Cesarean birth rates are associated with increased maternal morbidity. This project evaluated a quality improvement (QI) initiative implemented to reduce cesarean births among Nulliparous Term Singleton Vertex (NTSV) obstetric populations, the largest contributor to cesarean births. Variations in labor management practice contribute to cesarean birth rate; implementation of labor management bundles have been endorsed to influence practice- and system-level changes in the promotion of vaginal births. The problem addressed in this project was an organizational NTSV cesarean section rate of 30%. The purpose of the project was to use secondary data to evaluate a previously implemented labor management bundle at a large hospital in the northwestern United States. The model of improvement was used as a framework for the QI initiative and this evaluation project. The practice-focused question asked in this project was: Did NTSV cesarean birth rates change after implementation of an evidenced-based standardized labor management bundle? Archived data were collected on cesarean birth rates for 3 time periods: prebaseline, 1 year postimplementation, and 2 years postimplementation. Chi-squareï? tests compared the differences between observed and expected results of data following implementation of labor management bundles. Results show no statistically significant difference between the pre- and post- implementation periods in the NTSV laboring population. Results suggest use of labor management practice bundles alone may not lead to expected outcomes improvements and that operationalization of such practices are sensitive to institutional and/or patient population contexts. This project may serve to promote positive social change by framing evidence-based practice as a process that must attend to contextual considerations.

No description available.

Syfte: Studiens syfte var att undersöka arbetsterapeuters erfarenheter av arbetssituationen inom äldreomsorgen i den kommunala hälso- och sjukvården. Metod: För att besvara studiens syfte genomfördes nio semistrukturerade kvalitativa intervjuer med yrkesverksamma arbetsterapeuter från tre olika kommuner i Norrbotten. Bearbetning av insamlad data genomfördes med en kvalitativ innehållsanalys med induktiv ansats, vilket resulterade i tre kategorier. Resultat: Kategorin Tidfördelning mellan olika arbetsuppgifter speglar arbetsterapeuternas upplevelse av hur tidfördelning påverkar arbetssituationen och klientarbetet. Kategorin Organisationens inverkan på arbetssituationen beskriver möjligheter och utmaningar som arbetsterapeuter inom den kommunala hälso- och sjukvården upplever i sitt arbete. Sista kategorin Digitalisering kan både ta tid och skapa förutsättningar belyser ökade förutsättningar för effektiv och kvalitetssäker vård samtidigt som digitaliseringen kan innebära ökat krav på kompetensutveckling. Resultatet visade att arbetsterapeuters dagliga arbete bestod av många tidskrävande arbetsuppgifter som på olika sätt och omfattning påverkade klientarbete och arbetsmiljö. Ledarskapets inställning, stöd och engagemang upplevdes i hög grad påverka det kliniska arbetet. Slutsats: Studiens resultat visade att bristfälligt ledarskap, organisatoriska förändringar samt begränsade resurser och bristen på tid påverkade arbetsterapeutens arbete. Studien indikerade att deltagarna verkade i en högintensiv miljö där omfattande krav ställdes på både generell- och fördjupad kunskap, vilket innebar att kontinuerlig fortbildning samt kompetens- och evidensbaserat arbete upplevdes avgörande för att möta de krav som ställs på vården idag. Ytterligare forskning behövs för att undersöka vikten av kunskap och vidareutbildning där vårdprioriteringar har ett tydligt arbetsterapeutiskt fokus. / Aim: The aim of this study was to describe occupational therapists’ experiences of their work situation for elderly care in municipal healthcare. Method: To answer the aim of the study nine semi-structured qualitative interviews were conducted with working occupational therapists from three different municipalities in northern Sweden. Collected data were analyzed with a qualitative content analysis and an inductive approach which resulted in three categories. Result: The category Time allocation between different work tasks reflects occupational therapists experience of the effect of work situation and client work. The category Organizational impact on work situation describes possibilities and challenges that occupational therapist experience within the municipal healthcare. Final category Digitalization can take time and create opportunities highlights increased conditions for effective and quality care while digitalization concurrently can entail increased demand for competence development. The result showed that occupational therapists work consisted of many time- consuming work tasks that in different ways and extent affected client work and work environment. The leaderships attitudes, support and engagement were experienced to highly influence the clinical work. Conclusion: The result of the study showed that inadequate leadership, organizational changes, limited resources, and lack of time affected the occupational therapists´ work. The study indicated that the participants worked in a highly intense environment with extensive demands regarding general and advanced knowledge which implied that continues education as well as evidence-based practice were paramount for meeting the demands in healthcare of today. Further research is needed to illustrate the importance of knowledge and education for healthcare priorities with a distinct occupational therapy focus.

No description available.

Patient-focused research systems have been developed to monitor and inform therapists of patients' treatment progress in psychotherapy as a method to enhance patient outcome. The current study examined the effects of providing treatment progress information and problem-solving tools to both patients and therapists during the course of psychotherapy. Three hundred seventy patients at a hospital-based outpatient psychotherapy clinic were randomly assigned to one of two treatment groups: treatment-as-usual, or an experimental condition based on the use of patient/therapist feedback and clinical decision-support tools. Patients in the feedback condition were significantly more improved at termination than the patients in the treatment as usual condition. These findings are consistent with past research on these approaches although the effect size was smaller in this study. Treatment effects were not a consequence of different amounts of psychotherapy received by experimental and control clients. Not all therapists were aided by the feedback intervention.

No description available.

Bakgrund Honung har använts inom sårvård i tusentals år. Dock har den fallit i glömska i modern tid då sjukvården fick tillgång till antibiotika. Överutskrivning av antibiotika bidrar till att antibiotikaresistenta bakterier utvecklas. Nyare forskning visar att sårbehandling med honung uppfattas som lovande. Sjuksköterskor ansvarar för val av lämpliga förband vilket gör att sjuksköterskor behöver kontinuerlig utbildning för att kunna utföra en evidensbaserad praktik. Syfte Syftet med denna litteraturöversikt är att sammanställa forskningsbaserad kunskap om effekterna på sårläkning av medicinsk honung hos patienter med sår. Metod Litteraturöversikt bygd på tio vetenskapliga studier har genomförts som en strukturerad litteraturstudie med inslag av den metodologi som används vid systematiska översikter. Resultat Ett tema: God sårläkningsförmåga samt fyra huvudkategorier av effekter av medicinsk honung i sårläkningsprocessen: antimikrobiell effekt, understöd till sårläkningsprocessen, förbättrad livskvalitet samt säkerhet har identifierats i denna studie. Slutsats Medicinsk honung har god sårläkningsförmåga tack vare sin antimikrobiella effekt, understöd till sårläkningsprocessen, förbättrad livskvalitet för patienterna samt säker användning. Medicinsk honung kan användas på alla typer av sår i olika faser av sårläkningsprocessen. Medicinsk honung är säker att använda både för vuxna och barn. Sjuksköterskornas evidensbaserade praktik ger en möjlighet att bidra till minskningen av användandet av antibiotika genom att välja medicinsk honung i sårbehandlingen. / Background Honey has been used in wound care for thousands of years. However, in modern times it has been forgotten ever since antibiotics was introduced. Overprescription of antibiotics can lead to antibiotic resistant bacteria. New research shows promising results with medical honey in wound care. Registered nurses are responsible to choose an appropriate wound dressing, this stipulates the need for a nurse to continuously update their knowledge in wound care to be able to perform evidence-based practice. Aim The aim with this literature review is to compile research-based knowledge about the effect on wound healing medical honey can provide on patents with wound. Method This literature review based on ten studies has been conducted as a structured literature review with elements of a systematic review. Results One theme: good wound healing ability and four head categories of effects of medical honey in wound healing process: antimicrobial effect, support of wound healing process, improved quality of life and security has been identified in this study. Conclusions Medical honey has good wound healing ability because of its antimicrobial effect, support of wound healing process, improved quality of life and safe for patients to use. Medical honey can be used on all types of wounds in different phases of the wound healing process. Medical honey is safe to use both for adults and for children. Nurses evidenced based practice give an opportunity to contribute to reduce the utilization of antibiotics by choosing medical grade honey in wound care.

Denna studie undersökte 33 socialsekreterares självskattade tillämpning av evidensbaserad praktik i arbetet med unga lagöverträdare och dess samband med deras självskattade handlingsutrymme och arbetslivserfarenhet. Vidare undersökte studien i vilken utsträckning socialsekreterarna ansåg att deras utbildningsbakgrund försett dem med kunskap kring evidensbaserad praktik. Studien genomfördes som en kvantitativ tvärsnittsstudie genom en webbenkät. Teoretiska utgångspunkter i studien var gräsrotbyråkrati och isomorfism. Genom en korrelationsanalys påvisade resultatet att det inte fanns något samband mellan evidensbaserad praktik och professionellt handlingsutrymme samt mellan evidensbaserad praktik och arbetslivserfarenhet. Socialsekreterarna arbetade enligt en evidensbaserad praktik med unga lagöverträdare i viss utsträckning men skattade något lägre när det gäller huruvida insatserna tillgodosåg målgruppens behov. Resultatet påvisade att socialsekreterarna inte fått med sig tillräcklig kunskap gällande evidensbaserad praktik från sin socionomutbildning. / This study investigated 33 social workers' self-accessed application of evidence-based practice in combination with young offenders and it’s connection to their self-assessed professional discretion and length of work experience. Furthermore, the study investigated to which extent social workers regard that their educational background has provided them with knowledge about evidence-based practice. The study was carried out as a quantitative cross-sectional study through a websurvey. Theoretical points of departure included the street-level bureaucracy and isomorfism. Through a correlation analysis the result showed that there is no connection between evidence-based practice and work experience, as well as no connection between evidence-based practice and professional discretion. Social workers worked in an evidence-based manner with young offenders to some extent but scored somewhat lower in regards to whether their aids were satisfactory to the needs of the target audience. The result showed that the social workers didn’t acquire sufficient knowledge regarding evidence-based practice from their bachelor degree in social work.

No description available.

No description available.