Bakgrund: Sjuksköterskestudenter kan genomföra verksamhetsförlagd utbildning inom utbildningsvårdavdelningar. En modell benämns Utvecklande och Lärande Vårdenhet (ULVE), där studenter handleds och vårdar i par. Det finns studier som visar att modellen stödjer studenters lärande, men det finns få studier om hur patienter upplever det att vårdas av studenter i par. Därför är det intressant att undersöka hur patienterna ser på att det är två studenter som vårdar dem och hur de upplever den vård de får. Syfte: Syftet med studien är att beskriva patienters erfarenheter av att vårdas av sjuksköterskestudenter som handleds och vårdar i par. Metod: Studien är genomförd med en reflekterande livsvärldsansats grundad i fenomenologisk kunskapsteori. Fenomenet i studien är ”Att vårdas av sjuksköterskestudenter som vårdar och handleds i par”. Data har samlats in via intervjuer av sjutton patienter som vårdats inom ULVE. Resultat: Att vårdas av studenter som handleds i par innebär att bli involverad i studenternas lärande och att mötas av ansvarstagande och en vilja att vårda och lära.  Patienterna känner trygghet och är positivt inställda till att vårdas av studentpar. Tilltro till att vården ges med stöd av handledning bidrar även till trygghet i vårdsituationen. Resultatet beskrivs vidare med innebördselementen: Involverad i lärande och vårdande, Att vara i centrum för vård, Tilltro och tillit till vårdens kvalitet och Att få något utöver det ”vanliga”. Konklusion: Studien visar att patienter som vårdas av studenter som handleds och vårdar i par sätts i centrum, blir tagna på allvar och lyssnade till som människor. Det visar sig i respektfulla möten som präglas av omtänksamhet, engagemang, närvaro och där behov tillgodoses. Studien stödjer att studenter ger god vård när de handleds och vårdar  i par. / Background: Nursing students can complete clinical training in educational hospital wards. A model called Developing and Learning Care Unit (ULVE), where students care and supports in pair. Studies show that the model supports student learning, but there are few studies about how patients perceive to be cared for by students in pairs. It would be of interest to examine what patient’s experience are, what they think about being cared of students who work in pairs and if they believe that they receive good care.  Aim: The aim of this study is to describe how patients’ experience being cared for by student nurses who are caring and supervised in pairs.     Method: The study was conducted with a reflective lifeworld approach based on phenomenological epistemology. The phenomenon of the study is ”to be cared for by  student nurses caring and supports in pairs”. Data was collected through interviews of seventeen patients cared for  within ULVE.       Results: The care of students who are supported in pairs means to become involved in student learning and to meet the responsibility and a desire to nurture and learn. Patients feel secure and are positive to be looked after by student nurses in pair.  Confidence in the healthcare provided under the supervision also contributes to security in the care situation. The result is further described with four meaningful elements: Being involved  in learning and caring, being the center of care,  confidence and trust in the quality of care and  getting something out of the ”ordinary”. Conclusion: The study showed that patients cared by pairs of students is taken seriously and humanly during supervision of nursing clinician and it focuses in a patient centered care. This method of pair nursing students care shows respect, thoughtfulness, engagement and presence to patients where needs are fulfilled.

In an era of value based purchasing and healthcare reform, hospitals face the challenge of delivering high quality care in an environment of diminishing resources. This performance improvement project describes the use of master’s prepared nurses on medical surgical units to improve quality and patient satisfaction. The setting was five medical surgical units in a 200+ bed hospital in the southeastern United States. Declining resources necessitated an increase in the nurse to patient ratios on the units (from 5:1 to 6:1). The project involved the modification of the model of care through the change in nurse/patient ratios and the addition of master’s prepared nurses to coordinate and supplement the care of the staff RNs for complex patients. While inconclusive, the literature review confirmed the impact of master’s prepared nurses on quality metrics and did not conclusively confirm that delivering high quality, safe care was not possible with nurse/patient ratios of 1:6. The goal of the project was to determine if the presence of the master’s prepared nurse could mitigate the changes in ratios and produce high quality and satisfaction outcomes. Measures of success were drawn from archived standardized quality measures in the realms of service (HCAHPS questions), patient safety (CABSI, HAPU) and quality outcomes (core measures and 30 day readmissions). The project design was a retrospective, one-group pre-post design looking at two six-month intervals—before and after project implementation. Results demonstrated sustained or improved quality in six of ten measures. Highest positive impact was in readmissions and nurse sensitive indicators. The most negative results were in patient satisfaction. Modifying the model of care is an iterative process requiring continued evaluation and changes to improve outcomes. Results of this project supported the further evaluation of staffing and expansion of the number of master’s prepared nurses on medical surgical units.

Aim of the study is to explore the role caring practices within the nurse-patient relationship, in facilitating effective chronic pain management in the primary health care context. Objectives are to analyse the current caring practices within the nurse-patient relationship during the management of patients with chronic pain within primary health care services; explore the challenges experienced by nurses in primary health care services when managing patients with chronic pain; observe the caring practices within the nurse patient interaction for the patients suffering from chronic pain within the Primary health care setting and explain the nurses‟ caring practices when managing their chronic pain in the primary health care setting. Method The research design for this study is sequential, explanatory and mixed method, which is more appropriate due to the complexity of the phenomenon under study. Findings: Although the survey measured the caring practices subjectively which other studies had done consistently, generally nurses associated caring as their core function within the health profession. Nurses do not actively involve the patients in the development of a treatment plan and as a result the caring behaviours that are intended to benefit the patients are not realised and, thus patients report nurses as not being caring. The results indicated that lack of an inclusive treatment plan, which can only be discovered through the development of the therapeutic NPR, is not given priority in the management of patients with chronic pain Conclusions: Caring should not be seen as concrete execution of the set of activities towards the patient but rather as a joint venture between the nurse and the patient. The strength of the model developed in this study is the identification of the nurses‟ internal readiness to create a caring environment by experiencing the love, faith and hope before engaging with the patient. / Health Studies

Introduction. L’ostéoporose est une maladie chronique habituellement asymptomatique jusqu’à ce qu’il y ait fracture de fragilisation (FF). Ces fractures engendrent des coûts importants dont une partie pourrait être évitée par la prise en charge de ces patients pour l’ostéoporose. L’implantation d’un programme de prévention des fractures subséquentes géré par des infirmières en orthopédie pourrait permettre de parer à ces problèmes. Objectifs. L’objectif principal de ce projet était de déterminer si une infirmière peut gérer de façon efficace et sécuritaire un service de liaison pour fracture. Méthode. Les décisions cliniques d’infirmières entre 2010 et 2012 pour 525 patients d’un service de liaison pour fracture à l’étude ont été évaluées par deux médecins spécialistes indépendants avec expertise dans les soins pour l’ostéoporose. Résultats. Les infirmières ont pu identifier la totalité des sujets à risque et référer 26.7% de ceux-ci à un spécialiste. L’accord entre chacun des évaluateurs et les infirmières était de >97%. Les évaluateurs ont donné les mêmes réponses à >96% pour chaque type de décision et le niveau d’accord inter-juge était presque parfait (AC1 >0.960). Aucune référence n’a été jugée inutile. Les comorbidités majeures ont toutes été prises en charge. Conclusion. L’accord élevé entre les décisions cliniques des infirmières et des médecins évaluateurs démontre que la prise en charge par une infirmière est sécuritaire et recommandable pour les patients avec FF. Ce type d’intervention pourrait contribuer à résoudre les problèmes d’accessibilité aux soins chez les patients avec fragilité osseuse, ainsi qu’à diminuer le fardeau économique que représente le traitement des FF pour la société. / Introduction. Osteoporosis is a chronic condition which is usually asymptomatic until a fragility fracture (FF) occurs. These fractures lead to increased morbidity and mortality in patients. Moreover, a major care gap exists in the investigation for bone fragility and initiation of treatment for individuals who sustain a FF. The implementation of a subsequent fracture prevention program managed by nurses could be the key in resolving these problems. Objectives. The main objective of this project was to determine if a nurse can manage safely and efficiently a fracture liaison service (FLS). Methods. Clinical decisions of nurses for 525 subjects in a studied FLS between 2010 and 2012 were assessed by two independent physicians with expertise in osteoporosis treatment. Results. The nurses succeeded in identifying all patients at risk and referred 26.7% of patients to a specialist. Thereby, they managed 73.3% of subjects with FF. No needless referrals were made according to both physicians. Agreement between each evaluator and the nurses was of >97%. Physicians’ decisions were the same in >96% for each type of decision and AC1 coefficient was of >0.960 (almost perfect level of agreement). All major comorbidities were adequately managed. Conclusion. High agreement between nurses and physicians’ clinical decisions indicate that the management by a nurse of a FLS is safe and recommended for patients with FF. This kind of intervention could help resolve the existing care gap in osteoporosis care as well as the societal economic burden associated with treatment of FF.

Aim of the study is to explore the role caring practices within the nurse-patient relationship, in facilitating effective chronic pain management in the primary health care context. Objectives are to analyse the current caring practices within the nurse-patient relationship during the management of patients with chronic pain within primary health care services; explore the challenges experienced by nurses in primary health care services when managing patients with chronic pain; observe the caring practices within the nurse patient interaction for the patients suffering from chronic pain within the Primary health care setting and explain the nurses‟ caring practices when managing their chronic pain in the primary health care setting. Method The research design for this study is sequential, explanatory and mixed method, which is more appropriate due to the complexity of the phenomenon under study. Findings: Although the survey measured the caring practices subjectively which other studies had done consistently, generally nurses associated caring as their core function within the health profession. Nurses do not actively involve the patients in the development of a treatment plan and as a result the caring behaviours that are intended to benefit the patients are not realised and, thus patients report nurses as not being caring. The results indicated that lack of an inclusive treatment plan, which can only be discovered through the development of the therapeutic NPR, is not given priority in the management of patients with chronic pain Conclusions: Caring should not be seen as concrete execution of the set of activities towards the patient but rather as a joint venture between the nurse and the patient. The strength of the model developed in this study is the identification of the nurses‟ internal readiness to create a caring environment by experiencing the love, faith and hope before engaging with the patient. / Health Studies