Suicide as an individual event as well as a social phenomenon attracts great interest and attention in various spheres, both in the immediate environment of the self-murderer and in broader public. The definition of suicide differs according to authors and changes in the course of historical development. Most definitions are identical in two essential aspects of suicidal behavior. These are a voluntary individual's intention to terminate his life and a purposeful behaviour leading to death. Suicide is the conscious and intentional killing of oneself. About 95% of suicidal attempts are just acute intoxications by any amount or kind of a poisonous substance. Acute intoxication belongs to a group of serious conditions threatening human health and life. Acute poisoning is one of the frequent admission diagnoses in the Departments of anesthesiology and resuscitation and Intensive care units. 80% of poisonings are caused by drugs. Damage to the organism by ingesting a poisonous substance is the more significant the longer is the interval between the exposure to noxae and the professional medical assistance provision. For the future fate of the patient the medical equipment and the competence of health professionals who provide intensive care for these patients is crucial. After stabilization of all physiological functions, balancing inner environment of the patient and after the time that may have led to late complications of intoxication, the following phase of treatment is provided by psychological and psychiatric interventions. Determination of suicidal risk among the most common challenge in urgent psychiatry is suicide risk assessment. The aim is to prevent further suicide attempts. The objective of the thesis was to determine, with regard to the competence of nurses, the predominant character of patients´ experience after intoxication, and also the reasons for aggressive behavior of intoxicated patients towards the nursing staff. The third objective was to establish a standard of nursing care of intoxicated patients. The research was designed as explorative with the goal to map the nursing process in intoxicated patients and to provide information for the establishment of the standard of nursing care, which should include both somatic and psychological aspects. Quantitative and qualitative methods were combined. The outcomes of the thesis should lead to detection of the most frequent problems in nursing care for patients with intentional intoxication with suicidal tendency and the establishment of nursing standards to help improve the care of these patients.

Akutsjukvård är tidskänsliga vårdinsatser som ges till patienter som drabbas av akut sjukdom. Akut sjukdom kan innebära försämring av kronisk sjukdom eller nytillkommen plötslig ohälsa i behov av snabb handläggning. När en patient drabbas av akut sjukdom ökar risken för vätskebalansrubbningar, exempelvis dehydrering och hyperhydrering. Vätskebalansrubbningar kan leda till ökad ohälsa samt ökade samhällskostnader. Sjuksköterskan ansvarar för bedömning och dokumentation av vätskebalans. Detta ska göras med en helhetssyn och består till stor del av tre komponenter; bedömning av kliniskt status, klinisk kemi och dokumentation i vätskebalanslistor. Hantering av den akut sjuka patientens vätskebalans utgör en avgörande del av patientens vård. Då bedömning och dokumentation av vätskebalans syftar till att tidigt upptäcka inadekvat vätskebalans innebär suboptimal hantering en ökad risk för vårdskada hos patienten. Syftet var att belysa sjuksköterskans genomförande av bedömning och dokumentation av vätskebalans hos patienter som vårdas inom akutsjukvård. Metoden litteraturöversikt valdes för att besvara studiens syfte. Endast studier publicerade mellan åren 2007-2017 samt genomförda inom en akutsjukvårdskontext på vuxna patienter inkluderades. Datainsamlingen skedde genom sökning i de elektroniska databaserna PubMed, CINAHL complete, MEDLINE samt SveMed+ med indexeringsord och fritextord baserade på litteraturöversiktens syfte. Därtill genomfördes en manuell sökning. Datainsamlingen resulterade i att 17 originalartiklar inkluderades i litteraturöversikten. Artiklarnas kvalitet granskades mha Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering samt kvalitet. Artiklarnas resultat analyserades med integrerad analys och presenterades därefter i en integrerad text. Resultatet visade att det fanns brister i sjuksköterskans bedömning och dokumentation av vätskebalans. Det fanns en fördröjning i agerande vid upptäckt av vätskebalansrubbningar och onormala värden i den kliniska kemin. Sjuksköterskan dokumenterade inte patientens vätskebalans i vätskebalanslista eller kroppsvikt på ett tillfredsställande vis. Faktorer som kunde påverka sjuksköterskans bedömning och dokumentation av vätskebalans var kommunikation, kunskap och patientens sjukdomstillstånd. Därtill indikerade resultatet att de mätmetoder som används för att bedöma vätskebalans inte verkar helt ändamålsenliga för äldre patienter, vilket gällande riktlinjer inte tillsynes tar hänsyn till. Vidare forskning behövs för att kartlägga detta vidare. Slutsatsen av litteraturöversiktens resultat indikerar att sjuksköterskans bedömning och dokumentation av vätskebalans idag är bristfällig. Insatser f  f ör att öka sjuksköterskans kunskap kring vätskebalans torde vara av värde för att förbättra detta. Vidare forskning behövs för att utvärdera huruvida de mätmetoder som används för bedömning och dokumentation av vätskebalans är väl lämpade för akutsjukvård. / Acute care is time sensitive care interventions given to patients who are acutely ill. Acute illness may imply deterioration of chronic disease or newly sudden illness that needs urgent treatment. In this state the risk of fluid balance disorders, such as dehydration and hyperhydration, increases. Fluid balance disorders may lead to increased morbidity and social costs. The nurse has a responsibility to assess and document fluid balance. This should be done with a holistic view and largely consists of three components; assessment of clinical status, clinical chemistry and documentation in fluid balance charts. Fluid balance management in the care of the acutely ill is a fundamental part of patient care. The aim of the assessment and documentation of fluid balance is to discover deviations early, and a suboptimal management of fluid balance implies an increases risk of care related injury. The aim was to illuminate the nurse’s implementation of fluid balance assessment and documentation in patients within acute care. The study was executed through a literature review. Only articles published between 2007 and 2017, conducted in acute care settings and of adult patients were included. The data collection was carried out using the electronic databases PubMed, CINAHL complete, MEDLINE and SveMed+ using keywords based on the purpose of the literature review. Both thesaurus and free text words were used as keywords. Thereafter a manual search was performed. The data collection process resulted in 17 original articles that were included in the literature review. The quality of the articles was assessed using the review template compiled by Sophiahemmet University. The results of the articles were analyzed using integrated analysis and presented within an integrated text. The findings revealed shortcomings in the nurse’s assessment and documentation of fluid balance. There was a delay in action after the detection of fluid imbalances and abnormal values ​​in the clinical chemistry. The nurse did not adequately document the patient's bodyweight or fluid balance in the fluid balance chart. Factors such as communication, knowledge, and the patient’s medical condition could affect the nurse’s assessment and documentation of fluid balance. In addition, the findings indicated that the measurement methods used to assess fluid balance do not appear to be entirely suitable for elderly patients. Applicable guidelines do not seem to recognize the diverse needs of these patients. Additional research is needed to explore this further. The conclusions of this literature review indicates that the nursing assessment and documentation of fluid balance is inadequate. Efforts to increase the nurse’s knowledge of fluid balance might be of value to improve this. Further research is needed to evaluate whether the measurement methods used for the assessment and documentation of the fluid balance are well suited for acute care settings.

The overall aim of this thesis was to study the thinking strategies and clinical reasoning processes of registered nurses (RNs) and to implement and test a computerized decision support system (CDSS) integrated into the electronic health care record (EHR) to improve patient outcomes, i.e. to prevent pressure ulcers (PUs) and malnutrition among residents in nursing homes.  A think-aloud (TA) study with a purposeful sample of RNs (n=30) was conducted to explore their thinking strategies and clinical reasoning (Paper I). A quasi-experimental study with a convenience sample of residents (at baseline, n=491 and at follow-up, n=480) from nursing homes (n=15) allocated into two intervention groups and one control group was carried out in 2007 and 2009 (Paper II). In Paper III residents’ records were reviewed with three instruments. Nursing personnel (n=25) from four nursing homes that had used the CDSS for eight months were interviewed and the CDSS was tested by nursing personnel (n=5) in two usability evaluations (Paper IV). The results showed that the RNs used a variety of thinking strategies and a lack of systematic risk assessment was identified (Paper I). The proportion of malnourished residents decreased significantly in one of the intervention groups after implementing the CDSS, however there were no differences between the groups (Paper II). The CDSS resulted in more complete and comprehensive documentation of PUs and malnutrition (Paper III). The nursing personnel considered ease of use, usefulness and a supportive work environment as the main facilitators of CDSS use in nursing homes. Barriers were lack of training, resistance to using computers and limited integration of the CDSS within the EHR system (Paper IV). In conclusion, the findings support integrating CDSSs into the EHR in nursing homes to support the nursing personnel.

Improvement of patient care in any hospital depends primarily on the quality of nursing care. Nursing care is enhanced by the nursing process, which outlines the nursing activities to be provided for a patient. The purpose of this study was to determine to what extent the nursing process could improve the quality of nursing care, and to explore the knowledge limitations of nursing staff in implementing the nursing process, nursing care planning and proper documentation. Quantitative research, making use of an exploratory, descriptive and contextual design was conducted, utilising a structured questionnaire for data collection. Registered nurses (n=120) employed at a Referral Hospital in Tanzania served as the respondents. The findings revealed a lack of knowledge in understanding and applying the concepts of the nursing process, especially in formulating the nursing diagnosis. Recommendations pertaining to a focused in-service training programme, integrating theory and practice, were made to enhance the effective implementation of the nursing process. / Health Studies / MA (Health Studies)

Background Swedish nurses are required by law to document nursing care. Studies have proved scarce in nursing documentation with regard to written language, the nursing process and the nurse´s caring perspective. Educating nurses in using the VIPS model have improved nursing documentation. Few studies have included nursing documentation of psychiatric care. Aim The aim of this study was to describe nursing documentation within psychiatric care of inpatient settings. Method A quantitative, retrospective descriptive research design was applied. A total of 60 nursing journals from a psychiatric department of six wards were studied. Data was audited using the Cat-ch-Ing audit instrument that comprises 22 questions reflecting various issues relating to the VIPS model and the nursing process. Measurements of quantity and quality were evaluated for each question using a 4-point scale. Results The nursing documentation showed a better quantity and quality at the patients’ admission for care than the remaining documentation, long duration of hospital stay indicated better quantity of documented nursing diagnoses and nursing interventions, all of the wards showed a poorly quantitative documentation of status after admission for care as well as nursing care plans. Conclusion The nursing documentation within psychiatric care of inpatient settings of one department showed an inadequate documentation of nursing both quantitatively and qualitatively. The nursing care of the patient was neither described nor evaluated. Clinical implications The results suggest that strategies for improving nursing documentation will be needed in the future. In addition, further education in using the VIPS fully can be a means to enhance the nurses’ documentation.

The diploma thesis is structured into a theoretical part and an empirical part. The theoretical part consists of four chapters. The empirical part of the diploma thesis is based on qualitative research. The data were collected via semi-structured interviews with the senior citizens and the nurses. The replies were processed into clearly arranged charts and categories with brief descriptions. Another research method applied was observation. The interviews were followed by a detailed analysis of the documentation, which involved the analysis of the medical records of the senior citizens with a focus on medical diagnosis, chronic medication, and processing of the fall risk and its evaluation. The diploma thesis pursued three objectives by means of four related research questions. The first objective was to ascertain the extent of the clients' awareness of fall risks. The second objective was to assess the discomfort associated with usage of the special device preventing hip joint injuries resulting from falls during common everyday activities of the senior citizens. Finally, the third objective was to obtain the opinions of the healthcare staff on working with clients wearing special devices preventing the hip joint injuries. Four research questions were formulated in connection with these three objectives. Research question No. 1: What is the quality of information provided by the healthcare staff as part of the preventive intervention regarding the falls? Research question No. 2: How willing are the clients to accept changes contributing to fall prevention? Research question No. 3: To what extent is the comfort of the client affected by using special devices preventing fall-related hip joint injuries? Research question No. 4: To what extent is the work of the healthcare staff affected if their clients use devices preventing fall-related hip joint injuries? The results of the qualitative research suggest that the extent of information provided by the healthcare staff as part of the preventive intervention regarding the falls is insufficient in terms of awareness of the risky places. In particular, the research revealed that the nurses fail to sufficiently monitor the effects of chronic medication which may contribute to psycho-motor inhibition of the senior clients. As far as mobility aids are concerned, the nurses offer these devices sufficiently. The nurses demonstrated very good knowledge of all the mobility aids which may facilitate self-reliance of the senior clients. Another problematic issue is the safety of the rooms, particularly in terms of various protrusions and unevenness in the bathrooms. The results of the research do not show any unwillingness of the clients to accept changes contributing to fall prevention. Nevertheless, two of the respondents failed to engage in the activities and maintain physical fitness by regular exercise in the Retirement House. Furthermore, the results do not show any limitation of the clients' comfort resulting from using special devices preventing fall-related hip joint injuries. Finally, according to the research the healthcare staff does not feel restricted in any way when working with senior clients using such device. The results of the research will be used for repeated meetings with the senior clients and particularly with the nurses. The management of the Retirement House, together with the healthcare staff, are working on a new educational material which would indicate risky places with increased probability of falls. These results could be beneficial also for other facilities where healthcare staff takes care of senior citizens. Last but not least, the results are of interest also to the health insurance companies which could provide this special device with at least partial subsidy as part of the primary prevention programme.

Administration and documentation are inseparable and obligatory parts of nurse's everyday work. Documentation in healthcare serves to communication of necessary patient information. Medical documentation is kept by physicians. Nursing documentation is conducted in parallel with medical documentation. Nursing documentation records facts of the nursing care provided to a particular patient. Duly kept nursing documentation is a quality indicator of qualified nurse's work. It has to comply with applicable legislation and reflect the latest research results. Documentation has to be brief, clear, concise and factual. It should definitely not be extensive, time consuming, complicated and it should not contain useless information and duplicities. Nurses should not be overloaded by document keeping and should not spend more time on it than with patients. The aims of the thesis: Aim 1: To map the approach to documentation among nurses at selected hospital departments. Aim 2: To map how nurses perceive document keeping in terms of time, how much time they really spend on documentation within their working hours. Aim 3: To analyse nursing documentation at selected hospital departments. Research questions: Research question 1: Do nurses feel overloaded by nursing documentation keeping? Research question 2: How much time do nurses have to spend on documentation within their working hours? Research question 3: Is the time spent on documentation used effectively? Research question 4: Would nurses welcome changes in nursing documentation? Applied methods: The research part of the thesis was based on qualitative research method applied at selected departments of a regional type hospital.The research results from the interviews, document analysis and working hours scanning will be provided to the examined hospital management. They may help the hospital management with better insight into their documentation and lead to improvement of the document keeping in general and particularly ease the work of nurses as they are overloaded anyway.

Nursing documentation became an important part of work of a general nurse / a midwife. The nursing documentation differs in individual hospitals. The clinic management is responsible for the documentation contents in given hospital and general nurses / midwives at least participate in its development. The nursing documentation serves as the work aid for the nursing staff, being the material providing important information for other medical staff and institutions. The documentation objectively informs the medical team members about the health conditions of the given individual. Recently, significant stress started to be put on education activities of a nurse and its documenting. New examination methods or therapeutic procedures are being introduced into practice, which should help in treatment of clients. Regardless modern progress, the number of chronically ill clients increases ? for example diabetes mellitus, chronic renal insufficiency, asthma bronchiale etc. That is why nurses in the positions of educators play very important rules. The graduation thesis / diploma work aims at nursing documentation in practice. The aim of the graduation thesis / diploma work was to map the efficiency of nursing documentation and to find out what an importance attach the nurses to nursing documentation keeping. Another aim was to find out whether education plans make a part of nursing documentation. My last aim was to find out whether an education nurse is a member of the nursing team. For the research part of this work, a combination of qualitative and quantitative research solution was used. A semi-structured interview was used s the data collection technique for the qualitative part, while there were interviewed the chief nurses working in a hospital in Plzeň region. A questionnaire was used as the data collection technique for the quantitative part and it was designed for general nurses working in the faculty, regional and district hospitals in Plzeň region, in standard department, intensive care unit and in consequent care unit. The aims of the work were reached. Four hypotheses were set for the quantitative research. 1. Nurses perceive the efficiency of nursing documentation in case of being kept by an appointed nurse. 2. The shift nurses consider nursing documentation keeping to be rather a stress instead of an expression of professional activities of a nurse. 3. A part of standard equipment of nursing documentation is reserved for education activities. 4. The system of nursing care provision in the hospital departments does not allow application of education process, even though its keeping in nursing documentation is required. The first two hypotheses were confirmed, the third and fourth hypotheses were not confirmed. Five chief nurses expressed their interest in results of our research and investigations. They are interested in results obtained in their departments. We continue our co-operation as the output of the work is a draft of documentation for education of a client, the education standard and a seminar or course of education activities of a nurse.

Bakgrund: En bra kommunikation är en förutsättning för god kvalitet och patientsäkerhet i vården och när två olika system används har vi funderat över vad som händer med omvårdnadsdokumentationen när patienten förflyttas mellan vårdenheterna. Syftet: Vårt syfte med studien var att undersöka om de omvårdnadsåtgärder som operations-sjuksköterskan dokumenterat i operationsplaneringssystemet och rapporterat vidare, återfinns i omvårdnadsjournalen. Metod: En kvalitetsgranskning av journalanteckningar har utförts. Inklusionskriterierna var att patienterna opererats under minst tre timmar och att vårdtiden efter operationen var minst 24 timmar, då det var det första dygnets journalföring som kvalitetsgranskades. Sammanlagt granskades 40 stycken journaler. Resultat: I studien granskades sex stycken sökord ur operationsplaneringssystemet, vilka var; hudstatus, operationsläge, dränage, KAD, förband samt hudsuturer. Studien visade att överföringen av informationen var bristfällig. I en del fall framkommer det att information saknades eller förändrades när patienten förflyttades från operationsavdelningen till vårdavdelningen. Vidare framkom det att patienten förflyttades mer än en gång mellan vårdenheter. Slutsats: Resultatet i vår studie anser vi tyder på att en gemensam standardiserad journal med tydliga riktlinjer skulle underlätta för informationsöverföringen mellan de olika enheterna. Klinisk betydelse: Risken för att fel eller missförstånd uppstår minskar om ett gemensamt journalsystem används, vilket vi anser ökar patientsäkerheten. / Background: Good communication is prerequisite for good quality and patient safety in health care and when two different systems are used, we wondered what happens to the nursing documentation when the patient moves between different care units. Aim: The aim of the study was to examine whether the operation theatre nurses nursing care documentations in the operations planning system was reported on and can be found in the nursing journal. Method: A quality review of nursing care journal documentations was performed. Inclusion criteria was that the patient should have had an operation for at least three hours and aftercare for at least 24 hours, since it was the nursing care documentation that were done during the first day that were being quality reviewed. A total of 40 journals were examined. Results: Six keywords out of the operation planning system were examined, which are; skin status, operation position, drainage, KAD, dressing and skin sutures. Result of the study showed that the transfer of data was incomplete. In some cases it revealed that information was missing or altered when the patient was moved from the surgical ward to the care unit. Furthermore, it was found that the patient was moved more than once between different units. Conclusion: According to our study, we suggest that a common standardized journal with clear guidelines could make it easier to transfer the information between the different units. Clinical significance: Risk of error or misunderstandings are reduced in a common journal system, which we believe increases the patient safety.

Bakgrund: Patienter som vårdas inom intensivvården befinner sig ofta i en situation som präglas av snabba fysiologiska förändringar där patientens vitala funktioner kontinuerligt måste övervakas och registreras. I intensivvårdens komplexa miljö utgör dokumentationen en viktig del för att upprätthålla en hög patientsäkerhet. Syfte: Att undersöka intensivvårdssjuksköterskors uppfattning om dokumentation. Metod: En empirisk deskriptiv studie har genomförts. Fokusgruppintervjuer användes för att inhämta data. Materialet analyserades med en kvalitativ innehållsanalys. Resultat: Intensivvårdssjuksköterskor anser att dokumentationen fyller en viktig funktion för patientsäkerhet, som informationskälla samt för den egna professionen. Förutsättningar för dokumentationen kunde härledas till tid och organisation, datasystemens för- och nackdelar samt den kulturella påverkan som fanns på arbetsplatsen. Slutsats: Dokumentationen i omvårdnadsjournalen upplevs ofta som bristfällig. Studiens resultat att visat på ett flertal orsaker till detta; avsaknaden av funktionella datasystem, oklara riktlinjer samt ett lågt engagemang hos intensivvårdssjuksköterskor. Klinisk betydelse: Resultatet kan öka intensivvårdssjuksköterskor förståelse för dokumentationens betydelse. De förbättringsförslag som framkommer i studien kan användas för att utveckla dokumentationen inom intensivvården. / Background: Patients cared for in an intensive care unit often find themselves in a situation of rapid physiological changes where the patient´s vital signs must be continuously monitored and registered. In the complex environment of the intensive care units documentation is an important part of maintaining a high level of patient safety. Objective: To examine the intensive care nurse's views of documentation. Method: A descriptive empirical study has been conducted. Focus group interviews were used to collect data and the material was analysed by a qualitative content analysis. Results: Intensive care nurses consider documentation to play an important role for patient safety, as a source of information and for their own profession. They believe that the documentation is affected by time and organization, computer systems and the culture of the workplace. Conclusion: Documentation in the nursing records is often viewed as inadequate. Result of the study revealed a number of reasons for this; lack of functional computer systems, unclear guidelines and a low engagement of the intensive care nurses. Clinical significance: The result could increase intensive care nurses understanding of the importance of documentation. The suggestions for improvement that emerge from this study can be used to develop documentation within intensive care.