Bakgrund: Arbetsrelaterad stress är ett världsomfattande problem inom hälso- och sjukvården och kan missgynna sjuksköterskornas prestationsförmåga och omvårdnadsarbete. Det finns en obalans mellan sjuksköterskornas resurser och förväntningar från verksamheten vilket är oroväckande för vårdkvaliteten och patientsäkerheten. Syfte: Syftet är att beskriva hur patientsäkerheten påverkas i samband med arbetsrelaterad stress hos sjuksköterskor inom slutenvården. Metod: Studiens design var en litteraturöversikt med 16 inkluderade artiklar från olika delar av världen från databaserna PubMed och CINAHL. Resultat: Bristande kommunikation, försenad eller utebliven omvårdnad och vårdskador, läkemedelskomplikationer samt sjuksköterskans kognitiva försämring framkom som påverkande faktorer för patientsäkerheten relaterat till sjuksköterskans stressiga arbetssituation. Slutsats: Den arbetsrelaterade stressen har en allmänt negativ påverkan på hälso- och sjukvårdens kvalitet och produktivitet. Studiens resultat visar att sjuksköterskornas stressiga arbetssituation påverkar patientsäkerheten och bidrar till en oförmåga att vårda patienterna på ett respektfullt vis utifrån ett helhetsperspektiv. / Background: Work-related stress is a worldwide healthcare problem and may adversely affect the nurses’ performance and nursing work. There is an imbalance between the nurses' resources and the expectations from the healthcare organization, which causes concern among the nurses about the negative effects for quality of care and patient safety. Aim: The aim of this study is to describe how patient safety is affected by the nurses’ work-related stress in inpatient care. Method: The design of this study was a literature review with 16 included articles from different parts of the world from the databases PubMed and CINAHL. Result: Lack of communication, delayed or non-occurred nursing and care-related injuries, drug complications and nurses’ cognitive failure emerged as influencing factors for patient safety related to the nurses’ stressful work situation. Conclusion: The work-related stress has a generally negative impact on the quality and productivity of healthcare. The study's findings show that the stressful work situation of nurses affects patient safety and contributes to the inability to adequately care for patients from a holistic perspective.

Class of 2011 Abstract / OBJECTIVES: To assess the role of patient, payer, clinical and disease-related factors in charges and mortality among adult inpatient cases of polycythemia vera in the United States from 2004 to 2008. METHODS: This retrospective cohort study utilized hospital discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) five consecutive years from 2004 to 2008. RESULTS: There were a total of 156,490 episodes of care involving polycythemia vera between 2004 and 2008. Average age upon admission was 65.94 years (±16.03), with 56% of cases being male (n=87,662). The mean length of stay was 5.14 days (±5.31) and inpatient mortality occurred in 3.1% of cases (n=4,927). The mean number of procedures performed was 1.43 (±2.08) and the mean number of diagnoses on record was 9.56 (±3.86). Charges for each episode of care averaged $32,620 (±42,801), summing to a national bill of $5.02 billion (2010 dollars) over the five-year time horizon. Higher charges were associated with longer length of stay, larger hospital bed size, urban hospital location, teaching status, increased number of diagnoses and procedures, private payer, Western U.S. region, and higher income bracket. Increased mortality was associated with increased age, increased number of diagnoses and procedures, self pay, payer other than Medicare, Medicaid, private or self, and the comorbidities of congestive heart failure, coagulopathy, and fluid/electrolyte disorders. CONCLUSION: Polycythemia vera is associated with considerable burden of illness.

Bakgrund: Hot och våld i psykiatrisk slutenvård är ett vanligt förekommande fenomen. Hot och våld uppstår av en rad olika anledningar. Det är ett störande moment i sjuksköterskans arbete och väcker negativa känslor, vilket kan avspeglas i sjuksköterskornas interaktioner med patienterna. Syfte: Att beskriva sjuksköterskors upplevelser av att vårda hotfulla och våldsamma patienter i psykiatrisk slutenvård. Metod: En intervjustudie genomfördes med åtta sjuksköterskor på två psykiatriska kliniker vid ett större sjukhus i en storstadsregion i västra Sverige. Materialet analyserades genom kvalitativ innehållsanalys. Resultat: Fyra kategorier framkommer. Den första är olustkänslor med underkategorierna att känna oro och ångest, att känna stress, att känna sig ledsen samt att känna sig kränkt. Den andra kategorin är rädsla, med underkategorierna rädsla för den hotfulla patienten samt att känna rädsla för andras skull. Den tredje kategorin är maktlöshet med underkategorierna att förlora kontrollen, att känna frustration samt att arbeta med en tickande bomb. Den fjärde kategorin är trygghetsskapande strategier med underkategorierna att sätta sig in i patientens situation samt att våga stå kvar. Slutsats: Ofta kan det aggressiva beteendet hos patienterna associeras till sjukdomsbild och/eller missbruksproblematik, vilket bekräftades i vår studie. I de flesta fall har sjuksköterskorna en djupare förståelse för patientens beteende och har därmed högre tolerans för hot och våld. Sjuksköterskorna betonar att det är viktigt att alltid vara tillgänglig för patienterna, då det skapar trygghet för båda parter samt är en förutsättning för en god vårdande relation. / Background: Inpatient aggression is common as a phenomenon in psychiatric inpatient care. Inpatient aggression arises for several reasons. It disturbs the nurses in their work assignments and causes negative emotions, which can be reflected in the interaction with the patients. Aim: To describe nurse's experiences of caring for aggressive patients in psychiatric inpatient care Method: An interview study was conducted with eight nurses at two psychiatric clinics at a hospital in a big town in Western Sweden. The material was analysed through qualitative content analysis. Results: The analysis resulted in four main categories. The first category is uneasiness, with subcategories: to feel anxiety, to feel stress, to feel sad and to feel offended. The second category is fear, with subcategories: to feel fear for the aggressive patient and to feel fear for others sake. The third category is powerlessness, with subcategories: to lose control, to feel frustration and to work with a ticking time bomb. The fourth category is work to create security policies with subcategories: understanding the patients' situation and courage to remain in an aggressive encounter. Conclusion: Inpatient aggression is often associated to symtoms and/or drug abuse, which also was confirmed in our study. In most scenarios the nurses had a deeper understanding for the patients behavior and thereby a higher tolerance towards inpatient aggresion. The nurses claimed that beeing available to the patients was very important, since that created an atmosphere of security for both parties and it was assumed a presumtion for a good caring relationship.

Please read the abstract in the 00front of this dissertation. / Dissertation (MA)--University of Pretoria, 2011. / Psychology / unrestricted

The aim of theses is create a strategy based on results from analysis witch ware created during the writing this theses. Elected subject is Inpatient Health-Care Facility: Jinřichův Hradec Hospital. The facility is situated in South Bohemia and is also part of South Bohemia hospitals association. Majority owner is South Bohemia Region. In this region are located another seven hospitals witch may be considered as competitors. Analysis will verify internal as well as external environment of organization. Based on these findings, the current status, strenghts and weaknesses, opportunities and potential threats will be determined strategy.

Bakgrund: Omvårdnadsdokumentation är en viktig del av sjuksköterskans arbete. På grund av utvecklingen inom vården, lagar och patienternas olika problem, behövs alltmer dokumenteras, vilket leder till att omvårdnadsdokumentationen förändras ständigt. För att förbättra dokumentationen och dess kvalité är det viktigt att sjuksköterskornas erfarenheter av omvårdnadsdokumentation undersöks. Syfte: Syftet med litteraturstudien var att belysa sjuksköterskors erfarenheter av faktorer på arbetsplatsen som påverkar omvårdnadsdokumentation i slutenvård. Metod: Litteraturstudien baserades på empiriska studier. Databearbetning utfördes enligt en manifest kvalitativ innehållsanalys. Resultat: Databearbetning av tio artiklar resulterade i tre kategorier: Teknik, Kommunikation, och Organisation. Erfarenheterna var delade mellan sjuksköterskor som ansåg att tekniken bakom de elektroniska dokumentationssystemen var positiv och andra som erfor den som negativ. Dessutom var sjuksköterskornas erfarenheter av omvårdnadsdokumentation inom slutenvården som ett kommunikationsverktyg delad mellan de som ansåg att den var lämplig och andra som upplevde den dålig. Även ledningen och deras kontroll över sjuksköterskorna var faktorer på arbetsplatsen som påverkade omvårdnadsdokumentationen. Konklusion: Vårdkedjan bör hållas samman genom en tydlig kommunikation och en stöttande organisation. Vidare forskning bör utreda hur elektronisk omvårdnadsdokumentation kan förenklas och hur patienten upplever delaktigheten i omvårdnadsdokumentationen. / Background: Nursing documentation is an important part of the nurse's work. Because of developments in healthcare, laws and the patients’ varying problems, documentation is increasingly needed, leading to nursing documentation constantly changing. For improving nursing documentation and its’ quality, it is important to explore the nurses' experiences of factors that affect nursing documentation in an inpatient setting. Aim: The aim of the literature study was to explore nurses' experiences regarding factors at the workplace affecting nursing documentation in inpatient setting. Methods: The literature study was based on empirical studies. Data analysis was performed according to a qualitative manifest content analysis. Results: The analysis of ten articles resulted in three categories: Technique, Communication, and Organization. The experiences differed between nurses who considered thetechnology behind the electronic documentation systems as positive and others who experienced it as negative. In addition, the nurses' experiences of nursing documentation in an inpatient setting as a communication tool differed between those who considered it appropriate and others who experienced it poorly. Moreover, nurses’ experiences of nursing documentation were affected by the management and their control over the nurses. Conclusion: The chain of care should be hold together through a clear communication and a supportive organization. Further research should investigate how electronic nursing documentation can be made simpler and how the patients experience participation in nursing documentation.

Bakgrund: Sjuksköterskor kan drabbas av arbetsrelaterad stress, vilket innebär attindividen inte har tillräckliga resurser att hantera påfrestning som härstammar frånarbetet. Den arbetsrelaterade stressen skulle kunna resultera i bristandepatientsäkerhet. Sjuksköterskan förhåller sig till arbetsrelaterade stressorer genomatt anpassa sig kognitivt och beteendemässigt med emotionsfokuserade ochproblemfokuserade copingstrategier. Syfte: Att genom sammanställning avkvalitativ vetenskaplig litteratur undersöka hur sjuksköterskor uppleveranvändningen av copingstrategier i samband med arbetsrelaterad stress inomsluten vård. Metod: En litteraturstudie med tolv artiklar av kvalitativ ansatsgenomfördes. Sökningarna utfördes i databaserna PubMed, CINAHL ochPsycINFO. Artiklarna analyserades och tematiserades därefter till ett egetkodningssystem. Resultat: Fyra huvudteman sammanställdes: tekniker för atthantera stress, förhållningssätt för att hantera stress, stöd för att hantera stress, ochavslappningsmetoder. Dessa hade tillsammans tolv underteman, vilka innefattadekortsiktiga och långsiktiga copingstrategier som både kunde vara positiva ochnegativa för den psykiska hälsan. Konklusion: Det framkommer attcopingstrategier är viktiga för hanteringen av arbetsrelaterad stress, men att det ärviktigt att veta vilka copingstrategier som skulle kunna leda till negativa utfall förden psykiska hälsan, samt ta reda på vilka som passar för den enskildasjuksköterskan. / Background: Nurses can suffer from occupational stress, which means that theindividual lacks sufficient resources to manage strain arising from work. Theoccupational stress could result in poor patient safety. The nurse responds to thestressors by adapting cognitively and behaviorally with emotion-focused orproblem-focused coping strategies. Aim: To examine how nurses perceive the useof coping strategies in relation to occupational stress in inpatient settings bycompiling qualitative scientific literature. Method: A literature study with twelvearticles of qualitative approach was conducted. The searches were carried out inthe PubMed, CINAHL and PsycINFO databases. The articles were then analyzedand thematized into a coding system designed by the authors. Findings: Fourmain themes were compiled: techniques to handle stress, approaches to handlestress, support to handle stress, and relaxation methods. These together had twelvesub-themes. All themes included short-term and long-term coping strategies thatcould be both positive and negative for mental health. Conclusion: Copingstrategies are important for coping with occupational stress, but it is alsoimportant to know which coping strategies can lead to negative outcomes formental health, and to find out which ones suit the individual nurse.

Pharmaceutical expenditures are an important part of the entire hospital operating budget, and inpatient pharmaceuticals denote one of the highest costs in hospital care. Predictions for medication budgets based on the types of patients have been largely undertaken in medical hospitals and not psychiatric facilities. According to several previous studies, gender, age, diagnosis, comorbidity and length of stay (LOS) affect the general inpatient treatment expenditures. However, whether or not the impact of these factors differs in psychiatric hospitals remains to be investigated. To that end, the current study examines medication costs for mental and behavioral health disorder as well as the primary chronic diseases commonly comorbid with mental and behavioral health disorders that suggest formulary management control might be helpful. Multiple regression models were developed to determine the leading drivers associated with the growing inpatient hospital medication costs among patients admitted to an acute psychiatric hospital. We also analyzed LOS using a Poisson model in order to determine whether it is a proxy for psychiatric inpatient medication costs. Our finding selected 51 medications (14% of the 364 total medications consumed 90% of the total medication cost) under A category (AV, AE, and AN) and B category (BV, BE, and BN) in order to develop a medication list (MUC, medication under control) that suggested cost control measures based on cost and clinical criticality could be important. This study demonstrated that comorbidity, principal and secondary diagnoses, LOS, and MUC are associated with higher inpatient medication costs than other factors, including age, gender, insurance type, and month admitted. Our study also observed that the principal ICD-10-CM codes F10 (Alcohol related disorders) is associated with high inpatient medication cost. Secondary diagnosis related groups (DRGs) 203 (Bronchitis & asthma), 192 (Chronic obstructive pulmonary disease, COPD), 201 (pneumothorax), 639 (Diabetes), 642 (Inborn and other disorders of metabolism), 645 (Endocrine disorders), 641 (Nutritional & miscellaneous metabolic disorders), 690 (Kidney & urinary tract infections), 675 (Other kidney & urinary tract procedures), 699 (Other kidney & urinary tract diagnoses), and 700 (Other kidney and urinary tract diagnoses), 305 (Hypertension), 310 (Cardiac arrhythmia & conduction disorders), 303 (Atherosclerosis), 293 (Heart failure & shock), and 316 (Other circulatory system diagnoses) were found to be associated with higher inpatient medication costs. In addition, LOS can be used as an indicator (proxy) for inpatient medication cost when patients present with a secondary DRG 639 (diabetes) and 690 (kidney & urinary tract infections) in an acute psychiatric hospital. Viewed collectively, this study would enable executives of acute psychiatric hospitals to identify the most important factors that are associated with high inpatient medication costs, thereby assisting in the development of the hospital pharmaceutical budget using a novel and scientific approach.

Falls are the most frequently reported incidents among hospitalized patients in the United States with at least 4 falls per 1,000 patient days occurring annually. Falls are related to high rates of mortality and morbidity and high hospital costs. The purpose of this project was to evaluate a fall prevention quality initiative to reduce falls in an acute care facility by educating staff on an evidence-based fall prevention protocol. The project sought to explore whether implementation of an evidence-based fall prevention initiative in educating nurses would affect the nurses’ professional knowledge and the number of patient fall incidences in the cardiac care unit. The theoretical framework supporting this project was Neuman’s systems theory. The Iowa model was used to guide this evidence-based project. An educational session was implemented to increase nurses’ awareness of fall prevention practices. Two sets of data were collected: the pretest and posttest results, and the number of falls on the unit. A total of 21 unit nurses participated in the pretest; 18 (86.0%) completed the posttest. The mean score on the pretest was 81.62%; the mean score was 85.89% for the posttest with a mean difference of 4.27%. A paired sample t-test revealed no statistically significant differences in scores after education. This project has implications for social change by supporting patient safety, decreased hospital stays, and reduced health care expenses to patients and health care organizations.

Hospital systems in the United States are facing a dilemma regarding capacity management in the emergency department (ED) and the inpatient care setting. The average wait time in EDs across the United States exceeds 98 minutes, which is also the point at which patients begin to abandon healthcare treatment. The purpose of this quantitative study was to examine the use of queueing theory in capacity management on length-of-stay (LOS) rates, left-without-being-seen (LWBS) rates, and boarding rates in the ED and inpatient setting. The boarding rates represent the rate in which patients were roomed in the ED but required inpatient care. This study assessed the relationships between capacity management using queueing theory and a reduction in the aforementioned rates compared to traditional processes across systems within the continental United States. A linear regression analysis with a confidence interval 95% paired with an independent sample t test was used to analyze the secondary datasets. A sample size of approximately 33,000 patients was tested in the areas of LOS, LWBS, and boarding. The results of the analysis determined that access was improved in the ED and inpatient setting when queueing theory was deployed within the hospital system compared to traditional processes for managing capacity within the system. Queuing theory used for capacity management resulted in lower LOS, LWBS, and boarding rates. The implications of this study for positive social change include the opportunity to provide greater access to care for the population as a whole, and better health outcomes for the promotion of population health.