Acceptability of restrictions in the COVID-19 pandemic: a population-based survey in Denmark and Sweden

IntroductionDenmark and Sweden initially adopted different responses to the COVID-19 pandemic although the two countries share many characteristics. Denmark responded swiftly with many mandatory restrictions. In contrast, Sweden relied on voluntary restrictions and a more “relaxed” response during the first wave of the pandemic. However, increased rates of COVID-19 cases led to a new approach that involved many more mandatory restrictions, thus making Sweden’s response similar to Denmark’s in the second wave of the pandemic.AimThe aim was to investigate and compare the extent to which the populations in Denmark and Sweden considered the COVID-19 restrictions to be acceptable during the first two waves of the pandemic. The study also aimed to identify the characteristics of those who were least accepting of the restrictions in the two countries.Materials and methodsCross-sectional surveys were conducted in Denmark and Sweden in 2021. The study population was sampled from nationally representative web panels in the two countries, consisting of 2,619 individuals from Denmark and 2,633 from Sweden. The questionnaire captured key socio-demographic characteristics. Acceptability was operationalized based on a theoretical framework consisting of seven constructs and one overarching construct.ResultsThe respondents’ age and gender patterns were similar in the two countries. The proportion of respondents in Denmark who agreed with the statements (“agree” alternative) that captured various acceptability constructs was generally higher for the first wave than the second wave of the pandemic. The opposite pattern was seen for Sweden. In Denmark, 66% in the first wave and 50% in the second wave were accepting of the restrictions. The corresponding figures for Sweden was 42% (first wave) and 47% (second wave). Low acceptance of the restrictions, defined as the 25% with the lowest total score on the seven acceptability statements, was associated with younger age, male gender and lower education levels.ConclusionRespondents in Sweden were more accepting of the restrictions in the second wave, when the country used many mandatory restrictions. In contrast, respondents in Denmark were more accepting of the restrictions in the first wave than in the second wave, implying an increased weariness to comply with the restrictions over time. There were considerable socio-demographic differences between those who expressed low acceptance of the restrictions and the others in both countries, suggesting the importance of tailoring communication about the pandemic to different segments of the population

Implementing a new Emergency Department: A qualitative study of health professionals\u27 change responses and perceptions

BACKGROUND: The aim of the study is two-fold. It explores how managers and key employees at the Emergency Department (ED) and specialist departments in a university hospital in the Capital Region of Denmark respond to the planned change to a new ED, and how they perceive the change involved in the implementation of the new ED. The study investigates what happens when health professionals are confronted with implementation of policy that changes their organization and everyday work lives. Few studies provide in-depth investigations of health professionals\u27 reactions to the implementation of new EDs, and particularly how they influence the implementation of a nationwide organizational change framed within a political strategy. METHODS: The study used semi-structured individual interviews with 51 health professionals involved in implementation activities related to an organizational change of establishing a new ED with new patient pathways for acutely ill patients. The data was deductively analyzed using Leon Coetsee\u27s theoretical framework of change responses, but the analysis also allowed for a more inductive reading of the material. RESULTS: Fourteen types of responses to establishing a new ED were identified and mapped onto six of the seven overall change responses in Coetsee\u27s framework. The participants perceived the change as particularly three changes. Firstly, they wished to create the best possible acute patient pathway in relation to their specialty. Whether the planned new ED would redeem this was disputed. Secondly, participants perceived the change as relocation to a new building, which both posed potentials and worries. Thirdly, both hopeful and frustrated statements were given about the newly established medical specialty of emergency medicine (EM), which was connected to the success of the new ED. CONCLUSIONS: The study showcases how implementation processes within health care are not straightforward and that it is not only the content of the implementation that determines the success of the implementation and its outcomes but also how these are perceived by managers and employees responsible for the process and their context. In this way, managers must recognize that it cannot be pre-determined how implementation will proceed, which necessitates fluid implementation plans and demands implementation managements skills

Flowkulturs betydning for sygeplejerskers brug af evidensbaseret viden

DANSK ABSTRAKTBaggrund: Inden for implementeringsforskningen ses en stigende anerkendelse af relevansen af den organisatoriske kontekst og kulturen, som faktorer der påvirker implementeringen af evidensbaseret viden og herunder en evidensbaseret sygepleje.Formål: Gennem et kulturhistorisk aktivitetsteoretisk perspektiv i (Cultural Historical Activity Theory), var formålet med studiet, at undersøge hvordan organisationskulturen i en akutmodtagelse i Danmark havde indflydelse på sygeplejerskernes prioriteringer med hensyn til brugen af evidensbaseret viden, herunder brugen af screeninger og retningslinjer.Metoder: Studiet blev udført som et etnografisk studie baseret på feltarbejde og semi-strukturerede interviews. Førsteforfatter fulgte de sundhedsprofessionelle igennem en periode på tre måneder i en akutmodtagelse på et af Region Hovedstadens hospitaler. Efterfølgende blev afholdt 14 semi-strukturerede interviews. Unde feltstudiet blev 34 forskellige sundhedsprofessionelle fulgt, repræsenteret ved læger, sygeplejersker og lægesekretærer.  Resultater: På baggrund af en kulturanalyse blev begrebet flow kultur udviklet. En flow kultur forstås som et system af kollektive handlinger, som de sundhedsprofessionelle udfører i akutmodtagelsen. Disse handlinger er prioriterede i forhold til at indfri nogle samfundsmæssige og institutionelle krav og behov om at sikre ledige senge, så der kan opretholdes et konstant flow af patienter igennem afdelingen. De handlinger de sundhedsprofessionelle udfører, skaber et netværk af relationer og forbindelser, som bliver styrende for, hvordan de erfarne sundhedsprofessionelle handler, men også styrende for implementeringen af screeninger og retningslinjer. ENGELSK ABSTRACTBackground: Within the field of implementation science there is an increasing recognition of the relevance of organizational context and culture, i.e. influences beyond the individual level, for successful implementation of evidence-based nursing practices.Aim: Applying the Cultural Historical Activity Theory (CHAT), the aim of this study was to explore how the organizational culture in an emergency department in Denmark influenced the nurses’ priorities with regard to the use of research.Methods: The study was designed as an ethnographic inquiry based on fieldwork and semi-structured interviews.  The first author followed nurses, medical secretaries and doctors over three months in the emergency department. Data were collected by means of semi-structured interviews. Results: Based on an activity system analysis, the concept of flow culture emerged. This culture is defined as a cultural–historical activity system, mediated by artefacts, in which the objective of the nursing staff is primarily to free up beds, thus ensuring a flow of patients.Conclusion:  A flow culture leads to a strong focus on securing vacant beds which impeded the nurses’ use of research in the everyday clinical practice

An Ethnographic study of unhealthy alcohol use in a Danish Emergency Department

BACKGROUND: Emergency Departments (EDs) are important arenas for the detection of unhealthy substance use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for unhealthy alcohol use has been used in some ED settings with funding support from external sources. However, widespread sustained implementation is uncommon, and research aimed at understanding culture as a determinant for implementation is lacking. This study aims to explore cultural practices concerning the handling of patients with unhealthy alcohol use admitted to an ED. METHODS: An ethnographic study was conducted in an ED in the Capital Region of Denmark. The data consists of participant observations of Health Care Professionals (HCPs) and semi-structured interviews with nurses. Data was collected from July 2018 to February 2020. A cultural analysis was performed by using Qualitative Content Analysis as an analytic tool. RESULTS: 150 h of observation and 11 interviews were conducted. Three themes emerged from the analysis: (1) Setting the scene describes how subthemes “flow,” “risky environment,” and “physical spaces and artefacts” are a part of the contextual environment of an ED, and their implications for patients with unhealthy alcohol use, such as placement in certain rooms; (2) The encounter presents how patients’ and HCPs’ encounters unfold in everyday practice. Subtheme “Professional differences” showcases how nurses and doctors address patients’ alcohol habits differently, and how they do not necessarily act on the information provided, due to several factors. These factors are shown in remaining sub-themes “gut-feeling vs. clinical parameters,” “ethical reasoning,” and “from compliance to zero-tolerance”; and (3) Collective repertoires shows how language shapes the perception of patients with unhealthy alcohol use, which may cause stigma and stereotyping. Subthemes are “occupiers” and “alcoholic or party animal?”. CONCLUSIONS: Unhealthy alcohol use in the ED is entangled in complex cultural networks. Patients with severe and easily recognizable unhealthy alcohol use—characterized by an alcohol diagnosis in the electronic medical record, intoxication, or unwanted behavior—shape the general approach and attitude to unhealthy alcohol use. Consequently, from a prevention perspective, this means that patients with less apparent unhealthy alcohol use tend to be overlooked or neglected, which calls for a systematic screening approach. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13722-021-00269-z

The challenge of involving old patients with polypharmacy in their medication during hospitalization in a medical emergency department:An ethnographic study

BACKGROUND: More than 70% of patients admitted to emergency departments (EDs) in Denmark are older patients with multimorbidity and polypharmacy vulnerable to adverse events and poor outcomes. Research suggests that patient involvement and shared decision-making (SDM) could optimize the treatment of older patients with polypharmacy. The patients become more aware of potential outcomes and, therefore, often tend to choose less medication. However, implementing SDM in clinical practice is challenging if it does not fit into existing workflows and healthcare systems. AIM: The aim was to explore the determinants of patient involvement in decisions made in the ED about the patient’s medication. METHODS: The design was a qualitative ethnographic study. We observed forty-eight multidisciplinary healthcare professionals in two medical EDs focusing on medication processes and patient involvement in medication. Based on field notes, we developed a semi-structured interview guide. We conducted 20 semi-structured interviews with healthcare professionals to elaborate on the findings. Data were analyzed with thematic analyses. FINDINGS: We found five themes (determinants) which affected patient involvement in decisions about medicine in the ED: 1) blurred roles among multidisciplinary healthcare professionals, 2) older patients with polypharmacy increase complexity, 3) time pressure, 4) faulty IT- systems, and 5) the medicine list as a missed enabler of patient involvement. CONCLUSION: There are several barriers to patient involvement in decisions about medicine in the ED and some facilitators. A tailored medication conversation guide based on the SDM methodology combined with the patient’s printed medicine list and well-functioning IT- systems can function as a boundary object, ensuring the treatment is optimized and aligned with the patient’s preferences and goals

Is Promotion of Mobility in Older Patients Hospitalized for Medical Illness a Physicians Job? - An Interview Study with Physicians in Denmark

The aim of this study was to identify the most common barriers and facilitators physicians perceive regarding their role in the promotion of mobility in older adults hospitalized for medical illness as part of on an intervention to promote mobility. Twelve physicians at two medical departments were interviewed face-to-face using semi-structed interviews based on the Theoretical Domains Framework. The physicians perceived barriers to promoting mobility were: the patients being too ill, the departments interior does not fit with mobility, a culture of bedrest, mobility not being part their job, lack of time and resources and unwillingness to accept an extra workload. The facilitators for encouraging mobility were enhanced cross-professional cooperation focusing on mobility, physician encouragement of mobility and patient independence in e.g., picking up beverages and clothes. The identified barriers and facilitators reflected both individual and social influences on physicians behaviors to achieve increased mobility in hospitalized older medical patients and suggest that targeting multiple levels is necessary to influence physicians propensity to promote mobility.Funding Agencies|Velux Foundations [F-21835-01-04-03]; Association of Danish Physiotherapists [PD-2018-30-10]; Capital Region of Denmark [P-2018-2-11]</p

Challenges facing the clinical adoption of a new prognostic biomarker:A case study

In this article we show how a particular biomarker comes into being in an emergency department in a hospital in Copenhagen, Denmark. We explore the contextual becoming of this biomarker, suPAR, through interviews and relational ontology. We find that as a prognostic biomarker suPAR is challenged in its becoming as an object for clinical practice in the emergency department by the power of diagnostic practices that create a desire for experience-based scripts that quickly enable the clinician to reach the right diagnosis to form patient pathways. We discuss how the becoming of suPAR is strengthened through enactments of specificity and engagement in triage strategies and we reflect on its becoming through new diagnostic practices with the need to accommodate diagnostic ambiguity, which characterizes the majority of patients with complex health issues arriving at this emergency department.In this article, we show how a particular biomarker comes into being in an emergency department in a hospital in Copenhagen, Denmark. We explore the contextual becoming of this biomarker, suPAR, through interviews with nurses and physicians and through relational ontology. We find that as a prognostic biomarker suPAR is challenged in it becoming as an object for clinical practice in the emergency department by the power of diagnostic practices and the desire for experience-based scripts that quickly enable the clinician to reach the right diagnosis. Although suPAR is enacted as a promising triage strategy suggesting a low or high risk of disease, the inability to rule out specific diagnoses and producing the notion of secure clinical actions make its non-specificity and prognostic character problematic in clinical practices. Specific diagnostic criteria versus prognostic interpretation and non-specificity risk profiling challenges the way healthcare workers in an emergency depart-ment understand the tasks they are set to solve and how to solve them. We discuss how the becoming of suPAR is strengthened through enactments of specificity and engagement in triage strategies and we reflect on it’s becoming through new diagnostic practices with the need to accommodate diagnostic ambiguity

Disentangling the complexity of mobility of older medical patients in routine practice: An ethnographic study in Denmark

Aim Many older medical patients experience persistent functional limitations after hospitalization, such as dependency in activities of daily living, recurring fall incidents and increased mortality. Therefore, increased activity and mobilization during hospitalization are essential to prevent functional decline in older medical patients. No previous studies have explored how the social context influences how health professionals decide whether or not to mobilize patients. This qualitative study aimed to explore how social contextual circumstances affect the mobility of older medical patients in medical departments. Methods An ethnographic field study was conducted in six medical departments in three public hospitals in the capital region of Copenhagen, Denmark. Participant observations were carried out from January to June 2017. The researchers were present for up to 14 days (range, 8-14 days) in the six departments. A total of 210 pages of field notes were produced. The participants were health professionals involved in the care of older medical patients: physiotherapists, registered nurses, nursing assistants and physicians. A content analysis was conducted. Findings Five themes concerning mobility of patients emerged: (1) materialities; (2) professional roles; (3) encouraging moments; (4) patients and relatives; and (5) organization and management. Of these, professional roles seem to be the most important because it pervaded all themes. Different health professionals in the medical departments recognized, spoke and acted based on different cultural models. Conclusion It was found that mobility of older medical patients is entangled in a complex network of social contextual circumstances. Mobility of older medical patients is based on health professionals different cultural models, which shape distinct professional identities and lead to contradictions and blurring of the priorities and responsibilities among the health professionals involved in mobilization. The consequence is that no profession "owns" the responsibility for mobilization, thus restricting mobilization of the patients during hospitalization.Funding Agencies|Velux Foundation (Lauritz William Foundation) [00013449]</p

Co-designing implementation strategies for the WALK-Cph intervention in Denmark aimed at increasing mobility in acutely hospitalized older patients : a qualitative analysis of selected strategies and their justifications

Background: Selecting appropriate strategies to target barriers to implementing interventions represents a considerable challenge in implementation research and practice. The aim was to investigate what categories of implementation strategies were selected by health care practitioners and their managers in a co-design process and how they justified these strategies aimed at facilitating the implementation of the WALK-Cph intervention. Methods: The study used a qualitative research design to explore what implementation strategies were selected and the justifications for selecting these strategies. Workshops were used because this qualitative method is particularly well suited for studying co-design processes that involve substantial attention to social interaction and the context. Data were 1) analyzed deductively based on the Proctor et al. taxonomy of implementation strategies, 2) categorized in accordance with the ERIC compilation of implementation strategies by Powell et al., and 3) analyzed to examine the justification for the selected strategies by the Proctor et al. framework for justifications of implementation strategies. Results: Thirteen different types of implementation strategies were chosen across two hospitals. The deductive analysis showed that selection of implementation strategies was based on pragmatic and theoretical justifications. The contents of the two types of justifications were thematized into nine subthemes. Conclusion: This study contributes with knowledge about categories and justification of implementation strategies selected in a co-design process. In this study, implementation strategies were selected through pragmatic and theoretical justifications. This points to a challenge in balancing strategies based on practice-based and research-based knowledge and thereby selection of strategies with or without proven effectiveness.Funding Agencies|Velux FoundationsVelux Fonden [F-21835-0104-03]; Association of Danish Physiotherapists [PD-2018-30-10]; Capital Region of Denmark [P-2018-2-11]</p