Två eller fler individer som tillsammans arbetar på ett ömsesidigt beroende sätt mot ett gemensamt mål är den vanligaste definitionen av vad ett team är. Inom akutsjukvården bildas ständigt nya team, ofta samarbetar akutsjuksköterskan med flera olika personer varje arbetspass. Vid akuta livshotande tillstånd samlas en mängd olika professioner tillsammansför att bilda ett gemensamt team för att omhänderta patienter. Specialistsjuksköterskan med inriktning akutsjukvård ska ständigt bedriva en säker vård utifrån de sex kärnkompetenserna. Säker vård innebär att minska risken att det ska uppstå skador hos patienter genom att arbeta efter vetenskaplig beprövad erfarenhet. Att bedriva patientsäker vård syftar till att vården skall arbeta utefter system och processer som minskar risken att göra fel och skada patienten. Syftet med litteraturöversikten var att belysa personalens erfarenheter av teamarbetet vidomhändertagande av patienter inom akutsjukvården. Detta är en litteraturöversikt som har ettsystematiskt tillvägagångssätt. Artiklar som svarade på syftet valdes ut från databaserna Cumulative Index to nursing and Allied Health Literature (CINAHL) samt PubMed och sammanlagt valdes 15 artiklar ut som presenterades i en artikelmatris. Resultatet blev två huvudkategorier med åtta underkategorier. Huvudkategorierna bestod av teamarbetets beståndsdelar samt faktorer som påverkar teamarbetet. Viktigaste fyndet iresultatet var vikten av ett välfungerande ledarskap, tydliga rollfördelningar, hierarkiernas inverkan på kommunikationen samt teamets stora påverkan på patientsäkerheten. Resultatet påvisade att när teamarbetet är välfungerande så får patienten ett snabbare och säkrare omhändertagande. Av studiens resultat kan slutsatsen dras att vårdpersonalen upplever att teamarbete är fördelaktigt inom akutsjukvård och det finns många positiva aspekter. Det framkom att vårdpersonalen upplevde att en välfungerad teamledare höll de övriga teammedlemmarna organiserade och strukturerade. Vårdpersonalen upplevde att när de arbetar i team kan bedömningar ske snabbare och effektivare vilket leder till en ökad patientsäkerhet / Two or more individuals working together in a mutually dependent way towards a common goal is the most common definition of a team. In emergency care, new teams are constantly being formed, often the emergency nurse collaborates with several different people each work shift. In acute life-threatening conditions, a variety of professions come together to form a big team to care for patients. The emergency nurse must constantly provide patient safety based on the six core competencies. Patient safety means reducing the risk of injuries to patients by working from scientifically proven experience. Conducting patient-safe care aims for the care to work according to systems and processes that reduce the risk of making mistakes and harming the patient. The aim of this literature review was to shed light on the staff's experiences of teamwork in the care of patients in emergency care. This is a literature review that has a systematic approach. Articles that aimed towared responing to our topics intent were selected from the databases Cumulative Index to nursing and Allied Health Literature (CINAHL) and PubMed, a total of 15 articles were selected that were presented in an article matrix. The result was two main categories with eight subcategories. The main categories consisted of the components of teamwork and factors that affect teamwork. The most important finding in the result was the importance of well-functioning leadership, clear role distributions, the impact of the hierarchies on communication and the team's major impact on patient safety. The results showed that when teamwork is well-functioning, the patient receives faster and safer care. From the results of the study, it can be concluded that the healthcare staff feel that teamwork is beneficial in emergency care and there are many positive aspects. It emerged that the healthcare staff felt that a well-functioning team leader kept the other team members organized and structured. The healthcare staff experienced that when they work in teams, assessments can take place faster and more efficiently, which leads to increased patient safety

Personer med allvarligt akut sjukdomstillstånd eller skada omhändertas inom akutsjukvården. Omhändertagandet utförs ofta av team där flera yrkesprofessioner är representerade. Det akuta omhändertagandet syftar till att ge den sjuka eller skadade adekvat vård med fokus på den enskilda och med hög nivå av säkerhet. Teamarbetet i det akuta omhändertagandet ställer höga krav på teammedlemmarnas förmåga att kommunicera och samarbeta med varandra. Syftet med studien var att belysa det interprofessionella akutvårdsteamets uppfattning om hur teamarbete kan påverka omhändertagandet av den akut sjuka patienten. Metoden som användes för att besvara syftet var en litteraturöversikt. Arton vetenskapliga studier, publicerade mellan år 2011-2021, samlades in från sökningar i databaserna PubMed och CINAHL. För att analysera och syntetisera resultatet av de inkluderade artiklarna användes en integrerad analys.  Resultatet belyser faktorer i teamarbete som uppfattas kunna påverka omhändertagandet av patienten och utmynnade i två huvudkategorier; Faktorer som uppfattas förbättra omhändertagandet och Faktorer som uppfattas försämra omhändertagandet. Till vardera huvudkategorin presenteras fem underkategorier. De förbättrande faktorerna omfattas av teamets sammansättning, sammanhållningen i teamet, teammedlemmarnas förståelse för roller och ansvarsområden, effektiv kommunikation och att arbeta mot gemensamma mål. De försämrande faktorerna innefattar negativa teamegenskaper, hierarkier och avvikande syner på roller, ineffektiv kommunikation, konflikter och hög arbetsbelastning. Slutsatsen av litteraturöversikten var att interprofessionell teambaserad vård kan skapa goda förutsättningar för vård av kvalitet med den akut sjuka patienten i fokus. Teamets utmaning kan vara att hantera konflikter, roller och ansvarsområden för att trots höga patientflöden och belastad arbetsmiljö, lyckas arbeta med en god sammanhållning och kommunikation. Därför behöver aktiviteter som stärker teamarbetet vara vedertagna investeringar på arbetsplatser då de i längden kan förbättra teamets prestation och därmed främja hälsa och lindra lidande för patienten. / Individuals with a serious acute illness or injury are cared for in emergency care. The care is often performed by teams where several professions are represented. The emergency care aims to provide the ill or injured with adequate care with a focus on the individual and with a high level of safety. The teamwork in emergency care places high demands on the team members' ability to communicate and collaborate with each other. The purpose of the study was to highlight the interprofessional emergency care team's perception of how teamwork can affect the care of the acutely ill patient. The method used to answer the purpose was a literature review. Eighteen scientific studies, published between the years 2011-2021, were collected from searches in the PubMed and CINAHL databases. An integrated analysis was used to analyze and synthesize the results of the included articles. The results highlight factors in teamwork that are perceived to be able to influence the care of the patient and result in two main categories; Factors that are perceived to improve care and Factors that are perceived to impair care. Five subcategories are presented for each main category. The improving factors included the composition of the team, the cohesion of the team, the team members' understanding of roles and areas of responsibility, effective communication and working towards common goals. The deteriorating factors included negative team characteristics, hierarchies and divergent views on roles, ineffective communication, conflicts, and high workload. The conclusion of the literature review is that interprofessional team-based care can create good conditions for quality care with the acutely ill patient in focus. The team's challenge can be to handle conflicts, roles, and areas of responsibility in order to succeed in working with good cohesion and communication, despite high patient flows and a stressful work environment. Therefore, activities that strengthen teamwork need to be accepted investments in workplaces as they can improve the team's performance in the long run, and thereby promote health and alleviate patients' suffering.

Frontline RNs knowledgeable in the strategic objectives of their organization made a difference in the selection of an electronic medical record business partner for a large, complex healthcare system. Their impact was significant because of the chief nurse executive's personal articulation of the organization's strategic goals and of her investment in their education. These factors provided the frontline RNs with a foundational base of knowledge about a variety of electronic medical record systems. The preparation and exposure enabled the frontline RNs to make a valuable contribution to the selection of an electronic medical record business partner. The RNs were a major force in affecting philosophical change from the organization's original pursuit of "best-of-breed" interfaced systems to a fully integrated, "best-of-class" vendor business partner. The learning experiences of the frontline RNs are explored to answer the following question: Why must frontline RNs play a key role in this process?

Substantial research has been done on inpatient provider order entry systems with varying degrees of clinical decision support. Such studies have examined how these technologies impact patient safety as well as the quality and cost of care. However, given that most medical care and prescriptions are administered in an ambulatory setting, the dearth of research on ACPOE systems is quite astonishing. This knowledge gap demonstrates the need for an integrative and systematic literature review that attempts to assess the research done on computerized patient safety interventions in ambulatory care. This review’s findings provided adequate evidence that ACPOE systems are effective interventions for reducing medication errors. Other evidence further indicated that, in terms of functional capabilities, commercial ACPOE and e-prescribing systems may be catching up with their homegrown counterparts. PDA-based CDSSs were depicted as useful tools for raising adherence to guidelines and inducing safer prescribing. These findings suggest that ACPOE And PDA-based CDS systems show promise for improving safety and healthcare quality in ambulatory settings. ACPOE specifically, tended to have more advanced CDS attributes but, nonetheless, showed more negative results compared to the e-prescribing systems. Close scrutiny should therefore be given to the elements of decision support that ambulatory physicians find most useful.

Bakgrunden visar på att crowding är ett växande problem på akutmottagningar. Studier visar en koppling mellan crowding och förhöjd mortalitet hos patienterna. Crowding leder till att sjuksköterskorna arbetar under en mycket hög belastning samt ansvarar över alltför många patienter. Syftet var att beskriva sjuksköterskors erfarenheter av att arbeta under “crowding” på akutmottagning. Metoden som användes var en litteraturöversikt av kvalitativ design med utgångspunkt ur France m.fl. (2019) metaetnografiska genomförande. Resultatet mynnade ut i fem teman som kom att kallas “Bristande förutsättningar för att bedriva god vård”, “En utmanande arbetsmiljö”, “Att tvingas kompromissa om säkerheten”, “Påverkad hälsa” och “Kollegors betydelse”, vilka slutligen syntetiserades samman under nyckelmetaforen “Att balansera på bristningsgränsen”. Slutsats Den eskalerande arbetsbördan på akutmottagningar runt om i världen har medfört att sjuksköterskorna i allt större utsträckning blivit utarbetade. Att ständigt behöva kämpa för att patienter ska få vård i tid och känna oro över att de riskerar att försämras på grund av en patientmängd som överstiger sjuksköterskornas kapacitet att bedriva god vård har visat sig leda till en etisk stress och förekomst av utbrändhet. / The Background indicates that crowding is a growing problem in emergency departments. Studies show a link between crowding and a raised mortality rate for the patients. Nurses are also under added pressure when they are responsible for too many patients at one time. The aim of the study was to describe the experience of the nurse working during crowding. The method used was a literary review with a qualitative design. The analysis was performed with a starting point out of France et al. (2019) methodological systematic review of meta-ethnography. The results were divided into five main themes: “Lacking conditions to give good care”, “Challenging work environment”, “Compromise on safety”, “Value of a colleague” and “Affected health” which conclude under the key metaphor “To balance on the breaking point”. The conclusion is that the escalating workload in emergency departments have led to nurses becoming “worn out”. The ratio of nurses to patient exceeds the nurses capacity when they are constantly fighting to give patients the care they need and worrying about them deteriorating. This leads to nurses feeling ethically stressed and run-down.

Background: Medication errors continue to be one of the most prevalent problems in healthcare related to patient safety, often resulting in injury or death, with higher incidences of error occurring with intravenous medications. The purpose of this study was to explore the use of deliberate practice (DP) with second-degree nursing students in developing and maintaining fundamental intravenous medication management practices required for safe practice. Method: This was a feasibility study using a two-arm, single-blind, randomized controlled trial design. Vygotsky’s Zone of Proximal Development model was used to explore the use of a DP teaching intervention to achieve competency in skills associated with safe IV medication management. A convenience sample of first-year, first-semester nursing students enrolled in an accelerated graduate program (N = 32) were invited to participate; 19 enrolled, and 12 completed the study. Students (n = 12) received three 30- minute one-on-one practice sessions at 2-week intervals with an expert nurse (the intervention group focused on IV skills and the control group on skills unrelated to IVs). Pre- and post-intervention instruments tested participants’ confidence with IV management and safety skills. The primary outcome was their ability to safely administer and monitor IV medications during a 20-minute videotaped medication administration scenario. Results: Low recruitment (19 of 32) and high attrition (37%) were observed. Participants completing the study (5 in the intervention group and 7 in the control group) reported that the time required to attend the sessions was not burdensome (91.7%); time allotted was adequate (100%); 100% reported positive experience; 91.7% found the DP sessions essential to learning. Change in confidence scores for IV skills were not significant (P = 0.210), but were higher in the intervention group (2.97–4.14 = 1.50 change) compared to the control group (2.71–3.77 = 1.04 change). Significant differences were found in overall medication administration skills between the control and intervention groups (t [-2.302], p = 0.044) in favor of the intervention group, particularly with medication preparation skills (p = 0.039). Overall raw scores were low in both groups; only 16–42 (26%–70%) of the total 60 steps required for safe practice were completed. Participants scored lowest in the evaluation phase, with all participants performing less than 50% of the 14 steps. Conclusion: Even though participant satisfaction was high, significant attrition occurred. Students reported the DP sessions to be beneficial and they felt more confident in performing skills, but three 30-minute sessions (90 minutes) were not adequate to develop, maintain, or refine all the IV-management skills associated with safe medication practices. Determining the length and duration of DP sessions as well as comparing the efficacy of DP sessions between individual and group sessions with varying doses and frequencies is needed to advance our understanding of using DP within nursing education.

Suicide is a worldwide problem that generates both great suffering for the individual and its family as well as a large economic impact for the society. 800 000 people commit suicide each year globally, of whom many have already been in contact with the care system without getting the help they need. The aim of this study was to describe nurses’ experiences of caring for suicidal patients. We conducted a literature study based on analysis of qualitative studies according to Friberg’s five step model. Ten studies, published 2011-2021, were included. When asked about their experiences, nurses empathize the need of patient safety and the importance of forming a close partnership with the patient. They also empathize the emotional impact the caring of these patients put on them. Patient safety for these patients is a matter of both a safe hospital environment and nurses being well educated and aware of suicidal cues. The formation of a partnership is crucial for the nurse’s ability to make a good assessment and is usually facilitated by nurses being open and personal as well as empathic and present in the moment. However, becoming too close to the patient may be emotionally tough if the patient commits suicide. Nurses therefore need support and tools for handling their emotions. Further on, to make a good assessment the nurses also need to be able to tune into the patients verbally unexpressed needs.

Bakgrund: Omfattande patientflöden leder till stort fokus på triagering, dels för att tilldela patienten en korrekt vårdnivå och dels för att sjukvården skall ges i rätt tid. Implementeringen av triagesystemen inom hälso- och sjukvården resulterar däremot inte enbart i fördelar och det finns flera aspekter som inverkar på förutsättningarna för sjuksköterskans triagehantering och patientsäkerheten. Syfte: Syftet var att identifiera faktorer som påverkar sjuksköterskans förutsättningar för att åstadkomma en patientsäker triagehantering på akutmottagningen. Metod: Data samlades in via tre vetenskapliga databaser inom huvudområdet omvårdnad. Detta resulterade i tio artiklar som analyserades med en innehållsanalys. Resultat: Framförallt påverkades förutsättningarna för triagehanteringen av bristfälliga möjligheter till vidareutbildning, dålig efterföljsamhet gentemot riktlinjer och negativa stressorer såsom tidsbrist och frustration från patienter. Dessutom beaktade inte sjuksköterskan i tillräckligt hög grad det samlade värdet av visuell, vital och verbal information. Slutsats: För att upprätthålla kvaliteten och patientsäkerheten vid triagering krävs kontinuerlig utbildning och uppföljning, där särskild hänsyn tas till riktlinjerna. Utbildningen kan i sin tur leda till att sjuksköterskan inbegriper samtliga tre informationskällor i triageprocessen och inte förbiser betydande uppgifter om sjukdomstillståndet, trots tidsbegränsningen och frustrationen bland patienter. / Background: Extensive patient flow lead to a focus on triage, partly to assign the patient a correct level of care and partly to ensure that medical care is provided at the right time. Implementation of triage systems in health care does not only result in benefits and there are several aspects that affect the conditions for the nurse's triage management and patient safety. Aim: The aim was to identify factors that affected the nurse's conditions for achieving patient-safe triage in the emergency department. Method: Data were collected from three scientific databases in the area of nursing. This resulted in ten articles that were analyzed with the support of a content analysis. Results: The conditions for triage were affected by inadequate opportunities for further education, poor compliance with guidelines and negative stressors such as lack of time and frustration from patients. Nurse's did not necessarily take into account the total value of visual, vital and verbal information. Conclusion: In order to maintain the quality and patient safety during triage, continuous education and follow-up is required, where special consideration is given to the guidelines. The education can lead to nurse's inclusion of all three sources of information in the triage process and not overlooking significant information about the patient's illness, despite the time constraint and frustration among patients.

Bakgrund: Patientsäkerheten brister ibland i vården men är så viktig för den enskilda individens mående och tillfrisknande, begreppet innebär att patienter inte ska komma till skada eller att vårdåtgärder uteblir som patienten är i behov utav. Olika faktorer kan påverka att oförutsedda händelser inträffar som kan medföra en patientsäkerhetsrisk, för att dessa faktorer skall kunna uppmärksammas rapporteras händelser in som avvikelser av involverad personal. Det saknas studier gjorda på vilka områden som identifieras bland dessa avvikelser. Syfte: Syftet var att beskriva vilka typer av avvikelser som rapporterats in samt antal per år och analysera vilka områden som identifieras bland avvikelserna inom intensivvården för att främja patientsäkerheten. Metod: En registergranskning med tematisk analys av 212 avvikelser inrapporterade i sjukhusets interna avvikelsesystem. Resultat: Studien visar att de avvikelser som rapporterats till största del består av undvikbara vårdskador, 85 %, samt 15 % oundvikliga vårdskador. De områden som förekommer rör mestadels läkemedelsförseelser samt bristande följsamhet kring riktlinjer. Det är många olika faktorer som identifierats som potentiella orsaksområden men arbetsmiljö, kompetensbrist, den mänskliga faktorn samt organisatoriska faktorer är de återkommande områden som identifierats. Slutsats: Resultaten från denna studie visade att arbetsmiljö är en faktor som är starkt förknippad med patientsäkerhet. Majoriteten av alla negativa händelser som inträffar är undvikbara då det till största del är läkemedelsbetingade eller en brist på följsamhet av etablerade rutiner på avdelningen. De oundvikbara händelser som inträffat är till största del beroende på organisatoriska faktorer och därmed ej något som vårdpersonal hade kunnat förändra utgången av. / Background: Sometimes patient safety is lacking in care, but it is very important for the individuals care and recovery, the concept means that patients should not be harmed or lack nursing care that the patient is in need of. Various factors can affect the occurrence of unforeseen events that may be a patient safety risk, so for these factors to be noticed, events are reported as deviations of the staff involved, no studies have been done on what these deviations have for common areas. Purpose: The purpose was to describe which types of deviations that were reported over time and to analyze what common areas there is for the deviations reported in intensive care units to improve patient safety. Method: A registries study of 212 deviations from the hospitals internal deviation-database with a thematic analysis. Result: The deviations reported consists of avoidable medical errors, 85%, and 15% of unavoidable medical errors. The common areas that occur are drug misconducts and lack of adherence to guidelines. There are different factors that have been identified as potential causes, but the working environment, lack of competence, the human factor and organizational factors are the recurring areas identified. Conclusion: The working environment is a factor that is strongly associated with patient safety. The majority of all deviations that occur are avoidable as they are drug misconducts or lack of adherence to established guidelines on the department. The unavoidable medical errors occurred due to organizational factors and are therefore not something that healthcare personnel could have changed the outcome of.

Bakgrund: Tidigare forskning visar att uteblivna omvårdnadsåtgärder förekommer på vårdavdelningar. Det leder i vissa fall till svåra konsekvenser för patienten, med ökad morbiditet och mortalitet. Syfte: Att undersöka vilka omvårdnadsåtgärder som uteblir inom intensivvården, och vilka orsaker som leder till uteblivna omvårdnadsåtgärder. Metod: En litteraturöversikt med deskriptiv design för att granska kvantitativa artiklar. Resultat: Resultatet visar att uteblivna omvårdnadsåtgärder förekom även inom intensivvården. Åtgärder som uteblev var bland annat hygienrutiner, mobilisering, stöd och undervisning. Läkemedelsrelaterade avvikelser inträffade i mindre utsträckning än på vårdavdelningar men ledde till svårare konsekvenser för patienten. Flera brister i arbetsmiljön medförde att omvårdnadsåtgärder uteblev. Sjuksköterskor stördes i sitt arbete, av bland annat kollegor och övervakningsutrustning. Otillräcklig bemanning hade en stor betydelse för förekomsten av uteblivna omvårdnadsåtgärder. Bra kommunikation och samarbete minskade frekvensen. När sjuksköterskor konsulterade varandra inför åtgärder inträffade färre misstag, och när en checklista användes aktivt under ronden minskade bland annat respiratortid och mortalitetsrisken för patienten. Hög utbildningsnivå och lång yrkeserfarenhet kunde minska förekomsten av uteblivna omvårdnadsåtgärder. Uteblivna omvårdnadsåtgärder förekom i lägre utsträckning inom intensivvården jämfört med vårdavdelningar men tenderade att ha en större negativ påverkan på patienten. Slutsats: Litteraturöversikten visar att uteblivna omvårdnadsåtgärder förekommer inom intensivvården i mindre utsträckning än på vårdavdelningar, men att det påverkar patienten mer negativt då det inträffar. Det är av vikt att förbättra arbetsmiljö, kommunikation och samarbete för sjuksköterskor, och att främja utbildning och yrkeserfarenhet för att minska risken för att omvårdnadsåtgärder uteblir. / Background: Previous research indicates that missed nursing care occurs in health care units. In sometimes this leads to serious consequences for patients, with increased morbidity and mortality. Aim: To investigate what missed nursing care that occurs in intensive care, and the reasons for missed nursing care. Methods: A literature review with descriptive design for reviewing quantitative articles. Result: Missed nursing care was also present in intensive care. Missed nursing actions included hygiene routines, mobilization, support and teaching. Medication errors occurred to a lesser extent than in health care units but led to more severe consequences for patients. Shortcomings in the work environment led to missed nursing care. Nurses were often disturbed in their work, and inadequate staffing was strongly associated with missed nursing care. God communication and teamwork reduced the frequency. When nurses consulted each other before acting fewer mistakes occurred. When using a checklist actively during rounds respiration time and the risk of mortality for the patient was reduced. High levels of education and long professional experience were important for reducing missed nursing care. Missed nursing care was less common in intensive care but tended to have a greater negative impact on the patient. Conclusion: This review demonstrates that missed nursing care is less frequent in intensive care than in health care units but has a greater negative impact on the patient. It is important to improve the working environment, communication and teamwork for nurses, to promote education and professional experience to reduce missed nursing care.