O papel desempenhado pelos recursos humanos na produção de serviços de saúde e, particularmente, no campo da enfermagem merece atenção especial. Este estudo aborda a temática da gerência de recursos humanos tomando por referência a questão do dimensionamento de pessoal de enfermagem em um setor específico de atuação: o hospital. Trata-se de uma investigação na modalidade de estudo de caso cujo objetivo geral é dimensionar o quadro de pessoal de enfermagem para unidades de internação de um hospital universitário situado em um município do oeste do estado do Paraná. A metodologia adotada é aquela proposta por Gaidzinski (1998) que contempla a identificação de determinadas variáveis, às quais correspondem instrumentos específicos de coleta de dados. Para identificação do grau de dependência do paciente em relação ao cuidado de enfermagem, utilizou-se o Sistema de Classificação de Pacientes segundo Perroca (2000); para as horas médias de assistência de enfermagem e o percentual de cada categoria profissional adotou-se como parâmetro a Resolução COFEN nº 189/96; a definição do índice de absenteísmo bem como a equação para cálculo do quadro de pessoal foram desenvolvidas segundo a metodologia preconizada por Gaidzinski (1998). As unidades de internação estudadas foram aquelas em que a clientela atendida era composta por adultos (≥ 14 anos), nas especialidades de clínica médica e clínica cirúrgica. Do total de 62 leitos ativados nas três unidades de internação estudadas, foram classificados, diariamente durante 92 dias consecutivos, 72,5% dos leitos que correspondem a 4.135 pacientes/dia. Para os demais 27,5% dos leitos, a classificação não se efetivou devido à recusa do paciente em participar do estudo e outras ocorrências. Dos pacientes classificados, 9,4% requeriam cuidados intensivos, 14,6% cuidados semi-intensivos, 45,1% cuidados intermediários e 30,9% cuidados mínimos. Para as ausências previstas, o maior índice deve-se às folgas semanais, para as ausências não previstas o índice mais elevado ocorre devido às licenças médicas. Aplicando-se a equação de dimensionamento, obteve-se um quadro projetado de 28 enfermeiros e 48 auxiliares de enfermagem. Comparando-se o quadro existente com o projetado verifica-se que para a categoria enfermeiro, o quantitativo existente corresponde a 50% daquele previsto; para a categoria de auxiliares de enfermagem há um excedente de 29,2%. Diante do quadro reduzido de enfermeiros, levanta-se a hipótese de que determinadas ações de enfermagem inerentes a esse profissional estejam sendo desenvolvidas pelo pessoal de nível médio, sem um processo de supervisão que permita o desenvolvimento de um trabalho mais articulado e integrativo, resultando em uma assistência de enfermagem de melhor qualidade. Entende-se, ainda, que a adoção, pelos enfermeiros, de um sistema de classificação de pacientes em suas respectivas unidades, permitirá ampliar o conhecimento acerca da clientela atendida, suas reais necessidades, bem como o desenvolvimento de habilidades e competências que lhe assegurem assistir e gerenciar de um modo mais seguro, inovador, autônomo e participativo. / and particularly in the Nursing field, deserves special attention. This study approaches human resources management based on the dimensioning of nursing personnel in a specific sector of activity: the hospital. It is a case study whose goal is to dimension the nursing personnel for inpatient units at a university hospital located in a city of western Paraná state. The methodology adopted is that proposed by Gaidzinski (1998), as it contemplates the identification of certain variables to which specific data collection instruments correspond. In order to identify patients’ dependence in relation to nursing care, the Patient Classification System was used according to Perroca (2000); concerning the mean hours of nursing care and the percentage of each professional category, Resolution COFEN no. 189/96 was adopted as a parameter; the definition of absence rates as well as the equation used to calculate the staff were developed according to the methodology proposed by Gaidzinski (1998). The inpatient units under study were those in which the clients assisted consisted of adults (≥ 14 years old) in the specialties of medical clinic and surgical clinic. Of the total number of 62 activated beds in the three inpatient units under study, 72.5% of the beds were classified daily during a period of 92 consecutive days, which corresponds to 4.135 patients/day. As to the remaining 27.5% beds, classification was not conducted due to patients’ refusal to participate in the study and to other occurrences. Of the classified patients, 9.4% required intensive care, 14.6% semi-intensive care, 45.1% intermediate care and 30.9% minimum care. Concerning predicted absences, the highest rate was due to weekly work pauses whereas for non-predicted absences, the highest rate occurred as a result of sick leaves. The application of the dimensioning equation resulted in a staff consisting of 28 nurses and 48 nursing auxiliaries. By comparing the existing staff and the projected staff, it was observed that the number of working nurses corresponded to 50% of the predicted number whereas, in relation to nursing auxiliaries, there was an excess of 29.2%. In view of the reduced number of nurses, a hypothesis was made that certain nursing actions which are inherent to that professional category are being performed by nursing auxiliaries without a supervision process that would allow for the development of more articulated and integrative work, which would, in turn, result in better quality nursing care. It is also understood that the adoption, by nurses, of a patient classification system in their respective units will bring further knowledge concerning the clients assisted, their real needs as well as the development of skills and competencies that will enable them to provide care and manage their work in a more safe, innovative, autonomous and participant fashion.

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-11-09T17:36:02Z No. of bitstreams: 1 AnaElisaSáAntunesRibeiro_dissert.pdf: 805165 bytes, checksum: 7720adcb407cb6da50267edcda4ffc8b (MD5) / Made available in DSpace on 2018-11-09T17:36:02Z (GMT). No. of bitstreams: 1 AnaElisaSáAntunesRibeiro_dissert.pdf: 805165 bytes, checksum: 7720adcb407cb6da50267edcda4ffc8b (MD5) Previous issue date: 2018-03-09 / The aging process is a reality for most societies and it brings challenges. The elderly patients are more vulnerable to hospitalization and, as a consequence, the impact of this environment on their health. Given the high prevalence of the development of behavioral changes on this population, the psychiatrist plays an important role through Consultation Liaison Psychiatry (CLP). Few studies have evaluated the CLP service and its impact on the elderly inpatient population. Objectives: To characterize the clinical and socio-demographic profile of the hospitalized elderlies who needed CLP, allowing the identification of their characteristics and main psychiatric and clinical disorders. Methods: An observational, descriptive, cross-sectional study was carried out to analyze the CLP requests for elderly patients admitted at Hospital de Base of São José do Rio Preto from 2010 to 2014, using a semi-structured protocol. Data were analyzed by means of a descriptive statistics, with absolute and relative frequencies, as well as Chi-Square test. A value of p <0.05 was considered significant. Results: A total of 204 elderly individuals were evaluated at the CLP service in this period. The mean age was 70.27%, 55.4% were female, 43.6% were married, 92.69% had low schooling and the vast majority did not have paid work (94, 4%). The majority of the evaluations was requested by the medical clinic (38.7%), the main reasons for hospitalization were hypertensive diseases (11.76%). More than a half had a psychiatric history and used psychotropic drugs, especially benzodiazepines. Of these, 24.11% required hospitalization in the past. The most frequent reasons for requesting CLP were: difficulty in dealing with hospitalization (24.74%) and previous psychiatric illness (22.2%). Among psychiatric diagnoses, mood disorders were the most frequent, especially depressive disorders (44.89%). The majority of the patients evaluated by CLP service (60.78%) was treated with pharmacological procedures guided by the team. Conclusion: The increase of aging in association with the elderlies’ fragility makes hospital admissions rates and behavioral changes to this population more prevalent. The elderlies attended by the CLP service have common characteristics with other elderly people evaluated in national and international surveys. CLP can favor a closer relationship between physicians and the multidisciplinary team, thus providing a more appropriate approach and treatment for the elderly patients. The use of a semi-structured protocol for collecting information has added a deeper understanding of this population assisted as well as the medical service provided. Further comparisons can generate greater knowledge, refinement, and should be encouraged. / O processo de envelhecimento é uma realidade para a maioria das sociedades e traz desafios. O paciente idoso está mais vulnerável à hospitalização e, como consequência, ao seu impacto sobre a sua saúde. Diante da grande prevalência de alterações comportamentais nessa população internada, a atuação do psiquiatra por meio da Interconsulta psiquiátrica (IP) assume um papel importante. Poucos estudos têm avaliado o serviço de IP e o seu impacto na população idosa internada. Objetivos: Caracterizar o perfil clínico e sócio-demográfico de idosos hospitalizados que necessitaram de IP, possibilitando a identificação de suas características e principais transtornos psiquiátricos e clínicos. Métodos: Estudo observacional, descritivo, retrospectivo, de corte transversal no qual foram analisadas as solicitações de IP para idosos internados no Hospital de Base de São José do Rio Preto-SP nos anos de 2010 a 2014, por meio de protocolo semiestruturado. Os dados foram analisados através de estatística descritiva, com frequências absolutas e relativas, e também por meio do teste qui-quadrado. Um valor de p< 0,05 foi considerado significativo. Resultados: Foram avaliados 204 idosos pelo serviço de IP neste período. A média de idade foi de 70,27 anos; 55,4% eram do sexo feminino, 43,6% dos pacientes eram casados, 92,69% apresentavam baixa escolaridade e a grande maioria, 94,4% não exercia atividade remunerada. As avaliações foram solicitadas, em sua maior parte, pela equipe clínica médica (38,7%), sendo os principais motivos de internação as doenças hipertensivas (11,76%). Mais da metade apresentava antecedentes psiquiátricos e usava psicofármacos, especialmente, os benzodiazepínicos. Destes, 24,11% necessitaram de internação no passado. Os motivos mais frequentes de solicitação de IP foram: dificuldade em lidar com a internação (24,74%) e doença psiquiátrica prévia (22,2%). Entre os diagnósticos psiquiátricos, os transtornos de humor foram os mais frequentes, em especial, os transtornos depressivos (44,89%). A maioria dos pacientes avaliados pela IP (60,78%) foi tratada com condutas farmacológicas orientadas pela equipe. Conclusão: O aumento do envelhecimento em associação com as fragilidades do idoso tornam as taxas de internações hospitalares e de alterações comportamentais nessa população mais prevalentes. Os idosos atendidos pelo serviço de IP apresentam características comuns com outros idosos avaliados em pesquisas nacionais e internacionais. A IP pode favorecer o estreitamento da relação entre médicos e a equipe multidisciplinar, propiciando, assim, uma abordagem e tratamento adequados aos pacientes idosos. O uso de protocolo semiestruturado para coleta de informações contribuiu para o conhecimento mais profundo da população atendida e do serviço médico prestado. Comparações futuras podem gerar tanto maior conhecimento, quanto aperfeiçoamento e devem ser estimuladas.

Introdução. A terapia medicamentosa é uma intervenção terapêutica realizada com a finalidade de reduzir sofrimento, promover a cura e melhorar a saúde e qualidade de vida, entretanto, não é isenta de riscos. A ocorrência de erros de medicação é comum nas instituições hospitalares e pode afetar a segurança do paciente. A prevenção de erros de medicação tem sido reconhecida como uma prioridade para os serviços de saúde, visto que, esses eventos acarretam repercussões assistenciais, econômicas e sociais e são considerados crescentes problemas de saúde pública. Objetivo. Analisar a literatura sobre erros de prescrição de medicamentos ocorridos em pacientes adultos hospitalizados em unidades de clínica médica e cirúrgica. Método. Pesquisou-se nas bases de dados Medline/PubMed, IPA, Lilacs, Embase, Web of Science e Scopus para seleção de estudos com dados primários publicados em português, inglês e espanhol, entre janeiro de 1999 e dezembro de 2009. Foi utilizada como estratégia de busca os seguintes termos, medication error(s), medication order(s), prescribing error(s), prescription error(s), prescrição, hospital(s), medication system, inpatient(s), adult(s) e os resultados foram filtrados utilizando-se a expressão and. Resultados. Foram selecionadas 51 publicações. A análise revelou que 71% dos artigos não utilizaram nenhuma definição para determinar erro de prescrição, sendo que a definição proposta por DEAN e col. (2000) foi verificada em 22% das publicações. Diversos métodos de coleta de dados foram utilizados, entretanto, a revisão de prescrição/prontuário foi a técnica mais utilizada (51%) e o acompanhamento prospectivo foi empregado em 72% dos estudos. O farmacêutico foi o principal profissional envolvido na coleta de dados, em 41% das publicações e a prescrição manual foi o tipo de prescrição mais analisada, em 39% dos estudos. Os erros de dosagem (frequência, dose e omissão), erros administrativos (ilegibilidade, rasura e prescrição incompleta) e erros terapêuticos (interação medicamentosa, seleção de medicamento) foram considerados os tipos mais comuns de erros de prescrição. Observou-se que os erros de prescrição com gravidade leve e moderada apresentaram expressiva ocorrência, apesar da falta de uma padronização nas escalas de gravidade entre os estudos. A frequência de erros de prescrição variou de 1% a 62% por prescrição; 2,1% a 66,1% por medicamentos prescritos e 0,25 a 2,72 erros por 100 pacientes-dia. O denominador número de prescrições foi o mais utilizado em 41% dos artigos. As principais classes de medicamentos envolvidas foram cardiovasculares, antimicrobianos, analgésicos, psicoativos, gastrointestinais e respiratórios. Múltiplas causas foram associadas a erros de prescrição verificadas em 31% dos estudos, incluindo lapsos de memória e deslizes, excesso de trabalho, falta de comunicação, conhecimento inadequado sobre medicamento. A implantação de prescrição eletrônica com suporte de decisão clínica e introdução de farmacêutico clínico foram as principais estratégias para redução dos erros destacadas em 47% e 27% dos estudos analisados, respectivamente. Conclusão. A literatura apresenta uma diversidade de definições e métodos para detecção de erros de prescrição, o que pode influenciar na variabilidade das taxas de ocorrência de erros de prescrição. Não foi observada diferença na frequência de erro em relação ao tipo de prescrição (manual ou eletrônica). Apesar de algumas publicações referirem que erros de prescrição são os tipos mais graves que ocorrem com a utilização de medicamentos, observou-se nesta revisão, que os erros de gravidade leve e moderada foram relatados com maior frequência. Como os erros de prescrição estão associados a múltiplas causas, faz-se necessária a implantação de intervenções multifatoriais nas diversas etapas do sistema de uso de medicamentos para ajudar na prevenção ou minimização do impacto dos erros. / Introduction. Drug therapy is a therapeutic intervention performed in order to reduce suffering, promote healing and improve health and quality of life, however, is not without risks. The occurrence of medication errors in hospitals is common and can affect patient safety. Prevention of medication errors has been recognized as a priority for health services, since these events cause important impact in terms of hospital stay, social factors and financial costs and is considered public health issue. Objective. Analyze the literature on prescribing errors in adult patients hospitalized in a medical and surgery units. Method. Medline/PubMed, IPA, Lilacs, Embase, Scopus and Web of Science were searched to select studies using primary data published in Portuguese, English and Spanish between January and December 2009. The following terms were used as a strategy to search: \"medication error (s)\", \"medication order (s)\", \"prescribing error (s)\", \"prescription error (s)\", \"prescription\", \"hospital (s ) \",\" medication system; \"inpatient (s), \" adult (s)\" and the results were filtered using the expression \"and\". Results. In total, 51 publications were selected. The analysis revealed that 71% of articles did not use any setting to determine prescribing error, and the definition proposed by Dean et al. (2000) was detected in 22% of publications. Several methods of data collection were used, however, review of prescription or medical record is the most widely used technique (51%) and prospective monitoring was used in 72% of studies. The pharmacist was the primary professional involved in data collection in 41% of publications and prescription manual was the most studied type of prescription in 39% of studies. The dosage errors (frequency, dosage and omission), administrative errors (illegible and incomplete prescription) and therapeutic errors (drug-drug interaction, indication) were considered the most common types of prescription errors. It was observed that the prescribing errors of mild to moderate severity, showed a significant occurrence, despite the lack of standardization in the scales of severity among the studies. The frequency of prescription errors ranged from 1% to 62% per prescription, 2.1% to 66.1% for prescription drugs and from 0.25 to 2.72 errors per 100 patient-days. The denominator number of prescriptions was the most used in 41% of articles. The main drug classes involved were cardiovascular, antibiotics, analgesics, psychoactive drugs, gastrointestinal and respiratory. Multiple causes associated with prescription errors were found in 31% of studies, including memory lapses and slips, overwork, lack of communication, inadequate knowledge about medicine. The implementation of electronic prescribing with clinical decision support and introduction of clinical pharmacist were the main strategies for reducing errors highlighted in 47% and 27% of the studies analyzed, respectively. Conclusion. The literature shows a variety of definitions and methods for detecting prescription errors, which may influence the variability of rates of occurrence of prescription errors. No difference was observed in the frequency error in the type of prescription (manual or electronic). Although some publications refer to prescription errors are the most serious types that occur with medication use, it was observed in this review, that errors of mild and moderate severity were reported more often. Like all prescription errors are associated with multiple causes, it is necessary to implement a multifactorial interventions at different stages of the system of drug use to help prevent or minimize the impact of errors.

The present thesis was carried out in part fulfilment of the Doctorate in Clinical Psychology at the University of Edinburgh. It is presented in portfolio format, comprising of two individual papers although a total thesis abstract provides an overview of the entire thesis. The first paper is a systematic review of existing empirical research. It explores the predictive validity of risk assessment tools for imminent (short-term) violence and aggression in forensic psychiatric settings. The second paper is an empirical study exploring how frontline nursing staff both predict and emotionally cope with experiencing violence and aggression in a high-security setting. Paper one was prepared for Aggression and Violent Behavior and paper two for The International Journal of Forensic Mental Health; so, follow their respective author guidelines. Mental health, and forensic mental health nurses have been identified as being at particular risk of experiencing patient perpetrated violence and aggression (PPVA). There is relatively little research investigating how nursing staff predict and cope with more immediate, imminent inpatient violence and aggression, specifically within secure (forensic) settings. Negative outcomes of PPVA are widely accepted and demonstrated within empirical literature, including increased anxiety and stress for staff, fractures to the therapeutic relationship between patients and staff, and difficulties with staff retention and absenteeism for the organization. Due to the extensive negative outcomes associated with PPVA, a wealth of research has focused on developing the area of violence risk assessment. Despite this, there remains limited understanding regarding the utility of existing risk assessment tools for predicting and assessing violence risk over brief time frames (i.e. days to weeks). Therefore, a systematic review was conducted to explore the predictive validity of violence risk assessment tools for imminent, short-term risk in inpatient forensic psychiatric settings. Findings demonstrated that multiple tools had decent predictive validity, however quality scores were impacted by small sample sizes. The Dynamic Appraisal of Situational Aggression- Inpatient Version was the most effective tool with the highest mean quality score. The main limitations were the small number of studies assessing some of the included tools and the level of ambiguity between studies regarding the definition of imminent, short-term violence. Developing a shared understanding of what constitutes short-term risk and improving the number and quality of studies on the largely neglected tools, should therefore be research priorities. How nurses actually recognize and predict inpatient violence and aggression in forensic psychiatric settings, and how they emotionally cope with the aftermath, are poorly explored and understood processes. A social constructivist grounded theory approach was used to analyze the transcripts from 12 interviews with frontline nursing staff from an inpatient high-security setting. A model was constructed integrating nurses' beliefs and assumptions about subtypes of violence, their efforts to use observation skills in order to aid risk prediction, and their resultant emotional experiences following PPVA. Nurses emotional coping seemed to be affected by several factors relating to the culture of the organization and the accessibility of support. Seemingly, knowing the patient helped nurses to better identify underlying needs leading to violent behavior. This understanding helped nurses to implement targeted, needs-led interventions to address these unmet needs, and so reduce recurrent and cyclical violence. Recommendations are made to build upon, and utilize nursing skills in risk prediction and management, and to help better support the emotional impact of experiencing PPVA within forensic psychiatric settings.

There is growing awareness of the benefits of rehabilitation both in Australia and overseas. While the provision of rehabilitation services is not new, recognition of this type of health service as an integral part of health care has been linked to changes in the provision of acute care services, advances in medical technology, improvements in the management of trauma and an ageing population. Despite this, little attention has been paid to nursing's contribution to patient rehabilitation in Australia. The aim of this grounded theory study, therefore, was to collect and analyse nurses' reports of their contributions to patient rehabilitation and to describe and analyse contextual factors influencing that contribution. Data were collected during interviews with registered and enrolled nurses working in five inpatient rehabilitation units in New South Wales and during observation of the nurses' everyday practice. A total of 53 nurses participated in the study, 35 registered nurses and 18 enrolled nurses. Grounded theory, informed by the theoretical perspective of symbolic interactionism, was used to guide data analysis, the ongoing collection of data and the generation of a substantive theory. The findings revealed six major categories. One was an everyday problem labelled incongruence between nurses' and patients' understandings and expectations of rehabilitation. Another category, labelled coaching patients to self-care, described how nurses independently negotiated the everyday problem of incongruence. The remaining four categories captured conditions in the inpatient context which influenced how nurses could contribute to patient rehabilitation. Two categories, labelled segregation: divided and dividing work practices between nursing and allied health and role ambiguity, were powerful in shaping nursing's contribution as they acted individually and synergistically to constrain nursing's contribution to patient rehabilitation. The other two categories, labelled distancing to manage systemic constraints and grasping the nettle to realise nursing's potential, represent the mutually exclusive strategies nurses used in response to segregation and role ambiguity. From exploration of the relationship between the six categories, the core category and an interactive grounded theory called opting in and opting out emerged. In turn, this grounded theory reveals nursing's contribution to inpatient rehabilitation as well as contextual conditions constraining that contribution. The significance of these findings is made manifest through their contribution to the advancement of nursing knowledge and through implications for nursing practice and education, rehabilitation service delivery and research.

The objective of this study was to explore inpatients’ opinions on their hospital paper medical records after they had incidental access to them. One hundred inpatients in the C.T. department at St. Michael's Hospital were surveyed: 65 patients who read their records and 35 who did not. Overall, 75.4% of readers found their records easy to understand, and most found their records correct, complete and did not find anything unexpected or distressing. Seventy-nine percent of all respondents would trust the hospital, approximately half would trust Google Health or Microsoft Healthvault and 5.6% would trust Facebook to provide online medical records. Being female, under 60 years and having a higher education predicted readership. Younger patients were also more likely to think that accessing their records would help decrease errors. Patients with higher education were more likely to find their records useful and trusted the hospital to provide online medical records.

While depression and psychopathy have long been believed to be mutually exclusive traits, a number of MMPI-2 studies have found relatively high correlations between the original Depression and Psychopathic Deviate Scales. This high degree of covariation might be accounted for by the often observed result that all of the basic nine scales of the MMPI-2 are saturated with a general negative affect factor called demoralization. Recently, a series of studies were completed in which this demoralization factor was extracted from the original basic nine scales and they were restructured such that they would each be a more "pure" measure of the clinical dimensions they were intended to assess. These new scales are called the Restructured Clinical (RC) Scales. The major purpose of this study was to examine the items found on the original Depression and Psychopathy Scales for multidimensionality and item overlap, and to compare these scales with their RC counterparts. It was assumed that there would be little if any covariation of the RC Depression and RC Psychopathic Deviate Scales as has been found with the original Depression and Psychopathic Deviate Scales. A factor analysis of the items from each scale was done. Results showed that the original scales indeed had significant item overlap as well as multidimensionality. In addition, the new RC Scales were shown to be much purer in their measurement of their respective constructs. This study provides strong support for the practice of including at least these two scales in the clinical assessment of depression and psychopathy. It would appear that these restructured scales have met the goal of refining the measurement of these two dimensions. / "July 2005." / Thesis (Ph.D.)--Wichita State University, College of Liberal Arts and Sciences, Dept. of Psychology.

The objective of this study was to explore inpatients’ opinions on their hospital paper medical records after they had incidental access to them. One hundred inpatients in the C.T. department at St. Michael's Hospital were surveyed: 65 patients who read their records and 35 who did not. Overall, 75.4% of readers found their records easy to understand, and most found their records correct, complete and did not find anything unexpected or distressing. Seventy-nine percent of all respondents would trust the hospital, approximately half would trust Google Health or Microsoft Healthvault and 5.6% would trust Facebook to provide online medical records. Being female, under 60 years and having a higher education predicted readership. Younger patients were also more likely to think that accessing their records would help decrease errors. Patients with higher education were more likely to find their records useful and trusted the hospital to provide online medical records.

Background Malnutrition in hospitalized patients has a high prevalence. This led to an action plan against malnutrition that was conducted in 2012 at Enköpings hospital. This paper investigated the nursing staff perceptions of this project on nutrition and nutrient intake in two different departments, and whether these perceptions differ between departments.   Method An inductive approach with semi-structured interview was used in interviews with eight persons from the staff of the two departments of the hospital in Enköping involved in the project. Interviews were recorded, transcribed and analyzed by content analysis.   Results In the interview material four categories were identified as well as six different subcategories. The different categories were: "Attitude", "Knowledge", "Procedures" and "Workload". The results showed that there were differences in attitude to the project by the two departments. There were also differences in perceptions about the knowledge level of the staff who worked on the project. However, the staffs of the two departments agreed that there existed a high workload and inadequate procedures on the wards.   Conclusions There was a distinction in the perception of the level of expertise of the staff but consensus regarding inadequate procedures and workload. The differences in attitude are considered due to the high workload and staff turnover but also diffuse professional roles. Further studies in this area is of value to answer more concretely why a department achieves better results than an equivalent department in the same hospital. This essay has only studied if workload and working environment can affect the reception of new routines, so there is scope to identify additional factors. / Bakgrund Undernäring är underdiagnostiserad hos patienter som är inneliggande på sjukhus. Detta gjorde att en handlingsplan mot undernäring genomfördes 2012 vid Enköpings lasarett. Mätningar av dygnsintaget av energi genomfördes vid två tillfällen på två avdelningar. Denna uppsats undersökte vårdpersonalens uppfattningar om detta projekt gällande nutrition och näringsintag på två olika avdelningar samt om dessa uppfattningar skiljer sig åt mellan avdelningarna.   Metod En induktiv ansats med semistrukturerad intervju användes vid intervjuer av åtta ur personalen på två avdelningar vid lasarettet i Enköping som varit involverade i projektet. Intervjuerna spelades in, transkriberades och analyserades med innehållsanalys.   Resultat I intervjumaterialet identifierades fyra kategorier, samt sex olika underkategorier. De olika kategotierna var: ”Attityd”,”Kunskap”,”Rutiner” samt ”Arbetsbelastning”. Resultatet visade att det fanns skillnader i attityd till projektet vid de två avdelningarna. Det fanns också skillnader angående uppfattningen av kunskapsnivån hos personalen som arbetat med projektet. Däremot så var personalen på de båda avdelningarna överens om att det existerade en hög arbetsbelastning samt bristande rutiner på avdelningarna.   Slutsats Det fanns åtskillnad i uppfattningen av kunskapsnivån hos personalen men konsensus gällande bristande rutiner och hög arbetsbelastning. Olikheterna i attityd anses bero på den höga arbetsbelastningen och personalomsättningen men även diffusa yrkesroller. Vidare studier inom området är av vikt för att kunna besvara mer konkret varför en avdelning uppnår resultat bättre än en annan likvärdig avdelning på samma sjukhus. Denna uppsats har endast angripit om arbetsbelastning och arbetsklimat kan påverka mottagandet av nya rutiner, så det finns utrymme för att identifiera fler faktorer.

Thesis (Ph.D.)--University of Alabama at Birmingham, 2007. / Title from PDF title page (viewed on Sept. 16, 2009). Includes bibliographical references (p. 94-98).