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Eklund Saksberg M, Bielsten T, Cahill S, Jaarsma T, Nedlund AC, Sandman L, Jaarsma P. Nurses' priority-setting for older nursing home residents during COVID-19. Nurs Ethics 2024:9697330241226597. [PMID: 38317371 DOI: 10.1177/09697330241226597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Ethical principles behind prioritization in healthcare are continuously relevant. However, applying ethical principles during times of increased need, such as during the COVID-19 pandemic, is challenging. Also, little is known about nursing home nurses' prioritizations in their work to achieve well-being and health for nursing home residents. AIM The aim of this study was to explore nursing home nurses' priority-setting for older nursing home residents in Sweden during the COVID-19 pandemic. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT We conducted a qualitative interview study. Data were collected through in-depth interviews (retrospective self-reports) between February and May 2021 with 21 nursing home nurses. To help respondents to recall their memories, we used the critical incident technique (CIT). We analyzed data within the theoretical framework and the methodological orientation of content analysis. ETHICAL CONSIDERATIONS Written and verbal consent was obtained before the interviews, and information was given to participants informing them that participation was entirely voluntary. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to the research project (Dnr. 2020-05649). FINDINGS We identified an overarching theme-nursing home nurses struggling on multiple fronts, "just do it"-and seven categories: striving for survival and caring about a dignified death; responding sensitively to relatives' expectations; ranking the urgency of needed care; responding to input from different actors; combating the spread of infection in unconventional ways; taking the lead and doing what is required; and following the ideals of person-centered nursing. CONCLUSIONS Nurses' priority-setting for older nursing homes residents during the COVID-19 pandemic meant strain and struggle. In some cases, nurses had taken responsibility for priorities falling outside their statutory powers. Different demands and interests affected nurses' priorities. Nursing home nurses need organizational and managerial support to prioritize.
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Abstract
Qualitative research provides an in-depth understanding of lived experiences. However, these experiences can be hard to apprehend by using just one method of data analysis. A good example is the experience of resilience. In this paper, the authors describe the chain of the decision-making process in the research of the construct of "resilience". s The authors justify the implications of a multi-method, pluralistic approach, and show how the triangulation of two or more qualitative methods and integration of several qualitative data analysis methods can improve a deeper understanding of the resilience among people with chronic pain. By combining the thematic analysis, narrative analysis, and critical incident technique, lived experiences can be seen from different perspectives.Therefore, the thematic analysis describes the content and answers to "what" regarding resilience, the narrative analysis describes the dynamics of resilience, and answers to "how", while the critical incident technique clarifies the most significant experience and the answers to "why" changes happen. This integrative approach could be used in the analysis of other psychological constructs and can serve as an example of how the rigour of qualitative research could be provided.
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Affiliation(s)
- Elīna Zelčāne
- Department of Health Psychology and Paedagogy, Riga Stradiņš University, Riga, Latvia,CONTACT Elīna Zelčāne Department of Health Psychology and Paedagogy, Riga Stradiņš University, Jāņa Asara street 5, RigaLV-1009, Latvia
| | - Anita Pipere
- Department of Health Psychology and Paedagogy, Riga Stradiņš University, Riga, Latvia
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Pettersson E, Christensen BM, Berglund IG, Huus K. Healthcare professionals' experiences of situations during a procedure with a child with autism spectrum disorder in the high-technology environment. Child Care Health Dev 2023; 49:1087-1095. [PMID: 37009780 DOI: 10.1111/cch.13119] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/24/2023] [Accepted: 03/17/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND High technological environments can be challenging for children with autism spectrum disorders (ASD), because they can be sensitive to new environments, new faces and changes in daily routines. Those children are frequent visitors in those settings, and due to their heightened healthcare needs and their comorbidities, it could constitute a challenge for healthcare professionals to encounter those children. Exploring the healthcare professionals' experiences can contribute to facilitate the procedure for a child with ASD. METHOD A qualitative descriptive retrospective design with a critical incident technique has been used to capture the situations. Twenty healthcare professionals were interviewed about situations affecting the procedure in the high-technology environments, defined as anaesthesia and radiology departments. RESULT The findings revealed both favourable situations and unfavourable situations affecting the procedure in the high-technology environment. The situations described by the healthcare professionals often involved their interactions with the child and the parents. The interactions were influenced by the parents' attitudes to the procedure and also the healthcare professionals and the parents' different expectations on the procedure. Other experiences described by the healthcare professionals were the unpredictability in different situations. Those situations were related to the child's unpredictable behaviour in those environments and also to the unpredictable effect of premedication provided to the child. Moreover, the result revealed the organizational prerequisites for facilitating a procedure, such as not feeling any time pressure when leading a child through a procedure. CONCLUSIONS Interactions between healthcare professionals, children with ASD and parents in the high-technology environment are complex. Unpredictability characterizes situations when leading a child with ASD through a procedure. This place demands on the healthcare professional, the environment and the organization.
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Affiliation(s)
- Emelie Pettersson
- CHILD Research Group, Nursing Department, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Berit Møller Christensen
- CHILD Research Group, Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Ingalill Gimbler Berglund
- CHILD Research Group, Nursing Department, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Karina Huus
- CHILD Research Group, Nursing Department, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Almqvist D, Norberg D, Larsson F, Gustafsson SR. Strategies for a safe interhospital transfer with an intubated patient or where readiness for intubation is needed: A critical incidents study. Intensive Crit Care Nurs 2023; 74:103330. [PMID: 36220764 DOI: 10.1016/j.iccn.2022.103330] [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: 02/15/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The number of interhospital transports with intubated patients or where intubation readiness is required is increasing in Sweden and globally. Specialist nurses are often responsible for these transports, which involve numerous risks for critically ill patients. AIM The aim of this study was to describe nurse anaesthetists' and intensive care nurses' strategies for safe interhospital transports with intubated patients or where intubation readiness is required. METHOD A qualitative study was conducted using the critical incident technique. During March and April 2020, 12 semi-structured interviews were conducted with nurse anaesthetists and intensive care nurses. Data were analysed according to the critical incident technique, and a total of 197 critical incidents were identified. The analysis revealed five final strategies for safe interhospital transport. RESULTS Participants described the importance of ensuring clear and adequate information transfers between caregivers to obtain vital patient information that enables the nurse in charge to identify risks and problems in advance and create an action plan. Stabilising and optimising the patient's condition before departure and preparing drugs and equipment were other strategies described by the participants, as well as requesting assistance or support if questions or complications arose during transport. CONCLUSION Transports with intubated patients or where intubation readiness is required are complex and require systematic patient-safety work to ensure that strategies for increasing patient safety and decreasing risks are visible to the nurses in charge, that they are applied, and that they are, indeed, effective.
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Affiliation(s)
- Daniel Almqvist
- Department of Surgery, Piteå Hospital, Lasarettsvägen 14, 94150 Piteå, Sweden
| | - David Norberg
- Department of Surgery, Skellefteå lasarett, Lasarettsvägen 29, 93141 Skellefteå, Sweden
| | - Fanny Larsson
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology, 97187 Luleå, Sweden.
| | - Silje Rysst Gustafsson
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology, 97187 Luleå, Sweden
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Holmqvist M, Thor J, Ros A, Johansson L. Evaluation of older persons' medications: a critical incident technique study exploring healthcare professionals' experiences and actions. BMC Health Serv Res 2021; 21:557. [PMID: 34098957 PMCID: PMC8182897 DOI: 10.1186/s12913-021-06518-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Older persons with polypharmacy are at increased risk of harm from medications. Therefore, it is important that physicians and nurses, together with the persons, evaluate medications to avoid hazardous polypharmacy. It remains unclear how healthcare professionals experience such evaluations. This study aimed to explore physicians’ and nurses’ experiences from evaluations of older persons’ medications, and their related actions to manage concerns related to the evaluations. Method Individual interview data from 29 physicians and nurses were collected and analysed according to the critical incident technique. Results The medication evaluation for older persons was influenced by the working conditions (e.g. healthcare professionals’ clinical knowledge, experiences, and situational conditions) and working in partnership (e.g. cooperating around and with the older person). Actions taken to manage these evaluations were related to working with a plan (e.g. performing day-to-day work and planning for continued treatment) and collaborative problem-solving (e.g. finding a solution, involving the older person, and communicating with colleagues). Conclusion Working conditions and cooperation with colleagues, the older persons and their formal or informal caregivers, emerged as important factors related to the medication evaluation. By adjusting their performance to variations in these conditions, healthcare professionals contributed to the resilience of the healthcare system by its capacity to prevent, notice and mitigate medication problems. Based on these findings, we hypothesize that a joint plan for continued treatment could facilitate such resilience, if it articulates what to observe, when to act, who should act and what actions to take in case of deviations from what is expected. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06518-w.
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Affiliation(s)
- Malin Holmqvist
- Department of Hospital Pharmacy, Region Jönköping County, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. .,The School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Johan Thor
- Jönköping Academy for Improvement of Health and Welfare, the School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Axel Ros
- Jönköping Academy for Improvement of Health and Welfare, the School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Futurum, Region Jönköping County, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Linda Johansson
- Institute of Gerontology, Aging Research Network-Jönköping, the School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Aschieri F, Barello S, Durosini I. "Invisible Voices": A Critical Incident Study of Family Caregivers' Experience of Nursing Homes After Their Elder Relative's Death. J Nurs Scholarsh 2020; 53:65-74. [PMID: 33206459 DOI: 10.1111/jnu.12610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/12/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The literature provides few examples of family caregivers' retrospective evaluation of nursing home services. This study aimed at analyzing narratives of Italian family caregivers of elders who experienced nursing home placement. DESIGN AND METHODS Data were gathered through in-depth interviews with family members after their relatives' death. The interviews were based on the Critical Incident Technique, which allowed the categorization of the most memorable positive and negative events from the perspective of family members of elders deceased in nursing homes. Interviews were interpreted with a phenomenologically inspired thematic analysis approach. Participants were screened for complicated grief disorder as a confounding variable in relatives' accounts of the treatment. RESULTS Results suggested that positive long-term recollection of the nursing home was associated with different themes emerging from the interviews: medical reliability and expertise, active demonstrations of care that extend beyond the contract with the facility, individualized attention, responsiveness, openness to dialog with family members about routines, management of the first impression, and family engagement. Lack of professionals' expertise and medical failures, lack of care for patients' personal goods, lack of family involvement, lack of individualized attention, lack of responsiveness, poor patient surveillance, and structural limits of the facilities were the themes that were more frequently negatively associated with the nursing home experience. IMPLICATIONS FOR PRACTICE Focusing on the key dimensions connected to the quality of the experience of family members can enrich the quality of existing nursing home services and allow healthcare policymakers and managers to design better facilities for the patients.
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Affiliation(s)
- Filippo Aschieri
- Associate Professor, European Center for Therapeutic Assessment; Department of Psychology, Università Cattolica del Sacro Cuore, Milano, Lombardia, Italy
| | - Serena Barello
- Assistant Professor, EngageMinds Hub, Consumer, Food & Health Engagement Research Center; Department of Psychology, Università Cattolica del Sacro Cuore, Milano, Lombardia, Italy
| | - Ilaria Durosini
- Research fellow, Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Holden RJ, Daley CN, Mickelson RS, Bolchini D, Toscos T, Cornet VP, Miller A, Mirro MJ. Patient decision-making personas: An application of a patient-centered cognitive task analysis (P-CTA). Appl Ergon 2020; 87:103107. [PMID: 32310109 DOI: 10.1016/j.apergo.2020.103107] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 12/23/2018] [Revised: 12/21/2019] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
Personas can be used to understand patterns of variation in patients' performance of cognitive work, particularly self-care decision making. In this study, we used a patient-centered cognitive task analysis (P-CTA) to develop self-care decision-making personas. We collected data from 24 older adults with chronic heart failure and 14 support persons, using critical incident and fictitious scenario interviews. Qualitative analyses produced three personas but revealed that individuals exemplify different personas across situations. The Rule-Following persona seeks clear rules, exercises caution under uncertainty, and grounds actions in confidence in clinician experts. The Researching persona seeks information to gain better understanding, invents strategies, and conducts experiments independently or with clinicians. The Disengaging persona does not actively seek rules or information and does not attempt to reduce uncertainty or conduct experiments. We discuss the situational nature of personas, their use in design, and the benefits of P-CTA for studying patient decision making.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., USA.
| | - Carly N Daley
- Department of BioHealth Informatics, IUPUI School of Informatics and Computing, USA; Parkview Mirro Center for Research and Innovation, Parkview Health, USA
| | | | - Davide Bolchini
- Department of Human-Centered Computing, IUPUI School of Informatics and Computing, USA
| | - Tammy Toscos
- Parkview Mirro Center for Research and Innovation, Parkview Health, USA
| | - Victor P Cornet
- Parkview Mirro Center for Research and Innovation, Parkview Health, USA; Department of Human-Centered Computing, IUPUI School of Informatics and Computing, USA
| | - Amy Miller
- Department of Radiology Oncology, Indiana University School of Medicine, USA
| | - Michael J Mirro
- Parkview Mirro Center for Research and Innovation, Parkview Health, USA
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Pelto-Piri V, Warg LE, Kjellin L. Violence and aggression in psychiatric inpatient care in Sweden: a critical incident technique analysis of staff descriptions. BMC Health Serv Res 2020; 20:362. [PMID: 32336265 PMCID: PMC7184692 DOI: 10.1186/s12913-020-05239-w] [Citation(s) in RCA: 21] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 04/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Violence towards staff working in psychiatric inpatient care is a serious problem. The aim of the present study was to explore staff perspectives of serious violent incidents involving psychiatric inpatients through the following research questions: Which factors contributed to violent incidents, according to staff? How do staff describe their actions and experiences during and after violent incidents? METHODS We collected data via a questionnaire with open-ended questions, and captured 283 incidents reported by 181 staff members from 10 inpatient psychiatric wards in four different regions. We used the Critical Incident Technique to analyse the material. Our structural analysis started by structuring extracts from the critical incidents into descriptions, which were grouped into three chronological units of analyses: before the incident, during the incident and after the incident. Thereafter, we categorised all descriptions into subcategories, categories and main areas. RESULTS Staff members often attributed aggression and violence to internal patient factors rather than situational/relational or organisational factors. The descriptions of violent acts included verbal threats, serious assault and death threats. In addition to coercive measures and removal of patients from the ward, staff often dealt with these incidents using other active measures rather than passive defence or de-escalation. The main effects of violent incidents on staff were psychological and emotional. After violent incidents, staff had to continue caring for patients, and colleagues provided support. Support from managers was reported more rarely and staff expressed some dissatisfaction with the management. CONCLUSIONS As a primary prevention effort, it is important to raise awareness that external factors (organisational, situational and relational) are important causes of violence and may be easier to modify than internal patient factors. A secondary prevention approach could be to improve staff competence in the use of de-escalation techniques. An important tertiary prevention measure would be for management to follow up with staff regularly after violent incidents and to increase psychological support in such situations.
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Affiliation(s)
- Veikko Pelto-Piri
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Lars-Erik Warg
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Lars Kjellin
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Curran C, Lydon S, Kelly ME, Murphy AW, O'Connor P. An analysis of general practitioners' perspectives on patient safety incidents using critical incident technique interviews. Fam Pract 2019; 36:736-742. [PMID: 30926981 DOI: 10.1093/fampra/cmz012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND General practitioners report difficulty in knowing how to improve patient safety. OBJECTIVES To analyse general practitioners' perspectives of contributing factors to patient safety incidents by collecting accounts of incidents, identifying the contributory factors to these incidents, assessing the impact and likelihood of occurrence of these incidents and examining whether certain categories of contributory factors were associated with the occurrence of high-risk incidents. METHODS Critical incident technique interviews were carried out with 30 general practitioners in Ireland about a patient safety incident they had experienced. The Yorkshire Contributory Factors Framework was used to classify the contributory factors to incidents. Seven subject matter experts rated the impact and likelihood of occurrence of each incident. RESULTS A total of 26 interviews were analysed. Almost two-thirds of the patient safety incidents were rated as having a major-to-extreme impact on the patient, and over a third were judged as having at least a bimonthly likelihood of occurrence. The most commonly described active failures were 'Medication Error' (34.6%) and 'Diagnostic Error' (30.8%). 'Situational Domain' was identified as a contributory domain in all patient safety incidents. 'Communication' breakdown at both practice and other healthcare-provider interfaces (69.2%) was also a commonly cited contributory factor. There were no significant differences in the levels of risk associated with the contributory factors. CONCLUSIONS Critical incident technique interviews support the identification of contributory factors to patient safety incidents. There is a need to explore the use of the resulting data for quality and safety improvement in general practice.
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Affiliation(s)
- Ciara Curran
- Department of General Practice, School of Medicine, Ireland.,Irish Centre for Applied Patient Safety and Simulation, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, Ireland.,School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | | | - Paul O'Connor
- Department of General Practice, School of Medicine, Ireland.,Irish Centre for Applied Patient Safety and Simulation, Ireland
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Colldén Benneck J, Bremer A. Registered nurses' experiences of near misses in ambulance care - A critical incident technique study. Int Emerg Nurs 2019; 47:100776. [PMID: 31331835 DOI: 10.1016/j.ienj.2019.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 05/06/2019] [Accepted: 05/30/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND In hospitals, potentially harmful near misses occur daily exposing patients to adverse events and safety risks. The same applies to ambulance care, but it is unclear what the risks are and why near misses arise. AIM To explore registered nurses' experiences and behaviours associated with near misses where patient safety in the ambulance service was jeopardized. METHODS Based on critical incident technique, a retrospective and descriptive design with individual qualitative interviews was used. Ten men and five women from the Swedish ambulance service participated. RESULTS Seventy-three critical incidents of near misses constituted four main areas: Drug management; Human-technology interactions; Assessment and care and Patient protection actions. Incidents were found in drug management with incorrect drug mixing and dosage. In human-technology interactions, near misses were found in handling of electrocardiography, mechanical chest compression devices and other equipment. Misjudgement and delayed treatment were found in patient assessments and care measures while patient protection actions failed in transport safety, hygiene and local area knowledge. CONCLUSIONS Experiencing near misses led to stress, guilt and shame. The typical behaviour in response to near misses was to immediately correct the action. Occasionally, however, the near miss was not discovered until later without causing any harm.
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Bergman L, Pettersson M, Chaboyer W, Carlström E, Ringdal M. Improving quality and safety during intrahospital transport of critically ill patients: A critical incident study. Aust Crit Care 2019; 33:12-19. [PMID: 30674422 DOI: 10.1016/j.aucc.2018.12.003] [Citation(s) in RCA: 10] [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: 09/24/2018] [Revised: 11/29/2018] [Accepted: 12/11/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Intrahospital transport is a high-risk procedure for critically ill patients, yet there is little known about how the transport team manages critical incidents that occur. OBJECTIVES The aim of this study was to explore critical care nurses' and physicians' experiences and practices associated with critical incidents during the transfer process in critically ill patients. METHODS As a part of an ethnographic study, semistructured interviews were performed using the critical incident technique. Data were collected in two intensive care units at one university hospital in a Swedish metropolitan city. Critical care nurses (n = 15) and physicians (n = 5) were interviewed, together describing a total of 46 critical incidents. Data were analysed using qualitative content and thematic analysis approaches. RESULTS Content analysis of nurses' and physicians' practices resulted in a description of requirements for safe transports, including organisational prerequisites, professional skills and attributes, as well as actions and behaviours of safely performing transfers. Exploring the experiences of nurses and physicians in transporting critically ill patients yielded three main themes. The first theme, a hazardous process, revealed how caring for critically ill patients during intrahospital transfers was perceived as an unsafe, demanding task that presents several threats to the patient's safety. However, despite worries and concerns, participants trusted their own abilities to handle unexpected events, resulting in the second theme, performing when it matters. The third theme, towards safe practice, captured suggestions for improvement and attitudes towards existing safety hazards. CONCLUSIONS To prevent and manage critical incidents during intrahospital transport, findings of this study suggest that nontechnical skills such as situational awareness and teamwork are essential. In addition, the team must possess the requisite technical skills and knowledge to undertake transports. Finally, organisations are required to provide a supportive and sustainable transport environment that includes fewer transport-related hazards.
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Affiliation(s)
- Lina Bergman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden.
| | - Monica Pettersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden; Vascular Department, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden.
| | - Wendy Chaboyer
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden; Menzies Health Institute Queensland, G40 Griffith Health Centre, Level 8.86, Gold Coast Campus, Griffith University, QLD 4222, Australia.
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden; University of Southeast Norway, Vestfold, Postbox 235, 3603 Kongsberg, Norway.
| | - Mona Ringdal
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden; Department of Anaesthesiology and Intensive Care, Kungälvs Hospital, SE-442 83, Kungälv, Sweden.
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Sverker A, Thyberg I, Valtersson E, Björk M, Hjalmarsson S, Östlund G. Time to update the ICF by including socioemotional qualities of participation? The development of a "patient ladder of participation" based on interview data of people with early rheumatoid arthritis (the Swedish TIRA study). Disabil Rehabil 2019; 42:1212-1219. [PMID: 30634866 DOI: 10.1080/09638288.2018.1518494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The aim of was to identify and illustrate in what situations and with what qualities people with early RA experience participation in every day's life.Methods: Fifty-nine patients (age 18-63 years) were interviewed; 25 men and 34 women. Content analysis was used to identify meaning units that were sorted based on the type of situations described and later on, categories based on quality aspects of participation were developed.Results: Participation was described as: 1. being part of a group, where a sense of belonging arose. 2. In doing activities with others for example at work or in leisure. 3. When sharing everyday chores and responsibilities for example in domestic duties. 4. When experiencing influence on actions such as when being asked for opinions on how to conduct a specific task. 5. When having the possibility to give direction of goals in rehabilitation, or elsewhere. 6. When sharing decision making and experiencing a high degree of influence in the situation.Conclusions: Participation from an individual's perspective is about belonging and having influence that mediates a positive feeling of being included and that you matter as a person. The results are important when using participation as a goal in clinical care. It is important to expand participation beyond the definitions in ICF and guidelines to include the patients' socio-emotional participation in order to promote health.Implications for rehabilitationFacilitation of participation in daily activities is an important part of rehabilitation.Participation is expressed as determined by a person's unique life circumstances often in engagement with others.It is important to expand participation beyond the definitions in ICF and guidelines to include the patients' socio-emotional participation in order to promote health.Collected information about socioemotional participation can serve as a starting point for interventions aimed at the patient's social environment and also provide support for health professions how to involve significant others in the rehabilitation.
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Affiliation(s)
- Annette Sverker
- Department of Activity and Health, Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ingrid Thyberg
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Rheumatology, Heart and Medicine Centre, Region, Östergötland
| | - Eva Valtersson
- Department of Activity and Health and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- Division of Occupational Therapy, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Rheumatology, Heat and Medicine Centre, Region, Östergötland
| | - Sara Hjalmarsson
- Patient Research Partner, Swedish Rheumatism Association, Norrköping, Sweden
| | - Gunnel Östlund
- Division of Social Work, School of Health Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
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Hopia H, Heino-Tolonen T. Families in Paediatric Oncology Nursing: Critical Incidents From the Nurses' Perspective. J Pediatr Nurs 2019; 44:e28-e35. [PMID: 30528181 DOI: 10.1016/j.pedn.2018.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Paediatric oncology nurses encounter challenges with families on a daily basis. This study explores how nurses describe significant incidents when encountering families and family members during the child's hospitalisation in the paediatric oncology unit. DESIGN AND METHODS A qualitative study with a phenomenological approach in which 17 paediatric oncology nurses from three different hospitals described critical incidents related to families. The participants' written descriptions were analysed using inductive content analysis. RESULTS The results indicate three domains where critical incidents occur: 1) Families' capability and resources, 2) parents' behaviour and 3) emotional labour in paediatric oncology nursing. CONCLUSION The results indicate that paediatric oncology nurses face situations with patients' parents that can cause them stress and uncertainty, as well as burden them emotionally. Some of the incidents dealt with difficult ethical questions. Because of the challenges that families are facing, as described in the study, nurses need to focus more on helping families identify their resources and empower themselves in order to adapt to a new situation in their lives. IMPLICATIONS The results provide important information not only for paediatric nursing but also for education and management. Since the quality of family nursing does not only depend on the competence of nurses or available resources, support from management concerning the work with families of severely sick children would be beneficial to the nurses. In addition, educational interventions need to be developed in order to strengthen the capability of nurses to successfully respond to challenging situations with families.
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Affiliation(s)
- Hanna Hopia
- JAMK University of Applied Sciences, School of Health and Social Studies, Jyvaskyla, Finland.
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14
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Stålberg A, Sandberg A, Söderbäck M. Child-centred Care - Health Professionals' Perceptions of What Aspects are Meaningful When Using Interactive Technology as a Facilitator in Healthcare Situations. J Pediatr Nurs 2018; 43:e10-e17. [PMID: 30056996 DOI: 10.1016/j.pedn.2018.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Anna Stålberg
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
| | - Anette Sandberg
- School of Education, Culture and Communication, Mälardalen University, Västerås, Sweden
| | - Maja Söderbäck
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Graybill E, Heggs A, Truscott S, Vinoski E, Crenshaw M, Crimmins D. Using the critical incident technique to measure long-term outcomes of interprofessional education. J Interprof Care 2017; 31:533-536. [PMID: 28467135 DOI: 10.1080/13561820.2017.1307172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a critical need to develop methods that capture long-term trainee outcomes and link these outcomes to interprofessional education (IPE) to establish the value added from IPE. This article describes the use of the critical incident technique (CIT) to evaluate long-term trainee outcomes attributed to IPE. Critical incidents (CIs) are specific examples of behaviours that occurred within the recent past. Trainees of an IPE programme (n = 24) were interviewed using CIT. Across the trainees, 41 CIs were reported, of which 9 were collapsed due to similarity in theme. A final total of 32 CIs were mapped along the Kirkpatrick/Barr Model of Learner Outcomes. The mapping process revealed that all of the CIs reported described incidents at Levels 3, 4a, and 4b, indicating changes in trainees' own professional behaviour and improvements in patient outcomes related to their IPE experience. Implications for evaluating IPE using the CIT method are discussed.
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Affiliation(s)
- Emily Graybill
- a Center for Leadership in Disability , Georgia State University , Atlanta , Georgia , USA
| | - Akilah Heggs
- a Center for Leadership in Disability , Georgia State University , Atlanta , Georgia , USA
| | - Stephen Truscott
- b Counseling and Psychological Services , Georgia State University , Atlanta , Georgia , USA
| | - Erin Vinoski
- a Center for Leadership in Disability , Georgia State University , Atlanta , Georgia , USA
| | - Mark Crenshaw
- a Center for Leadership in Disability , Georgia State University , Atlanta , Georgia , USA
| | - Daniel Crimmins
- a Center for Leadership in Disability , Georgia State University , Atlanta , Georgia , USA
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Wihlborg J, Edgren G, Johansson A, Sivberg B. Reflective and collaborative skills enhances Ambulance nurses' competence - A study based on qualitative analysis of professional experiences. Int Emerg Nurs 2016; 32:20-27. [PMID: 27374021 DOI: 10.1016/j.ienj.2016.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 11/27/2015] [Revised: 04/25/2016] [Accepted: 06/07/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Swedish ambulance health care services are changing and developing, with the ambulance nurse playing a central role in the development of practice. The competence required by ambulance nurses in the profession remains undefined and provides a challenge. The need for a clear and updated description of ambulance nurses' competence, including the perspective of professional experiences, seems to be essential. AIM The aim of this study was to elucidate ambulance nurses' professional experiences and to describe aspects affecting their competence. METHODS For data collection, the study used the Critical Incident Technique, interviewing 32 ambulance nurses. A qualitative content analysis was applied. RESULTS AND CONCLUSION This study elucidates essential parts of the development, usage and perceptions of the competence of ambulance nurses and how, in various ways, this is affected by professional experiences. The development of competence is strongly affected by the ability and possibility to reflect on practice on a professional and personal level, particularly in cooperation with colleagues. Experiences and communication skills are regarded as decisive in challenging clinical situations. The way ambulance nurses perceive their own competence is closely linked to patient outcome. The results of this study can be used in professional and curriculum development.
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Affiliation(s)
- Jonas Wihlborg
- Department of Health Sciences, Faculty of Medicine, Lund University, Health Sciences Centre, 221 00 Lund, Sweden.
| | - Gudrun Edgren
- Centre for Teaching and Learning, Faculty of Medicine, Lund University, 221 00 Lund, Sweden
| | - Anders Johansson
- Department of Health Sciences, Faculty of Medicine, Lund University, Health Sciences Centre, 221 00 Lund, Sweden
| | - Bengt Sivberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Health Sciences Centre, 221 00 Lund, Sweden
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17
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Eriksson K, Wikström L, Fridlund B, Årestedt K, Broström A. Patients' experiences and actions when describing pain after surgery--a critical incident technique analysis. Int J Nurs Stud 2015; 56:27-36. [PMID: 26772655 DOI: 10.1016/j.ijnurstu.2015.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 06/03/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postoperative pain assessment remains a significant problem in clinical care despite patients wanting to describe their pain and be treated as unique individuals. Deeper knowledge about variations in patients' experiences and actions could help healthcare professionals to improve pain management and could increase patients' participation in pain assessments. OBJECTIVE The aim of this study was, through an examination of critical incidents, to describe patients' experiences and actions when needing to describe pain after surgery. METHODS An explorative design involving the critical incident technique was used. Patients from one university and three county hospitals in both urban and rural areas were included. To ensure variation of patients a strategic sampling was made according to age, gender, education and surgery. A total of 25 patients who had undergone orthopaedic or general surgery was asked to participate in an interview, of whom three declined. FINDINGS Pain experiences were described according to two main areas: "Patients' resources when in need of pain assessment" and "Ward resources for performing pain assessments". Patients were affected by their expectations and tolerance for pain. Ability to describe pain could be limited by a fear of coming into conflict with healthcare professionals or being perceived as whining. Furthermore, attitudes from healthcare professionals and their lack of adherence to procedures affected patients' ability to describe pain. Two main areas regarding actions emerged: "Patients used active strategies when needing to describe pain" and "Patients used passive strategies when needing to describe pain". Patients informed healthcare professionals about their pain and asked questions in order to make decisions about their pain situation. Selfcare was performed by distraction and avoiding pain or treating pain by themselves, while others were passive and endured pain or refrained from contact with healthcare professionals due to healthcare professionals' large work load.
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Affiliation(s)
- Kerstin Eriksson
- School of Health Sciences, Jönköping University, PO Box 1026, 551 11 Jönköping, Sweden; Department of Anaesthesia and Intensive Care, Ryhov County Hospital, 551 85 Jönköping Sweden.
| | - Lotta Wikström
- School of Health Sciences, Jönköping University, PO Box 1026, 551 11 Jönköping, Sweden; Department of Anaesthesia and Intensive Care, Ryhov County Hospital, 551 85 Jönköping Sweden
| | - Bengt Fridlund
- School of Health Sciences, Jönköping University, PO Box 1026, 551 11 Jönköping, Sweden.
| | - Kristofer Årestedt
- School of Health and Caring Sciences, Linnaeus University, 391 82 Kalmar, Sweden; Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, 581 83 Linköping, Sweden; Department of Clinical Neurophysiology, University Hospital, 581 85 Linköping, Sweden.
| | - Anders Broström
- School of Health Sciences, Jönköping University, PO Box 1026, 551 11 Jönköping, Sweden; Department of Clinical Neurophysiology, University Hospital, 581 85 Linköping, Sweden.
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Jakopovic D, Falk AC, Lindström V. Ambulance personnel's experience of pain management for patients with a suspected hip fracture: A qualitative study. Int Emerg Nurs 2015; 23:244-9. [PMID: 25676257 DOI: 10.1016/j.ienj.2014.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 12/23/2014] [Accepted: 12/30/2014] [Indexed: 11/19/2022]
Abstract
Pain management is described to be insufficient for patients suffering from a hip fracture, and the management for this vulnerable group of patients may be challenging due to their medical history (multiple comorbidities) and polypharmacy. Previous research has mainly focused on fast tracks aiming to reduce time to surgery. But the research on how pain management is handled for these patients in the prehospital context has been sparse. Therefore, the purpose of this study was to describe the ambulance personnel's experience of managing the pain of patients with a suspected hip fracture. A descriptive and qualitative design with Critical Incident Technique was used for collecting data. Moreover, a qualitative content analysis was used for analysing the collected data. Twenty-two participants communicated their experiences and 51 incidents were analysed. The main finding in the study was that the ambulance personnel, by using their clinical knowledge and by empowering the patients to participate in their own care, managed to individualize the pain relief for patients with a suspected hip fracture through a variety of interventions.
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Paraskevas A, Altinay L. Signal detection as the first line of defence in tourism crisis management. Tour Manag 2013; 34:158-171. [PMID: 32287739 PMCID: PMC7115597 DOI: 10.1016/j.tourman.2012.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 04/17/2012] [Indexed: 05/05/2023]
Abstract
The vulnerability of the tourism industry to a range of crises has attracted many scholars to investigate the crisis strategies and practices employed by destinations and tourism organizations mainly with regards to crisis preparedness, containment and damage limitation, crisis recovery and subsequent learning. One over-looked area has been that of crisis signal detection. This paper proposes a three-stage conceptual framework for crisis signal detection consisting of signal scanning, capture and transmission to the crisis response centre. With this framework as a basis, 16 corporate level executives of international tourism organizations were interviewed in order to explore the significance of signal detection in their crisis management practice and the challenges faced in each of these three stages. The findings offer insights into the design of crisis management mechanisms and open areas for further research.
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Affiliation(s)
- Alexandros Paraskevas
- Oxford School of Hospitality Management, Faculty of Business, Oxford Brookes University, Headington Campus, Oxford OX3 0BP, United Kingdom
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