MCur / Department of Advanced Nursing Science / Se the attached abstract below

Team collaboration is a fundamental part of Quality Management (QM), and working together successfully is an important part of improving an organization. Team collaboration is also essential for achieving quality of care, patient safety and care continuity, especially when handling critically ill patients. Transferring a patient from an intensive care unit (ICU) to a general ward demands planning, communication, competence, a system view, and a quality culture. This patient transfer process, called ICU transitional care, extends across hospital boundaries, which have different organizational cultures, technologies, and knowledge. It is a challenge to manage these differences in order for team collaboration to meet the needs of patients, relatives and co-workers. To achieve this, further research is required to understand how care teams, both within hospital units and between organizational boundaries, can collaborate more successfully and efficiently to achieve quality of care in the ICU transitional care process. The overall purpose of this thesis is to contribute to a deeper understanding of how to improve team collaboration within ICU transitional care aiming to increase quality of care. To achieve this, four research questions were formulated and three case studies conducted. In the first case, a systematic literature review was performed to explore the extent to which Quality Management and Nursing Science can offer complementary perspectives to provide better quality of care by looking at Quality Management core concepts and tools. Findings from this study revealed, among other things, a need for further research on team collaboration in ICU transitional care. The purpose of the second study was to develop and test a questionnaire aiming to measure the perception of team collaboration in the patient transfer process from the ICU to the general ward. This study also aimed to analyze the results to see how the questionnaire could help improve team collaboration within ICU transitional care. Empirical data were collected from two ICUs at two hospitals. Participants at the ICUs answered the developed questionnaire, and the results showed that it could be used for measuring perceived team collaboration in this patient transfer process. The results from the questionnaire also gave insights that might be useful for improving team collaboration in this ICU transitional care process. The purposes of the third study were, first, to describe how co-workers’, within a team, perceived team collaboration in patient transfers from ICU to general wards and, second, to describe co-workers’ suggestions for an improved future state of team collaboration. Focus group discussions (FGDs) were conducted at two hospitals to answer the two questions. There were several findings from the study, and the results indicated that team collaboration has an important role when creating prerequisites for a holistic view of the process, and that there was a perceived need among the co-workers to improve team collaboration over organizational boundaries. Co-workers also expressed a need for more involving patients and relatives when improving team collaboration.   Four overarching conclusions can be drawn from this research. Firstly, Quality Management is used in ICU transitional care to improve the quality of care. Secondly, multi-professional team collaboration is perceived to be easier and better developed within hospital units than between them. Collaborating in teams between hospital units is challenging for several reasons. Some reasons are unclarity in routines for communication and decision-making, for example who decides what.  A third conclusion is the importance of how teams and team collaboration are defined and structured in ICU transitional care. This involves roles and responsibilities of teams. Teams have specific characteristics that are important for their performance. A fourth conclusion is an expressed need to involve patients and relatives more when it comes to improve team collaboration in ICU transitional care. The main findings from the three studies presented in this thesis have given insight and deeper understanding of how co-workers perceive team collaboration within ICU transitional care at two hospitals located in Sweden, and co-workers’ suggestions for how team collaboration can be improved aiming to increase quality of care. / <p>Vid tidpunkten för framläggningen av avhandlingen var följande delarbete opublicerat: delarbete 3 (inskickat).</p><p>At the time of the defence the following paper was unpublished: paper 3 (submitted).</p>

Summary: The aim of thi disertation was to enlighten the term magnet hospital. Introduction of this thesis describes personnel situation in health care systém in the Czech republic and globaly. It also shows predictions of the future critical nurse staff shortage on labour market all around the world and it's possible impact on quality of care. Magnet hospitals as the kind of organization that creates work enviroment which increases nurses work satisfaction, quality of care and patients outcomes, sees the author as one of the possible solution of nursing shortage in the Czech republic. Second part of this theses, rpresents the results of the qualitative and quantitative research, participant were 16 nurses at the management positions (structured intewies) and 250 nurses (questionare NWI-R autor's own translation). Results: It was obvious that still prevails the traditional hierarchy and medical model of care delivery. Also there is streotypical view of the role and position of the nurses in health care teams, nurses do not feel like they are involved in management of the hospital. According to the findings we cannot describe those organizations as magnet hospital. It's also clear that the nursing care managers play the key role in creating the good work environment. We should pay more attention to their...

Den första tiden i yrkeslivet kan upplevas utmanande för den nyutexaminerade sjuksköterskan. Därför är det av stor betydelse att rätt förutsättningar ges från hälso- och sjukvården för att den nyutexaminerade sjuksköterskan ska kunna ge patienten en god vård. Syfte: Syftet var att belysa nyutexaminerade sjuksköterskors första tid i yrket. Metod: En litteraturstudie genomfördes med en induktiv ansats som grundades på tio vetenskapliga artiklar, fyra kvantitativa, fem kvalitativa samt en med mixad metod. Resultatartiklarna analyserades utifrån en innehållsanalys. Resultat: Resultatet utmynnade i fyra kategorier: vikten av en stödjande övergång in i yrkesrollen, arbetsklimatets betydelse den första tiden i yrket, värdet av kompetensutveckling för yrkesrollen och grundläggande resurser för god omvårdnad. Resultatet visade att den nyutexaminerade sjuksköterskan var i behov av mer stöttning vid övergången, ett bättre arbetsklimat och fler resurser för att kunna utveckla kompetens och bedriva arbetet med hög vårdkvalité. Konklusion: Kontinuitet och tillgänglighet hos arbetsgivare och kollegor samt stöttning i form av stödprogram förhindrade en ogynnsam transition för de nyutexaminerade sjuksköterskorna och bidrog till en bättre vårdkvalité för patienten. / The first time in working life can be experienced as challenging for the newly graduated nurse. Therefore, it is of great importance that the right prerequisites are provided to the newly graduated nurse by the healthcare, in order to give good care for the patient. Aim: The aim was to illustrate newly graduated nurses' experiences of the first time in the profession. Method: A literature study was conducted with an inductive approach based on ten scientific articles, four quantitative, five qualitative and one with a mixed method. The result articles were based on a content analysis. Result: Data processing resulted in four categories: the importance of a supportive transition into the professional role, the importance of the work climate during the first period in the profession, the value of competence development for the professional role and basic resources for good nursing. The results showed that the newly graduated nurse was in need of a better work climate, more support during the transition and more resources to be able to develop skills and conduct the work with high quality. Conclusion: Continuity and availability of managers and colleagues as well as support in the form of support-programs prevented the transition to become overwhelming for the newly graduated nurses and contributed to a better quality of care for the patient.

Ce travail décrit comment la qualité des soins prothétiques délivrés au sein du service d’odontologie du CHU de Clermont-Ferrand a été évaluée. Pour cela, la qualité des soins a été définie selon deux champs d’évaluation du concept développé par Avedis Donabedian : la procédure de soin et le résultat du soin. Deux domaines prothétiques ont été explorés : les réhabilitations prothétiques utilisant la technologie CFAO et les réhabilitations implantoprothétiques.Les procédures de soin prothétiques ont été évaluées cliniquement selon les indicateurs de la Fédération Dentaire Internationale pour les restaurations unitaires et les critères validés de succès implantaires. Cette évaluation permet la diffusion de pratiques de soin validées. Le relevé d’indicateurs a initié également une démarche d’Évaluation des Pratiques Professionnelles (EPP) en permettant aux praticiens de s’auto-évaluer vis-à-vis de référentiels issus de la littérature scientifique. L’évaluation du résultat du soin a été réalisée selon deux aspects. Dans un premier temps, la fonction masticatoire a été évaluée selon des critères objectifs (paramètres cinétiques et mesure de granulométrie du bol alimentaire). Dans un second temps, la qualité de vie en lien avec la santé bucco-dentaire et la satisfaction prothétique ont été évaluées en prenant en compte des critères subjectifs (questionnaires). Cet aspect de l’évaluation des pratiques peut permettre d’argumenter des choix thérapeutiques. Par ailleurs, une évaluation médico-économique associée pourrait permettre de justifier sur le plan de la santé publique le recours à des thérapeutiques innovantes. / This work described the manner in which the quality of prosthetic dental care performed at the Clermont-Ferrand University Hospital was evaluated. In that context, quality of care was defined according to Avedis Donabedian's concept through two dimensions : process and outome of care. Two different fields, the CAD/CAM dental prosthetics rehabilitations and implantprosthodontics were assessed using this method. Assessment of dental care processes for both prosthetic fields were performed using a series of indicators, such as the International Dental Federation clinical evaluation criteria for restorations and criteria for implant success. Through this evaluation, validated dental care processes could be largely diffused amongst dental practitioners. Moreover, self-assessment by pratcitioners using indicators than can be measured against evidenced-based points of reference could set up an evaluation of professional practice procedure. Two aspects were explored to assess the care outcome. Firstly, the masticatory function was evaluated through the use of objective criteria (kinetic parameters and food bolus granulometry measurement). Secondly, the oral health related quality of life and the prosthetic satisfaction were assessed using subjective criteria (questionnaires). This particular aspect of practices’ evaluation could be a supporting argument to justify therapeutic options. Subsequently, associated medicoeconomic studies could argue in favor of choosing innovative therapeutic approaches within a public health context.

Background: Approximately 32% of all lymphoma patients experience immunocompromised severe avoidable side effects of nadir at home after discharge postchemotherapy. The certified oncology nurses employed at a large metropolitan hospital in Atlanta, Georgia, lack standardized discharge guidelines that include regulatory organizations’ recommendations to assist patients/families with at-home self-management of the avoidable side effects. Purpose: The purpose of this quality improvement project was to utilize the institution’s existing postchemotherapy discharge protocol to assess certified oncology nurses’ knowledge of severe avoidable side effects of nadir; modify the existing healthcare institution’s postchemotherapy discharge protocol to reflect standardized practice for promoting clinical practice continuity by leading organizations; conduct multifaceted training seminars to disseminate the modified postchemotherapy discharge guideline; evaluate the oncology nurses’ knowledge of severe avoidable side effects of nadir postchemotherapy after modified guideline implementation; and collaborate with the intraprofessional team to determine if the modified postchemotherapy discharge guideline was feasible and acceptable for system wide hospital implementation. Theoretical Framework: The theoretical framework used was Benner’s model of nurse proficiency: expert nurses develop skills and understanding of patient care through a sound educational base and a multitude of experiences. Methods: The existing postchemotherapy discharge protocol was used to develop a developed standardized guideline incorporating regulatory organizations’ recommendations for severe avoidable side effects of nadir postchemotherapy for nursing discharge information and patients’ at-home management. Ten oncology registered nurses on a 16-bed oncology unit participated in two 10-question Likert scale questionnaires based on the existing guideline (pretest) and the modified guideline (posttest) before and after an educational intervention. A quantitative nonparametric descriptive design was used. The questionnaires were analyzed with a two-tailed paired t test, p = 0.05, CI = 95, SD = 12. Results: Nurses significantly improved from pretest to posttest—63% before receiving modified guideline education and 83% after receiving education (p < 0.005). Conclusion: A standardized guideline that included regulatory organizations’ recommendations for at-home management of severe avoidable side effects of nadir showed significant nurses’ improvement in knowledge and competency. The effectiveness of nurses disseminating discharge information was paramount when knowledge awareness and appropriate patient/family assessment were incorporated in the discharge instructions.

The submitted dissertation of the PhD study programme Longevity Studies was prepared and financially supported by the project GAUK - Grant Agency of Charles University No. 760219 entitled "Met and Unmet Needs Of Particularly Vulnerable Older Patients in Home and Inpatient Care", of which I am a co-investigator. The mentioned research project is also in the intentions of the strategic plan and long-term activities of the research team CELLO (Center for the Study of Longevity and Long-Term Care), which is the scientific basis of the PhD study programme Longevity Studies. The main goal of the GAUK project is to provide a comprehensive overview of the needs of vulnerable older patients who are provided health care. The project is focused on three areas, which are: the needs of patients with dementia, the needs of geriatric patients at home and the needs of geriatric patients in hospital care. Partial goals are the exploration of current knowledge of the issue based on a review of Czech and foreign literature. The aim of the survey is to find out attitudes and opinions on satisfying needs from the perspective of patients and healthcare professionals. The practical goal is to create recommendations for good practice for the health care of these patients. The dissertation consists of a total of seven...

SAMMANFATTNING Kronisk obstruktiv lungsjukdom (KOL) är en av de vanligaste dödsorsakerna i världen. KOL räknas som en av de kroniska sjukdomar där en stor del av vården bör ske inom primärvården. Studier visar att KOL på grund av underdiagnostik leder till sämre hälsa och livskvalitet. Med en allt äldre befolkning kommer allt fler drabbas av kronisk sjukdom, vilket kräver att vården bygger på god kvalité. Hur patienter upplever vårdkvalité blir allt viktigare i dagens sjukvård, eftersom vården bör baseras på personcentrerad vård. Patienters normer, förväntningar, erfarenheter och vårdens struktur beskriver vad vårdkvalité egentligen innebär och är en länk i ett förbättringsarbete. Astma-KOL sjuksköterskan bedriver mottagningsarbete, som har till syfte att ge patientutbildning om KOL och inhalationsteknik, motiverande samtal om motion och rökstopp, bedöma nutritionsstatus och utföra spirometrier. Med hjälp av Astma-KOL sjuksköterskans patientutbildning och stöd ökar livskvalité för patienter med KOL.   Syftet med studien var att beskriva hur patienter med KOL skattar vårdkvalité vid besöket hos Astma-KOL sjuksköterskan i primärvården.    Studiens metod är deskriptiv tvärsnittsstudie med kvantitativ ansats som bygger på KUPP frågeformulär. Femtio två deltagare hade besvarat formuläret under hösten 2015. Åtgärdsindex användes för att beskriva hur deltagarna upplevde vårdkvalitén.   Resultatet av studien visade att majoriteten av alla deltagare skattade att de fick vård av god kvalité. Ett flertal deltagare skattade att de fick bra information, bra bemötande och kände sig delaktiga, men att det spelade mindre roll för deltagarnas intresse. Män och kvinnor hade skattat frågor som rör egenvård, medkänsla och delaktighet olika.   Slutsatsen visar att det finns flera områden där förbättringsarbete kan vara av betydelse för att äldre patienter med KOL ska kunna uppleva vårdkvalité.       Nyckelord: Vårdkvalité, Astma-KOL sjuksköterska, KOL, primärvård, äldre. / ABSTRACT Chronic obstructive lung disease (COPD) is one of common causes in the world, which can lead to death. COPD is considered to be one of the chronic diseases where the major part of healthcare should be handled in the primary healthcare. Studies show that, when COPD is being underdiagnosed, it leads to poorer health and a decrease in quality of life for the patient. With an aging population, more people are affected by chronic illness which requires a healthcare system that provides good quality of care. How patients experience the quality of care will be of importance in the future, when their care should be person-centered. Patients standards, expectations, experiences and health care structure describes what the quality of care really means, and is a link in the development process. The asthma/COPD nurse has the role to conduct patient education, improve inhalations techniques, concentrate on their motivational interviewing regarding exercise as well as smoking cessation, assess their nutritional status, and to perform spirometry tests. Nurse's support and expertise creates the confidence and security for COPD patients and this increased knowledge aims to increase the quality of life for the patient.   The aim of the study was to describe how people with COPD experience the quality of the care when visiting the asthma/COPD nurse in a primary care clinic.   The studies method was a descriptive cross-sectional study with a quantitative approach based on the KUPP questionnaire. Fifty-two participants answered the questionnaire in the autumn of 2015. KUPP's action indices were used to describe how the participants experienced care quality.   The studies result found that the majority of participants estimated that they received care of good quality. Several participants estimated that they received good information, courteous care from the nurse and a feeling of involvement, but in reality it did not matter for the participant's interest. Men and women estimated the issues related to self-care, compassion and participation differently.   Conclusion shows several areas where improvements can be important for elderly patients with COPD so they can be able to experience quality of care.     Keywords: Quality of care, asthma/COPD nurse, COPD, primary care, elderly.

Access to affordable high-quality health care solutions is a global challenge, especially in emerging markets where health care systems are the most resource constrained. The socio-economic benefits of investing in health care are considerable, especially in terms of improvement of life quality and economic development. This creates a strong demand for efficient health care delivery models with good health outcomes. In particular, health programs targeting children in their formative years can have a longlasting effect on the children’s and their families’ lives. In India, which has one of the highest burdens of disease in the world, many states lack adequate school health programs. To address this need, the NICE Foundation has developed a school health program that provides free health care to over 200,000 children. The NICE Foundation has experienced a great interest in their school health model and thus aims to expand their operations. This study analyses the characteristics of the school health program in order to identify future opportunities and to provide strategic advice for the expansion of the NICE Foundation School Health Program. / Tillgång till prisvärd och högkvalitativ sjukvård är en global utmaning, i synnerhet i tillväxtländer där sjukvårdssystemen  är mycket  resursbegränsade.  De socio-ekonomiska  fördelarna  av att investera  i sjukvård  är avsevärda,  med förbättrad  livskvalitet  och ekonomisk  utveckling  som följd.  Det  finns  därför  en  stor  efterfrågan  på  effektiva  hälsomodeller  som  renderar  goda hälsoresultat.   Särskilt  hälsoprogram   som  är  inriktade  på  barn  i  deras  formativa  år  har dokumenterats ge långtgående positiva effekter för individerna och samhället. I Indien, som har en  av  de  högsta  nivåerna   av  sjukdomsbörda   i  världen,   saknar  många  av  delstaterna skolhälsoprogram.   För   att   addressera   detta   behov   har   NICE   Foundation   utvecklat   ett skolhälsoprogram   som  i  nuläget  erbjuder  gratis  sjukvård  för  över  200  000  barn.  NICE Foundation  skolhälsomodell  har  fått  mycket  positiv  respons  och  organisationen  ämnar  att expandera  programmet.  Denna  studie  analyserar  NICE  Foundation  skolhälsomodell  för  att identifiera framtida möjligheter samt för att tillhandahålla strategiska råd för expansion.

The adoption of healthcare information technology (HIT) has been advocated by various groups as critical in addressing the growing crisis in the healthcare industry. Despite the plethora of evidence on the benefits of HIT, however, the healthcare industry lags behind many other economic sectors in the adoption of information technology. A significant number of healthcare providers still keep patient information on paper. With the recent trends of reimbursement reduction and rapid technological advances, therefore, it would be critical to understand differences in structural characteristics and healthcare performance between providers that do and that do not adopt HIT. This is accomplished in this research, first by identifying organizational and contextual factors associated with the adoption of HIT in US acute care hospitals and second by examining the relationships between the adoption of HIT and two important healthcare outcomes: patient safety and quality of care. After conducting literature a review, the structure-process-outcome model and diffusion of innovations theory were used to develop a conceptual framework. Hypotheses were developed and variables were selected based on the conceptual framework. Publicly available secondary data were obtained from the American Hospital Association (AHA), the Health Information and Management Systems Society (HIMSS), and the Healthcare Cost and Utilization Project (HCUP) databases. The information technologies were grouped into three clusters: clinical, administrative, and strategic decision making ITs. After the data from the three sources were cleaned and merged, regression models were built to identify organizational and contextual factors that affect HIT adoption and to determine the effects of HIT adoption on patient safety and quality of care. Most prior studies on HIT were restricted in scope as they primarily focused on a limited number of technologies, single healthcare outcomes, individual healthcare institutions, limited geographic locations, and/or small market segments. This limits the generalizability of the findings and makes it difficult to draw definitive conclusions. The new contribution of the present study lies in the fact that it uses nationally representative latest available data and it incorporates a large number of technologies and two risk adjusted healthcare outcomes. Large size and urban location were found to be the most influential hospital characteristics that positively affect information technology adoption. However, the adoption of HIT was not found to significantly affect hospitals' performance in terms of patient safety and quality of care measures. Perhaps a remarkable finding of this study is the better quality of care performance of hospitals in the Midwest, South, and West compared to hospitals in the Northeast despite the fact that the latter reported higher HIT adoption rates. In terms of theoretical implications, this study confirms that organizational and contextual factors (structure) affect adoption of information technology (process) which in turn affects healthcare outcomes (outcome), though not consistently, validating Avedis Donabedian's structure-process-outcome model. In addition, diffusion of innovations theory links factors associated with resource abundance, access to information, and prestige with adoption of information technology. The present findings also confirm that hospitals with these attributes adopted more technologies. The methodological implication of this study is that the lack of a single common variable and uniformity of data among the data sources imply the need for standardization in data collection and preparation. In terms of policy implication, the findings in this study indicate that a significant number of hospitals are still reluctant to use clinical HIT. Thus, even though the passage of the American Recovery and Reinvestment Act (ARRA) of 2009 was a good stimulus, a more aggressive policy intervention from the government is warranted in order to direct the healthcare industry towards a better adoption of clinical HIT.