Bakgrund Sjuksköterskor ansvarar för att bedöma om en patient har smärta, vilket kan vara utmanande om patienten har svårt att kommunicera. För att bidra med mer kunskap kring detta uppfattades ett behov av att undersöka vad sjuksköterskor inom olika verksamheter har för erfarenheter kring att bedöma smärta hos dessa patienter och deras tankar kring smärtskattning som omvårdnadsåtgärd. Syfte Syftet med studien var att belysa sjuksköterskors erfarenheter kring smärtskattning av patienter med nedsatt förmåga att kommunicera. Metod Semistrukturerade intervjuer genomfördes med sjuksköterskor inom olika verksamheter i Umeå och analyserades med kvalitativ innehållsanalys. Resultat Vi identifierade erfarenheter som sammanställdes inom åtta olika kategorier fördelade på fyra domäner. Centrala iakttagelser är att smärtskattning bör ske med välfungerande metoder och att smidiga rutiner för deras användning är viktiga. Det behövs mer kunskap om smärtskattning för att kunna komplettera de erfarenheter som finns. För att förbättra kvaliteten bör likaså hänsyn tas till nackdelar med alltför stela arbetssätt för att inte den personliga kunskapen och viljan ska gå förlorad. Likaledes behöver verktygen förbättras. Slutsats Smärtskattning är ett komplext ämne. Sjuksköterskorna som idag utför smärtskattning på olika sätt anser att välfungerande, enkla verktyg tillsammans med fungerande lokala rutiner kring deras användning skulle kunna förbättra omvårdnaden i många fall. / Background Nurses are responsible for pain assessment in patients, a challenging task if the patient has a communicative impairment. To contribute to more knowledge regarding the present situation we identified a need to study nurses’ experiences regarding assessment of pain among these patients, and their thoughts around pain assessment as a nursing method. Aim The aim of the study was to illuminate nurses’ experiences of pain assessment in patients with impaired ability to communicate. Method Semi-structural interviews were conducted with nurses within different health care settings in Umeå. They were interpreted using a qualitative content analysis. Results The analysis identified experiences within eight categories in four domains. A central observation is that assessment needs to be conducted with good quality methods and that smooth routines regarding there use is crucial. Deeper knowledge about pain assessment need to complement the nurses’ experiences to improve quality, as well as recognising disadvantages with too strict routines need to be taken into consideration. The assessment tools also need further development. Conclusion Pain assessment is a complex issue. Nurses that are practicing this today reflects the view that well functioning tools together with functional routines regarding their use could help improve nursing in many cases.

As instituições de saúde buscam melhorar a qualidade assistencial e segurança do paciente reduzindo agravos como a ocorrência da Úlcera por Pressão (UPP) pela análise dos processos que interferem neste resultado, um indicador de qualidade da enfermagem e serviços de saúde. Estudo objetivou analisar a ocorrência de Úlcera por Pressão em Unidades de Terapia Intensiva e a conformidade do uso de medidas preventivas pelos enfermeiros. Utilizando desenho descritivo exploratório com análise quantitativa, foram analisados dados sociodemográficos e clínicos de pacientes internados em quatro UTIs, incidência e prevalência de UPP, ações para prevenção registradas em prontuário, concordância entre enfermeiros e pesquisadora quanto subescores e escore total da escala de Braden e classificação de risco para UPP. Foram avaliados 346 pacientes, sendo 68 na UTI 1, 84 na UTI 2, 97 na UTI 3 e 97 na UTI 4. Desses, 61,8% eram do sexo masculino, média de idade 56 anos, tempo médio de internação nas UTIs 8,51 dias. A maioria apresentou escores médios na escala entre 13 e 16 na avaliação inicial. Cinqüenta e quatro pacientes (15,6%) foram admitidos na UTI com UPP e 40 (13,69%) pacientes desenvolveram UPP enquanto internados na UTI. Os pacientes que tiveram maior freqüência de UPP eram de alto risco com escores de 10 a 12. Houve predomínio de UPP na região sacral e de estágio II. A maioria desenvolveu-se entre o 2º e o 7º dia de internação e a maior freqüência ocorreu nos pacientes com idade 60 anos. Em 100% dos prontuários não havia registro de enfermagem sobre o risco do paciente para UPP. Havia 39,7% registros corretos de pele íntegra e 85,5% registros corretos da presença de UPP. Quanto ao registro do estadiamento da UPP, a maioria não apresentava conformidade com as recomendações internacionais. Os pacientes admitidos com UPP tiveram maior número de registro de medidas preventivas (57%), com maior freqüência para a hidratação da pele (80,3%) e uso do colchão caixa de ovo (66,9%). Vinte e dois enfermeiros participaram da avaliação da concordância dos dados dos pacientes com a pesquisadora. Tinham tempo médio de profissão de 5 anos e tempo de atuação nas UTIs de 2 anos e oito meses. Houve concordância geral para os escores das subescalas Percepção Sensorial, Mobilidade, Fricção e Cisalhamento. A subescala Umidade, obteve pobre concordância nas UTIs 2 e 4, e não houve concordância na UTI 3. Nas UTIs 3 e 4 não houve concordância para a subescala Atividade e nas UTIs 2 e 4 para a subescala Nutrição. Quanto ao escore total da escala de Braden e classificação em níveis de risco, a concordância ocorreu apenas nas UTIs 1 e 2 (Kappa > 0,5). Os resultados obtidos demonstram a necessidade da avaliação do processo da assistência de enfermagem, de modo a identificar a conformidade das ações de enfermagem e os aspectos que exigem mudanças institucionais, já que podem interferir na ocorrência da UPP visando à melhoria da qualidade e maior segurança para os pacientes internados em Unidades de Terapia Intensiva. / Health institutions seek to improve the quality of care and patient safety by reducing the occurrence of events such as pressure ulcers (PU) by the analysis of the processes that interfere with this result, an quality indicator of nursing and health services. Study aimed to analyze the occurrence of pressure ulcers in Intensive Care Units and the conformity with preventive measures used by nurses. Using an exploratory descriptive design with quantitative methods sociodemographic and clinical data of patients admitted to four ICUs were colected and analyzed, as well as incidence and prevalence of PU, actions for prevention recorded in patient records, agreement among the nurses and researcher related to Braden scale total score and subscores and classification of level of risk for PU development. There were evaluated 346 patients, 68 in ICU 1, 84 in ICU 2, 97 in ICU 3 and 97 in ICU 4. Of the total, 61.8% were male, mean age 56 years, mean lenght of ICU stay 8.51 days. Most ICUs had Braden mean scores in the range of 13 and 16 in the initial evaluation. Fifty-four patients (15,6%) were admitted to the ICU with UPP and 40 (13,69%) patients developed pressure ulcers while hospitalized in ICU. Patients who had higher frequency of UPP were in high risk with a score 10-12. PU were predominantly in the sacral region and stage II. Most ulcers developed between the 2nd and 7th day of hospitalization and occurred more frequently in patients aged 60 years. In 100% of the records nursing records about patient's risk for PU was not documented. There were 39.7% correct records about intact skin and 85.5% correct records about the presence of PU. As for the staging of the PU, the majority of nursing records were not in conformity with international recommendations. Patients admitted with PU had higher registration number of preventive actions (57%), more frequently related to hydration of the skin (80.3%) and use the eggcrate mattress (66.9%). Twenty-two 22 nurses participated in the appraisal of their agreement with the researcher about patient's collected data. Their average time of working in nursing was 5 years and time working in ICU was 2,8 years. There was general agreement for the scores of the subscales Sensory Perception, Mobility, Friction and Shear. Related to subscale humidity, poor agreement was obtained in ICUs 2 and 4, and no agreement was obtained in ICU 3. On ICU 3 and 4 there was no agreement for Activity subscale and in ICUs 2 and 4 for subscale Nutrition. Regarding the total score of the Braden scale and classification of risk levels, the correlation was observed only in ICU 1 and 2 (kappa > 0.5). The results demonstrate the need for evaluation of nursing care process in order to identify the compliance conformity of nursing actions and issues requiring institutional changes that may interfere with detection of the PU to increase quality of care and safety management of patients in intensive care units.

Made available in DSpace on 2014-07-29T15:04:28Z (GMT). No. of bitstreams: 1 dissertacao marcia borges de melo.pdf: 463440 bytes, checksum: 5d679a03c290cff16d165c1bb978e365 (MD5) Previous issue date: 2011-05-10 / Job satisfaction consists of a feeling of well-being resulting from the interaction of several occupational aspects with the general conditions of life. This is a complex and dynamic process, more and more valued by scholars of organizational behavior, due to the possible influence on the worker health, and therefore, on the results of the services provided. In this context, nursing emerges as a profession that deals with a large number of events that goes beyond the health-disease process, becoming important for the quality of care, a reflection of the main factors of satisfaction and dissatisfaction in the work of this team. Based on this, we focused on the analysis of the scientific publications related to job satisfaction of Brazilian nursing between the years 2000 and 2009. The practice based on the evidences has represented the theoretical method adopted. An integrative literature review in the databases LILACS and MEDLINE BDENF was the focus, totaling 17 publications in the last ten years. The results have revealed 01 literature review, 01 article of level III evidence, 13 of level IV, and 02 of level VI, which were categorized in the following topics: Job Satisfaction, Job Dissatisfaction and correlated factors. As key factors to job satisfaction, the research showed: to like what one does, to be inserted in an innovative proposal, recognition of the work well done, quality of performed services, spiritual support and relationship at work. On the other hand, the dissatisfaction factors cited were: lack of integration between team members, work overload, low wages, professional depreciation, insufficiency and / or lack of material and equipment, rules and routines out of job reality, lack of motivation, lack of interaction with other units, little incentive to the work, lack of communication with the population in relation to knowledge, and the real needs of the emergency room utilization, lack of professional commitment from colleagues and lack organization. Regarding the variables that may have an effect on job satisfaction, differences were observed regarding gender, marital status, educational level and length of service. Thus, the conclusion is that job satisfaction is determined by a complex network of factors and may vary depending on the group studied. Additional research, particularly with levels of III evidence in different fields of the nursing, covering all of Brazil, are necessary to support the implementation of improvements occupational. / A satisfação no trabalho consiste em um sentimento de bem-estar resultante da interação de vários aspectos ocupacionais com as condições gerais de vida. Tratase de um processo complexo e dinâmico cada vez mais valorizado pelos estudiosos do comportamento organizacional, em função de sua possível influência na saúde do trabalhador e, consequentemente, nos resultados dos serviços prestados. Nesse contexto, a enfermagem surge como uma profissão que lida com uma pluralidade de eventos que vão além do processo saúde-doença, tornando-se importante para a qualidade da assistência uma reflexão sobre os principais fatores de satisfação e insatisfação no trabalho desta equipe. D ante disso, objetivou-se analisar as publicações científicas referentes à satisfação no trabalho da enfermagem brasileira entre os anos de 2000 e 2009. A Prática Baseada em Evidências representou o referencial teórico-metodológico adotado. Tratou-se de uma revisão integrativa da literatura nas bases de dados LILACS, MEDLINE e BDENF, totalizando 17 publicações nos últimos dez anos. Os resultados revelaram 01 revisão de literatura, 01 artigo de nível de evidência III, 13 de nível IV, 02 de nível VI, os quais foram categorizados nas seguintes temáticas: Satisfação no Trabalho, Insatisfação no Trabalho e Fatores Correlacionais. Como fatores de satisfação no trabalho, as pesquisas apontaram: gostar do que faz, inserção em uma proposta inovadora, reconhecimento pelo trabalho realizado, qualidade dos serviços prestados, apoio espiritual e relacionamento interpessoal no trabalho. Quanto aos fatores de insatisfação foram citados: falta de integração entre os membros da equipe, sobrecarga de trabalho, baixos salários, desvalorização profissional, falta e/ou insuficiência de material e equipamentos, normas e rotinas fora da realidade do serviço, falta de incentivo, falta de interação com outras unidades, pouco estímulo para o trabalho, carência de comunicação com a população em relação ao conhecimento e as reais necessidades de utilização do pronto socorro, falta compromisso profissional dos colegas e desorganização dos serviços. No que se refere às variáveis que podem exercer efeito sobre a satisfação no trabalho, foram observadas diferenças quanto ao sexo, estado civil, à escolaridade e ao tempo de serviço. Assim, concluiu-se que a satisfação no trabalho é determinada por uma rede complexa de fatores, podendo variar conforme o grupo estudado. Pesquisas adicionais, especialmente com níveis de evidências III, em diferentes campos de atuação da enfermagem, abrangendo todo o Brasil, são necessárias para subsidiar a implantação de melhorias ocupacionais.

Introdução: A falta de adesão ao tratamento é fator limitante para o sucesso dos transplantes de coração, pois contribui para o aumento da morbidade e mortalidade, reduz a qualidade de vida e aumenta os custos referentes ao uso de serviços de saúde. Objetivo: Sintetizar as melhores evidências sobre as intervenções para o manejo da adesão ao tratamento farmacológico e não farmacológico no transplante cardíaco. Método: Revisão sistemática de literatura por meio de busca de estudos publicados e não publicados nas seguintes bases: CINAHL, EMBASE, ProQuest dissertations and theses, PsycINFO, MEDLINE/Pubmed, SCOPUS, Web of Science e banco de Teses da Capes. Foram critérios de inclusão: estudos clínicos com pacientes adultos depois de transplante cardíaco, que tivessem testado o impacto de qualquer intervenção na adesão ao tratamento, avaliada objetivamente ou por auto-relato, usando instrumentos válidos e confiáveis, comparada ao cuidado usual. A qualidade metodológica dos estudos elegíveis foi realizada por dois revisores independentes e as discordâncias foram resolvidas por consenso. Os resultados foram integrados de forma narrativa. Resultados: Foram identificadas 2.519 citações potencialmente relevantes. Excluídos 1.336 por repetição, restaram 1.183 citações que tiveram seus resumos lidos e, após a aplicação de critérios de inclusão, restaram sete publicações para análise da qualidade metodológica. Quatro estudos foram excluídos e os principais motivos foram a falta de avaliação de intervenção (dois estudos), estudo teórico (um estudo) e a adesão ao tratamento não ter sido o foco da intervenção estudada (um estudo). Um dos estudos mantidos não detectou diferença entre intervenção educativa realizada em laboratório de ensino comparada a cuidado usual; outro estudo também não detectou diferença entre uma intervenção multifacetada, composta por oficinas interativas, oferecida pela internet comparada a cuidado usual; e o terceiro detectou impacto positivo da diminuição na dose diária do imunossupressor, de duas vezes ao dia para uma vez. Com relação ao método, dois estudos utilizaram ensaio clínico controlado não randomizado e um foi descritivo / observacional. Conclusões: As evidências disponíveis para orientar decisões sobre intervenções para controlar a adesão do paciente submetido ao transplante de coração ainda são escassas. A realização de ensaios clínicos randomizados, com alta qualidade metodológica, é fundamental para fornecer evidencias mais robustas sobre o manejo da adesão no transplante cardíaco. / Introduction: Treatment adherence failure is a limiting factor for effective heart transplants, as it contributes with increased morbidity and mortality and a reduced quality of life in addition to increasing health service costs. Objective: To synthesize the best available evidence regarding interventions for managing adherence to pharmacological and non-pharmacological treatments in heart transplant patients. Method: Systematic literature review by searching published and unpublished studies on the following databases: CINAHL, EMBASE, ProQuest dissertations and theses, PsycINFO, MEDLINE/Pubmed, SCOPUS, Web of Science and the Capes Thesis database. The inclusion criteria were: clinical studies with adult heart transplant patients, which tested the impact of any intervention over treatment adherence, evaluated objectively or through self-reports, using validated and reliable instruments, compared to common care. Two independent raters assessed the methodological quality of the eligible studies and any disagreements were solved by consensus. The results were integrated in a narrative form. Results: A total of 2.519 potentially relevant statements were identified. Of the total, 1.336 were repeated, and, therefore, excluded. The abstracts of the remaining 1.183 statements were read and, after considering the inclusion criteria, seven publications were analyzed in terms of their methodological quality. Four studies were excluded mainly because they did not present an evaluation of the intervention (two studies), one was a theoretical study, and one study was not center the investigation on treatment adherence. On of the selected studies did not find any difference between the educational intervention performed in a teaching laboratory compared to common care; another study also did not find any difference between one multiple intervention, comprised of online interactive workshops, compared to common care; and the third study found a positive impact from reducing the immunosuppressant dose from twice to once a day. Regarding the method, there were two non-randomized clinical trials and one descriptive/observational study. Conclusions: The current best evidence to guide decisions regarding interventions to manage treatment adherence of heart transplant patients remain scant. Randomized clinical trials with high methodological rigor are key to obtain more robust evidence regarding treatment adherence management in heart transplants.

BakgrundTrycksår är en komplikation till sjukdom, vård och behandling. Såren kan bli en källa till ett lidande. Mer än hundra riskfaktorer för uppkomst av trycksår har identifierats och därför kan inte enskilda faktorer leda till uppkomst av trycksår. Evidensbaserad vård innebär att vid utformning av vård för patienten ska dennes unika egenskaper och preferenser utifrån främsta till buds stående vetenskapliga stöd, vägas samman för nyttan av olika insatser.SyfteSyftet var att beskriva evidensbaserade omvårdnadsåtgärder som minskar förekomsten av trycksår hos patienten.MetodLitteraturstudien har genomförts som en litteraturöversikt genom systematisk sökning av artiklar, som baserades på nitton artiklar från Pubmed och CINAHL.ResultatRådande metoder som ompositionering och olika tryckavlastande stödytor har inte något starkt stöd i inkluderade artiklar gällande trycksårsprevention. Ny teknik som skanning och mätning av hudtemperatur ger positiva resultat, men kan inte ensamt förhindra uppkomst av trycksår utan bör kombineras med andra evidensbaserade omvårdnadsåtgärder. Preventionsprogram ger positiva resultat och utförs i flera fall multiprofessionellt och med patienters delaktighet.SlutsatsEvidensbaserade strategier är nyckeln till framgångsrika förebyggande program. Här behöver flera faktorer samverka för att uppnå en synergisk effekt och verka optimalt. Skanning och annan ny teknik, som SEM Scanner och MiS som är objektiva hjälpmedel och kan komplettera trycksårsvården. / BackgroundPressure ulcers are a complication of disease, care and treatment. The wounds can become a source of suffering. More than one hundred risk factors have been identified to cause pressure ulcer therefore a single risk factor cannot cause the onset of pressure ulcers. Evidence-based care means that when planning the care for the patient, their unique characteristics and preferences should be weighed together for the benefit of different interventions based on the latest scientific knowledge.AimThe aim was to describe evidence-based nursing measures that reduce the incidence of pressure ulcers in the patient.MethodThe literature study has been conducted as a literature review through systematic search of articles, which were based on nineteen articles from Pubmed and CINAHL.ResultsCurrent methods such as repositioning and various pressure-relieving support surfaces do not have strong support in included articles regarding pressure ulcer prevention. New technology such as scanning and measuring skin temperature have favorable outcomes but cannot alone prevent the onset of pressure ulcers but should be combined by other evidence based nursing measures. Prevention programs contributes to promising results and are in many cases carried out multiprofessionally and with the participation of patients.ConclusionsEvidence based strategies are key to successful prevention programs. Several factors need to work together to achieve a synergistic effect and operate optimally. Scanning and other new technologies, such as SEM Scanner and MiS, are objective aids and can complement pressure ulcer care.

Bakgrund: Sepsis är ett allvarligt tillstånd som obehandlat kan leda till organsvikt och död. Infektioner kan utvecklas till sepsis hos såväl tidigare fullt friska som multisjuka personer, i alla åldersgrupper och samhällsskikt. Kombinationen av diffusa symtom och ett snabbt sjukdomsförlopp ställer krav på sjuksköterskors kompetens, eftersom tidig identifiering och behandling är avgörande för patienternas överlevnad. Syfte: Syftet med studien är att kartlägga olika interventioners effekt på sjuksköterskors tidiga identifiering och omvårdnad av patienter med sepsis. Metod: Litteraturöversikt baserad på 12 kvantitativa interventionsstudier från PubMed och Cinahl. Artiklarna kvalitetsgranskades och analyserades därefter med kvantitativ ansats. Resultatet presenteras i text samt med deskriptiv statistik. Resultat: Studiens resultat presenteras i tre kategorier; Identifiering, Åtgärder och Patientutfall. Statistiskt signifikanta förbättringar identifierades i samtliga tre kategorier i form av bland annat minskad dödlighet och LOS samt förbättrad identifiering och följsamhet för sepsis bundles. Konklusion: Studien indikerar att testade interventioner har potential att förbättra identifiering, omvårdnad och utfall för sepsispatienter. Litteraturstudien betonar behovet av screeningverktyg och omvårdnadsåtgärder med högre evidensgrad, mer tydliga riktlinjer och en arbetsmiljö som ger sjuksköterskor möjlighet att arbeta med hela sin kompetens. / Background: Sepsis is a serious condition that untreated may cause organ failure and death. Infections can develop into sepsis in previously healthy people as well as multimorbid patients, in all ages and social strata. The combination of diffuse symptoms and quick progression of disease make demands on nurses’ competence, thus early identification and treatment is crucial for patients’ survival. Aim: The aim of the study was to examine the effect of different interventions on nurses’ early identification and care of patients with sepsis. Methods: Literature review of 12 quantitative intervention studies from PubMed and Cinahl. The articles were quality checked and analyzed with a quantitative approach. Results are presented in written text and descriptive statistics. Results: The results are presented in three categories; Identification, Nursing interventions and Patient outcomes. This study demonstrated statistically significant improvements in all three categories including reduced mortality and LOS, improved identification and compliance to sepsis bundles. Conclusion: This study indicates that examined interventions have potential to improve identification, care and outcome for septic patients. It further emphasizes the need for higher evidence screening tools and nursing interventions, clearer guidelines and a working environment which gives nurses the opportunity to carry out their competencies.

Bakgrund: Smärta hos barn i samband med procedurer i sjukvården är ett vanligt problem som sjuksköterskan hanterar. Hos barn är smärta tydligt kopplat till rädsla och otrygghet. Syfte: Att kartlägga icke-farmakologiska metoder för att hantera procedursmärta hos barn. Metod: En litteraturstudie med systematisk ansats som studerar kvantitativa studier. Resultat: Tio vetenskapliga studier på ämnet icke-farmakologiska metoder att hantera procedursmärta hos barn i åldern 2–10 år inkluderades i analysen. Smärthanteringsmetoderna kategoriserades under rubrikerna aktiva distraktionsmetoder, passiva distraktionsmetoder och fysikaliska metoder. De aktiva distraktionsmetoderna att barnet blåser såpbubblor eller spelar spel på surfplatta/smartphone eller virtual reality och användning av de fysikaliska metoderna vibration kombinerat med kyla i den medicintekniska produkten Buzzy, visade god evidens. Vidare forskning på ämnet passiv distraktion med sjukhusclowner och effekten av utformningen på sjuksköterskors arbetskläder är önskvärt. Aktiv distraktion visade lovande resultat och vidare kartläggning rekommenderas. Slutsats: Hantering av procedursmärta bör inkludera barns lek med såpbubblor, spel på surfplatta/smartphone, lek med distraktionskort samt de fysikaliska metoderna vibration och kyla. / Background: Pain in children associated with procedures in healthcare is a common problem that nurses deal with. In children, pain is clearly linked to fear and insecurity. Aim: To map non-pharmacological methods to manage procedural pain in children. Method: A literature study with a systematic approach that studies quantitative studies. Results: Ten scientific studies on the topic of non-pharmacological methods of managing procedural pain in children aged 2–10 years were included in the analysis. The pain management methods were categorized under the headings active distraction methods, passive distraction methods and physical methods. The active distraction methods of the child blowing soap bubbles or playing games on a tablet/smartphone or virtual reality and using the physical methods vibration combined with cold in the medical device Buzzy, showed good evidence. Further research on the topic of passive distraction with hospital clowns and the effect of the design on nurses' work clothes is desirable. Active distraction showed promising results and further survey is recommended. Conclusion: Management of procedural pain should include children's play with soap bubbles, tablet/smartphone games, distraction card play, and the physical methods of vibration and cold.

Nurses face ongoing difficulties in using evidence and making a reality of evidence-based practice. Studies of the factors that facilitate or impede evidence-based practice suggest that nurse managers should have a key role, but the nature of this role has not yet been fully articulated. This study aimed to explore and explain the roles of nurse managers in relation to evidence-based practice implementation. Four case studies in Scottish NHS Acute Trusts provide rich data on evidence-based practice implementation, drawing on interviews (n = 51), observation and documentary analysis. A wide literature on evidence use in nursing suggests that implementation is hindered by confusion and debate about what counts as evidence, and by an incomplete understanding by staff of the complexity of implementation processes. This study confirms such conclusions. Moreover, the study reveals that the roles of nurse managers in facilitating evidence use are currently limited, largely passive and under-articulated. As such, the findings expose significant discrepancies between nurse managers' roles in practice and those espoused in much of the literature. Partial explanation for this can be found in the organisational contexts in which nurses and their managers work (e.g. competing demands; confused communication; diffuse and overloaded roles and limits to authority and autonomy). In particular, the role of the contemporary nurse manager is one that places considerable emphasis on aspects of general management to the detriment of clinical practice issues. More positively, the study uncovered genuine facilitation in two study sites where hybrid roles of nurse manager and clinical nurse specialist were in place. In both sites, these roles had been successful in supporting and progressing implementation in discrete areas of practice and show some potential for advancing evidence-based practice more widely. These findings have significant implications for research, policy and practice in relation to evidence-based practice in nursing.

Bakgrund: CVK-relaterade infektioner i blodbanan är förenat med förlängd sjukhusvistelse, ökad mortalitet, ökade ekonomiska kostnader samt ökat lidande för patienten. Användningen av centrala venösa katetrar ökar och därmed är risken att drabbas av infektion större. Det finns en bristande kunskap hos sjuksköterskan gällande förebyggandet av dessa infektioner och en bristande följsamhet till riktlinjer. Syfte: Beskriva hur sjuksköterskan kan förebygga CVK-relaterade infektioner i blodbanan. Metod: Allmän litteraturstudie av kvantitativa artiklar. Resultat: En kombination av utbildning, praktiska åtgärder såsom skötsel, hygienrutiner och checklistor samt feedback minskade antalet CVK-relaterade infektioner i blodbanan. Slutsatser: Utbildning, olika typer av praktiska åtgärder samt feedback minskar antalet CVK-relaterade infektioner i blodbanan och är viktigt för sjuksköterskans förebyggande vård. En stor del av vad som framkom i resultat stämmer överens med riktlinjerna för förebyggandet av CVK-relaterade infektioner, dock bör utbildning och feedback prioriteras i högre utsträckning. Det är känt sedan tidigare att följsamhet till riktlinjer bland sjuksköterskor skulle underlätta utförandet av evidensbaserad omvårdnad. Mer fokus bör därför ligga på att få sjuksköterskor att följa riktlinjer. Klinisk betydelse: Studien kan bidra med ökad kunskap hos sjuksköterskor om hur CVK-relaterade infektioner i blodbanan kan förebyggas vilket i sin tur skulle kunna generera bättre vård, minskat lidande för patienten, minskad mortalitet samt ekonomiska besparingar. / Background: CVC-related bloodstream infections often lead to prolonged hospitalization, increased mortality, higher economical cost and more suffering for the patient. The usage of central venous catheters increases and therefore the risk of infection is also higher. When it comes to prevention of these infections there is a lack of knowledge amongst nurses and compliance with the guidelines. Aim: Describe how the nurse can prevent CVC-related bloodstream infections. Method: General literature review of quantitative studies. Results: A combination of education, hands-on initiatives such as management, hygieneroutines and checklists as well as feedback turned out to reduce CVC-related bloodstream infections. Conclusions: Education, different hands-on initiatives and feedback decreases the number of CVC-related bloodstream infection and is essential for the nurse’s preventive care. Most of the results correlate with the guidelines for the prevention of CVC-related bloodsteam infections, nevertheless education and feedback should be prioritized in higher extent. It is known that adherence to guidelines among nurses would facilitate the execution of evidence-based nursing. Therefore more focus should be on having nurses follow the guidelines. Clinical importance: This study would contribute with increased knowledge amongst nurses regarding prevention of CVC-related bloodstream infections which would give better care, diminish the suffering of the patient, decrease mortality and lead to economical benefits.

Nursing care is considered a primary predictor of patient assessment of the overall hospital experience. Yet, quality nursing care remains difficult to define. Limited research about nurse or patient perspectives on what constitutes quality nursing care in hospital settings prevents the identification of a shared description or insight into their possible interrelationship. Research about nurse and patient descriptions is needed to establish behaviors, attributes, and activities associated with quality nursing care to improve the health and well-being of hospitalized patients. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection