Background Patient safety is an undisputable part of healthcare. The use of clinical practice guidelines, usually based on evidence-based practice/best practice, promotes patient safety and high quality care, reduces unnecessary patient suffering, and healthcare costs. Analysing results from venous blood specimen collection is one of the most commonly used services within healthcare, and a substantial number of decisions on diagnosis, treatment, and treatment evaluation are based on the results. Hence, the accuracy of these tests are vitally important. Earlier research has demonstrated that healthcare staff report suboptimal adherence to venous blood specimen collection guidelines together with the need for improved practices. Blood sample collection is carried out by several professionals, among them registered nurses and, as a consequence, nursing students too. University nursing students learn and practice venous blood specimen collection in one of their first semesters. After initial skill training at clinical skill laboratories, they continue to perform the task during clinical placements in various clinical settings. Few or no studies have been performed on nursing students, hence it seemed important to assess guideline adherence to venous blood specimen collection among university students as well as to further explore adherence to guidelines among healthcare staff. Therefore, the overall aim for this thesis was to explore adherence to, and factors influencing venous blood specimen collection guidelines practice among university nursing students and healthcare staff. Methods The thesis includes four studies. Study I-III had a quantitative, cross-sectional design, study IV had a qualitative approach. Study I included 164 healthcare staff from 25 primary healthcare centres. Study II included 101 nursing students in their 5th and 6th semesters, and study III included 305 nursing students in their 2nd, 4th, and 6th semesters. To assess adherence to venous blood specimen collection guidelines, data were collected using the Venous Blood Specimen Questionnaire, completed with background variables (I, II, III) and additional scales (III). Descriptive statistics, multilevel and multiple logistic regression analyses were used to analyse the data. In study IV, data were collected through five focus group interviews among 6th semester nursing students (n=26). Data were analysed using qualitative content analysis. Results Workplace affiliation was found to explain variances in reported adherence between different primary healthcare centres. Associations between reported venous blood specimen collection practices and individual as well as workplace factors were revealed. Nursing students were found to increasingly deviate from guideline adherence during their education. Also among students, several associations between guideline adherence and other iv factors were revealed. Reported research use at clinical practice was associated with higher levels of adherence, as were higher capability beliefs regarding both evidence-based practice and academic ability. Analyses from focus group interviews summarised students’ reflections on deviations from VBSC guidelines in the overall theme ‘Striving to blend in and simultaneously follow guidelines’. Conclusion Both healthcare staff at primary healthcare centres and nursing students demonstrate decreasing levels of guideline adherence with time. Factors influencing adherence are both individual as well as contextual. This indicate that both students and staff are subjected to socialisation processes that influences levels of adherence. In order to enhance venous blood specimen collection practices and thereby patient safety, actions must be taken - both in healthcare clinical contexts and by educators. The use of models in practical skill training, and in the ambition to bridge the theory-practice gap may be the path to success. It is reasonable to assume that collaboration between, on the one hand, education representatives and on the other, supervising RNs in clinical settings, will be fruitful. Finally, by empowering students their self-efficacy may be strengthened, and hence their ability to maintain guideline adherence.

Since laboratory tests influence as much as 70% of the medical decisions, errors throughout the blood sampling process may jeopardize the safety of the patient. Research has shown that the pre-analytical phase of the blood sampling process is where the most errors occur. Moreover, this phase is said to be the most influential part of the total testing process, due to maximal involvement of humans. In this study, the pre-analytical errors in the blood sample handling process and their causes were investigated. Therefore, a literature study was performed, and first-hand data was collected through interviews. A total of 8 interviews was conducted in Sweden, Belgium, and the Netherlands. From these interviews, qualitative data was collected and analysed with a thematic approach. The 5 themes that were obtained are: nurse vs. lab technician, sample identification, logistics, location dependency of sample quality, and hospital management. Each theme included multiple observations and conclusions. One specific observation was a lack of communication and knowledge management amongst nurses and lab technicians. To minimize this gap between nurse and lab technician from a knowledge transfer perspective, a conceptual framework was constructed. This framework can be used both from an academic and practical point of view. This research has both academic and practical implications. Within the academic perspective, empirical data is gathered among hospitals in three different countries, which is compared to data found in academic literature. Moreover, with the analysis of the empirics gathered in this study and the framework that is proposed, a contribution is made to knowledge management within hospitals. From a practical perspective, a contribution is made in helping to minimise the pre-analytical errors in their blood sampling process, while giving the hospital a better understanding of the lack of communication and knowledge management amongst their key employees. By strengthening the communication and knowledge transfer, errors can be avoided. This would not only benefit the speed and accuracy of the diagnose process, but also benefit the nurses and lab technicians in workload. / Eftersom laboratorietester påverkar så mycket som 70 % av de medicinska besluten kan fel i blodprovstagningen äventyra patientsäkerheten. Forskning visar att det är i den föranalytiska fasen av blodprovstagningsprocessen som de flesta felen uppstår. Dessutom sägs denna fas vara den mest inflytelserika delen av den totala provtagningsprocessen, på grund av den höga graden av människors inblandning. Denna studie undersökte de föranalytiska felen i blodprovshanteringen och deras orsaker. En litteraturstudien genomfördes, och förstahandsuppgifter samlades in genom intervjuer. Totalt åtta intervjuer genomfördes i Sverige, Belgien och Nederländerna. Från dessa intervjuer samlades kvalitativa data in och analyserades med en tematisk ansats. De fem teman som erhölls var: sjuksköterska jämte laboratorietekniker, providentifiering, logistik, platsberoende provkvalitet och sjukhusledning. Varje tema innehöll flera observationer och slutsatser. En specifik observation var bristen på kommunikation och kunskapshantering mellan sjuksköterskor och laboratorietekniker. För att minimera denna klyfta mellan sjuksköterska och laboratorietekniker ur ett kunskapsöverföringsperspektiv konstruerades en konceptuell ram. Denna ram kan användas både ur akademisk och praktisk synvinkel. Denna forskning har både akademiska och praktiska konsekvenser. Utifrån det akademiska perspektivet samlades empiriska data in bland sjukhus i tre olika länder, som jämförs med data i den existerande litteraturen. Med analysen av den empiri som samlats in i den här studien och det ramverk som föreslås ges dessutom ett bidrag till kunskapshantering inom sjukhus. Ur ett praktiskt perspektiv bidrar detta till att minimera de föranalytiska felen i blodprovstagningsprocessen, samtidigt som sjukhuset får en bättre förståelse för bristen på kommunikation och kunskapshantering bland sina nyckelpersoner. Genom att stärka kommunikationen och kunskapsöverföringen kan fel undvikas. Detta skulle inte bara gynna diagnostikprocessens snabbhet och noggrannhet, utan även avlasta sjuksköterskorna och laboratorieteknikernas arbetsbörda.