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  • 1.
    Athlin, Åsa Muntlin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Univ Uppsala Hosp, Dept Emergency Care & Internal Med, Entrance 40, S-75185 Uppsala, Sweden.;Univ Adelaide, Sch Nursing, Adelaide, SA, Australia..
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Gavle, Fac Hlth & Occupat Studies, Dept Hlth & Caring Sci, Gavle, Sweden.;Lishui Univ, Sch Med & Hlth, Dept Nursing, Lishui, Peoples R China..
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Uppsala Hosp, Qual Dept, Uppsala, Sweden..
    Baath, Carina
    Karlstad Univ, Fac Hlth Sci & Technol, Dept Hlth Sci, Karlstad, Sweden.;Cty Council Varmland, Karlstad, Sweden..
    Heel pressure ulcer, prevention and predictors during the care delivery chain - when and where to take action?: A descriptive and explorative study2016In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, article id 134Article in journal (Refereed)
    Abstract [en]

    Background: Hazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Pressure ulcer prevalence is still at unreasonably high levels, causing increased healthcare costs and suffering for patients. Recent biomedical research reveals that the first signs of cell damage could arise within minutes. However, few studies have investigated optimal pressure ulcer prevention in the initial stage of the care process, e.g. in the ambulance care or at the emergency department. The aim of the study was to describe heel pressure ulcer prevalence and nursing actions in relation to pressure ulcer prevention during the care delivery chain, for older patients with neurological symptoms or reduced general condition. Another aim was to investigate early predictors for the development of heel pressure ulcer during the care delivery chain. Methods: Existing data collected from a multi-centre randomized controlled trial investigating the effect of using a heel prevention boot to reduce the incidence of heel pressure ulcer across the care delivery chain was used. Totally 183 patients participated. The settings for the study were five ambulance stations, two emergency departments and 16 wards at two hospitals in Sweden. Results: A total of 39 individual patients (21 %) developed heel pressure ulcer at different stages across the care delivery chain. Findings revealed that 47-64 % of the patients were assessed as being at risk for developing heel pressure ulcer. Preventive action was taken. However, all patients who developed pressure ulcer during the care delivery chain did not receive adequate pressure ulcer prevention actions during their hospital stay. Discussion and Conclusions: In the ambulance and at the emergency department, skin inspection seems to be appropriate for preventing pressure ulcer. However, carrying out risk assessment with a validated instrument is of significant importance at the ward level. This would also be an appropriate level of resource use. Context-specific actions for pressure ulcer prevention should be incorporated into the care of the patient from the very beginning of the care delivery chain.

  • 2.
    Athlin, Åsa Muntlin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Farrokhnia, N.
    Schwarz, U. von Thiele
    Introduction of multi-professional teamwork: a promising approach towards a more patient-centred care in the emergency department2014In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 4, p. 274-275Article in journal (Other academic)
  • 3.
    Athlin, Åsa Muntlin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Univ Adelaide, Sch Nursing, Adelaide, SA, Australia..
    Juhlin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Jangland, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Education in Nursing.
    Lack of existing guidelines for a large group of patients in Sweden: a national survey across the acute surgical care delivery chain2017In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, no 1, p. 89-95Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectivesEvidence-informed healthcare is the fundament for prac-tice, whereby guidelines based on the best available evidence should assist health profes-sionals in managing patients. Patients seeking care for acute abdominal pain form acommon group in acute care settings worldwide, for whom decision-making and timelytreatment are of paramount importance. There is ambiguity about the existence, use andcontent of guidelines for patients with acute abdomen. The objective was to describe andcompare guidelines and management of patients with acute abdomen in different settingsacross the acute care delivery chain in Sweden.MethodA national cross-sectional design was used. Twenty-nine ambulance stations, 17emergency departments and 33 surgical wards covering all six Swedish health regions wereincluded, and 23 guidelines were quality appraised using the validated Appraisal of Guide-lines for Research & Evaluation II tool.ResultsThere is a lack of guidelines in use for the management of this large group of pa-tients between and within different healthcare areas across the acute care delivery chain.The quality appraisal identified that several guidelines were of poor quality, especiallythe in-hospital ones. Further, range orders for analgesics are common in the ambulance ser-vices and the surgical wards, but are seldom present in the emergency departments. Also,education in pain management is more common in the ambulance services. Thesefindingsare noteworthy as, hypothetically, the same patient could be treated in three different waysduring the same care episode.ConclusionsThere is an urgent need to develop high-quality evidence-based clinicalguidelines for this patient group, with the entire care process in focus

  • 4. Browall, M.
    et al.
    Athlin, Åsa Muntlin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Wengstrom, Y.
    Conroy, T.
    Kitson, A.
    Experiences of Fundamentals of Care (FOC) for people with a cancer diagnosis - striving for normality and regaining control: striving for normality and regaining control2014In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 18, no S1, p. S12-S12Article in journal (Other academic)
  • 5.
    Bååth, Carina
    et al.
    Karlstad Univ, Fac Hlth Sci & Technol, Dept Hlth Sci, Univ Gatan 2, S-65188 Karlstad, Sweden.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Uppsala Hosp, Surg & Oncol Div, Uppsala, Sweden.
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Uppsala Hosp, Surg & Oncol Div, Uppsala, Sweden.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Univ Adelaide, Sch Nursing, Adelaide, SA, Australia.; Univ Uppsala Hosp, Dept Emergency Care, Uppsala, Sweden.
    Prevention of heel pressure ulcers among older patients - from ambulance care to hospital discharge: A multi-centre randomized controlled trial.2016In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 30, p. 170-175Article in journal (Refereed)
    Abstract [en]

    UNLABELLED: The aim was to investigate the effect of an early intervention, a heel suspension device boot, on the incidence of heel pressure ulcers among older patients (aged 70+).

    BACKGROUND: Pressure ulcers are a global healthcare issue; furthermore, the heel is an exposed location. Research indicates that preventive nursing interventions starting during the ambulance care and used across the acute care delivery chain are seldom used.

    METHODS: A multi-centre randomized control study design was used. Five ambulance stations, two emergency departments and 16 wards at two Swedish hospitals participated. Altogether, 183 patients were transferred by ambulance to the emergency department and were thereafter admitted to one of the participating wards.

    RESULTS: Significantly fewer patients in the intervention group (n=15 of 103; 14.6%) than the control group (n=24 of 80; 30%) developed heel pressure ulcers during their hospital stay (p=0.017).

    CONCLUSIONS: Pressure ulcer prevention should start early in the acute care delivery chain to increase patient safety.

  • 6.
    Feo, Rebecca
    et al.
    University of Adelaide/Adelaide Nursing School.
    Conroy, Tiffany
    School of Nursing, University of Adelaide, Australia.
    Jangland, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. School of Nursing, University of Adelaide.
    Brovall, Maria
    Högskolan i Skövde/Institutionen för hälsa och lärande.
    Parr, Jenny
    Department of Health Care Practice, Auckland University of Technology, New Zealand.
    Blomberg, Karin
    Örebro universitet/Institutionen för hälsovetenskaper .
    Kitson, Alison
    School of Nursing, University of Adelaide, Australia; Centre for Evidence based Practice South Australia, School of Nursing, The University of Adelaide, Australia;Green Templeton College, University of Oxford, United Kingdom .
    Towards a standardised definition for fundamental care: A modified Delphi study2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES:

    To generate a standardised definition for fundamental care and identify the discrete elements that constitute such care.

    BACKGROUND:

    There is poor conceptual clarity surrounding fundamental care. The Fundamentals of Care Framework aims to overcome this problem by outlining three core dimensions underpinning such care. Implementing the Framework requires a standardised definition for fundamental care that reflects the Framework's conceptual understanding, as well as agreement on the elements that comprise such care (i.e., patient needs, such as nutrition, and nurse actions, such as empathy). This study sought to achieve this consensus.

    DESIGN:

    Modified Delphi study.

    METHODS:

    Three phases: (i) engaging stakeholders via an interactive workshop; (ii) using workshop findings to develop a preliminary definition for, and identify the discrete elements that constitute, fundamental care; and (iii) gaining consensus on the definition and elements via a two-round Delphi approach (Round 1 n = 38; Round 2 n = 28).

    RESULTS:

    Delphi participants perceived both the definition and elements generated from the workshop as comprehensive, but beyond the scope of fundamental care. Participants questioned whether the definition should focus on patient needs and nurse actions, or more broadly on how fundamental care should be delivered (e.g., through a trusting nurse-patient relationship), and the outcomes of this care delivery. There were also mixed opinions whether the definition should be nursing specific.

    CONCLUSIONS:

    This study has initiated crucial dialogue around how fundamental care is conceptualised and defined. Future work should focus on further refinements of the definition and elements with a larger, international group of practising nurses and service users.

    RELEVANCE TO CLINICAL PRACTICE:

    The definition and elements, through ongoing refinement, will contribute to a robust evidence base that will underpin policy development and the systematic and effective teaching, delivery, measurement and evaluation of fundamental care.

  • 7. Frykman, Mandus
    et al.
    Hasson, Henna
    Athlin, Åsa Muntlin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Schwarz, Ulrica von Thiele
    Functions of behavior change interventions when implementing multi-professional teamwork at an emergency department: a comparative case study2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, p. 218-Article in journal (Refereed)
    Abstract [en]

    Background: While there is strong support for the benefits of working in multi-professional teams in health care, the implementation of multi-professional teamwork is reported to be complex and challenging. Implementation strategies combining multiple behavior change interventions are recommended, but the understanding of how and why the behavior change interventions influence staff behavior is limited. There is a lack of studies focusing on the functions of different behavior change interventions and the mechanisms driving behavior change. In this study, applied behavior analysis is used to analyze the function and impact of different behavior change interventions when implementing multi-professional teamwork. Methods: A comparative case study design was applied. Two sections of an emergency department implemented multi-professional teamwork involving changes in work processes, aimed at increasing inter-professional collaboration. Behavior change interventions and staff behavior change were studied using observations, interviews and document analysis. Using a hybrid thematic analysis, the behavior change interventions were categorized according to the DCOM (R) model. The functions of the behavior change interventions were then analyzed using applied behavior analysis. Results: The two sections used different behavior change interventions, resulting in a large difference in the degree of staff behavior change. The successful section enabled staff performance of teamwork behaviors with a strategy based on ongoing problem-solving and frequent clarification of directions. Managerial feedback initially played an important role in motivating teamwork behaviors. Gradually, as staff started to experience positive outcomes of the intervention, motivation for teamwork behaviors was replaced by positive task-generated feedback. Conclusions: The functional perspective of applied behavior analysis offers insight into the behavioral mechanisms that describe how and why behavior change interventions influence staff behavior. The analysis demonstrates how enabling behavior change interventions, managerial feedback and task-related feedback interact in their influence on behavior and have complementary functions during different stages of implementation.

  • 8.
    Gunningberg, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Mårtensson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Psychosocial oncology and supportive care. Högskolan Gävle.
    Mamhidir, Anna-Greta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Högskolan Gävle.
    Florin, Jan
    Högskolan Dalarna.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Bååth, Carina
    Karlstad universitet.
    Pressure ulcer knowledge of registered nurses, assistant nurses and student nurses: a descriptive, comparative multicentre study in Sweden2015In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 12, no 4, p. 462-468Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe and compare the knowledge of registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs) about preventing pressure ulcers (PUs). PU prevention behaviours in the clinical practice of RNs and ANs were also explored. A descriptive, comparative multicentre study was performed. Hospital wards and universities from four Swedish county councils participated. In total, 415 participants (RN, AN and SN) completed the Pressure Ulcer Knowledge Assessment Tool. The mean knowledge score for the sample was 58·9%. The highest scores were found in the themes 'nutrition' (83·1%) and 'risk assessment' (75·7%). The lowest scores were found in the themes 'reduction in the amount of pressure and shear' (47·5%) and 'classification and observation' (55·5%). RNs and SNs had higher scores than ANs on 'aetiology and causes'. SNs had higher scores than RNs and ANs on 'nutrition'. It has been concluded that there is a knowledge deficit in PU prevention among nursing staff in Sweden. A major educational campaign needs to be undertaken both in hospital settings and in nursing education.

  • 9.
    Hvitfeldt Forsberg, Helena
    et al.
    Karolinska Institutet.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. School of Nursing, University of Adelaide.
    von Thiele Schwarz, Ulrica
    Karolinska institutet.
    Nurses' perceptions of multitasking in the emergency department: Effective, fun and unproblematic (at least for me): a qualitative study2015In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, no 2, p. 59-64Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    The aim was to understand how multitasking is experienced by registered nurses and how it relates to their everyday practice in the emergency department.

    METHOD:

    Interviews with open-ended questions were conducted with registered nurses (n = 9) working in one of two included emergency departments in Sweden. Data were analyzed using Schilling's structured model for qualitative content analysis.

    RESULTS:

    Three core concepts related to multitasking emerged from the interviews: 'multitasking - an attractive prerequisite for ED care'; 'multitasking implies efficiency' and 'multitasking is not stressful'. From these core concepts an additional theme emerged: '… and does not cause errors - at least for me', related to patient safety.

    DISCUSSION:

    This study shows how the patient load and the unreflected multitasking that follows relate to nurses' perceived efficiency and job satisfaction. It also shows that the relationship between multitasking and errors is perceived to be mediated by whom the actor is, and his or her level of experience. Findings from this study add value to the discourse on multitasking and the emergency department context, as few studies go beyond examining the quantitative aspect of interruptions and multitasking and how it is experienced by the staff in their everyday practice.

  • 10. Hvitfeldt, H. Forsberg
    et al.
    Athlin, Åsa Muntlin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Schwarz, U. von Thiele
    Multitasking in the emergency department: does it affect the registered nurses' perceptions of their everyday practice?2014In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 4, p. 258-258, article id O23.2Article in journal (Other academic)
  • 11.
    Jangland, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Education in Nursing.
    Kitson, Alison
    Univ Adelaide, Sch Nursing, Adelaide, SA 5005, Australia;Australia Green Templeton Coll, Cent Adelaide Local Hlth Network, Adelaide, SA, Australia;Univ Oxford, Oxford OX1 2JD, England.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. School of Nursing, University of Adelaide, South Australia, Australia.
    Patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode: a multi-stage qualitative case study2016In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 4, p. 791-801Article in journal (Refereed)
    Abstract [en]

    AIM: To explore how patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode.

    BACKGROUND: Acute abdominal pain is one of the most common conditions to present in the acute care setting. Little is known about how patients' fundamental care needs are managed from presentation to post discharge.

    DESIGN: A multi-stage qualitative case study using the Fundamentals of Care framework as the overarching theoretical and explanatory mechanism.

    METHODS: Repeated reflective interviews were conducted with five adult patients over a 6-month period in 2013 at a university hospital in Sweden. The interviews (n = 14) were analysed using directed content analysis.

    RESULTS: Patients' experiences across the acute care episode are presented as five patient narratives and synthesized into five descriptions of the entire hospital journey. The patients talked about the fundamentals of care and had vivid accounts of what they meant to them. The experiences of each of the patients were influenced by the extent to which they felt engaged with the health professionals. The ability to engage or build a rapport was identified as a central component across the fundamental care elements, but it varied in visibility.

    CONCLUSION: Consistent pain management, comfort, timely and accurate information, choice and dignity and relationships were identified as essential fundamental care needs of patients experiencing acute abdominal pain regardless of setting, diagnosis, or demographic variables. These were variously achieved and the patients' narratives raised areas for improvement in several areas.

  • 12.
    Jeffs, Lianne
    et al.
    Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. School of Nursing, University of Adelaide, Australia.
    Needleman, Jack
    UCLA Fielding School of Public Health / Department of Health Policy and Management, USA.
    Jackson, Debra
    Oxford Brookes University/Department of Nursing,Faculty of Health and Life Sciences, UK.
    Kitson, Alison
    School of Nursing, University of Adelaide, Australia; Centre for Evidence based Practice South Australia, School of Nursing, The University of Adelaide, Australia;Green Templeton College, University of Oxford, United Kingdom .
    Building the Foundation to Generate a Fundamental Care Standardized Data Set2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
    Abstract [en]

    Considerable transformation is occurring in healthcare globally with organizations focusing on achieving the quadruple aim of improving the experience of care, the health of populations, and the experience of providing care while reducing per capita costs of health care. In response, health care organizations are employing performance measurement and quality improvement methods to achieve the quadruple aim. Despite the plethora of measures available to health managers, there is no standardized data set and virtually no indicators reflecting how patients actually experience the delivery of fundamental care, such as nutrition, hydration, mobility, respect, education, and psychosocial support. Given the linkages of fundamental care to safety and quality metrics, efforts to build the evidence base and knowledge that captures the impact of enacting fundamental care across the health care continuum and lifespan should include generating a routinely collected data set of relevant measures. This paper provides an overview of the current state of performance measurement, key trends, and a methodological approach to leverage in efforts to generate a standardized data set for fundamental care.

  • 13. Kaisdotter Andersson, Annika
    et al.
    Kron, Josefin
    Karolinska institutet.
    Castren, Maaret
    Karolinska institutet.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. School of Nursing, University of Adelaide.
    Hök, Bertil
    Wiklund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Assessment of the breath alcohol concentration in emergency care patients with different level of consciousness2015In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, no 1, article id 11Article in journal (Refereed)
    Abstract [en]

    Background

    Many patients seeking emergency care are under the influence of alcohol, which in many cases implies a differential diagnostic problem. For this reason early objective alcohol screening is of importance not to falsely assign the medical condition to intake of alcohol and thus secure a correct medical assessment.

    Objective

    At two emergency departments, demonstrate the feasibility of accurate breath alcohol testing in emergency patients with different levels of cooperation.

    Method

    Assessment of the correlation and ratio between the venous blood alcohol concentration (BAC) and the breath alcohol concentration (BrAC) measured in adult emergency care patients. The BrAC was measured with a breathalyzer prototype based on infrared spectroscopy, which uses the partial pressure of carbon dioxide (pCO2) in the exhaled air as a quality indicator.

    Result

    Eighty-eight patients enrolled (mean 45 years, 53 men, 35 women) performed 201 breath tests in total. For 51% of the patients intoxication from alcohol or tablets was considered to be the main reason for seeking medical care. Twenty-seven percent of the patients were found to have a BAC of <0.04 mg/g. With use of a common conversion factor of 2100:1 between BAC and BrAC an increased agreement with BAC was found when the level of pCO2 was used to estimate the end-expiratory BrAC (underestimation of 6%, r = 0.94), as compared to the BrAC measured in the expired breath (underestimation of 26%, r = 0.94). Performance of a forced or a non-forced expiration was not found to have a significant effect (p = 0.09) on the bias between the BAC and the BrAC estimated with use of the level of CO2. A variation corresponding to a BAC of 0.3 mg/g was found between two sequential breath tests, which is not considered to be of clinical significance.

    Conclusion

    With use of the expired pCO2 as a quality marker the BrAC can be reliably assessed in emergency care patients regardless of their cooperation, and type and length of the expiration.

  • 14.
    Khoddam, Homeira
    et al.
    Iran University of Medical Sciences, Iran.
    Mehrdad, Neda
    Tehran University of Medical Sciences, Iran.
    Peyrovi, Hamid
    Iran University of Medical Sciences, Iran.
    Kitson, Alison
    School of Nursing, University of Adelaide, Australia; Centre for Evidence based Practice South Australia, School of Nursing, The University of Adelaide, Australia;Green Templeton College, University of Oxford, United Kingdom .
    Schultz, Timothy
    School of Nursing, Faculty of Health Sciences, the University of Adelaide, Australia.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. School of Nursing, University of Adelaide.
    Knowledge translation in health care: a concept analysis2014In: Medical Journal of the Islamic Republic of Iran, ISSN 1016-1430, E-ISSN 2251-6840, Vol. 28, article id 98Article in journal (Refereed)
    Abstract [en]

    Background:

    Although knowledge translation is one of the most widely used concepts in health and medicalliterature, there is a sense of ambiguity and confusion over its definition. The aim of this paper is to clarify thecharacteristics of KT. This will assist the theoretical development of it and shape its implementation into thehealth care system

    Methods:

    Walker and Avant’s framework was used to analyze the concept and the related literature publishedbetween 2000 and 2010 was reviewed. A total of 112 papers were analyzed.

    Results:

    Review of the literature showed that "KT is a process" and "implementing refined knowledge into aparticipatory context through a set of challenging activities" are the characteristics of KT. Moreover, to occursuccessfully, KT needssome necessary antecedents like an integrated source of knowledge, a receptive context,and preparedness. The main consequence of successful process is a change in four fields of healthcare, i.e. quali-ty of patient care, professional practice, health system, and community. In addition, this study revealed someempirical referents which are helpful to evaluate the process.

    Conclusion:

    By aiming to portray a clear picture of KT, we highlighted its attributes, antecedents, conse-quences and empiricalreferents. Identifying the characteristics of this concept may resolve the existing ambigui-ties in its definition and boundaries thereby facilitate distinction from similar concepts. In addition, these find-ings can be used as a knowledge infrastructure fordeveloping the KT-related models, theories, or tools.

  • 15.
    Kitson, Alison
    et al.
    School of Nursing, University of Adelaide, Australia; Centre for Evidence based Practice South Australia, School of Nursing, The University of Adelaide, Australia;Green Templeton College, University of Oxford, United Kingdom .
    Dow, Clare
    Institute of Health and Wellbeing, University of Glasgow, United Kingdom.
    Calabrese, Joseph D
    University College London, United Kingdom.
    Locock, Louise
    Health Experiences Research Group, Dept Primary Care Health Sciences, University of Oxford, United Kingdom; National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Stroke survivors’ experiences of the fundamentals of care: A qualitative analysis2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 3, p. 392-403Article in journal (Refereed)
    Abstract [en]

    Background

    Managing the fundamentals of care (e.g. elimination, personal hygiene, eating,) needs to be more explicitly addressed within the patient-centred care discourse. It is not possible to investigate issues of patient dignity and respect without acknowledging these basic physical needs. While the literature on caring for people with a stroke is extensive, no studies to date have described stroke survivors’ experiences of all of these fundamentals during the in-hospital phase of their care.

    Design

    Secondary analysis of qualitative data grounded in interpretative phenomenology Participants and settings: Fifteen stroke survivors with in-hospital experiences from multiple healthcare settings and healthcare professionals across the United Kingdom were included.

    Method

    A secondary thematic analysis of primary narrative interview data from stroke survivors.

    Results

    Survivors of strokes have vivid and often distressing recollections of their experiences of the fundamentals of care. For every description of a physical need (elimination, eating and drinking, personal hygiene) there where lucid accounts of the psychosocial and emotional impact (humiliation, distress, lack of dignity, recovery, confidence). Linked to the somatic and emotional dimensions were narratives around the relationship between the patient and the carer (nurse, doctor, allied health professional). Positive recollections of the fundamentals of care were less evident than more distressing experiences. Consistent features of positive experiences included: stroke survivors describing how the physical, psychosocial and relational dimensions of care were integrated and coordinated around their particular need. They reported feeling involved in setting achievable targets to regain control of their bodily functions and regain a sense of personal integrity and sense of self. Sociological constructs such as biographical disruption and loss of self were found to be relevant to stroke survivors’ experiences. Indeed, such constructs may be more linked to the disruption of such fundamental activities rather than the experience of the illness itself.

    Conclusions

    We recommend more practical and integrated approaches be taken around understanding and meeting the physical, psychosocial and relational needs of patients in hospital which could lead to more patient-centred care experiences. These three dimensions need to co-exist in every care episode. More exploration is required to identify the common fundamentals of care needs of patients regardless of illness experience.

  • 16.
    Kitson, Alison
    et al.
    School of Nursing, University of Adelaide, Australia; Centre for Evidence based Practice South Australia, School of Nursing, The University of Adelaide, Australia;Green Templeton College, University of Oxford, United Kingdom .
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Development and preliminary testing of a framework to evaluate patients' experiences of the fundamentals of care: a secondary analysis of three stroke survivor narratives.2013In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2013, p. 572437-Article in journal (Refereed)
    Abstract [en]

    Aim. To develop and test a framework describing the interrelationship of three key dimensions (physical, psychosocial, and relational) in the provision of the fundamentals of care to patients. Background. There are few conceptual frameworks to help healthcare staff, particularly nurses, know how to provide direct care around fundamental needs such as eating, drinking, and going to the toilet. Design. Deductive development of a conceptual framework and qualitative analysis of secondary interview data. Method. Framework development followed by a secondary in-depth analysis of primary narrative interview data from three stroke survivors. Results. Using the physical, psychosocial and relational dimensions to develop a conceptual framework, it was possible to identify a number of "archetypes" or scenarios that could explain stroke survivors' positive experiences of their care. Factors contributing to suboptimal care were also identified. Conclusions. This way of thinking about how the fundamentals of care are experienced by patients may help to elucidate the complex processes involved around providing high quality fundamentals of care. This analysis illustrates the multiple dimensions at play. However, more systematic investigation is required with further refining and testing with wider healthcare user groups. The framework has potential to be used as a predictive, evaluative, and explanatory tool.

  • 17.
    Kitson, Alison
    et al.
    School of Nursing, University of Adelaide, Australia; Centre for Evidence based Practice South Australia, School of Nursing, The University of Adelaide, Australia;Green Templeton College, University of Oxford, United Kingdom .
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. School of Nursing, University of Adelaide.
    Conroy, Tiffany
    School of Nursing, University of Adelaide, Australia.
    Anything but basic: Nursing’s challenge in meeting patients' fundamental care needs2014In: Journal of Nursing Scholarship, ISSN 1527-6546, E-ISSN 1547-5069, Vol. 46, no 5, p. 331-339Article in journal (Refereed)
    Abstract [en]

    Purpose

    Nursing has not explored the fundamental aspects of patient care in a systematic, conceptually coherent, scientific way, and this has created a number of ongoing challenges.

    Organizing Construct

    Each challenge is identified and addressed in the form of a proposition, with evidence provided to support the arguments put forward and defend the proposed actions.

    Findings

    The challenges include: the need for an integrated way of thinking about the fundamentals of care from a conceptual, methodological, and practical perspective; the ongoing and unresolved tension in nursing practice between a depersonalized and mechanistic approach (termed a “task and time” driven culture) and the need for consistency around understanding and managing the dynamics of the nurse–patient relationship or encounter (termed a “thinking and linking” approach); and the need for a systematic approach to the fundamentals or basics of care that combines the physical, psychosocial, and relational dimensions of the care encounter within the wider context of the care environment. Pragmatic and practical frameworks are needed to ensure that the basic physical and psychosocial needs of patients are embedded not only in the practice but also in the thinking, reflection, and assessment processes of the nurse.

    Conclusions

    Nursing's challenge to meet patients’ basic or fundamental needs is complex. Developing a knowledge base will include identifying researchable questions, using rigorous methodologies, ensuring the relational dimensions are not lost, and ensuring the new knowledge is applied in practice. This requires collaboration on an international scale to achieve improvements in care.

    Clinical Relevance

    To work collaboratively to generate, test, and implement meaningful ways of capturing nursing practice around basic or fundamental care in order to ensure more integrated, holistic patient care nursing practices.

  • 18.
    Kitson, Alison
    et al.
    School of Nursing, University of Adelaide, Australia; Centre for Evidence based Practice South Australia, School of Nursing, The University of Adelaide, Australia;Green Templeton College, University of Oxford, United Kingdom .
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. School of Nursing, University of Adelaide.
    Elliott, Janice
    School of Nursing, University of Adelaide, Australia.
    Cant, Megan
    School of Nursing, University of Adelaide, Australia.
    What’s my line?: A narrative review and synthesis of the literature on Registered Nurses' communication behaviours between shifts2014In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 70, no 6, p. 1228-1242Article, review/survey (Refereed)
    Abstract [en]

    Aim

    To describe, appraise and synthesize the seminal and empirical literature around Registered Nurses' communication behaviours between shifts in acute hospital settings.

    Background

    Effective communication between shifts (at nursing handover) is acknowledged as a prerequisite to safe and high-quality patient-centred care. However, gaps and inconsistencies continue to prevail.

    Design

    Narrative review and synthesis.

    Data sources

    The electronic databases PubMED, CINAHL and Scopus were used.

    Review methods

    English language, peer-reviewed papers published between 1970–April 2012 were considered for review. Criteria included Registered Nurses' communication during handovers in adult hospital settings.

    Results

    Twenty-nine papers were reviewed. The research lacks a clear conceptual framework to define the core purposes of Nurses' communication behaviours between shifts. Seven themes were identified: overall purpose; report givers and receivers; seeing the whole picture; teaching and education; language; patient-centred care; and social cohesion. Two main communication processes are required – one articulating the whole picture and the other detailing information about patients.

    Conclusion

    This area of research is challenged by lack of consistency in terminology and methodological rigour. While recent research has confirmed the findings from the seminal work, it has not been able to elaborate on some of the key challenges to refine the knowledge base. A more integrated approach is required to understand the complex process of improving nursing communication behaviours, particularly around the nursing handover. A neglected area of study is the role of the unit lead in determining the communication standards of the whole nursing team.

  • 19.
    Muntlin Athlin, Åsa
    Uppsala University.
    Akutmottagning2009In: Prehospital akutsjukvård / [ed] Suserud, B-O, Svensson, L, Stockholm: Liber , 2009, 1Chapter in book (Other academic)
  • 20.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Hur kan vi som sjuksköterskor förbättra vården på akutmottagningar för patienter som söker för buksmärta?2010In: Smärta, ISSN 1402-1048, no 3, p. 16-19Article in journal (Other academic)
  • 21.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. School of Nursing, University of Adelaide; Department of Emergency Care and Internal Medicine, Uppsala.
    Methods, metrics and research gaps around minimum data sets for nursing practice and fundamental care: A scoping literature review2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
    Abstract [en]

    Aims and objectives

    To examine and map research on minimum data sets linked to nursing practice and the fundamentals of care. Another aim was to identify gaps in the evidence to suggest future research questions to highlight the need for standardisation of terminology around nursing practice and fundamental care.

    Background

    Addressing fundamental care has been highlighted internationally as a response to missed nursing care. Systematic performance measurements are needed to capture nursing practice outcomes.

    Design

    Overview of the literature framed by the scoping study methodology.

    Method

    PubMed and CINAHL were searched using the following inclusion criteria: peer‐reviewed empirical quantitative and qualitative studies related to minimum data sets and nursing practice published in English. No time restrictions were set. Exclusion criteria were as follows: no available full text, reviews and methodological and discursive studies. Data were categorised into one of the fundamentals of care elements.

    Results

    The review included 20 studies published in 1999–2016. Settings were mainly nursing homes or hospitals. Of 14 elements of the fundamentals of care, 11 were identified as measures in the included studies, but their frequency varied. The most commonly identified elements concerned safety, prevention and medication (n = 11), comfort (n = 6) and eating and drinking (n = 5).

    Conclusion

    Studies have used minimum data sets and included variables linked to nursing practices and fundamentals of care. However, the relations of these variables to nursing practice were not always clearly described and the main purpose of the studies was seldom to measure the outcomes of nursing interventions. More robust studies focusing on nursing practice and patient outcomes are warranted.

  • 22.
    Muntlin Athlin, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. School of Nursing, University of Adelaide; Department of Emergency Care and Internal Medicine, Uppsala University Hospital, 751 85 Uppsala, Sweden .
    Brovall, Maria
    Högskolan i Skövde/Institutionen för hälsa och lärande.
    Wengström, Yvonne
    Karolinska Institutet/ Institutionen för Neurobiologi, Vårdvetenskap och Samhälle (NVS), H1, Sektionen för omvårdnad- Omvårdnad 2, Karolinska Universitetssjukhuset ; CRU .
    Conroy, Tiffany
    School of Nursing, University of Adelaide, Australia.
    Kitson, Alison
    School of Nursing, University of Adelaide, Australia; Centre for Evidence based Practice South Australia, School of Nursing, The University of Adelaide, Australia;Green Templeton College, University of Oxford, United Kingdom .
    Descriptions of Fundamental Care needs in cancer care: an exploratory study2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
    Abstract [en]

    Aims and objectives

    To explore the experiences of the fundamentals of care for people with a cancer diagnosis, from diagnosis to after adjuvant treatment.

    Background

    More focus is needed on the experience of people living with cancer, as current cancer care more emphasises on independence and resilience without fully acknowledging that there will be moments in the cancer journey where patients will need ‘basic nursing care’ to manage their symptoms and care pathways.

    Design

    Secondary analysis of qualitative data.

    Method

    Secondary thematic analysis of interview data from 30 people with a diagnosis of breast (n=10), colorectal (n=10) or prostate (n=10) cancer was undertaken.

    Results

    The findings revealed vivid descriptions of the fundamentals of care (i.e. basic needs) and participants described physical, psychosocial and relational aspects of the delivery of care. Both positive (e.g. supportive and kind) and negative (e.g. humiliating) experiences related to the relationship with the healthcare professionals were re-counted and affected the participants’ experiences of the fundamentals of care. Participants’ accounts of their fundamental care needs were provided without them identifying who, within the health care system, was responsible for providing these needs. Specific nursing interventions were seldom described.

    Conclusion

    Some people with a cancer diagnosis have to strive for help and support from the nursing staff to manage to regain control over their recovery. Nurses in cancer care need to focus on the patients’ fundamental care needs to optimise their patients’ recovery.

  • 23.
    Muntlin Athlin, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. School of Nursing, University of Adelaide.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    To Receive or Not to Receive Analgesics in the Emergency Department: The Importance of the Pain Intensity Assessment and Initial Nursing Assessment2015In: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635, Vol. 16, no 5, p. 743-750Article in journal (Refereed)
    Abstract [en]

    Patients seeking emergency care for abdominal pain still experience poor pain management. Pain intensity is not always seen as a mandatory parameter in the initial nurse assessment. Despite the development of nurse-initiated analgesic protocols, many patients do not receive analgesics in the emergency department. The aim of this study was to describe initial nursing assessment related to pain management and to identify predictors for receiving or not receiving analgesics in the emergency department. The sample consists of 100 patients from an intervention group in a previously undertaken Swedish intervention study. The main findings were that the registered nurses assessed 62 patients as being in need of analgesics, and that 52 of these obtained analgesics. The majority of the patients assessed as not being in need of analgesics did not receive analgesics because they did not want medication. Median value for pain intensity at initial assessment was 6 on the numerical rating scale. The results for the logistic regression (n = 80) showed significant differences between receiving analgesics/not receiving analgesics and the predictor pain intensity (measured at initial nurse assessment). Nurses in emergency departments play a crucial role, in that their initial assessment is of specific importance for the patient's further care and whether the patient may or may not receive analgesics. However, more attention has to be paid to patients' experiences and their expectations regarding the pain management in the emergency department. These complex questions have to be studied further in a more systematic way.

  • 24.
    Muntlin Athlin, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. School of Nursing, University of Adelaide, Australia.
    von Thiele Schwarz, Ulrica
    Karolinska institutet.
    Farrokhnia, Nasim
    Karolinska institutet/Södersjukhuset.
    Effects of multidisciplinary teamwork on lead times and patient flow in the emergency department: a longitudinal interventional cohort study2013In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, p. 76-Article in journal (Refereed)
    Abstract [en]

    Background: Long waiting times for emergency care are claimed to be caused by overcrowded emergency departments and non-effective working routines. Teamwork has been suggested as a promising solution to these issues. The aim of the present study was to investigate the effects of teamwork in a Swedish emergency department on lead times and patient flow. Methods: The study was set in an emergency department of a university hospital where teamwork, a multi-professional team responsible for the whole care process for a group of patients, was introduced. The study has a longitudinal non-randomized intervention study design. Data were collected for five two-week periods during a period of 1.5 years. The first part of the data collection used an ABAB design whereby standard procedure (A) was altered weekly with teamwork (B). Then, three follow-ups were conducted. At last follow-up, teamwork was permanently implemented. The outcome measures were: number of patients handled within teamwork time, time to physician, total visit time and number of patients handled within the 4-hour target. Results: A total of 1,838 patient visits were studied. The effect on lead times was only evident at the last follow-up. Findings showed that the number of patients handled within teamwork time was almost equal between the different study periods. At the last follow-up, the median time to physician was significantly decreased by 11 minutes (p = 0.0005) compared to the control phase and the total visit time was significantly shorter at last follow-up compared to control phase (p = <0.0001; 39 minutes shorter on average). Finally, the 4-hour target was met in 71% in the last follow-up compared to 59% in the control phase (p = 0.0005). Conclusions: Teamwork seems to contribute to the quality improvement of emergency care in terms of small but significant decreases in lead times. However, although efficient work processes such as teamwork are necessary to ensure safe patient care, it is likely not sufficient for bringing about larger decreases in lead times or for meeting the 4-hour target in the emergency department.

  • 25.
    Muntlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Identifying and Improving Quality of Care at an Emergency Department: Patient and healthcare professional perspectives2009Doctoral 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.

    List of papers
    1. Patients' perceptions of quality of care at an emergency department and identification of areas for quality improvement
    Open this publication in new window or tab >>Patients' perceptions of quality of care at an emergency department and identification of areas for quality improvement
    2006 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 15, no 8, p. 1045-1056Article in journal (Refereed) Published
    Abstract [en]

    Aims. This paper reports a study to identify patient's perceptions of quality of care at an emergency department and areas for quality improvement. Background. Patients are not always satisfied with the care received at emergency departments. More attention needs to be paid to the specific needs and expectations of the non-urgent group of patients, who make up the majority of attenders at many emergency departments. Nurses' and physicians' perceptions about good quality of care do not always agree with patients' perceptions. Instruments measuring patient satisfaction have often been focused on inpatient treatment. Method. A prospective, descriptive survey design was adopted and the study took place in one emergency department at a Swedish university hospital in 2002. The participants were 99 women and 101 men, with an average age of 51 years. The emergency department version of the questionnaire Quality from the Patient's Perspective was used for data collection. Results. Patients estimated quality of care at the emergency department as fairly good, but there were areas in need of improvement. A high percent of inadequate quality was related to the environment in the emergency department. About 20% of patients reported that they did not receive effective pain relief. More than 20% estimated that nurses did not show an interest in their life situation and patients did not receive useful information on self-care and about which physician was responsible for their medical care. Conclusions. The use of a research-based instrument gave valuable information for quality improvement in clinical practice. Many of the identified areas for quality improvement are related to nursing care. Therefore, the importance of nursing care in the emergency department should be highlighted to nurses and physicians and they also need to be more attentive to the need of the individual patient. Relevance to clinical practice. Identifying areas for quality improvements are important, to know where to take action. These findings may facilitate the work with changing attitudes and working routines, which are needed to deliver effective care and to improve patients' perceptions of quality of care at emergency departments.

    Keyword
    emergency department, nurses, nursing, patient perceptions, quality improvement, quality of care
    National Category
    Nursing
    Research subject
    Caring Sciences in Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-110251 (URN)10.1111/j.1365-2702.2006.01368.x (DOI)16879549 (PubMedID)
    Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2017-12-12Bibliographically approved
    2. Different patient groups request different emergency care: A survey in a Swedish emergency department
    Open this publication in new window or tab >>Different patient groups request different emergency care: A survey in a Swedish emergency department
    2008 (English)In: International Emergency Nursing, ISSN 1755-599X, Vol. 16, p. 223-232Article in journal (Refereed) Published
    Abstract [en]

    AIM: This study investigates possible differences in the perception of quality of care at an emergency department, as related to patient background and visit characteristics. METHODS: The study uses a prospective, descriptive survey design with data collected in May 2002 from the emergency department of a Swedish university hospital. It included 200 patients with an average age of 51 yr (range 18-91 yr). The research-based Quality from the Patient's Perspective (QPP) questionnaire, emergency department version, was used for data collection. RESULTS: Several factors, for example, information after procedures, respect and empathy, nutrition, general atmosphere and routines, were rated significantly lower by patients with gastrointestinal symptoms, general surgery patients and patients admitted to a hospital ward, than by patients with other background or visit characteristics. CONCLUSIONS: There are differences in the perception of quality of care related to patient background and visit characteristics at the emergency department. Clinical guidelines for different patient groups could facilitate the quality improvement work. However, to improve the quality of care at the emergency department there should be a balance between standardized care and individualized patient care. In addition, there has to be a changed attitude and behaviour towards the ED patients to improve their perception of the emergency care.

    Keyword
    Patients’perceptions; Quality of care; Emergency department; Quality improvement
    National Category
    Nursing
    Research subject
    Caring Sciences
    Identifiers
    urn:nbn:se:uu:diva-110252 (URN)10.1016/j.ienj.2008.07.006 (DOI)18929340 (PubMedID)
    Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2010-11-09Bibliographically approved
    3. Barriers to change hindering quality improvement: the reality of emergency care
    Open this publication in new window or tab >>Barriers to change hindering quality improvement: the reality of emergency care
    2010 (English)In: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966, Vol. 36, no 4, p. 317-323Article 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
    Keyword
    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:nbn:se:uu:diva-110253 (URN)10.1016/j.jen.2009.09.003 (DOI)000280329500009 ()20624564 (PubMedID)
    Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2017-12-12Bibliographically approved
    4. Outcomes of a nurse-initiated intravenous analgesic protocol for abdominal pain in an emergency department: a quasi-experimental study
    Open this publication in new window or tab >>Outcomes of a nurse-initiated intravenous analgesic protocol for abdominal pain in an emergency department: a quasi-experimental study
    2011 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, no 1, p. 13-23Article in journal (Refereed) Published
    Abstract [en]

    Background: Abdominal pain is one of the most frequent reasons for seeking care in an emergency department. Surveys have shown that patients are not satisfied with the pain management they receive. Reasons for giving inadequate pain management may include poor knowledge about pain assessment, myths concerning pain, lack of communication between the patient and healthcare professional, and organizational limitations.

    Objectives: The aim of the study was to investigate the outcome of nursing assessment, pain assessment and nurse-initiated intravenous opioid analgesic compared to standard procedure for patients seeking emergency care for abdominal pain. Outcome measures were: a) pain intensity, b) frequency of received analgesic, c) time to analgesic, d) transit time, and e) patients’ perceptions of the quality of care in pain management.

    Design: A quasi-experimental design with ABA phases was used.

    Setting: The study was conducted in an emergency department at a Swedish university hospital.

    Participants: Patients with abdominal pain seeking care in the emergency department were invited to participate. A total of 50, 100 and 50 patients, respectively, were included for the three phases of the study. The inclusion criteria were: ongoing abdominal pain not lasting for more than 2 days, ≥18 years of age and oriented to person, place and time. Exclusion criteria were: abdominal pain due to trauma, in need of immediate care and pain intensity scored as 9-10.

    Methods: The patients’ perceptions of the quality of care in pain management in the emergency department were evaluated by means of a patient questionnaire carried out in the three study phases. The intervention phase included education, nursing assessment protocol and a range order for analgesic.

    Results: The nursing assessment and the nurse-initiated intravenous opioid analgesic resulted in significant improvement in frequency of receiving analgesic and a reduction in time to analgesic. Patients perceived lower pain intensity and improved quality of care in pain management.

    Conclusions: The intervention improved the pain management in the emergency department. A structured nursing assessment could also affect the patients’ perceptions of the quality of care in pain management in the emergency department.

    Keyword
    Abdominal pain, analgesic, emergency department, nursing assessment, intervention study, range order
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Caring Sciences in Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-110254 (URN)10.1016/j.ijnurstu.2010.06.003 (DOI)000286703400003 ()20598691 (PubMedID)
    Available from: 2009-11-06 Created: 2009-11-06 Last updated: 2017-12-12Bibliographically approved
  • 26.
    Muntlin, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Barriers to change hindering quality improvement: the reality of emergency care2010In: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966, Vol. 36, no 4, p. 317-323Article in journal (Refereed)
    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.

  • 27.
    Muntlin, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Säfwenberg, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Outcomes of a nurse-initiated intravenous analgesic protocol for abdominal pain in an emergency department: a quasi-experimental study2011In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, no 1, p. 13-23Article in journal (Refereed)
    Abstract [en]

    Background: Abdominal pain is one of the most frequent reasons for seeking care in an emergency department. Surveys have shown that patients are not satisfied with the pain management they receive. Reasons for giving inadequate pain management may include poor knowledge about pain assessment, myths concerning pain, lack of communication between the patient and healthcare professional, and organizational limitations.

    Objectives: The aim of the study was to investigate the outcome of nursing assessment, pain assessment and nurse-initiated intravenous opioid analgesic compared to standard procedure for patients seeking emergency care for abdominal pain. Outcome measures were: a) pain intensity, b) frequency of received analgesic, c) time to analgesic, d) transit time, and e) patients’ perceptions of the quality of care in pain management.

    Design: A quasi-experimental design with ABA phases was used.

    Setting: The study was conducted in an emergency department at a Swedish university hospital.

    Participants: Patients with abdominal pain seeking care in the emergency department were invited to participate. A total of 50, 100 and 50 patients, respectively, were included for the three phases of the study. The inclusion criteria were: ongoing abdominal pain not lasting for more than 2 days, ≥18 years of age and oriented to person, place and time. Exclusion criteria were: abdominal pain due to trauma, in need of immediate care and pain intensity scored as 9-10.

    Methods: The patients’ perceptions of the quality of care in pain management in the emergency department were evaluated by means of a patient questionnaire carried out in the three study phases. The intervention phase included education, nursing assessment protocol and a range order for analgesic.

    Results: The nursing assessment and the nurse-initiated intravenous opioid analgesic resulted in significant improvement in frequency of receiving analgesic and a reduction in time to analgesic. Patients perceived lower pain intensity and improved quality of care in pain management.

    Conclusions: The intervention improved the pain management in the emergency department. A structured nursing assessment could also affect the patients’ perceptions of the quality of care in pain management in the emergency department.

  • 28.
    Muntlin, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Different patient groups request different emergency care: A survey in a Swedish emergency department2008In: International Emergency Nursing, ISSN 1755-599X, Vol. 16, p. 223-232Article in journal (Refereed)
    Abstract [en]

    AIM: This study investigates possible differences in the perception of quality of care at an emergency department, as related to patient background and visit characteristics. METHODS: The study uses a prospective, descriptive survey design with data collected in May 2002 from the emergency department of a Swedish university hospital. It included 200 patients with an average age of 51 yr (range 18-91 yr). The research-based Quality from the Patient's Perspective (QPP) questionnaire, emergency department version, was used for data collection. RESULTS: Several factors, for example, information after procedures, respect and empathy, nutrition, general atmosphere and routines, were rated significantly lower by patients with gastrointestinal symptoms, general surgery patients and patients admitted to a hospital ward, than by patients with other background or visit characteristics. CONCLUSIONS: There are differences in the perception of quality of care related to patient background and visit characteristics at the emergency department. Clinical guidelines for different patient groups could facilitate the quality improvement work. However, to improve the quality of care at the emergency department there should be a balance between standardized care and individualized patient care. In addition, there has to be a changed attitude and behaviour towards the ED patients to improve their perception of the emergency care.

  • 29.
    Muntlin, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Patients' perceptions of quality of care at an emergency department and identification of areas for quality improvement2006In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 15, no 8, p. 1045-1056Article in journal (Refereed)
    Abstract [en]

    Aims. This paper reports a study to identify patient's perceptions of quality of care at an emergency department and areas for quality improvement. Background. Patients are not always satisfied with the care received at emergency departments. More attention needs to be paid to the specific needs and expectations of the non-urgent group of patients, who make up the majority of attenders at many emergency departments. Nurses' and physicians' perceptions about good quality of care do not always agree with patients' perceptions. Instruments measuring patient satisfaction have often been focused on inpatient treatment. Method. A prospective, descriptive survey design was adopted and the study took place in one emergency department at a Swedish university hospital in 2002. The participants were 99 women and 101 men, with an average age of 51 years. The emergency department version of the questionnaire Quality from the Patient's Perspective was used for data collection. Results. Patients estimated quality of care at the emergency department as fairly good, but there were areas in need of improvement. A high percent of inadequate quality was related to the environment in the emergency department. About 20% of patients reported that they did not receive effective pain relief. More than 20% estimated that nurses did not show an interest in their life situation and patients did not receive useful information on self-care and about which physician was responsible for their medical care. Conclusions. The use of a research-based instrument gave valuable information for quality improvement in clinical practice. Many of the identified areas for quality improvement are related to nursing care. Therefore, the importance of nursing care in the emergency department should be highlighted to nurses and physicians and they also need to be more attentive to the need of the individual patient. Relevance to clinical practice. Identifying areas for quality improvements are important, to know where to take action. These findings may facilitate the work with changing attitudes and working routines, which are needed to deliver effective care and to improve patients' perceptions of quality of care at emergency departments.

  • 30.
    von Thiele Schwarz, Ulrica
    et al.
    Karolinska Inst, Dept Learning Informat Management & Eth LIME, Med Management Ctr, S-10401 Stockholm, Sweden.
    Hasson, Henna
    Karolinska Inst, Dept Learning Informat Management & Eth LIME, Med Management Ctr, S-10401 Stockholm, Sweden; Stockholm Cty Council, Unit Implementat, Ctr Epidemiol & Community Med, Stockholm, Sweden.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Univ Adelaide, Sch Nursing, Adelaide, SA 5005, Australia; Univ Uppsala Hosp, Dept Emergency Care & Internal Med, Uppsala, Sweden.
    Efficiency in the emergency department: A complex relationship between throughput rates and staff perceptions2016In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 29, p. 15-20Article in journal (Refereed)
    Abstract [en]

    Introduction

    It is well known that emergency departments (EDs) suffer from crowding and throughput challenges, which make the ED a challenging workplace. However, the interplay between the throughput of patients and how staff experience work is seldom studied. The aim of this study was to investigate whether staff experience of work (efficiency, work-related efforts and rewards, and quantity and quality of work) differs between days with low and high patient throughput rates.

    Method

    Throughput times were collected from electronic medical records and staff (n = 252 individuals, mainly nurses) ratings in daily questionnaires over a total of six weeks. Days were grouped into low and high throughput rate days for the orthopedic, surgical and internal medicine sections, respectively, and staff ratings were compared.

    Results

    On days with low throughput rates, employees rated their efficiency, effort, reward and quantity of work significantly higher than on days with high throughput rates. There was no difference in perceived quality of work.

    Conclusions

    There is a complex relationship between ED throughput rates and staff perceptions of efficiency and efforts/rewards with work, suggesting that whereas low throughput may be troublesome from a patient and organizational perspective, working conditions may still be perceived as more favorable.

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