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Patient safety continues to be a challenge for health care. Medical errors are not decreasing but continue to show roughly the same patterns in Sweden and other Western countries. This interview study aims to explore how 27 hospital middle managers responsible for patient safety work in a Swedish university hospital perceive this task. A qualitative analysis was performed. A code template was created, and each code was explored in depth and summarized into six categories. We conclude that patient safety work appears to have low priority; hospital top management does not seem to have any real interest in patient safety; incidents are underreported; and the organization of patient safety work seems to be insufficient and carried out insofar as resources are available. These parameters may explain why medical errors remain on a certain level and do not seem to decrease in spite of various support programs.

Phenomenography is a qualitative research approach developed within an educational framework, focusing on the qualitative experience of learning. It is also being used, to a lesser degree, in healthcare research. In the present study, we conducted a meta-ethnographic synthesis of phenomenographic studies on chronic illness, in order to give a broader perspective of how chronic illness can be experienced. Our aim was not to describe patients' various individual experiences of illness, but instead to identify the different ways chronic illness can be experienced by patients. Our synthesis and phenomenographic interpretation of 12 selected articles found that patients' experiences of chronic illness can be described in terms of a different lived body, a struggle with threat to identity and self-esteem, a diminished lifeworld, and a challenging reality. These experiences relate to each other in a process of recurring loops, where the different ways of experiencing continue to influence each other over time. According to these findings, the use of phenomenography as a research approach has the potential to add to the understanding of how chronic illness can be experienced. Patients may benefit from seeing that their illness can be experienced in many different ways and that it has many aspects, which then can lead to a better understanding and coping with their illness. We suggest that it may be worthwhile to expand the scope of phenomenography outside pedagogics. This presupposes a revision of the application to include a wider and more comprehensive description, for instance, of the different ways illness and healthcare phenomena can be experienced, and how these different ways are related to each other, with less focus on hierarchical relations.

BAKGRUNN Behovet for organer til transplantasjon øker. Behandlingsteamets kunnskap om og holdninger til organdonasjon kan påvirke donasjonsprosessen. Når åndedrett og hjertevirksomhet blir opprettholdt med kunstige midler, krever norsk lov angiografisk påvist opphevet cerebral sirkulasjon i tillegg til klinisk undersøkelse før organdonasjon kan gjennomføres. Vi ønsket å kartlegge norske legers holdning til organdonasjon og hvordan donasjonsprosessen håndteres.

MATERIALE OG METODE Et spørreskjema med definerte svaralternativer ble sendt til leger ved intensivavdelinger og til spesialister og utdanningskandidater i nevrokirurgi ved landets donorsykehus i 2008/09.

RESULTATER 435 leger (55 %) returnerte spørreskjemaet. 315 av 420 (75 %) svarte at de kunne tenke seg å starte organbevarende behandling når det ikke finnes håp for pasienten, mens 18 % var i tvil og 7 % svarte at de ikke kunne tenke seg dette. 68 av 424 (16 %) mente at dersom organdonasjon var aktuelt og de så bort fra eksisterende lovverk, var klinisk diagostikk tilstrekkelig til å kunne stille dødsdiagnosen. 22 % var i tvil, mens 62 % mente at klinisk diagostikk ikke var tilstrekkelig. 258 av 416 (62 %) svarte at de trodde pårørende som oftest forsto hva total ødeleggelse av hjernen innebar etter at de var blitt det forklart.

FORTOLKNING I fremtidig undervisning bør man legge vekt på muligheten for organbevarende behandling når man forventer dødelig utgang.

BackgroundIn Sweden, a mass vaccination campaign against the influenza A(H1N1) 2009 resulted in 60% vaccination coverage. However, many countries had difficulty in motivating citizens to be vaccinated. To be prepared for future vaccination campaigns, it is important to understand people's reasons for not taking the vaccination.

ObjectiveThe aim of this qualitative study was to explore motives, beliefs and reactions of individuals with varying backgrounds who did not get vaccinated.

Data and methodsThe total 28 individuals participating in the interviews were permitted to speak freely about their experiences and ideas about the vaccination. Interviews were analysed using a Grounded Theory approach. The strength of participants' decisions not to be vaccinated was also estimated.

FindingsPatterns of motives were identified and described in five main categories: (A) distinguishing between unnecessary and necessary vaccination, (B) distrust, (C) the idea of the natural, (D) resisting an exaggerated safety culture, and (E) injection fear. The core category, upholding autonomy and own health, constitutes the base on which the decisions were grounded.

ConclusionA prerequisite for taking the vaccine would be that people feel involved in the vaccination enterprise to make a sensible decision regarding whether their health will be best protected by vaccination.

Bakgrunn. Ferdighetene til den som spør om organdonasjon og tidspunktet for samtalen kan påvirke muligheten for at pårørende samtykker. Hensikten med studien var å undersøke intensivlegers og nevrokirurgers erfaring i å ta vare på organgivere og i å kommunisere med pårørende – og deres læringsbehov.

Materiale og metode. I 2008 sendte vi et spørreskjema til alle leger ved intensivavdelingene ved samtlige donorsykehus i Norge og til alle nevrokirurger/utdanningskandidater i nevrokirurgi.

Resultater. 435 leger (55 %) besvarte spørreskjemaet. 63 % var spesialister i intensivmedisin. Over halvparten hadde liten erfaring både med organdonasjon og med å ivareta de pårørende. Mange oppga behov for å lære mer om medisinske forhold knyttet til organdonasjon og om kommunikasjon i denne situasjonen.

Fortolkning. Mange leger følger ikke anbefalt praksis når de møter pårørende. I undervisningstilbudet bør man særlig vektlegge kommunikasjon med pårørende.

Aims and objectives

To present data on Swedish ICU nurses' attitudes to brain death and organ donation and to test a questionnaire designed to explore these issues in terms of validity and reliability.

Background

Previous studies have identified various barriers to organ donation. The single most important factor was the attitude of ICU staff. Design.  A 34-item instrument was developed to explore attitudes and experiences of organ donation.

Method

The questionnaire was sent to 50% of ICU nurses in Sweden (n = 1013) and the response rate was 69% (n = 702). The expected scale dimensionality was examined both by explorative principal component analysis and confirmatory multi-trait analysis. Scale reliability was further estimated using Cronbach's alpha. Chi-squared test was used to compare proportions between ICU specialities and Pearson correlations were calculated to investigate relationships between each of the factors verified and the single items.

Results

The main findings were that less than half of the ICU nurses trusted clinical diagnosis of brain death without a confirmatory cerebral angiography. Twenty-five percent of the respondents indicated that mechanical ventilation was withdrawn to reduce the possible suffering of a person assumed to be clinically dead, without the issue of organ donation being raised. A total of 39% had experienced occasions when the question about organ donation was never raised with the relatives. Four factors were verified and labelled: personal attitudes to organ donation as a situation; Organisational attitudes to organ donation as a phenomenon; Environmental resources; and Personal wish to donate, which accounted for 70% of the variance.

Conclusions

Swedish ICU nurses reported several barriers to organ donation. An action plan including education in brain death diagnostics, interpersonal relationships and interaction with relatives as well as regular follow-up regarding donation issues in various ICU settings would be useful.

Relevance to clinical practice

All nurses working in ICUs are obliged to participate in organ donation and are therefore included in these results. 

BACKGROUND: Much remains to be done to facilitate the transplantation process for patients with end-stage renal disease. The aim here was to explore these patients' experiences of the donation process and factors related to whether the actual donors of the recipients were living or deceased and describe which issues needed attention in a quality development project. Method. A specially constructed questionnaire was sent to 246 recipients of living and deceased kidney transplants who had been transplanted at the Karolinska University Hospital in Stockholm, Sweden. The response rate was 87%.

RESULTS: Six conditions were identified as problematic:- Most living-donor kidney recipients perceived the evaluation period for the donors as too long. - Although a living donor was available, most living-donor kidney recipients had to undergo dialysis for a relatively long period. - A majority of the patients perceived it difficult to ask for a donation. Deceased-donor kidney recipients were least satisfied with the offered support in finding a living donor. - Patients perceived fear as the main reason for potential living donors to refuse donation. - About one-fourth of living-donor kidney recipients thought that the donors were abandoned by healthcare after nephrectomy. - Older patients and singles were least likely to receive a living-donor kidney.

CONCLUSIONS: The problem issues outlined above should be scrutinized and improved. Checking these issues can be used in quality control when analysing living kidney donation at local and national levels.

Abstract: The anaesthetist's work, aimed at giving safe anaesthesia to patients, can do both harm and good to the anaesthetist. Research on stress in anaesthesia has traditionally focused on how the negative effects of stress can be avoided and much effort has been put into improving anaesthetists' work environment to reduce the level of stress. In this review, however, we give attention instead to what the individual anaesthetist can do to improve his or her well-being at work. Stress is, and will remain, an inevitable aspect of the anaesthetist's occupation but, as for any professional working in a stressful environment, adaptive coping can make a big difference in outcome. The choice between construing a difficult clinical situation as threat or challenge is important here because of the difference in the resulting stress response. The anaesthetist can reduce the stress effect of a potentially stressful situation by thinking of it in a new way, by redefining it through reappraisal. We describe here some lines of thought that experienced anaesthetists use to buffer the effects of work stress on physical health and mental well-being. By reframing a situation, they can reduce its stress content even if the problem at hand cannot be successfully solved. Trainee anaesthetists, who experience much stress at work and are at risk of burnout, would benefit from learning about these coping strategies.

Aim. To explore the meaning of rehabilitation to older, Swedish stroke survivors, from the time of the acute stroke to the end of the rehabilitation.

Background. Many people who are stroke survivors do not resume social activities even though they have regained physical functions. However, the contents of stroke rehabilitation seems to depend on whether rehabilitation is understood from the disease perspective or the illness perspective contained in the International Classification of Functioning, Disability and Health. This in turn may determine the kind of rehabilitation offered to survivors.

Design. Inductive, qualitative interview study undertaken during 2003.

Method. Nineteen Swedish stroke survivors were interviewed twice, and the interviews were analysed using a Grounded Theory approach.

Findings. To the older survivors, the meaning of rehabilitation was social reintegration. To achieve this they tried to regain lost physical and cognitive functions, relations (including play activities, everyday narratives and self-esteem) and lost certainty. The survivors needed to regain their ability to be not only to perform social activities. However, their rehabilitation ended when its focus turned to impairments found in the illness experiences of the survivors. The survivors developed their own cognitive and behavioural strategies for overcoming these kinds of obstacles to their social reintegration.

Conclusion. Older, Swedish stroke survivors strive for a socially integrated life. Unacknowledged impairments experienced from the illness perspective of the survivors and the survivors’ own rehabilitation strategies should therefore be considered in their rehabilitation.

Relevance to clinical practice. Stroke survivors need support from professionals who can understand and acknowledge the illness perspective of rehabilitation. Professionals should be able to understand how to facilitate the cognitive and behavioural strategies found in survivors’ illness narratives. In order to socially reintegrate, survivors’ rehabilitation should be transferred to the places where they have previously performed play activities together with family and friends.