Introduction. Patient falls occur frequently in the acute hospital setting and are one of the most common adverse events experienced by hospitalised patients. In-hospital falls have negative outcomes for patients, causing injuries in up to half of those who fall. Falls in hospital create additional costs for health services due to increased length of stay (LOS), and greater health resource use. In contrast to much research focused on in-hospital falls worldwide, little is known about the rate, contributing factors and outcomes of inpatient falls in the state sector in South African hospitals. At the research hospital, a Falls Policy has been in place since 2013. The chosen falls risk screening tool, the Morse Falls Scale (MFS), had not been locally validated, and therefore its ability to accurately discriminate between patients who fall and patients who do not fall was unknown. A focused analysis of local falls incident reporting, and a description of contributory factors and consequences of falls, could better inform and target falls and fall injury prevention. Furthermore, this research may assist in service development and refining the Falls Policy. Methodology. The aim of this study was to obtain broad-based data on the magnitude of patient falls, and to identify factors contributing to falls. The aim was achieved in two parts, the first was a retrospective record review design. Predictive risk factors for falls were explored by comparing two patient groups, a Fall-Group and a Non-fall Group. In the FallGroup, further objectives related to describing circumstances surrounding fall events, including activities patients were performing at the time of the fall, the time of day and day of week the fall occurred, locations of fall events, and the clinical consequences sustained as a result of the fall. The use of the existing falls risk screening tool, the MFS, as well as its predictive accuracy to correctly identify patients at increased risk of falling was investigated. Second, a survey of nurses at the research hospital was undertaken to examine nurses' knowledge, attitudes and beliefs around the Falls Policy and current falls prevention practices. Results. There were 171 reported fall events during the ten-month period, representing 11.77% of adverse events and a falls rate of 0.73 per 1000 patient occupied bed days (POBD) during this time. Significant predictive risk factors for falling were a longer LOS and having a greater number of comorbid conditions. While the mean age of the sample was 50.0 years (SD=17.3 years), the Fall Group was significantly older than the Non-fall Group (p = .004). There were significantly more deaths in the Fall Group (p = .001), and this group had a longer average LOS (p < .001) compared to the Non-fall Group. The only sub-scale from the MFS that was significantly associated with falls was walking status. Minor-moderate clinical consequences were experienced as a result of the fall in 97% of cases (n=124). This study demonstrated that the MFS in use in the hospital has a low predictive accuracy of 55% at the current cut-off score of 50. At this score, the MFS has a sensitivity of 35.9% and a specificity of 75.4%. While an initial MFS was found in each of the cases, there was only evidence of a repeat MFS in 13 participants (9.7%) in the Fall Group. The nursing survey showed 70% of respondents had not had training on the Falls Policy (n=93) and only 37% (n=49) reported receiving regular feedback on fall rates. Receptiveness of most (66%, n=91) nurses to more training in falls prevention is encouraging. Discussion. The fall rate of 0.73 falls per POBD was lower than expected when compared to international studies. At the research hospital, when the Falls Policy was introduced in 2013, a fall was not defined in the policy and as highlighted in the nursing survey, there still appears to be lack of clarity on the fall definition. The MFS had a low predictive accuracy at the current cut-off score. The low sensitivity and specificity of the MFS in this setting may be due to the MFS not being updated regularly as per the Falls Policy. A further reason for the MFS poor predictive value may be the younger age group found in this sample when compared to international studies where the scale has performed better. Recommendations. The poor predictive value of the current risk screening tool found in this study is concerning. Therefore, further investigation into whether the MFS performs better if it is updated more frequently, and if completed in full, as per the Falls Policy, is recommended. Alternatively, the hospital should consider all patients with multiple comorbidities and those with longer length of stays at high risk, and provide interventions to minimise risk as per the Falls Policy. Future research into factors contributing to fall events and falls prevention should follow a prospective design and be supported at management as well as ward level. Further investigation into the most appropriate way to reduce harm from falls is recommended at the research site. Conclusion. This descriptive study provides a starting point for the hospital to examine the Falls Policy and falls prevention strategies currently in use. It is hoped that the study will contribute to local awareness-raising and capacity-building and help the hospital evaluate current practice and set a baseline for improvement.

Bakgrund: Vid forskningsgenomgång framkom det i internationell forskning att det finns kunskap om sjuksköterskans arbetsbelastning, om stressfaktorer på arbetsplatsen och dess negativa påverkan på sjuksköterskans hälsa. Sjuksköterskan upplever en stark arbetsrelaterad stress, där tidspress och hög arbetsbelastning är återkommande fenomen på akutvårdsavdelningar. En kunskapsbrist råder kring sjuksköterskans upplevda hälsa, specifikt i relation till hennes upplevda möjlighet att ge god omvårdnad. Syfte: Studiens syfte var att undersöka sjuksköterskans upplevda hälsa i relation till hennes upplevda möjlighet att ge god omvårdnad i en akutvårdskontext. Metod: Enkätundersökning av empirisk deskriptiv design med kvantitativ ansats. Resultat: Utifrån sjuksköterskornas skattning av hälsa och god omvårdnad sorterades frågorna in i rubrikerna: sjuksköterskans upplevda hälsa, omvårdnadens atmosfär, sjuksköterskans upplevda möjlighet att underhålla omvårdnadens kvalitet och stressorer i arbetsmiljön. Slutsats: Studien illustrerar ett gott exempel på sjuksköterskans upplevelse av hälsa och upplevelse av god omvårdnad i relation till varandra och KASAM. Sjuksköterskan kan ha en hög KASAM eller låg KASAM beroende på hög begriplighet och hanterbarhet men låg meningsfullhet, eller låg begriplighet och hanterbarhet men hög meningsfullhet. Det vill säga att en sjuksköterska väl kan ha god hälsa utan att hon har relation till god omvårdnad om begriplighet och hanterbarhet finns. Likaså kan sjuksköterskan uppleva avsaknad av hälsa med att detta är i relation till att uppleva god omvårdnad om meningsfullhet finns. Klinisk betydelse: Det krävs en insikt om vad relationen hälsa och välmående hos sjuksköterskan, satt i sammanhang med huvuduppgiften, det utförda omvårdnadsarbetet, egentligen kräver. / Background: Internationally, there is an existing knowledge about nurses’ workload, stress factors in workplaces and its negative impact on nurses’ health. In acute care settings, the nurses experience a strong work-related stress, where time pressure and heavy workload are recurring phenomena. A lack of knowledge exists about the nurse's perceived health, specifically in relation to her experienced ability to provide good care. Aim: The aim of this study was to examine nurses’ experienced health, in relation to her experienced ability to provide good nursing, in acute care settings. Method: A survey of empirical descriptive design with quantitative approach. Result: Based on nurses' estimates of health and good nursing, the questions were arranged under the following headlines: experienced health – good nursing, lack of health – absence of nursing, experienced health – absence of nursing and lack of health – good nursing. Conclusion: The study is a good example of the relation between a nurse's experienced health, her cognition of well performed nursing and sense of coherence. The nurse may have a high or low sense of coherence due to high comprehensibility and manageability but low meaningfulness, or low comprehensibility and manageability but high meaningfulness. Due to high comprehensibility and manageability the nurse can experience good health, but it may not be related to good nursing. The nurse can also experience a lack of health but perform good nursing, due to high meaningfulness. Clinical significance: The study indicates that it requires an understanding for the relation between health and well-being of the nurses, put in context with the main task, the nursing.

During the last several decades, venous thromboembolism (VTE) has been identified as a preventable health condition. The gaps in clinical practice have led to an increased incidence of VTE. The lack of using existing evidence-based VTE prevention guidelines in practice has limited the implementation of VTE risk assessment stratifications and affected the appropriateness and timeliness of addressing pharmacologic and mechanical prophylaxis. The purpose of the scholarly project was to educate practitioners on existing VTE prevention practice guidelines. The practice-focused question explored whether an educational learning activity on evidence-based VTE prevention guidelines improved the awareness, knowledge, and compliance with existing evidence-based VTE guidelines of practitioners that assess and treat patients at risk for VTE. The theoretical framework for the project was Lewin's change process theory. A total of 38 participants comprised registered nurses (82%), physicians (5%), nurse practitioners (2%), and nonclinical personnel (11%). A program evaluation was provided to determine the effectiveness of the project. The findings showed that practitioners participated in the learning activity to improve knowledge (48%), increase VTE awareness (43%), and would change the management and treatment of patients at risk for VTE (39%). Hospitalized patients at risk for VTE can benefit from the results of this project through a change in clinical practice that might decrease the incidence of VTE and potentially bring about social change by reducing the number of preventable deaths.

Bakgrund: Akutsjukvård innefattar olika typer av vård på avdelningar på och utanför ett sjukhus. Inom akutsjukvård kan miljön upplevas stressande för de äldre personerna som är känsliga för bland annat ljud och ljus. Ett personcentrerat bemötande kan hjälpa dem i situationen. Bemötandet är därför en av sjuksköterskans uppgifter inom akutsjukvård. Syfte: Att belysa äldre personers upplevelser av att vårdas inom akutsjukvård. Metod: Arbetet utformades som en strukturerad litteraturöversikt vilken fokuserade på äldre personer över 65 år. Resultatet sammanställdes utifrån 13 vetenskapliga artiklar som var publicerade mellan årtalen 2012–2023 i databaserna CINAHL, PubMed och APA PsycINFO. De delar av resultaten i de inkluderade vetenskapliga artiklarna som svarade mot arbetets syfte markerades och överfördes till post-it-lappar som parades ihop efter liknande betydelse och framkomna kategorier. Resultat: De äldre personerna upplevde miljön inom akutsjukvård som stressfylld och med bristfällig information samt kommunikation vilket sågs främst vid utskrivningen. Bemötandet visade sig spela en betydande roll för deras känsla av respekt, värdighet och delaktighet i många vårdsituationer, detta visade sig svårt att möta inom just akutsjukvård. De äldre personerna delade med sig av flest negativa upplevelser av personalen och organisationen inom akutsjukvård. Slutsats: De äldre personernas upplevelser visade att det fanns förbättringspotential inom miljö, omvårdnad, bemötande och utskrivning i området akutsjukvård för dem äldre personerna. / Background: The acute care included different kinds of care in separate wards in and outside the hospital setting. The environment in the acute care setting could be experienced as stressful for the older persons who were sensitive to noise and lighting among other things. A person-centered care could help them in this situation. The nurse in acute care setting therefore had personal treatment as a work task. Aim: To explore the older persons experiences of care in the acute care setting. Method: This study was designed as a structured literature review with focus on older persons over 65 years. The results are compiled of data from 13 research articles published between the years 2012-2023 from the databases CINAHL, PubMed and APA PsycINFO. The parts of the results who met the study’s aim was marked and transferred to post-it-notes witch was paired by similar meaning and emerged categories. Results: The older persons experienced the environment in the acute care setting as stressful and with flaws in information and communication regarding their care mainly at discharge. The treatment was shown to be a part of their sense of respect, dignity, and participation in their care, this proved difficult to achieve in the acute care setting. The older people shared mainly negative experiences with the staff and organization in the acute care. Conclusions: The older persons experiences of the acute care setting have shown potential to advance in environment, care, treatment, and discharge in area of the acute care for older persons.

Background: The diagnoses of dementia increases in line with the aging population of the earth. Symptoms vary between different dementia diagnoses and for some, a diagnosis might be a relief and confirmation of what’s really going on for both the patient and their relatives. Person centered care aims to empower a person's self-esteem and involvement in their own care. It urges healthcare professionals to look beyond the diagnosis of the patient, which makes this the form of care advocated for patients with dementia. Despite the fact that long waiting times is an acknowledged problem, nurses are still obliged to pursue nursing on equal standardse. Aim: The aim was to acknowledge nurses' experiences of caring for patients with dementia in acute care settings Method: A literature-based study with nine qualitative articles were chosen. Results: The analysis identified three main categories; lack of knowledge, structural deficiencies and relatives as a co-actor of the caring process, and eight subcategories. Conclusion: Dedication and education are central aspects regarding the care of patients with dementia. It becomes apparent that regardless of context, caring for patients with dementia is often mired in complexity. Nurses claim that lack of time and education combined with structural deficiencies constitutes an obstacle for nurses providing what they would consider sufficient care. These deficiencies may also negatively affect attitudes and perceptions and consequently the care of patients with dementia can be stigmatized. / Bakgrund: Diagnostik av demens ökar i takt med världens åldrande befolkning. Symtom skiljer sig mellan olika diagnostyper och en diagnos kan innebära en lättnad och bekräftelse för både patient och anhöriga. Den vårdform som förespråkas för patienter med demens är personcentrerad vård som syftar till att stärka en persons självkänsla och delaktighet i vården och se bortom diagnoser. Även om väntetiderna på landets akutmottagningar är erkänt långa för äldre patienter har sjuksköterskor en skyldighet att ge omvårdnad på en likvärdig grund. Syfte: Syftet med studien var att belysa sjuksköterskors erfarenheter av att vårda patienter med demens på akutvårdsavdelningar. Metod: En litteraturbaserad studie valdes där nio kvalitativa artiklar analyserats Resultat: Ur analysen framträdde tre kategorier; bristande kunskap, strukturella brister och anhöriga en medaktör i vårdandet med åtta underkategorier. Konklusion: Vårdandet av patienter med demens kräver engagemang och utbildning och det visar sig att det oavsett kontext är komplext att vårda patienter med demens. Sjuksköterskors erfarenheter visar att tid, utbildning och strukturella brister utgör ett hinder i vårdandet. Dessa brister kan även påverka attityder i negativ riktning och vårdandet av patienter med demens kan stigmatiseras.

The prevalence of diabetes mellitus (DM) continues to be a global concern among health care practitioners. Without collaboration and interventions, this chronic disease, which poses a significant financial burden for health care institutions, will continue to be problematic. Promoting the use of glycemic control measures among diabetic patients is an intervention, which has the potential to reduce diabetic complications and improve outcomes. The purpose of this doctoral project was to explore available evidence through a systematic review of the best practices for glucose management. The chronic care model served as the theoretical framework. The evidence based practice question was, What is the current evidence supporting the utilization of a computer-based glucose management system (CBGMS) for inpatient diabetic adults in acute and critical care settings? A systematic review was conducted, yielding 532 studies in which 3 of the studies related to CBGMSs published from 2008 to 2017 were critically appraised. The John Hopkins Nursing Evidence Appraisal Tool with specific inclusion and exclusion criteria was utilized. Participants were adult patients (aged 18 and over) with DM in inpatient care settings who were English speaking. Interventions included the traditional paper-based sliding scale regimen versus the utilization of a CBGMS. Outcome measures included decreased length of stay, reduced cost, and glucose optimization. A conclusion was the implementation of a CBGMS has the potential to improve patient outcomes with additional research that exhibits overall benefits and implement into practice. Thus, implementation of a CBGMS can lead to positive social change by aiding in a change in practice that will ultimately ameliorate patient health outcomes.

No description available.

Bakgrund: Den palliativa vården syftar till att främja bästa möjliga livskvalitet för människor drabbade av obotlig, livshotande sjukdom. För att den sista tiden i livet ska bli så bra som möjligt för patienter och närstående krävs en helhetssyn på människan där hänsyn tas till både fysiska, psykiska, sociala och existentiella behov och att vården ges utifrån patientens önskemål. Sjuksköterskor har ett betydelsefullt omvårdnadsansvar i vården av svårt sjuka och döende patienter, men ansvaret kan se olika ut beroende på var patienten vårdas. I Sverige sker cirka en tredjedel av alla dödsfall varje år på sjukhus, i en miljö vars huvudsakliga fokus är att rädda liv. Palliativ vård är en grundläggande rättighet för alla människor och sjukvården har ett ansvar att ge en god, säker, jämlik och individanpassad vård, oavsett var patienten vårdas. Trots detta har den palliativa vården på sjukhus visat sig vara otillräcklig ur många perspektiv. Syfte: Syftet med litteraturöversikten var att beskriva sjuksköterskors syn på sitt omvårdnadsansvar i vården av patienter i livets slutskede på sjukhus. Metod: En litteraturöversikt med kvalitativ ansats utfördes på ett systematiskt sätt. Artiklar söktes med hjälp av relevanta sökord i databaserna PubMed och CINAHL.12 vetenskapliga originalartiklar inkluderades, kvalitetsgranskades och analyserades och resultatet sammanställdes med hjälp av tematisk innehållsanalys. Resultat: Fyra huvudteman utkristalliserades. Det första handlade framför allt om känslor av osäkerhet i rollen och ansvaret relaterat till kunskaps- och erfarenhetsbrist och det andra om ansvaret att ge en helhetsvård utifrån patientens behov och önskemål, ofta svårt i en akut vårdkontext. Det tredje temat beskrev att sjuksköterskorna ofta fick kämpa sig till ett samarbete, att deras profession inte alltid togs på allvar och att ansvaret att bygga tillitsfulla relationer med patienter och närstående krävde förutsättningar som inte alltid fanns. Sista temat handlade om ansvaret att företräda patienterna och viljan att göra det bästa möjliga för patienter och närstående. Samtliga teman beskrev faktorer som påverkade sjuksköterskans möjlighet att ta sitt omvårdnadsansvar. Slutsats: Det finns en önskan och strävan hos sjuksköterskorna i litteraturöversiktenatt vården i livets slutskede ska vara den bästa möjliga, men de saknar många gånger rätt förutsättningar för att ge en god vård utifrån ett palliativt förhållningssätt. För att kunna tillgodose patientens fysiska, psykiska, sociala och existentiella behov behöver sjuksköterskorna mer utbildning och kunskap, tid samt ett bättre teamarbete professionerna emellan. / Background: Palliative care is an approach aimed to improve quality of life for patients with serious, life-threatening illness. To optimize the time for patients and their families the care should be provided through the integration of physical, psychological, social and spiritual needs and health professionals that pay special attention to the preferences of individuals. Nurses have a significant responsibility in the care of the terminal ill, and the responsibility can look different depending on where the patients are cared for. In Sweden, about a third of all deaths occur in hospitals, in an environment whose main focus is to save lives. Palliative care is a basic human right and healthcare has a responsibility to give a good, secure, equal and person-centered care, regardless of where the patients are cared for. Despite this, the hospital palliative care has been shown as insufficient in many perspectives. Aim: The aim was to describe nurses’ view of their responsibility in the end-of-life care in hospitals. Method: A qualitative literature review was made in a systematic way. Articles were sought with relevant search terms in the PubMed and CINAHL databases. 12 scientific original articles were included, quality reviewed and analysed and the result was compiled with thematic content analysis. Results: Four main themes crystallised. The first was mainly about feelings of uncertainty in the role and responsibility related to lack of knowledge and experience. The second was about the responsibility to provide comprehensive care based on the patient’s needs and wishes, often difficult in an acute care context. The third theme described that nurses often had to fight their way to a collaboration, that their profession was not always taken seriously and that the responsibility to build trusting relationships with patients and loved ones required conditions that did not always exist. The last theme was about the responsibility to represent patients and the desire to do the best possible for patients and loved ones. All themes described factors that affected the nurse’s ability to assume her nursing responsibilities. Conclusion: There is a desire and ambition among the nurses in the study that end-of-life care should be as good as possible, but they often lack the right conditions to provide good care based on a palliative approach. To meet the patient's physical, mental, social and existential needs, nurses need more education and knowledge, time and better teamwork between the professions.

Bakgrund: Den palliativa vården syftar till att främja bästa möjliga livskvalitet för människor drabbade av obotlig, livshotande sjukdom. För att den sista tiden i livet ska bli så bra som möjligt för patienter och närstående krävs en helhetssyn på människan där hänsyn tas till både fysiska, psykiska, sociala och existentiella behov och att vården ges utifrån patientens önskemål. Sjuksköterskor har ett betydelsefullt omvårdnadsansvar i vården av svårt sjuka och döende patienter, men ansvaret kan se olika ut beroende på var patienten vårdas. I Sverige sker cirka en tredjedel av alla dödsfall varje år på sjukhus, i en miljö vars huvudsakliga fokus är att rädda liv. Palliativ vård är en grundläggande rättighet för alla människor och sjukvården har ett ansvar att ge en god, säker, jämlik och individanpassad vård, oavsett var patienten vårdas. Trots detta har den palliativa vården på sjukhus visat sig vara otillräcklig ur många perspektiv. Syfte: Syftet med litteraturöversikten var att beskriva sjuksköterskors syn på sitt omvårdnadsansvar i vården av patienter i livets slutskede på sjukhus. Metod: En litteraturöversikt med kvalitativ ansats utfördes på ett systematiskt sätt. Artiklar söktes med hjälp av relevanta sökord i databaserna PubMed och CINAHL.12 vetenskapliga originalartiklar inkluderades, kvalitetsgranskades och analyserades och resultatet sammanställdes med hjälp av tematisk innehållsanalys. Resultat: Fyra huvudteman utkristalliserades. Det första handlade framför allt om känslor av osäkerhet i rollen och ansvaret relaterat till kunskaps- och erfarenhetsbrist och det andra om ansvaret att ge en helhetsvård utifrån patientens behov och önskemål, ofta svårt i en akut vårdkontext. Det tredje temat beskrev att sjuksköterskorna ofta fick kämpa sig till ett samarbete, att deras profession inte alltid togs på allvar och att ansvaret att bygga tillitsfulla relationer med patienter och närstående krävde förutsättningar som inte alltid fanns. Sista temat handlade om ansvaret att företräda patienterna och viljan att göra det bästa möjliga för patienter och närstående. Samtliga teman beskrev faktorer som påverkade sjuksköterskans möjlighet att ta sitt omvårdnadsansvar. Slutsats: Det finns en önskan och strävan hos sjuksköterskorna i litteraturöversiktenatt vården i livets slutskede ska vara den bästa möjliga, men de saknar många gånger rätt förutsättningar för att ge en god vård utifrån ett palliativt förhållningssätt. För att kunna tillgodose patientens fysiska, psykiska, sociala och existentiella behov behöver sjuksköterskorna mer utbildning och kunskap, tid samt ett bättre teamarbete professionerna emellan. / Background: Palliative care is an approach aimed to improve quality of life for patients with serious, life-threatening illness. To optimize the time for patients and their families the care should be provided through the integration of physical, psychological, social and spiritual needs and health professionals that pay special attention to the preferences of individuals. Nurses have a significant responsibility in the care of the terminal ill, and the responsibility can look different depending on where the patients are cared for. In Sweden, about a third of all deaths occur in hospitals, in an environment whose main focus is to save lives. Palliative care is a basic human right and healthcare has a responsibility to give a good, secure, equal and person-centered care, regardless of where the patients are cared for. Despite this, the hospital palliative care has been shown as insufficient in many perspectives. Aim: The aim was to describe nurses’ view of their responsibility in the end-of-life care in hospitals. Method: A qualitative literature review was made in a systematic way. Articles were sought with relevant search terms in the PubMed and CINAHL databases. 12 scientific original articles were included, quality reviewed and analysed and the result was compiled with thematic content analysis. Results: Four main themes crystallised. The first was mainly about feelings of uncertainty in the role and responsibility related to lack of knowledge and experience. The second was about the responsibility to provide comprehensive care based on the patient’s needs and wishes, often difficult in an acute care context. The third theme described that nurses often had to fight their way to a collaboration, that their profession was not always taken seriously and that the responsibility to build trusting relationships with patients and loved ones required conditions that did not always exist. The last theme was about the responsibility to represent patients and the desire to do the best possible for patients and loved ones. All themes described factors that affected the nurse’s ability to assume her nursing responsibilities. Conclusion: There is a desire and ambition among the nurses in the study that end-of-life care should be as good as possible, but they often lack the right conditions to provide good care based on a palliative approach. To meet the patient's physical, mental, social and existential needs, nurses need more education and knowledge, time and better teamwork between the professions.