Dissertations / Theses on the topic 'Safety Team'
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Ballangrud, Randi. "Building patient safety in intensive care nursing : Patient safety culture, team performance and simulation-based training." Doctoral thesis, Karlstads universitet, Institutionen för hälsovetenskaper, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-29870.
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Aim: The overall aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing. Methods: Quantitative and qualitative methods were used. In Study I, 220 RNs from ten ICUs responded to a patient safety culture questionnaire analysed with statistics. Studies II-IV were based on an evaluation of a simulation-based team training programme. Studies II-III included 53 RNs from seven ICUs and ten RNs from a post-graduate programme (II). The data were collected with questionnaires (II) and measurement scales (III), and analysed with statistics. In Study IV, 18 RNs were interviewed and the data were analysed with a qualitative content analysis. Main findings: The RNs had positive perceptions of the overall patient safety culture in the ICUs. Hence, a potential for improvements was identified at both the unit and hospital level. Differences between types of ICUs and between hospitals were found. The dimensions at the unit level were predictors for the outcome dimensions (I). The RNs evaluated the simulation-based team training programme in a positive way. Differences with regard to scenario roles, prior simulation experience and area of intensive care practice were found (II). The expert raters assessed the teams’ performance as advanced novice or competent. There were differences between the expert raters’ assessments and the RNs’ self-assessments (III). One main category emerged to illuminate the RNs’ perceptions of simulation-based team training for building patient safety: Regular training increases the awareness of clinical practice and acknowledges the importance of structured work in teams (IV). Conclusions: Patient safety culture measurements have the potential to identify areas in need of improvement, and simulation-based team training is appropriate to create a common understanding of structured work in teams with regard to patient safety.Baksidestext Intensive care represents potential patient safety challenges for critically ill patients. Human errors are the most common cause of incidents, and failures in team performance are identified as contributory factors. The measurements of patient safety culture and simulation-based team training are recommended initiatives to improve patient safety. The aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing. The nurses had a positive perception of the overall patient safety culture. A potential for improvements were found in incident reporting, feedback and communication about errors and organizational learning. The RNs evaluated the simulation-based team training programme in a positive way. The assessments of nurses’ team performance with respect to communication, leadership and decision-making in a simulation-based emergency situation showed a variation in competencies from advanced novice to competent. There were differences between expert raters’ assessments and nurses’ self-assessments. The nurses perceived that simulation-based team training on a regular basis increases the awareness of clinical practice and acknowledges the importance of structured teamwork.
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Zagarese, Vivian. "Leadership During Action Team Formation: The Influence of Shared Leadership Among Team Members During the Perioperative Process." Thesis, Virginia Tech, 2020. http://hdl.handle.net/10919/100875.
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There are many leadership theories that dominate the field of Industrial and Organizational Psychology, however there is a lack of understanding as to which leadership processes may be most appropriate for action teams in high stress environments. Previous research has articulated leadership behaviors, but has largely ignored the temporal processes of leadership, and how it changes throughout the operating team’s tenure. The proposed study investigates two types of leadership, namely shared and autocratic leadership, that take place during critical steps of the perioperative process and relates these leadership behaviors to team dynamics and psychological processes. Specifically, this study builds upon other studies by testing how leadership behaviors are related to levels of psychological safety and the optimization of teamwork and communication among team members. We were also interested in understanding if the surgeon’s perception of past performance of their team has an impact on the amount of trust the leader has in his/her team and if this in turn, has an impact on the type of leadership utilized during the team’s tenure. As an exemplar environment, we explored these dynamics in the operating theater, which is a high stakes environment requiring both technical and non-technical skills, such as leadership, communication, and teamwork. Results show that the correlation between the surgeon’s perceived past performance of the team and the trust the surgeon has in his/her team and the relationship between team’s trust and teamwork and communication were significant at the alpha =.1 level. All other relationships were non-significant.M.S.
In the field of Industrial and Organizational Psychology, many leadership theories have been developed, however, there is a lack of understanding as to which type of leadership is best for teams who work in high-stress environments, such as the operating room. This study looks at two types of leadership: shared leadership and autocratic leadership. Shared leadership is when all team members emerge and have a leadership role, whereas autocratic leadership is when one person makes all the decisions without consulting other team members. Previous research has articulated leadership behaviors, but has largely ignored the temporal processes of leadership, and how it changes over time throughout the surgical procedure. This study builds upon other studies by testing how leadership behaviors are related to levels of psychological safety and the optimization of teamwork and communication among team members. We were also interested in understanding if the surgeon’s perception of past performance of their team has an impact on the amount of trust the leader has in his/her team and if this in turn, has an impact on the type of leadership utilized during the team’s tenure. As an exemplar environment, we explored these dynamics in the operating theater, which is a high stakes environment requiring both technical and non-technical skills, such as leadership, communication, and teamwork. Results show that the relationship between the surgeon’s perceived past performance of the team and the trust the surgeon has in his/her team is significant and the relationship between the trust the surgical team members have in each other and the amount that they communicate with each other is also significant.
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Young, Stephen Mark. "Attitude change following a team-based intervention to improve industrial safety." Thesis, University of Liverpool, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.298699.
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D'Esmond, Lynn Berggren Knapp. "Distracted Practice and Patient Safety: The Healthcare Team Experience: A Dissertation." eScholarship@UMMS, 2016. https://escholarship.umassmed.edu/gsn_diss/41.
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Purpose: The purpose of this study was to explore the experiences of distracted practice across the healthcare team.
Definition: Distracted practice is the diversion of a portion of available cognitive resources that may be needed to effectively perform/carry out the current activity.
Background: Distracted practice is the result of individuals interacting with the healthcare team, the environment and technology in the performance of their jobs. The resultant behaviors can lead to error and affect patient safety.
Methods: A qualitative descriptive (QD) approach was used that integrated observations with semi-structured interviews. The conceptual framework was based on the distracted driving model and a completed concept analysis.
Results: There were 22 observation sessions and 32 interviews (12 RNs, 11 MDs, and 9 Pharmacists) completed between December, 2014 and July 2015. Results suggested that distracted practice is based on the main theme of cognitive resources which varies by the subthemes of individual differences; environmental disruptions; team awareness; and “rush mode”/time pressure.
Conclusions and Implications: Distracted practice is an individual human experience that occurs when there are not enough cognitive resources available to effectively complete the task at hand. In that moment an individual shifts from thinking critically, being able to complete their current task without error, to not thinking critically and working in an automatic mode. This is when errors occur. Additional research is needed to evaluate intervention strategies to reduce and prevent distracted practice.
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Clack, Katinka. "Empowering leadership and safety behaviour in extreme work environments." Diss., University of Pretoria, 2017. http://hdl.handle.net/2263/62690.
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Research purpose The purpose of this study is to examine the extent to which both employees and leaders in extreme environments perceive the same levels of safety participation. Furthermore, this study examines the association between empowering leadership and team performance as well as empowering leadership and safety participation. Research design, approach and methods This study follows a quantitative approach as its main purpose is to establish relationships between constructs. As such, correlations and multiple regression analyses were conducted. Convenience sampling was applied to obtain the data. Firefighters and their immediate line officers (lieutenants) were surveyed. Five fire departments in small to medium cities were chosen in the Great Lakes and south-eastern regions in the United States (US). Questionnaires were distributed to 263 firemen, of which 186 were firefighters and 78 were their line officers/lieutenants. Main findings Results indicated that a positive association does not exist between firefighters' perceptions of safety participation and their leaders' perception of safety participation when control variables are added. Therefore, no significant relationship exists between firefighters' perceptions of safety participation and their leaders' perception of safety participation. Furthermore, the results also showed a positive association does not exist between empowering leadership and safety participation when control variables are added. Consequently, no significant relationship exists between firefighters' reports of empowering leadership and lieutenants' reports of safety participation. Lastly, regarding empowering leadership and team performance, the results did not support a direct relationship between these two constructs. Limitations The results should be interpreted bearing in mind that they are applicable to the United States of America and may not be generalised to the South African context. Additionally, very little research has been conducted on empowering leadership and safety behaviour in extreme environments, and therefore the literature review was limited to other organisational environments. Lastly, only three cultural groups (White, Black and Hispanic) and only men participated in this study, so results may not be generalisable to other demographic groups. The study was only positioned in extreme environments, specifically in firefighting, therefore it is unclear whether the results can be generalised to other work environments. Future Research It is suggested that this study is replicated, firstly because little research has been done in extreme environments but, secondly, that it also be specifically replicated in South Africa. Indicated by the data, a lieutenant's age has a positive association with how he perceives his team's safety participation. This could be due to various reasons. For example, the more experienced the lieutenant the more comfortable he gets towards the extreme environment. Lastly, it is suggested that research is conducted to determine other leadership styles which could be effective in extreme environments. Conclusion Insight was given into the empowering leadership style in terms of team performance and safety behaviour. Furthermore, the relation between firefighters' perceptions of safety participation and their leaders' perceptions of safety participation was not confirmed.Dissertation (MCom)--University of Pretoria, 2017.
Human Resource Management
MCom
Unrestricted
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Walker, Raquel Maria. "Improving Perinatal Team Communication to Decrease Patient Harm With Team Strategies and Tools to Enhance Performance and Patient Safety Training." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3265.
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During childbirth, multiple providers deliver care at the bedside that requires optimal teamwork and communication to prevent patient harm. The complexity of caring for obstetrical patient demands a well-coordinated team to relay information and respond to conditions that can change quickly during childbirth. A patient safety strategy to prevent perinatal harm is Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training. TeamSTEPPS is an evidence-based program based on crew resource management (CRM) principles developed in the aviation and military industries. This process improvement project used the Plan-Do-Study-Act framework and Kotter's change theory to implement TeamSTEPPS training after an increase in patient safety events from 2014 to 2016. A convenience sample of 200 physicians, nurses, respiratory therapists, scrub techs, and patient care techs from perinatal units completed the training in a community hospital setting. The Teamwork Perceptions Questionnaire administered pre- and posttraining show a statistical improvement in teamwork, communication, and situational awareness among nursing staff that correlated with a decrease in safety events. Project limitations include lack of a control group for comparison and lack of physician involvement with training. The positive social impact of TeamSTEPPS training is the decrease in maternal and newborn adverse events surrounding childbirth due to perinatal teams using CRM principles. Over the long term, TeamSTEPPs training may become the standard team training method to improve birth outcomes and support the establishment of a patient safety culture, which may be replicated in perinatal centers around the world.
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Spitulnik, Jay J. "Physician Collaboration and Improving Health Care Team Patient Safety Culture: A Quantitative Approach." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6486.
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Studies have found links between physician relationships with nurses, patient safety culture, and patient outcomes, but less is known about a similar link between physician relationships with allied health professionals (AHPs), patient safety culture, and patient outcomes. The purpose of this exploratory quantitative, survey study was to investigate whether physician interactions with AHPs contribute to improved patient-safety culture, AHP empowerment, and self-efficacy. Based on a theoretical framework consisting of structural empowerment, psychological empowerment, and self-efficacy, it was hypothesized that self-efficacy is predicted by structural and psychological empowerment and self-efficacy predicts a positive patient safety culture. The AHP Survey of Physician Collaboration was constructed using psychometrically sound items from instruments that have studied similar phenomena. A purposive sample with 95 respondents consisted of occupational and physical therapists currently working in hospitals. Pearson Product-Moment correlation, standard multiple regression analysis, independent groups t-tests, and one-way between groups analyses of variance were employed. Although the survey results did not indicate a statistically significant relationship between psychological empowerment and patient-safety culture, findings in this study indicated that patient-safety culture has a significant positive correlation with structural empowerment and self-efficacy. Structural empowerment and self-efficacy were found to significantly predict patient-safety culture. The results did not show differences based on gender, profession, age, or years of service. By illustrating the nature of the relationship between physicians and AHPs, the results of this study can affect social change through enhancing the ability to reduce the number of preventable negative health outcomes in hospitals.
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Gregg, Lisa. "Collaboration in family violence intervention: A process evaluation of the hamilton Family Safety Team." The University of Waikato, 2007. http://hdl.handle.net/10289/2520.
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The Family Safety Team (FST) is a collaborative intervention developed to address family violence in New Zealand. Interagency collaborations are effective at addressing the social supports for battery, improving the systems and responses of agencies that address battery, and improving cohesion and consistency across agencies. The FST has a particular focus on justice system agencies. The purpose of this research was to evaluate the Hamilton FST. The research was conducted using in-depth interviews with FST members and others directly involved with the project, archival research using police family violence files, observation of FST meetings, and a focus group with battered women. The evaluation was constructed around four aims: to identify any barriers to establishing the FST, to assess the strengths and weaknesses of the Hamilton FST, to determine the adequacy of the FST structure, and to assess the extent to which the FST has improved the ability of agencies to enhance the safety and autonomy of battered women and hold offenders accountable. An overall finding of this evaluation was that people are feeling very positive about the Hamilton FST. The evaluation found that the FST has increased contact and communication between community and government agencies, and there was improvement in each agency's awareness of the policies, processes and protocols of other agencies in the FST. The evaluation found some limitations in the amount of monitoring and measurable outcomes from the FST, but this was understandable considering the infancy of the project and the time taken for members to understand their roles and the function of the FST. However, there were some positive developments in police responsiveness: an improved police attitude towards family violence cases, and an increase in cases coded as family violence. An important finding of this evaluation was that the Hamilton FST is functioning as a genuine collaboration. This seemed to be due to: mutual respect and an equal distribution of power among FST members, trusted working relationships, recognising each member for their area of expertise, and the role of the coordinator. There are, however, some limitations of the FST model that FST members need to acknowledge.
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Leak, Michelle A. "Teaming Up for Patient Safety| A Case Study of Social Interactions among Surgical Team Members." Thesis, The George Washington University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3688016.
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Despite increased awareness of the link between teamwork and medical errors, and increased development of interventions aimed at improving team performance, the incidence of preventable errors in hospitals, and in the surgical environment particularly, remains high. Absent from interdisciplinary team development efforts is empirical evidence informed by the voices of surgical team members specific to their day- to- day experiences of teamwork. For this reason, a case study of interdisciplinary teamwork among Orthopedic Surgery team members was conducted from June to December 2013 to: (a) discover how teamwork behaviors are enacted in the surgical environment to affect the incidence of preventable surgical errors; and (b) understand the experience of teamwork from the perspective of surgical team members.
The case study data included 37 one-on-one interviews with Orthopedic Surgery team members (including two supervisors), and observations by the researcher guided by the Observational Teamwork Assessment for Surgery (OTAS) instrument. This study finds that while mindfulness is a prerequisite to safety behaviors that are found in the surgical setting, there is a dynamic interplay between processes of collective mindfulness and traditional teamwork behaviors wherein one continuously informs, shapes, and reinforces the other. Noting contributions of the this study to practice, the opportunity exists to expand the present inquiry beyond Orthopedic Surgery to include other surgical specialties as well as non-surgical practices within the hospital and clinic environments.
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Chitwood, Tara Marshall. "SECOND VICTIM: SUPPORT FOR THE HEALTHCARE TEAM." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1554820138107259.
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Bunch, Jacinda Lea. "Rapid response systems : evaluation of program context, mechanism, and outcome factors." Diss., University of Iowa, 2014. https://ir.uiowa.edu/etd/1558.
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Prevention of in-hospital cardiac arrest (IHCA) is critical to reducing morbidity and mortality as both the rates of return to pre-hospital functional status and overall survival after IHCAs are low. Early identification of patients at risk and prompt clinical intervention are vital patient safety strategies to reduce IHCA. One widespread strategy is the Rapid Response System (RRS), which incorporates early risk identification, expert consultation, and key clinical interventions to bedside nurses caring for patients in clinical deterioration. However, evidence of RRS effectiveness has been equivocal in the patient safety literature.
This study utilized a holistic Realistic Evaluation (RE) framework to identify important clinical environment (context) and system triggers (mechanisms) to refine our understanding of an RRS to improve local patient emoutcomesem and develop a foundation for building the next level of evidence within RE research. The specific aims of the study are to describe a RRS through context, mechanism, and outcome variables; explore differences in RRS outcomes between medical and surgical settings, and identify relationships between RRS context and mechanism variables for patient outcomes.
Study RRS data was collected retrospectively from a 397-bed community hospital in the Midwest; including all adult inpatient RRS events from May 2006 (2 weeks post-RRS implementation) through November 2013. RRS events were analyzed through descriptive, comparative, and proportional odds (ordinal) logistic regression analyses.
The study found the majority of adult inpatient RRS events occurred in medical settings and most were activated by staff nurses. Significant differences were noted between RRS events in medical and surgical settings; including patient status changes in the preceding 12 hours, event trigger patterns, and immediate clinical outcomes. Finally, proportional odds logistic regression revealed significant relationships between context and mechanism factors with changes in the risk of increased clinical severity immediately following at RRS event. RE was utilized to structure a preliminary study to explore the complex variables and relationships surrounding RRSs and patient outcomes. Further exploration of settings, changes in clinical status, staffing and resource access, and the ways nurses use RRSs is necessary to promote the early identification of vulnerable patients and strengthen hospital patient safety strategies.
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Björk, Jessica, and Alina Lindholm. "Att respektera varandras kompetenser : Sjuksköterskors erfarenheter av att arbeta i interprofessionella team." Thesis, Högskolan i Halmstad, Akademin för hälsa och välfärd, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-28212.
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Framgångsrik interprofessionell samverkan i team har bevisats öka patientsäkerheten i hälso- och sjukvården. Sjuksköterskor är ofta en del av interprofessionella team och en av deras kärnkompetenser är samverkan i team. För att uppfylla kärnkompetensen krävs kunskap om vad som påverkar samverkan. Syftet var således att belysa sjuksköterskors erfarenheter av samverkan i interprofessionella team. Metoden som tillämpades var en osystematisk litteraturöversikt med systematiska sökningar av omvårdnadsforskning. Litteraturöversikten baserades på 13 vetenskapliga artiklar där resultaten bearbetades med inspiration av kvalitativ innehållsanalys och fyra kategorier av erfarenheter kunde skapas. De fyra kategorier som framkom var att respektera varandras kompetenser, att ha en tydlig arbetsfördelning, att arbeta med olika personligheter och att arbeta för gemensamma mål. Sjuksköterskor erfor att klinisk kompetens, social kompetens, respekt, kommunikation, tillit, utbildning, rollförståelse och gemensamma mål var grundläggande för en fungerande samverkan. För att förbereda sjuksköterskestudenter för interprofessionell samverkan rekommenderas såväl teoretisk som praktisk utbildning tillsammans med andra vårdaktörer under utbildning. Även gemensam utbildning för befintlig hälso- och sjukvårdspersonal anses värdefull. Ytterligare forskning kring sjuksköterskors erfarenheter av interprofessionell samverkan är angeläget för att öka sjuksköterskors kompetens i samverkan i team.In the healthcare sector, interprofessional collaboration has proven to enhance patient safety. Nurses are often a part of interprofessional teams and collaboration is one of the core competencies of nurses. Knowledge about what affects collaboration is needed to fulfill this core competence. The purpose was therefore to illustrate nurses experiences of interprofessional collaboration. The study was conducted as a literature review of nursing research. The literature review was based on 13 scientific articles whos results were analyzed with guidance from a qualitative content analysis and four categories of nurses experiences arose from the analysis. These categories were to respect each others competences, to have a clear job allocation, to work with different personalities and to work towards a common goal. According to nurses experiences, clinical competence, social competence, respect, communication, trust, education, understanding of roles and common goals were essential for succesfull collaboration. To prepare nursing students for interprofessional collaboration, theoretical and practical education with other healthcare students are suggested. Education for staff already working in the healthcare sector is also believed to be valuable. To enhace nurses competence in collaboration, further research of nurses experiences of interprofessional collaboration is necessary.
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Ekström, Ellen. "Using Shared Priorities to Support Training of Nuclear Power Plant Control Room Crews." Thesis, Linköpings universitet, Institutionen för datavetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-120076.
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Swedish nuclear power plant control room crews have training sessions in full scope simulators every year. These sessions are designed to prepare operators to cope with incidents and accidents. The aim is to develop operators’ knowledge, skills and abilities necessary to operate the nuclear power plant in a safe manner. Training sessions is an opportunity to practice and develop the crews’ teamwork, decision processes and working strategies. The purpose of this study was to explore if and how the instrument Shared Priorities can support training of nuclear power plant control room crews. Shared Priorities is an instrument to measure teams’ shared awareness of a situation and has in earlier studies been used in military and student teams. During the simulator re-training period of control room crews, 14 crews used the instrument Shared Priorities in one or two of their training scenarios. The instrument consists of two steps. Firstly, crew members generate and prioritise a list of five items they think are most important for the crew to cope with in the scenarios current situation. They also rank another crew member’s list. Secondly, the crews and instructors perform a focus group discussion based on the generated lists. Results from questionnaires, focus group discussions and an interview with instructors showed that operators and instructors believe that Shared Priorities can support their training in several ways. Crews see meetings and other disseminations of information as an essential part of maintaining shared understanding of different situations. They believe the instrument may help crews reflect upon and develop their meeting procedures. Operators and instructors also believe that by using the instrument it can help crews to increase their understanding of having a shared situation understanding and shared vision. However the procedure when using Shared Priorities has to be modified in order to be able to support crews’ training in an optimal way.
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Turner, John R. "Knowledge Sharing: Examining Employee Perceptions Using Structural Equation Modeling." Thesis, University of North Texas, 2015. https://digital.library.unt.edu/ark:/67531/metadc804846/.
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During team decision-making practices information is often shared among team members as part of the decision making process. Knowledge sharing involves one team member sharing information so that other team members can encode the knowledge to make their own mental representation of the new information (Huan & Jiang, 2012). Unfortunately, the literature has shown that new information is not always shared between team members during decision making processes (Stasser & Titus, 1985). When teams make decisions without considering all the information available poor decisions can result. This research study tests a team conceptual model derived by Turner (2013) addressing attitudes toward knowledge sharing. Structural equation modeling was conducted to test a portion of Turner’s (2013) team conceptual model. The tested model included the independent variables of psychological safety, team conflict, team cohesion, and transactive memory systems. The dependent variable for the dissertation was knowledge sharing.
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Caiman, Elin. "Psykologisk säkerhet i scrum-team : en fallstudie om kulturella skillnader." Thesis, Luleå tekniska universitet, Institutionen för ekonomi, teknik och samhälle, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-63962.
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Syfte - Att skapa en djupare förståelse för hur kulturskillnader påverkar arbetet med scrum, med specifikt fokus på psykologisk säkerhet. Metod – En kvalitativ fallstudie med induktiv ansats har gjorts där semistrukturerade intervjuer tillsammans med observationer har använts för att samla in data. Tillsammans med litteratur har sedan en innehållsanalys gjorts. Resultat – Studien har identifierat tre dimensioner som är viktiga att beakta vid arbetet med scrum. Dessa dimensioner är Inställningen till människan, Hanteringen av människan och Beteenden av människan, och belyser hur kulturskillnader skapar olika förutsättningar för psykologisk säkerhet i scrum-team. Vidare kan dessa insikter leda till ett förbättrat arbete med scrum och i förlängningen skapa mer innovativa och konkurrenskraftiga scrum-team och organisationer. Teoretiska implikationer – Studien bidrar till litteraturen om psykologisk säkerhet med en empirisk förankrad teori som visar hur kulturskillnader skapar olika konsekvenser för psykologisk säkerhet. Mer specifikt visar den hur dessa kulturskillnader hänger samman och påverkar varandra. Ett andra bidrag som den här studien gör är att skapa djupare förståelse för hur implementering av scrum och agil övergång med fördel bör ske i en ny kultur, som karaktäriseras av hög maktdistans, osäkerhetsundvikande och kollektivism. Praktiska implikationer – Studiens resultat visar att de identifierade kulturskillnaderna hänger ihop vilket innebär att samtliga behöver adresseras för att skapa ett psykologiskt säkert scrum-team i en ny kultur. Psykologisk säkerhet är en förutsättning för självorganiserade team, så som scrum-team, och därmed är studiens resultat av intresse för gruppchefer på samtliga företag som arbetar med scrum, både i olika nationella kontexter och med multinationella team samt i globala virtuella team.Purpose – To create a deeper knowledge for how cultural differences influences the work with scrum, with specific focus on psychological safety. Method – A qualitative case study with an inductive approach have been carried out where semi-structured interviews together with observations have been used to collect data. Together with literature a content analysis was then preformed. Result – The study has identified three dimensions that are important to consider when working with scrum. These dimensions are Attitude to the human, Managing the human and Behaviors of the human, and these show how cultural differences creates different basis for psychological safety in scrum teams. Moreover, these insights can lead to improved work with scrum and in turn create more innovative and competitive scrum teams and organizations. Theoretical implications – The study contributes to the literature about psychological safety with empirical theory that shows how cultural differences creates different consequences for psychological safety. More specifically, it shows how these differences in culture are related to one another and affects each other. Another contribution of this study is that the result creates a deeper understanding of how the implementation of scrum and agile transitioning best can be done in a new culture, specifically that is characterized by high power distance, uncertainty avoidance and collectivism. Practical implications – The study shows that the identified differences in culture are related to each other, which means that all needs to be addressed to create a psychological safe scrum team in a new culture. Psychological safety is a prerequisite for self-organized teams, such as scrum teams, and thus the result is of interest for group managers in all companies and organizations working with scrum, both in different cultural contexts and with multinational teams as well as in global virtual teams.
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Riccetti, Sauro. "Design of equipment safety & reliability for an aseptic liquid food packaging line through maintenance engineering." Thesis, Brunel University, 2011. http://bura.brunel.ac.uk/handle/2438/5301.
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The organisation of maintenance, in the Aseptic Liquid Food (ALF) industry, represents an important management task that enables a company to pursue higher manufacturing effectiveness and improved market share. This research is concerned with the process to design and implement maintenance tasks. These two complementary processes (design and implementation) have been thought and designed to answer the particular needs of food industry regarding product safety and equipment reliability. Numerous maintenance engineering researchers have focused on maintenance engineering and reliability techniques highlighting the contribution of maintenance in achieving world class manufacturing and competitive advantage. Their outcome emphasizes that maintenance is not a “necessary evil” because of costs associated, but it can be considered an “investment” that produces an added value which generates a real company profit. The existing maintenance engineering techniques pursue equipment reliability at minimum cost; but in food industry, food safety represents the most critical issue to address and solve. The research methodology chosen is based on case studies coming from ALF industries. These show that low maintenance effectiveness could have dramatic effects on final consumers and on the company’s image and underline the need of a maintenance design and implementation process that takes into consideration all critical factors relevant to liquid food industry. The analysis of measurable indicators available, represents a tool necessary to show the status of critical performance indicators and reveals the urgency of a research necessary to address and solve the maintenance problems in food industry. The literature review underlines the increasing regulations in place in food industry and that no literature is available to define a maintenance design and implementation process for ALF and in general for food industry. The literature review enabled also the gap existing between theory and real maintenance status, in the ALF, to be identified and the aim of the research was to explore this gap. The analysis of case studies and Key Performance Indicators (KPI’s) available highlights the problem and the literature review provides the knowledge necessary to identify the process to design and implement maintenance procedures for ALF industry. The research findings provide a useful guide to identify the process to design maintenance tasks able to put under control food safety and equipment reliability issues. Company’s restraining forces and cultural inertia, that work against new maintenance procedures, have been analysed and a maintenance implementation process have been designed to avoid losing the benefits produced by the design phase. The analysis of condition monitoring systems shows devices and techniques useful to improve product safety, equipment reliability, and then maintenance effectiveness. This research aimed to fill the gap in the existing literature showing the solution to manage both food safety and production effectiveness issues in food industry. It identifies a maintenance design process able to capture all conceivable critical factors in food industry and to provide the solution to design reliable task lists. Furthermore, the maintenance implementation process shows the way to maximize the maintenance design outcome through the empowerment of equipment operators and close cooperation with maintenance and quality specialists. The new maintenance design and implementation process represents the answer to the research problem and a reliable solution that allows the food industry to improve food safety and production effectiveness.
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Björk, Johan, and Kristofer Ellery. "Simulera mera : Ger övning färdighet?" Thesis, Röda Korsets Högskola, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-242.
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Bakgrund: Kommunikation mellan personal inom hälso- och sjukvården är viktiga faktorer för att kunna garantera patienten säker vård. Sjuksköterskan ska ha kompetens att kunna fördela och koordinera uppgifter samt ha översikt av teamarbetet. Sjuksköterskan bör ha kunskap om säkerhetsarbete för att kunna garantera säker vård. Det finns ett uttryckt behov inom vården av relevanta och tidsenliga lag- och kommunikationsövningar, där teambaserade simulatorövningar framstår som en pedagogisk och tillförlitlig inlärningsmetod. Syfte: Att beskriva vad studenter vid ett lärosäte, som utbildar sig till specialistsjuksköterskor inom intensivvård, anser om teambaserad fullskalesimulatorträning. Metod: En pilotstudie där 32 sjuksköterskor som studerar till specialister inom intensivvård, ombads svara på en enkät om vad de ansåg om en simulatorövning som de genomfört där omhändertagandet av svårt skadade patienter tränades i team. Resultat: Majoriteten av studenterna ansåg att simulatorövningen haft god effekt och beskrev att övningen haft positiv inverkan på deras förmåga att öva kommunikation i ett team samt att få tillämpa teori i praktik. De uttryckte önskemål om mer simulatorträning under utbildningen samt kontinuerlig övning i sin yrkesverksamma roll. Slutsats: Teambaserade fullskalesimulatorövningar tycks vara en pedagogisk inlärningsmetod för att öka kompetenser och lära studenter att arbeta tillsammans mot ett gemensamt mål.Aim:To describe what nursing students, specializing in intensive care, at a university college think about team based simulation training. Background: Communication and organization in health care are important factors to ensure patient safety. Nurses are called upon to be able to distribute and coordinate work tasks, while at the same time nurses should also be aware of safety promotion in health care to be able to provide safe patient care. There is a need in healthcare for team and communication training where team based simulation appears to be a pedagogic and reliable educational tool. Method: A pilot study where 32 nurses specializing in intensive care, were asked to respond to a survey on what they thought about a previously performed team based full scale simulation training. Results: In general the students confirmed that the exercise had a positive impact on their ability to practice team communication skills and to apply theory in practice. They expressed a wish for more simulation training during their education and in their upcoming professional role. Conclusion: Team based full scale simulation exercises seem to be a pedagogical teaching method to enhance competences and teach students to work together toward a common goal.
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Manges, Kirstin. "Transition to home study: the influence of interprofessional team shared mental models on patient post-hospitalization outcomes." Diss., University of Iowa, 2018. https://ir.uiowa.edu/etd/6193.
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Background: The quality of team-based care impacts patient post-hospitalization outcomes, yet there is a gap in our understanding of how specific team processes impact patient post-hospitalization outcomes. Shared Mental Models (SMMs) is a team process from organizational psychology; it provides an understanding of how providers coordinate complex tasks as a team. SMMs are the team members’ organized knowledge needed for effective team performance. Military research shows that teams with more convergent SMMs have higher performance and better outcomes. In healthcare, patient discharge exemplifies an activity that requires a high level of coordination among interprofessional team members. Two relevant domains of SMMs are Taskwork SMM (team assessment of patient’s readiness for hospital discharge) and Teamwork SMM (quality of day of discharge teamwork). Because of the newness of SMM to healthcare, we lack measures to understand SMMs among interprofessional discharge teams.
Study Purpose & Aims: The purpose was to pilot a novel measurement approach assessing SMMs of discharge teams, and explore their relationships to patient 30-day post-hospitalization outcomes (quality of care transition and utilization of unplanned medical services). Aim 1 determined the content and degree of convergence of discharge teams’ SMMs (taskwork and teamwork). Aim 2 examined the relationship between discharge team SMMs and patient post-hospitalization outcomes.
Methods: A prospective longitudinal pilot study was used to examine the SMMs of 64 unique discharge events in three inpatient units at a single hospital. Discharge team members independently completed a questionnaire measuring the Teamwork SMM (using the Shared Mental Model Scale) and the Taskwork SMM (using the Discharge Provider-Readiness for Hospital Discharge Scale). Data were collected from the patient 30 days post-discharge to determine the quality of transition (using the Care Transition Measure or CTM-15) and use of unplanned utilization of medical services (unplanned readmission or ED visit). Interrater Agreement (r*wg(j)) was used to determine the SMM convergence (or level of agreement) among the discharge team. The relationship between SMMs and the quality of transition outcome (n = 42) was determined using standard regression analysis. Logistic regression was used determine the relationship of SMMs with utilization of unplanned medical services (n = 56).
Results: Overall, discharge teams reported high levels of Taskwork SMMs (M = 8.46, SD =.91) and Taskwork SMM Convergence (M = .90, SD =.10), indicating that the discharge team perceived and agreed that patients had high levels of readiness for hospital discharge. Discharge teams also reported having high-quality Teamwork SMMs (M = 6.11, SD = 0.39) and Teamwork SMM Convergence (M = .85, SD = .10), suggesting that most discharge teams perceived and agreed that high quality teamwork was provided during the discharge process. Discharge events from the three inpatient units significantly differed in their Teamwork and Teamwork SMM content and convergence scores. Discharge teams’ Teamwork SMMs and Taskwork SMMs were positively associated with the CTM-15 score, while controlling for key contextual factors (t = 3.94, p = .001; t = 3.94, p = .001, respectively).
Conclusion : Discharge teams’ Taskwork SMM and Teamwork SMM was positively associated with patient-reported quality of transition from the hospital. There was insufficient evidence to support that utilization of unplanned medical services is related to discharge teams’ SMMs. Measuring the SMMs of the discharge team provides a method for assessing a team process critical to safe patient discharges.
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Viklund, Sandra, and Theresa Falck. "Team- och ledarskapsfaktorer som påverkar sjuksköterskors förmåga att arbeta patientsäkert – en litteraturstudie : Team level- and leadership predictors that affect nurses' in their work to achieve patient safety- a literature study." Thesis, Karlstads universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-42574.
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Sjuksköterskor ska arbeta utifrån patientens behov för att åstadkomma en patientsäker vård. Det är teamet samt ledaren som står sjuksköterskor närmast i utövandet av hens omvårdnadsarbete. Syftet med denna litteraturstudie var att beskriva vilka team- och ledarskapsfaktorer som påverkar sjuksköterskors förmåga att arbeta patientsäkert. Metoden som användes för denna litteraturstudie är baserad på Forsberg & Wengströms modell (2013). Resultatet är baserat på 11 vetenskapliga artiklar, publicerade mellan år 2000 och 2016. Vid bearbetning av artiklarna framkom flera teman vilka delades in mot teamfaktorer som påverkar sjuksköterskors förmåga att arbeta patientsäkert samt ledarskapsfaktorer som påverkar sjuksköterskors förmåga att arbeta patientsäkert. Teamets huvudfaktor identifierades som att ha förmåga att samarbeta. Teman som visade ingå var förmåga att kommunicera och förmedla kunskap samt relationer i teamet genom respekt och konflikthantering. Ledarens huvudtema som identifierades var att inspirera och motivera samt att ge stöd. Slutsatsen av denna litteraturstudie är att teamet samt ledaren visade sig ha en betydande roll för sjuksköterskors förmåga att arbeta patientsäkerhet. Då teamet och ledaren har visat sig kunna påverka patientsäkerheten på många olika sätt, genom att påverka sjuksköterskors arbete, är det väsentligt att dessa uppmärksammas i patientsäkerhetsarbete.
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Eklund, Therese, and Cecilia Nordmark. "Omvårdnadsteamets arbete intraoperativt beträffande patientsäkerheten : En integrerad systematisk litteraturstudie." Thesis, Karlstads universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-42693.
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Introduktion: Hälften av alla vårdskador uppkommer i samband med operation. Operationsteamet är ett multidisciplinärt samarbete där många människor från flera yrkeskategorier arbetar tillsammans i olika konstellationer med patientsäkerheten som en av de viktigaste delarna. Operationssjuksköterskan och anestesisjuksköterskan ansvarar för patientens omvårdnad före, under och efter operationen. Syfte: Att beskriva hur omvårdnadsteamet arbetar intraoperativt beträffande patientsäkerheten. Metod: En integrerad systematisk litteraturstudie där artiklar söktes i databaserna Cinahl och PubMed. Elva artiklar med kvantitativ, kvalitativ och mixed method valdes ut och analyserades. Resultat: Materialet resulterade i tre kategorier: Att vara förberedd, att utbyta information med varandra och att vara förtrogen med varandras färdigheter. Konklusion: En stor del av resultatet visade på att förberedelser där hela omvårdnadsteamet involveras, kontinuerligt utbyter information med varandra och är förtrogna med varandras yrkesprofessionella färdigheter stärker patientsäkerheten. Resultatet av denna litteraturstudie kan leda till en ökad förståelse för operationsteamets betydelse för patientsäkerheten intraoperativt.Introduction: Half of all health care-associated injuries occur in conjunction with surgery. The patient care team is a multidisciplinary collaboration where many people from different professions work together in different configurations with patient safety as one of the most important aspects. The operating theatre nurse and the nurse anesthetist are responsible for the patients nursing care before, during and after the surgery. Aim: To describe how the patient care team works intraoperatively regarding the patient safety. Method: An integrated systematic literature study were articles searches where made using the databases Cinahl and PubMed. Eleven articles with quantitative, qualitative and mixed method analysis has been reviewed. Result: The material resulted in three categories: To be prepared, to exchange information with each other and to be familiar with each other’s skills. Conclusion: A large part of the result showed that preparations where the whole patient care team was involved, continuously exchanging information with each other and were familiar with each other’s professional skills enhances the patient safety. The result of this literature study might lead to an increased understanding of the importance of the patient care team for patient safety intraoperatively.
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Žigutienė, Rūta. "Kauno regiono greitosios medicinos pagalbos tarnybų darbo vietos saugos kultūros vertinimas." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2014. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2014~D_20140714_134740-45524.
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Saugos kultūra – pacientų saugos elementas nukreiptas sumažinti žalą pacientui, kuri gali būti padaryta teikiant jam sveikatos priežiūros paslaugas.
Tikslas – Įvertinti Kauno regiono greitosios medicinos pagalbos tarnybų darbo vietos saugos kultūrą.
Tyrimo metodas: 2012 metų kovo–gegužės mėnesiais atlikta vienmomentinė anoniminė apklausa. Tyrime dalyvavo aštuonių Kauno regiono greitosios medicinos pagalbos tarnybų darbuotojai (N=325, atsako dažnis 82,9 proc.). Tyrimui naudotas Požiūrio į saugą klausimynas (The Emergency Medical Services Safety Attitudes Questionnaire – EMS–SAQ). Nustatyta GMP Požiūrio į saugą klausimyno pakankamai aukštas vidinis nuoseklumas (α=0,822).
Rezultatai: Kauno regiono greitosios medicinos pagalbos tarnybų specialistai, vertindami septynias saugos kultūros sritis, aukščiausiais teigiamais įverčiais vertino komandinio darbo (76,34 balai), pasitenkinimo darbu (76,49 balai) ir vadovų požiūrio į saugą sritis (75,98 balai). Žemiausiais balais darbuotojai vertino streso pripažinimo ir nepageidaujamų įvykių raiškos sritis, atitinkamai – 49,62 ir 37,24 balai. Komandinį darbą ir vadovų požiūrį į saugą dažniau teigiamai vertino slaugytojai, lyginant su GMP vairuotojais, o paramedikai labiau teigiamai vertino pasitenkinimą darbu, lyginant su gydytojais (p<0,05). Gydytojai ir paramedikai dažniau pripažino stresą, lyginant su slaugytojais ir vairuotojais (p<0,01). Daugiau kvietimų per metus atliekantys darbuotojai dažniau teigiamai vertino saugos klimato... [toliau žr. visą tekstą]Safety culture is the element of patient safety that purposes to decrease the damage to the patient that may be done during provision of health care service. The purpose of this study was to investigate the safety culture at the workplace of emergency medical service at Kaunas region. Material and methods: Anonymous survey was conducted on March-May in 2012. The staff from eight emergency medical service institutions at Kaunas region took part in the survey (N=325 with response rate of 82.9 %). The Emergency Medical Services Safety Attitudes Questionnaire – EMS–SAQ was used after the permission by the authors was issued. The internal consistency of translated and adapted instrument was sufficiently high (Cronbach α=0,822). Results: The staff of emergency medical service of Kaunas region evaluated six dimensions of safety culture rating team work (76.34 scores), work satisfaction (76.49 scores) and perceptions of management at the highest level (75.98 scores). The lowest ratings were related to stress recognition and present of adverse events, respectively – 49.62 and 37.24 scores. Nurses scored the team work and perceptions of management more positive in comparison to drivers; paramedics have had more positive attitudes towards work satisfaction than physicians. Physicians and paramedics recognised stress more often in comparison to nurses and drivers. The attitudes towards a safety climate, perceptions of management and work satisfaction were more positive in... [to full text]
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Albinsson, Elisa, and Gunnhild Nilssen. "Alla redo för time-out och sign-out? : Operationsteamets följsamhet till time-out och sign-out i WHO:s checklista för säker kirurgi." Thesis, Högskolan i Skövde, Institutionen för hälsovetenskaper, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-19443.
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Bakgrund: 2008 infördes WHO:s checklista för säker kirurgi för att minska antal dödsfall, förbättra patientsäkerheten och reducera risken för vårdskador i samband med kirurgi genom att ha ett kommunikationsverktyg som säkrar att kontroller och insatser blir utförda. Tidigare studier visar varierande följsamhet till checklistan och att olika delmoment inte utförs i sin helhet. Syfte: Att undersöka operationsteamets följsamhet till time-out och sign-out i WHO:s checklista för säker kirurgi. Metod: En kvantitativ tvärsnittsstudie utförd som en icke-deltagande observationsstudie. Data samlades in via 24 observationer vid två sjukhus med hjälp av ett strukturerat observationsprotokoll. Data analyserades med hjälp av SPSS och redovisas genom deskriptiv statistik i form av cirkel- och stapeldiagram, tabeller samt löpande text. Resultat: Time-out initierades i 95,8 % av observationerna och utfördes komplett i 4,2 %. Sign-out initierades i 100 % av observationerna och 29,2 % utfördes komplett. Ingen i operationsteamet intog rollen som checklisteansvarig. Vid 19 av 22 observationer signerades samtliga tre delmoment i Orbit innan sign-out var genomförd. Slutsats: Både time-out och sign-out genomförs i hög grad, dock varierar följsamheten till checklistans samtliga kontrollpunkter vid de två delmomenten. Studien påvisar att diskrepans finns mellan den faktiska användningen av checklistan och den administrativa inrapporterade användningen av checklistan.Background: In 2008, the WHO Surgical safety checklist was introduced to reduce mortality, improve patient safety and reduce risk of medical injuries in connection to surgery by means of a communication tool ensuring that checks and interventions are performed. Previous studies show a variation in compliance to the checklist, and that different items not are entirely performed. Aim: To describe the surgical team’s compliance to time-out and sign-out in the WHO Surgical safety checklist. Method: A quantitative cross-sectional study conducted as a non-participatory observational study. Data was collected during 24 observations at two hospitals using a structured observational protocol. Data was analysed using SPSS and reported through descriptive statistics, using pie and bar charts as well as tables and discussion. Result: Time-out was initiated in 95,8 % of the observations and completed in 4,2%. Sign-out was initiated in 100 % of the observations and 29,2 % were completed. No member of the surgical team was responsible for performing the safety checks. In 19 of 22 observations, all three parts of the checklist were signed in Orbit before the sign-out was completed. Conclusion: Both time-out and sign-out are carried out to a great extent, however, compliance with all items of the checklist varies. The study shows a discrepancy between the actual use of the checklist and the administratively reported use of the checklist.
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Borglin, Lina, and Martin Eriksson. "Att bevittna patientens utsatthet : En intervjustudie om anestesisjuksköterskans erfarenheter och upplevelser av kommunikation vid akuta omhändertaganden utanför sin ordinarie arbetsmiljö." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-407.
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Teamarbete och kommunikation är en utmaning för anestesisjuksköterskan. Vid akuta tillstånd omhändertas patienten enligt ABCDE som är hämtat från konceptet Advanced Trauma Life Support (ATLS) som är standard på skadeplatser och akutmottagningar i Sverige. Luftväg, andning och cirkulation utgör en del av anestesisjuksköterskans spetskompetens och anestesisjuksköterskan ska kunna medverka vid olyckor och i vården av svårt skadade personer. Forskning har visat att patienter kan dö till följd av dålig kommunikation mellan vårdarna. I kompetensbeskrivningen för anestesisjuksköterskor och under området säkerhet och vårdmiljö beskrivs vikten av tydlig kommunikation i förhållande till vårdteamet. Forskning har visat att god kommunikation bidrar till lägre mortalitet. Genom att använda kommunikationsverktyget SBAR kan patientsäkerheten höjas, särskilt i akuta situationer. Syftet med vår studie var att undersöka anestesisjuksköterskors upplevelser och erfarenheter av kommunikation i larmsituationer under ett akut omhändertagande då anestesisjuksköterskan arbetar utanför ordinarie arbetsmiljö. En kvalitativ, analytisk och induktiv design användes. Intervjuerna, som genomfördes med anestesisjuksköterskor med olika lång yrkeserfarenhet, påvisade patientens utsatthet där olika former av kränkande behandling beskrevs. Genom anestesisjuksköterskans placering vid patientens huvudända ges goda möjligheter att företräda patienten men också till kommunikation med patienten och övriga teammedlemmar. Genom att göra patienten delaktig i vården kan oro och ångest minskas. Bevittnandet av patientens utsatthet diskuteras. Obehagliga undersökningar utförs och i situationer där patienten blottas. Gemensamma övningar efterfrågades när det gäller trauma-, akuta omhändertaganden där vikten av god kommunikation upplevs som central.
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Jernigan, Mark (J Mark) 1957. "Adding elements of innate human behavior to improve system performance and safety in the design of complex systems with corollaries to improve team performance." Thesis, Massachusetts Institute of Technology, 2002. http://hdl.handle.net/1721.1/91736.
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Kulp, Caroline, and Sini Kriikkula. "Operationsteamets upplevelser av kommunikationssvårigheter : - En litteraturstudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-102021.
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Bakgrund: Operationsteamet består av olika professioner som alla utgör en viktig del i arbetet. För att tillvarata allas unika kompetens krävs ett effektivt samarbete och informationsutbyte. Studier har emellertid visat att kommunikationssvårigheter inom teamet är vanligt förekommande, vilket försvårar samarbetet och utgör en risk för patientsäkerheten. Syfte: Syftet var att undersöka operationsteamets upplevelser av kommunikationssvårigheter i operationssalen. Metod: Litteraturstudie med systematiskt tillvägagångssätt enligt Bettany-Saltikov och McSherry (2016). Litteratursökning genomfördes via databaserna Cinahl och PubMed. Tio kvalitativa artiklar inkluderades. Resultat: Kommunikationssvårigheter upplevdes vara en följd av bristande gemenskap, olämpligt beteende, olika perspektiv och prioriteringar. Kommunikationssvårigheterna hade enligt operationsteamet en negativ inverkan på både patientsäkerheten, arbetsglädjen och effektiviteten i operationssalen. Konklusion: Kommunikationssvårigheter utgör ett problem inom operationssjukvården då det försvårar samarbetet i operationsteamet. Kommunikationssvårigheterna kan resultera i negativa konsekvenser för såväl patienten som anställda.Background: The operating team consists of various professionals who all are an important part of the work. To take advantage of all team members’ unique skills, effective collaboration and communication is required. However, studies have shown that communication difficulties within the team are common, which complicates collaboration and poses a risk to patient safety. Objective: The aim of the study was to investigate the operating team members’ experiences of communication failures in the operating room. Method: Literature study with systematic approach in accordance with Bettany-Saltikov and McSherry (2016). The literature search was conducted in the databases Cinahl and PubMed. Ten qualitative articles were included. Outcome: Communication difficulties were perceived as a result of lack of community within the group, inappropriate behavior, different perspectives and priorities. According to the operating team, the communication difficulties had a negative impact on both patient safety, job satisfaction and efficiency in the operating room. Conclusion: Communication difficulties are a problem in surgical care as it complicates the cooperation in the surgical team. The communication difficulties can result in negative consequences for both the patient and the employees.
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Tegnér, Elias, and Elly Westerberg. "Strävan efter den goda kommunikationen i det interprofessionella operationsteamet - en intervjustudie." Thesis, Karlstads universitet, Institutionen för hälsovetenskaper (from 2013), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-78479.
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Introduktion: I den perioperativa vården arbetar flera yrkeskategorier som ska samverka tillsammans på ett patientsäkert sätt. Kommunikation är en viktig del till att kunna arbeta patientsäkert. Enligt patientsäkerhetslagen är vårdgivare skyldiga att förebygga vårdskador där en fungerande kommunikation kan vara en del att upprätthålla patientsäkerheten. Tidigare forskning har visat att kommunikation i operationsteamet kan påverka patientsäkerheten både positivt och negativt. Syfte: Syftet var att beskriva det interprofessionella operationsteamets upplevelser av kommunikation för att främja patientens säkerhet inom perioperativ vård. Metod: En kvalitativ intervjustudie utfördes med hjälp av semistrukturerade intervjuer. Intervjuerna utfördes på tre sjukhus i Mellansverige. Totalt femton intervjuer utfördes. Fem olika yrkeskategorier intervjuades, med tre deltagare från varje kategori: operationssjuksköterskor, anestesisjuksköterskor, undersköterskor, anestesiläkare och operatörer. Totalt femton intervjuer utfördes. Intervjuerna analyserades utifrån kvalitativ innehållsanalys. Resultat: Analysen resulterade i ett övergripande tema och tre kategorier. Temat var: ”Strävan efter den goda kommunikationen”, där det interprofessionella operationsteamets upplevelser beskrevs utifrån följande kategorier: ”De personliga relationernas betydelse”, ”Individuella strategier” och ”Användandet av kommunikationshjälpmedel”. Konklusion: Studien visade att det interprofessionella teamet strävade efter en god kommunikation som främjar patienten säkerhet. Dock fanns det även svårigheter i att uppnå detta.
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Söderbäck-Hallman, Magdalena, and Alexander Weman. "Sjuksköterskors beskrivning av omvårdnad för patienter med endokardit." Thesis, Röda Korsets Högskola, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-2545.
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Bakgrund Endokardit är dagsläget en relativt sällsynt infektionssjukdom som drabbar hjärtat och framförallt hjärtklaffarna. I Sverige drabbas årligen cirka 500 personer och överlevnaden med adekvat behandling ligger på cirka 80-90%. Endokardit är ett komplext sjukdomstillstånd med ofta kräver expertis från många olika specialister. Vårdtiden är lång och inte sällan med olika former av komplikationer som följd. Syftet med studien var att beskriva omvårdnaden av patienter med endokardit från ett sjuksköterskeperspektiv.Metoden som användes var en kvalitativ metod med beskrivande design. Intervjuer med strategiskt ändamålsurval som använt sig av inklusions- och exklusions kriterier har genomförts. Sex sjuksköterskor från olika bakgrund, kön och arbetsplatser deltog i studien. Datan som framkom analyserades genom manifest innehållsanalys med till viss del latenta inslag.Resultatet visar informanternas beskrivning av omvårdnad kring patienter med endokardit ur ett sjuksköterskeperspektiv. Detta ses i resultatets tre huvud kategorier: Patientens förutsättningar, organisationens förutsättningar, sjuksköterskans förutsättningar. Alla kategorierna påvisar hur komplex omvårdnad kring denna patientgrupp är utifrån ett sjuksköterskeperspektiv. Slutsats av studien visar att begreppet omvårdnad är ett svårtolkat begrepp även för erfarna sjuksköterskor. Patienter med ett tidigare missbruk är en speciellt sårbar grupp att hantera, där behöver arbetet ske med tanke på deras missbruk samtidigt som behandlingen av endokardit fortgår. Hur väl omvårdnadsmässigt infektionsavdelningar i Mellansverige tar hand om och behandlar patienter med endokardit beror till stor del på vilka resurser sjukhuset har samt hur stor erfarenhet de sjuksköterskor som arbetar där har av att vårda patienter med endokardit.Background endocarditis is a relatively uncommon diagnosis compared to other infectious diseases. Endocarditis affects the heart muscle but is mainly situated in the heart valves. In Sweden today about 500 persons are affected annually, with adequate treatment and care the survival rate is high within 80-90% of all cases. Endocarditis is a complex disease that requires treatment and care from multiple specialists, the time spent in hospital is long compared to other diseases and is often prolonged by complications of the treatment.The Aim of the study was to describe the caring of patients with endocarditis from a nurse’s perspective.The method used was a qualitative analysis using descriptive design, with the use of strategic purposeful sampling with help of inclusion and exclusions criterias. Six Nurses from different backgrounds, genders and workplaces participated in the interview study. The data analysis was conducted using manifest content analysis with some grade of latent analysis included.The Result showed how the informants of the study described caring for patients with endocarditis from a nurses point of view. This is explained by the three major categories: Patients conditions, The Organisations prerequisite and the Nursing staffs experienced and educational level. They all tell about the complexity of caring for patients with endocarditis.The Conclusion of the study showed that Nursing care and the term caring itself are terms that are somewhat hard to grasp because of their wide meaning in the Nursing community. Patients with predeveloped addiction to some sort of drug is a special group of patients to handle, especially when they are infected by endocarditis. Since they have to be cared for in their addiction as well as their infection. How well nurses on infections wards in Sweden care for patients affected by endocarditis depends a lot on what other resources the hospital has and on the experienced level of the nurses working there.
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Nikman, Samira. "Multidisciplinärt trakeostomiteam : en litteraturöversikt." Thesis, Sophiahemmet Högskola, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-1862.
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SAMMANFATTNING Trakeotomi är ett operativt ingrepp och innebär att man gör ett strupsnitt på halsens framsida för att skapa fri luftväg. Denna öppning, trakeostoma, som skapats på halsen hålls öppen av en trakealkanyl. Trakealkanylen sitter i luftstrupen och skapar patientens artificiella andningsväg. Trakeostomi är ett ingrepp som ökar i Sverige och görs när sjukdomar eller skador i luftvägarna eller i centrala nervsystemet försämrar eller hindrar patienten från att andas genom näsan och munnen. Ingreppet genomförs också på patienter som behöver långvarig respiratorbehandling. Komplikationer av olika allvarlighetsgrad förekommer hos trakeostomerade patienter. Vård av trakeostomerade patienter är komplext och kräver ibland fördjupad förståelse och specialistkunskap av varje enskilt aspekt och därför kan samverkan i team mellan olika professioner behövas för professionellt omhändertagande. Syftet med denna studie var att beskriva vilken effekt multidisciplinärt trakeostomiteam har på vården av trakeostomerade patienter. Studien är en litteraturöversikt och sökning av de 15 inkluderade artiklarna genomfördes i PubMed och CINAHL. Majoriteten av de inkluderade artiklarna är baserade på observationsstudier där data insamlades retrospektivt. Litteraturöversikten resulterade i följande beskrivna effekter av multidisciplinärt trakeostomiteam på vården av trakeostomerade patienter, minskade komplikationer av olika allvarlighetsgrad. De minskade vårdtiden, den totala längden på sjukhusvistelse, vistelsetid efter utskrivning från intensivvårdsavdelningen och den totala tiden på intensivvårdsavdelningen. Teamet bidrog även till snabbare handläggning och beslut om dekanylering, förbättrade kommunikationsmöjligheter för patienten men även bättre kommunikation inom teamet. Utöver detta utarbetade och implementerade teamet kliniska riktlinjer och ansvarade för utbildning av personal, patienter och anhöriga. Några få studier visade även på kostnadseffektivitet. Resultatet av denna litteraturöversikt visade att multidisciplinärt trakeostomiteam har positiva effekter i vården av trakeostomerade patienter framförallt i form av minskade komplikationer och reducerad vårdtid. Teamet bidrar även till effektivare dekanyleringsprocess och snabbare initiering av talventil. Men dessa effekter måste tolkas med stor försiktighet pga. de inkluderade studiernas metodologiska svaghet och för att resultaten inte rakt av går att generalisera och överföra till svenska förhållanden och sjukvård.
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Halliday, Cynthia Saldanha. "Toward a Better Understanding of the Roles of Social Exchanges and Psychological Safety on Followers' Change-Oriented Behaviors." FIU Digital Commons, 2019. https://digitalcommons.fiu.edu/etd/3959.
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Organizational change and innovation are critical for business survival and more likely to occur when employees engage in change-oriented behaviors. Previous studies have examined the direct effects of workplace social exchanges on employees’ change-oriented behaviors; however, less attention has been given to the combined effects of these exchanges and the mechanisms by which these relationships occur. In this study, I look at the combined effects of leader-member exchange, trust in team members, and perceived organizational support on voice, innovative, and learning behaviors via psychological safety. In addition, based on the understanding that psychological safety is not always present in the work environment, I look at the conditions under which these workplace social exchanges lead to the aforementioned behaviors even when psychological safety is low or absent. Therefore, the purpose of this dissertation is three-fold: (1) to explore the combined effects of leader-member exchange, trust in team members, and perceived organizational support in improving followers’ psychological safety within the organization, (2) to investigate the mediating role of psychological safety on the relationships between workplace social exchanges and followers’ change-oriented behaviors, and (3) to expand on previous findings and examine the conditions under which these social exchanges and psychological safety lead to followers’ change-oriented behaviors. Specifically, I propose and test a theoretical model derived from social exchange theory to examine conditional indirect effects of leader-member exchange, trust in team members, and perceived organizational support on voice, innovative, and learning behaviors through psychological safety within the organization, and to examine the role of proactive personality, political skill, perceived team social integration, perceived support for innovation and perceived organizational justice as second stage moderating variables that may compensate for low psychological safety within the organization. My theoretical model was tested using lagged data collected from leader-follower dyads representing 174 followers and 85 leaders from four organizations located in the United States. To test this theoretical model, I used a quantitative non-experimental research design, a survey method, and multilevel analytical procedures.
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Fredriksson, Christina, and Annelie Askling. "Faktorer som påverkar det interprofessionella teamet på operationssal : En litteraturstudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-82597.
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Bakgrund: Varje år drabbas patienter i Sverige av vårdskador på grund av bristfällig patientsäkerhet inom sjukvården. Operationspersonalen arbetar i en högriskmiljö där det ställs stora krav på deras kommunikation inom teamet. Operationssjuksköterskan, tillsammans med det interprofessionella teamet, måste fullfölja sitt ansvar och upprätthålla kompetensen vilket annars kan leda till bristande patientsäkerhet. Syfte: Studiens syfte var att beskriva operationspersonalens uppfattningar om faktorer som är av betydelse för ett välfungerande team. Metod: Systematisk litteraturstudie med kvalitativ metod och innehållsanalys enligt Bettany-Saltikov & McSherry`s, (2016) niostegs-metod. Artiklar har sökts i databaserna Pubmed och Cinahl med ett strukturerat arbetssätt. Resultat: Litteraturstudiens resultat bygger på analyser av 17 vetenskapliga artiklar. Det framkom två huvudteman med sex subteman som belyste vilka faktorer som var av betydelse för teamet på operationssal. Första huvudtemat är Organisationens ansvar med tre subteman; Utbildning till effektiva interprofessionella team, Förutsättningar till ett tryggt och säkert interprofessionellt team och Kompetens i det interprofessionella teamet. Andra huvudtemat är Samverkan med tre subteman; Interprofessionellt team, Kommunikation i samverkan, Betydelsen av WHO Surgical Safety Checklist. Slutsats: I det interprofessionella teamet ingår flera professioner med ett gemensamt mål, att ge en trygg och säker vård till patienten, för att förhindra vårdskada. Det är ett flertal faktorer som påverkar patientsäkerheten såsom samverkan och kommunikation.Background: Every year, patients in Sweden suffer from healthcare injuries due to inadequate patient safety in healthcare. The operating staff work in a high-risk environment where great demands are placed on the operating team and their communication. An operating theatre nurse, must together with the interprofessional team, fulfill their responsibilities and maintain their expertise, which could otherwise lead to a lack of patient safety. Purpose: The aim of the study was to describe the operating staff's perceptions of factors that are important for a wellfunctioning team. Method: Systematic literature study with qualitative method and content analysis according to Bettany-Saltikov & McSherry`s, (2016) nine-step method. Articles were found using structures search methods in the databases Pubmed and Cinahl. Results: The results of the literature study are based on analyzes of 17 scientific articles. Two main themes emerged with six sub-themes highlighting which factors that were of importance in the operating room. The first main theme is the Organization's responsibility with three sub-themes; Education for effective interprofessional teams, Prerequisites for a safe and secure interprofessional team and Expertise in the interprofessional team. The second main theme is Collaboration with three sub-themes; Interprofessional team, Communication in collaboration, Importance of WHO Surgical Safety Checklist. Conclusion: The interprofessional team includes several professions with a common goal, to provide a safe and secure care to the patient in order to prevent care damage. There are several factors that affect patient safety such as collaboration and communication.
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Teske, Christofer, and Sara Andreasson. "Vård i rörelse : En kvalitativ intervjustudie om den mobila vården." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-85513.
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Bakgrund: Vård i hemmet tycks bli allt mer nödvändigt när befolkningen blir allt äldre och det förordas i nationella utredningar om framtidens vårdorganisation. Det finns dock stora utmaningar med att förflytta vård av akut sjuka patienter från akutmottagningar till patienters hem. Syfte: Studiens syfte är att beskriva erfarenheter av den mobila vården. Metod: Semistrukturerade intervjuer genomförs med 12 personer med erfarenhet av mobil vård i Sverige, så som sjuksköterskor, läkare, tjänstemän och politiker. Kvalitativ latent innehållsanalys användes som analysmetod. Resultat: Studiens resultat redovisas utifrån ett tema “En holistisk vård given genom samverkan i patientens hemmiljö”, med tre huvudkategorier “gränslöst samarbete”, “resurser i närmiljö” och “helhetssyn av patienten”. Studiens resultat visade att samverkan är av stor vikt för fungerande mobil vård. Det behövs både organisatoriskt samarbete mellan olika vårdorganisationer och ett nära samarbete mellan de olika läkare och sjuksköterskor som har hand om samma patient för att de ska kunna ta ett gemensamt ansvar för patienten. Eftersom mobil vård främst används för äldre multisjuka behövs en helhetssyn på patienten, där mobil vård ger patienter och anhöriga en upplevelse av trygghet. Slutsats: Studien antyder att den mobila vården ses som en rörlig vård som kommer till den vårdsökande och inte tvärtom. Resurserna fördelas där de gör mest nytta, det vill säga närmast individen. Den mobila vården ses som ett komplement till den traditionella sjukhusvården. Det innebär ett annorlunda arbetssätt som kräver ett tätt samarbete mellan olika personalkategorier och organisationer, där det inte pratas om gränser utan om patientens behov och situation.Introduction: Provision of mobile care at the home of patients appears to become necessary as the population becomes increasingly older. But there are challenges in moving acute care from hospitals to the home of patients. Aim: The aim of the study is to describe the experiences of the mobile care. Method: Semi structured interviews are conducted with 12 persons with experience of mobile care in Sweden, such as nurses, doctors, civil servants and politicians. Qualitative latent content analysis was used as an analysis method. Result: The study's result is presented on the basis of a theme "A holistic care given through collaboration in the patient's home environment", with three main categories "borderless cooperation" "resources in the immediate environment" and "holistic view of the patient". The results show that cooperation is of utmost importance to achieve functioning mobile care. Cooperation both on an interorganizational level and on a close teamwork level is required for all of the involved parties in mobile care to take on a joint responsibility for the patient. As mobile care is foremost provided to elderly multimorbid patients, a comprehensive view on patient care is required in which the patient and its relatives experience security. Conclusion: This study suggests that mobile care is seen as a moving care that comes to the seeking person and not the other way around. The resources are distributed where they make the most use, that is, closest to the individual. Mobile care is seen as a complement to the traditional hospital care. This means a different way of working that requires close collaboration between different categories of personnel and organizations, where it does not talk about boundaries but about the patient's needs and situation.
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Bisbey, Tiffany. "Toward a Theory of Practical Drift in Teams." Honors in the Major Thesis, University of Central Florida, 2014. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1574.
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Practical drift is defined as the unintentional adaptation of routine behaviors from written procedure. The occurrence of practical drift can result in catastrophic disaster in high-reliability
organizations (e.g. the military, emergency medicine, space exploration). Given the lack of empirical research on practical drift, this research sought to develop a better understanding by
investigating ways to assess and stop the process in high-reliability organizations. An introductory literature review was conducted to investigate the variables that play a role in the occurrence of practical drift in teams. Research was guided by the input-throughput-output model of team adaptation posed by Burke, Stagl, Salas, Pierce, and Kendall (2006). It demonstrates relationships supported by the results of the literature review and the Burke and colleagues (2006) model denoting potential indicators of practical drift in teams. Research
centralized on the core processes and emergent states of the adaptive cycle; namely, shared mental models, team situation awareness, and coordination. The resulting model shows the
relationship of procedure—practice coupling demands misfit and maladaptive violations of procedure being mediated by shared mental models, team situation awareness, and coordination. Shared mental models also lead to team situation awareness, and both depict a mutual, positive relationship with coordination. The cycle restarts when an error caused by maladaptive violations of procedure creates a greater misfit between procedural demands and practical demands. This movement toward a theory of practical drift in teams provides a conceptual framework and testable propositions for future research to build from, giving practical avenues to predict and prevent accidents resulting from drift in high-reliability organizations. Suggestions for future research are also discussed, including possible directions to explore. By examining the relationships reflected in the new model, steps can be taken to counteract organizational failures in the process of practical drift in teams.B.S.
Bachelors
Psychology
Sciences
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Athanassiou, Georgios [Verfasser]. "Mariners’ Adaptive Performance under Stress : Individual Visual Performance and Team Safety Performance as Indicators of Adaptive Responses to Task-Integral Cognitive and Affective Workload during a Complex Ship Management Task / Georgios Athanassiou." Kassel : Kassel University Press, 2016. http://d-nb.info/1119923905/34.
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Silva, Amarilis Pagel Floriano da. "SEGURANÇA DO PACIENTE NA ATENÇÃO PRIMÁRIA EM SAÚDE: SABERES E PRÁTICAS DO PROFISSIONAL ENFERMEIRO." Universidade Franciscana, 2018. http://www.tede.universidadefranciscana.edu.br:8080/handle/UFN-BDTD/611.
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Introduction: patient safety represents an important concern in the quality of health care and has an analogy with the prevention of errors in care. Adverse events take place wherever health care is provided and, in many circumstances, could be prevented through preventive measures. Objective: to identify the actions of the professional practice of nurses that indicate patient safety in primary health care, with a view of qualifying health care. Specific Objectives: to identify, in the literature the area, the scientific publications related to patient safety actions related to the nurses' performance in primary health care and to understand the conceptions of nurses working in the Family Health Strategy on safety knowledge and practices of the patient in primary health care. Methodology: This dissertation was developed in two stages, one consisting of a integrative review of literature in which scientific articles were found with the objective of the review. The second stage consisted of a descriptive-exploratory study with a qualitative approach, developed in Family Health Strategies located in the western region of Santa Maria - RS. The data were analyzed according to the thematic content analysis of Minayo. This research is approved by the Research Ethics Committee of the Franciscan University, and is registered under opinion nº 1.876.855. Results: The publications found in the review totaled 10 scientific articles presented in a synthesis table, in order to characterize the publications according to author / year, objectives, type of study, approach, results and conclusions. In field research, the analysis process resulted in the organization of three thematic categories: Patient safety meanings for the nurses of the Family Health Strategy; Barriers to safe care in the context of Primary Health Care and Strategies for safe care in the work of nurses of the Family Health Strategy. Discussion: the findings of the integrative literature review did not allow a more in-depth analysis of the topic, since the studies about nurses' work in primary care related to the subject are scarce and incipient, indicating the existence of spaces for new research to be carried out. Many articles, because they are international, have brought a primary health care organization that is very similar to the Family Health Strategy model and traditional Basic Health Units, which are characteristic models of Primary Care in Brazil. In the field research, it was noticed that the conception of the majority of the nurses regarding the safety of the patient are related to the safe care that avoids damages. Some participants highlighted the concern about infection prevention as one of the criteria for avoiding risk and harm. Some difficulties were also signaled both in the speeches and in the professional performance, through the observations. Although many difficulties have been mentioned and observed in nurses' work, it is important to highlight that they have been developing some strategies to promote safe care, even in adverse working conditions. Final Considerations: the integrative review made it possible to identify and ponder existing studies on nurses' performance in primary care pertinent to patient safety. The data allowed to address nurses' understanding of the patient's knowledge and safety practices in primary health care, as well as the main barriers and strategies for the development of safe care. It is necessary to explore in depth questions related to patient safety in the work of nurses, since this topic presents a strategic role in the planning and implementation of health team actions and in the direct supervision of the work of Community Health Agents. attributions are heavily included actions of health promotion and care management, which impacts on a role of articulation and leadership towards the team.
Introdução: a segurança do paciente representa uma importante preocupação na qualidade do cuidado de saúde e tem analogia com a prevenção de erros no atendimento e ao cuidado. Eventos adversos acontecem em qualquer lugar onde se proporcionam cuidados de saúde e, em muitas circunstâncias, poderiam ser evitados por meio de medidas preventivas. Objetivo: identificar as ações da prática profissional do enfermeiro que indiquem a segurança do paciente na atenção primária em saúde, com vistas à qualificação do cuidado em saúde. Objetivos Específicos: identificar, na literatura da área, as publicações científicas referentes às ações de segurança do paciente relacionadas à atuação do enfermeiro na atenção primária em saúde e compreender as concepções de enfermeiros atuantes na Estratégia de Saúde da Família acerca dos saberes e práticas de segurança do paciente na atenção primária em saúde. Metodologia: esta dissertação foi desenvolvida em duas etapas, uma constituída de uma revisão integrativa de literatura na qual foram encontrados artigos científicos que atenderam ao objetivo da revisão. A segunda etapa constou de um estudo descritivo-exploratório com abordagem qualitativa, desenvolvido em Estratégias de Saúde da Família localizadas na região oeste de Santa Maria – RS. Os dados foram analisados segundo análise de conteúdo temática de Minayo. A pesquisa possui aprovação do Comitê de Ética em Pesquisa da Universidade Franciscana, estando registrada sob o parecer nº1.876.855. Resultados: As publicações encontradas na revisão totalizaram 10 artigos científicos apresentados em um quadro síntese, a fim de caracterizar as publicações segundo autor/ano, objetivos, tipo de estudo, abordagem, resultados e conclusões. Na pesquisa de campo, o processo de análise resultou na organização de três categorias temáticas: Significados de segurança do paciente para as enfermeiras da Estratégia de Saúde da Família; Barreiras para o cuidado seguro no contexto da Atenção Primária em Saúde e Estratégias para o cuidado seguro na atuação das enfermeiras da Estratégia de Saúde da Família. Discussão: os achados da revisão integrativa de literatura não permitiram uma análise mais aprofundada sobre o tema, pois os estudos acerca do trabalho do enfermeiro na atenção primária relacionados à temática são escassos e incipientes, o que indica a existência de espaços para que novas pesquisas sejam realizadas. Muitos artigos, por serem internacionais, trouxeram uma organização de atenção primária em saúde que pouco se assemelha com o modelo de Estratégia de Saúde da Família e Unidades Básicas de Saúde tradicionais, que são modelos característicos da Atenção Primária do Brasil. Na pesquisa de campo, percebeu-se que a concepção da maioria das enfermeiras quanto à segurança do paciente está relacionada com o cuidado seguro que evita danos. Algumas participantes elencaram a preocupação com a prevenção de infecções como um dos critérios para se evitar o risco e o dano. Algumas dificuldades também foram sinalizadas tanto nas falas como na atuação profissional, por meio das observações. Embora muitas dificuldades tenham sido referidas e observadas na atuação das enfermeiras, destaca-se que estas vêm desenvolvendo algumas estratégias para potencializar um cuidado seguro, mesmo que em condições de trabalho adversas. Considerações Finais: a revisão integrativa possibilitou identificar e ponderar sobre os estudos já existentes sobre a atuação do enfermeiro na atenção primária pertinentes à segurança do paciente. Os dados permitiram abordar a compreensão das enfermeiras sobre os saberes e práticas de segurança do paciente na atenção primária em saúde, assim como as principais barreiras e estratégias para o desenvolvimento do cuidado seguro. É necessário explorar em profundidade questões pertinentes à segurança do paciente no trabalho do enfermeiro, uma vez que este tema apresenta papel estratégico no planejamento e implementação das ações de equipe de saúde e na supervisão direta do trabalho dos Agentes Comunitários de Saúde. Ainda, dentre suas atribuições estão fortemente incluídas as ações de promoção da saúde e de gestão do cuidado, o que repercute em um papel de articulação e liderança perante a equipe.
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Gunnarsson, Liselotte, and Victoria Arvidsson. "Sjuksköterskors upplevelser av kommunikation i traumateam- En kvalitativ intervjustudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-62528.
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Bakgrund: Traumavård innebär vård av allvarligt somatiskt skadade patienter. För att vårda dessa patienter samlas multiprofessionella team, vilket ställer krav på teamarbete och god kommunikation för ett säkert och strukturerat omhändertagande. Kommunikation och informationsöverföring är ett riskområde inom vården och sambandet mellan bristande kommunikation och bristande behandlingsresultat är väldokumenterat. Traumaomhändertagande är en stressfylld situation, som ställer stora krav på sjuksköterskan på akutmottagningen, och innebär utmaningar för att uppnå en välfungerande kollaborativ kommunikation. Syfte: Syftet var att belysa sjuksköterskors upplevelser av kommunikation i traumateam. Metod: Studien genomfördes med en kvalitativ ansats, där semistrukturerade intervjuer genomfördes med 11 sjuksköterskor som arbetar på två akutmottagningar. En kvalitativ innehållsanalys genomfördes av datamaterialet. Resultat: Studiens resultat genererade i ett tema Kommunikation – ett komplext samspel, vilket belyser komplexiteten av kommunikation i traumateam. Resultatet presenteras i tre huvudkategorier: Kollaborativ kommunikation utmanar, Struktur- att förhålla sig till vissa ramar och Kommunikationen påverkar patienten. Komplexiteten i kommunikationen inom teamet beror på personliga egenskaper samt hur teamarbetet fungerar i övrigt. Vikten av struktur och att förhålla sig till riktlinjer och rutiner påverkar kommunikationen, och ledarskapet spelar här en central roll. Kommunikationens kvalitet påverkar utfallet för patienten och är något som förbättras genom traumaövning. Slutsats: Studien identifierar komplexiteten av kommunikationen inom traumateamet. Ett tydligt ledarskap och teamets samspel spelar en avgörande roll för utfallet för patienten, och vikten ligger i att kommunicera rakt och tydligt. Brister i kommunikation leder till ett försämrat teamarbete och negativa påföljder för patient. Genom traumaövning kan kommunikationen främjas och sjuksköterskan stärker sin yrkesroll.Background: Trauma care involves the care of seriously somatic injured patients. To care for these patients a multi-disciplinary team is gathered, which requires teamwork and good communication skills for a safe and structured care of the patient. Communication and the transmit of information comprise a risk in healthcare and the relationship between bad communication and lacking treatment results is widely documented. Trauma care is a stressful situation that put demands on the nurse at the emergency department, and means challenges to achieve an effective collaborative communication. Aim: The aim was to illustrate nurses´ experiences of communication in the trauma team. Method: The study was conducted with a qualitative approach, where semi-structured interviews were performed with 11 nurses working in two emergency departments. All the data was analyzed by the help of qualitative content analysis method. Result: Study results generated in a theme Team communication -and its complexity. The result is presented in three main categories: The challenges of collaborative communication, Structure- to relate to certain rules and The Communication affects the patient. The complexity of communication within the team depends on personal characteristics and how teamwork otherwise functions. The value of leadership is essential as well as a structured approach and how to relate to policies and routines. The communication quality affects the care process for the patient and can be improved by trauma training. Conclusion: The study identifies the complexity of communication within the trauma team. Leadership and team interaction plays a crucial role for the outcome of the patient. It is of importance to communicate direct and clear. Lack of communication leads to impaired teamwork and adverse consequences for the patient safety. By trauma training, communication can be promoted and the nurses develop professional skills.
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Dias, Alexsandro de Oliveira. "Atendimentos realizados por times de respostas rápidas em hospitais." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-28032018-183143/.
Full textAbstract:
A segurança do paciente tornou-se indispensável para o sistema de saúde, portanto iniciativas vêm sendo implantadas, no decorrer dos anos, com vistas a reduzir os eventos adversos. A atuação do time de resposta rápida (TRR) consolida-se como estratégia para prover atendimento ao paciente que apresente sinais de deterioração clínica no setor de internação geral em hospitais. O serviço é formado por equipe multiprofissional capacitada para prestar tratamento intensivo ao paciente com quadro de deterioração clínica aguda no setor de internação, por meio de códigos (amarelo e azul) instituídos para seu acionamento, com vistas a reduzir a probabilidade de agravamento do quadro clínico ou risco de óbito imediato do paciente, durante o seu período de hospitalização. O estudo objetiva caracterizar as exigências críticas nos atendimentos emergenciais realizados por TRR, em um hospital público no estado do Paraná e um filantrópico no estado de São Paulo. Pesquisa descritiva, exploratória, qualitativa, com utilização da Técnica do Incidente Crítico como guia do processo metodológico, realizada por meio de entrevistas com 19 médicos, 20 fisioterapeutas e 23 enfermeiros. Os resultados encontrados foram agrupados em 89 incidentes críticos extraídos das entrevistas. A análise dos dados constou da identificação e do agrupamento de 220 comportamentos e 130 consequências. A partir das situações, comportamentos e consequências identificadas, destacam-se a necessidade da melhoria na via aferente do TRR (reconhecimento da deterioração clínica e acionamento do TRR na unidade), a capacitação dos profissionais das unidades de internação para exercer as habilidades técnicas iniciais necessárias frente ao atendimento de emergência até a chegada do TRR, a falha na interação entre os diversos profissionais durante o atendimento do código azul com prejuízo na sistematização do atendimento de emergência para reverter o quadro de parada cardiorrespiratória dos pacientes e os sentimentos e emoções negativas geradas nos profissionais como dificultadores dos atendimentos emergenciais em código azul. Em relação aos destaques positivos a partir das situações, comportamentos e consequências identificados, ressaltam-se o tempo de chegada do TRR na unidade para realizar o atendimento de emergência, a sistematização do atendimento de reanimação cardiopulmonar realizada pela equipe multiprofissional, o restabelecimento das funções vitais do paciente após o atendimento e a sua transferência após a finalização do atendimento da unidade de internação para um ambiente de cuidados intensivos. Como principais sugestões ao TRR, os entrevistados pontuaram a importância da capacitação de atendimento de emergência aos profissionais das unidades de internação, a necessidade de mantê-los atuando exclusivamente no TRR, o número adequado de profissionais no quarto durante o atendimento de emergência e a importância do registro em prontuário do paciente sobre a decisão de não reanimação frente aos cuidados paliativos. Destaca-se a expressiva frequência dos resultados positivos comparados aos negativos que permearam as situações, comportamentos e consequências decorrentes das entrevistas. Infere-se que mesmo ocorrendo dificuldades, enfrentadas por esses profissionais durante os atendimentos realizados aos pacientes que se tornam críticos nas enfermarias, predominaram os relatos positivos nas diversas categorias que legitimaram a importância da implantação desse serviço, como contribuição à qualidade e segurança dos que estão hospitalizadosPatient safety has become indispensable for the health system. Therefore, initiatives have been implemented over the years to reduce adverse events. The performance of the Rapid Response Team (RRT) has been consolidated as a strategy to provide care to patients who get in critical conditions at the general hospital admission unit. The service is constituted by a multiprofessional team with an approach in the intensive treatment of patients with signs of acute clinical deterioration in the inpatient unit, through codes established for its activation, in order to reduce the probability of worsening of the clinical condition or imminent death risk of the patient during the hospitalization period. The study aims to characterize the critical requirements in emergency care provided by the RRT at a public hospital in the state of Paraná and a philanthropic hospital in the state of São Paulo, Brazil. This is a descriptive, exploratory study with a qualitative approach, adopting the Critical Incident Technique to guide the methodological procedures, performed with 62 health professionals, being 19 physicians, 20 physiotherapists and 23 nurses. The results were grouped into 89 critical incidents extracted from the interviews. Data analysis consisted of the identification and grouping of 220 behaviors and 130 consequences. Based on the situations, behaviors and consequences identified, there is a need to improve the afferent pathway of RRT (recognition of clinical deterioration and activation of the RRT in the unit), the qualification of the professionals of the inpatient units to perform the necessary initial technical skills in the emergency response until the arrival of the RRT, the failure in the interaction among the different professionals during blue-code care with negative effects for the systematization of emergency care to revert the patients\' CPA and the negative feelings and emotions generated in the professionals as impediments to code-blue emergency care. Regarding the positive highlights from the situations, behaviors and consequences identified, the arrival time of the RRT in the unit to perform the emergency care, the systematization of the cardiopulmonary resuscitation service performed by the multiprofessional team, the restoration of the patient\'s vital functions after the care and transfer of the patient after the end of the care from the inpatient unit to an intensive care environment. As the main suggestions to the RRT, the interviewees pointed out the importance of emergency care training for the professionals of the inpatient units, the need to keep the professionals working exclusively in the RRT, the appropriate number of professionals in the room during emergency care and the importance of registering the patient\'s decision not to reanimate in the patient file in view of palliative care. The significant frequency of positive over negative results was highlighted, which permeated the situations, behaviors and consequences deriving from the interviews. It is inferred that, even though these professionals encountered difficulties during the visits to patients who became critical in the wards, the positive reports predominated in the various categories that legitimized the importance of implementing this service, as a contribution to the quality and safety of hospitalized patients
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Rydgren, Madeleine, and Emma Svensson. "Operationsteamets omvårdnadsåtgärder för att förebygga hypotermi : En observationsstudie med kvantitativ ansats." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-85432.
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Introduktion: Hypotermi innebär att patientens kärntemperatur är under 36 grader. Alla patienter riskerar att bli hypoterma vid kirurgiska ingrepp om inga förebyggande åtgärder utförs. Det går att förebygga hypotermi med antingen värmetillförande åtgärder eller genom att bibehålla patientens normala temperatur. Hypotermi kan leda till komplikationer för patienten så som sämre sårläkning, postoperativa sårinfektioner, ökad risk för trycksår, hjärtproblem och ökad blödningsbenägenhet. Trots att studier har visat på kunskap om ämnet är hypotermi vanligt förekommande vid kirurgiska ingrepp. Syfte: Syftet med studien var att undersöka i vilken utsträckning omvårdnadsåtgärder utfördes av operationsteamet för att förebygga hypotermi intraoperativt. Metod: Studien var en kvantitativ strukturerad observationsstudie. Data samlades in under 43 operationer på två sjukhus i södra Sverige. Observationerna utgick från ett protokoll som skapades utefter AORN (Association of perioperative registered nurses) och NICE:s (National institute for health och care excellence) riktlinjer och innehöll 12 förebyggande omvårdnadsåtgärder för att förhindra hypotermi. Resultat: Samtliga patienter fick varma täcken och varma intravenösa vätskor. All personal följde WHO:s checklista och majoriteten undvek att exponera patienten i onödan. Omvårdnadsåtgärder som inte utfördes lika frekvent var varmluftstäcke, varma spolvätskor, fot och benvärmare samt temperaturmätning på patienten. Aluminiumtäcke, värmemadrass, värmemössa och varm huddesinfektion användes aldrig. På de patienter som en temperatur togs på hade omvårdnadsåtgärderna en god effekt då majoriteten av patienterna inte längre var hypoterma i slutet av den intraoperativa fasen. Slutsats: Operationsteamet använde sig alltid av förebyggande omvårdnadsåtgärd för att förhindra hypotermi, några i högre utsträckning än andra. Några patienter var fortfarande hypoterma i slutet av den intraoperativa fasen vilken kan tyda på att en förbättring skulle kunna ske på de omvårdnadsåtgärder som inte användes lika frekvent.Introduction: The definition of hypothermia is when the patients core temperature is below 36 degrees. All the patients have an increased risk of becoming hypothermic during surgical procedures if no preventive measures are taken. Hypothermia is preventable with either heat inducing measures or by maintaining the patient’s normal temperature. Hypothermia can lead to complications for the patients such as impaired wound healing, Increased risk of postoperative wound infection, increased risk of bedsores, heart conditions and increased tendency to bleed. Although studies have shown knowledge of this topic hypothermia is a common occurrence in surgical procedures. Aim: The aim of this study was to investigate in which extension nursing measures were used by the operations team to prevent hypothermia intraoperatively. Method: The study was a quantitative structured observational study. Data was collected during 43 operations at two hospitals in southern Sweden. The observations followed a protocol that was created along AORN (Association of perioperative registered nurses) and NICE: s (National institute for health and care excellence) recommendations and contained 12 nursing measures to prevent hypothermia. Result: All the patients received warm blankets and warm intravenous fluids. All the operating staff used the WHO: s checklist and the majority avoided unnecessary patient exposure. The nursing measures that were used less frequently were warm air blankets, feet-and leg warmers and temperature measurement on the patient. Aluminum blankets, heating mattress, heat caps and warm skin antisepsis were never used. On the patients of whom a temperature was taken, the nursing measures had a good effect since the majority of the patients were no longer hypothermic at the end of the intraoperative phase. Conclusion: The operation team always used care measures to prevent hypothermia, some to a greater extent than others. Some patients were still hypothermic at the end of the intraoperative phase, which may indicate that an improvement could occur in the nursing measures that weren’t used as frequently.
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Veiga, Viviane Cordeiro 1976. "Atuação do time de resposta rápida nos indicadores de melhoria da qualidade assistencial." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311906.
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Orientador: Salomón Soriano Ordinola RojasTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: A segurança do paciente tornou-se prioridade estratégica para o sistema de saúde. Ações têm sido implantadas nas Instituições, na tentativa de reduzir a mortalidade hospitalar e os eventos não previsíveis. Objetivo: O objetivo deste trabalho é avaliar a atuação do time de resposta rápida nos indicadores de melhoria da qualidade assistencial, comparando dois períodos de seguimento. Casuística e Método: No período de maio de 2010 a dezembro de 2012, foram avaliados os atendimentos realizados pelo time de resposta rápida, em pacientes com idade maior ou igual a 18 anos. O estudo foi dividido em dois períodos, denominado "antes" e "depois", sendo que o primeiro compreendeu o intervalo de maio de 2010 a julho de 2011 e o segundo, entre agosto de 2011 e dezembro de 2012. O acionamento do grupo era feito por qualquer profissional da equipe assistencial, baseado em critérios preestabelecidos e amplamente divulgados na Instituição. Após 15 meses de seguimento, optou-se pela alteração nos critérios de acionamento (período "depois"), visando à detecção precoce da deterioração clínica e baseados no perfil epidemiológico da Instituição. No período, foram atendidos 8009 pacientes, sendo 1830 no "antes" e 6179 no "depois", com idade média de 66,37±16,88 e 65,99±20,08 anos, respectivamente. O gênero masculino foi predominante em ambos os períodos, representando 52,5% dos atendimentos no primeiro e 53% no segundo. No período "antes", as alterações respiratórias representaram o maior número de chamados, enquanto que, no período "depois", a busca ativa de sepse foi o critério mais acionado, seguido pelas alterações respiratórias. Foi denominado código azul, os atendimentos de parada cardiorrespiratória e código amarelo, os atendimentos decorrentes de deterioração clínica. Os indicadores de qualidade assistencial mensurados foram: reinternação precoce em terapia intensiva (UTI), transferências para UTI, chamados de código amarelo, número de paradas cardiorrespiratórias fora da UTI e mortalidade hospitalar. Resultados: No período analisado, não houve diferença estatisticamente significante de perfil dos pacientes nos dois períodos, quanto ao gênero e idade (p=0,631 e p=0,550, respectivamente). Ao longo dos meses avaliados, houve um aumento significativo no número total de atendimentos, com 98,1% de chamados de código amarelo no segundo período. A proporção encontrada de códigos azuis foi de 7,59% no período "antes" e 1,91% no período "depois". O número de pacientes atendidos que necessitaram transferência para a UTI representava 33,3% dos atendimentos no período "antes", com redução para 20,8% no "depois" (p<0,001). Houve redução no número de reinternações em UTI na comparação entre os dois períodos (p <0,001). Não houve diferença estatisticamente significante no número de paradas cardiorrespiratórias fora da UTI e na mortalidade entre os períodos, no entanto, com tendência de redução no decorrer do tempo. Conclusão: A implantação do time de resposta rápida resulta em melhoria da qualidade assistencial, com redução no número de transferências e reinternação precoce em UTI. O número de paradas cardiorrespiratórias e a mortalidade apresentaram tendência de redução ao longo do tempo estudado
Abstract: Introduction: Patient safety has become a strategic priority for the health system. Actions have been implemented in health institutions in an attempt to reduce mortality and adverse events. Objective: The objective of this study is to evaluate the performance of the rapid response team on indicators of improving quality of care, comparing two periods of follow-up. Methods: Between May 2010 and December 2012, we assessed the care provided by a rapid response team in patients aged greater than or equal to 18 years. The study was divided into two periods, "before" and "after", the first of which included the period May 2010 to July 2011 and the second between August 2011 and December 2012. The group was called by any professional health care team, based on predetermined criteria. After 15 months of follow-up, we decided to drive change in criteria (period "after"), aimed at early detection before clinical deterioration and based on the epidemiological profile of the institution. During the period, 8009 patients were treated, and 1830 in the period "before" and in 6179 "after", with a mean age of 66.37 ± 16.88 and 65.99 ± 20.08 years, respectively. The male gender predominated in both periods, representing 52.5% of visits in the 1st period and 53% in the second. In the period "before", the respiratory changes accounted for the largest number of calls, while in the period "after" sepsis was the most called, followed by respiratory disorders. Blue code was called the attendance of cardiac arrest and yellow code, the clinic visits resulting from deterioration. The quality of care indicators measured were: unplanned admission to intensive care unit (ICU), ICU transfers, time-driven service, called code yellow and number of cardiac arrests outside the ICU. Results: During the period analyzed, there was no statistically significant difference in the profile of patients in both periods, according to gender and age (p = 0.631 and p = 0.550, respectively). Over the months studied, there was an increase of approximately 300% in the total number of visits, with 98.1% of calls to code yellow in the second period. The proportion of code blue was 7.59% in the period "before" and 1.91% in the period "after." The number of patients seen who required transfer to the ICU represented 33.3% of attendances in period "before", with a reduction to 20.8% in the "after" (p <0.001). There was a reduction in the number of unplanned ICU admissions when comparing the two periods (p <0.001). There was no statistically significant difference in the number of cardiac arrests outside the ICU and mortality between the periods. Conclusion: The implementation of the rapid response team results in improving quality of care, reducing the number of transfers and early readmission to the ICU. The number of cardiopulmonary arrests and mortality tended to decrease over time studied
Doutorado
Fisiopatologia Cirúrgica
Doutora em Ciências
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Casse, Christelle. "Concevoir un dispositif de retour d'expérience intégrant l'activité réflexive collective : un enjeu de sécurité dans les tunnels routiers." Thesis, Université Grenoble Alpes (ComUE), 2015. http://www.theses.fr/2015GREAH024/document.
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Le retour d'expérience (REX), sous la forme d'analyses d'accident le plus souvent, constitue un instrument privilégié de management de la sécurité dans les organisations industrielles à hauts risques. Cette recherche s'inscrit dans le domaine de la sécurité dans les tunnels routiers et vise à proposer une approche intégrée du REX, qui repose sur le travail quotidien de gestion de la sécurité par les opérateurs en s'appuyant sur les espaces collectifs de construction de l'expérience. La thèse défendue est que la sécurité dans les environnements dynamiques tels que les tunnels routiers repose sur la capacité des collectifs de travail transverses à faire face aux imprévus, les perturbations quotidiennes comme les évènements. Cette capacité se construit notamment à travers les discussions entre opérateurs et avec leurs managers sur les difficultés de leur travail. Les dispositifs de REX doivent favoriser l'existence de débats sur l'activité pour améliorer la gestion de la sécurité et favoriser ainsi le développement de l'individu et de l'organisation. Cependant cela implique des conditions d'organisation pour que le débat soit possible et pérenne.Une intervention-recherche visant la conception d'un dispositif de REX fondé sur l'activité individuelle et collective a été réalisée chez un exploitant de tunnels routiers pour éclairer cette problématique. Les analyses menées en collaboration avec les opérateurs de l'exploitation avaient pour objectifs d'aider les opérateurs à mettre en relation la manière dont ils gèrent la sécurité sur le terrain avec la manière dont le REX traite les évènements. L'analyse du REX existant montre dans un premier temps qu'il est centré sur les évènements de trafic majeurs, faisant l'objet de procédures et de règles formelles, alors que les incidents critiques pour les opérateurs sont majoritairement des incidents d'exploitation, peu cadrés. Dans un second temps, l'analyse de l'activité montre que les opérateurs développent de façon informelle des instances d'échange collectif pour anticiper les aléas, s'organiser et analyser les évènements. Une démarche de simulation organisationnelle avec les opérateurs, les managers et les partenaires de la recherche a été engagée pour transformer le dispositif de REX. Elle débouche sur un REX élargi en termes de définition des évènements et d'acteurs impliqués. Le nouveau dispositif s'appuie sur les processus-métiers existants, tout en développant les instances collectives d'analyse inter-métiers et inter-organisations. Il structure les pratiques informelles d'organisation et de partage d'expérience des opérateurs. Des espaces de discussion inter-métiers sur les pratiques réelles ont pu s'élaborer à partir de simulations d'évènement, animés par des managers de proximité. L'expérimentation de cette méthodologie montre que ces espaces favorisent la confrontation des représentations, des pratiques et la transmission des connaissances. Ils permettent aussi l'élaboration de règles opérationnelles transverses et font émerger les besoins de règles formelles à relayer aux managers. Ils sont constructifs car ils participent au développement de l'organisation formelle autant que de l'activité des opérateurs. Cette méthodologie a favorisé la construction de l'expérience à partir de l'analyse des évènements.L'intervention-recherche a permis de revenir sur les classifications officielles des évènements dans les tunnels routiers. Les conditions et modalités de mise en place d'un REX intégré sont définies et discutées, ainsi que celles des espaces de discussion par simulation. L'ingénierie de l'intervention ergonomique de conception organisationnelle et la place de l'intervenant sont aussi revisitées à l'aune de nos résultatsOperating experience feedback, mainly through accident analysis is a method of choice for safety management in high risk organizations. The present research takes place in the field of road tunnel safety, proposing an integrated approach of experience feedback from the daily management of safety by tunnel monitoring staff through collective spaces for discussion and experience building.Our hypothesis is that safety in such dynamic environments as road tunnels depends on the capacity of operating teams to face the unexpected events, disturbances and accidents. This capacity is built through discussions between operating staff and with the management about the difficulties encountered during work. The return on operating experience should allow the debate on work activity in order to reach a better safety management, foster individual development and a better organization. However, there are organizational conditions for the debate to be possible and sustainable.A research and intervention protocol was set up with a road tunnel operator to test and improve a scheme for the return on operating experience based on individual and collective activity. Analyses were conducted to help operational staff link the way events are treated in day to day security management with the processing in the operational experience feedback scheme. An analysis of the current scheme showed that it is focussed on major traffic events, comprising of a set of procedures and formal rules, while the operational events, felt as critical by operators do not have a framework for discussion. Further, work activity analysis shows that operational staff develops informal spaces of collective exchanges to organize work, anticipate hazards and analyse events.Organizational simulations including operating staff, managers and the research partners were set up to transform the feedback scheme. The simulation led to an enlarged framework for feedback, defining the events to be analysed and participants to be included. The new scheme roots in the existing professional processes, develops inter-professional as well as inter-organization discussion spaces. The new scheme facilitates the sharing of experience among operating staff and structures the informal organizational practices we observed.Inter-professional discussion spaces, conducted by the team managers, were set up based on the analysis of simulated events. These structured discussion spaces proved to be effective in the confrontation of work practices, events and roles representations as well as conducive for knowledge transmission. The discussion space allows setting transverse operational rules and highlights the need for formal rules to be set by the management. The inter-professional discussion spaces are operant in improving the formal organisation as well as developing the activity of operational staff. This methodology favoured the building of experience from event analysis.This research-intervention was an opportunity to review the official classification of road tunnel events. The conditions for an integrated operating experience feedback scheme are set and discussed, as well as the implementation of simulation-based discussion spaces.From our results, we re-consider the design of interventions in organizational design, as well as the role of the intervening ergonomist
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Hendricks, Rahzia. "The use of in vitro assays to screen for endocrine modulation." Thesis, University of the Western Cape, 2008. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_5859_1259070342.
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Aspalathus linearis (A. linearis), commonly known as Rooibos tea or Red bush tea and amellia sinensis (C. sinensis) or Black tea are beverages that are consumed throughout theworld. These teas possess antioxidant, immunomodulating and anti-cancer actions. The aim of this study was to use in vitro assays to screen Rooibos and Black tea for endocrine modulation. The immune modulating effects of Rooibos and Black tea were investigated using an in vitro whole blood culture (WBC) assay. Unstimulated WBCs treated with Rooibos tea secreted higher levels of IL-6, IL-10 and IFN&gamma
than cultures treated with DMSO control. Rooibos treatment of stimulated WBCs resulted in higher IL-6, lower IL-10 and no effect on IFN&gamma
secretion compared to DMSO treated stimulated WBC. Black tea treatment of stimulated WBC resulted in decreased IL-6, IL-10 and IFN&gamma
secretion compared to the DMSO treated stimulated WBC. Extracts of Rooibos and Black tea were assessed for phytoestrogens using quantitative estrogen ELISAs. Both teas contain phytoestrogens. The quantitative ELISAs showed that Rooibos tea contained significantly lower estrone (E1), estradiol (E2) and estriol (E3) levels than Black tea. The effects of Rooibos and Black tea on proliferation of the estrogen dependant MCF-7 cell line was determined to further characterise the phytoestrogenic properties of the teas. Both Rooibos and Black tea extracts caused a significant inhibition of MCF-7 proliferation. This study shows that Rooibos tea and Black tea are beverages that can either stimulate or suppress the immune system. Also, both teas contain significant levels of phytoestrogens as determined by quantitative ELISAs. The current study confirms previous reports showing inhibition of growth in breast cancer cell lines by phytoestrogens. The findings extend related observations on the anti-carcinogenic potential of the two teas.
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Moreira, Isadora Alves. "Notificação de eventos adversos: o saber e o fazer de enfermeiros." Universidade Federal de Goiás, 2018. http://repositorio.bc.ufg.br/tede/handle/tede/8759.
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Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2018-08-01T13:25:51Z
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Introduction: Patient safety has been a topic of discussion in health institutions and the reporting of adverse events is one of the main indicators used to assess the quality of care provided. The nurse, supervisor of the nursing team, has a prominent role in risk management and through the systematic notification of these events should implement preventive strategies for improvements in the quality of care and patient safety. Objective: To analyze nurses' knowledge and performance through the process of reporting adverse events in hospitalized patients. Method: A descriptive, mixed-type cross-sectional study developed at a teaching hospital in the Center-West region of Brazil, with the participation of 60 nurses from the various Clinical Units. Quantitative data were obtained through VIGIHOSP reports, online hospital notification systems, for 2016 and 2017 and analyzed statistically by absolute and relative frequencies. Qualitative data were obtained through interviews with nurses through a structured instrument, in March 2018. The contents of the ATLAS.ti 8.0 software were analyzed and three contents were analyzed: The Nurse's Knowledge; The Making of the Nurse; Intervening factors for the reporting of adverse events. Results and Discussion: In VIGIHOSP, 2495 incidents were reported, the main ones related to surgeries (60.6%) and medications (23.3%). As for surgeries, 98.6% were cancellation of the surgical procedure, being 23.1% due to patient non-attendance, 18.4% due to lack of organizational structure and 15% due to lack of patient's clinical conditions. Of the drug-related incidents, 61.8% were prescription errors and 27.6% dispensing errors. As for the profile of the participants, 46.6% work at night or mixed shift, have more than one employment relationship, working for more than 40 hours a week. It was evidenced underreporting of incidents, since most nurses do not notify the events in the system. Although they reveal knowledge of the institution's event notification system, they do not know its flow, especially regarding the return to the notifier. Factors related to underreporting of incidents were lack of time, lack of professionals / human resources, unavailability of computers for notification and low qualification of some professionals to use the online program. Conclusions: The need for greater investment in nurses' training on the dynamics and flow of the hospital's notification system is evident through continuing education programsinvolving the communication of events as an educational strategy to achieve improvements in the quality of practice care and patient safety.
Introdução: A segurança do paciente tem sido tema de discussão nas instituições de saúde e a notificação dos eventos adversos um dos principais indicadores utilizados para avaliar a qualidade da assistência prestada. O enfermeiro, supervisor da equipe de enfermagem, tem papel de destaque na gestão de riscos e por meio da notificação sistemática desses eventosdeve implementar estratégias preventivas para melhorias da qualidade da assistência e segurança do paciente. Objetivo: Analisar o conhecimento e a atuação dos enfermeiros mediante o processo de notificação de eventos adversos de pacientes hospitalizados. Método: Estudo do tipo descritivo, de natureza mista e corte transversal, desenvolvido em um hospital de ensino da região Centro-Oeste do Brasil, com a participação de 60 enfermeiros das diversas Unidades Clínicas. Os dados quantitativos foram obtidos por meio de os relatórios do VIGIHOSP, sistemas online de notificação do hospital, anos 2016 e 2017 e analisados estatisticamente por meio de frequências absolutas e relativas. Os dados qualitativos foram obtidos por meio de entrevistas com os enfermeiros mediante um instrumento estruturado, no mês de março de 2018. Foram inseridos no software ATLAS.ti 8.0 e realizada análise de conteúdo sendo evidenciadas três categorias: O Saber do Enfermeiro; O Fazer do Enfermeiro; Fatores intervenientes para a notificação de eventos adversos. Resultados e Discussão: Foram notificados no VIGIHOSP, 2495 incidentes, os principais relacionados a cirurgias (60,6%) e medicações (23,3%). Quanto às cirurgias, 98,6% foi cancelamento do procedimento cirúrgicos sendo 23,1% por não comparecimento do paciente, 18,4% por falta de estrutura organizacional e 15% por falta de condições clínicas do paciente. Dos incidentes relacionados a medicamentos, 61,8% foram erros de prescrição e 27,6% erros de dispensação. Quanto ao perfil dos participantes, 46,6% trabalham no noturno ou turno misto, possuem mais de um vínculo empregatício, atuando por mais de 40 horas semanais. Foi evidenciada subnotificação de incidentes, visto que a maioria dos enfermeiros não notificam os eventos no sistema. Apesar de revelarem conhecimento do sistema de notificação de eventos da instituição, desconhecem o seu fluxo, especialmente em relação ao retorno ao notificador. Como fatores relacionados a subnotificação de incidentes foram ressaltados a falta de tempo, falta de profissionais/recursos humanos, indisponibilidade de computadores para notificação e baixa qualificação de alguns profissionais para utilizar o programa online. Conclusões: Torna-se evidente a necessidade de maior investimento na capacitação dos enfermeiros acerca da dinâmica e fluxo do sistema de notificação do hospital por meio de programas de educação continuada envolvendo a comunicação dos eventos como estratégia educativa para o alcance de melhorias na qualidade da prática assistencial e segurança do paciente.
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Braga, Quéren de Pádua. "Incidentes em unidades de atenção primária em saúde: percepção da equipe de enfermagem." Universidade Federal de Goiás, 2018. http://repositorio.bc.ufg.br/tede/handle/tede/9145.
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Submitted by Ana Caroline Costa (ana_caroline212@hotmail.com) on 2018-12-12T17:34:51Z
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Introduction: Primary Health Care is the gateway and the first point of contact between the patient and the health system. Investigations focused on patient safety at this level of care are scarce but essential for diagnosing care processes for that preventive measures are taken to improve the quality of care and minimize possible incidents. There is a need for more nursing commitment to involve patients and professionals in the prevention of incidents in this context. Objective: To analyze the perception of professionals of the nursing team regarding the occurrence of incidents in patients attending primary healthcare units. Methodology: A cross-sectional descriptive study with a mixed approach, developed in 24 Basic Health Units of a municipality in the Central South Region of Goiás, with a population of 97 professionals from the nursing team. The data were collected in March 2018 through an interview with the PCISME (Primary Care International Study of Medical Errors) questionnaire to register incidents in APS, adapted and validated for the Brazilian reality. Descriptive analysis of quantitative data and content analysis of qualitative data were performed with the help of ATLAS.ti 7.5.4. Results / Discussion: We identified 88 incidents, divided into care: the most frequent were the vaccination, with 26 reports, followed by medication and fall; and administrative: being 11 related to administrative service and seven organizational structure and material resources. Among the incidents, 52 were considered adverse events, as they caused damage to the patient, two of which were permanent damage and two deaths. The professional category involved in the highest number of incidents were the nursing technicians in 45 reports, followed by doctors, administrative staff and nurses. The results presented the need to deepen this theme in other primary care services in order to improve the quality of care provided by qualified professionals and improve the quality of the organization of services and consequently the safety of patient care. Conclusions: The perception of nursing team's evidenced the need to sensitize managers and health professionals in order to expand strategies of permanent education, the use of instruments of notification of the incidents, since these actions contribute in the diagnosis of the health situation and professionals to promote improvements through safe and quality care. It should be emphasized that encouraging the production of research related to the subject in PHC is a way forward.
Introdução: A Atenção Primária a Saúde é a porta de entrada e o primeiro ponto de encontro entre o paciente e o sistema de saúde. Investigações com foco em Segurança do Paciente neste nível de atenção são escassos, mas imprescíndiveis por levantar diagnósticos dos processos assistenciais para que medidas preventivas sejam adotadas a fim de melhorar a qualidade do atendimento e minimizar possíveis incidentes. Há necessidade de maior compromisso da enfermagem no sentido de envolver os pacientes e profissionais para a prevenção de incidentes neste contexto. Objetivo: Analisar a percepção dos profissionais da equipe de enfermagem quanto à ocorrência de incidentes em pacientes atendidos em unidades de serviços da atenção primária à saúde. Metodologia: Estudo descritivo transversal com abordagem mista, desenvolvido em 24 Unidades Básicas de Saúde de um município da Região Centro Sul de Goiás, com população de 97 profissionais da equipe de enfermagem. Os dados foram coletados em março de 2018 por meio de entrevista auxiliada pelo questionário PCISME (Primary Care International Study of Medical Errors) pioneiro no sentido de registrar incidentes na APS, adaptado e validado para a realidade brasileira. Foi realizada análise descritiva dos dados quantitativos e análise de conteúdo dos dados qualitativos com o auxílio do ATLAS.ti 7.5.4. Resultados/Discussão: Foram identificados 88 incidentes, divididos em assistenciais: sendo os de vacinação os mais frequentes, com 26 relatos, seguido de medicação e queda; e administrativos: sendo 11 relacionados ao atendimento administrativo e sete a estrutura organizacional e recursos materiais. Dentre os incidentes, 52 foram considerados eventos adversos, pois causaram dano ao paciente, sendo dois de dano permanente e dois óbitos. A categoria profissional envolvida no maior número de incidentes foram os técnicos de enfermagem em 45 relatos, seguido pelos médicos, administrativos e enfermeiros. Os resultados mostraram a necessidade de aprofundamento dessa temática nos demais serviços de atenção primária com intuito de melhorar a qualidade da assistência prestada por profissionais capacitados e melhorar a qualidade da organização dos serviços e consequentemente a segurança no atendimento aos pacientes. Conclusões: A percepção da equipe de enfermagem evidenciou a necessidade de sensibilizar os gestores e profissionais de saúde no sentido de ampliar as estratégias de educação permanente, o uso de instrumentos de notificação dos incidentes, já que estas ações contribuem no diagnóstico da situação de saúde e qualificação dos profissionais para promoção de melhorias mediante um cuidado seguro e com qualidade. Ressalta-se que o incentivo à produção de pesquisas relacionadas ao tema na APS é um caminho a seguir.
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Batalha, Edenise Maria Santos da Silva. "A cultura de segurança do paciente na percepção de profissionais de enfermagem de um hospital de ensino." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/7/7140/tde-03012013-105906/.
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Trata-se de um estudo quantitativo descritivo-exploratório, cujos objetivos foram avaliar a percepção de profissionais de enfermagem de um hospital de ensino acerca das dimensões de cultura de segurança do paciente e identificar os fatores intervenientes que influenciam na segurança do paciente. A pesquisa foi desenvolvida em um hospital de ensino no Município de São Paulo e a população foi constituída por 305 profissionais de enfermagem. A pesquisa foi aprovada nos Comitês de Ética da EEUSP e da instituição - cenário do estudo. Os dados foram coletados no período de fevereiro a junho de 2012, por meio do questionário da Agency for Health Research and Quality, intitulado Hospital Survey on Patient Safety Culture. O referido instrumento incorpora dez dimensões de segurança do paciente, duas variáveis de resultados, o grau de segurança do paciente e o número de eventos adversos (EA) relatados. A análise dos dados ocorreu por meio de estatísticas descritivas e analíticas. O instrumento de coleta de dados mostrou-se confiável (Alpha de Cronbach total de 0,90). Na caracterização dos participantes 18,9% eram enfermeiros, 26,6% técnicos e 54,5% auxiliares de enfermagem e a maioria estava na faixa etária de 26-40 anos. Nas dimensões avaliadas salientamos que no Trabalho em equipe no âmbito das unidades 72,5% concordam que quando há sobrecarga de trabalho os profissionais colaboram entre si. Referente às Expectativa/ações de promoção da segurança pelos supervisores 78,3% afirmam que o supervisor mostra-se aberto à comunicação dos problemas de segurança do paciente. Concernente ao Apoio da gestão hospitalar 53,6% percebem que a administração do hospital não propicia um clima de trabalho que favorece a segurança do paciente. Relativo ao Feedback e comunicação a respeito de erros 12,3% nunca discutem maneiras de prevenir erros e 19,3% afirmaram discutir sempre. Conforme as Respostas não punitivas aos erros 78,2% consideram que os seus erros podem ser usados contra eles. Quanto à Percepções generalizadas sobre segurança: 60,2% revelam não ser por acaso que erros mais sérios não acontecem na unidade e 52,9% concordam em haver problemas de segurança na unidade. No que refere a Frequência de relatórios de EA: a categoria do erro não influencia na sua notificação e 73,5% responderam não notificar nenhum EA nos últimos 12 meses. Em relação ao Grau de Segurança do Paciente, a maioria o classifica como aceitável. Concluímos, frente à magnitude da temática segurança do paciente, que avanços no cenário atual das organizações de saúde sejam desafiadores, todavia é imperativo a efetiva mobilização dos profissionais, a fim de consolidar uma cultura de segurança profícua e construtiva.This is a descriptive-exploratory quantitative study, which aimed to evaluate the perception of nursing professionals from a teaching hospital about the dimensions of patient safety culture and identify the intervening factors that influence patient safety. The study was developed in a teaching hospital from São Paulo city, and the population comprised 305 nursing professionals. This study was approved in the Ethic committees from the EEUSP and the studied teaching hospital. Data from this study were obtained from February to June in 2012, by using the questionnaire Hospital Survey on Patient Safety Culture from the Agency for Health Research and Quality. The questionnaire comprises ten dimensions of patient safety, two outcome variables, the degree of patient safety and the number of communicated adverse events (AE). Data were analyzed by using analytic and descriptive statistics. The instrument of data collection was reliable, as evidenced by the total Cronbachs Alpha of 0.90. The characterization of the sampling consisted of 18.9% of nurses, 26.6% of technicians, and 54.5% of auxiliaries, which are in the age group among 26 and 40 years. In dimension Teamwork within units 72.5% of professionals agree that when there is overwork they collaborated between them. Concerning dimension Supervisor/Manager Expectations and Actions Promoting Patient Safety 78.3% alleged that the supervisor is open to communication about problems of patient safety. Regarding dimension Management Support for Patient Safety 53.6% realize that the hospital administration do not provide a work climate that favors the patient safety. Concerning Feedback and Communication About Error 12.3% never discuss ways to prevent errors and 19.3% said they always discuss. According to dimension Nonpunitive Response to Errors 78.2% consider that their errors can be used against them. Concerning dimension Overall Perceptions of Patient Safety 60.2% reveal not be by accident that more serious mistakes do not happen in unity, and 52.9% agree to have security problems in the unit. Regarding dimension Frequency of Events Reported \": the error category did not affect its notification, and 73.5% answered not notify any AE in the past 12 months. Concerning to the Patient Safety Grade, ranks as the most acceptable. We conclude, on the topic of patient safety, which the advances on current scenario of health organizations are challenging, however it is imperative the effective mobilization of professionals in order to consolidate a culture of safety fruitful and constructive.
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Costa, Daniele Bernardi da. "Cultura de segurança do paciente em serviços de enfermagem hospitalar." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-06022015-192856/.
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Trata-se de uma pesquisa quantitativa e descritiva, tipo survey, cujo objetivo foi investigar a cultura de segurança do paciente, na ótica dos profissionais de enfermagem de serviço hospitalar. O estudo foi realizado em dois hospitais e aprovado pelo Comitê de Ética da Escola de Enfermagem de Ribeirão Preto e em ambas instituições. A amostra foi composta por 46 enfermeiros, 124 auxiliares de enfermagem e 112 técnicos de enfermagem. A coleta de dados ocorreu nos meses de junho e julho de 2013, através da aplicação questionário intitulado Hospital SurveyonPatientSafetyCulture, instrumento da Agency for Health ResearchandQuality. A análise dos dados ocorreu através de estatísticas descritivas. Quanto a caracterização dos participantes 84,7% eram do sexo feminino e 15,3% do sexo masculino, com média de 37,7 anos de idade, observa-se a predominância de técnicos de enfermagem com 41,2%, 34,6% de auxiliares de enfermagem e 24,3% de enfermeiros. Com base na avaliação das dimensões, salienta-se na dimensão trabalho em equipe dentro das unidades, que 69,4% dos profissionais concordam que quando há muito trabalho a ser feito rapidamente, trabalham em equipe para concluí-lo devidamente, na dimensão expectativas e ações de promoção de segurança dos supervisores / gerentes, 70,2% concordam que sua chefia não dá atenção suficiente aos problemas repetidos de segurança do paciente. Relativo a aprendizagem organizacional e melhoria contínua, 56,5% concordam que há avaliação da efetividade das mudanças após sua implementação. Quanto ao apoio da gestão hospitalar para a segurança do paciente os profissionais apontam com 52,8% que as ações da direção do hospital demonstram que a segurança do paciente é a principal prioridade. Sobre a percepção geral da segurança do paciente 57,2% discordam de que a segurança do paciente não deve ser comprometida em função de maior quantidade de trabalho a ser concluída. No retorno das informações e da comunicação sobre erro, 57,7% afirmam receber tais informações sempre e quase sempre. Relativo a abertura da comunicação, 42,9% apontam que nunca ou raramente sentem-se à vontade para questionar as decisões/ações de seus superiores. Quanto a frequência de notificações de eventos, 64,7% apontam notificar quase sempre e sempre o erro, engano ou falha que poderiam, mas não causam danos ao paciente. Sobre trabalho em equipe entre as unidades, nota-se proximidade entre as porcentagens de discordância e concordância, como no item há uma boa cooperação entre unidades do hospital que precisam trabalhar em conjunto\", com 41,4% e 40,5% respectivamente. Sobre a adequação de profissionais, 77,8% discordam da existência de quantidade de funcionários suficientes para dar conta do trabalho, 52,4% concordam que as mudanças de plantão são problemáticas para os pacientes. Relativo as respostas não punitivas aos erros, 71,7% apontam que quando um evento é relatado parece que o foco recai sobre a pessoa. Sobre a nota de segurança da instituição, 41,6% classificam como muito boa. Quanto as notificações nos últimos 12 meses,77,80% não notificaram nenhum evento. Conclui-se que o envolvimento dos profissionais de enfermagem é essencial para a construção de uma cultura de segurança positiva, focada em melhorias para a segurança do pacienteThis is a quantitative, descriptive research, which the goal is to investigate patient safety culture from the perspective of professional from the hospital nursing team. The study was conducted in two hospitals, and approved by the Research Ethics Committee of the EERP and of both hospital institutions. The sample consisted of 46 nurses, 124 nursing assistants and 112 nursing technicians. Data collection occurred during the months of June and July 2013, through the questionnaire Hospital Survey on Patient Safety Culture, of the Agency for Health Research and Quality. Data analysis occurred using descriptive statistics. Regarding the characterization of participants, 84.7% were female and 15.3% male, with a mean of 37.7 years of age, there is a predominance of nursing technicians with 41.2%, nursing assistants with 34.6 % and 24.3% of nurses. Based on the assessment of the dimensions is stressed that, in the dimension teamwork across hospital units, 69.4% of professionals agree that when a lot of work needs to be done quickly, they work together as a team to get the work done; about the dimension supervisor/ manager expectations and actions promoting safety, 70.2% agree that their supervisor/ manager overlooks patient safety problems that happen over and over.Related to organizational learning and continuous improvement, 56.5% agree that there is evaluation of the effectiveness of the changes after its implementation.Onhospital management support for patient safety, 52.8% of the professionals refer that the actions of hospital management show that patient safety is a top priority.On the overall perception of patient safety, 57.2% disagree that patient safety is never compromised due to higher amount of work to be completed.In what refers to feedback and communication about error, 57.7% refer that always and usually receive such information. Relative to communication openness, 42.9% said they never or rarely feel free to question the decisions / actions of their superiors.Onfrequency of event reporting, 64.7% said often and always notify mistakes that could, but do not harm the patient.Aboutteamwork across hospital units is noted similarity between the percentages of agreement and disagreement, as on the item there is a good cooperation among hospital units that need to work together, that indicates 41.4% and 40.5% respectively.Related to adequacy of professionals, 77.8% disagree on the existence of sufficient amount of employees to do the job, 52.4% agree that shift changes are problematic for patients. On nonpunitive response to errors, 71.7% indicate that when an event is reported it seems that the focus is on the person.On the patient safety grade of the institution, 41.6% classified as very good. About notifications made in the last 12 months, 77.80% did not report any events.It is conclude that the involvement of nursing professionals is essential to building a positive safety culture focused on improvements to patient safety
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Webster, Alva. "Promoting Long-Term Iontophoresis through Safety Electronics." University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1523628670322302.
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Hyléen, Andrea, and Cecilia Lewin. "Sjuksköterskans upplevelser av ett rapid response system och dess påverkan på patientsäkerheten : en litteraturöversikt." Thesis, Sophiahemmet Högskola, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-2724.
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Akutsjuksköterskans roll är att tillhandahålla omedelbar vård till människor eller att utföra en omvårdnadsåtgärd som kan förhindra att en nödsituation uppstår. Akutsjuksköterskan ska leda, initiera och samordna patientvården. Faktorer som påverkar patientsäkerheten är ledarskapet, att arbeta i team, att arbeta evidensbaserat, kommunikation, utbildning och att arbeta patientcentrerat. Rapid response system (RRS) utvecklades för att förbättra patientsäkerheten inom akutsjukvården. Det finns fyra enheter som är grundläggande för systemet. Den afferenta komponenten som omfattar av sjuksköterskan som ansvarar för identifiering av varningssignaler för kritiskt sjuka patienter och aktivering av RRS. Till sin hjälp har sjuksköterskan ett track- and triggersystem som baseras på patientens vitalparametrar för att identifiera kritiskt sjuka patienter på avdelning. De vanligaste förekommande vitalparametrarna inom akutsjukvården är: respiration, temperatur, blodtryck, hjärtfrekvens, medvetandegrad samt urinproduktion. Den efferenta komponenten är den hjälpinsats som den afferenta komponenten tillkallar vid aktivering av RRS när avvikande vitalparametrar är observerade och genererar hög poängsumma i ett track- and triggersystem alternativt på inrådan av sjuksköterskans instinktiva känsla av att patientens tillstånd försämrats. Syftet var att belysa sjuksköterskans upplevelser av att arbeta utefter ett rapid response system och belysa dess påverkan på patientsäkerheten. Metoden som användes var litteraturöversikt. Databassökningar gjordes i PubMed, CINAHL och Web Of Science, vilket resulterade i att 16 artiklar inkluderades i studien. Inklusionskriterier som användes var att artikeln skulle vara publicerad på engelska, ’peer- reviewed’ och publicerade i vetenskapliga tidskrifter mellan år 2006–2016. En integrerad analysmetod användes för att finna likheter och skillnader i resultatet. I resultatet framkom det att RRS ökade identifieringen av kritiskt sjuka patienter och flertalet artiklar konstaterade att RRS minskade antalet hjärtstopp och oväntade dödsfall. I resultatet framkom svårigheter och begränsningar med att arbeta utefter RRS så som otillräcklig kompetens, hög arbetsbelastning och hierarki. Avvikande vitalparametrar togs mer på allvar jämfört med ”tysta” förändringar. Sjuksköterskorna aktiverade systemet på grund av oro relaterat till klinisk erfarenhet, trots att vitalparametrarna var normala RRS var till hjälp att hantera kritiskt sjuka patienter och fungerade som sjukhusets 112. Avdelningssjuksköterskorna upplevde att de mestadels fick stöttning av det medicinska akutvårdsteamet men tillfällen då sjuksköterskan upplevde otrevligt bemötande påverkade det beslutsfattandet av aktivering av RRS negativt framöver. Slutsatsen av denna litteraturöversikt tyder på att RRS främjar patientsäkerheten och hjälper sjuksköterskan i sitt dagliga arbete genom att främja säker vård. Sjuksköterskans upplevelser belyser gynnsamma omständigheter och upplevda svårigheter med RRS som kan användas till vidare forskning för att utveckla systemet.The role of the emergency nurse is to provide immediate care to patients or to perform a nursing intervention that can prevent an emergency. They should lead, initiate and coordinate patient care. Factors that affect patient safety could be leadership, working in teams, evidence-based work, communication, training, or patient-centered work. Rapid response system (RRS) was developed to improve patient safety in emergency care. There are four units that are essential for the system to function. The afferent component includes the nurse who is responsible to identify warning signs if the patient is deteriorating and activate RRS. A track-and trigger system based on the patient’s vital signs is used to assist the nurse to identify deteriorating patients on wards. The most common vital signs in emergency care are: respiration, temperature, blood pressure, heart rate, consciousness and urine production. The efferent component is the relief effort that the afferent component calls for by activating RRS when abnormal vital signs are observed and generate a high score in the track-and trigger system. Alternatively, on the advice of the nurse's instinctive feeling that the patient's condition has deteriorated. The aim of this study was to highlight nurses' experiences of applying rapid response system in their work and illustrate its impact on patient safety. The method used was a literature review. Database searches were made in PubMed, CINAHL and Web of Science, which resulted in 16 articles being included in the study. Inclusion criteria used were English language, ’peer-reviewed’ and published in scientific journals between the years 2006-2016. An integrated analysis was used to find similarities and differences in the results. The result showed that RRS increased identification of critically ill patients, resulting in reduced number of cardiac arrests and unexpected deaths and led to more patients being moved to a higher level of care. Difficulties or limitations that emerged were inadequate skills, high workload and hierarchy. Abnormal vital signs were taken more seriously compared to "silent" changes. The nurses sometimes activated the system due to concerns based on their clinical experience, despite vital signs being normal. RRS was a help to manage critically ill patients and served as the hospital's Department 112. The emergency medical team mostly supported the nurses, but sometimes they experienced negative attitudes, which affected the future activations negatively. The conclusion of this literature review indicates that RRS for patient safety could help nurses in their daily work by promoting safe care. The nurse's experiences highlight the favorable circumstances and perceived difficulties with the RRS, which could be used for further research to develop the system.
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Silva, Marcelo Ribeiro. "Aprendizagem nas organizações: uma análise de grupos multifuncionais de empresas do ramo automotivo." Universidade Presbiteriana Mackenzie, 2013. http://tede.mackenzie.br/jspui/handle/tede/793.
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Previous issue date: 2013-02-26Fundo Mackenzie de Pesquisa
The objective of this thesis is to understand the learning processes that occur in crossfunctional groups in a perspective of Advanced Planning Product Quality (APQP) in automotive companies. The specific objectives seeks to identify and describe the constitution process of cross-functional groups and its relationship to learning; identify and describe the methodologies used inside cross-functional groups and its relationship to learning; identify, describe and discuss the factors that difficult the learning process inside cross-functional groups; identify, describe and discuss the factors that facilitate the learning process of crossfunctional groups and identify, describe and discuss the moments which there was evidence of group and collective learning. The theoretical framework proposed is designed of individual and collective learning developed by Nancy Dixon and team learning from the perspective developed especially in studies of Amy C. Edmondson and colleagues. The field research was developed in a qualitative, descriptive and interpretative way. It is also considered exploratory because the phenomenon of learning in work groups has been a topic that reveals little knowledge accumulated and systematized. Considering that research begins with a contextual-interpretive perspective, was proposed as the method qualitative case-study to observe, explore, interpret, understand and discuss issues related to learning processes. In order to achieve the proposed objectives and answer the research question, respondents were members of cross-functional groups of two distinct organizations (Alfa and Beta), three groups per company, totaling nineteen interviewees. Moreover, the non-participant observation is also a strategy to collect data. In order to structure, organize and analyze the data, was employed the templates analysis method, offered by Nigel King, that consist in the use of a priori codes derived from the theoretical framework. The results showed that, since there is psychological safety established, both team and collective learning occurs when the entire group, converging the members conflicts and discussions on consensus. Furthermore, the learning process is facilitated since the group constitution, mainly due to the mobility of its members, the manager's role as a catalyst of information, working methodologies employed in the two organizations, the Transitive Memory Systems, the "corridors", the practice of consulting the functional areas by its members, the existence of international forums, the actual physical arrangement of the companies surveyed, the moral support practiced in the core community, the investment of financial resources for the development of ideas members, the recognition of the expertise of the members, learning through practice of collective work, the willingness of participants to learning, among others. The indications for future studies encompass elements as macro-organizational culture and meso-organizational diversity and its influence on group learning, which are also limiting aspects of this research.
O objetivo desta tese é compreender os principais processos de aprendizagem que ocorrem em grupos multifuncionais de Planejamento Avançado da Qualidade do Produto (APQP) que atuam em empresas fornecedoras de autopeças. Os objetivos específicos buscam identificar e descrever o processo de formação de grupos multifuncionais e sua relação com a aprendizagem; identificar e descrever as metodologias utilizadas no funcionamento dos grupos multifuncionais e sua relação com a aprendizagem; identificar, descrever e discutir os fatores que prejudicam a aprendizagem dos grupos multifuncionais; identificar, descrever e discutir os fatores que facilitam a aprendizagem dos grupos multifuncionais e identificar, descrever e discutir momentos nos quais houve evidências de aprendizagem (grupal e coletiva) nos grupos multifuncionais pesquisados. O arcabouço teórico proposto está assentado na concepção de aprendizagem individual e coletiva desenvolvida por Nancy Dixon e na perspectiva da aprendizagem em nível grupal especialmente tratada nos estudos de Amy C. Edmondson e colaboradores. A pesquisa de campo foi desenvolvida em uma perspectiva qualitativa, de natureza descritiva e interpretativa. Considera-se também exploratória, pois o fenômeno da aprendizagem em grupos de trabalho tem sido um tema que revela pouco conhecimento acumulado e sistematizado. Considerando-se que a pesquisa parte de uma perspectiva contextual-interpretativa, foi proposto como método o estudo de caso qualitativo a fim de observar, explorar, interpretar, compreender e discutir aspectos relacionados aos processos de aprendizagem. Com a finalidade de se atingir os objetivos propostos e responder à pergunta de pesquisa, foram entrevistados integrantes de grupos multifuncionais de duas organizações distintas (Alfa e Beta), sendo três grupos por empresa, totalizando dezenove entrevistados. Além disso, a observação não participante também se constituiu em uma estratégia de investigação. Como forma de estruturar, organizar e analisar os dados utilizou-se os templates propostos por Nigel King - uso a priori de códigos obtidos a partir do referencial teórico. Os resultados mostraram que a segurança psicológica instaurada no âmbito grupal e coletivo, a aprendizagem ocorre quando o grupo inteiro consegue convergir seus conflitos e discussões internas em consensos. Além disso, o processo de aprendizagem é facilitado desde o momento em que o grupo é formado, principalmente devido à mobilidade dos seus membros, ao papel do gestor enquanto agente catalisador de informações, às metodologias de trabalho empregadas nas duas organizações, ao sistema artificial de Memória Transitiva, aos corredores , à prática de consultas às áreas funcionais pelos seus membros, à existência de fóruns internacionais, ao próprio arranjo físico das empresas pesquisadas, ao apoio moral praticado no ceio da coletividade, ao aporte dos recursos financeiros para o desenvolvimento das ideias, ao reconhecimento do conhecimento dos membros, à aprendizagem por meio da prática do trabalho coletivo, à predisposição para a aprendizagem dos participantes, entre outras. As indicações resultantes para estudos futuros abarcam elementos como cultura macro-organizacional e diversidade meso-organizacional e sua influência na aprendizagem do grupo, sendo estes também os aspectos limitadores desta pesquisa.
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Edgren, Gustaf. "Blood donors' long-term health : implications for transfusion safety /." Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-340-5/.
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Reckhouse, William. "Optimisation of short term conflict alert safety related systems." Thesis, University of Exeter, 2010. http://hdl.handle.net/10036/3154.
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Short Term Conflict Alert (STCA) is an automated warning system designed to alert air traffic controllers to possible loss of separation between aircraft. STCA systems are complex, with many parameters that must be adjusted to achieve best performance. Current procedure is to manually ‘tune’ the governing parameters in order to finely balance the trade-off between wanted alerts and nuisance alerts. We present an incremental approach to automatically optimising STCA systems, using a simple evolutionary algorithm. By dividing the parameter space into regional subsets, we investigate methods of reducing the number of evaluations required to generate the Pareto optimal Receiver Operating Characteristic (ROC) curve. Multi-archive techniques are devised and are shown to cut the necessary number of iterations by half. A method of estimating the fitness of recombined regional parameter subsets without actual evaluation on the STCA system is presented, however, convergence is shown to be severely stunted when relatively weak sources of noise are present. We describe a method of aggressively perturbing parameters outside of their known ‘safe’ ranges when complex inhibitory interactions are present that prevent an exhaustive search of permitted values. The scheme prevents the optimiser from repeating ‘mistakes’ and unnecessarily wasting evaluations. Results show that a more complete picture of the Pareto-optimal ROC curve may be obtained without increasing the number of necessary iterations. Efficacy of the new methods is discussed, with suggestions for improving efficiency. Sources of parameter interdependence and noise are explored and where possible mitigating techniques and procedures suggested. Classifier performance on training and test data is investigated and potential solutions for reducing overfitting are evaluated on a toy problem. We comment on potential uses of the ROC in characterising STCA performance, for comparison to other systems and airspaces. Many industrial systems are structured in a similar way to STCA, we hope that techniques presented will be applicable to other highly parametrised, expensive problem domains.
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Souza, Aline Brenner de. "Cultura de segurança: avaliação das atitudes de segurança da equipe de enfermagem de um Hospital Geral de grande Porte de Porto Alegre." Universidade do Vale do Rio dos Sinos, 2016. http://www.repositorio.jesuita.org.br/handle/UNISINOS/6463.
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A partir da divulgação do relatório do Institute of Medicine, Errar é Humano, o tema segurança do paciente ganhou relevância e a prevenção de eventos adversos passou a ser uma preocupação da maioria das instituições de saúde. Dentro deste contexto, entende-se que as instituições consideradas “mais seguras” têm desenvolvida a cultura de segurança. A avaliação da cultura de segurança tem sido uma recomendação de órgãos certificadores e a utilização de instrumentos validados para esta avaliação é recomendada. O Safety Attitudes Questionnaire (SAQ) é um instrumento utilizado em diversas instituições. Objetivo: avaliar a cultura de segurança da equipe de enfermagem de uma Instituição privada de Porto Alegre e desenvolver e implantar plano de ação que busque o fortalecimento da cultura de segurança na Instituição. Método: estudo transversal, com abordagem quantitativa. Participaram do estudo 637 profissionais de enfermagem, sendo 198 enfermeiros e 439 técnicos e auxiliares de enfermagem, das áreas de internação e ambulatoriais da Instituição. As respostas ao questionário foram analisadas pelos domínios previstos na ferramenta do SAQ e consideradas positivas as pontuações acima de 75. Resultados: na média das respostas o resultado foi positivo para os enfermeiros (78 pontos) e os técnicos de enfermagem (76,1 pontos). Os domínios com resultados abaixo de 75 pontos foram o de “Percepção do Estresse” e “Condições de Trabalho” para ambas as categorias e, para os técnicos de enfermagem, a “Percepção da Gerência” também apresentou resultado abaixo de 75 pontos. Em relação a área de atuação, a terapia intensiva adulta foi a área que mais teve domínios com pontuação abaixo de 75 pontos e a maternidade apresentou resultado positivo em todos os domínios. Na avaliação da pontuação por questão, os piores resultados foram relacionados à percepção do cansaço e o impacto no atendimento a urgências, o quantitativo de profissionais e as falhas na comunicação. Como pontos positivos, destacaram-se a satisfação com o trabalho e a atuação da direção da Instituição. Conclusão: embora este estudo já traga diversos dados de acompanhamento e ações, sugere-se que sejam estendidos para os demais colaboradores médicos assistenciais da Instituição.
From the publication of the Institute of Medicine report, To Err is Human, the patient safety issue gained relevance and prevention of adverse events has become a concern of most health institutions. In this context, it is understood that the institutions considered "safer" have the safety culture developed. The assessment of safety culture has been a recommendation of certification bodies and the use of validated instruments for this assessment is recommended. The Safety Attitudes Questionnaire (SAQ) is a tool used in various institutions. Objective: To evaluate the safety culture of a private institution nursing staff of Porto Alegre and develop and implement action plan that seeks to strengthen the safety culture in the institution. Method: Cross-sectional study with a quantitative approach. Study participants were 637 nursing professionals, from which 198 were nurses and 439 nursing technicians and assistants, from the institutions hospitalization and ambulatory areas. Responses to the questionnaire were analyzed by the fields referred to in the SAQ tool and considered positive scores above 75. Results: the response average results was positive for nurses (78 points) and nursing technicians (76.1 points). Fields with results below 75 points were the perception of stress and working conditions for both categories, and nursing technicians perception of management also presented results slightly below 75 points. Regarding the area of operation, the adult intensive care was the area that had more areas with scores below 75 points and the maternity was positive in all areas. In the evaluation of the score by question, the worst results were related to perception of fatigue and the impact on the attending emergency cases, the amount of professionals and miscommunication. As positive points, job satisfaction and the institution’s executive committee performance can be highlighted. Conclusion: Although this study already brings various data monitoring and actions, it is suggested to be extended to other medical assistance employees of the institution.