Many existing hospitals have problems with their ward layouts. However, the increase in construction costs and the decrease in the number of hospitals have made renovation more economical than building new facilities. Compounding the problem of inefficient floor layouts is the increasing severity of cases treated on an inpatient basis. This research was designed to evaluate the problems faced by nurses working on long corridor patient wards in Montgomery Regional Hospital in Blacksburg, Virginia. It was shown in the study and through previous studies in the literature that these types of wards have physical design problems that affect adversely nurses’ activities in patient care. This study used a time travel method to evaluate the amount of time the nurses spent traveling between the nurses’ station, patient rooms, and other functional areas. Nurses’ perspectives concerning their physical environment and layout were also studied using a questionnaire. It was found that the travel time on the ward was directly related to the geometry of the ward. It was also shown that the total travel time was dependant on the number of patients in the ward. The average amount of time nurses spent traveling in Ward-A was more than the average time they spent in patient rooms. The average time the nurses spent traveling in Ward-B was less than the average time they spent in patient rooms. In addition to a discussion of the time travel data the study also posed several design solutions to problems found in Montgomery Regional Hospital. / Master of Science

Bakgrund: Många patienter har behov av palliativ vård innan de avlider. I Sverige finns idag flera olika alternativ för specialiserad palliativ vård. Dessa räcker dock inte till för att vårda alla palliativa patienter vilket leder till att sjuksköterskor som arbetar på somatiska vårdavdelningar på sjukhus ofta möter dessa patienter. Syfte: Att beskriva sjuksköterskors upplevelser av att ge palliativ vård till patienter som vårdas på somatiska vårdavdelningar. Metod: Studien genomfördes som en litteraturöversikt där 15 artiklar ingick i resultatet. Datainsamling har gjorts i databaserna Cinahl, PubMed och Web of Science. Resultat: Sjuksköterskor upplevde att kommunikationen vid vård av palliativa patienter var svår på flera sätt. Rädsla att bemöta existentiella frågor, tidsbrist och en dysfunktionell kommunikation mellan vårdpersonal upplevdes som svårigheter för sjuksköterskorna. Detta ledde till att sjuksköterskor upplevde ett stort behov av utbildning och kompetensutveckling. Slutsats: Ett stort utbildningsbehov finns hos sjuksköterskor då de upplever många svårigheter i att vårda palliativt. För att kunna utveckla denna vårdform på somatiska avdelningar behövs mer utbildning och forskning inom området. / Background: Many patients are in need of palliative care before they die. In Sweden there are several different options for specialized palliative care today. However, the specialized palliative care units are not sufficient to care for all patients in need of palliative care which leads to that nurses working at somatic wards in hospitals frequently encounter these patients. Aim: To describe nurses experiences of giving palliative care to patients in somatic hospital wards. Method: The study was conducted as a review. Data-collection was performed using the databases Cinahl, PubMed and Web of Science, resulting in the inclusion of 15 articles. Results: When caring for palliative patients, the nurses experienced communication to be difficult in many respects. Experienced difficulties for the nurses were fear to meet existential issues, lack of time and dysfunctional communication between professionals. Nurses experienced a major need for education and updating of skills. Conclusion: As palliative care implies a lot of challenges and difficulties, there is a need of specialized training. In order to develop care in somatic wards more education and research is required in this area.

Bakgrund: Att vårdas vid livets slut kan vara en stor omställning för både patient och närstående. Enligt tidigare forskning saknas kunskap om de närståendes upplevelser kring vården och blev därmed ett relevant område att forska vidare på. Sjuksköterskan har som ansvar att se till de närståendes behov samt kunna erbjuda information, stöd och delaktighet i en situation som beskrivs som påfrestande. Syfte: Syftet var att beskriva närståendes upplevelser av vård vid livets slutskede på vårdavdelningar. Metod: Litteraturöversikt. Åtta kvalitativa artiklar en kvantitativ artikel och en artikel med mixad metod samlades in från databaserna CINAHL Complete och PUBMED. Sökningarna begränsades till full text, peer reviewed, English samt avgränsning mellan 2006 och 2016. Resultat: Fyra teman framkom under analysen; kommunikationens betydelse för vård vid livets slut, relationens betydelse och behov av närhet, upplevelse av stöd, tröst och bemötande samt närståendes delaktighet vid livets slut. Kommunikationens betydelse var stor då många närstående upplevde informationen kring vården vid livets slutskede som bristfällig och således kände sig oförmögna att fatta rätt beslut. Även en del positiva och negativa aspekter vad gäller de närståendes upplevelse av stöd samt relationens betydelse för vårdandet framkom, vilket i sin tur ledde till deras chans till delaktighet. Diskussion: I resultatet framkom stora likheter vad gäller information och kunskap, alltså kommunikationen mellan sjuksköterska och närstående. En fungerande kommunikation ansågs enligt de närstående som en väsentlig faktor för hur upplevelsen av omvårdnaden utföll. Detta diskuteras utifrån Andersheds teori samt andra infallsvinklar och på vilket sätt de närståendes delaktighet påverkas. / Background: Receiving end-of-life care can turn into a big adjustment for both the patient and the next of kin. According to previous research the knowledge is inadequate regarding this type of care-giving, which turned out to be a relevant area for further research. The nurse carries a great responsibility when it comes to the wishes and requirements of the next of kin, and is also providing information, support and involvement in this trying situation. Aim: The aim was to describe how someone who is a next of kin might experience the end-of-life care in hospital wards. Method: Literature review. Eight qualitative articles, one quantitative article and one article with mixed method were collected from the databases CINAHL Complete and PUBMED. The searches were limited to full text, peer reviewed, in English and the years of publishing from 2006 to 2016. Results: Four themes emerged during the analysis; The importance of communication for end-of-life care, the relationship’s importance and the need of closeness, experience of support, comfort and attitude and next of kin’s involvement in end-of-life care. The importance of communication was vital. This emerged from the experiences the next of kin described as inadequate, and thus feeling unable to make the right decisions. Also, some positive and negative aspects regarding the next of kin’s experiences of support emerged. This included the meaning of the relationships for the caring, which leads to an improved chance for them to get involved. Discussion: The results showed great similarities in terms of information and knowledge, which leads to improved communication between the nurse and next of kin. Direct communication was considered, according to the next of kin, as an essential factor in the development of the perception of nursing care. This is discussed on the basis of Andershed’s theory, as well as other perspectives, of the nurses and the patients, and the way in which the next of kin’s involvement is affected.

Bakgrund: På 1990-talet började hot och våld inom vården uppmärksammas vilket ledde till fler rapporter framkom inom området. Det finns dock fortfarande ett behov av att olika riskfaktorer som påverkar hot och vålds utbredning och konsekvenserna för sjuksköterskan. Syfte: Syftet var att belysa riskfaktor som finns gällande hot och våld gentemot sjuksköterskor på somatiska sjukhusavdelningar för vuxna samt sjuksköterskans hantering och eventuella konsekvenser av hot och våld. Metod: Resultatet bygger på 17 kvantitativa vetenskapliga artiklar som kritiskt genomlästs och granskats. Resultat: Resultatet visade att det fanns organisatoriska, patient- och sjuksköterskerelaterade riskfaktorer för hot och våld. Det framkom att sjuksköterskor ofta fick emotionella men efter en incident. Det kunde även ge upphov till en osäkerhet gällande yrkesvalet. Det fanns en tveksamhet bland sjuksköterskor att rapportera hot- och våldsincidenter. Många valde att inte prata om det som skett. Det fanns även de sjuksköterskor som hanterade hot- och våldsincidenten genom att förändra sitt beteende. Resultatdiskussion: Utbildning inom hot och våld är en viktig preventiv åtgärd. Genom detta kan sjuksköterskan lära sig hantera utåtagerande patienter och därmed behålla sitt professionella förhållningssätt. Det är även viktigt att sjukvårdsledningen bjuder in till samtal efter incidenten för att öka sjuksköterskans trygghet i yrket. / Background: During the 1990s threat and violence began to be acknowledged, which lead to more reports in the area. But there is still a need to highlight different risk factors that affects the prevalence of threats and violence and the consequences for the nurse. Aim:  The aim of the study was to highlight risk factors regarding threats and violence against nurses in somatic hospital wards for adults, and the handling and eventual consequences of threats and violence against nurses. Method: The result is built up on 17 quantitative scientific articles that have been critically reviewed to get material relevant to this study. Results: The result shows that there are organizational, patient and nurse related threats and violence risk factors. It was shown that nurses often got emotional harms after an incident. This could also cause an insecurity regarding the career-choice. There was hesitation among nurses to report threat- and violence incidents and many chose not to talk about what had happened. There were also nurses that handled the threats and violence incidents by changing their behavior. Discussion of results: Education in threats and violence is an important preventive measure. By this the nurse can learn to handle outward behavioral patients and thereby remain a professional approach. It is also important that healthcare management invites to a dialog after the incidents to increase the nurses safety in their profession.

Background: Since the 1980s, Saudi Arabia’s socio economic transformation has led to vast social development. As a result there has been increased adoption of behaviours such as smoking and sedentary life styles, which pose a risk to health. It is anticipated that cancer incidence will double over the next two decades and it is thus vital that high quality of care is provided to meet the growing health care demands. Moreover, it is important that patients are satisfied with their care provision. This thesis begins with a narrative synthesis of the existing literature about patient satisfaction in the Saudi context and beyond. An evaluation of the key concepts for understanding patient satisfaction illuminated the lack of evidence about the assessment of patient satisfaction including specific key domains of the structure and process of care. This evaluation also indicated the need to further investigate the Saudi patient perspectives in oncology hospital setting. The aim of my study was to examine the extent to which clinical effectiveness impacts upon patient satisfaction in oncology ward settings in the Kingdom of Saudi Arabia (KSA). Methods: A sequential explanatory mixed methods design was employed. The Donabedian quality framework (1980) and Patient experience model (Reimann and Strech 2010) were used to assess patient satisfaction with quality of care provided. A quantitative phase was followed by a qualitative phase. In the first phase, the European Organisation for Research and Treatment of Cancer (EORTC) IN-PATSAT32 validated questionnaire was used to collect data from 100 adult oncology inpatients at a Cancer Centre in Riyadh. The second qualitative phase involved semi-structured telephone and face to face interviews with 22 adult oncology inpatients who previously answered the questionnaire. Synthesis occurred at the intersection of quantitative Phase 1 and qualitative Phase 2 data. The qualitative Phase 2 thus further explored the satisfaction scores of quantitative Phase1 to deepen the understanding of patient satisfaction in oncology ward settings in KSA. Findings: The main findings were that patient satisfaction levels are influenced by the clinical effectiveness of doctors and nurses, accessibility to health care and socio-demographic factors. Specifically, the interpersonal aspects of care were deemed core to patient experiences in oncology ward settings in KSA. It emerged that doctor-patient relationships, nurse shortages and language barriers are particular areas where changes could be made to improve care, thereby enhancing patient satisfaction. These findings contribute important new insights into the interpersonal aspects of care in the light of the underlying social and cultural contextual factors that influence patient satisfaction in the KSA. Conclusion: This study has provided new evidence supporting the need for stronger interpersonal relations and a more patient-centred approach in the oncology health system in KSA. In particular, the influential role of cultural issues in influencing patient satisfaction in oncology ward settings was apparent. Evidence provided by this research will make a substantial contribution to policy makers and hospital management teams in the KSA wanting to improve patient satisfaction in oncology wards and in other health care settings.

Abstract [en] Title: Discrepancies in medication lists at hospital wards identified by medication reconciliation Authors: Anderberg M. Institute: Uppsala University, Uppsala, Sweden Background and objective: An accurate medication list is essential for a correct assessment of a patient´s condition at hospitals. Previous studies have shown that patients in emergency departments often are affected by discrepancies in medication lists at hospital admission. Less research has been done regarding discrepancies after transferring patients to medical wards. The aim of this study was to identify discrepancies in the electronic medical record in hospital wards for patients admitted via the emergency department. Design: Observational study. Medication reconciliation was performed by a pharmacist shortly after the arrival of patients from the emergency department. This included a patient interview and the investigation of the patient’s medical record. The discrepancies identified at the wards were classified as either omitted drug, wrong dose, additional drug, incorrect frequency or duplicate therapy. Descriptive statistics were used and the proportion of medication lists with at least one discrepancy was presented with 95 % confidence interval. Setting: Three medical wards at Capio S:t Görans Hospital in Stockholm.  Main outcome measures: The proportion of medication lists with at least one discrepancy. The mean value of discrepancies among all patients. Classification and categorization of discrepancies regarding type and ATC index.  Results: In total, 63 patients were included with a mean age of 63 years. At least one discrepancy was identified in 43 % (95 % CI 31-55) of the medication lists. 52 discrepancies were found in total generating a mean value of 0,83 ± 1,17 discrepancies per medication list. The two most common categories were Omitted drug(33%) and Wrong dose(33%). The most frequent drug class associated with medication discrepancies was Drugs for obstructive airway diseases.  Conclusion: 43 % of the patients had at least one discrepancy in the medication list. This indicates the importance of medication reconciliations at medical wards even though the medication list has been updated at the emergency department.

The purpose of this study was to determine the contribution of nursing auxiliaries towards health care services against their scope of practice. Nursing auxiliaries practising within the Elim, Letaba, Malamulele, Nkhensani, Shiluvana and Tintswalo hospitals in the Gazankulu Health Administration, in the Northern Transvaal Province, constituted the target population. The findings revealed that nursing auxiliaries are not functioning strictly according to their scope of practice. They are an essential component of nursing services in Gazankulu by rendering a major contribution towards health care services in fulfilling their scope of practice-role. Apart from their prescribed practice-role, they are also engaged in activities that should be performed by enrolled and professional nurses as well as doctors and general assistants. There appears to be a need for education for all categories of nursing staff regarding the scope of practice of nursing auxiliaries for improving the effective utilisation of this category of nursing personnel / M.A. (Nursing Science) / Health Studies

The purpose of this study was to determine the contribution of nursing auxiliaries towards health care services against their scope of practice. Nursing auxiliaries practising within the Elim, Letaba, Malamulele, Nkhensani, Shiluvana and Tintswalo hospitals in the Gazankulu Health Administration, in the Northern Transvaal Province, constituted the target population. The findings revealed that nursing auxiliaries are not functioning strictly according to their scope of practice. They are an essential component of nursing services in Gazankulu by rendering a major contribution towards health care services in fulfilling their scope of practice-role. Apart from their prescribed practice-role, they are also engaged in activities that should be performed by enrolled and professional nurses as well as doctors and general assistants. There appears to be a need for education for all categories of nursing staff regarding the scope of practice of nursing auxiliaries for improving the effective utilisation of this category of nursing personnel / M.A. (Nursing Science) / Health Studies

Aim: This study explores what type of information patients and nurses share with, or provide to, each other, and whether or not the information received was relevant and sufficient for their needs. Background: Information exchange, as part of shared decision-making, is advocated in policy and practice throughout the healthcare sector. Much of the literature on information exchange relates to one-to-one consultations with consultants or GPs. To date, no studies have explored information exchange between patients and nurses in ward settings. Nursing literature on patients’ information needs focuses on one-way information provision from nurses to patients, rather than on two-way information exchange between patients and nurses. Methods: Interactions between patients and nurses were observed and audio-recorded using a remotely controlled audio-recording system. Semi-structured individual face-to-face interviews were then conducted to clarify and add to the observation data. A multiple case study design was used for this study: each case comprised one patient, the nurses caring for that patient, and the interactions between them. A pilot study was undertaken to inform the methods for recruitment and data collection for the main study. Results: The pilot study comprised five cases (patients n=5, nurses n=3). Changes to the recruitment strategy for the main study included surgical patients being invited to participate in the same way as medical patients. There were no difficulties with the data collection methods. The main study comprised nineteen cases (patients n=19, nurses n=22). Information exchange seemed unfamiliar to ward-based nurses. The findings show that information exchange may not be a one-off event but a complex series of interactions. Patients did not distinguish between clinical and non-clinical information in the same way as nurses. Primary reasons for patients’ hospital admission were not discussed and nurses did not share information about nursing interventions. The relevance for patients and nurses differed; patients generally wanted information for reducing anxiety and socialization; nurses wanted information for assessment and care planning. In terms of sufficiency, observation sessions highlighted that insufficient information was provided, often due to lost opportunities and paternalistic practice. However, the majority of patients and nurses perceived that they had exchanged sufficient information. Conclusion: This multiple case study provides insights into the type, relevance and sufficiency of information for patients and nurses in ward settings. In ward settings, information exchange as conceptualised by Charles et al. (1997 and 1999) may be difficult to achieve due to the complexity of patient/nurse interactions. Therefore, there are implications for policy makers as policies are not context specific. However, information exchange may be helpful for reducing patients’ anxieties. The concepts of shared decision-making and information exchange are not part of ward-based cultures and philosophies, which suggests implications for patient and nurse education. Research on information exchange between patients and nurses in other ward contexts may contribute to further understanding of information exchange in ward settings.

Digitalisering och införandet av hälsoinformationssystem som digitala journalsystem har inneburit många fördelar inom sjukvårdssektorn jämfört med de äldre pappersjournalsystemen, exempelvis genom en ökad möjlighet både dela och spara patientinformation. Dock så har även en hel del problem uppkommit med deras införande, varav en av de större är att de digitala journalsystem som finns inte är anpassade efter klinisk sjukvård och vårdpersonalens arbetssätt. Sjuksköterskor är en av de största användargrupperna av dessa digitala journalsystem och de är även den arbetsgrupp som har hand om patienterna på vårdavdelning dygnet runt. Därmed är deras arbete även starkt knutet till patienternas säkerhet. Denna studie har undersökt vilka patientsäkerhetsrisker som användning av digitala journalsystem medför vid sjuksköterskearbete på vårdavdelning. Det gjordes med hjälp av en kvalitativ ansats där en litteraturstudie, intervjuer och deltagande observationer genomfördes. Studiens resultat har bidragit till en ökad förstående för de patientsäkerhetsrisker som användning av digitala journalsystem vid sjuksköterskearbete medför samt en ökad förståelse för den kontext som digitala journalsystem används i. / Digitalization and the introduction of health information systems (such as the electronic health records) has contributed to many advantages within the healthcare industry, especially compared to the old paper-based system. For instance, an electronic health record makes it easier to archive and share patient information, but the advances these systems contribute is also accompanied by its fair share of problems. One of the main problems being that there is a mismatch between the electronic health records in use and the way the healthcare personnel work. Nurses are one of the biggest user groups of the electronic health records and they are also providing healthcare to the patients admitted to hospital wards 24/7. That means that their work is tightly intertwined with patient safety. This study has examined risks for patient safety connected to the use of electronic health records during nursing practice at hospital wards. The study was conducted using a qualitative approach with a literature study, interviews and participatory observations. The result of the study has contributed to increased knowledge and insights regarding patient risks connected to the use of electronic health records during nursing practice at hospital wards as well as an increased understanding for the context in which the electronic health records are used.