Attractive Work : Nurses´ work in operating departments, and factors that make it attractive

Background: Previous studies show that nurse retention is one of the most effective strategies to counteract nursing shortages. Few studies have focused on the crucial resource of registered specialist nurses in operating departments. Aim: The overall aim of this thesis was to gain knowledge on registered specialist nurses’ and assistant nurses’ work in operating departments and on what factors they consider to be important for attractive work. Methods: In Study I, operating room nurses were interviewed regarding their perspective on their work. In Studies II and III, specialist registered nurses and assistant nurses at operating departments in a Swedish county council responded to the Attractive Work Questionnaire. Study IV is a case study with interviews, a review of organisational goal documents and data concerning the number of planned, acute and cancelled operations. Findings: The adaption of the Attractive Work Questionnaire for nurses in operating departments was satisfying. The most important factors for attractive work were: Relationship, Leadership and Status. The factors with the largest discrepancies between their important to work attractiveness and their rating at the nurses’ current work were: Salary, Organisation and Physical Work Environment. It was important for nurses to be able to prepare for and be in control of the different work tasks. However, the daily operating schedule guided the nurses’ work, and changes in the schedule, nurse shortages and the design of the premises constituted obstacles to their work. Conclusion: The Attractive Work Questionnaire provided specific information to management on what to focus on to make work attractive. The majority of the identified attractive factors are already known to be of importance in nurse retention; however, factors requiring more investigation are Equipment, Physical Work Environment and Location (of the workplace). Their work prerequisites did not enable the specialist and assistant nurses to reach what they saw as their daily goals. Regularly occurring activities, such as acute and cancelled operations, were interpreted as obstacles to reaching daily goals

Arbetsklimatets betydelse för kriminalvårdares arbetsrelaterade attityder

För att bättre förstå vad som leder till frånvaro och frivilliga avgångar inom kriminalvården är det aktuellt att undersöka vilka faktorer som påverkar dessa beteenden. Syftet med denna studie var att undersöka vad ett antal faktorer i arbetsklimatet betydde för individers arbetsrelaterade attityder. Vidare undersöktes om effekterna av klimatvariablerna på attityden intention till uppsägning medierades av de arbetsrelaterade attityderna. Deltagare i undersökningen var kriminalvårdare (N = 90) på en anstalt i Norrtälje. Sammanfattningsvis tyder resultatet på att det varierade vilka klimatfaktorer som kunde predicera de olika attityderna. Arbetstrivsel och lönetillfredsställelse visade sig vara de viktigaste faktorerna för att predicera attityden intention till uppsägning. För att reducera negativa beteenden och frivillig avgång inom kriminalvården bör tillgång till medbestämmande, lärande och kompetensutveckling samt feedback ökas, samtidigt som måloklarheten reduceras

Arbetsklimatets betydelse för kriminalvårdares arbetsrelaterade attityder

För att bättre förstå vad som leder till frånvaro och frivilliga avgångar inom kriminalvården är det aktuellt att undersöka vilka faktorer som påverkar dessa beteenden. Syftet med denna studie var att undersöka vad ett antal faktorer i arbetsklimatet betydde för individers arbetsrelaterade attityder. Vidare undersöktes om effekterna av klimatvariablerna på attityden intention till uppsägning medierades av de arbetsrelaterade attityderna. Deltagare i undersökningen var kriminalvårdare (N = 90) på en anstalt i Norrtälje. Sammanfattningsvis tyder resultatet på att det varierade vilka klimatfaktorer som kunde predicera de olika attityderna. Arbetstrivsel och lönetillfredsställelse visade sig vara de viktigaste faktorerna för att predicera attityden intention till uppsägning. För att reducera negativa beteenden och frivillig avgång inom kriminalvården bör tillgång till medbestämmande, lärande och kompetensutveckling samt feedback ökas, samtidigt som måloklarheten reduceras

Theatre Nurses Understanding of their Work : A phenomenographic study at a hospital theatre

The operating theatre is a place where people work together in a multidisciplinary team. It has a very high patient through-put, and use of advanced technology and surgical routine. Working in an operating theatre has been described as dynamic and challenging. The nurse’s perspective of her/his practice role in the operating theatre department is poorly identified, a fact that makes it necessary for the theatre nurses themselves to define their role as nurses in the multidisciplinary team. The aim of this study was to begin the work of describing the theatre nurses’ work using a qualitative descriptive design with a phenomenographic approach. A purposeful sample from two hospitals in Sweden was employed to select the 15 theatre nurses, the interviews formed the basis of this study. As in several other phenomenographic studies three specific questions guided the data collection: What aspect of your practice do you find the easiest? What aspect of your practice do you find the most challenging? What do you think is the most important aspect of your practice? To deepen the interview, what and how questions were used to probe the responses. The interviews were audio-taped and transcribed verbatim. The interviews were read several times, after which an analysis was undertaken. The analysis revealed the following three understandings of the phenomenon of “the work of the theatre nurse”: Theatre nurses achieve control of the situation referred to having the appropriate equipment prepared in advance for the operation, the hygienic aspect, for example keeping the operation area, surgical instruments and people involved sterile, and to control patient, instrument and implant logistics by advance planning and being one step ahead. The possibility of good teamwork is enhanced by being attentive to the spoken and unspoken wishes and needs of the patient as well as all members of the team, especially the surgeon; and Theatre nurses develop their professional practice through practical experience. All three understandings that emerged in present study are useful for both competence development and quality improvement.

Theatre Nurses Understanding of their Work : A phenomenographic study at a hospital theatre

The operating theatre is a place where people work together in a multidisciplinary team. It has a very high patient through-put, and use of advanced technology and surgical routine. Working in an operating theatre has been described as dynamic and challenging. The nurse’s perspective of her/his practice role in the operating theatre department is poorly identified, a fact that makes it necessary for the theatre nurses themselves to define their role as nurses in the multidisciplinary team. The aim of this study was to begin the work of describing the theatre nurses’ work using a qualitative descriptive design with a phenomenographic approach. A purposeful sample from two hospitals in Sweden was employed to select the 15 theatre nurses, the interviews formed the basis of this study. As in several other phenomenographic studies three specific questions guided the data collection: What aspect of your practice do you find the easiest? What aspect of your practice do you find the most challenging? What do you think is the most important aspect of your practice? To deepen the interview, what and how questions were used to probe the responses. The interviews were audio-taped and transcribed verbatim. The interviews were read several times, after which an analysis was undertaken. The analysis revealed the following three understandings of the phenomenon of “the work of the theatre nurse”: Theatre nurses achieve control of the situation referred to having the appropriate equipment prepared in advance for the operation, the hygienic aspect, for example keeping the operation area, surgical instruments and people involved sterile, and to control patient, instrument and implant logistics by advance planning and being one step ahead. The possibility of good teamwork is enhanced by being attentive to the spoken and unspoken wishes and needs of the patient as well as all members of the team, especially the surgeon; and Theatre nurses develop their professional practice through practical experience. All three understandings that emerged in present study are useful for both competence development and quality improvement.

Nurses’ Perceptions of Patient Safety in Community Mental Health Settings : A Qualitative Study

Mental health care has moved from hospital settings to community mental health settings, and there is a need to explore the perceptions of patient safety among registered nurses working in this field. Patient safety is to include everyone and to be the goal in all aspects of health care. The aim of the study was to explore registered nurses’ perceptions of patient safety in community mental health settings for people with serious mental illness. The study was qualitative and descriptive in nature and interviews were carried out during spring 2012, with seven registered nurses working in community mental health settings for people with serious mental illness in five municipalities in the middle of Sweden. The sampling was purposive and data were analysed using qualitative content analysis. The findings showed that the registered nurses understood patient safety as providing support to people with serious mental illness in regaining and maintaining health through good treatment and respecting self-determination and avoiding coercion. The terms of daily living in small community mental health settings within the a large community health care organization, communication, sufficient knowledge of psychiatric disabilities among people in the residents’ network, and national laws and regulations, all had implications for patient safety. The registered nurses perceived patient safety as involving a wide range of issues that in other areas of care are more often discussed in terms of quality of care. Determining the boundaries of patient safety in community mental health settings for people with serious mental illness can be a first step in establishing workable routines that ensure safe patient care

Using pressure mapping intraoperatively to prevent pressure ulcers-A quasi-experimental study

Background and Aim: Patients undergoing surgery are at high risk of developing pressure ulcers. However, pressure ulcer prevention in the operating room department is demanding and restricted. New techniques, such as continuous pressure mapping that visualizes interface pressure, are now available. The aim of the study was to determine whether pressure mapping information of interface pressure intraoperatively leads to (1) more frequent intraoperative micro repositioning and a reduced amount of pressure on the sacrum area and (2) a lower frequency of pressure ulcer development. Methods: A quasi-experimental ABA design was used. A total of 116 patients undergoing surgery were included. During the B phase, the need to consider repositioning the patient according to interface pressure readings was initiated. Results: The result showed that there was significantly higher interface pressure in the A2 phase than in the B phase. Micro repositioning of the patient during surgery was performed in the B phase, but not in the A phase. The regression model showed that a higher BMI was associated with higher interface pressure. None of the patients developed hospital-acquired pressure ulcers up to Day 1 postoperatively. Conclusion: Pressure mapping involves moving away from expert opinion and tradition towards objective assessment and flexibility and we see the benefits of using pressure-mapping equipment in operating room contexts. However, more research is needed in this area

Swedish translation, cultural adaptation and psychometric evaluation of the pressure ulcer knowledge assessment tool for use in the operating room

The aim of this study was to psychometrically evaluate the Swedish operating room version of PUKAT 2.0. In total, 284 Swedish operating room nurses completed the survey of whom 50 completed the retest. The item difficulty P-value of 14 items ranged between 0.38 and 0.96 (median 0.65). Three items were found to be too easy (0.90-0.96). The D-value of 14 items ranged between 0.00 and 0.42 (median 0.46). Three items had a D-value lower than 0.20 (0.11-0.16) and eight items scored higher than 0.40 (0.45-0.61). The quality of the response alternatives (a-value) ranged between 0.00 and 0.42. This showed that nurses with a master's degree had a higher knowledge than nurses with a professional degree (respectively 9.4/14 versus 8.6/14; t = -2.4, df = 199, P = 0.02). The ICC was 0.65 (95% CI 0.45-0.78). The ICCs for the domains varied from 0.12 (95% CI = -0.16-0.39) to 0.59 (95% CI = 0.38-0.75). Results indicated that 11 of the original items contributed to the overall validity. However, the low participation in the test-retest made the reliability of the instrument low. An extended evaluation with a larger sample should be considered in order to confirm aspects of the psychometric properties of this instrument