qualitative study. J Nurs Manag 2017; 26:140-147. [DOI: 10.1111/jonm.12526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lena Gunningberg
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala University Hospital; Uppsala Sweden
| | - Carina Bååth
- Faculty of Health, Sciences and Technology; Department of Health Sciences; Karlstad University; County Council of Värmland; Värmland Sweden
| | - Eva Sving
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala University Hospital; Uppsala Sweden
- Region Gävleborg; Gävle Sweden
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Gunningberg L, Sedin IM, Andersson S, Pingel R. Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomised controlled trial. Int J Nurs Stud 2017; 72:53-59. [DOI: 10.1016/j.ijnurstu.2017.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/05/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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15
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Sving E, Fredriksson L, Gunningberg L, Mamhidir AG. Getting evidence-based pressure ulcer prevention into practice: a process evaluation of a multifaceted intervention in a hospital setting. J Clin Nurs 2017; 26:3200-3211. [DOI: 10.1111/jocn.13668] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Eva Sving
- Department of Patient Safety; Region Gävleborg Sweden
- Centre for Research & Development; Uppsala University/Region Gävleborg; Uppsala Sweden
- Department of Public Health and Caring Sciences, Caring Sciences; Uppsala University; Uppsala Sweden
| | - Lennart Fredriksson
- Centre for Research & Development; Uppsala University/Region Gävleborg; Uppsala Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Caring Sciences; Uppsala University; Uppsala Sweden
| | - Anna-Greta Mamhidir
- Department of Public Health and Caring Sciences, Caring Sciences; Uppsala University; Uppsala Sweden
- Faculty of Health and Occupational Studies; University of Gävle; Gävle Sweden
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16
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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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17
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Gunnarsson AK, Gunningberg L, Larsson S, Jonsson KB. Cranberry juice concentrate does not significantly decrease the incidence of acquired bacteriuria in female hip fracture patients receiving urine catheter: a double-blind randomized trial. Clin Interv Aging 2017; 12:137-143. [PMID: 28144131 PMCID: PMC5245868 DOI: 10.2147/cia.s113597] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Indexed: 12/17/2022] Open
Abstract
Background Urinary tract infection (UTI) is a common complication among patients with hip fractures. Receiving an indwelling urinary catheter is a risk factor for developing UTIs. Treatment of symptomatic UTIs with antibiotics is expensive and can result in the development of antimicrobial resistance. Cranberries are thought to prevent UTI. There is no previous research on this potential effect in patients with hip fracture who receive urinary catheters. Aim The aim of this study is to investigate whether intake of cranberry juice concentrate pre-operatively decreases the incidence of postoperative UTIs in hip fracture patients that received a urinary catheter. Design This study employed a randomized, placebo-controlled double-blind trial. Method Female patients, aged 60 years and older, with hip fracture (n=227) were randomized to receive cranberry or placebo capsules daily, from admission, until 5 days postoperatively. Urine cultures were obtained at admission, 5 and 14 days postoperatively. In addition, Euro Qual five Dimensions assessments were performed and patients were screened for UTI symptoms. Result In the intention-to-treat analysis, there was no difference between the groups in the proportion of patients with hospital-acquired postoperative positive urine cultures at any time point. When limiting the analysis to patients that ingested at least 80% of the prescribed capsules, 13 of 33 (39%) in the placebo group and 13 of 47 (28%) in the cranberry group (P=0.270) had a positive urine culture at 5 days postoperatively. However, this difference was not statistically significant (P=0.270). Conclusion Cranberry concentrate does not seem to effectively prevent UTIs in female patients with hip fracture and indwelling urinary catheter.
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Affiliation(s)
| | - Lena Gunningberg
- Institution of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Sune Larsson
- Institution of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Kenneth B Jonsson
- Institution of Surgical Sciences, Uppsala University, Uppsala, Sweden
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18
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Carlsson ME, Gunningberg L. Predictors for Development of Pressure Ulcer in End-of-Life Care: A National Quality Register Study. J Palliat Med 2017; 20:53-58. [DOI: 10.1089/jpm.2016.0166] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maria E. Carlsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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19
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Hommel A, Gunningberg L, Idvall E, Bååth C. Successful factors to prevent pressure ulcers - an interview study. J Clin Nurs 2016; 26:182-189. [DOI: 10.1111/jocn.13465] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences; Uppsala University and Uppsala University Hospital; Uppsala Sweden
| | - Ewa Idvall
- Faculty of Health and Society; Malmö University and Skane University Hospital; Malmö Sweden
| | - Carina Bååth
- Department of Health Sciences; Karlstad University; Karlstad Sweden
- County Council of Värmland; Karlstad Sweden
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20
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Muntlin Athlin Å, Engström M, Gunningberg L, Bååth C. Heel pressure ulcer, prevention and predictors during the care delivery chain - when and where to take action? A descriptive and explorative study. Scand J Trauma Resusc Emerg Med 2016; 24:134. [PMID: 27842564 PMCID: PMC5109774 DOI: 10.1186/s13049-016-0326-0] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Hazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Pressure ulcer prevalence is still at unreasonably high levels, causing increased healthcare costs and suffering for patients. Recent biomedical research reveals that the first signs of cell damage could arise within minutes. However, few studies have investigated optimal pressure ulcer prevention in the initial stage of the care process, e.g. in the ambulance care or at the emergency department. The aim of the study was to describe heel pressure ulcer prevalence and nursing actions in relation to pressure ulcer prevention during the care delivery chain, for older patients with neurological symptoms or reduced general condition. Another aim was to investigate early predictors for the development of heel pressure ulcer during the care delivery chain. Methods Existing data collected from a multi-centre randomized controlled trial investigating the effect of using a heel prevention boot to reduce the incidence of heel pressure ulcer across the care delivery chain was used. Totally 183 patients participated. The settings for the study were five ambulance stations, two emergency departments and 16 wards at two hospitals in Sweden. Results A total of 39 individual patients (21 %) developed heel pressure ulcer at different stages across the care delivery chain. Findings revealed that 47–64 % of the patients were assessed as being at risk for developing heel pressure ulcer. Preventive action was taken. However, all patients who developed pressure ulcer during the care delivery chain did not receive adequate pressure ulcer prevention actions during their hospital stay. Discussion and Conclusions In the ambulance and at the emergency department, skin inspection seems to be appropriate for preventing pressure ulcer. However, carrying out risk assessment with a validated instrument is of significant importance at the ward level. This would also be an appropriate level of resource use. Context-specific actions for pressure ulcer prevention should be incorporated into the care of the patient from the very beginning of the care delivery chain. Trial registration ISRCTN85296908. Electronic supplementary material The online version of this article (doi:10.1186/s13049-016-0326-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Åsa Muntlin Athlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Entrance 40, 751 85, Uppsala, Sweden. .,Department of Medical Sciences, Uppsala University, Uppsala, Sweden. .,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. .,School of Nursing, University of Adelaide, Adelaide, Australia.
| | - Maria Engström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden.,Nursing Department, School of Medicine and Health, Lishui University, Lishui, China
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Quality Department, Uppsala University Hospital, Uppsala, Sweden
| | - Carina Bååth
- Faculty of Health, Sciences and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden.,County Council of Värmland, Karlstad, Sweden
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21
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Sving E, Högman M, Mamhidir AG, Gunningberg L. Getting evidence-based pressure ulcer prevention into practice: a multi-faceted unit-tailored intervention in a hospital setting. Int Wound J 2016; 13:645-54. [PMID: 25060416 PMCID: PMC7950133 DOI: 10.1111/iwj.12337] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 04/26/2014] [Revised: 06/18/2014] [Accepted: 06/25/2014] [Indexed: 12/01/2022] Open
Abstract
The aim of the study was to evaluate whether a multi-faceted, unit-tailored intervention using evidenced-based pressure ulcer prevention affects (i) the performance of pressure ulcer prevention, (ii) the prevalence of pressure ulcers and (iii) knowledge and attitudes concerning pressure ulcer prevention among registered and assistant nurses. A quasi-experimental, clustered pre- and post-test design was used. Five units at a hospital setting were included. The intervention was based on the PARIHS framework and included a multi-professional team, training and repeated quality measurements. An established methodology was used to evaluate the prevalence and prevention of pressure ulcers. Nurses' knowledge and attitudes were evaluated using a validated questionnaire. A total of 506 patients were included, of whom 105 patients had a risk to develop pressure ulcer. More patients were provided pressure ulcer prevention care (P = 0·001) and more prevention care was given to each patient (P = 0·021) after the intervention. Corresponding results were shown in the group of patients assessed as being at risk for developing pressure ulcers. Nurses' knowledge about pressure ulcer prevention increased (P < 0·001). Positive attitudes towards pressure ulcer prevention remained high between pre- and post-test surveys. This multi-faceted unit-tailored intervention affected pressure ulcer prevention. Facilitation and repeated quality measurement together with constructed feedback of results seemed to be the most important factor for pressure ulcer prevention.
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Affiliation(s)
- Eva Sving
- Clinical Training Centre, County Council of Gävleborg, Gävle, Sweden.
- Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden.
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Gävle, Sweden.
| | - Marieann Högman
- Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
- Department of Medical Sciences, Lung Medicine and Allergology, Uppsala University, Gävle, Sweden
| | - Anna-Greta Mamhidir
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Gävle, Sweden
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Gävle, Sweden
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22
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Bredesen IM, Bjøro K, Gunningberg L, Hofoss D. Effect of e-learning program on risk assessment and pressure ulcer classification - A randomized study. Nurse Educ Today 2016; 40:191-7. [PMID: 27125172 DOI: 10.1016/j.nedt.2016.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 02/23/2016] [Accepted: 03/09/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND Pressure ulcers (PUs) are a problem in health care. Staff competency is paramount to PU prevention. Education is essential to increase skills in pressure ulcer classification and risk assessment. Currently, no pressure ulcer learning programs are available in Norwegian. OBJECTIVES Develop and test an e-learning program for assessment of pressure ulcer risk and pressure ulcer classification. DESIGN, PARTICIPANTS AND SETTING Forty-four nurses working in acute care hospital wards or nursing homes participated and were assigned randomly into two groups: an e-learning program group (intervention) and a traditional classroom lecture group (control). Data was collected immediately before and after training, and again after three months. The study was conducted at one nursing home and two hospitals between May and December 2012. ANALYSIS Accuracy of risk assessment (five patient cases) and pressure ulcer classification (40 photos [normal skin, pressure ulcer categories I-IV] split in two sets) were measured by comparing nurse evaluations in each of the two groups to a pre-established standard based on ratings by experts in pressure ulcer classification and risk assessment. Inter-rater reliability was measured by exact percent agreement and multi-rater Fleiss kappa. A Mann-Whitney U test was used for continuous sum score variables. RESULTS An e-learning program did not improve Braden subscale scoring. For pressure ulcer classification, however, the intervention group scored significantly higher than the control group on several of the categories in post-test immediately after training. However, after three months there were no significant differences in classification skills between the groups. CONCLUSION An e-learning program appears to have a greater effect on the accuracy of pressure ulcer classification than classroom teaching in the short term. For proficiency in Braden scoring, no significant effect of educational methods on learning results was detected.
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Affiliation(s)
| | - Karen Bjøro
- Department of Orthopaedic Surgery, Oslo University Hospital, Norway.
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Sweden.
| | - Dag Hofoss
- Institute of Health and Society, University of Oslo, Norway.
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23
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Schoeps LN, Tallberg AB, Gunningberg L. Patients' knowledge of and participation in preventing pressure ulcers- an intervention study. Int Wound J 2016; 14:344-348. [PMID: 27112492 DOI: 10.1111/iwj.12606] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 12/20/2015] [Revised: 03/15/2016] [Accepted: 03/29/2016] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to evaluate a patient information pamphlet on pressure ulcer (PU) prevention using a descriptive, comparative pre- and post-test study design. The patient information pamphlet 'How can you help to stop pressure ulcers?' developed by the European PU Advisory Panel in 2012 was implemented in two surgical wards in a university hospital. A total of 61 patients answered pre- and post-test questionnaires. Patients assessed their knowledge of the risks, causes and ways to prevent PUs significantly higher after the intervention than before. Twenty-eight patients (46%) reported that they had participated in PU prevention during the last 24 hours. The patients assessed the content of the PU pamphlet as useful, its language as quite easy to understand and its layout as good. Patients with a PU pamphlet during their hospital stay were more knowledgeable about and more active in their own care. It is important that nurses invite patients to be active partners in preventing PUs but also that they identify patients who need to have a more passive role. The PU pamphlet could be updated to increase its comprehensibility, meaningfulness and manageability for patients.
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Affiliation(s)
- Lena N Schoeps
- Department of Public Health and Caring Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Anna-Britta Tallberg
- Department of Public Health and Caring Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
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24
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Bååth C, Engström M, Gunningberg L, Muntlin Athlin Å. Prevention of heel pressure ulcers among older patients--from ambulance care to hospital discharge: A multi-centre randomized controlled trial. Appl Nurs Res 2015; 30:170-5. [PMID: 27091274 DOI: 10.1016/j.apnr.2015.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 02/17/2015] [Revised: 09/29/2015] [Accepted: 10/22/2015] [Indexed: 11/18/2022]
Abstract
UNLABELLED The aim was to investigate the effect of an early intervention, a heel suspension device boot, on the incidence of heel pressure ulcers among older patients (aged 70+). BACKGROUND Pressure ulcers are a global healthcare issue; furthermore, the heel is an exposed location. Research indicates that preventive nursing interventions starting during the ambulance care and used across the acute care delivery chain are seldom used. METHODS A multi-centre randomized control study design was used. Five ambulance stations, two emergency departments and 16 wards at two Swedish hospitals participated. Altogether, 183 patients were transferred by ambulance to the emergency department and were thereafter admitted to one of the participating wards. RESULTS Significantly fewer patients in the intervention group (n=15 of 103; 14.6%) than the control group (n=24 of 80; 30%) developed heel pressure ulcers during their hospital stay (p=0.017). CONCLUSIONS Pressure ulcer prevention should start early in the acute care delivery chain to increase patient safety.
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Affiliation(s)
- Carina Bååth
- Faculty of Health, Sciences and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden; County Council of Värmland, Karlstad, Sweden.
| | - Maria Engström
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Surgery and Oncology Division, Uppsala University Hospital, Uppsala, Sweden
| | - Åsa Muntlin Athlin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden; School of Nursing, University of Adelaide, Adelaide, Australia; Department of Emergency Care, Uppsala University Hospital, Uppsala, Sweden
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25
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Abstract
OBJECTIVES To investigate the association of ward-level differences in the odds of hospital-acquired pressure ulcers (HAPUs) with selected ward organisational variables and patient risk factors. DESIGN Multilevel approach to data from 2 cross-sectional studies. SETTINGS 4 hospitals in Norway were studied. PARTICIPANTS 1056 patients at 84 somatic wards. PRIMARY OUTCOME MEASURE HAPU. RESULTS Significant variance in the odds of HAPUs was found across wards. A regression model using only organisational variables left a significant variance in the odds of HAPUs across wards but patient variables eliminated the across-ward variance. In the model including organisational and patient variables, significant ward-level HAPU variables were ward type (rehabilitation vs surgery/internal medicine: OR 0.17 (95% CI 0.04 to 0.66)), use of preventive measures (yes vs no: OR 2.02 (95% CI 1.12 to 3.64)) and ward patient safety culture (OR 0.97 (95% CI 0.96 to 0.99)). Significant patient-level predictors were age >70 vs <70 (OR 2.70 (95% CI 1.54 to 4.74)), Braden scale total score (OR 0.73 (95% CI 0.67 to 0.80)) and overweight (body mass index 25-29.99 kg/m(2)) (OR 0.32 (95% CI 0.17 to 0.62)). CONCLUSIONS The fact that the odds of HAPU varied across wards, and that across-ward variance was reduced when the selected ward-level variables entered the explanatory model, indicates that the HAPU problem may be reduced by ward-level organisation of care improvements, that is, by improving the patient safety culture and implementation of preventive measures. Some wards may prevent pressure ulcers better than other wards. The fact that ward-level variation was eliminated when patient-level HAPU variables were included in the model indicates that even wards with the best HAPU prevention will be challenged by an influx of high-risk patients.
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Affiliation(s)
- Ida Marie Bredesen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Karen Bjøro
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Dag Hofoss
- Institute of Health and Society, University of Oslo, Oslo, Norway
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26
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Åkerfeldt T, Gunningberg L, Swenne CL, Ronquist G, Larsson A. Elective orthopedic and cardiopulmonary bypass surgery causes a reduction in serum endostatin levels. Eur J Med Res 2014; 19:61. [PMID: 25380724 PMCID: PMC4230358 DOI: 10.1186/s40001-014-0061-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/23/2014] [Indexed: 12/11/2022] Open
Abstract
Background Endostatin is an endogenous inhibitor of angiogenesis that inhibits neovascularisation. The aim of the study was to evaluate the effect of elective surgery on endostatin levels. Methods Blood samples were collected prior to elective surgery and 4 and 30 days postoperatively in 2 patient groups: orthopedic surgery (n =27) and coronary bypass patients (n =21). Serum endostatin levels were measured by ELISA. Results Serum endostatin was significantly reduced 30 days after surgery in comparison with presurgical values in both the orthopedic (P =0.03) and cardiopulmonary surgery (P =0.04) group. Conclusion Serum endostatin is reduced 30 days after surgery. This reduction would favor angiogenesis and wound-healing.
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Affiliation(s)
- Torbjörn Åkerfeldt
- Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, Uppsala, Sweden.
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - Christine Leo Swenne
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - Göran Ronquist
- Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, Uppsala, Sweden.
| | - Anders Larsson
- Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, Uppsala, Sweden.
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27
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Gunningberg L, Carli C. Reduced pressure for fewer pressure ulcers: can real-time feedback of interface pressure optimise repositioning in bed? Int Wound J 2014; 13:774-9. [PMID: 25224508 DOI: 10.1111/iwj.12374] [Citation(s) in RCA: 20] [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: 07/02/2014] [Revised: 08/13/2014] [Accepted: 08/25/2014] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to (i) describe registered nurses' and assistant nurses' repositioning skills with regard to their existing attitudes to and theoretical knowledge of pressure ulcer (PU) prevention, and (ii) evaluate if the continuous bedside pressure mapping (CBPM) system provides staff with a pedagogic tool to optimise repositioning. A quantitative study was performed using a descriptive, comparative design. Registered nurses (n = 19) and assistant nurses (n = 33) worked in pairs, and were instructed to place two volunteers (aged over 70 years) in the best pressure-reducing position (lateral and supine), first without viewing the CBPM monitor and then again after feedback. In total, 240 positionings were conducted. The results show that for the same person with the same available pressure-reducing equipment, the peak pressure varied considerably between nursing pairs. Reducing pressure in the lateral position appeared to be the most challenging. Peak pressures were significantly reduced, based on visual feedback from the CBPM monitor. The number of preventive interventions also increased, as well as patients' comfort. For the nurses as a group, the knowledge score was 59·7% and the attitude score was 88·8%. Real-time visual feedback of pressure points appears to provide another dimension to complement decision making with respect to PU prevention.
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Affiliation(s)
- Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - Cheryl Carli
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden.,Department of Dermatology, Uppsala University Hospital, Uppsala, Sweden.,Department of Rheumatology, Uppsala University Hospital, Uppsala, Sweden
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28
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Florin J, Bååth C, Gunningberg L, Mårtensson G. Attitudes towards pressure ulcer prevention: a psychometric evaluation of the Swedish version of the APuP instrument. Int Wound J 2014; 13:655-62. [PMID: 25124833 DOI: 10.1111/iwj.12338] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 05/06/2014] [Accepted: 06/25/2014] [Indexed: 11/28/2022] Open
Abstract
The primary aim was to conduct a psychometric evaluation of the Attitude towards Pressure ulcer Prevention (APuP) instrument in a Swedish context. A further aim was to describe and compare attitudes towards pressure ulcer prevention between registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs). In total, 415 RNs, ANs and SNs responded to the questionnaire. In addition to descriptive and comparative statistics, confirmatory factor analyses were performed. Because of a lack of support for the instrument structure, further explorative and consecutive confirmatory tests were conducted. Overall, positive attitudes towards pressure ulcer prevention were identified for all three groups, but SNs reported lower attitude scores on three items and a higher score on one item compared to RNs and ANs. The findings indicated no support in this Swedish sample for the previously reported five-factor model of APuP. Further explorative and confirmative factor analyses indicated that a four-factor model was most interpretable: (i) Priority (five items), (ii) Competence (three items), (iii) Importance (three items) and (iv) Responsibility (two items). The five-factor solution could not be confirmed. Further research is recommended to develop a valid and reliable tool to assess nurses' attitudes towards pressure ulcer prevention working across different settings on an international level.
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Affiliation(s)
- Jan Florin
- Department of Health and Social Sciences, Dalarna University, Falun, Sweden.
| | - Carina Bååth
- Faculty of Health, Sciences, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden.,County Council of Värmland, Värmland, Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gunilla Mårtensson
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.,Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
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Gunningberg L, Pöder U, Donaldson N, Leo Swenne C. Medication administration accuracy: using clinical observation and review of patient records to assess safety and guide performance improvement. J Eval Clin Pract 2014; 20:411-6. [PMID: 24798301 DOI: 10.1111/jep.12150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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] [Accepted: 03/31/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Medication-related errors are common and can occur at every step of the medication process. The aim was to explore (1) the extent to which nurses perform fundamental safe practices related to medication administration (MA); (2) the frequency and characteristics of MA errors; and (3) the clinical significance of medication types (classes) subject to error. METHODS A descriptive, exploratory cross sectional design with point in time sampling was used combining direct observations, conducted by naïve observers, and medical record review. A convenience sample of three adult surgical units was drawn from a 1000-bed university hospital. Seventy-two patient-nurse MA encounters were observed including 306 MA doses based on a minimum sample of 100 doses per unit. The Medication Administration Accuracy Assessment developed by the Collaborative Alliance for Nursing Outcomes in the United States was used. RESULTS Observed adherence to MA safe practices varied between units. Identity control (9%), explaining medication to patient (11%) and medication labelled throughout the process (25%) were found to be safe practices with greatest deviation. 18% of doses involved a MA error (n = 54). Wrong time (9%) was the most common MA error, typically involving analgesics. CONCLUSIONS Given recent reports suggesting MA safe practices are strongly associated with MA errors, it is timely to strengthen RN awareness of the critical role of safe practices in MA safety. In nursing education, clinical examination using the six safe practices studied herein may enhance medication administration accuracy.
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Affiliation(s)
- Lena Gunningberg
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden
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Bredesen IM, Bjøro K, Gunningberg L, Hofoss D. The prevalence, prevention and multilevel variance of pressure ulcers in Norwegian hospitals: a cross-sectional study. Int J Nurs Stud 2014; 52:149-56. [PMID: 25443301 DOI: 10.1016/j.ijnurstu.2014.07.005] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [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: 12/04/2013] [Revised: 04/08/2014] [Accepted: 07/10/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Pressure ulcers are preventable adverse events. Organizational differences may influence the quality of prevention across wards and hospitals. OBJECTIVE To investigate the prevalence of pressure ulcers, patient-related risk factors, the use of preventive measures and how much of the pressure ulcer variance is at patient, ward and hospital level. DESIGN A cross-sectional study. SETTING Six of the 11 invited hospitals in South-Eastern Norway agreed to participate. PARTICIPANTS Inpatients ≥18 years at 88 somatic hospital wards (N=1209). Patients in paediatric and maternity wards and day surgery patients were excluded. METHODS The methodology for pressure ulcer prevalence studies developed by the European Pressure Ulcer Advisory Panel was used, including demographic data, the Braden scale, skin assessment, the location and severity of pressure ulcers and preventive measures. Multilevel analysis was used to investigate variance across hierarchical levels. RESULTS The prevalence was 18.2% for pressure ulcer category I-IV, 7.2% when category I was excluded. Among patients at risk of pressure ulcers, 44.3% had pressure redistributing support surfaces in bed and only 22.3% received planned repositioning in bed. Multilevel analysis showed that although the dominant part of the variance in the occurrence of pressure ulcers was at patient level there was also a significant amount of variance at ward level. There was, however, no significant variance at hospital level. CONCLUSIONS Pressure ulcer prevalence in this Norwegian sample is similar to comparable European studies. At-risk patients were less likely to receive preventive measures than patients in earlier studies. There was significant variance in the occurrence of pressure ulcers at ward level but not at hospital level, indicating that although interventions for improvement are basically patient related, improvement of procedures and organization at ward level may also be important.
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Affiliation(s)
| | - Karen Bjøro
- Department of Orthopaedic Surgery, Oslo University Hospital, Norway
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Sweden
| | - Dag Hofoss
- Institute of Health and Society, University of Oslo, Norway
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31
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Sving E, Idvall E, Högberg H, Gunningberg L. Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study. Int J Nurs Stud 2014; 51:717-25. [DOI: 10.1016/j.ijnurstu.2013.09.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 08/13/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
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Bååth C, Idvall E, Gunningberg L, Hommel A. Pressure-reducing interventions among persons with pressure ulcers: results from the first three national pressure ulcer prevalence surveys in Sweden. J Eval Clin Pract 2014; 20:58-65. [PMID: 23992564 DOI: 10.1111/jep.12079] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [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] [Accepted: 08/05/2013] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The overall aim of this study was to describe preventive interventions among persons with pressure ulcer (PU) in three nationwide PU prevalence surveys in Sweden. METHODS A cross-sectional research design was used; more than 70 000 persons from different hospitals and nursing homes participated in the three prevalence surveys conducted in March 2011, October 2011 and March 2012. The methodology used was that recommended by the European Pressure Ulcers Advisory Panel. RESULTS The overall prevalence of PU categories I-IV in hospitals was 16.6%, 14.4% and 16.1%, respectively. Corresponding figures for nursing homes were 14.5%, 14.2% and 11.8%, respectively. Heel protection/floating heels and sliding sheets were more frequently planned for persons with PU category I. CONCLUSIONS Despite the three prevalence studies that have showed high prevalence of PU the use of preventing interventions is still not on an acceptable level. Heel protection/floating heels and sliding sheets were more frequently planned for persons with PUs, and individual-planned repositioning also increased. However, when persons already have a PU they should all have pressure-reducing preventive interventions to prevent the development of more PUs. Preventing PUs presents a challenge even when facilities have prevention programmes. A PU prevention programme requires an enthusiastic leader who will maintain the team's focus and direction for all staff involved in patient care.
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Affiliation(s)
- Carina Bååth
- Faculty of Health, Science and Technology, Department of Health Sciences, Karlstad University and Research, County Council of Värmland, Karlstad, Sweden
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Abstract
AIM To report data from the first national pressure ulcer prevalence survey in Sweden on prevalence, pressure ulcer categories, locations and preventive interventions for persons at risk for developing pressure ulcers. METHODS A cross-sectional research design was used in a total sample of 35,058 persons in hospitals and nursing homes. The methodology used was that recommended by the European Pressure Ulcer Advisory Panel. RESULTS The prevalence of pressure ulcers was 16.6% in hospitals and 14.5% in nursing homes. Many persons at risk for developing pressure ulcers did not receive a pressure-reducing mattress (23.3-27.9%) or planned repositioning in bed (50.2-57.5%). CONCLUSIONS Despite great effort on the national level to encourage the prevention of pressure ulcers, the prevalence is high. Public reporting and benchmarking are now available, evidence-based guidelines have been disseminated and national goals have been set. Strategies for implementing practices outlined in the guidelines, meeting goals and changing attitudes must be further developed.
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Affiliation(s)
- Lena Gunningberg
- Associate Professor, Department of Public Health and Caring Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden and Adjunct Assistant Professor, School of Nursing, University of California, San Francisco, CA, USA Assistant Professor, Lund University and Skåne University Hospital, Lund, Sweden Assistant Professor, Karlstad University and County Council of Värmland, Karlstad, Sweden Professor, Faculty of Health and Society, Malmö University and Skåne University Hospital, Malmö, Sweden
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Gunningberg L, Mårtensson G, Mamhidir AG, Florin J, Muntlin Athlin Å, Bååth C. Pressure ulcer knowledge of registered nurses, assistant nurses and student nurses: a descriptive, comparative multicentre study in Sweden. Int Wound J 2013; 12:462-8. [PMID: 23919728 DOI: 10.1111/iwj.12138] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [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: 01/02/2013] [Revised: 07/05/2013] [Accepted: 07/08/2013] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to describe and compare the knowledge of registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs) about preventing pressure ulcers (PUs). PU prevention behaviours in the clinical practice of RNs and ANs were also explored. A descriptive, comparative multicentre study was performed. Hospital wards and universities from four Swedish county councils participated. In total, 415 participants (RN, AN and SN) completed the Pressure Ulcer Knowledge Assessment Tool. The mean knowledge score for the sample was 58·9%. The highest scores were found in the themes 'nutrition' (83·1%) and 'risk assessment' (75·7%). The lowest scores were found in the themes 'reduction in the amount of pressure and shear' (47·5%) and 'classification and observation' (55·5%). RNs and SNs had higher scores than ANs on 'aetiology and causes'. SNs had higher scores than RNs and ANs on 'nutrition'. It has been concluded that there is a knowledge deficit in PU prevention among nursing staff in Sweden. A major educational campaign needs to be undertaken both in hospital settings and in nursing education.
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Affiliation(s)
- Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University and University Hospital, Uppsala, Sweden.,School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Gunilla Mårtensson
- Department of Public Health and Caring Sciences, Uppsala University and University Hospital, Uppsala, Sweden.,Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Anna-Greta Mamhidir
- Department of Public Health and Caring Sciences, Uppsala University and University Hospital, Uppsala, Sweden.,Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Jan Florin
- Department of Health and Social Sciences, Dalarna University, Falun, Sweden
| | - Åsa Muntlin Athlin
- Department of Public Health and Caring Sciences, Uppsala University and University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,School of Nursing, University of Adelaide, Adelaide, Australia
| | - Carina Bååth
- Faculty of Social and Life Sciences, Department of Nursing, Karlstad University, Karlstad, Sweden.,County Council of Värmland, Karlstad, Sweden
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Gunnarsson AK, Akerfeldt T, Larsson S, Gunningberg L. Increased energy intake in hip fracture patients affects nutritional biochemical markers. Scand J Surg 2013; 101:204-10. [PMID: 22968245 DOI: 10.1177/145749691210100311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS We have previously shown that nutritional guidelines decreased the incidence of pressure ulcers in hip fracture patients. In the present study, we evaluate whether the nutritional biochemical markers S-IGF-1 (Insulin-like Growth Factor 1), S-Transthyretin and S-Albumin are affected by patients' energy intake, and whether the markers are useful as predictors of postoperative complications. MATERIAL AND METHODS Quasi-experimental design, with one intervention and one control group, as well as pre- and post-study measurements. Eighty-eight hip fracture patients were included: 42 in the control group and 46 in the intervention group. The control group received regular nutritional support pre- and postoperatively, while the intervention group received nutritional support that followed new, improved clinical guidelines from admission to five days postoperatively. S-Albumin, S-Transthyretin, C-Reactive Protein (S-CRP) and S-IGF-1 were analysed at admission and five days postoperatively as well as complications like pressure ulcer and infection. RESULTS The intervention group had a significantly higher energy intake; for example, 1636 kcal versus 852 kcal postoperative day 1. S-IGF-1 levels decreased significantly in the control group, while no decrease in the intervention group. S-Albumin and S-Transthyretin decreased and S-CRP increased significantly in both groups, indicating that those markers were not affected short-term by a high-energy intake. There was no correlation between short-term post-operative complications and S-IGF-1, S-Transthyretin or S-Albumin at admission. CONCLUSION The results of our study showed that S-IGF-1 can be used as a short-term nutritional biochemical marker, as it was affected by a five-day high-energy regimen. However, neither S-IGF-1, S-Transthyretin or S-Albumin were useful in predicting postoperative complications within five days postoperatively.
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Affiliation(s)
- A-K Gunnarsson
- Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden.
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Abstract
AIM To compare overall unit-level pressure ulcer (PU) prevalence, hospital-acquired pressure ulcer (HAPU) prevalence and prevention strategies, as well as nurse staffing and workload in two hospitals in Sweden with data from the USA. METHODS Medical and surgical units in a university hospital and a general hospital in Sweden were compared with 207 hospitals in the USA participating in the Collaborative Alliance for Nursing Outcomes (CALNOC) benchmarking registry. All adult inpatients in university hospital (n = 630), general hospital (n = 253) and CALNOC hospitals (n = 3506) were included in the study. Outcome indicators were pressure ulcer prevalence for all types (PU) and HAPU prevalence, specifically. Process indicators were risk assessment and PU prevention strategies. Structure indicators were nurse staffing (hours of care, and skill mix) and workload (admissions, discharges and transfers). RESULTS The prevalence of PU (categories 1-4) was 17.6% (university hospital) and 9.5% (general hospital) compared with 6.3-6.7% in the CALNOC sample. The prevalence of full thickness HAPU (categories 3 and 4) was 2.7% (university hospital) and 2.0% (general hospital) compared with 0-0.5% in the CALNOC sample. Risk and skin assessment varied between 6% and 60% in the Swedish hospitals compared with 100% in the CALNOC sample. Total hours per patient day were 8.4 in both Swedish hospitals and 9.5 to 9.8 in the CALNOC hospitals CONCLUSIONS The findings suggest a link between processes of care and outcomes that is exciting to observe internationally and suggest the opportunity to expedite performance improvement through global benchmarking. Using HAPU as a complement to point prevalence of PU in Sweden has revealed this indicator as a more valid measure for patient care quality.
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Affiliation(s)
- Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden.
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Sving E, Gunningberg L, Högman M, Mamhidir AG. Registered nurses’ attention to and perceptions of pressure ulcer prevention in hospital settings. J Clin Nurs 2012; 21:1293-303. [DOI: 10.1111/j.1365-2702.2011.04000.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [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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38
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Helmersson-Karlqvist J, Åkerfeldt T, Gunningberg L, Swenne CL, Larsson A. Serum MMP-9 and TIMP-1 concentrations and MMP-9 activity during surgery-induced inflammation in humans. Clin Chem Lab Med 2012; 50:1115-9. [DOI: 10.1515/cclm-2011-0234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 02/06/2012] [Indexed: 11/15/2022]
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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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Arakelian E, Gunningberg L, Larsson J, Norlén K, Mahteme H. Factors influencing early postoperative recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 2011; 37:897-903. [DOI: 10.1016/j.ejso.2011.06.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 05/17/2011] [Accepted: 06/13/2011] [Indexed: 11/27/2022] Open
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Gunningberg L, Hommel A, Bååth C, Idvall E. Pressure ulcer prevention in Sweden -evidence-based guidelines and prevalence studies on the national agenda. INT J EVID-BASED HEA 2011. [DOI: 10.1097/01258363-201109000-00032] [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: 11/25/2022]
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Gunningberg L, Stotts NA, Idvall E. Hospital-acquired pressure ulcers in two Swedish County Councils: cross-sectional data as the foundation for future quality improvement. Int Wound J 2011; 8:465-73. [PMID: 21722316 DOI: 10.1111/j.1742-481x.2011.00818.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The objectives of the study were to examine the prevalence of pressure ulcers and hospital-acquired pressure ulcers (HAPU) and identify modifiable factors in patients who develop HAPU as the basis for subsequent quality assurance studies and improvement in hospital care. The study was conducted in five hospitals in two Swedish County Councils. A 1-day prevalence study (n = 1192) using the standards of the European Pressure Ulcer Advisory Panel and Collaborative Alliance for Nursing Outcomes was conducted. The prevalence of ulcers was 14·9% and 11·6% were HAPU. Older age, more days of hospitalisation, less activity, problems with shear and friction and reduced sensory perception contributed significantly to HAPU. Pressure ulcer prevention strategies used more often in those with HAPU were risk assessment at admission, provision of a pressure relief mattress, having a turning schedule and using a heel or chair cushion. The prevalence of pressure ulcers continues to be a significant issue in acute care and the prevalence of HAPU is high. There is significant room for quality improvement in pressure ulcer prevention in Swedish hospitals. Future research needs to address both HAPU and community-acquired pressure ulcers and focus on preventive strategies, including when they are initiated and which are effective in mitigating the high HAPU rate.
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Affiliation(s)
- Lena Gunningberg
- Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden.
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Idvall E, Bahtsevani C, Gunningberg L. Commentary on Hasselberg D, Ivarsson B, Andersson R & Tingstedt B (2010) The handling of peripheral venous catheters - from non-compliance to evidence-based needs. Journal of Clinical Nursing 19, 3358-3363. J Clin Nurs 2011; 20:2081-2. [PMID: 21668543 DOI: 10.1111/j.1365-2702.2011.03758.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ewa Idvall
- Faculty of Health and Society and Skåne University Hospital, Malmö University, Malmö, Sweden.
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Wadensten B, Fröjd C, Swenne CL, Gordh T, Gunningberg L. Why is pain still not being assessed adequately? Results of a pain prevalence study in a university hospital in Sweden. J Clin Nurs 2011; 20:624-34. [PMID: 21320191 DOI: 10.1111/j.1365-2702.2010.03482.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to investigate the prevalence of pain and pain assessment among inpatients in a university hospital. BACKGROUND Pain management could be considered an indicator of quality of care. Few studies report on prevalence measures including all inpatients. DESIGN Quantitative and explorative. METHOD Survey. RESULTS Of the inpatients at the hospital who answered the survey, 494 (65%) reported having experienced pain during the preceding 24 hours. Of the patients who reported having experienced pain during the preceding 24 hours, 81% rated their pain >3 and 42.1% rated their pain >7. Of the patients who reported having experienced pain during the preceding 24 hours, 38.7% had been asked to self-assess their pain using a Numeric Rating Scale (NRS); 29.6% of the patients were completely satisfied, and 11.5% were not at all satisfied with their participation in pain management. CONCLUSIONS The result showed that too many patients are still suffering from pain and that the NRS is not used to the extent it should be. Efforts to overcome under-implementation of pain assessment are required, particularly on wards where pain is not obvious, e.g., wards that do not deal with surgery patients. Work to improve pain management must be carried out through collaboration across professional groups. RELEVANCE TO CLINICAL PRACTICE Using a pain assessment tool such as the NRS could help patients express their pain and improve communication between nurses and patients in relation to pain as well as allow patients to participate in their own care. Carrying out prevalence pain measures similar to those used here could be helpful in performing quality improvement work in the area of pain management.
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Affiliation(s)
- Barbro Wadensten
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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Arakelian E, Gunningberg L, Larsson J. Defining operating room efficiency from the perspective of the staff member and the supervisor. Int J Qual Health Care 2011. [DOI: 10.1093/intqhc/mzr016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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46
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Fröjd C, Swenne CL, Rubertsson C, Gunningberg L, Wadensten B. Patient information and participation still in need of improvement: evaluation of patients' perceptions of quality of care. J Nurs Manag 2011; 19:226-36. [PMID: 21375626 DOI: 10.1111/j.1365-2834.2010.01197.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS To identify areas in need of quality improvement by investigating inpatients' perceptions of quality of care, and to identify differences in perceptions of care related to patient gender, age and type of admission. BACKGROUND Nursing managers play an important role in the development of high-quality care. METHODS Quality of care was assessed using the Quality from the Patients' Perspective (QPP). In all, 2734 inpatients at a Swedish university hospital completed the QPP. RESULTS Inadequate quality was identified for 15 out of 24 items, e.g. information given on treatment and examination results, opportunities to participate in decisions related to care and information on self-care. Patients with emergency admissions reported lower scores for quality of information and doctors' care than did patients with planned admissions. CONCLUSION Results from the present survey identified areas in need of quality improvement and differences in perceived care quality between patients. Quality of care must be developed in close collaboration with other healthcare professionals; in this respect, nursing managers could play an important role. IMPLICATIONS FOR NURSING MANAGEMENT Nursing managers could play a more active part in measuring quality of care, and in using results from such measurements to develop and improve quality of care.
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Affiliation(s)
- Camilla Fröjd
- Department of Surgical Sciences, Uppsala University, 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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Arakelian E, Gunningberg L, Larsson J. How operating room efficiency is understood in a surgical team: a qualitative study. Int J Qual Health Care 2010; 23:100-6. [DOI: 10.1093/intqhc/mzq063] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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49
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Muntlin A, Carlsson M, Gunningberg L. Barriers to change hindering quality improvement: the reality of emergency care. J Emerg Nurs 2009; 36:317-23. [PMID: 20624564 DOI: 10.1016/j.jen.2009.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 07/30/2009] [Accepted: 09/02/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to investigate physicians' and nurses' perspectives and prerequisites for quality improvement in the emergency department based on results from a previous patient survey. METHOD The study used an explorative design with a qualitative approach and was conducted at the main emergency department of a Swedish university hospital. Interviews were conducted with 5 focus groups. In total, the groups comprised 22 respondents. RESULTS The respondents suggested goals and quality improvements, such as more patient-centered care, reduced waiting times, and better pain management. However, barriers to quality improvement also were identified and represented 3 themes: the patient is looked upon as an object or a problem; the physicians and nurses belong to different organizational cultures; and the hospital's organization hinders the optimal flow of patients and improvements to quality. DISCUSSION When assigning priority to the topic areas, most of the focus groups ranked "information, respect, and empathy" as most important to improve. Adequate information, proper care, and treatment within a reasonable time in the emergency department were cited as the goals for patient care, but the health care professionals perceived barriers to change in the hospital culture and organization. To ensure quality care and patient safety, these barriers should be addressed by leaders on all levels in the organization, including the hospital board. Health care professionals' perspectives of quality of care are valuable and should be included in quality improvement work.
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Affiliation(s)
- Asa Muntlin
- Department of Public Health and Caring Sciences, Uppsala University Hospital, Uppsala, Sweden.
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Gunningberg L, Fogelberg-Dahm M, Ehrenberg A. Improved quality and comprehensiveness in nursing documentation of pressure ulcers after implementing an electronic health record in hospital care. J Clin Nurs 2009; 18:1557-64. [DOI: 10.1111/j.1365-2702.2008.02647.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [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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