uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Barriers to change hindering quality improvement: the reality of emergency care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
2010 (English)In: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966, Vol. 36, no 4, 317-323 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to investigate physicians' and nurses' perspectives and prerequisites for quality improvement in the emergency department based on results from a previous patient survey. Method: The study used an explorative design with a qualitative approach and was conducted at the main emergency department of a Swedish university hospital. Interviews were conducted with 5 focus groups. In total, the groups comprised 22 respondents. Results: The respondents suggested goals and quality improvements, such as more patient-centered care, reduced waiting times, and better pain management. However, barriers to quality improvement also were identified and represented 3 themes: the patient is looked upon as an object or a problem; the physicians and nurses belong to different organizational cultures; and the hospital's organization hinders the optimal flow of patients and improvements to quality. Discussion: When assigning priority to the topic areas, most of the focus groups ranked "information, respect, and empathy" as most important to improve. Adequate information, proper care, and treatment within a reasonable time in the emergency department were cited as the goals for patient care, but the health care professionals perceived barriers to change in the hospital culture and organization. To ensure quality care and patient safety, these barriers should be addressed by leaders on all levels in the organization, including the hospital board. Health care professionals' perspectives of quality of care are valuable and should be included in quality improvement work.

Place, publisher, year, edition, pages
Elsevier , 2010. Vol. 36, no 4, 317-323 p.
Keyword [en]
Barriers to change, focus group interview, emergency department, quality improvement, health care professionals' perspective
National Category
Medical and Health Sciences
Research subject
Caring Sciences in Medical Sciences
Identifiers
URN: urn:nbn:se:uu:diva-110253DOI: 10.1016/j.jen.2009.09.003ISI: 000280329500009PubMedID: 20624564OAI: oai:DiVA.org:uu-110253DiVA: diva2:275583
Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Identifying and Improving Quality of Care at an Emergency Department: Patient and healthcare professional perspectives
Open this publication in new window or tab >>Identifying and Improving Quality of Care at an Emergency Department: Patient and healthcare professional perspectives
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Patients in the emergency department are not always satisfied with the care received and the nursing care in the emergency department is sometimes described as instrumental and non-holistic. Structured quality improvement work and evidence-based practice are needed. Aim: The overall aim was to emphasize general patients in the emergency department to enhance the knowledge on how they perceive the quality of care and how the care could be improved through collaboration with the healthcare professionals. Methods: Four studies, with quantitative and qualitative designs, were conducted in a Swedish emergency department. Two hundred patients answered a questionnaire, after which 22 healthcare professionals comprising five focus groups were interviewed, and finally 200 patients were included in an intervention study. Results: The following five areas for improvement were identified: “information, respect and empathy”, “pain relief”, “nutrition”, “waiting time” and “general atmosphere”. Of these areas, the healthcare professionals prioritized “information, respect and empathy”, “waiting time” and “pain relief” to be highlighted in the quality improvement work. Although goals and suggestions for changes were stated, barriers to quality improvement at different levels in the health care were detected. The results of the intervention study showed that structured nursing assessment of the patients’ abdominal status and nurse-initiated intravenous opioid analgesic could increase frequency of analgesic and reduce time to analgesic in the emergency department. Patients perceived lower pain intensity and improved quality of care in pain management. Conclusions: An uncomplicated nursing intervention, related to pain management, based on the results from a patient questionnaire and interviews with healthcare professionals, can improve the care process and pain management in the emergency department, as well as patients’ perceptions of the quality of care in pain management. To succeed with continuous quality improvement work, barriers to change should be addressed.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 76 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 499
Keyword
nursing, emergency department, quality improvement, evidence-based care, patient perspectives, healthcare professional perspectives, pain management, intervention, implementation
National Category
Nursing
Research subject
Caring Sciences in Medical Sciences
Identifiers
urn:nbn:se:uu:diva-110260 (URN)978-91-554-7657-1 (ISBN)
Public defence
2009-12-18, Grönwallsalen, Akademiska sjukhuset, Ing 70, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2009-11-27 Created: 2009-11-06 Last updated: 2010-11-09Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Authority records BETA

Muntlin, Åsa

Search in DiVA

By author/editor
Muntlin, Åsa
By organisation
Caring SciencesDepartment of Public Health and Caring Sciences
In the same journal
Journal of Emergency Nursing
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 543 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf