Development and preliminary testing of a framework to evaluate patients' experiences of the fundamentals of care: a secondary analysis of three stroke survivor narratives

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.Alison L. Kitson and Åsa Muntlin Athli

Protected forests in Sweden, now and in the past : an analysis of the protected forest with data from the Sweden national forest inventory

Den första riksskogstaxeringen (RT) i Sverige genomfördes under åren 1923-1929. Data från den inventeringen är nu digitaliserad och är sparad i en SQL-databas med geografisk information. Digitaliseringen öppnar för nya möjlighetera att genomföra beräkningar på materialeti egendefinierade geografiska områden.Den svenska naturvårdslagen instiftades 1965 och i och med den kunde naturreservat inrättas. Tidigare var det enbart den svenska staten som kunde skydda områden i nationalparker. Syftet med detta arbete är att jämföra skogstillståndet i områden inom naturreservat och nationalparker (benämnt NR) under tre olika tidsperioder samt att jämföra med omkringliggande skogar. De tre perioderna är 1923-1929 (benämnt 1926), 1960-1964 (1962) och 2007-2011 (2009). Studien omfattar variabler som är intressanta i skyddad skog, tillgängliga i RT vid de tre tidpunkterna och godtagbart jämförbara över tid. Variabler som omfattades var bland andra virkesförråd, mängd död ved, mängd grov skog och skogens ålder. Resultaten visar att tillståndet inom NR 1926 skiljer sig från omkringliggande områden (RO) i vissa avseenden. I norra Sverige är den stående volymen lägre än i RO och har en större andel skog äldre än 120 år. I södra Sverige har NR en större andel hård död ved och en lägre stående volym. Detta är mest troligt en effekt av dimensionshuggning av grova träd. Efter 1965 när de första NR bildades har andelen hård död ved, andelen skog över 120 år och volymen grova träd ökat mer inom NR än RO. Detta är ett resultat av bildandet av NR under denna period. Även om den stående volymen är högre 2009 än under någon av de andra studerade perioderna hade de ursprungliga urskogarna i Sverige ett högre virkesförråd och var mindre täta än dagens NR. Mängden grova träd är mindre vanlig nu än i urskogar. De viktigaste slutsatserna i studien är att skogstillståndet i naturreservaten har förändrats över tid. De kan inte betraktas som några urskogar varken idag eller 1926.The first national forest inventory (NFI) in Sweden was carried out during the years 1923-1929. Data from that inventory are now digitalised and stored in an SQL-database with geographic information. This opens new possibilities for undertaking estimations of the data within any geographic area. The Swedish Nature conservation act was constituted in 1965 and the act opened the possibility of establishing nature reserves. Prior to 1965 there were only national parks that were protected by the state. The purpose of this thesis is to compare the forest condition in areas within current national parks and nature reserves (hereafter entitled NR) over three different periods of time and to compare these with surrounding areas. These periods are 1923-1929 (hereafter entitled 1926), 1960-1964 (1962) and 2007-2011 (2009).Comparisons have been undertaken for variables that are of interest, are available in the NFI datasets for all periods and are comparable over time. Variables included in the study were among others standing volume, volume of dead and wind thrown trees, volume of large trees and stand age. The results show that state of the NR in 1926 differs from surrounding areas (entitled RO) in some aspects. NR in the north of Sweden had a lower standing volume than RO and a greater proportion of old forests. In southern Sweden NR have a greater amount of hard dead and wind thrown trees and a lower standing volume. This is probably due to early selective cutting of large trees. After 1965, when the first NRs were established, the amount of hard dead and wind thrown trees, proportion of old forest and large trees have increased more in NR than in RO. This is a result of the establishment of nature reserves during this period. Even though the standing volume is higher in 2009 than any other point in the study period the original virgin forests most likely had more standing volume and less dense forests. The amount of large trees is less common now than in virgin forests. The key conclusions of this thesis are that the forests within nature reserves in Sweden have changed over time. Key findings are that the forest are now more dense and that even at the start of this study period (1926) the forest areas within current NR were not virgin forests but rather low intensity managed forests

Functions of behavior change interventions when implementing multi-professional teamwork at an emergency department: a comparative case study

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® 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.Mandus Frykman, Henna Hasson, Åsa Muntlin Athlin, and Ulrica von Thiele Schwar

The future shape of the nursing workforce: a synthesis of the evidence of factors that impact on quality nursing care

BACKGROUND To effectively respond to the growing demand for healthcare, governments need to consider how to recruit and retain their healthcare staff. This challenge is recognised by the nursing and midwifery professions. This umbrella review, supported by a group of nurse leaders in Australia, aimed to identify those elements known to support a high quality workforce by drawing on the best available Australian and international evidence. The findings provided recommendations that relate to practice, research, education and policy initiatives to help shape the future nursing workforce in Australia and internationally. METHOD An umbrella review of published systematic reviews was undertaken focusing on the Australian and international evidence for factors that are known to impact upon the ability of nurses and midwives to deliver high quality patient care. A total of 79 systematic reviews published between 1995 and 2012 met the inclusion criteria and of these 50 were considered of sufficient quality and were included in the results.Alison L. Kitson, Rick Wiechula, Tiffany Conroy, Åsa Muntlin Athlin, Nancy Whitake

Assessment of the breath alcohol concentration in emergency care patients with different level of consciousness

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.Annika Kaisdotter Andersson, Josefine Kron, Maaret Castren, Asa Muntlin Athlin, Bertil Hok, and Lars Wiklun

Knowledge translation in health care: a concept analysis

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.Background :Although knowledge translation is one of the most widely used concepts in health and medical literature, there is a sense of ambiguity and confusion over its definition. The aim of this paper is to clarify the characteristics of KT. This will assist the theoretical development of it and shape its implementation into the health care system Methods : Walker and Avant’s framework was used to analyze the concept and the related literature published between 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 a participatory context through a set of challenging activities" are the characteristics of KT. Moreover, to occur successfully, KT needs some 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. quality of patient care, professional practice, health system, and community. In addition, this study revealed some empirical referents which are helpful to evaluate the process. Conclusion : By aiming to portray a clear picture of KT, we highlighted its attributes, antecedents, consequences and empirical referents. Identifying the characteristics of this concept may resolve the existing ambiguities in its definition and boundaries thereby facilitate distinction from similar concepts. In addition, these findings can be used as a knowledge infrastructure for developing the KT-related models, theories, or tools

Speaking Up for Fundamental Care: the ILC Aalborg Statement.

OBJECTIVE: The International Learning Collaborative (ILC) is an organisation dedicated to understanding why fundamental care, the care required by all patients regardless of clinical condition, fails to be provided in healthcare systems globally. At its 11th annual meeting in 2019, nursing leaders from 11 countries, together with patient representatives, confirmed that patients' fundamental care needs are still being ignored and nurses are still afraid to 'speak up' when these care failures occur. While the ILC's efforts over the past decade have led to increased recognition of the importance of fundamental care, it is not enough. To generate practical, sustainable solutions, we need to substantially rethink fundamental care and its contribution to patient outcomes and experiences, staff well-being, safety and quality, and the economic viability of healthcare systems. KEY ARGUMENTS: We present five propositions for radically transforming fundamental care delivery:Value: fundamental care must be foundational to all caring activities, systems and institutionsTalk: fundamental care must be explicitly articulated in all caring activities, systems and institutions.Do: fundamental care must be explicitly actioned and evaluated in all caring activities, systems and institutions.Own: fundamental care must be owned by each individual who delivers care, works in a system that is responsible for care or works in an institution whose mission is to deliver care. RESEARCH: fundamental care must undergo systematic and high-quality investigations to generate the evidence needed to inform care practices and shape health systems and education curricula. CONCLUSION: For radical transformation within health systems globally, we must move beyond nursing and ensure all members of the healthcare team-educators, students, consumers, clinicians, leaders, researchers, policy-makers and politicians-value, talk, do, own and research fundamental care. It is only through coordinated, collaborative effort that we will, and must, achieve real change

European bedside nurses' perspective on the fundamentals of care framework and its application in clinical practice : a multi-site focus group interview study

Background. A changing nursing workforce and an increase in demands for care together with more complex care, raise arguments that leading and guiding nursing practice is more challenging than ever. Therefore, nurses need to have a shared agenda and a common language to show the importance of nursing care and the consequences of not addressing this in an appropriate way. In response to this the Fundamentals of Care framework was developed to also contribute to the delivery of person-centred care in an integrated way. However, to gain acceptance and applicability we need to ensure the framework's relevance to clinical practice from bedside nurses' perspectives. Objective. To describe bedside nurses' perspectives on the Fundamentals of Care framework and how it can be applied in clinical practice. Design. A descriptive qualitative design informed by the Fundamentals of Care framework. Setting(s). The study was undertaken at seven hospitals in Sweden, Denmark and the Netherlands during 2019. Participants. A total sample of 53 registered nurses working at the bedside participated. Participants had a wide variety of clinical experience and represented a range of different nursing practice areas. Methods. Twelve focus group interviews were used to collect data and analysed with a deductive content analysis approach. Results. Bedside nurses perceived that the Fundamentals of Care framework was adequate, easy to understand and recognised as representative for the core of nursing care. The definition for fundamental care covered many aspects of nursing care, but was also perceived as too general and too idealistic in relation to the registered nurses' work. The participants recognised the elements within the framework, but appeared not to be using this to articulate their practice. Three main categories emerged for implications for clinical practice; guiding reflection on one's work; ensuring person-centred fundamental care and reinforcing nursing leadership. Conclusions. The Fundamentals of Care framework is perceived by bedside nurses as a modern framework describing the core of nursing. The framework was recognised as having clinical relevance and provides nurses with a common language to articulate the complexity of nursing practice. This knowledge is crucial for nurses both in clinical practice and in leadership roles to be able to speak up for the need to integrate all dimensions of care to achieve person-centred fundamental care. Various activities for reflection, person-centred care and leadership to apply the framework in clinical practice were presented, together with minor suggestions for development of the framework

Patients' satisfaction and opinions of their experiences during admission in a tertiary care hospital in Pakistan – a cross sectional study

<p>Abstract</p> <p>Background</p> <p>It is often felt that developing countries need to improve their quality of healthcare provision. This study hopes to generate data that can help managers and doctors to improve the standard of care they provide in line with the wishes of the patients.</p> <p>Methods</p> <p>It was a cross sectional study carried out at a major tertiary care hospital of Karachi. Patients between the ages of 18 and 80 years admitted to the hospital for at least one day were included. Patients in the maternity, psychiatry and chemotherapy wards and those in the ICU/CCU were excluded. A pretested, peer reviewed translation of a validated patient satisfaction scale developed by the Picker Institute of Europe was administered.</p> <p>Results</p> <p>A total of 173 patients (response rate: 78.6 %) filled the questionnaire. Patient satisfaction was at levels comparable to European surveys for most aspects of hospital care. However, nearly half the patients (48%) felt they had to wait too long to get a bed in the hospital after presenting to the ER. 68.6% of the patients said that they were never asked for views on the quality of care provided. 20% of the patients did not find anyone in the staff to talk to about their worries and fears while 27.6% felt that they were given emotional support to only some extent. Up to one third of the patients said they were not provided enough information regarding their operative procedures beforehand.</p> <p>Conclusion</p> <p>Although several components of patient care equal the quality levels of the west, many sections require considerable improvement in order to improve health care provision. The healthcare team needs to get more involved with the patients, providing them greater support and keeping them informed and involved with their medical treatment. Efforts should be made to get regular feedback from the patients.</p

Speaking up for Fundamental Care: The ILC Aalborg Statement

This is the final version. Available on open access from BMJ Publishing Group via the DOI in this recordObjective The International Learning Collaborative (ILC) is an organisation dedicated to understanding why fundamental care, the care required by all patients regardless of clinical condition, fails to be provided in healthcare systems globally. At its 11th annual meeting in 2019, nursing leaders from 11 countries, together with patient representatives, confirmed that patients' fundamental care needs are still being ignored and nurses are still afraid to 'speak up' when these care failures occur. While the ILC's efforts over the past decade have led to increased recognition of the importance of fundamental care, it is not enough. To generate practical, sustainable solutions, we need to substantially rethink fundamental care and its contribution to patient outcomes and experiences, staff well-being, safety and quality, and the economic viability of healthcare systems. Key arguments We present five propositions for radically transforming fundamental care delivery: Value: fundamental care must be foundational to all caring activities, systems and institutions Talk: fundamental care must be explicitly articulated in all caring activities, systems and institutions. Do: fundamental care must be explicitly actioned and evaluated in all caring activities, systems and institutions. Own: fundamental care must be owned by each individual who delivers care, works in a system that is responsible for care or works in an institution whose mission is to deliver care. Research: fundamental care must undergo systematic and high-quality investigations to generate the evidence needed to inform care practices and shape health systems and education curricula. Conclusion For radical transformation within health systems globally, we must move beyond nursing and ensure all members of the healthcare team - educators, students, consumers, clinicians, leaders, researchers, policy-makers and politicians - value, talk, do, own and research fundamental care. It is only through coordinated, collaborative effort that we will, and must, achieve real change