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Medikaliserat och resultatstyrt vårdarbete på akutmottagning: en studie med utgångspunkt i medarbetares och chefers perspektiv
University of Borås, School of Health Science.
2014 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis is to obtain an understanding of Emergency Healthcare Work (EHW) at the Emergency Department (ED), including the competencies required by EHW, and based on practitioners' and managers' perspectives. Methods: In study I, a quantitative method was employed. A questionnaire was sent to all Swedish EDs and data was analysed using descriptive statistics and content analysis. In studies II- IV, qualitative methods were used. In study II, participant observations and individual and group interviews were conducted. In studies III-IV individual and group interviews were conducted. In studies II-IV, data was analysed using qualitative content analysis. Results: According to head nurses, basic nursing education does not lead to sufficient competence for working at an ED and thus supplementary formal education is needed. A minority of head nurses perceive that they are completely responsible for creating preconditions for competence development (study I). The EHW is characterized by rapid, brief and standardized encounters with limited scope for providing individualized care. Practitioners strive to be adaptable by structuring EHW and they cooperate to achieve a good workflow (study II). Management is characterized by a command and control approach. Managers experience EHW as lifesaving work and they experience difficulties in meeting the expectations of their staff (study III). There is also tension between professional groups in EDs as well as hierarchical boundaries that influence the possibilities to develop competencies in EHW. The focus on competence in EHW is on account of the emergency and lifesaving nature of its actions. Purely medical competencies are valued and caring competencies are subsequently downgraded. A medical competence approach consolidates the current view of competencies necessary in everyday work in EDs (study IV). Conclusions: EHW and the competencies required by EHW are defined from a purely medicalized and result-driven viewpoint. Patients' medical needs are given greater importance than their caring needs. Medicalized and result-driven EHW makes it difficult to provide individualized care. This difficulty is a hindrance to the implementation of a holistic view in EHW.

Place, publisher, year, edition, pages
University of Gothenburg. Sahlgrenska Academy, Institute of Health and Care Sciences , 2014.
Keyword [en]
Emergency healthcare, Everyday work, Competencies, Emergency Department, Practitioners, Management, Content analysis, Integrated nursing science
National Category
Nursing Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hb:diva-3710Local ID: 2320/14435ISBN: 978-91-628-9114-5 (print)ISBN: 978-91-628-9115-2 (print)OAI: oai:DiVA.org:hb-3710DiVA: diva2:877100
Note

Akademisk avhandling som för avläggande av filosofie doktorsexamen vid Sahlgrenska akademin, Göteborgs universitet kommer att offentligt försvaras Fredagen den 12 december, kl. 09.00 i hörsalen 2119 Institutionen för vårdvetenskap och hälsa, Arvid Wallgens Backe, Hus 2, Göteborg

I. Andersson, H. & Nilsson, K. (2009). Questioning Nursing Competences in Emergency Health Care. Journal of Emergency Nursing, 35, 305-311. II. Andersson, H., Jakobsson, E., Furåker, C. & Nilsson, K. (2012). The everyday work at a Swedish emergency department - The practitioners' perspective. International Emergency Nursing. 20, 58-68. III. Andersson, H., Wireklint Sundström, B., Nilsson, K. & Jakobsson Ung, E. (2014). Management of everyday work in Emergency Departments – An exploratory study with Swedish Manager. International Emergency Nursing. 22, 190-196. IV. Andersson, H., Wireklint Sundström, B., Nilsson, K. & Jakobsson Ung, E. (2014). Competencies in Swedish emergency departments - The practitioners' and managers' perspective. International Emergency Nursing. 22, 81-87.

Available from: 2015-12-04 Created: 2015-12-04 Last updated: 2017-05-04Bibliographically approved
List of papers
1. Competencies in Swedish emergency departments: The practitioners’ and managers’ perspective
Open this publication in new window or tab >>Competencies in Swedish emergency departments: The practitioners’ and managers’ perspective
2014 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 2, 81-87 p.Article in journal (Refereed) Published
Abstract [en]

The task of emergency departments (EDs) is to provide safe emergency healthcare while adopting a caring, cost-effective approach. Patients attending EDs have different medical and caring needs and it is assumed that practitioners have the requisite competencies to meet those needs. The aim of the present study is to explore what kind of competencies practitioners and managers describe as necessary for the practitioners to perform their everyday work in EDs. Methods: This study used a qualitative, exploratory design. Interviews were conducted in two EDs. Data were analysed using inductive content analysis. Results: The competence focus in everyday work in EDs is on emergency and life-saving actions. There is a polarisation between medical and caring competencies. There is also tension between professional groups in EDs as well as hierarchical boundaries that influence the ability to develop competencies in everyday work. Medical competencies are valued more and caring competencies are subsequently downgraded. A medical approach to competencies consolidates the view of necessary competencies in everyday work in EDs. Conclusions: The study shows that the competencies that are valued consolidate the prevailing medical paradigm. There is a traditional, one-sided approach to competencies, a hierarchical distinction between professional groups and unclear occupational functions.

Place, publisher, year, edition, pages
Elsevier Ltd, 2014
Keyword
emergency department, emergency care
National Category
Medical and Health Sciences Nursing
Research subject
Integrated Caring Science
Identifiers
urn:nbn:se:hb:diva-1910 (URN)10.1016/j.ienj.2013.06.005 (DOI)000334438600004 ()24012407 (PubMedID)2320/14215 (Local ID)2320/14215 (Archive number)2320/14215 (OAI)
Available from: 2015-11-13 Created: 2015-11-13 Last updated: 2017-12-01Bibliographically approved

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