Bakgrund Det blir allt vanligare att sjuksköterskor väljer att avsluta sina anställningar, byta arbetsplats eller byta bransch, vilket leder till att det på många håll råder brist på sjuksköterskor samt är underbemannat på arbetsplatser. Brist på sjuksköterskor innebär större arbetsbelastning och tidsbrist vilket riskerar att vårdkvalitet, personcentrerad vård samt patientsäkerhet äventyras. Syfte Syftet med denna litteraturstudie är att belysa hur omvårdnadsarbete påverkas vid underbemanning av sjuksköterskor avseende patientsäkerhet och vårdkvalitet. Metod Examensarbetet genomfördes som en strukturerad litteraturstudie med inslag av den metodologi som används vid systematiska översikter. En innehållsanalys genomfördes av13 vetenskapliga artiklar. Resultat En konsekvens av underbemanning av sjuksköterskor var brister i utförande av omvårdnadsmoment. Bristerna påverkade patientnära arbete, sjuksköterskors arbetsmiljö och förutsättningar för att vårda patienter utifrån ett personcentrerat förhållningssätt. Ett högt antal patienter per sjuksköterska kunde påverka vården negativt. Slutsats Underbemanning av sjuksköterskor bidrar till hög arbetsbelastning och tidsbrist, vilket resulterar i att utförande av omvårdnadsåtgärder blir bristande. Sjuksköterskor tvingas prioritera mellan arbetsuppgifter, vilket resulterar i att vården som bedrivs inte alltid uppfyller principerna för personcentrerad vård. Konsekvenser av underbemanning påverkar både patienter och sjuksköterskor negativt och riskerar att resultera i försämrad vårdkvalitet och minskad patientsäkerhet. / Background It is becoming more common that nurses choose to end their employment, change workplaces or change industries, resulting in nursing shortage and understaffed workplaces. A lack of nurses means a greater workload and time shortage, providing a risk that the quality of care, person-centred care and patient safety are compromised. Aim The aim of this literature review is to illustrate how nursing care is affected by nurse understaffing regarding patient safety and quality of care. Method This thesis was carried out as a structured literature study with elements of the methodology used in systematic reviews. A content analysis was conducted on 13 articles in this literature review. Results A consequence of nurse understaffing is insufficiency in conducting nursing care tasks. The shortcomings in nursing care tasks affect bedside care, nurses’ work environment and the circumstances that provide for person-centered care. High nurse-to-patient ratio affects the care that nurses can provide to patients. Conclusions Nurse understaffing contributed to high workload and time shortage which resulted in insufficiency in conducting nursing care tasks. Nurses were forced to prioritize between work tasks which resulted in care that not always met the principles of conducting personcentered care. The consequences of nurse understaffing affected both patients and nurses negatively and risked resulting in declining quality of care and patient safety.

Problème. L'administration de médicaments aux propriétés sédatives pour la gestion des symptômes comportementaux, aussi appelée contention chimique, est une intervention complexe dont les finalités de contrôle, de protection, de traitement et d'alternative à d'autres coercitions entrent en conflit et sèment le désaccord chez les acteurs en établissements de santé. Tous s'entendent toutefois sur la nécessité d'en mesurer l'usage et d'évaluer la conformité des pratiques des soignants aux normes de qualité applicable. Or, à l'heure actuelle, aucune définition opérationnelle de la contention chimique, aucun outil ni indicateur de qualité des soins valide ne permet d'évaluer l'usage des contentions chimiques. But. Cette étude métrologique a pour but de développer et de valider un outil d'évaluation réflexive de la qualité des soins en matière de contention chimique de la perspective de l'infirmière. Méthodologie. Quatre questions de recherche rassemblées en deux grandes phases de l'étude ont permis de poursuivre ce but, lors desquelles des méthodes qualitatives et quantitatives ont été utilisées. La phase de développement de l'outil d'évaluation réflexive impliquait la conduite d'une revue réaliste pour rassembler, à l'intérieur d'un modèle théorique, un inventaire d'items potentiels. Cette méthode systématique de synthèse des connaissances suggère une étape préliminaire destinée à clarifier la nature et les contextes de déploiement de l'intervention d'intérêt, ici l'usage des contentions chimiques. Pour ce faire, un examen de la portée a été réalisé. Puis, une technique Delphi a permis la validation du contenu des items recensés, lesquels ont ensuite été intégrés dans une plateforme virtuelle d'évaluation réflexive qui permet de mesurer les perceptions des professionnelles en charge de la décision d'administrer la contention chimique, soit les infirmières. L'outil d'évaluation au format innovant, appelé E-value-action, a ensuite été pré-testé pour une appréciation de la validité apparente (face validity) auprès de futurs- utilisateurs d'un Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Québec, Canada, lesquels ont offert une rétroaction qualitative suite à une simulation d'évaluation. Résultats. L'examen de la portée basé sur 33 articles de provenance internationale a fait ressortir la nécessité d'élargir le concept à définir et à mesurer pour aborder la contention chimique comme une notion synonyme à la sédation des symptômes comportementaux. Ensuite, par le biais de la revue réaliste, 28 normes de pratique répertoriées dans 45 articles scientifiques ou textes de lignes directrices ont pu être insérées au modèle théorique puis libellés sous forme d'items à intégrer à l'outil d'évaluation. Ces normes, appuyées d'exemples concrets, reflètent la qualité des soins infirmiers en trois contextes principaux : les soins en santé mentale, les soins aigus à l'adulte et les soins de longue durée à la clientèle âgée. Au niveau de la validité de contenu, les items de l'outil ont présenté un degré d'accord sur la clarté des items de 90% et de 95% sur la pertinence, témoignant d'un consensus (>70%) chez le panel d'experts chercheurs, gestionnaires et cliniciens (n = 20) de différentes régions administratives du Québec, Canada. L'adéquation de la plateforme virtuelle d'évaluation et l'intérêt pour son implantation en contextes cliniques ressortent de l'analyse des données de la validité apparente auprès d'infirmières en soins directs (n = 7) d'un CIUSSS québécois. Discussion. L'usage de cet outil d'évaluation réflexive devrait favoriser l'intégration des normes de pratique en soins infirmiers en plus de promouvoir une culture de réduction des mesures de contrôle favorable à des soins plus sécuritaires, efficaces et centrés sur la personne. Une validation ultérieure à plus grande échelle et la traduction du contenu d'E-value-action avec validations transculturelles sont recommandées pour soutenir les nombreux états/provinces et pays anglophones qui possèdent, comme le Québec, une règlementation sur la réduction ou l'usage d'exception des mesures de contrôle dont la substance chimique. / Background. The administration of sedative agents for the management of behavioral symptoms, also called chemical restraint, is a complex intervention of which the various goals of control, protection, treatment and alternative to other coercion inspire vigorous debate among professionals within the health care field. There is general consensus, however, on the necessity to reduce the application and to evaluate professional practices against relevant quality standards. Despite this clear recommendation, there is currently no operational definition of chemical restraint, and there is no valid measurement tool or indicator available for the evaluation of chemical restraint interventions in healthcare. Aim. This metrological study aims to develop and validate an instrument to assess the quality of chemical restraint practices from the perspective of nurses. Methods. This goal has been pursued through the formulation of four research questions organized into two large phases of study, involving both qualitative and quantitative methods. The development phase was based on a realist review of existing quality standards in order to gather, within a theoretical model, an inventory of potential items. This systematic method of knowledge synthesis requires, as a preliminary step, the clarification of the nature and various contexts of the intervention of interest, in this case, chemical restraint. This was accomplished through a scoping review. Following this, the Delphi method enabled the content validation of the identified items, which were then integrated into a virtual reflexive assessment tool within which the perceptions of the nurses in charge of administering chemical restraints could be measured. In order to gain an appreciation of the face validity of this innovative assessment tool, called E-value- action, it was then pre-tested among future users at one of Quebec's Integrated University Health and Social Services Centers (CIUSSS), Canada. After completing this simulated evaluation, participants were invited to provide a qualitative description of their experience. Results. The scoping review, based on 33 internationally sourced articles, highlighted the necessity to expand the concept being defined and measured to include chemical restraint or behavioral sedation. The realist review method was then used to identify 28 quality standards, inventoried within 45 scientific articles or practical guidelines, which were then integrated into the theoretical model and itemized to facilitate their inclusion within the quality assessment tool. These items, supported by concrete examples, reflect nursing practices in three principal contexts: mental health care, acute care for adults and long- term elder care. As concerns the content validity, the items within the theoretical model presented an agreement of 90% for the clarity, and of 95% for the relevance, demonstrating a consensus (>70%) among the panel of expert researchers, managers and clinicians (n = 20) from different administrative regions of Quebec, Canada. The alignment between the virtual self-evaluation platform and the interest for its implementation within clinical contexts is palpable from the analysis of the face validity data gathered from direct care nurses (n = 7) in the Quebec CIUSSS. Discussion. The application of this reflexive self-evaluation tool should engender a deeper integration of nursing standards in addition to promoting a diminished utilization of coercive measures leading to care that is more secure, effective and patient-centered. A subsequent large-scale pilot testing of the E-value-action platform is recommended, including the translation and adaptation for cross-cultural analysis, in order to support the numerous English-speaking jurisdictions which, like Quebec, have developed regulations concerning the reduction or exceptional application of coercive measures such as pharmacological agents.

No description available.

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. This reform, it is argued, is projected to increase insurance coverage of pre-existing conditions, to expand access to insurance for more than 30 million Americans, and to increase estimated National medical spending while lowering projected Medicare spending. This thesis sought to investigate and analyze the perceptions of senior citizens in Central Florida about PPACA and their perceived effects on the healthcare quality provided to them under this law. Four sections of PPACA bill, thought to specifically pertain to the elderly, were selected for this study; respondents were asked their opinions regarding PPACA's aspects of: (1) the reform on preventive healthcare services; (2) Medicare Part D (prescription drugs); (3) Medicare; and (4) Medicaid. This thesis employed both qualitative and quantitative methodologies; data were collected and analyzed with findings presented and discussed.

The purpose of the study was to analyse if the two year upgrading programme done at Malawi College of Health Sciences attended by Nurse Midwife Technicians (NMTs) is able to improve the competencies, knowledge, skills and attitude of the graduates when providing comprehensive nursing and midwifery care. The main objectives of this study were • to determine the effectiveness of the Upgrading Diploma in Nursing and Midwifery programme in preparing the competencies of State Registered Nurse Midwifes (SRNMs) • to make recommendations on the training of Upgrading Diploma in Nursing and Midwifery programme The researcher used a quantitative, exploratory, descriptive design. A questionnaire with closed and open-ended questions was used to collect data from SRNMs who completed the upgrading programme. The findings indicated that the upgrading programme has a significant impact to improve the competencies of the NMTs to work as SRNMs. / Health Studies / M.A. (Health Studies)

This descriptive quantitative survey attempted to identify reasons why pregnant women who have been screened as low-risk pregnancies failed to utilise MOUs for the delivery of their babies. The objective of the study was to investigate the factors determining the under-utilisation of Sharpville MOU in Emfuleni sub-district. The research population comprised all postnatal mothers residing in Sharpeville who delivered their babies at hospital and who were screened as low-risk pregnancies; the accessible convenience sample consisted of all postnatal mothers who attended Sharpeville Clinic for their six weeks follow-up postnatal care from 5 December 2005 till 6 January 2006 and who were willing to complete questionnaires. Data was collected by means of a structured questionnaire and analysed using the SPSS computer program. Major factors drawn from the study that influence their decision on place of delivery were nurses' attitudes, lack of doctors, transport, privacy and resources. / Health Studies / M.A. (Health Studies)

The contribution of Emergency Obstetric Care (EmOC) in reducing maternal mortality in Ethiopia is very minimal as evidenced by poor provision and low utilization of EmOC. Client centred EmOC provision improves the provision and utilization of EmOC; leading to the treatment of the majority of obstetric complications which are the main causes of maternal mortality. This study describes clients’ views and perspectives concerning the quality of EmOC provision in Ethiopian public health facilities. An explorative and descriptive phenomenological qualitative study design was used in the study in order to explore and describe the lived experiences of clients with EmOC services. Key informant interviews with women who had direct obstetric complications and received EmOC at three public health facilities in Addis Ababa generated rich data on their lived experiences. Content analysis was used to analyze the data as it complies with the phenomenological data analysis and Atlas ti version 6.2 qualitative data analysis software was employed. The findings revealed that quality EmOC is a welcoming, life-saving timely care given in a clean environment with humility, respect, equal treatment and encouragement. It is care that is safe for the client, technically sound, responsive and meets clients’ needs and expectations. Accessibility of life saving care at all time and collaborative and coordinated care created good experiences for the clients. The causes of clients’ disappointment with the provision of EmOC were higher expectations from female providers, underestimation by providers, non responsive providers, and ethical misconduct by providers such as mocking, insulting, yelling, advantage taking providers, undelivered promises by providers, expectation with place of delivery, expectation with newborn care and a limited number of health workers attending delivery. Discrimination, high cost of care and asking client to buy drugs and supplies and referrals from centres, are some of the barriers on r the use of EmOC at public health facilities. The provision of EmOC is constrained by overloaded staffs, shortage of space to accommodate clients and inadequate number of beds. In conclusion, clients have expectations and experiences of provision of EmOC that influence their future decision to seek care. Finally, a client centred guideline for the provision of client centred EmOC provision was developed. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to examine the extent to which human resources capacity of the Ministry of Health and Social Services (MoHSS), Namibia, influences health care services delivery to the Namibian population. A qualitative research model using exploratory and descriptive study designs was adopted. Data were collected through semi-structured interviews with 46 health workers from two referral hospitals and two directorates in Windhoek District. The study found that there is severe staff shortage in the MoHSS, which has resulted in high workload and poor health care. Health worker migration, new services and programmes, emerging diseases, and population growth were reported to have contributed to staff shortage and high workload in the MoHSS. Study findings suggested a need to create more posts to accommodate emerging needs, and to introduce an effective retention strategy to attract and retain health professionals with scarce skills, and those working under difficult conditions. / Public Administration & Management / M. Tech. (Public Management)

Problembakgrund: Mellan år 1970-2009 utgjordes apoteksmarknaden i Sverige av ett statligt monopol, där Apoteket AB hanterade läkemedelsförsörjning för samtliga landsting i Sverige. År 2009 privatiserades däremot apoteksmarknaden, och landstingen fick nu välja om det skulle hantera läkemedelsförsörjningen i egen regi eller fortsätta upphandla tjänsten till en extern aktör. Åren efter avregleringen har landstingen valt att gå olika vägar, där några valt att fortsätta outsourca denna tjänst och andra har tagit hem tjänsten och hanterar den i egen regi. Med kostnadsbesparingar och vårdkvalitet i fokus för landstingen, är det därför intressant att undersöka varför de hanterar tjänsten olika. Syfte: Syftet med studien är att först kartlägga hur landstingen i Sverige hanterar läkemedelsförsörjningen och därefter undersöka och identifiera vilka kritiska faktorer som finns gällande valet av hanteringssätt. Vidare avser studien att analysera hur valet av hanteringsätt påverkas av dessa kritiska faktorer. Utifrån denna analys är det sedan möjligt att utarbeta en modell för sourcingbeslut gällande läkemedelsförsörjning i svensk hälso- och sjukvård. Metod: I studien genomfördes en surveyundersökning, där avsikten var att utföra strukturerade telefonintervjuer på samtliga landsting i Sverige. Studien utgick ifrån en kvantitativ forskningsstrategi med inslag av kvalitativa delar. Detta för att kartlägga landstingens hanteringssätt av läkemedelsförsörjning, samt undersöka drivkrafter och kritiska faktorer vid valet av hanteringssätt. Slutsats: En beslutsmodell i form av ett beslutsträd utformades för sourcingbeslut gällande läkemedelsförsörjningen för svenska landsting. Beslutsmodellen utgick ifrån tre huvudområden som var kritiska vid valet av hanteringssätt gällande läkemedelsförsörjning – fokus på kärnverksamhet, kostnadsbesparingar och vårdkvalitet. Dessa utgjorde grunden i beslutsmodellen, och var avgörande vid beslutsfattandet gällande hanteringssättet. / Background: During the years of 1970-2009 the pharmacy market In Sweden was run by the government, where Apoteket AB managed drug supply for all counties in Sweden. In 2009, however, the pharmacy market was privatized and the county councils, which are responsible for the Swedish health care, now had to choose whether it would manage the drug supply in-house, or continue to procure the service from an external player. The years after deregulation county councils decided to go different ways with this, where some chose to continue to outsourcing this service and other decided to manage it in-house. With cost savings and quality of care as the main focus of the county councils, it is interesting to examine why they handle this service differently. Purpose: The purpose of the study is to first identify how the county councils in Sweden handle their drug supply, and then examine and identify the critical factors by outsourcing this service or by managing it in-house. Furthermore, the study will analyze how the choice of managing this service in-house or outsource it is affected by these critical factors. Based on this analysis, it is then possible to develop a model for sourcing decisions regarding drug supply in the Swedish health care. Method: The study was conducted using a survey study, where structured telephone interviews were used as a data collection method on the county councils in Sweden. The study was based on a quantitative research strategy, with some qualitative elements. This was considered necessary to map out how the county councils managed their drug supplying, and to examine the driving forces and critical factors in choosing between outsourcing or in-house. Conclusion: A decision model in the form of a decision tree was designed for sourcing decisions regarding drug supply for the Swedish county councils. The decision model was based on three main areas that were established as critical in the selection of management methods regarding the drug supplying – focus on core activities, cost savings and quality of care. These areas formed the basis of the decision model, and were established instrumental in sourcing decisions regarding drug supplying in Swedish health care.

Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2008. / The South African Nursing Council believes that “quality nursing practice is based on adequate knowledge, skills or competencies, ethically and scientifically based comprehensive and holistic patient care, timely, accurate and complete or comprehensive recording” (SANC, n.d.). The aim of professional regulation is to protect the public from unsafe practices and to ensure quality services (SANC, n.d.). A shortage of nursing staff resulted in the implementation of a staffing strategy of increasing the work hours of nurses by ten hours a week. Patient complaints and unacceptable patient incidences resulted in it becoming essential to evaluate the effect of this strategy on patient care. As a goal of this study, the researcher decided to investigate the quality of patient care before the implementation of the strategy and the effect of the strategy on patient care after the implementation. The objectives of the study were set to determine whether • The patients were assessed according to activities of daily living and psychosocial data; • The nursing diagnosis was done • Nursing interventions are prescribed for each problem identified • The patients’ records were utilised to enhance individualised patient care and to ensure responsibility and accountability for patient care • The evaluation of patient progress was done according to the different prescriptions and interventions at least twice in 24 hours • A written final report for discharge criteria and health education was provided • A comparison of the quality of nursing care delivered before and after the implementation of the staffing strategy exist Research question What is the effect of an implemented staffing strategy in a selected hospital in KwaZulu-Natal on the quality of care delivered? Research methodology A non-experimental, descriptive design with a quantitative approach was applied. Population and sampling The target population for the study was patient care records of patients who were hospitalised during 2003. A non-probability convenience sample for a retrospective audit of a total of 372 patient care records over a period of 12 months was audited. An evaluation of the records was done and a comparison was drawn between the results obtained before and after the implementation of the staffing strategy. For both periods, 186 patient records were audited. The pilot study included the audit of 40 files. Reliability and validity were assured with a pilot study and the use of experts in nursing management, quality assurance, research methodology and statistics. The researcher audited the patient files personally. Ethical approval was obtained from Stellenbosch University and the ethics committee of the hospital. All principles related to ethics, such as confidentiality and anonymity, were maintained. Neither patient names were used nor the name of the hospital or wards from which the records were used. Codes were used to identify the hospital wards. The hospital was informed in the letter requesting consent to conduct the research, that the researcher intends publishing the findings of the research. Data analysis and interpretation Statistical associations using Chi-square tests were carried out to determine the significance between the various variables. The results of this study were presented in percentages, tables and histograms. Findings obtained showed that the quality of nursing declined after the strategy. Documentation of patient records was incomplete and did not meet legal requirements. Recommendations The implementation and maintenance of a quality assurance programme, human resource management, the on-going use of the nursing process and record keeping should be emphasised in the clinical practice environment and in the formal education environment.