Bakgrund: Vårdskador är vanligt förekommande i både svensk och utländsk sjukvård. Överlag bidrar vårdskadorna med flera dygns förlängda vårdtider och upptar ett stort antal vårdplatser. Detta upptar resurser och kostar samhället många miljarder kronor varje år. Hälso- och sjukvårdspersonal ansvarar för patientsäkerheten i vården, vilket i Sverige är reglerat i lagar och föreskrifter. Dessa finns till för att skydda patienter mot vårdskador och innebär en skyldighet för hälso- och sjukvården att ständigt jobba för att utveckla kvalitet och säkerhet i vården. Syfte: Syftet med litteraturöversikten var att beskriva patienters upplevelser av att drabbas av vårdskada. Metod: En litteraturöversikt enligt Friberg har genomförts. Sökning efter resultatartiklar till översikten gjordes i CINAHL Complete och PubMed. Elva originalartiklar hittades, vilka utgör underlag för resultatet i översikten. Resultat: Med stöd i Katie Erikssons vårdteori identifierades tre huvudkategorier av upplevelser, vilka var vårdlidande, sjukdomslidande och livslidande. Varje kategori hade tillhörande underkategorier där patienternas upplevelser beskrivs. Diskussion: Huvudfynd i resultatet har diskuterats utifrån bakgrund, annan forskning och Katie Erikssons vårdteori. Kommunikation och information från vårdpersonalen efter en vårdskada upplevs av patienter bristfällig. I de fall då kommunikation och information upplevs tillfredställande minskar också vårdlidandet. Patienters upplevelser visar att vårdpersonal inte följer sitt ansvar och befintliga lagar, vilket tycks utgöra ett problem som hämmar kvalitet och säkerhet i vården. I kontrast till de negativa upplevelserna förekommer också positiva upplevelser vilka relateras till god vård innan och efter vårdskadan. / Background: Adverse events are common in Swedish and foreign healthcare. These events overall contribute to several days of prolonged hospital stay and occupies a large number of hospital beds. It occupies resources and costs the society billions of Swedish crowns (SEK) every year. Healthcare professionals are responsible for the patients’ safety in the healthcare, which in Sweden is regulated by laws and regulations. These are designed to protect patients against adverse events and injuries in the healthcare and entail obligations for healthcare professionals to constantly work to develop the quality and safety for the patients in the healthcare.  Aim: The aim of this literature review was to describe patients´ experiences of being affected by an adverse event. Method: A literature review has been performed according to Friberg’s method. The databases CINAHL Complete and PubMed were used for searching articles for this literature review. Eleven original articles were found, which are used to form the results of this review. Results: With support in Katie Eriksson´s theory of caring, three main categories of patients experiences were found, these categories were suffering related to healthcare, suffering from illness, suffering of life. Each category had related subcategories where patients' experiences are described. Discussion: Main findings has been discussed on the basis of the background, other research and Katie Eriksson’s theory of caring. A lack of communication and information from the healthcare professionals after an adverse event was experienced. In cases when the communication and information perceived satisfactorily the suffer were reduced. Patients’ experiences show that healthcare professionals do not follow their responsibilities and the existing laws, which inhibits the quality and safety of the healthcare. In contrast to the negative experiences there were also positive experiences, which are related to good care before and after the adverse event.

Bakgrund: Kvaliteten på sjuksköterskans omvårdnadsjournal kan återspegla den vårdkvalitet som tillhandahålls patienter. Patienter med en höftfraktur har ofta ett omfattande vårdbehov där omvårdnadsjournalen har en viktig funktion att strukturera dokumentation av vårdinsatser genom patientens vårdförlopp. Patienter med höftfraktur har ofta en komplex sjukdomsbild, där omvårdnadsdokumentationens kvalitet kan bidra till en säkrare vård för patienten. Kvaliteten på dokumentationen ökar vid en strukturerad journal och framförallt när ett standardiserat språk används. Journalgranskning är ett sätt att göra kvalitetskontroll av dokumentation. Motiv: Att drabbas av en höftfraktur innebär stora hälsorisker för en ofta redan skör person. Omvårdnadsdokumentationens kvalitet vid höftfraktur kan bidra till att patienten får bättre förutsättningar för att undvika komplikationer och till kortare vårdtid. Syfte: Att undersöka kvaliteten av omvårdnadsdokumentation för patienter med höftfraktur.Metod: En retrospektiv, deskriptiv och jämförande design där granskning av omvårdnadsjournaler användes för att besvara studiens syfte. Ett konsekutivt urval har gjorts av omvårdnadsdokumentation från 40 vårdtillfällen med patienter över 60 år som vårdats för en höftfraktur på en akutortopedisk avdelning. För granskningen användes journalgranskningsinstrumentet Cat-ch-ing. Resultat: De granskade omvårdnadsjournalernas kvalitet var varierande; ingen av journalerna hade en komplett dokumentation. Dokumentation av vårdplan och resultat av omvårdnadsåtgärder saknades i en majoritet av journalerna. Dokumentationen var av bättre kvalitet i gruppen yngre äldre patienter vid jämförelse med gruppen äldre äldre patienter. Ingen skillnad av kvalitet i dokumentationen kunde urskiljas utifrån vårdtidens längd då patienter som vårdats mindre än sju dygn eller sju dygn eller mer jämfördes. Konklusion: Kvaliteten av omvårdnadsdokumentationen var inte komplett. Det krävs ytterligare kunskap om förbättringsåtgärder i den kliniskas verksamheten för att säkerställa en omvårdnadsdokumentation av god kvalitet där patienter med höftfraktur vårdas. / Background: The quality of the nursing record can reflect the quality of nursing care provided to patients. Patients with a hip fracture often have an extensive need for care. The nursing record has an important function of describing the nursing process, nursing diagnoses and interventions. Patients with hip fractures often have complex health care needs and the nursing documentation can contribute to patient safety. The quality of the documentation increases with a structured journal. Furthermore, it should be written in a standardized language. Audit of nursing documentation can contribute to quality of care. Motive: Great health risks is a fact when suffering from a hip fracture, especially an already fragile person. The quality of the nursing documentation can contribute to better outcome in patient safety and the length of stay. Aim: To explore the quality of nursing documentation for patients with hip fractures. Methods: A retrospective descriptive and comparative design where audit of nursing records was used to attain the study's aim. A consecutive sample was used, where 40 patients’ health care records of nursing documentation for patients over the age of 60 with a hip fracture in an emergency orthopedic ward were included. The audit instrument Cat-ch-Ing was used. Result: The result showed that the quality was variable; none of the records had a complete documentation. Documentation of care plans were missing in a majority of the records. The documentation was of better quality in the group of younger elderly patients compared to that of older elderly patients. No quality differences were seen based on the length of stay. Conclusion: None of the records had a complete documentation. Further knowledge of how good quality nursing documentation on hip fractur patients can be implement for a sustainable result in clinical activities.

Abstrakt Bakgrund: Flertalet av patienterna vilka söker akuten är inte i behov av akutsjukvård. Sjuksköterskor på akutmottagningarna kan idag hänvisa patienter till annan vårdnivå så som primärvård eller till hemmet med egenvårdsråd.   Syfte: Syftet var att belysa triagesjuksköterskans erfarenhet av hänvisning till annan vårdnivå än akutmottagning.   Metod: Studien var en kvalitativ intervjustudie genomförd med semistrukturerade intervjuer. I studien ingick intervjuer med 12 sjuksköterskor, både med och utan specialistutbildning, vilka arbetar på akutmottagning samt har erfarenhet av hänvisning av patienter till annan vårdnivå. Kvalitativ innehållsanalys har använts för att bearbeta insamlad data.   Resultat: Triagesjuksköterskans erfarenhet av att hänvisa patienter till annan vårdnivå tolkades utifrån följande teman för att belysa olika faktorer som påverkar sjuksköterskans handling på en akutmottagning; faktorer som påverkar hänvisning, professionella stöd och handläggningsstrategier vid hänvisning. Resultatet visade att respondenterna upplever hänvisning som komplext och stundtals svårt där sjuksköterskan känner sig osäker, samtliga respondenter uppgav att de hade erfarenhet av patienter som uppträder agiterat samt hotfullt vid hänvisning, flertalet uttryckte därför att de kände sig otrygga på sin arbetsplats, de uttryckte även att erfarenhet samt klinisk blick var av stor betydelse vid hänvisning av patienter.   Slutsats: Författarnas kliniska slutsats är att respondenterna anser att möjligheten till att kunna hänvisa patienterna till en annan vårdnivå är av stor patientnytta. Detta då patienten får adekvat och rätt vård från början relaterat till deras sjukdomstillstånd vilket även kan leda till att väntetiden på akutmottagningen minskar. Mer utbildning liksom beslutstöd behövs för att göra sjuk sjuksköterskor tryggare med sin hänvisning. Författarna anser även att studien ger viktiga infallsvinklar inom problemområdet som kan vara användbara i en kommande yrkesroll. / Abstract Background: The majority of patients who seek emergency care, are not in need of it. Nurses at emergency departments can refer patients to other type of care, such as primary care or to the home with self-care advices. Referral are often carried out independent and therefore the nurses requires a high level of expertise as well as good communication skills.   Purpose: The aim of the study is to highlight the triage nurse's experience of referral of patients from the emergency department to other care givers such as primary healthcare and self-care.   Method: The study was a qualitative interview study, conducted with semi-structured interviews. The study included interviews with 12 nurses, both with and without specialisteducation, who works in the emergency department and has experience of referring patients to other level of care. Content analysis has been used to process the collected data   Result: The triagenurse experience of referring patients to other care was interpreted based on the following themes to highlight the various factors affecting the nurse's action in an emergency; factors affecting reference, professional support and management strategies by reference. The results showed that respondents perceive reference as complex and sometimes difficult where the nurse feels insecure, all respondents stated that they had the experience of patients who appear agitated and threatening at time of referral, the majority of the respondents therefore expressed they felt insecure in their workplace, they also expressed that the experience and clinical gaze was of great importance in referring patients.   Conclusion: The authors' clinical conclusion is that the respondents believe that the ability to be able to refer patients to other level of care is of significant patient benefit. This resulting in the patient receiving adequate care from the start related to their disease severity which also can lead to that the waiting time at the emergency room is reduced. More education and decision support is needed to make nurses more secure whilst performing referrals. The authors also believe that the study provides important insights in the problem area that may be useful in a future profession.

Made available in DSpace on 2016-12-23T14:36:49Z (GMT). No. of bitstreams: 1 dissertacao marlon bertolani.pdf: 1217798 bytes, checksum: 8ad34118a49d79e31016c94a1d50fa35 (MD5) Previous issue date: 2008-09-25 / O movimento indígena, a partir da década de 80 do século passado, inscreveu definitivamente na agenda nacional o direito a um atendimento específico, capaz de concatenar a melhoria na saúde com o respeito à diversidade cultural. Alicerçado na Teoria das Representações Sociais, este estudo tem por objetivo principal identificar e analisar as relações entre dois diferentes sistemas de saúde a biomedicina e o sistema de saúde indígena , no contexto das ações direcionadas aos Guarani aldeados no município de Aracruz (ES). Busca compreender como as representações sociais que os indígenas e profissionais de saúde constroem acerca de diversos aspectos dessa questão, relativos a si mesmos e aos outros , num cenário marcado por relações interétnicas, impactam ações desenvolvidas em tal área. A complexidade de implementação da referida proposição, aliada à intenção de compreender as representações dos atores em suas conexões com a vida cotidiana, demandou uma abordagem envolvendo diferentes métodos de coleta e análise de dados, quais sejam: pesquisa documental, observação participante, entrevistas na modalidade semi-estruturada e análise de conteúdo. Os resultados apontaram para a existência de relações de poder e disputas pela hegemonia entre os sujeitos ligados aos sistemas de saúde ora analisados. As representações da saúde e da biomedicina expressas pelos Guarani encontram-se em sintonia com as demandas do grupo no campo da saúde e orientam suas reivindicações, dentre as quais assume destaque aquela pelo direito à diferença. Destarte, os especialistas e as lideranças indígenas mobilizam o capital simbólico de que dispõem em estratégias para preservar a hegemonia do sistema de saúde Guarani no interior do próprio grupo, galgando maior controle da agência ocidental, bem como mais espaço na relação com a biomedicina. Por sua vez, nas representações expressas pelos profissionais de saúde, o sistema indígena de saúde aparece como subalterno e portador de eficácia mais simbólica do que propriamente empírica. Essa postura é corroborada pelas ações da Fundação Nacional de Saúde, que ignoram as demandas do grupo. Ademais, as representações existentes entre os profissionais de saúde acerca da cultura do grupo e do comportamento dos indígenas em assuntos relacionados à saúde e/ou aos serviços a eles prestados revelaram a perpetuação de uma postura quinhentista, manifesta na sociedade envolvente e calcada na compreensão do indígena pelo paradigma da falta. Perde-se, assim, a possibilidade de compreendê-lo em sua positividade concreta, ou como o outro é, realmente. Constata-se, portanto, no tocante aos Guarani enfocados neste estudo, que o reconhecimento da eficácia da medicina indígena e do direito desses povos à sua cultura, embora ratificado de um ponto de vista formal pelo Estado brasileiro, mantém-se, na prática, como parte de um enorme alfabeto de letras mortas . / The Brazilian indigenous movement, from the 1980s on, has definitively set in the national agenda the indigenous right to specific service, which should be able to join health improvement and the respect to cultural diversity. Based on the Theory of Social Representations, the main objective of this research is to identify and to analyze the relationships between two different healthcare systems biomedicne and the Indigenous healthcare system , in the context of actions towards the Guarani indians living in settlements in the outskirts of Aracruz (Espírito Santo, Brazil). It tries to understand how much impact on the actions developed in this área was caused by the social representations that indigenous and health professionals have created regarding the various aspects of this issue, concerning themselves and others , in a scenary marked by inter-ethnical relationships. Because of the complexity of implementing this proposition, which intends to understand actors representations in connection with daily life, an approach envolving a pool of different methodologies for collecting and analysing data has been required: document research, participant observation, semi-structured interview and content analysis. The results have shown the existence of power relationship and fight for hegemony between the subjects linked to the two healthcare systems hereby been analysed. The Guarani representations of health and biomedicine are in accordance with the group s health demands and lead their claims, among which the right to difference is of great importance. Thus, the indigenous experts and leaders have mobilized their available symbolical capital in strategies that aim at preserving the Guarani healthcare system within their own group, gaining this way more control over Occidental agency, as well as more space regarding biomedicine. On the other hand, in the representations expressed by health professionals, the indigenous healthcare system is shown as subordinated and as having a more symbolical than really empirical effectiveness. This attitude is reinforced by the actions put into effect by the Fundação Nacional de Saúde (Health National Foundation), which has ignored the indigenous demands. Besides that, the manner in which health professionals represent the indigenous culture and behavior regarding health and/or the provided services has revealed the perpetuation of an ancient position which is expressed by the envolving society and based on the undestanding of the indigenous by the lack paradigm. This way, the possibilty of understanding them in their concrete positiveness or of perceiving how the other really is get lost. So, what can be said about the Guarani focused in this research is that the recognition of the indian medicine and of theese people s right to their culture, although ratified by the Brazilian State under a formal point of view, has in fact been kept as part of an enormous alphabet of dead letters