Can care of elderly be measured? A method for estimating the individual care of recipients in community health care

<p>Abstract</p> <p>Background</p> <p>Almost every country in the Western world has great difficulties allocating enough financial resources to meet the needs in the care of the increasing elderly population. The main problem is common to all countries and concerns the efforts to meet elderly persons' needs on an individual level while still maintaining society's responsibility for distributing justice. The aim of this study is to elaborate an instrument for measuring the quality of individual care and staff's working time in order to allocate public resources fairly. The present study gives an account of a new classification system named TiC (Time in Care), indicating how it can be used most effectively and also investigating the validity and reliability of the system.</p> <p>Methods</p> <p>All recipients in 13 sheltered homes for elderly care (n = 505) in a Swedish municipality were surveyed regarding the care they needed, in dimensions of General Care, Medical Care, Cognitive Dysfunction and Rehabilitation, and the time required. Construct validity was assessed by means of factor analysis. The inter-rater agreement of two raters concerning 79 recipients was measured using weighted Kappa. The stability of the instrument and its sensitivity to change were investigated through test-retest reliability measurements, conducted once a month during a six-month period. The content validity of the instrument was also assessed.</p> <p>Results</p> <p>Factor analysis resulted in a reduction of the number of items from 25 to 16 in three dimensions: General Care, Medical Care and Cognitive Dysfunction. The Kappa analysis showed satisfactory to excellent inter-rater agreement. The care need scores were basically stable but showed sensitivity to change in health status.</p> <p>Conclusion</p> <p>The instrument was found to be useful and reliable for assessing individual needs in community health care.</p

Effects of multidisciplinary teamwork on lead times and patient flow in the emergency department: A longitudinal interventional cohort study

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.Åsa Muntlin Athlin, Ulrica von Thiele Schwarz and Nasim Farrohkni

Patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode: a multi-stage qualitative case study

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.Eva Jangland, Alison Kitson, Åsa Muntlin Athli

An attempt to improve nurses’ interest in and use of research in clinical practice by means of network support to ‘facilitator nurses’

Background: Scientific knowledge is expected to be used in clinical practice to ensure that patients are given evidence-based nursing care. Therefore, in order to improve nurses’ research utilisation in clinical practice a network had been provided for nurses especially interested in nursing development in eleven wards. These nurses were expected to take on the role of key person (facilitator) for nursing development in clinical practice. Aim: The study was aimed at describing nurses’ interest in nursing research, how network support to ‘facilitator nurses’ could improve development in patient care based on evidence, and what hindering factors for such development could be. Methods: One and a half years after onset of the project a follow-up study was conducted with a questionnaire answered by 75 (64%) nurses, and group interviews with nine facilitators and eleven head nurses. Findings: The nurses’ interest in research utilisation was in general high and in eight wards development work had started. The facilitator nurses had mostly worked without involving their colleagues. Hindering factors for nursing development were related to time, EBP knowledge, involvement and the interest of head nurses and colleagues. Education, work place, previous participation in research projects, and participation in the network impacted positively on nurses’ attitudes to and interest in research. Conclusion and implication for clinical practice: Providing networks to ‘facilitator nurses’ in the ward could be useful for developing nursing care based on research findings. However, support from nurse leaders, involvement of the whole nursing staff, and training in research utilisation are important factors for success

Inadequate environment, resources and values lead to missed nursing care: a focused ethnographic study on the surgical ward using the Fundamentals of Care framework

Aims and Objectives: To explore the delivery of care from the perspective of patients with acute abdominal pain focusing on the contextual factors at system level using the Fundamentals of Care framework. Background: The Fundamentals of Care framework describes several contextual and systemic factors that can impact the delivery of care. To deliver high-quality, person-centred care, it is important to understand how these factors affect patients' experiences and care needs. Design: A focused ethnographic approach. Method: A total of 20 observations were performed on two surgical wards at a Swedish university hospital. Data were collected using participant observation and informal interviews and analysed using deductive content analysis. Results: The findings, presented in four categories, reflect the value patients place on the caring relationship and a friendly atmosphere on the ward. Patients had concerns about the environment, particularly the high-tempo culture on the ward and its impact on their integrity, rest and sleep, access to information and planning, and need for support in addressing their existential thoughts. The observers also noted that missed nursing care had serious consequences for patient safety. Conclusions: Patients with acute abdominal pain were cared for in the high-tempo culture of a surgical ward with limited resources, unclear leadership and challenges to patients’ safety. The findings highlight the crucial importance of prioritising and valuing the patients’ fundamental care needs for recovery. Relevance to Clinical Practice: Nursing leaders and nurses need to take the lead to reconceptualise the value of fundamental care in the acute care setting. To improve clinical practice, the value of fundamentals of care must be addressed regardless of patient's clinical condition. Providing a caring relationship is paramount to ensure a positive impact on patient's well-being and recovery.Eva Jangland, Therese Teodorsson, Karin Molander, Åsa Muntlin Athli

An attempt to improve nurses’ interest in and use of research in clinical practice by means of network support to ‘facilitator nurses’

This article is designed as ”Open Access”. This is the journal's PDF originally published in Journal of Nursing Education and Practice, http://dx.doi.org/10.5430/jnep.v4n3p58Background: Scientific knowledge is expected to be used in clinical practice to ensure that patients are given evidence-based nursing care. Therefore, in order to improve nurses’ research utilisation in clinical practice a network had been provided for nurses especially interested in nursing development in eleven wards. These nurses were expected to take on the role of key person (facilitator) for nursing development in clinical practice. Aim: The study was aimed at describing nurses’ interest in nursing research, how network support to ‘facilitator nurses’ could improve development in patient care based on evidence, and what hindering factors for such development could be. Methods: One and a half years after onset of the project a follow-up study was conducted with a questionnaire answered by 75 (64%) nurses, and group interviews with nine facilitators and eleven head nurses. Findings: The nurses’ interest in research utilisation was in general high and in eight wards development work had started. The facilitator nurses had mostly worked without involving their colleagues. Hindering factors for nursing development were related to time, EBP knowledge, involvement and the interest of head nurses and colleagues. Education, work place, previous participation in research projects, and participation in the network impacted positively on nurses’ attitudes to and interest in research. Conclusion and implication for clinical practice: Providing networks to ‘facilitator nurses’ in the ward could be useful for developing nursing care based on research findings. However, support from nurse leaders, involvement of the whole nursing staff, and training in research utilisation are important factors for success