Dissertationen zum Thema „Nursing care measures“

Objective: This dissertation includes three projects that study care environments and apathy in dementia as well as measures of activity. Project 1 developed the Person-Environment Apathy Rating (PEAR) scale to measure environmental stimulation and apathy, and tested its psychometrics. Project 2 examined the association between care environments and apathy in persons with dementia. Project 3 tested the accuracy of ActiGraph and activPALTM activity monitors in measuring weight-bearing activities among persons with previous diabetic foot ulcers. Methods: The PEAR consists of environment (PEAR-Environment) and apathy (PEAR-Apathy) subscales. The validity and reliability of the PEAR was examined through video observation of 24 participants. Project 2 selected 40 participants with dementia in order to examine the association between apathy and environmental stimulation, ambiance, crowding, staff familiarity, and light and sound. Study procedures involved video observation and data extraction. Project 3 enrolled 31 participants to test the accuracy of ActiGraph and activPALTM in measuring number of steps taken and duration of walking, standing, sitting, and lying. Results: The PEAR-Environment subscale had significant but fair correlation with the Crowding Index (Ρ=.27, p<.01), suggesting fair validity. The PEAR-Apathy highly correlated with the Passivity in Dementia Scale (ρ=.81) and Neuropsychiatry Inventory (NPI)-Apathy subscale (ρ=.266), and moderately correlated with the NPI-Depression subscale (ρ=.46), indicating good convergent validity and moderate discriminate validity. The PEAR also demonstrated good internal consistency (Cronbach's Α= .84 -.85) and moderate to good inter-rater (Weighted Kappa=.47-.94) and intra-rater (Weighted Kappa=.47-.94) reliability. Project 2 revealed that stimulation clarity and strength were significantly associated with a low apathy level (p<.001). An increase of 1 point on stimulation clarity and strength corresponded to a decrease on apathy score of 1.3 and 1.9 points, respectively. Project 3 revealed that ActiGraph had widely varied accuracy in measuring duration of standing, walking, sitting, and lying (0-100%) and in measuring number of steps taken (43-81%). In contrast, activPALTM showed consistently high accuracy in measuring duration of standing, walking, sitting, and lying (97-100%) and in measuring number of steps of taken (91-99%). Discussion: The PEAR is a valid and reliable measure of care environment and apathy in long-term care residents with dementia. Care environments that contain clear and sufficiently strong environmental stimulation are significantly associated with lower apathy levels, providing a foundation for interventions targeting apathy. ActivPALTM is a valid tool to measure weight-bearing activity in persons with diabetes in order to examine the role of weight-bearing activity in foot ulceration. This monitor may also be useful as a supplemental measure for apathy in persons with dementia.

Syftet med denna systematiska litteraturstudie var att undersöka hur patienter upplever sitt venösa bensår och dess omvårdnadsåtgärder. Litteraturstudien grundades på metod av Forsberg & Wengström (2003). Tio vetenskapliga kvalitativa artiklar inkluderades i litteraturstudien. Resultatet visade på att patienters upplevelser av venösa bensår hade en negativ inverkan på livet. Hos patienterna fanns en ständig oro och rädsla för eventuella komplikationer, yttre våld mot såret samt känslor av hopplöshet gällande sårläkningen. Mer forskning krävs för att få en tydligare förståelse för dessa patienter och deras upplevelser av deras bensår samt upplevelser kring omvårdnadsbehandlingen vid venösa bensår.
The aim of this systematic literature review was to examine how patients perceived their risk of venous leg ulcers and its care measures. The literature study was based on a method of Forsberg & Wengström (2003). Ten scientific articles included in the literature study. The results showed that patients' perceptions of venous leg ulcers have a negative impact on their lives. Among the patients was a constant worry and fear of possible complications, external violence against the bone or the wound and feelings of hopelessness regarding the wound healing. More research is needed to reach a clearer understanding of these patients experience of their ulcers and the experiences of its care measures.

Introduktion: Patientens upplevelser från intensivvårdsavdelningen kan ge upphov till stress som orsakas av flera faktorer. Detta kan påverka patienten lång tid efter utskrivningen. Det är därför viktigt att veta vilka omvårdnadsåtgärder på intensivvårdsavdelningen som stödjer patientens återhämtning. Syfte: Studiens syfte var att beskriva intensivvårdssjuksköterskors uppfattningar av preventiva omvårdnadsåtgärder på intensivvårdsavdelningen som kan vara stödjande för patientens återhämtning. Metod: En kvalitativ metod valdes och datainsamling skedde i form av nio intervjuer med intensivvårdssjuksköterskor, med erfarenhet av uppföljningsarbete, på tre olika sjukhus. Analys av insamlat material, skedde med hjälp av kvalitativ innehållsanalys enligt Graneheim och Lundman. Huvudresultat: I resultatet framkom fyra huvudkategorier som beskriver områden för preventiva omvårdnadsåtgärder: Skapa meningsfullhet, Förklara omvärlden, Skapa trygghet och Förbered framtiden. Konklusion: Studiens resultat visar att kunskap om patientens historia kan användas som grund för att knyta an till patientens vardagsliv. Struktur, förklaringar och råd från personalen har uppfattats stödja patientens omvärldsuppfattning på IVA. Trygghet och närhet från personal och anhöriga anses viktigt för patienten. Framförallt har stöd till patientens inre resurser och anpassande av miljön genom nedtrappad övervakning, uppfattats kunna bidra till att patienten återfår sin självständighet och bättre kan hantera framtiden.
Introduction: A patient´s experiences during intensive care can lead to stress that is caused by several factors. This can affect the patient long after discharge. Therefore, it is essential to know which nursing interventions in the intensive care unit, that best support the patient's recovery. Aim: The aim of this study was to describe the intensive care nurses' perceptions of preventive care measures in the intensive care that can be supporting for the patient's recovery. Method: A qualitative method was chosen and the data collection was done by interviewing nine intensive care nurses with experience in monitoring work at three different hospitals. The collected material was analyzed in accordance with Graneheim and Lundman´s qualitative content analysis. Main Results: The results revealed four main categories in which preventive care measures are especially useful: Creating meaning, Explaining the environment, Creating safety and Preparing for the Future. Conclusion: By gaining knowledge about what is relevant to each particular patient it is possible to adapt care measures based on this. It seems that structure, detailed explanations and advice provided by the staff will help the patient to better assess his/her situation. Being close to staff and family is comforting for the patient. It is a great importance to help the patient regain independence in order to manage the future. It was perceived that this can be done by gradually decreasing the use of technology and supporting the patient´s inner strengths.

Nurses' working environment, together with their patient relationships, can elicit emotions which they will need to manage in order to perform successfully in their daily work activities. It is for this reason that it is crucial that sound emotional intelligence measures should be developed which hospitals can utilise to identify emotionally intelligent individuals for emotionally laden jobs or even to identify their developmental needs within the area of emotional intelligence. The objective of this study was to investigate the psychometric properties of the Emotional Intelligence Scale (EIS) developed by Schutte and colleagues in 1998 within a nursing environment. A convenience random sample of 5 11 nurses was taken from hospitals located in the areas of Klerksdorp, Potchefstroom, Krugersdorp, Johannesburg and Pretoria. The EIS was used as a measuring instrument. Cronbach alpha coefficients, Pearson-product correlation coefficients and MANOVAS were used to analyse the data. The results showed a 5-factor solution for the EIS, which explained 50,04% of the total variance. All of the five dimensions had adequate internal consistencies, except for the Negative Emotions dimension. Lastly, group differences were identified between personnel area and emotional intelligence, as well as between race and emotional intelligence levels. Recommendations were made for future research.
Thesis (M.Com. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2006.

Bakgrund: Diabetesfotsår är en av många komplikationer relaterade till diabetes mellitus typ I och II. Diabetesfotsår bidrar till en lägre livskvalité och funktionsnivå för individen samt medför höga vårdkostnader för samhället. Sjuksköterskan i primärvården har en central roll vid omvårdnad av denna patientgrupp. Primärvården fungerar som en första instans där initiala omvårdnadsåtgärder genomförs, dels som prevention men också i syfte att behandla. Syftet: Var att belysa sjuksköterskans omvårdnadsåtgärder relaterat till diabetesfotsår i primärvården. Metod: Litteraturstudien utfördes utifrån niostegsmodellen med en tematisk analys. Studier med kvantitativ och kvalitativ ansats inkluderades. Resultat: Ett huvudtema kunde identifieras, patientutbildning och egenvård, samt tre subteman. Resultatet visade att patientutbildning är en effektiv metod för att förbättra patientens egenvård relaterat till diabetesfotsår. Fler än tre utbildningstillfällen för patienter visades ge bäst resultat på egenvård. Adekvat egenvård minskar risken för diabetesfotsår. Slutsats: Patientutbildning är den omvårdnadsåtgärd sjuksköterskan i primärvården kan erbjuda patienten. Patientutbildning har som syfte att förbättra egenvården.
Background: Diabetic foot ulcers is one of many complications related to diabetes mellitus type I and II. Diabetic foot ulcers cause lower quality of life and disability for the individual, the healthcare cost is also significant for the society. Nurses in primary health care have a central role in the nursing in this group of patients. Aim: Bring light to nursing care measures related to the diabetic foot ulcer in a primary care setting. Method: The literature review was made with the “Nine step model” with a thematic analysis. Studies with both a quantitative and qualitative approaches were included. Results: One main theme could be identified, patient education and self-care, as well as three sub themes. The result indicate that patient education is an effective method for improving self-care related to diabetic foot ulcers. More than three occasions of education for patientsgave the best results on self-care. Adequate self-care lowers the risk of diabetic foot ulcers. Conclusion: Patient education is the nursing care measure that nurses in primary care can offer patients. Patient education has the purpose of improving self-care.

Muscle weakness is the most common and persistent problem after a critical illness. Early mobilization of the critically ill patient, beginning with passive exercise and progressing to ambulation, may mitigate muscle effects of the critical illness. However, mobilization may produce adverse effects, especially early in the illness when risk for physiologic deterioration is common. If safe, introducing a mobility intervention early in the illness may facilitate ventilator weaning, shorten intensive care unit and hospitals stays, and improve functional status and quality of life for mechanically ventilated critically ill patients. The aim of this study was assess the cardiopulmonary and inflammatory responses to an early standardized passive exercise protocol (PEP) in mechanically ventilated critically ill patients. Using a quasi-experimental within-subjects repeated measures design, mechanically ventilated critically ill adults who were physiologically stable received a single standardized PEP within 72 hours of intubation. The PEP consisted of 20 minutes of bilateral passive leg movement delivered by continuous passive motion machines at a rate of 20 repetitions per minute, from 5-75 degrees, to simulate very slow walking. Physiologic parameters evaluated included heart rate (HR), mean blood pressure (MBP), oxygen saturation, and cytokine levels (IL-6 and IL-10), obtained before, during, and after the intervention. The Behavioral Pain Scale (BPS), administered before, during and after the intervention was used as a measure of participant comfort. The study sample was comprised of 18 (60%) males and 12 (40%) females, with a mean age of 56.5 years (SD 16.9 years), who were primarily Caucasian (N=18, 64%). Mean APACHE II scores for the sample were 23.8 (SD 6.2) with a mean predicted death rate of 48.8 (SD 19.8), indicating moderate mortality risk related to illness severity. Number of comorbidities ranged from 1-10 (X=4). All participants completed the intervention with no adverse events. Using repeated measures analysis of variance (rmANOVA), no significant differences were found in HR, MBP, or oxygen saturation at any of the four time points in comparison to baseline. BPS scores were significantly reduced (F(2.43, 70.42)=4.08, p=.02) at 5 and 10 minutes after the PEP was started, and were sustained at 20 minutes and for one hour after the PEP was completed. IL-6 was significantly reduced (F(1.60, 43.1)=4.351, p=.03) at the end of the intervention but not at the end of the final rest period. IL-10 values were not significantly different at any of the three time points, but IL-6 to IL-10 ratios did decrease significantly (F(1.61, 43.38)=3.42, p=.05) at the end of the PEP and again after a 60 minute rest period. Passive leg exercise was well tolerated by study participants. HR, MBP, and oxygen saturation were maintained within order set-specified ranges during and for one hour after activity, and patient comfort improved during and after the intervention. A downward trend in HR was noted in participants, which is contrary to usual HR response during exercise, and may represent clinical improvement in this population related to reduction in pain. Reduction of mean IL-6 values at the end of the PEP, but not after the rest period, suggests that the PEP was responsible for the initial IL-6 improvement. Improvement of IL-6 to IL-10 ratios from the end of the PEP to the end of the final rest period suggests that IL-10, although non-significant, may have had some effect, indicating that IL-10 increases may occur later than the time period of study. Passive exercise can be used as an approach to facilitating mobilization in mechanically ventilated critically ill adults until they are ready to participate in more active exercise. It could be that more frequent and aggressive exercise, such as passive cycling at faster rates, four times daily, will be tolerated in this population. While the understanding of clinical significance of cytokine profiles in critically ill patients is still evolving, cytokine levels may be useful in explaining benefits of mobilization in this population. Further study is required to replicate the impact of passive exercise on pain, and it may represent a novel approach to pain management in critically ill patients.
ID: 031001499; System requirements: World Wide Web browser and PDF reader.; Mode of access: World Wide Web.; Adviser: .; Title from PDF title page (viewed July 26, 2013).; Thesis (Ph.D.)--University of Central Florida, 2012.; Includes bibliographical references.
Ph.D.
Doctorate
Nursing
Nursing
Nursing

Konfusion är mycket vanligt förekommande hos äldre och skapar stort lidande, ger höga samhällskostnader och orsakar hög mortalitet. Syftet med studien var att belysa sjuksköterskans icke farmakologiska omvårdnadsåtgärder vid konfusion hos äldre patienter. Metoden var en litteraturstudie, vilken innefattade tio artiklar där relevanta omvårdnadsåtgärder framkom, dessa presenterades i resultatet under VIPS - modellens åtgärdssökord. Resultatet av studien visade att patienter med konfusion mindes och uppmärksammade vad som skedde med och runt omkring dem. Viktigt var att få information om sitt konfusionstillstånd för att förstå vad som hände och varför. Samspelet mellan sjuksköterska och patient var av stor vikt. Återorientering av patienten var vanligt och ansågs oftast ha positiv effekt. Att bekräfta patientens upplevelse, och att visa omtanke och förståelse var väl fungerande stöd. Kontinuitet av personal, att eliminera bakomliggande orsaker och att främja god sömn var av stor betydelse. Vanligt förekommande var tvångsåtgärder för att skydda patienten från att skada sig själv och andra. Musik och ljusterapi togs upp som omvårdnadsåtgärder. Även närstående hade en stor roll vid omvårdnaden av patienten med konfusion. Relativt lite forskning finns inom området konfusion, i synnerhet gällande omvårdnadsåtgärder i samband med konfusionstillståndet. Behov av ytterligare forskning föreligger inom området. //

Confusion is quite common among elderly and creates great suffering, high cost for social services and high mortality. The purpose of this study was to highlight the non-pharmacological actions in care provided by nurses to elderly with confusion. The method was a literature study, based on ten articles containing relevant care measures where the result is presented in the VIPS-model’s keywords. The result of the study showed that patients with confusion remembered and registered what was happening around them. It was important for the patient to obtain proper information regarding the state of confusion to understand what is happening. The teamwork between nurse and patient is of great importance. Re-orientation of patient was common and mostly considered to have a positive effect. Important support by the nurse is to confirm the patient’s perception by showing concern and understanding. Other key concepts where continuity of staff, eliminate underlying causes, facilitate good sleep. It was common with supervision and constrainer to protect the patients from harming themselves and others. Music and light therapy were mentioned as care measures. Relatives also played an important part in treating a patient with confusion. There is relatively little research regarding confusion especially with focus on suitable care actions. There is a need of further studies in this matter.

Bakgrund I Sverige vårdas årligen ca 12 000 män och kvinnor med tvångsvård. Tvångsvård regleras av lagar och får endast ges till personer som anses vara en fara för sig själv eller sin omgivning. Denna vårdform syftar till att upprätthålla säkerhet för både patient och dess omgivning, målet är att patienten ska ta emot frivillig vård. Att vårda någon med tvång är komplext och kan leda till svåra situationer för sjuksköterskor, vården ska därför utföras så hänsynsfullt som möjligt för att främja patienters autonomi och delaktighet.  Syfte Att beskriva sjuksköterskors upplevelser och erfarenheter av tvångsvård inom psykiatrin. Metod Litteraturstudien genomfördes med en deskriptiv design. Artiklar söktes i databaserna PubMed, Cinahl och PsychINFO. Totalt tio kvalitativa artiklar och en kvantitativ artikel användes i studiens resultat. Artiklarna har analyserats där teman och subteman har urskilts.    Resultat Resultatet visade att sjuksköterskor saknar alternativ till tvångsåtgärder och detta har lett till etiska dilemman och negativa känslor. Trots detta fanns förståelse hos sjuksköterskor för syftet med tvångsåtgärderna och det sågs som en del av arbetet. Tvångsvård beskrevs ha en negativ påverkan på vårdrelationerna och därmed beskrevs även vikten av en god och tillitsfull relation mellan sjuksköterska och patient. Resultatet beskrevs i tre teman och fyra subteman.  Slutsats Utifrån resultatet till föreliggande litteraturstudie har författarna kommit fram till att det råder delade meningar om synen på tvångsvård hos sjuksköterskor. Sammanfattningsvis dras slutsatsen att det fanns en önskan om möjliga alternativ till tvångsåtgärder och det behövs mer forskning i ämnet.  Nyckelord Tvångsvård, tvångsåtgärder, sjuksköterska
Background In Sweden approximately 12 000 men and women are treated with forced care annually. Forced care is regulated by laws and may only be given to persons who are considered a danger to themselves or their surroundings. This form of care aims to maintain safety for both the patient and the surroundings, the goal is always for the patient to receive voluntary care. Caring for someone with coercion is complex and can lead to difficult situations for nurses, therefore care should be performed as careful as possible to promote patient autonomy and participation.  Aim To describe the experiences of nurses working with involuntary treatment in psychiatric care.  Method The study was conducted with a descriptive design. The articles were searched in the databases PubMed, Cinahl och PsychINFO. Ten qualitative articles and one quantitative article were used the study’s result. The articles have been analyzed and then themes and subthemes have been distinguished. Results The result showed that nurses lack alternatives to coercive measures and this has led to ethical dilemmas and negative emotions. Despite this, nurses understood the purpose of the coercive measures and it was seen as a part of the work. Compulsive care was descibed as having a negative impact on health care relationships, and thus the importance of a good and trusting relationship between nurse and patient was also described. The results were descibed in three themes and four subthemes.  Conclusions Based on the results of the present literature study, the authors have concluded that there are shared opinions about the view of forced care in nurses. In summary the authors conclude that there was a desire for possible alternatives to coercive measures and more research is needed on the subject.  Keywords Compulsory care, Coercive measures, Nurse

Thesis (MCur)--University of Stellenbosch, 2011.
ENGLISH ABSTRACT: The Joint Commission International Accreditation (JCIA) has included a patient safety goal as part of the standards for the accreditation of hospitals. Goal number six states the need to “reduce the risk of patient harm resulting from falls”. An acute care hospital setting in Abu Dhabi, United Arab Emirates had implemented a multifaceted, multidisciplinary fall prevention programme (FPP) in preparation for accreditation by the JCIA. The achievement of the above goal is dependent on compliance with JCIA standard requirements and the hospital’s FPP. This study was undertaken to identify the factors preventing the successful implementation of the existing FPP in an acute care setting. The FPP is recognised to be in its development stages and therefore has opportunities for improvement for better patient safety outcomes, more so by reducing the incidence of falls and the severity of injuries from falls. Literature studies by Gowdy and Godfrey (2003:365) and Hathaway, Walsh, Lacey and Saenger (2001:172) suggests that the most successful approach to reducing falls and the severity of injuries from falls among patients in an acute care setting is that of a multifaceted, multidisciplinary approach. The nurses, who were primarily responsible for completing the initial fall risk assessment, expressed feelings of being overwhelmed by more safety standards being required for the JCIA. Patients with a high risk for falls were not referred to the physicians and physical therapists, nor were they referred to the clinical pharmacists for the review of high-risk medications. In addition, fall risk assessments were sometimes not done in the afternoon and during the night shift. The existing programme also did not consider bedbound, long-term patients, who require less frequent assessment. There furthermore was observer evidence to suggest that the existing FPP was not being implemented correctly. The aim of this study was to describe factors preventing the successful implementation of the existing FPP. The objectives were to identify areas being implemented successfully, to identify any barriers to successful implementation and to identify aspects of the existing FPP that may need revision. A quantitative descriptive approach was applied. The population was healthcare providers (HCPs), including both registered and practical nurses, physicians, physical therapists and pharmacists, working in an acute care setting in the United Arab Emirates. The respondents were 118 (86%) from a stratified sample of n = 137 (20%) from 684 HCPs. A specifically developed structured questionnaire was used for data collection. Reliability and validity were assured through the use of experts in questionnaire design and statistical consulting, in addition to pre-testing of the questionnaire. Ethical approval was obtained from the University of Stellenbosch Committee for Human Research and the Ethics Committee of the hospital where the study was undertaken. The respondents’ completion of the questionnaire served as voluntary consent to participate. The data were analysed and are presented in frequency tables. The mean and standard deviation were used for the statistical analysis. Correlational analyses were not done because of the descriptive approach to the study. It was considered most practical to focus on the professional groups and not on the variables, as the initial analysis indicated weak correlations. The results show those aspects of the FPP that were successfully implemented and those areas that need improvement if the JCIA requirements are to be met. Policy revision to include a clearly defined referral process for the high-risk patients, in addition to consistency of the environmental safety rounds and greater involvement and support of the unit managers/supervisors, will contribute to the greater success of the FPP. The hallmark of a successful FPP is staff education, which should be the key step in addressing the identified barriers. The human need for safety and the patient’s right to safe care and a safe environment must be integrated into staff orientation, and education and safety training programmes for all HCPs. Increased compliance may occur when HCPs are more aware of the hospital’s commitment to the patient’s right to safety. Compliance with JCIA standards and the FPP will contribute in the achievement of the accreditation.
AFRIKAANSE OPSOMMING: Die Joint Commission International Accreditation (JCIA) het ’n pasiëntveiligheidsdoelwit as deel van die standaarde vir die akkreditasie van hospitale ingesluit. Doelwit nommer ses lui: “verminder die risiko vir leed aan die pasiënt as gevolg van val”. ’n Akute sorg hospitaal in die Verenigde Arabiese Emirate het ’n veelvuldig gefasetteerde, multidissiplinêre program vir die voorkoming van val (fall prevention programme (FPP)) geïmplementeer ter voorbereiding vir akkreditasie deur die JCIA. Die bereiking van bogenoemde doelwit is afhanklik van nakoming van die standaardvereistes van die JCIA en die hospitaal se FPP. Hierdie studie is onderneem om die faktore wat die suksesvolle implementering van die bestaande FPP in die akute sorg omgewing verhinder, te identifiseer. Daar word erken dat die FPP nog in die ontwikkelingstadium is en dat daar dus geleenthede vir beter pasiëntveiligheidsuitkomstes is, veral deur die aantal valvoorvalle en die erns van beserings as gevolg van val te verminder. Literatuurstudies deur Gowdy en Godfrey (2003:365) en Hathaway, Walsh, Lacey en Saenger (2001:172) stel voor dat die suksesvolste benadering tot die vermindering van val en die erns van die gevolglike beserings onder pasiënte in ’n akute sorg omgewing ’n veelvuldig gefasetteerde, multidissiplinêre benadering behels. Verpleërs, wat die primêre verantwoordelikheid vir die voltooiing van die aanvanklike assessering van die risiko vir val het, het daarop gewys dat hulle oorweldig voel deur bykomende veiligheidstandaarde wat vir die JCIA vereis word. Pasiënte met ’n hoë risiko vir val is nie na die geneeshere en fisiese terapeute verwys nie, en ook nie na die kliniese aptekers vir die beoordeling van hoë-risiko medikasie nie. Assessering van die risiko vir val is soms ook nie in die middag en tydens die nagskof gedoen nie. Die bestaande program het ook nie bedlêende, langtermyn pasiënte wat minder gereelde assessering benodig, oorweeg nie. Daar is verder ook waargeneem dat die bestaande FPP nie korrek geïmplementeer word nie. Die doel van hierdie studie was om die faktore te beskryf wat die suksesvolle implementering van die bestaande FPP verhoed. Die doelwitte was om areas wat suksesvol geïmplementeer word, te identifiseer, sowel as hindernisse tot suksesvolle implementering en aspekte van die bestaande FPP wat hersiening benodig. ’n Kwantitatiewe beskrywende benadering is gebruik. Die populasie was gesondheidsorgverskaffers, insluitend beide geregistreerde en praktiese verpleërs, geneeshere, fisiese terapeute en aptekers wat in ’n akute sorg omgewing in die Verenigde Arabiese Emirate werk. Daar war 118 (86%) respondente uit ’n gestratifiseerde steekproef van n = 137 (20%) uit 684 gesondheidsorgverskaffers. ’n Spesiaal ontwikkelde, gestruktureerde vraelys is vir dataversameling gebruik. Betroubaarheid en geldigheid is verseker deur die gebruik van kundiges in vraelysontwerp en statistiese raadgewing, sowel as die vooraftoetsing van die vraelys. Etiese goedkeuring is van die Universiteit Stellenbosch se Komitee vir Menslike Navorsing, en die Etiekkomitee van die hospitaal waar die studie onderneem is, verkry. Die voltooiing van die vraelys deur die respondente het gedien as vrywillige toestemming om deel te neem. Die data is geanaliseer en in frekwensietabelle voorgesit. Die gemiddelde en standaardafwyking is vir die statistiese analises gebruik. Korrelasie-analises is as gevolg van die beskrywende benadering nie onderneem nie. Daar is besluit dat die mees praktiese benadering sou wees om op die professionele groeperinge te fokus en nie op die veranderlikes nie, aangesien die aanvanklike analise swak korrelasies aangedui het. Die resultate identifiseer daardie aspekte van die FPP wat die suksesvolste geïmplementeer is, sowel as dié gebiede wat verbetering benodig om aan die JCIA-vereistes te voldoen. Faktore wat sal bydra tot die groter sukses van die FPP is beleidshersiening wat ’n duidelik bepaalde verwysingsproses vir hoë-risiko pasiënte insluit, sowel as konsekwentheid in die omgewingsveiligheidsrondtes, en meer betrokkenheid en ondersteuning deur die eenheidsbestuurders/toesighouers Die waarmerk van ’n suksesvolle FPP is personeelopvoeding, wat die belangrikste stap in die aanspreek van die geïdentifiseerde hindernisse moet wees. Die menslike behoefte aan veiligheid en die pasiënt se reg op veilige sorg en ’n veilige omgewing moet in personeeloriëntering, personeelopvoeding- en veiligheidsopleidingsprogramme vir alle gesondheidsorgverskaffers ingesluit word. Verhoogde nakoming sou moontlik plaasvind indien gesondheidsorgverskaffers meer bewus was van die hospitaal se verbintenis tot die pasiënt se reg op veiligheid. Nakoming van JCIA-standaarde en die FPP sal bydra tot die verkryging van die akkreditasie.

Bakgrund: Integrated Palliative care Outcome Scale (IPOS) syftar till att ge en multidimensionell bild av patienters situation. IPOS används som ett sätt att bedöma patienters upplevelse av sina symtom, sin funktionsförmåga och sitt välbefinnande i relation till svår sjukdom. Få studier har dock utgått från patienternas perspektiv för att undersöka upplevelser av att använda IPOS. Syfte: Att undersöka patienters erfarenheter av att använda Integrated Palliative care Outcome Scale under pågående specialiserad palliativ hemsjukvård. Metod: Studien är genomförd med en kvalitativ ansats och en tolkande beskrivande design. Rekrytering till studien gjordes från tre specialiserade palliativa hemsjukvårdsenheter. Intervjuer genomfördes med 10 patienter, sju män och tre kvinnor med medelåldern 72 år. En majoritet var diagnostiserade med obotlig cancer. Data analyserades genom tolkande beskrivning så som den beskrivs av Sally Thorne. Resultat: Patienterna upplevde att använda IPOS medförde säker vård eftersom att det underlättade för sjuksköterskorna att göra korrekta bedömningar av patienternas behov. Således var IPOS en hjälp att planera vården utifrån patienternas specifika behov. Detta gav patienterna en känsla av att vården de fick var anpassad för dem, vilket gav en känsla av trygghet. De upplevde även att använda IPOS försäkrade att information fördes vidare på ett korrekt sätt från patienterna till vårdpersonalen genom att det minskade risken för missförstånd. De uppgav att IPOS underlättade diskussioner mellan dem och sjuksköterskorna om sådant de upplevde som viktigt. Patienterna upplevde även att använda IPOS möjliggjorde för dem att reflektera över sitt välbefinnande och sin livssituation. Att göra detta tillsammans med en sjuksköterska var berikande eftersom att det kunde ge nya perspektiv. Slutsats: Resultatet indikerar att patienterna i denna studie upplever att använda IPOS var givande för dem. Det kan konstateras att IPOS med fördel kan användas i specialiserad palliativ hemsjukvård.
Background: The Integrated Palliative care Outcome Scale (IPOS) is intended to provide a multidimensional view of patients’ concerns. IPOS can be used with the purpose of assessing patients’ perceptions of their functional status and wellbeing. Few studies have undertaken the patients’ perspective when exploring experiences of using IPOS. Aim: To explore patients’ experiences of using the Integrated Palliative care Outcome Scale during specialized palliative home care. Method: The study adopted a qualitative approach with an interpretive descriptive design. The patients were recruited from three different specialized palliative home care settings. Interviews were performed with 10 patients, seven men and three women, with a mean age of 72 years. A majority of the patients were diagnosed with incurable cancer. Data were analysed using interpretive description, as described by Sally Thorne. Results: Patients experienced that the use of IPOS entailed secure care as it facilitated nurses in making accurate assessments of patient care needs. IPOS helped to plan the care according to patients’ specific needs, making them feel confident that the care provided was tailored to them, giving a sense of security. Patients expressed that IPOS facilitated discussions between them and the nurse about care needs. They believed that using IPOS enabled opportunities for reflection on their wellbeing and life situation. Doing so with a nurse present was enriching, providing new perspectives. Conclusions: Patients experienced that using IPOS was beneficial. It can be concluded that IPOS provide an effective way to enable person-centred care and with advantage could be used in specialized palliative home care.

Bakgrund: Smärta är en subjektiv upplevelse och ett flerdimensionellt begrepp som berör fysiska, psykiska, psykosociala och existentiella dimensioner av människan. Inom den palliativa vården är smärta ett vanligt förekommande symtom. För att uppnå en individanpassad smärtlindring bör sjuksköterskor ta hänsyn till smärtans olika dimensioner. Smärtlindring i palliativ vård anses som otillräcklig och berör främst åtgärder i ett medicinskt perspektiv. Sjuksköterskor kan bemöta patienterna som lider av smärta med icke- farmakologiska omvårdnadsåtgärder. Syfte: Att belysa icke- farmakologiska omvårdnadsåtgärder och dess betydelse i relation till smärta inom palliativ vård. Metod: Litteraturöversikten är grundad i tio vårdvetenskapliga artiklar; två kvalitativa, fyra kvantitativa och tre med mixad metod. Artiklarnas innehåll granskades och analyserades utifrån Katie Erikssons omvårdnadsbegrepp ansa, leka och lära. Resultat: Utifrån de tre begreppen visade resultatet från ansa att icke- farmakologiska omvårdnadsåtgärder som innefattades av fysisk beröring gav upphov till smärtlindring. Resultatet från kategorin leka visade att icke- farmakologiska omvårdnadsåtgärder berörde den psykiska dimensionen av patienternas smärta där sociala sammanhang kan påverka smärtlindringen. I kategorin lära påvisades att sjuksköterskors och patienters attityder samt förhållningssättet till icke- farmakologiska omvårdnadsåtgärder kan påverka smärtlindringen positivt och negativt. Diskussion: Resultatdiskussionen knyts an till Katie Erikssons omvårdnadsteori kring ansa, leka och lära. I diskussionen stärker och kritiserar författarna sitt resultat kopplat till sjuksköterskans kompetensbeskrivning.
Background: Pain is a subjective experience and a multi-dimensional concept based on physical, psychological, psychosocial and existential dimensions. Within palliative care, pain is a symptom that is regularly occurring. To achieve pain relief that is individually adapted, the nurses should have the different dimensions of pain in regard. Pain relief in palliative care is seen as inadequate and touches mostly on actions from a medical perspective. The nurses can respond to patients with non-pharmacological nursing measures to treat symptoms of pain. Aim: To illuminate non-pharmacological nursing measures and its meaning with pain in palliative care. Method: The literature review is based on ten articles in nursing science; two qualitative, four quantitative and three articles based on both methods. The content of the articles has been reviewed and analyzed with Katie Erikssons nursing theory by categories tend to, play and learn. Results: From these three concepts the results from the category tend to demonstrated that the non-pharmacological nursing measures which included physical touch gave rise to pain relief. Results from the category play demonstrated that non-pharmacological nursing measures affected the psychological aspect of the patients' pain where social interactions can affect pain relief. From the category learn it was shown that nurses and patients attitudes and approach to non-pharmacological nursing measures can affect the pain relief both positively and negatively. Discussion: The result is discussed and linked to Katie Erikssons theory of nursing tend to, play and learn. The writers also reinforces and critiques the result tied to the nursing skills description

Bakgrund: Demens är en ökande folksjukdom, att drabbas av demens ger i nio av tio fall beteendemässiga och psykiska symtom vid demenssjukdom. Beteendemässiga och Psykiska Symtom vid Demens ska enligt Socialstyrelsens riktlinjer för vård och omsorg vid demens i första hand lindras med omvårdnadsåtgärder. Syftet: Att beskriva sjuksköterskors erfarenheter av att använda omvårdnadsåtgärder vid Beteendemässiga och Psykiska Symtom vid Demenssjukdom på särskilt boende. Metod: En kvalitativ innehållsanalys av åtta intervjuer med öppna frågor för sjuksköterskor arbetande på särskilt boende för personer med demenssjukdom. Resultat: Studiens resultat visade att sjuksköterskornas erfarenheter kunde delas in i fyra subkategorier som tillsammans bildade fem huvudkategorier; Kartläggning av beteenden och symtom för att hitta rätt omvårdnadsåtgärder, Omvårdnadspersonalen påverkar kvalitén i omvårdnad, Teamets betydelse för omvårdnadsåtgärder & Personcentrerad vård för att lindra beteendemässiga och psykiska symtom vid demenssjukdom. Slutsats: Omvårdnadsåtgärder är till stor nytta för att lindra beteenden och symtom och skapar livskvalitet för personer med demenssjukdom. Att arbeta i team under hela processen från utredning till framtagande av omvårdnadsåtgärder var positivt för att skapa en personcentrerad vård. Personcentrerad vård bedrivs på det sätt att omvårdnadsåtgärder bör utgå ifrån individens behov och begär och kunde lättast formas efter personens levnadsberättelse. Inställningen hos omvårdnadspersonalen var avgörande för omvårdnadsåtgärdernas kvalitet.
Background: Dementia is a growing disease world-wide, and in nine of ten cases, dementia causes behavioral and psychological symptoms. According to the Swedish National Board of Health and Welfare's guidelines for dementia, BPSD should primarily be relieved by nursing measures. Purpose: To describe nurses experiences of nursing measures for person with behavioral and psychological symptoms of dementia in nursing homes. Method: A qualitative content analysis of eight interviews with open questions for reg. nurses working in nursing homes for persons with dementia. Results: The study's result showed that nurse’s experiences could be identified in four subcategories that established five main categories: Survey of behaviors and symptoms to find the right nursing measures, The nursing staff affects the quality of nursing, The team's importance for nursing measures & Person-centered care to relieve behavioral and mental symptoms in dementia. Conclusion: Nursing measures are very useful for relieving behaviors and symptoms and creating quality of life for people with dementia. Working in teams throughout the process from investigation to development of nursing measures was positive in creating a person-centered care. Person-centered care is conducted in such a way that nursing measures should be based on the individual's needs and desires and could most easily be shaped according to the person's life story. The attitude of the nursing staff was crucial to the quality of the nursing measures.

Medication administration constitutes a key element of acute care delivery, while errors in the process threaten patient safety. The purpose of the study is to explore patients’ perceptions, attitudes and beliefs about the safety practices utilized by nurses when administering medications. Specifically, the study addresses patients’ perceptions of nurse behaviours regarding safe medicine administration, patient behaviours, patients’ perceptions and nurse behaviours regarding pain medicine, patients’ perceptions of nursing care, and patients’ perceptions of their participation/accountability in care. The results identify key safety issues from a patients’ perspective to focus change strategies that will improve patient care.
x, 125 leaves ; 29 cm

Bakgrund: Lagen om psykiatrisk tvångsvård och Lagen om rättspsykiatrisk vård ger rätt att vårda patienter mot deras vilja. I psykiatrisk vård förekommer specifika omvårdnadsåtgärder som bältesläggning, tvångsmedicinering och avskiljning. Dessa väcker många känslor och kräver att sjuksköterskan arbetar med hänsyn och respekt. Relationen är en central del inom psykiatrisk omvårdnad och ska baseras på tillit och empati. Syfte: Att belysa sjuksköterskors uppfattning om tvångsåtgärders inverkan på omvårdnadsrelationen. Metod: Semi-strukturerade intervjuer med hjälp av en intervjuguide genomfördes med yrkesverksamma sjuksköterskor på en psykiatrisk klinik. Data bearbetades med en kvalitativ manifest innehållsanalys. Resultat: Studien resulterade i sex kategorier; professionellt förhållningssätt, vårdande samtal, tillitsfull relation, tvång som maktmedel, sjuksköterskans uppfattning av patientens känslor och sjuksköterskans känslor. Slutsats: Tvångsåtgärder väckte flera känslor hos sjuksköterskan. Med hjälp av ett professionellt förhållningssätt och vårdande samtal skapades en tillitsfull relation med patienten. Detta medförde att tvångsåtgärderna inte hade en negativ inverkan på omvårdnadsrelationen.
Background: The Compulsory Psychiatric Care Act and the Forensic Psychiatric Care Act gives the right to treat patients involuntarily. Specific nursing interventions in the form of restraint, coerced medication and seclusion occur in psychiatric care. These evoke a lot of emotions and require that the nurse work with consideration and respect. The nurse-patient relationship is an essential part within psychiatric nursing and should be based on trust and empathy. Aim: To illuminate nurses perception of coercive measures impact on the nurse-patient relationship. Method: Semi-structured interviews with the help of a topic guide were conducted with nurses on a psychiatric clinic. The data were processed through a qualitative manifest content analysis. Results: The study resulted in six categories; professional approach, caring dialogue, trusting relationship, coercion as an instrument of power, the nurse´s perception of patients emotions and the nurse´s emotions. Conclusion: Coercive measures raised several emotions within the nurse. With the use of a professional approach and a caring dialogue a trusting relationship was created with the patient. This meant that coercive measures didn't have a negative impact on the nurse-patient relationship.

A segurança do paciente grave é uma meta da qualidade do atendimento em Unidade de Terapia Intensiva (UTI), daí a necessidade de se investigar os fatores relacionados à ocorrência de eventos adversos nesse contexto. Trata-se este estudo de uma pesquisa quantitativa, retrospectiva, analítico-transversal que teve como objetivo analisar os fatores associados aos incidentes e/ou eventos adversos (INC/EA) no preparo e administração de medicamentos, nos cuidados com tubo endotraqueal/traqueostomia, sondas, drenos, cateteres e queda em UTI segundo as características demográficas e clínicas do paciente e recursos estruturais da Unidade. Os dados foram coletados por meio dos registros de INC/EA dos prontuários dos pacientes que tiveram notificado algum tipo de INC/EA no período de 2003 e 2006, inclusive, em cinco UTI de cinco hospitais do Município de São Paulo. No tratamento estatístico, foi utilizada a análise de regressão logística multivariada para a identificação dos fatores independentes de INC/EA e condições de saída da Unidade. Para a identificação dos fatores independentes do tempo de permanência nas UTI, utilizou-se a análise de regressão linear múltipla. As variáveis que entraram nos modelos foram aquelas que apresentaram na regressão logística univariada um valor de teste Wald<0,20; em todas as análises realizadas foi utilizado o nível de significância de 5%. Do total de 21.230 admissões nas UTI, 377 (1,78%) pacientes sofreram algum tipo de INC/EA. Foram notificadas 461 ocorrências, a maioria relacionada ao preparo e administração de medicamentos (196-42,51%), seguidas aos cateteres periféricos e arteriais (105-22,77%) e às sondas nasogástricas (73-15,83%). Quanto aos fatores associados aos INC/EA e recursos materiais/equipamentos e ambiente físico das unidades, o baixo número de ocorrências (16-2,82%) inviabilizou a análise dessas variáveis. Da mesma forma, nenhum hospital dispunha das escalas diárias de enfermagem com dados retrospectivos sobre os recursos humanos existentes no período do estudo. Verificou-se que o número de dias de permanência dos artefatos terapêuticos foi um dos principais fatores independentes associados aos INC/EA quer no preparo e administração de medicamentos (número de dias de TE/Traq.), quer nos cuidados com cateter periférico, sonda nasogástrica e cateter central (número de dias de artefatos terapêuticos), seguidos da gravidade e da não sobrevivência dos pacientes. Referente ao tempo de permanência na UTI, os fatores associados foram número de dias de sondas, drenos e cateteres, número de itens da prescrição medicamentosa, não sobrevivência e INC/EA com cateteres periféricos e medicamentos. Finalizando, constatou-se que pacientes não sobreviventes tiveram maior número de dias com TE/Traq., eram mais graves e apresentaram, aproximadamente, cinco vezes mais chance de sofrer um INC/EA com TE/Traq.. Considerando que o enfoque da segurança do paciente é de responsabilidade compartilhada de todos os profissionais, da área de saúde ou não, julga-se que os resultados dessa investigação contribuam para a melhoria da assistência ao paciente crítico, por abrir perspectivas para o estabelecimento de protocolos de prevenção dessas ocorrências
The safety of serious patients is a goal of the quality of service in Intensive Care Units (ICUs), therefore, the need to investigate the factors related to the occurrence of adverse events in this context. This study reports a quantitative, retrospective, analytic-transversal research that aimed to analyze the factors associated with the incidents and/or adverse events (INC/AE) in the preparation and administration of medication, in the care of endotracheal/tracheostomy tubes, probes, drains, catheters and fall in ICUs according to the demographic and clinical characteristics of patients and structural resources of the Units. Data was collected from the registry of INC/AE made in the charts of patients that were notified with some type of INC/AE in five ICUs of five hospitals of the City of Sao Paulo from 2003 to 2006. The statistical treatment consisted of an analysis of multivariate logistic regression to identify the independent factors of INC/AE and exit conditions of the Units. The author also ran the multiple linear regression analysis to identify the independent factors of the length of stay in the ICUs. Variables that presented a Wald test rate <0,20 in the univariate logistic regression entered in the models. All analysis adopted a 5% significance level. From 21.230 total admissions in the ICUs, 377 (1,78%) patients suffered some type of INC/AE. A total of 461 occurrences were notified. Most of these occurrences were related to the preparation and administration of medication (196-42,51%), followed by the peripheral catheters and A- lines (105-22,77%), and the nasograstic tubes (73-15,83%). The low number of occurrences (16-2,82%) of factors associated with INC/AE, material/equipment resources and physical settings of the units made the analysis of these variables unfeasible. The same way, no hospital made available daily nursing schedules that contained retrospective data about the existing human resources at the time of the study. The author verified that the number of days of use of therapeutic artifacts was one of the main independent factors associated with INC/AE. These related to the preparation and administration of medication (number of days of TE/Traq.), as well as to the care of peripheral catheters, nasograstic tubes and central catheters (number of days of therapeutic artifacts), followed by seriousness and non-survival of the patients. The factors associated with the length of stay in the ICU were number of days with probes, drains and catheters, number of items of the prescribed medication, non-survival and INC/AE with peripheral catheters and medication. At last, the author established that non-survival patients spent a greater number of days with TE/Traq. They were also more serious and were about five times more likely to suffer INC/AE with TE/Traq. Considering that the focus of a patient safety is shared responsibility of all professionals, from the health field or not, the author considers that the results of this investigation contribute to the improvement of the assistance to critical patients, as it opens perspectives for the establishment of protocols for the prevention of such occurrences

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2008.
Title from electronic title page (viewed Dec. 11, 2008). "... in partial fulfillment of the requirements for the degree of Doctorate of Philosophy in the School of Nursing." Discipline: Nursing; Department/School: Nursing.

Miljöbegreppet har i modern omvårdnadsforskning fått en allt bredare och djupare dimensiondär människan i sin miljö betraktas ur ett holistiskt perspektiv. Personcentrerad vård är ettarbetssätt där man utgår från patienten som person som inte kan reduceras till enbart sinsjukdom. Att som vårdgivare vara medveten om den fysiska miljön, personers handlingar ochhur den organisatoriska filosofin är uppbyggd skapar en större möjlighet att kunna arbetapersoncentrerat. Personcentrering är det som patienten upplever, medan personcentrerad vårdär arbetssättet som genererar patientens upplevelse av personcentrering. Personcentreratklimat är den miljö där personcentrerad vård sker. De förhållanden som formas mellanpatienten, vårdpersonal, närstående och teknik liksom miljöns atmosfär, omgivning ochomvärld, är avgörande för om patienten kommer att uppleva miljön som vårdande eller ickevårdande. Syftet med studien var att undersöka och beskriva förekomst av personcentrerad vård blandpersoner som vårdats i en högteknologisk vårdmiljö i samband med hjärtkirurgi ochhjärtsvikt. Metoden var en icke-experimentell tvärsnittsstudie som genomfördes inom högteknologiskahjärtsjukvård. Datainsamlingen utfördes med hjälp av två patientrapporterade mått: BeingTaken Seriously Questionnaire - Patient version (BTSQ-P) och Person-Centered ClimateQuestionnaire - Patient version (PCQ-P). Resultatet visade att patienterna upplevde att vården var personcentrerad utifrån att bli tagenpå allvar och att den innefattade ett personcentrerat klimat. Regressionsanalysen visade att ettsäkert klimat är den viktigaste komponenten för känslan av att bli tagen på allvar. Slutsatsen var att högteknologisk hjärtsjukvård inte enbart genererar goda medicinska resultatutan också kan bidra till personcentrerad vård. Vidare drar vi lärdom av studiens resultat medkunskapen om att ett säkert klimat är den viktigaste faktorn inom det personcentreradeklimatet, för patientens upplevelse av personcentrering.
In modern nursing research, the concept of the environment has acquired an ever broader anddeeper dimension where people in their environment are viewed from a holistic perspective.Person-centered care is a way of working that is based on the patient as a person who cannotbe reduced to his or her illness alone. As a caregiver, being aware of the physicalenvironment, people's actions and how the organizational philosophy is structured creates agreater opportunity to be able to work person-centered. Person-centeredness is what thepatient experiences, while person-centered care is the way of working that generates thepatient's experience of person-centeredness. Person-centered climate is the environment inwhich person-centered care takes place. The relationships that are formed between the patient,care staff, relatives and technology, as well as the environment's atmosphere, surroundingsand settings, are decisive for whether the patient will experience the environment as caring oruncaring. The aim of the study was to investigate the prevalence of person-centered care amongstpeople who have been cared for in a high-tech care environment in connection with heartsurgery and heart failure. The method was a non-experimental cross-sectional study conducted in high-tech cardiaccare. Data collection was performed using two patient-reported measures: Being TakenSeriously Questionnaire - Patient version (BTSQ-P) and Person-Centered ClimateQuestionnaire - Patient version (PCQ-P). The results showed that the patients felt that the care was person-centered based on beingtaken seriously and that it included a person-centered climate. The regression analysis showedthat a safe climate is the most important component for the feeling of being taken seriously. The conclusion was that high-tech cardiac care not only generates good medical results butcan also contribute to person-centered care. Furthermore, we learn from the study results withthe knowledge that a safe climate is the most important factor in the person-centered climate,for the patient's experience of person-centering.

This qualitative study was successful in utilization of grounded theory methodology to ascertain nurses' decision-making processes following their awareness of having made a medical error, as well as how and/or if they corrected and reported the error. Significant literature documents the existence of medical errors; however, this unique study interviewed thirty nurses from adult intensive care units seeking to discover through a detailed interview process their individual stories and experiences, which were then analyzed for common themes. Common themes led to the development of a theoretical model of thought processes regarding error reporting when nurses made an error. Within this theoretical model are multiple processes that outline a shared, time-orientated sequence of events nurses encounter before, during, and after an error. One common theme was the error occurred during a busy day when they had been doing something unfamiliar. Each nurse expressed personal anguish at the realization she had made an error, she sought to understand why the error happened and what corrective action was needed. Whether the error was reported on or told about depended on each unit's expectation and what needed to be done to protect the patient. If there was no perceived patient harm, errors were not reported. Even for reported errors, no one followed-up with the nurses in this study. Nurses were left on their own to reflect on what had happened and to consider what could be done to prevent error recurrence. The overall impact of the process of and the recovery from the error led to learning from the error that persisted throughout her nursing career. Findings from this study illuminate the unique viewpoint of licensed nurses' experiences with errors and have the potential to influence how the prevention of, notification about and resolution of errors are dealt with in the clinical setting. Further research is needed to answer multiple questions that will contribute to nursing knowledge about error reporting activities and the means to continue to improve error-reporting rates.

Introduction: A protocol for management of sedation and pain for mechanically ventilated patients at Flagstaff Medical Center (FMC) was implemented in August 2013. It was unknown whether the protocol is being adhered to or whether it has had an impact on patient outcomes. Objectives: To develop an audit and feedback mechanism to monitor adherence to sedation protocol at FMC and determine whether the protocol has impacted patient outcomes. Methods: A retrospective manual chart review was conducted including all mechanically ventilated adult patients for four, one-month periods: 1) pre-protocol; and 2) one month, 3) six months, and 4) 12 months post-protocol implementation. Results: 132 total patients were included (32 pre; 100 post-protocol). Mean weighted adherence score for post-protocol study groups were 5.0±0.6, 5.0±0.7, and 5.2±0.7 (p=0.926) out of ten. Time of mechanical ventilation (p=0.003) and hospital length of stay (LOS) (p=0.023) were reduced post (56±58h; 9.8±7.9days) vs. pre-protocol (90±67h; 13±7days). The adherence score was weakly correlated with hospital LOS but not time of mechanical ventilation. Conclusion: This project demonstrates improvements in patient outcomes from utilization of a sedation protocol. However, this project also highlights several challenges associated with the monitoring of protocol adherence. A lack of audit and feedback may be a factor in the observed unchanged adherence over time. Both research and monitoring activities are impaired by EHR systems that do not allow for the easy extraction of data. Ensuring that adequate audit and feedback strategies are designed and available prior to implementation of new protocols is an essential step in planning the implementation of a new protocol.

Increased adoption of health information systems in clinical practice has set a foundation for use of this data for Business Intelligence (BI). BI is the use of specialized tools to collect, analyze, and present organizational data to operational leaders in user-friendly formats to support organizational objectives. This is a routine component of management practice in sectors such as finance and manufacturing but has not yet reached its full potential in the health sector where limited availability of BI systems and factors such as data quality, complexity, and access to data have been identified as barriers. Correspondingly, there are no established conceptual models for measuring successful adoption of BI in the health sector. This dissertation study proposes a Business Intelligence Benefits Model for Health derived from frameworks used in other sectors and establishes health sector measures for two foundational constructs, BI Assimilation and Health System Organizational Performance. Through an online Delphi consensus process involving 25 Canadian health leadership panelists from four provinces, the study establishes a total of 30 concept measures for these constructs. Only seven (23.3%) of the concepts identified by the panelists in the study are reflected in an established non-health sector framework, the Business Value of BI Model, validating the need for sector specific measures. The study also compares priorities between leadership groups: top management team versus operational managers; and, leaders with a nursing related portfolio versus those without. The comparisons demonstrate variations among these groups but consistency in requirements overall. Establishing these BI constructs for healthcare is a precursor to measuring BI success and informs priorities and approaches for BI implementation as well as further instrument development.
Graduate

Congestive heart failure (CHF) is a disease with increasing incidence, which requires an adequate and costly management. Repeated hospitalisations due to decompensated CHF contribute to disease progression and herald dismal prognosis. An important goal of heart failure clinics is reduction in number of hospitalizations due to decompensated CHF. The main approaches to reach this aim seem to be effective diagnostics and treatment of CHF, and importantly, education of patients and their families. We aimed to evaluate knowledge of CHF patients regarding self-care in secondary prevention of CHF. We constructed three hypotheses and three research questions to reach the goal of the project. The theoretical part described recommended life-style interventions, pharmacologic and non-pharmacologic CHF management, and specifically, the role of nurses in education of patients with CHF. The practical part described the methods of analysis, the study group and the process of evaluation. To fulfil the study goal, we performed collection of data using qualitative and quantitative methods of research. The qualitative part of the research project included a non-standardized questionnaire for patients with CHF. A total of 260 questionnaires were distributed in six heart failure clinics. 183 completed questionnaires were returned and analysed. The obtained data were evaluated using descriptive statistical methods. Pearson´s chi-test and Student´s t-test were applied to test the hypotheses. Collection of qualitative data was performed using the technique of a semi-structured interview based on pre-prepared questions. The study respondents included general nurses from out-patient heart failure clinics. Six of nine contacted nurse respondents agreed to participate. Answers were recorded on Dictaphone. Data were analysed using the method of "card display". The quantitative part tested the following hypotheses: 1. CHF patients know symptoms and signs of decompensated CHF. 2. CHF patients follow the life-style recommendations. 3. CHF patients perform daily self-monitoring of their weight, blood pressure and pulse. Our study revealed insufficient knowledge of patients regarding symptoms of possible CHF decompensation. This finding was alarming because suboptimal knowledge of symptoms of decompensated CHF may cause inadequate response of the patient and may delay initiation of treatment. Assessment of compliance with life-style measures revealed that most patients did not use tobacco products and had a limited alcohol consumption. Most individuals reported a regular use of heart failure medication and knew the timing of the next follow-up in their heart failure clinic. Life-style measures included also some dietary restrictions modified by the current nutritional status. Respondents preferred recommended food over inappropriate foodstuffs, however, they did not follow neither the salt restriction nor the optimal frequency of meals. Most respondents did not report a regular exercise A significant ignorance was found in the process of self-monitoring. Most respondents did not monitor their body weight, blood pressure and pulse. The qualitative assessment evaluated the following questions: 1. Do we educate the CHF patients appropriately? 2. Are we able as nurses to pass correct information to CHF patients? 3. How is the process of education implemented in practice? Based on the above mentioned methods, we found that the process of education is a domain of doctors. Nurses have only a limited role in education of CHF patients...

Nursing care of restless and aggressive patients, despite the unstoppable progress, can hardly do without the use of restrictive measures in all cases. In order to provide quality nursing care and to ensure the patient´s safety even with the application of restrictive measures, it is necessary to determine the level of professional quality, or the introduction of nursing standards at all wards where restrictive measures are used. The aim of this thesis was to verify if the restrictive measures in psychiatric inpatient units and inpatient wards of other medical disciplines are being used in accordance with the standard of nursing care of patients who are restrained in bed, and analyze the current standards of nursing care determining the use of restrictive measures. Another objective was to find out nurses´ attitudes to application of restrictive measures and to survey their feelings while applying restrictive measures. On the base of the objectives hypotheses were formulated with regard to data in literature and my own clinical practice, which also includes the use of restrictive measures. The nursing research was conducted through a questionnaire at the wards where restrictive measures are applied. The respondents were nurses working in these units. The results provided clear evidence that not only worldwide, throughout Europe, but also within medical facilities of the Czech Republic, the care of psychiatric patients is inconsistent in terms of restrictive measures, and therefore, standardization of this care is highly desirable. A component part of this thesis is the created Standard of nursing care for application of restrictive measures in medical inpatient facilities, which will be used in practice in České Budějovice Hospital, Inc.

碩士
亞洲大學
長期照護研究所
96
Abstract Long term care is an important issue of a country with aged population, and the old age population in Taiwan reached 10% at the end of 2006. Due to the increase of aged and disabled population, the need for long-term care increases as well, and so does the number of nursing homes. Therefore, how to ensure the quality of nursing home care is an important task today. The registered nursing homes in Taichung City is what the research aimed at, and “the observable indicators of nursing home care quality” instrument was used as a tool, and the researcher used structural questionnaires and on-site observation method to collect the data, and the purpose of this research is to evaluate the level of consistency between “the accreditation survey for nursing homes” instrument and “the observable indicators of nursing home care quality” instrument. The total number of nursing home evaluated is 12, and the highest, the lowest and the average scores measured by “the observable indicators of nursing home care quality” instrument are 172, 115 and 139.33 respectively. The average scores for dimensions of instrument from the highest to the lowest are in the order of “staff”, “environment”, “care ”, “communication ” and “home/family involvement”. The level of consistency between ““the accreditation survey for nursing homes” instrument and “the observable indicators of nursing home care quality” instrument was evaluated by 0.167 kappa value, and it does not have an significant meaning, and it means that the result measured from “the accreditation survey for nursing homes” instrument is not consistent with the result from “the observable indicators of nursing home care quality” instrument. But the measured result of “staff” dimension in OIQs is consistent with the result of “health” and “daily life care”; the result of “staff” dimension in OIQs is consistent with the result of “health” and “daily life care”; the result of “environment” dimension in OIQs is consistent with the result of “safety and environment setting”; the result of “homelike/family involvement” dimension in OIQs is consistent with the result of “safety and environment setting”. The result of “communication” dimension in OIQs is not consistent with the result of “health”; the result of “staff” dimension in OIQs is not consistent with the result of “institute and staff management”. This research suggests that when the quality of a nursing home care is measured by “the observable indicators of nursing home care quality” instrument, other evaluation tools should be also used to ensure a complete and comprehensive evaluation. And the supervising authorities could use this instrument to evaluate the quality of a nursing home care periodically in order to continuously control the quality.

This dissertation examines the broad social impacts of the multiple polio epidemics that occurred in Manitoba between 1928 and 1953, a period I refer to as the epidemic era. It argues that examining the six major polio epidemics as an era, and the disabilities it engendered are useful windows into twentieth-century social history, particularly in terms of the capacities and limits of the state to control and manage disease, illness, and health, and the myriad ways the family negotiated discourses about disability and the intersections of disability and gender. It also examines the changes to nurses’ labour during the epidemic era, particularly in terms of the introduction of two new technologies of care – respirators and the Kenny method – both of which led to nursing shortages in the later epidemic, exposing the lingering gendered conceptions about women and voluntary nursing. This project also considers the post-war development of rehabilitation programs, and argues that they worked to discursively transform people with an illness into people with disabilities, in need of reformation in order to become useful, contributing citizens. Finally, this dissertation examines the impact of polio-related disabilities on the lived experiences of a number of Manitobans, and argues that while polio and ideologies about disability worked to shape their lives in many ways, these were not the only forces to impact people’s lives and that people with polio-related disabilities negotiated the quotidian aspects of life much like anyone else. Polio tested, but did not break, the bonds of family. This dissertation draws on a variety of sources, including oral histories, the records of social welfare organizations, hospital records and annual reports, newspapers, and other public records. By exploring the broad social impact of polio, this dissertation adds to a number of literatures and works to bring the history of disability and people with disabilities out of the margins and into the mainstream of Canadian social history.