Framgångsrik hållbarhetskommunikation : Kommunikationens betydelse för miljöarbete inom små och medelstora företag

Denna studie syftar att svara på frågeställningen om hur en klimatsatsning inom små och medelstora företag (SME) kommuniceras på bästa sätt och var i svårigheter kan ligga. Jämförelser görs också med liknande projekt som genomförts och de framgångsfaktorer de haft för att se om de går att överföras till de små och medelstora företagen i Halland, som ingår i denna studie. Genom jämförelser med andra rapporter, djupintervjuer med representanter ur de medverkande företagen, workshops i samarbete med EMC och Alexandersoninstitutet samt analys av dessa har utmaningar och möjligheter i arbetet med att implicera klimatarbetet i företagens verksamhet identifierats. Resultaten har analyserats i enlighet med miljöpsykologisk ansats. Genom att utvärdera attityder, upplevd kontroll och upplevda hinder, har förslag för implementering och kommunikation tagits fram. Resultatet av djupintervjuer och workshops visar att företagen behöver vägledning när det gäller kommunikationen av sitt klimatarbete internt såväl som externt. Företagen vet inte vilka kanaler som ska väljas eller vad som ska kommuniceras. De flesta är överens om att ledningen behöver föregå med gott exempel. Därför bör ledningen utbildas i första hand. Företagen har bland annat problem med att anställda tillhör olika grupper som arbetar på skilda sätt, vilket gör att kommunikationen behöver anpassas för att passa respektive grupp. Svårigheter att omvandla klimatåtgärder till mätbara värden så att de tydligt kan redovisas för medarbetare och därmed öka motivationen till ett förändrat beteende är andra faktorer företagen har problem med. Små och medelstora företag kan arbeta med ett antal framgångsfaktorer grundade på analyser av ovanstående. Det är viktigt att arbeta strukturerat och med tydliga mål, det är också viktigt att använda sig av mindre målgrupper, även under den interna hållbarhetskommunikationen. Tesen att den interna kommunikationen är avgörande för ett framgångsrikt hållbarhetsarbete kan styrkas med hjälp av denna studie

Digital support in wound treatment : Nurses experiences with using the OneWound app

Bakgrund: Äldres behov av vård kommer att öka med en åldrande befolkning och fler kommer att drabbas av svårläkta sår. För att möta det stigande vårdbehovet behövs digitala verktyg vid sårbehandling, som kan bidra till trygghet, tillgänglighet och att vårdens resurser används effektivt. Specialistsjuksköterskor har ett utökat ansvar vid utveckling och implementering av digitala verktyg. Genom digitala verktyg ska vård ges utifrån individens behov men det är en utmaning att utveckla verktyg som är personcentrerade. Idag finns det verksamheter i Sverige som arbetar med sårbehandling via appen OneWound. Syfte: Att undersöka sjuksköterskors erfarenheter av appen OneWound vid sårbehandling. Metod: Kvalitativ intervjustudie med induktiv ansats som analyserades med kvalitativ innehållsanalys, vilket mynnade ut i tre kategorier och åtta subkategorier. Resultat: Sjuksköterskorna utvecklades i sin profession genom teoretisk kunskap och användning av OneWound. Sjuksköterskorna kunde möta hinder vid implementering, vilket påverkade användningen. Påverkningsfaktorer beskrevs som personliga egenskaper, tekniska problem och brist på rutiner i verksamheten. Genom användning av OneWound med möjlighet till konsultation av sårexperter upplevde sjuksköterskorna trygghet, arbetsglädje och stöd viaappens funktioner samt vinster på individ- och samhällsnivå som bidrog till hållbar vård och en känsla av att erbjuda en vård av hög kvalité. Slutsats: OneWound tillfredsställde sjuksköterskornas behov av ny kunskap, struktur, och stöd vid sårbehandling. Utifrån ett omvårdnadsperspektiv ger studiens resultat en inblick i de utmaningar som finns vid sårbehandling och de positiva effekter som OneWound bidrar till. Forskning behövs för att utforska patientperspektivet samt hur OneWound erfars i förhållande till traditionell specialistkontakt vid svårläkta sår.Background: The elderly’s need for care will increase with an aging population and more will suffer from wounds that are hard-to-heal. To meet the rising need for care, digital tools are needed in wound care, which can contribute to safety, accessibility and efficient use of care resources. Specialist nurses have an increased responsibility for the development and implementation of digital tools. Through digital tools, care must be provided based on the individual’s needs. However, it is a challenge to develop tools that are person-centered. Today, there are healthcare providers in Sweden that work with wound care via the OneWound app. Aim: To investigate nurses’ experiences of the OneWound app in wound care. Method: Qualitative interview study with an inductive approach that was analyzed with qualitative content analysis, which resulted in three categories and eight subcategories. Results: The nurses developed in their profession through theoretical knowledge and use of the OneWound app. The nurses faced obstacles during implementation. Impact factors were described as personal characteristics, technical problems and lack of routines. Through the use of OneWound with the possibility to consult wound experts, nurses felt safe, experienced job satisfaction and support through the app's functions as well as gains at the individual and community level that contributed to sustainable care and a sense of offering high quality care.  Conclusion: OneWound satisfied the nurses' need for new knowledge, structure, and support in wound treatment. From a nursing perspective, the results of the study provide an insight into the challenges that exist in wound treatment and the positive effects that the OneWound app contributes to. Further research is needed to explore the patient perspective and how OneWound is experienced in relation to traditional specialist contact when facing hard-to-heal wounds

Självskadebeteende ur skolkuratorers perspektiv : - om bakomliggande orsaker, uppmärksammandet av och arbetet med självskadande ungdomar på gymnasiet

Självskadebeteende bland ungdomar är ett socialt problem världen över men är samtidigt tabubelagt och stigmatiserande. Skolan är en plats där ungdomar spenderar en stor del av sin tid och där det finns en chans för destruktiviteten att uppmärksammas. När det gäller att uppmärksamma självskadande ungdomar har skolkuratorn en viktig roll. Ju tidigare ett självskadebeteende påträffas och behandlas desto större möjligheter finns det för bättre framtidsutsikter. Kunskap behövs dels för att kunna se tidiga tecken och uppmärksamma den självskadande ungdomen och dels för att stötta och hjälpa ungdomen vidare. Syftet med denna studie är att undersöka skolkuratorers arbete med självskadande ungdomar och erfarenheter av bakgrunden till destruktiviteten. Studiens tre teoretiska utgångspunkter är socialkonstruktivism, stigma och kunskap som grund för sociala problem. Dessa perspektiv är relevanta när det gäller självskadebeteende som en konsekvens av samhällets konstruktion och bemötandet av det sociala problemet. Studien är kvalitativ och innefattar intervjuer med 10 skolkuratorer från 10 olika svenska gymnasieskolor. Intervjuerna transkriberades och datamaterialet analyserades sedan med hjälp av tematisk analys. Med hjälp av socialkonstruktivism kunde skolkuratorers uppfattning om bakomliggande orsaker samt samhällets påverkan i form av normer undersökas. Resultatet visade att skolkuratorerna hade en gemensam uppfattning om bakomliggande orsaker till ungdomars självskadebeteende, att det användes för att hantera starka känslor. I skolkuratorernas arbete ingår att stötta elever i skolan, skapa en förtroendefull relation till elever och personal, samarbeta med övrig skolpersonal och hänvisa självskadande ungdomar vidare till rätt instans. De hinder som skolkuratorer upplever i arbetet är tids- och resursbrist, att självskadan kan vara dold och att ungdomar kan ha svårt att prata om sitt självskadebeteende och därmed inte söker hjälp. Psykisk ohälsa menar skolkuratorer är dessutom tabubelagt. De möjligheter som föreligger är att informera och utbilda både elever och personal om psykisk ohälsa, självskadebeteende och hur känslor kan hanteras. 

Mortality trends among hospitalised COVID-19 patients in Sweden : A nationwide observational cohort study

Background: It is important to know if mortality among hospitalised COVID-19 patients has changed as the pandemic has progressed. The aim of this study was to describe the dynamics over time of mortality among patients hospitalised for COVID-19 in Sweden, using nationwide data compiled by the Swedish National Board of Health and Welfare. Methods: Observational cohort study where all patients hospitalised in Sweden between March 1 and September 30, 2020, with SARS-CoV-2 RNA positivity 14 days before to 5 days after admission and a discharge code for COVID-19 were included. Outcome was 60-day all-cause mortality. Patients were categorised according to month of hospital admission. Poisson regression was used to estimate the relative risk of death by month of admission, adjusting for, age, sex, comorbidities, care dependency, country of birth, healthcare region, and Simplified Acute Physiology, version 3 (patients in intensive care units; ICU). Findings: A total of 17,140 patients were included, of which 2943 died within 60 days of admission. The overall 60-day mortality was thus 17.2% (95% CI, 16.6%-17.7%), and it decreased from 24.7% (95% CI, 23.0%-26.5%) in March to 10.4% (95% CI, 8.9%-12.1%) post-wave (July-September). Adjusted relative risk (RR) of death was 0.46 (95% CI, 0.39-0.54) post-wave, using March as reference. Corresponding RR for patients not admitted to ICU and those admitted to ICU were 0.49 (95% CI, 0.42-0.59) and 0.49 (95% CI, 0.33-0.72), respectively. The proportion of patients admitted to ICU decreased from 19.4% (95% CI, 17.9%-21.1%) in the March cohort to 8.9% (95% CI, 7.5%-10.6%) post-wave. Interpretation: There was a gradual decline in mortality during the spring of 2020 in Swedish hospitalised COVID-19 patients, independent of baseline patient characteristics. Future research is needed to explain the reasons for this decline. The changing COVID-19 mortality should be taken into account when management and results of studies from the first pandemic wave are evaluated. (C) 2021 The Authors. Published by Elsevier Ltd.Funding Agencies|Swedens National Board of Health and Welfare</p

Mortality in hospitalized COVID-19 patients was associated with the COVID-19 admission rate during the first year of the pandemic in Sweden

Introduction Studies from the first pandemic wave found associations between COVID-19 hospital load and mortality. Here, we aimed to study if mortality of hospitalized COVID-19 patients was associated with the COVID-19 admission rate during a full year of the pandemic in Sweden. Method Observational review of all patients admitted to hospital with COVID-19 in Sweden between March 2020 and February 2021 (n = 42,017). Primary outcome was 60-day all-cause mortality related to number of COVID-19 hospital admissions per month/100,000 inhabitants. Poisson regression was used to estimate the relative risk for death by month of admission, adjusting for pre-existing factors. Results The overall mortality was 17.4%. Excluding March 2020, mortality was clearly correlated to the number of COVID-19 admissions per month (coefficient of correlation rho=.96; p&amp;lt;.0001). After adjustment for pre-existing factors, the correlation remained significant (rho=.75, p=.02). Patients admitted in December (high admission rate and high mortality) had more comorbidities and longer hospital stays, and patients treated in intensive care units (ICU) had longer pre-ICU hospital stays and worse respiratory status on ICU admission than those admitted in July to September (low admission rate and low mortality). Conclusion Mortality in hospitalized COVID-19 patients was clearly associated with the COVID-19 admission rate. Admission of healthier patients between pandemic waves and delayed ICU care during wave peaks could contribute to this pattern. The study supports measures to flatten-the-curve to reduce the number of COVID-19 patients admitted to hospital.Funding Agencies|Swedens National Board of Health and Welfare</p

The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)

Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. Methods: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥ 80 years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30 days. Results: A total of 5021 patients with a median age of 84 years (IQR 81–86 years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥ 5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38–1.73) for frail versus non-frail. Conclusions: Among very old patients (≥ 80 years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group. Trial registration: ClinicalTrials.gov (ID: NCT03134807)

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study

Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p &lt; 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p &lt; 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p &lt; 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival

Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

PURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. RESULTS: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries. CONCLUSIONS: The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NTC03134807)