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  • 1.
    Algurén, Beatrix
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. University of Gothenburg, Faculty of Education, Department of Food and Nutrition, and Sport Science, Sweden.
    Andersson Gäre, Boel
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Region Jönköping County, Futurum, Sweden.
    Thor, Johan
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson, Ann-Christine
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Quality indicators and their regular use in clinical practice – results from a survey among users of two cardiovascular National Registries in Sweden2018Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 30, nr 10, s. 786-792Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To examine the regular use of quality indicators from Swedish cardiovascular National Quality Registries (NQRs) by clinical staff; particularly differences in use between the two NQRs and between nurses and physicians.

    Design: Cross-sectional online survey study.

    Setting: Two Swedish cardiovascular NQRs: a) Swedish Heart Failure Registry and b) Swedeheart.

    Participants: Clinicians (n=185; 70% nurses, 26% physicians) via the NQRs’ email networks.

    Main outcome measures: Frequency of NQR use for a) producing healthcare activity statistics; b) comparing results between similar departments; c) sharing results with colleagues; d) identifying areas for quality improvement (QI); e) surveilling the impact of QI efforts; f) monitoring effects of implementation of new treatment methods; g) doing research; h) educating and informing healthcare professionals and patients.

    Results: Median use of NQRs was ten times a year (25th and 75th percentiles range: 3 – 23 times/year). Quality indicators from the NQRs were used mainly for producing healthcare activity statistics. Median use of Swedeheart was six times greater than SwedeHF (p<0.000). Physicians used the NQRs more than twice as often as nurses (18 vs. 7.5 times/year; p<0.000) and perceived NQR work more often as meaningful. Around twice as many Swedeheart users had the role to participate in data analysis and in QI efforts compared to SwedeHF users.

    Conclusions: Most respondents used quality indicators from the two cardiovascular NQRs infrequently (< 3 times/year). The results indicate that linking registration of quality indicators to using them for QI activities increases their routine use and makes them meaningful tools for professionals.

    Fulltekst (pdf)
    Fulltext
  • 2.
    Anchalia, Manju M
    et al.
    Civil Hospital, Asarwa, Ahmedabad, Gujarat, India .
    D'Ambruoso, Lucia
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Immpact, University of Aberdeen, UK.
    Seeking solutions: scaling-up audit as a quality improvement tool for infection control in Gujarat, India2011Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 23, nr 4, s. 464-470Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    QUALITY PROBLEM OR ISSUE: Surgical-site infections (SSIs) give rise to significant demands on the health systems as well as economic and social sequelae for patients. This article describes an audit for infection control developed in a surgical unit of a tertiary care setting in Gujarat state, India that was scaled-up to all state-owned hospitals in the district.

    IMPLEMENTATION: Surveillance and hospital epidemiology were established and practice reforms implemented. Monthly and annual meetings to review implementation were held.

    EVALUATION: After 12 months, an 88% decrease in the infection rate in the surgical unit was demonstrated. Thereafter, the process was replicated across the surgical department and for all cases undergoing surgery. After 12 months, a 67% reduction in the infection rate was detected. The process has since been applied across the state.

    LESSONS LEARNED: A locally owned and team-led process embedded within routine working conditions can challenge widely held perceptions, inform low-cost and no-cost remedial actions, and improve cultures of practice, quality of care and health outcomes. As urban populations grow, methods that are capable of continuously identifying, and responding to, problems and sustaining quality of care in facilities are necessary. SSIs may be largely preventable. With careful implementation, audit has the potential to be a major contributor to their reduction.

  • 3.
    Anderson, Janet E.
    et al.
    Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK.
    Robert, Glenn
    Jönköping University, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK.
    Nunes, Francisco
    Department of Human Resources and Organizational Behavior, ISCTE-IUL, Lisbon, Portugal.
    Bal, Roland
    Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Netherlands.
    Burnett, Susan
    Faculty of Medicine, Department of Surgery & Cancer, Imperial College, UK.
    Karltun, Anette
    Jönköping University, Tekniska Högskolan, JTH, Logistik och verksamhetsledning. Jönköping University, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Sanne, Johan
    IVL Swedish Environmental Research Institute, Sweden.
    Aase, Karina
    SHARE—Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Norway.
    Wiig, Siri
    SHARE—Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Norway.
    Fulop, Naomi J.
    Department of Applied Health Research, University College London, UK.
    The QUASER Team, ,
    Translating research on quality improvement in five European countries into a reflective guide for hospital leaders: the ‘QUASER Hospital Guide’2019Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 31, nr 8, s. G87-G96Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim was to translate the findings of the QUASER study into a reflective, dialogic guide to help senior hospital leaders develop an organization wide QI strategy.

    Design: The QUASER study involved in depth ethnographic research into QI work and practices in two hospitals in each of five European countries. Three translational stakeholder workshops were held to review research findings and advise on the design of the Guide. An extended iterative process involving researchers from each participant country was then used to populate the Guide.

    Setting: The research was carried out in two hospitals in each of five European countries.

    Participants: In total, 389 interviews with healthcare practitioners and 803 hours of observations.

    Intervention: None.

    Main outcome measure: None.

    Results: The QUASER Hospital Guide was designed for leadership teams to diagnose their organization’s strengths and weaknesses in the eight QI challenges. The Guide supports organizational dialogue about QI challenges, enables leaders to share perspectives, and helps teams to develop solutions to their situated problems. The Guide includes extensive examples of QI strategies drawn from the data and is published online and on paper.

    Conclusion: The QUASER Hospital Guide is empirically based, draws on a dialogical approach to Organizational Development and complexity science and can facilitate hospital leadership teams to identify the best solutions for their organization.

  • 4.
    Arakelian, Erebouni
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Gunningberg, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Larsson, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Defining operating room efficiency from the perspective of the staff member and the supervisor2011Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 23, nr 3, s. 220-221Artikkel i tidsskrift (Fagfellevurdert)
  • 5.
    Arakelian, Erebouni
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Gunningberg, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Larsson, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    How operating room efficiency is understood in a surgical team: a qualitative study2011Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 23, nr 1, s. 100-106Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. Building surgical teams is one attempt to ensure the health-care system becomes more efficient, but how is 'efficiency'understood or interpreted? The aim was to study how organized surgical team members and their leaders understood operating room efficiency.

    Design. Qualitative study.

    Settings. A 1100-bed Swedish university hospital.

    Participants. Eleven participants, nine team members from the same team and their two leaders were interviewed.

    Methods. The analysis was performed according to phenomenography, a research approach that aims to discover variationsin peoples' understanding of a henomenon.

    Results. Seven ways of understanding operating room efficiency were identified: doing one's best from one's prerequisites,enjoying work and adjusting it to the situation, interacting group performing parallel tasks, working with minimal resources to produce desired results, fast work with preserved quality, long-term effects for patient care and a relative concept. When talking about the quality and benefits of delivered care, most team members invoked the patient as the central focus. Despite seven ways of understanding efficiency between the team members, they described their team as efficient. The nurses and assistant nurses were involved in the production and discussed working in a timely manner more than the leaders.

    Conclusions. The seven ways of understanding operating room efficiency appear to represent both organization-oriented andindividual-oriented understanding of that concept in surgical teams. The patient is in focus and efficiency is understood as maintaining quality of care and measuring benefits of care for the patients.

  • 6.
    Eriksson, Andrea
    et al.
    KTH, Skolan för teknik och hälsa (STH), Hälso- och systemvetenskap, Ergonomi.
    Strömgren, Marcus
    KTH, Skolan för teknik och hälsa (STH), Hälso- och systemvetenskap, Ergonomi.
    Dellve, Lotta
    KTH, Skolan för teknik och hälsa (STH), Hälso- och systemvetenskap, Ergonomi.
    Experiences of Implementing Occupational Health Services Driven Intervention Methods for Sustainable Leadership in Health Care2016Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 28, s. 50-51Artikkel i tidsskrift (Annet vitenskapelig)
  • 7.
    Flink, Maria
    et al.
    Karolinska Institutet, Sweden.
    Tessma, Mesfin
    Karolinska University Hospital, Sweden.
    Cvancarova Småstuen, Milada
    Oslo and Akershus University College of Applied Sciences, Norway.
    Lindblad, Marléne
    Ersta Sköndal Bräcke University College, Sweden.
    Coleman, Eric A
    University of Colorado Denver Anschutz Medical Campus, USA.
    Ekstedt, Mirjam
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV). Karolinska Institutet, Sweden.
    Measuring care transitions in Sweden: validation of the care transitions measure2018Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 30, nr 4, s. 291-297Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To translate and assess the validity and reliability of the original American Care Transitions Measure, both the 15-item and the shortened 3-item versions, in a sample of people in transition from hospital to home within Sweden.

    Design: Translation of survey items, evaluation of psychometric properties.

    Setting: Ten surgical and medical wards at five hospitals in Sweden.

    Participants: Patients discharged from surgical and medical wards.

    Main outcome measure: Psychometric properties of the Swedish versions of the 15-item (CTM-15) and the 3-item (CTM-3) Care Transition Measure.

    Results: We compared the fit of nine models among a sample of 194 Swedish patients. Cronbach's alpha was 0.946 for CTM-15 and 0.74 for CTM-3. The model indices for CTM-15 and CTM-3 were strongly indicative of inferior goodness-of-fit between the hypothesized one-factor model and the sample data. A multidimensional three-factor model revealed a better fit compared with CTM-15 and CTM-3 one factor models. The one-factor solution, representing 4 items (CTM-4), showed an acceptable fit of the data, and was far superior to the one-factor CTM-15 and CTM-3 and the three-factor multidimensional models. The Cronbach's alpha for CTM-4 was 0.85.

    Conclusions: CTM-15 with multidimensional three-factor model was a better model than both CTM-15 and CTM-3 one-factor models. CTM-4 is a valid and reliable measure of care transfer among patients in medical and surgical wards in Sweden. It seems the Swedish CTM is best represented by the short Swedish version (CTM-4) unidimensional construct.

    Fulltekst (pdf)
    fulltext
  • 8.
    Flink, Maria
    et al.
    Karolinska institutet.
    Tessma, Mesfin
    Karolinska institutet.
    Cvancarova Småstuen, Milada
    Norge.
    Lindblad, Marléne
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap. Karolinska institutet.
    Coleman, Eric A.
    USA.
    Ekstedt, Mirjam
    Karolinska institutet; Linnéuniversitetet.
    Measuring care transitions in Sweden: validation of the care transitions measure.2018Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 30, nr 4, s. 291-297Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To translate and assess the validity and reliability of the original American Care Transitions Measure, both the 15-item and the shortened 3-item versions, in a sample of people in transition from hospital to home within Sweden.

    Design: Translation of survey items, evaluation of psychometric properties.

    Setting: Ten surgical and medical wards at five hospitals in Sweden.

    Participants: Patients discharged from surgical and medical wards.

    Main outcome measure: Psychometric properties of the Swedish versions of the 15-item (CTM-15) and the 3-item (CTM-3) Care Transition Measure.

    Results: We compared the fit of nine models among a sample of 194 Swedish patients. Cronbach's alpha was 0.946 for CTM-15 and 0.74 for CTM-3. The model indices for CTM-15 and CTM-3 were strongly indicative of inferior goodness-of-fit between the hypothesized one-factor model and the sample data. A multidimensional three-factor model revealed a better fit compared with CTM-15 and CTM-3 one factor models. The one-factor solution, representing 4 items (CTM-4), showed an acceptable fit of the data, and was far superior to the one-factor CTM-15 and CTM-3 and the three-factor multidimensional models. The Cronbach's alpha for CTM-4 was 0.85.

    Conclusions: CTM-15 with multidimensional three-factor model was a better model than both CTM-15 and CTM-3 one-factor models. CTM-4 is a valid and reliable measure of care transfer among patients in medical and surgical wards in Sweden. It seems the Swedish CTM is best represented by the short Swedish version (CTM-4) unidimensional construct.

  • 9.
    Fredriksson, Mio
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Halford, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Eldh, Ann Catrine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Dahlström, Tobias
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Vengberg, Sofie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Wallin, Lars
    Dalarna Univ, Sch Educ Hlth & Social Studies, SE-79188 Falun, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Alfred Nobels Alle 23, SE-14183 Huddinge, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Dept Hlth & Care Sci, Box 100, SE-40530 Gothenburg, Sweden..
    Winblad, Ulrika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Are data from national quality registries used in quality improvement at Swedish hospital clinics?2017Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 29, nr 7, s. 909-915Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To investigate the use of data from national quality registries (NQRs) in local quality improvement as well as purported key factors for effective clinical use in Sweden. Comparative descriptive: a web survey of all Swedish hospitals participating in three NQRs with different levels of development (certification level). Heads of the clinics and physician(s) at clinics participating in the Swedish Stroke Register (Riksstroke), the Swedish National Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Lung Cancer Registry (NLCR). Individual and unit level use of NQRs in local quality improvement, and perceptions on data quality, organizational conditions and user motivation. Riksstroke data were reported as most extensively used at individual and unit levels ((x) over bar 17.97 of 24 and (x) over bar 27.06 of 35). Data quality and usefulness was considered high for the two most developed NQRs ((x) over bar 19.86 for Riksstroke and (x) over bar 19.89 for GallRiks of 25). Organizational conditions were estimated at the same level for Riksstroke and GallRiks ((x) over bar 12.90 and (x) over bar 13.28 of 20) while the least developed registry, the NLCR, had lower estimates (x<overline> 10.32). In Riksstroke, the managers requested registry data more often ((x) over bar 15.17 of 20). While there were significant differences between registries in key factors such as management interest, use of NQR data in local quality improvement seems rather prevalent, at least for Riksstroke. The link between the registry's level of development and factors important for routinization of innovations such as NQRs needs investigation.

  • 10.
    Fredriksson, Mio
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Halford, Christina
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Eldh, Ann Catrine
    Dalarna University, Sweden; Uppsala University, Sweden.
    Dahlström, Tobias
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Vengberg, Sofie
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Wallin, Lars
    School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden; Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Winblad, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Are data from national quality registries used in quality improvement at Swedish hospital clinics?2017Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 29, nr 7, s. 909-915Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    To investigate the use of data from national quality registries (NQRs) in local quality improvement as well as purported key factors for effective clinical use in Sweden.

    Design

    Comparative descriptive: a web survey of all Swedish hospitals participating in three NQRs with different levels of development (certification level).

    Setting and Participants

    Heads of the clinics and physician(s) at clinics participating in the Swedish Stroke Register (Riksstroke), the Swedish National Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Lung Cancer Registry (NLCR).

    Main Outcome Measure(s)

    Individual and unit level use of NQRs in local quality improvement, and perceptions on data quality, organizational conditions and user motivation.

    Results

    Riksstroke data were reported as most extensively used at individual and unit levels ( x̅ 17.97 of 24 and x̅ 27.06 of 35). Data quality and usefulness was considered high for the two most developed NQRs ( x̅ 19.86 for Riksstroke and x̅ 19.89 for GallRiks of 25). Organizational conditions were estimated at the same level for Riksstroke and GallRiks ( x̅ 12.90 and x̅ 13.28 of 20) while the least developed registry, the NLCR, had lower estimates ( x̅ 10.32). In Riksstroke, the managers requested registry data more often ( x̅ 15.17 of 20).

    Conclusions

    While there were significant differences between registries in key factors such as management interest, use of NQR data in local quality improvement seems rather prevalent, at least for Riksstroke. The link between the registry’s level of development and factors important for routinization of innovations such as NQRs needs investigation.

  • 11. Fredriksson, Mio
    et al.
    Halford, Christina
    Eldh, Ann Catrine
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Uppsala University.
    Dahlström, Tobias
    Vengberg, Sofie
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institutet; The Sahlgrenska Academy, University of Gothenburg.
    Winblad, Ulrika
    Are data from national quality registries used in quality improvement at Swedish hospital clinics?2017Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 29, nr 7, s. 909-915Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To investigate the use of data from national quality registries (NQRs) in local quality improvement as well as purported key factors for effective clinical use in Sweden.

    Design: Comparative descriptive: a web survey of all Swedish hospitals participating in three NQRs with different levels of development (certification level).

    Setting and Participants: Heads of the clinics and physician(s) at clinics participating in the Swedish Stroke Register (Riksstroke), the Swedish National Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Lung Cancer Registry (NLCR).

    Main Outcome Measure(s): Individual and unit level use of NQRs in local quality improvement, and perceptions on data quality, organizational conditions and user motivation.

    Results: Riksstroke data were reported as most extensively used at individual and unit levels (x̅ 17.97 of 24 and x̅ 27.06 of 35). Data quality and usefulness was considered high for the two most developed NQRs (x̅ 19.86 for Riksstroke and x̅ 19.89 for GallRiks of 25). Organizational conditions were estimated at the same level for Riksstroke and GallRiks (x̅ 12.90 and x̅ 13.28 of 20) while the least developed registry, the NLCR, had lower estimates (x̅ 10.32). In Riksstroke, the managers requested registry data more often (x̅ 15.17 of 20).

    Conclusions: While there were significant differences between registries in key factors such as management interest, use of NQR data in local quality improvement seems rather prevalent, at least for Riksstroke. The link between the registry's level of development and factors important for routinization of innovations such as NQRs needs investigation.

  • 12.
    Gunningberg, Lena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Lindholm, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Carlsson, Marianne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Sjödén, Per-Olow
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Reduced incidence of pressure ulcers in patients with hip fractures: a 2-year follow-up of quality indicators2001Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 13, nr 5, s. 399-407Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In the framework of a quality improvement project, where research activities were integrated with practice-based developmental work, the incidence of pressure ulcers was reduced significantly in patients with hip fractures. The best predictor of pressure ulcer development was increased age.

  • 13.
    Gunningberg, Lena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Stotts, Nancy A.
    Tracking quality over time: what do pressure ulcer data show?2008Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 20, nr 4, s. 246-253Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To compare the prevalence of pressure ulcers and prevention before and after a quality improvement program, determine whether patient characteristics differed for those who did and did not develop pressure ulcers, identify pressure ulcer prevention implemented at admission and whether prevention and risk factors varied by pressure ulcer severity. Design. Descriptive comparative study based on two cross-sectional pressure ulcer surveys conducted in 2002 and 2006, complemented with a retrospective audit of the electronic health record and administrative system for patients identified with pressure ulcers. Setting. 1100-bed Swedish university hospital. Participants. 612 hospitalized patients in 2002 and 632 in 2006. Main outcome measures. Prevalence of pressure ulcers and prevention (pressure-reducing mattresses, planned repositioning, chair, heel and 30 degrees lateral positioning cushions). Results. Pressure ulcer prevalence was 23.9% in 2002 and 22.9% in 2006. When non-blanchable erythema was excluded, the prevalence was 8.0 and 12.0%, respectively. The use of pressure-reducing mattresses increased while planned repositioning decreased. Those who developed ulcers were older, at-risk for ulcers, incontinent and had longer length of stay. Little prevention was documented at admission. Some prevention strategies and risk factors were related to severity of ulcers. Conclusions. Pressure ulcer prevalence did not decrease, despite a comprehensive quality improvement program. Special attention is needed to provide prevention to older patients with acute admission. Skin and risk assessment, as well as prevention, should start early in the hospitalization. Identifying those persons with community-acquired versus hospital-acquired ulcers will strengthen pressure ulcers as an accurate marker of quality of care for hospitalized patients. If possible, data should be reported by ward level for comparison over time.

  • 14.
    Gustavsson, Catharina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna. Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, SE-17177 Stockholm, Sweden.
    Hinas, Elin
    Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, SE-17177 Stockholm, Sweden.
    Ljungquist, Therese
    Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, SE-17177 Stockholm, Sweden.
    Alexanderson, Kristina
    Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, SE-17177 Stockholm, Sweden.
    General practitioners' use of sickness certification guidelines in Sweden at introduction and four years later: a survey study2018Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 30, nr 6, s. 429-436Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: National sickness certification guidelines were introduced in Sweden in 2007, comprising both overarching and diagnoses-specific recommendations. This study aimed to investigate how general practitioners (GP) used and perceived the usefulness of these guidelines in the sickness certification process close after introduction and 4 years later. Design: Two nationwide cross-sectional surveys in 2008 and 2012. Setting: Swedish healthcare. Participants: Physicians working in primary healthcare and having sickness certification consultations at least a few times per year (n = 4214 in 2008, and n = 4067 in 2012). Main Outcome Measures: Frequency of use and perceived usefulness of the sickness certification guidelines. Results: Most GPs used the guidelines at least a few times per year (in 2008 74.6%; in 2012 85.2%). In 2008, 44.1% reported a need to develop competence in using the guidelines, compared with 23.3% in 2012. Of those using the guidelines, 36.7% in 2008 and 44.6% in 2012 reported it problematic to write sickness certificates in accordance with the guidelines. Most GPs (89.2% in 2008 and 88.8% in 2012) valued the guidelines beneficial to ensure quality in sickness certification consultations. A larger proportion in 2012 compared with 2008 reported that the guidelines facilitated contacts with patients (61.2%, respectively, 55.6%), as well as with other stakeholders. Conclusions: The guidelines were perceived as useful and beneficial to ensure high quality in sickness certification consultations, and facilitated contacts with patients as well as other stakeholders. In 2012, still one-fourth reported a need to develop more competence in using the sickness certification guidelines.

  • 15.
    Hallgren Elfgren, Ing-Marie
    et al.
    Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Törnvall, Eva
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Grodzinsky, Ewa
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    The process of implementation of the diabetes register in Primary Health Care2012Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 24, nr 4, s. 419-424Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Quality problem or issue According to Swedish law, all health care units must have a system for quality improvement. The aim of this study was to follow an implementation process of a uniform routine for quality control of diabetes care in Primary Health Care in one county.                    

    Initial assessment Primary Health Care had a decentralized organization and patients with type 2 diabetes were served at 42 different Primary Health Care Centres.                    

    Choice of solution As the Swedish Diabetes Register (National Diabetes Register, NDR) holds the most important quality indicators, implementation of the NDR registration at all centres was chosen to be the best way to follow up quality in diabetes care.                    

    Implementation The process of implementing the NDR went through different phases and the main way to encourage commitment to the process was to reward performance in a progressively more differentiated way.                    

    Evaluation During the implementation process (2001–05) there was an increasing rate of registration. When the programme ceased, the registration rate had reached a level of 75%, which has remained stable and was still in 2010 one of the highest rates in                        Sweden.                    

    Lessons learned Important factors for success were the initiative taken by the profession itself and strong support from the leaders of the county council. It was also important to let the process develop gradually in order to get all staff involved. Among the outcomes was an increase in computer use in clinical practice among the diabetes nurse specialists and a structured way of encouraging the patients' participation in self-care.                    

                   

  • 16.
    Heiwe, Susanne
    et al.
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden; Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden; Clinical Research Utilization, Karolinska University Hospital, Stockholm, Sweden .
    Kajermo, Kerstin Nilsson
    Clinical Research Utilization, Karolinska University Hospital, Stockholm, Sweden.
    Tyni-Lenné, Raija
    Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden ; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden .
    Guidetti, Susanne
    Clinical Research Utilization, Karolinska University Hospital, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Samuelsson, Monika
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Occupational Therapy, Karolinska University Hospital, Stockholm, Sweden.
    Andersson, Inga-Lena
    Department of Nutrition and Dietetics, Karolinska University Hospital, Stockholm, Sweden .
    Wengström, Yvonne
    Clinical Research Utilization, Karolinska University Hospital, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Evidence-based practice: attitudes, knowledge and behaviour among allied health care professionals2011Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 23, nr 2, s. 198-209Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore dieticians', occupational therapists' and physical therapists' attitudes, beliefs, knowledge and behaviour concerning evidence-based practice within a university hospital setting. Design: Cross-sectional survey. Setting. University hospital. Participants: All dieticians, occupational therapists and physical therapists employed at a Swedish university hospital (n = 306) of whom 227 (74%) responded. Main Outcome Measures: Attitudes towards, perceived benefits and limitations of evidence-based practice, use and understanding of clinical practice guidelines, availability of resources to access information and skills in using these resources. Results: Findings showed positive attitudes towards evidence-based practice and the use of evidence to support clinical decision-making. It was seen as necessary. Literature and research findings were perceived as useful in clinical practice. The majority indicated having the necessary skills to be able to interpret and understand the evidence, and that clinical practice guidelines were available and used. Evidence-based practice was not perceived as taking into account the patient preferences. Lack of time was perceived as the major barrier to evidence-based practice. Conclusions: The prerequisites for evidence-based practice were assessed as good, but ways to make evidence-based practice time efficient, easy to access and relevant to clinical practice need to be continuously supported at the management level, so that research evidence becomes linked to work-flow in a way that does not adversely affect productivity and the flow of patients. © The Author 2011. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  • 17.
    Holmberg, Leif
    Högskolan Kristianstad, Institutionen för ekonomi.
    Task uncertainty and rationality in medical problem solving2006Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 18, nr 6, s. 458-462Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    ISSUE:

    Medical problem-solving situations are characterized by various degrees of 'task uncertainty'--i.e. uncertainty related to the definition of a problem, the effect of a technology, the value of a solution, and so on. The need for professional discretion varies and depends on the degree of perceived task uncertainty. SUGGESTED

    SOLUTION:

    In this report it is argued that, in order to obtain rationality in problem-solving processes, differences in the degree of task uncertainty need to be met by variation in the structure of the health care organization.

    IMPLICATIONS:

    The main implications of this view are that (under norms of rationality) problem-solving processes with low task uncertainty must be organized in one way and processes with high task uncertainty in another. Furthermore, processes with high and low task uncertainty also need to be evaluated according to different standards. Some hypotheses regarding the different organizational requirements are presented.

  • 18.
    Jakobsson, Liselotte
    et al.
    Kristianstad College for the Health Professions.
    Hallberg, I. R.
    Kristianstad College for the Health Professions.
    Lovén, L.
    Ottosson, B.
    Patient satisfaction with nursing care: evaluation before and after expenditure cutback and intervention at a surgical clinic1994Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 6, nr 4, s. 361-369Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    After a major cutback in the budget and staffing of a surgical clinic in southern Sweden there was intervention to improve the quality of nursing care and to evaluate the outcome. The intervention consisted of the implementation of: (1) nursing care organized in such a way that it would secure continuity of the nurse—patient relationship, (2) individually planned care by means of diagnostic reasoning, and (3) quality assurance for aspects believed to be connected with quality of care. Patient satisfaction before and after the intervention was assessed by means of a patient questionnaire survey (May 1991; n = 105 and May 1992; n = 137). Patient satisfaction improved significantly in variables related to nursing care viz. overall satisfaction and satisfaction with information and decision making; satisfaction with contact and staff-patient relationship; ward facilities and physical treatment or examinations; and satisfaction with physical nursing care. The results were interpreted to mean that the intervention may have counteracted any negative impact the reduced budget might have had such as the higher patient turn-over and the shorter in-patient periods, and thus seemed to have improved the quality of the nursing care in terms of patient satisfaction.

  • 19.
    Kredo, Tamara
    et al.
    S African MRC, South Africa.
    Bernhardsson, Susanne
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Narhalsan Rehabil, Sweden.
    Machingaidze, Shingai
    S African MRC, South Africa.
    Young, Taryn
    S African MRC, South Africa; University of Stellenbosch, South Africa.
    Louw, Quinette
    University of Stellenbosch, South Africa.
    Ochodo, Eleanor
    University of Stellenbosch, South Africa.
    Grimmer, Karen
    University of Stellenbosch, South Africa; University of S Australia, Australia.
    Guide to clinical practice guidelines: the current state of play2016Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 28, nr 1, s. 122-128Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Extensive research has been undertaken over the last 30 years on the methods underpinning clinical practice guidelines (CPGs), including their development, updating, reporting, tailoring for specific purposes, implementation and evaluation. This has resulted in an increasing number of terms, tools and acronyms. Over time, CPGs have shifted from opinion-based to evidence-informed, including increasingly sophisticated methodologies and implementation strategies, and thus keeping abreast of evolution in this field of research can be challenging. Methods: This article collates findings from an extensive document search, to provide a guide describing standards, methods and systems reported in the current CPG methodology and implementation literature. This guide is targeted at those working in health care quality and safety and responsible for either commissioning, researching or delivering health care. It is presented in a way that can be updated as the field expands. Conclusion: CPG development and implementation have attracted the most international interest and activity, whilst CPG updating, adopting (with or without contextualization), adapting and impact evaluation are less well addressed.

    Fulltekst (pdf)
    fulltext
  • 20.
    Lindberg, Malou
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Ahlner, Johan
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Ekström, Tommy
    Linköpings universitet, Institutionen för medicin och vård, Lungmedicin. Linköpings universitet, Hälsouniversitetet.
    Möller, Margareta
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan. Linköpings universitet, Hälsouniversitetet.
    Patient questionnaires in primary health care: Validation of items used in asthma care2000Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 12, nr 1, s. 19-24Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective.To evaluate each item in a patient questionnaire for the purpose of investigating whether the validity of each item is acceptable.

    Design.The questionnaire was completed by the patients at an ordinary follow-up visit for their asthma, and within 1 week a nurse interviewed them by telephone with the aim of analysing the validity of each item through the use of predetermined criteria.

    Settings.Patients with asthma in primary health care settings in Sweden.

    Study participants.Fifty-one patients were consecutively included from three different primary health care units.

    Results.Nine of 13 items had an acceptable validity. The four items that were not found to have acceptable validity were developed further.

    Conclusion.Evaluating each item in a questionnaire by means of interviews with the specific patient population is a useful method of assuring that the intention of the patient questionnaire has been met.

  • 21.
    Lindberg, Malou
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Ekstrom, Tommy
    Linköpings universitet, Institutionen för medicin och vård, Lungmedicin. Linköpings universitet, Hälsouniversitetet.
    Moller, Margareta
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan. Linköpings universitet, Hälsouniversitetet.
    Ahlner, Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Asthma care and factors affecting medication compliance: the patient's point of view2001Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 13, nr 5, s. 375-383Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To identify important factors that can influence patient compliance with prescribed medication and to elucidate aspects of asthma care from the patient's point of view.

    Design. Field investigation; the interviewer used a semi‐structured questionnaire.

    Setting. Patients with asthma in primary health care settings in Sweden.

    Study participants. A sample of 77 patients was randomly selected from 11 primary health care centres in southern Sweden; 63 of these patients participated in the study.

    Conclusion. The factors of importance for self‐reported compliance with prescribed medication were age, gender, duration of the disease, the attitude of the staff and information/education about asthma. The patients expressed important aspects of care, and these are in accordance with how an asthma nurse practice functions in Sweden.

  • 22.
    Lindberg, Malou
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    Ekström, Tommy
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Lungmedicin. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Lungmedicinska kliniken US.
    Möller, Margareta
    Ahlner, Johan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi.
    Astma care and factors affectin medication comliance; the patient's point of view2001Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 13, s. 375-383Artikkel i tidsskrift (Fagfellevurdert)
  • 23.
    Lindberg, Malou
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Lind, Mildrid
    Petersson, Susanne
    Wilhelmsson, Susan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för vård och välfärd. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    The use of clinical guidelines for asthma, diabetes, and hypertension in primary health care2005Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 17, s. 217-220Artikkel i tidsskrift (Fagfellevurdert)
  • 24.
    Lindgren, Margareta
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Andersson, Inger S
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    The Karen instruments for measuring quality of nursing care: construct validity and internal consistency.2011Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 23, nr 3, s. 292-301Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Valid and reliable instruments for measuring the quality of care are needed for evaluation and improvement of nursing care. Previously developed and evaluated instruments, the Karen-patient and the Karen-personnel based on Donabedian's Structure–Process–Outcome triad (S–P–O triad) had promising content validity, discriminative power and internal consistency.

    Objective The objective of this study was to further develop the instruments with regard to construct validity and internal consistency.

    Design and Settings This prospective study was carried out in medical and surgical wards at a hospital in Sweden. A total of 95 patients and 120 personnel were included.

    Methods The instruments were tested for construct validity by performing factor analyses in two steps and for internal consistency using Cronbach's alpha coefficient.

    Results The first confirmatory factor analyses, with a pre-determined three-factor solution did not load well according to the S–P–O triad, but the second exploratory factor analysis with a six-factor solution appeared to be more coherent and the distribution of variables seemed to be logical. The reliability, i.e. internal consistency, was good in both factor analyses.

    Conclusions The Karen-patient and the Karen-personnel instruments have achieved acceptable levels of construct validity. The internal consistency of the instruments is good. This indicates that the instruments may be suitable to use in clinical practice for measuring the quality of nursing care.

  • 25.
    Lögde, Ann
    et al.
    Uppsala University, Department of Medical Sciences, Occupational and Environmental Medicine, Ulleråkersv. 40, 751 85 Uppsala, Sweden.
    Rudolfsson, Gudrun
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå. Nord University, Faculty of Nursing and Heath Sciences, 8049 Bodö, Norway.
    Broberg, Roma Runesson
    Uppsala University, Department of Medical Sciences, Occupational and Environmental Medicine, Ulleråkersv. 40, 751 85 Uppsala, Sweden.
    Rask-Andersen, Anna
    Uppsala University, Department of Medical Sciences, Occupational and Environmental Medicine, Ulleråkersv. 40, 751 85 Uppsala, Sweden.
    Wålinder, Robert
    Uppsala University, Department of Medical Sciences, Occupational and Environmental Medicine, Ulleråkersv. 40, 751 85 Uppsala, Sweden.
    Arakelian, Erebouni
    Uppsala University Hospital, Department of Surgical Sciences, Entrance 70, 1st Floor, 751 85 SE Uppsala, Sweden.
    I am quitting my job: Specialist nurses in perioperative context and their experiences of the process and reasons to quit their job2018Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 30, nr 4, s. 313-320Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The lack of specialist nurses in operating theatres is a serious problem. The aim of this study was to describe reasons why specialist nurses in perioperative care chose to leave their workplaces and to describe the process from the thought to the decision. Twenty specialist nurses (i.e. anaesthesia, NA, and operating room nurses) from seven university- and county hospitals in Sweden participated in qualitative individual in-depth interviews. Data were analysed by systematic text condensation. We identified four themes of reasons why specialist nurses quitted their jobs: the head nurses' betrayal and dismissive attitude, and not feeling needed; inhumane working conditions leading to the negative health effects; not being free to decide about one's life and family life being more important than work; and, colleagues' diminishing behaviour. Leaving one's job was described as a process and specialist nurses had thought about it for some time. Two main reasons were described; the head nurse manager's dismissive attitude and treatment of their employees and colleagues' mistreatment and colleagues' diminishing behaviour. Increasing knowledge on the role of the head nurse managers in specialist nurses' decision making for leaving their workplace, and creating a friendly, non-violent workplace, may give the opportunity for them to take action before it is too late.

  • 26.
    Lögde, Ann
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Rudolfsson, Gudrun
    Univ West, Div Nursing, Dept Hlth Sci, SE-46186 Trollhattan, Sweden;Nord Univ, Fac Nursing & Heath Sci, N-8049 Bodo, Norway.
    Runeson, Roma
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Rask-Andersen, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Wålinder, Robert
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Arakelian, Erebouni
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    I am quitting my job: Specialist nurses in perioperative context and their experiences of the process and reasons to quit their job2018Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 30, nr 4, s. 313-320Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The lack of specialist nurses in operating theatres is a serious problem. The aim of this study was to describe reasons why specialist nurses in perioperative care chose to leave their workplaces and to describe the process from the thought to the decision. Twenty specialist nurses (i.e. anaesthesia, NA, and operating room nurses) from seven university-and county hospitals in Sweden participated in qualitative individual in-depth interviews. Data were analysed by systematic text condensation. We identified four themes of reasons why specialist nurses quitted their jobs: the head nurses' betrayal and dismissive attitude, and not feeling needed; inhumane working conditions leading to the negative health effects; not being free to decide about one's life and family life being more important than work; and, colleagues' diminishing behaviour. Leaving one's job was described as a process and specialist nurses had thought about it for some time. Two main reasons were described; the head nurse manager's dismissive attitude and treatment of their employees and colleagues' mistreatment and colleagues' diminishing behaviour. Increasing knowledge on the role of the head nurse managers in specialist nurses' decision making for leaving their workplace, and creating a friendly, non-violent workplace, may give the opportunity for them to take action before it is too late.

  • 27. Löve, J
    et al.
    Hagberg, M
    Dellve, Lotta
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Balancing extensive ambition and a context overflowing with opportunities and demands: A grounded theory on stress and recovery among highly educated working young women entering male-dominated occupational areas2011Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 6, nr 3Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Several factors underline the issue of stress-related health among young highly educated women. Major societal changes might provide more new challenges with considerably changed and expanded roles than were expected by earlier generations, especially among women. The quantity of young women with higher education has also increased threefold in Sweden in less than two decades and there are a growing number of young women that hereby break with traditional gender positions and enter new occupational areas traditionally dominated by men. The research questions in the present study were: “What is the main concern, regarding stress and recovery, among young highly educated working women breaking with traditional gender positions and entering male-dominated occupational areas?” and “How do they handle this concern?” We conducted open-ended interviews with 20 informants, aged 23-29 years. The results showed that the synergy between highly ambitious individuals and a context overflowing with opportunities and demands ended up in the informants’ constantly striving to find a balance in daily life (main concern). This concern refers to the respondents experiencing a constant overload of ambiguity and that they easily became entangled in a loop of stress and dysfunctional coping behavior, threatening the balance between stress and sufficient recovery. In order to handle this concern, the respondents used different strategies in balancing extensive ambition and a context overflowing with opportunities and demands (core category). This preliminary theoretical model deepens our understanding of how the increasing numbers of highly educated young women face complex living conditions endangering their possibility of maintaining health and work ability.

  • 28.
    Nilsson, Erik
    et al.
    Department of Surgery, Motala Hospital, Motala.
    Ros, Axel
    Department of Surgery, Ryhov County Hospital, Jönköping.
    Rahmqvist, Mikael
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Bäckman, Karin
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Cholecystectomy: costs and health-related quality of life: a comparison of two techniques2004Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 16, nr 6, s. 473-482Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. Outcomes of previous health economic evaluations comparing minilaparotomy cholecystectomy and laparoscopic cholecystectomy have been inconsistent.

    Objective. To compare costs for minilaparotomy cholecystectomy and laparoscopic cholecystectomy and to study changes in quality of life induced by these operations.

    Design. Single-blind, randomized controlled trial, run from 1 March 1997 to 30 April 1999.

    Setting. One university hospital and four non-university hospitals in Sweden.

    Main measures. Cost and perceived health estimation according to the global quality of life instrument EuroQol-5D.

    Results. Of 1719 cholecystectomy patients at five centres, 724 entered the trial and were treated with minilaparotomy cholecystectomy or laparoscopic cholecystectomy, 362 in each group. Total health care costs were less for minilaparotomy cholecystectomy than for laparoscopic cholecystectomy (median values US$2428 for minilaparotomy cholecystectomy versus US$2613 or US$3006 for laparoscopic cholecystectomy with 100 operations per year and reusable trocars or 50 operations per year and disposable trocars, respectively). There was no significant difference in total costs (including costs due to loss of production) between minilaparotomy cholecystectomy and laparoscopic cholecystectomy with 100 operations per year and reusable trocars in laparoscopic cholecystectomy (US$3731 versus US$3649, respectively). However, in calculations assuming 50 operations per year and disposable trocars in laparoscopic cholecystectomy, this technique was more expensive than minilaparotomy cholecystectomy (US$4042 versus US$3731). Health-related quality of life was slightly but significantly lower for the minilaparotomy cholecystectomy group 1 week after surgery. One month and 1 year postoperatively no difference between the randomized groups was found.

    Conclusion. Total costs did not differ between minilaparotomy cholecystectomy and laparoscopic cholecystectomy with high-volume surgery and disposable trocars, whereas laparoscopic cholecystectomy was more expensive with fewer operations and disposable trocars. The gain in health-related quality of life with laparoscopic cholecystectomy compared with minilaparotomy cholecystectomy was small and of limited duration.

  • 29.
    Ottosson, Barbro
    et al.
    Lund University and Kristianstad University College of Health Care.
    Hallberg, Ingalill R.
    Lund University and Kristianstad University College of Health Care.
    Axelsson, Karin
    Lovén, Lars
    University of Umeå, Department of Advanced Nursing.
    Patients' satisfaction with surgical care impaired by cuts in expenditure and after interventions to improve nursing care at a surgical clinic1997Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 9, nr 1, s. 43-53Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Between 1991 and 1994 the number of beds in the surgical clinic at a central hospital in Southern Sweden was cut back by almost 50%. To develop the nursing care and to control the effects of the budgetary cuts, an intervention, including nursing care development, of an organization that would secure continuity in the nurse-patient relationship, individually planned care and quality assurance for aspects believed to be crucial to the quality of nursing care was implemented. The aim of this study was to analyse patients' satisfaction with surgical nursing care between, under and after the last cut in expenditure and the concluded intervention. A patient satisfaction questionnaire covering such areas as: patient satisfaction with information and decision-making; patient satisfaction with contact and the staff-patient relationship; patient satisfaction with ward facilities and the physical treatment or examination and patient satisfaction with various other aspects of care, was administered (1993 n = 131; 1994 n = 128). Subsample analysis showed lower scores for patient satisfaction if the respondents were women, young, or acutely ill when admitted. While surveys carried out between 1991 and 1993 showed an overall improvement in the quality of care, as measured by patient satisfaction, it remained at the same level in 1994 as in 1993, or decreased, regarding patient contacts with staff and physicians, involvement in decision-making, anxiety before examination/treatment, anxiety regarding professional secrecy, opportunity to influence the solution to their physical problems, chance to get sleep without being disturbed, physical nursing care and preparations before discharge. Thus a deterioration in quality seemed to take place in 1994 indicating that the cuts in expenditure may have been too hard and had been made at the expense of patient satisfaction.

  • 30.
    Ovretveit, John
    et al.
    Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden.
    Keller, Christina
    Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Informatik.
    Hvitfeldt Forsberg, Helena
    Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden.
    Essén, Anna
    Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden.
    Lindblad, Staffan
    Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden.
    Brommels, Mats
    Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden.
    Continuous innovation: developing and using a clinical database with new technology for patient-centred care - the case of the Swedish quality register for arthritis2013Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 25, nr 2, s. 118-124Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. We describe and explain the development of a clinical quality database and its use for different clinical, management and patient empowerment purposes.

    Design. A longitudinal case study covering 1993–2009.

    Setting. Rheumatology departments in Swedish hospitals.

    Participants. Those involved in developing the clinical database and its applications and a limited number of users.

    Intervention(s). Different methods for inputting and storing clinical and patient data and for analysing and presenting the data to providers and patients.

    Main outcome measure(s). Participants’ perceptions of the value of different applications and of influences, which helped and hindered the development of the system.

    Results. Different innovations were introduced at different times continually to increase the ultility of the clinical data and the clinic- and patient coverage of the clinical data system. Limited interview data show postive patient and provider perceptions of the latest application to collect and present data as time trend visual display in the clinical consultation.

    Conclusions. A longitudinal perspective revealed how a clinical quality register was developed and how new technologies not imagined in the early 1990s continue to increase the ultility and value of the clinical database. This historical perspective provided limited evidence of impact, but does provide lessons for current strategies for innovation for quality in health care and of the need to consider innovolution processes, rather than discrete innovations, given the rapid pace of change in new technologies. More evidence is needed of the impact of such registers, and of enhancements, on providers and patients and on costs.

  • 31.
    Põlluste, Kaja
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Kalda, Ruth
    Lember, Margus
    Primary health care system in transition: the patient's experience.2000Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 12, nr 6, s. 503-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To find out how Estonian people evaluate the changes in primary health care (PHC), how they perceive the acceptability of the new PHC system, and to assess patients' satisfaction with their primary care doctor.

    DESIGN: Face-to-face interviews using structured questionnaires.

    SETTING: Estonia.

    STUDY PARTICIPANTS: A random sample of Estonian residents aged 15-74 years (n = 997).

    MAIN MEASURES: Acceptability of PHC system (accessibility, the patient-practitioner relations, amenities, and patient's preferences) and patients' satisfaction with primary care doctor.

    RESULTS: Of the 997 respondents, 46% were sufficiently informed about the transition to the general practitioner (GP)-based PHC system; however, 45% of respondents had not personally experienced any changes. Of the 997 persons interviewed, 68% were registered on the patient list of a GCP, and 62% of those who had health problems preferred to consult the primary care doctor first. The waiting time for an outpatient appointment was brief (0-2 days). Of the 997 respondents, 68% were satisfied with their primary care doctor. Satisfaction was dependent on: (i) how patients evaluated the competence of the physician; (ii) comprehensibility of doctor's explanations; and (iii) comfort of the clinic. The right of patients to choose their own primary care doctor and having sufficient information about the changes in PHC system had a positive influence on the level of satisfaction.

    CONCLUSIONS: Patients' opinions are important in the evaluation of PHC. To increase the level of satisfaction, people need to understand the nature and intent of the primary care reforms. Personal choice of primary care doctor and good patient-doctor relationships are important factors too.

  • 32.
    Raberus, Anna
    et al.
    Univ Boras, Fac Caring Sci Work Life & Social Welf, S-50190 Boras, Sweden.
    Knutsson Holmström, Inger
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning. Malardalens Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden.
    Galvin, Kathleen
    Univ Brighton, Sch Hlth Sci, Brighton, E Sussex, England.
    Sundler, Annelie J.
    Univ Boras, Fac Caring Sci Work Life & Social Welf, S-50190 Boras, Sweden.
    The nature of patient complaints: a resource for healthcare improvements2019Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 31, nr 7, s. 556-562Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this study was to explore the nature, potential usefulness and meaning of complaints lodged by patients and their relatives. Design: A retrospective, descriptive design was used. Setting: The study was based on a sample of formal patient complaints made through a patient complaint reporting system for publicly funded healthcare services in Sweden. Participants: A systematic random sample of 170 patient complaints was yielded from a total of 5689 patient complaints made in a Swedish county in 2015. Main outcome measure: Themes emerging from patient complaints analysed using a qualitative thematic method. Results: The patient complaints reported patients' or their relatives' experiences of disadvantages and problems faced when seeking healthcare services. The meanings of the complaints reflected six themes regarding access to healthcare services, continuity and follow-up, incidents and patient harm, communication, attitudes and approaches, and healthcare options pursued against the patient's wishes. Conclusions: The patient complaints analysed in this study clearly indicate a number of specific areas that commonly give rise to dissatisfaction; however, the key findings point to the significance of patients' exposure and vulnerability. The findings suggest that communication needs to be improved overall and that patient vulnerability could be successfully reduced with a strong interpersonal focus. Prerequisites for meeting patients' needs include accounting for patients' preferences and views both at the individual and organizational levels.

  • 33.
    Rahmqvist, Mikael
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och miljö.
    Patient satisfaction in relation to age, health status and other background factors: A model for comparisons of care units2001Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 13, nr 5, s. 385-390Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To analyse the relationship between patient satisfaction and background factors such as age, gender, health status and pain. In addition, to use background factors to create less biased ranking in comparisons of patient satisfaction between medical specialities. Design. A questionnaire was sent by post to patients who had recently received inpatient care at a hospital within the County of ╓sterg÷tland, Sweden. The questionnaire contained 33 questions, 21 of which concerned the quality of health care and patient satisfaction. Setting. Inpatient departments at all four hospitals in the County of ╓sterg÷tland, Sweden. Subjects. All patients discharged from the hospital during a period of 6 weeks. Approximately 3400 patients aged 1-94 years responded to the questionnaire, resulting in a response rate of 69%. Main outcome measures. Patient satisfaction index score (PSI). Results. Of the background factors tested, patient age had the greatest explanatory value regarding the PSI, closely followed by experiencing anxiety during admission. With regard to variations in the PSI, about 20% could be explained by the background factors taken as a whole. Gender did not correlate with the PSI, although males were somewhat more satisfied than females. PSI scores differed among medical specialities and, interestingly, when age and other background factors were controlled for, the picture changed regarding the medical speciality that received the best PSI score. Conclusion. The change in ranking among medical specialities after adjustment for background factors emphasizes the importance of including background factors in patient satisfaction analyses in order to obtain less biased comparisons.

  • 34.
    Råberus, A.
    et al.
    Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
    Holmström, Inger K.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Galvin, K.
    School of Health Sciences, University of Brighton, United Kingdom.
    Sundler, A. J.
    Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
    The nature of patient complaints: a resource for healthcare improvements2019Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 31, nr 7, s. 556-562Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The aim of this study was to explore the nature, potential usefulness and meaning of complaints lodged by patients and their relatives. DESIGN: A retrospective, descriptive design was used. SETTING: The study was based on a sample of formal patient complaints made through a patient complaint reporting system for publicly funded healthcare services in Sweden. PARTICIPANTS: A systematic random sample of 170 patient complaints was yielded from a total of 5689 patient complaints made in a Swedish county in 2015. MAIN OUTCOME MEASURE: Themes emerging from patient complaints analysed using a qualitative thematic method. RESULTS: The patient complaints reported patients' or their relatives' experiences of disadvantages and problems faced when seeking healthcare services. The meanings of the complaints reflected six themes regarding access to healthcare services, continuity and follow-up, incidents and patient harm, communication, attitudes and approaches, and healthcare options pursued against the patient's wishes. CONCLUSIONS: The patient complaints analysed in this study clearly indicate a number of specific areas that commonly give rise to dissatisfaction; however, the key findings point to the significance of patients' exposure and vulnerability. The findings suggest that communication needs to be improved overall and that patient vulnerability could be successfully reduced with a strong interpersonal focus. Prerequisites for meeting patients' needs include accounting for patients' preferences and views both at the individual and organizational levels. 

  • 35.
    Råberus, Anna
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Holmström, I K
    School of Health, Care and Social Welfare, Mälardalens University.
    Galvin, Kathleen
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    The nature of patient complaints: a resource for healthcareimprovements2019Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 31, nr 7, s. 556-562Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    The aim of this study was to explore the nature, potential usefulness and meaning of complaints lodged by patients and their relatives.

    Design

    A retrospective, descriptive design was used.

    Setting

    The study was based on a sample of formal patient complaints made through a patient complaint reporting system for publicly funded healthcare services in Sweden.

    Participants

    A systematic random sample of 170 patient complaints was yielded from a total of 5689 patient complaints made in a Swedish county in 2015.

    Main outcome measure

    Themes emerging from patient complaints analysed using a qualitative thematic method.

    Results

    The patient complaints reported patients’ or their relatives’ experiences of disadvantages and problems faced when seeking healthcare services. The meanings of the complaints reflected six themes regarding access to healthcare services, continuity and follow-up, incidents and patient harm, communication, attitudes and approaches, and healthcare options pursued against the patient’s wishes.

    Conclusions

    The patient complaints analysed in this study clearly indicate a number of specific areas that commonly give rise to dissatisfaction; however, the key findings point to the significance of patients’ exposure and vulnerability. The findings suggest that communication needs to be improved overall and that patient vulnerability could be successfully reduced with a strong interpersonal focus. Prerequisites for meeting patients’ needs include accounting for patients’ preferences and views both at the individual and organizational levels.

  • 36. Santos, M
    et al.
    Ravn-Fischer, A
    Karlsson, T
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bergman, B
    Is early treatment of ac ute chest pain provided sooner to patients who speak the national language2013Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 25, nr 5, s. 582-589Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective Identify differences in the early treatment of acute chest pain patients with regard to the language proficiency of patients and thus identify opportunities for improving equity in cardiac care. Design Retrospective cross-sectional study comparing care delivered to Swedish-speaking (SS) and non-Swedish-speaking (NSS) patients. Setting A Swedish university hospital that provides highly specialized care to 1.6 million inhabitants. Participants All patients with acute chest pain or symptoms suggestive of acute coronary syndrome who sought care between mid-September and mid-December 2008 (2588 visits). Missing data on the patient group to which study subjects belonged were 2% (45 visits). NSS represented 8% of the 2543 visits (NSS = 2334; NNSS = 209). Main Outcome Measure(s) Delay times from arrival in hospital to admission to catheterization laboratory or ward (ΔTHOSP-PCI), first physical contact to first electrocardiogram (ΔTCONTACT-ECG), first physical contact to first aspirin (ΔTCONTACT-ASA) and arrival in hospital to coronary angiography (ΔTHOSP-ANGIO). Also included baseline characteristics of patients, diagnosis and findings in hospital and secondary preventive activities. Results The median ΔTHOSP-PCI was longer for NSS by 43 min [254 versus 211, 95% confidence interval (CI), odds ratio (OR) = (1.3; 2.8)]. The median ΔTCONTACT-ECG and ΔTHOSP-ANGIO were longer for NSS by 4 min [17 versus 13, 95% CI, OR = (0.8; 1.8)] and 14 h [44 versus 30, 95% CI, OR = (0.6; 3.6)], respectively. Conversely, the median ΔTCONTACT-ASA was longer for SS by 20 min [81 versus 61, 95% CI, OR = (0.3; 1.6)]. Conclusions Poorer language proficiency was associated with longer delay time from arrival in hospital to admission to catheterization laboratory or ward. No other delay times were found to be statistically significantly different with respect to the language proficiency of patients.

  • 37.
    Stenlund, Marie
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Sjödahl, Rune
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Yngman Uhlin, Pia
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland. Linköpings universitet, Medicinska fakulteten.
    Incidence and potential risk factors for hospital-acquired pneumonia in an emergency department of surgery2017Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 29, nr 2, s. 290-294Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Hospital-acquired pneumonia (HAP) is associated with high mortality and is the second most common nosocomial infection. The aim of this study was to calculate the incidence and to identify potential risk factors for HAP in an emergency ward for surgical patients admitted because of acute abdomen or trauma. A structured review of medical records was conducted. Patients diagnosed with pneumonia amp;gt; 48 h after admittance, were compared with a randomly chosen age-matched reference group. Ten variables judged as potential risk factors for HAP were studied in 90 patients. An emergency ward for surgical patients with acute abdomen or trauma at an Univerity hospital in Sweden. A total of 90 patients with HAP and 120 age-matched controls were included. Risk factors for HAP in patients at a surgical clinic. Of a total of 10 335 admitted patients, during 4.5 years the hospital stay was longer than 48 h in 4961 patients. Of these 90 (1.8%) fulfilled the strict criteria for HAP. Potential risk factors were suspected or verified aspiration (odds ratio (OR): 23.9) that was 2-fold higher than immobilization (OR: 11.2). Further, chronic pulmonary obstructive disease (COPD)/asthma, abdominal surgery and gastric retention/vomiting were risk factors for HAP. Verified or suspected aspiration was the dominating risk factor for HAP but also immobilization was frequently associated with HAP. Various established preventive measures should be implemented in the nursing care to reduce the frequency of HAP.

  • 38.
    Wallin, L
    et al.
    Falun.
    Boström, A
    Falun.
    Harvey, G
    Falun.
    Wikblad, Karin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Omvårdnad.
    Ewald, U
    Falun.
    National guidelines for Swedish neonatal nursing care: Evaluation of clinical application.2000Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 12, s. 465-474Artikkel i tidsskrift (Fagfellevurdert)
  • 39. Wilde Larsson, B.
    et al.
    Larsson, Gerry
    Försvarshögskolan, Institutionen för ledarskap och management (ILM).
    von Holsten, K.
    Wickman, M.
    Theory-based assessment of patients' views on quality of care in England, France, Norway, and Sweden.2005Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 18, s. 62-73Artikkel i tidsskrift (Fagfellevurdert)
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