Rural general practice staff experiences of patient safety incidents and low quality of care in Norway: an interview study

Background and objectives General practitioners (GPs), nurses and medical secretaries (practice staff) are responsible for the continuous provision of safe care in rural general practice. Little is known about their role in situations where patients were or could have been harmed in a rural setting. Therefore, we sought to investigate rural general practice staff experiences of patient safety incidents and low quality of care. Methods Descriptive qualitative interviews using the critical incident technique. Systematic text condensation analysis involving GPs and practice staff in eight rural municipalities in Norway. Results Sixteen participants (eight GPs, one nurse and seven medical secretaries) with mean work experience of 11.8 years were interviewed for a total of 11.5 hours. We identified three main factors that make rural GP clinics vulnerable to patient safety incidents and low quality of care: use of locums, work overload and rough weather and distance to hospital. There was a wide range of patient safety incidents. The healthcare personnel explained how they used local knowledge about people and context and greater awareness of risk of error in order to prevent these incidents from happening. Conclusion Rural GP clinics that suffer from frequent use of GP locums and work overload are vulnerable to patient safety incidents. Practice staff use various forms of continuity of care to prevent safety incidents from happening; this highlights the strengths but also some major safety concerns in these GP clinics. Staff at these clinics proved to be a resource for patient safety research. Podcast An accompanying podcast on patient safety is available as Supplementary Data, in which Martin Bruusgaardf Harbitz and Per Stensland provide insights into the context of this study.publishedVersio

Medisinsk profesjonalitet: Mestring av legeyrket

When the doctor uses theoretical knowledge, clinical skills, and clinical communication in a way that takes care of the patient, this may be called professionalism. The article aims to show that medical professionalism, in all specialities, may be understood and taught through the two complex concepts “leadership” and “patient-centred medicine”.The article is built on a literature-search with a selection of articles based on the authors’ experience in the field.Leadership is an implicit part of clinical work. The concept gives a perspective on the solution of clinical problems and gives a frame for understanding interaction in consultations and in other professional relations. The doctor personal leadership actualizes professional tutoring as part of the education.Models for patient-centred medicine have emphasized the doctor’s attitudes, skills, and use of linguistic means, and they have deepened the doctor’s understanding for exploring the patient’s problem. Newer models also discuss the doctor’s actions and therapeutic actions and underscorethe leader-role in series of decision-making moments in the consultation. Patient-centred clinical work should be based on an understanding of the doctor as an active co-editor and co-producer of the patient’s illness narrative.Professionalism, interpreted as patient-centred leadership, gives a direction for medical education that may help doctors to cope with their work

Medisinsk profesjonalitet: Mestring av legeyrket

When the doctor uses theoretical knowledge, clinical skills, and clinical communication in a way that takes care of the patient, this may be called professionalism. The article aims to show that medical professionalism, in all specialities, may be understood and taught through the two complex concepts “leadership” and “patient-centred medicine”. The article is built on a literature-search with a selection of articles based on the authors’ experience in the field. Leadership is an implicit part of clinical work. The concept gives a perspective on the solution of clinical problems and gives a frame for understanding interaction in consultations and in other professional relations. The doctor personal leadership actualizes professional tutoring as part of the education. Models for patient-centred medicine have emphasized the doctor’s attitudes, skills, and use of linguistic means, and they have deepened the doctor’s understanding for exploring the patient’s problem. Newer models also discuss the doctor’s actions and therapeutic actions and underscorethe leader-role in series of decision-making moments in the consultation. Patient-centred clinical work should be based on an understanding of the doctor as an active co-editor and co-producer of the patient’s illness narrative. Professionalism, interpreted as patient-centred leadership, gives a direction for medical education that may help doctors to cope with their work.publishedVersio

Effects of tourist boats on the behaviour of Indo-Pacific bottlenose dolphins off the south coast of Zanzibar

The short-term effects of tourist boats on the behaviour of Indo-Pacific bottlenose dolphins Tursiops aduncus were investigated off the south coast of Zanzibar, Tanzania, by comparing dolphin group behaviour in the presence (impact) and absence (control) of tourist boats. Groupfollows were conducted from a carefully maneuvered (non-invasive) independent research vessel and behavioural data on group activity were collected using scan sampling methods. By using a timediscrete Markov chain model, the transition probabilities of passing/changing from one behavioural state to another were calculated and compared between impact and control situations. The data were further used to construct behavioural budgets. In the presence of tourist boats, dolphins were less likely to stay in a resting or socialising activity but were more likely to start travelling or foraging, as inferred from the Markov chain model. The behavioral budgets showed that foraging, resting and socialising all decreased as an effect of tourist boat presence, while travelling increased. The behavioural responses are likely to have energetic implications, mainly by increasing physical demands. Further, the results demonstrate that the current level of tourism intensity off the south coast of Zanzibar affects the dolphins' cumulative behavioural budget. Regulations on dolphin tourism are therefore urgently needed to minimise potential long-term negative effects on the dolphins

Combined prompt gamma activation and neutron diffraction analyses of historic metal objects and limestone samples

Two non-destructive neutron techniques have been used for the analysis of archaeological objects, among them English monumental brass plates, Dutch tin-lead spoons, a Roman leaded bronze fibula and several limestone samples. Prompt Gamma Activation Analysis (PGAA) is a non-destructive method for determination of the major and trace element compositions of various archaeological materials. Time-Of-Flight Neutron Diffraction (TOF-ND), on the other hand, is a non-invasive diagnostic tool for obtaining structural information from ceramic and metal objects. The element information (PGAA) holds the key information for addressing questions of provenance and authentication, whereas the structure information (TOF-ND) addresses questions of ancient materials and making techniques. Here we present data from those two complementary neutron methods, applied to different types of materials and artefacts, in order to highlight commonalities and differences

Case stories in general practice: a focus group study

Objectives: To explore the interactive process of sharing case stories in small-group activity in general practice. Design: Qualitative focus group study. Setting: Peer-group meetings of doctors attending specialist training or continuous medical education in general practice. Participants: Twenty female and 30 male doctors working in general practice in Norway. Results: The storyline of case presentations included detailed stories with emotional engagement, coauthored by other group members. The stories initiated discussions and reflections concerning patients’ and doctors’ perspectives, medical ethics as well as clinical problems. The safe atmosphere allowed testing out boundaries of socially shared knowledge. Conclusions: Sharing case stories in small groups in general practice initiated interaction that facilitated meaning-making, reflection and peer support

A qualitative study of physicians’ and nurses’ experiences of multidisciplinary collaboration with pharmacists participating at case conferences

Objectives: previous studies have revealed a range of drug-related problems for nursing home and hospital patients. Different attempts to reduce drug-related problems have been tested. Medication reviews performed by pharmacists and subsequent presentation of findings at case conferences is one of these methods. Physicians’ and nurses’ experiences from multidisciplinary collaboration with pharmacists have to a lesser degree been investigated. This study aims to describe how Norwegian physicians and nurses experience collaborating with pharmacists at case conferences to reduce drug-related problems in elderly patients. Methods: this was a qualitative interview study using systematic text condensation. The setting was nursing homes (long-term care) and hospital wards (gerontology and rheumatology). Four physicians and eight nurses participated and the main outcome was physicians’ and nurses’ experiences of multidisciplinary collaboration with pharmacists. Key findings: organizational problems were experienced including, among others, what professional contribution team members could expect from pharmacists and what professional role the pharmacist should have in the multidisciplinary team. Both professions reported that ambiguities as to when and if the pharmacist was supposed to attend their regular meetings resulted in some aggravation. On the other hand, the participants valued contributions from pharmacists with regard to pharmaceutical skills, and felt that this raised awareness on prescribing quality. Conclusions: physicians and nurses valued the pharmacists’ services and reported that this collaboration improved patients’ drug therapy. However, before implementing this service in nursing homes there is a need to make an organizational framework for this collaboration to support the professional role of the pharmacist