Sammanfattning Nyexaminerade röntgensjuksköterskors upplevelse av övergången till arbetslivet Bakgrund: Att vara ny på arbetsplatsen kan vara en utmaning för många yrkesgrupper inom vården bland annat nyexaminerade röntgensjuksköterskor.  Syfte: Syftet med denna studie var att belysa nyexaminerade röntgensjuksköterskors upplevelse av övergången till arbetslivet på deras första arbetsplats. Design: En kvalitativ intervjustudie med induktivt ansats. Metod: Semi-strukturerade individuella intervjuer genomfördes med fyra nyexaminerade röntgensjuksköterskor på tre olika sjukhus. Dataanalysen gjordes med manifestinnehållsanalys. Resultat: Som resultat av dataanalysen formulerades fyra huvudkategorier: (I) Mötet med patienter; (II) Arbetsmiljö och utvecklingsmöjligheter; (III) Samarbete med olika yrkesgrupper; (IV) En bra start i arbetslivet.  Slutsats: Respondenternas svar varierade gällande övergången till arbetslivet men något som alla respondenter var eniga om var att de inte hade individuellt anpassat schema och att det inte fanns tid för egen utveckling.  Nyckelord: Introduktion, nyexaminerad, röntgensjuksköterska, upplevelse, övergång. / Abstract Newly graduated radiographers` experience of the transition to working life. Background: Being new to the workplace can be a challenge for many professional groups in healthcare, including newly graduated radiographers.  Purpose: The purpose of this study was to illustrate newly graduated radiographers’ experience of the transition at their first workplace. Design: A qualitative interview study with a inductive approach. Methods: Semi-structured individual interviews were conducted with four newly graduated radiographers at three different hospitals. The data analysis was done with manifest content analysis. Results: Four main categories were formulated, as a result of the data analysis. (I) The meeting with patients, (II) work environment and developing opportunities, (III) teamwork with various professional groups (IV) A good start in working life. Conclusion: The respondents' answers varied regarding the transition to working life, but something that all respondents agreed on was that they did not have an individually adapted schedule and that there was no time for professional development. Keywords: Experience, introduction, newly graduated, radiographer, transition.

Radiography has seen most development over the last 30 years with the evolution of new technologies, but perhaps more significantly changes in education models and radiographer roles. The development of advanced and consultant posts has facilitated the growth of the profession, although the evidence base is still evolving. Through a number of research projects this thesis will explore the growth in the radiography evidence base with specific reference to the extending role of the radiographer in image interpretation. Parallel clinical and academic developments have provided evidence of a scholarly profession which is slowly establishing its place through publication and a growing research base. / Please Note: The full text of each of the published articles, which are listed on page vii, has been removed from the PhD online copy due to publisher copyright restrictions. Links to the publisher¿s websites are given. To see the final full text version of the articles listed on page vii, please visit the publisher¿s website. Available access to the published online version may require a subscription.

Bakgrund: Röntgensjuksköterskan måste på kort tid bilda en förståelse för patienten och dennes behov för att kunna tillämpa ett gott omhändertagande. Det finns många delar inom omhändertagandet som måste appliceras för att kunna säkerställa en patientsäker vård. Syfte: Syftet med litteraturstudien var att belysa röntgensjuksköterskans erfarenheter av omhändertagande av patient i samband med röntgenundersökning.   Metod: En litteraturstudie innehållande nio kvalitativa studier. Sökningarna genomfördes i Pubmed, Cinahl och Scopus.  Resultat: Analysen resulterade i tre kategorier och sex underkategorier. Kategorierna bestod av: Medvetenhet om ansvaret, Känna krav på att vara och Hantera utmaningar. Konklusion: Hur röntgensjuksköterskan kommunicerar med patienten har en stor betydelse för hur mottaglig patienten blir mot den information som delges. Att ta sig tid att läsa av individen och dennes behov kan bidra till ett bättre omhändertagande. En tydligare beskrivning inom området som kan ge en vägledning vid olika patientmöten skulle kunna vara en tillgång för nyutexaminerade.  Nyckelord: erfarenheter, radiografi, röntgenundersökning, omhändertagande, röntgensjuksköterska / Background: The radiographer must in a short time form an understanding of the patient and his or her needs in order to be able to apply good care. There are many parts of care that must be applied to be able to ensure patient-safe care. Aim: The purpose of the literature study was to illuminate the radiographers’ experiences of the care of patients in connection with an diagnostic imaging examination. Method: A literature study containing nine qualitative studies. The searches were conducted in Pubmed, Cinahl and Scopus. Result: The analysis resulted in three categories and six subcategories. The categories consisted of: Awareness of responsibility, Feel the need to be effective and Handle challenges. Conclusion: How the radiographer communicates with the patient is of great importance for how receptive the patient becomes to the information provided. Taking the time to read the individual and his needs can contribute to better care. A clearer description in the area that can provide guidance at various patient meetings could be an asset for recent graduates. Keywords: experience, radiography, diagnostic imaging examination, caring for, radiographer

Bakgrund: Artificiell intelligens förväntas lösa en rad olika problemområden inom hälso-sjukvården, däribland röntgen. Både radiologer och röntgensjuksköterskor förväntas ta till sig ny information och forskning och utveckla området framåt. Trots detta finns det relativt lite information gällande personalens uppfattningar om artificiell intelligens. Syfte: Syftet med studien var att belysa röntgensjuksköterskor och radiologers uppfattningar av artificiell intelligens Metod: En kvalitativ litteraturstudie. Sökningarna genomfördes i databaserna Pubmed, Cinahl, Web Of Science och Google Scholar. Åtta artiklar analyserades och kvalitetsgranskades. Resultat: Resultatet delades in i kategorierna: Det finns oklarheter om AI:s fulla betydelse med subkategorierna: En önskan om mer utbildning, Osäkerheter kring AI:s värde inom röntgen samt förbättrad vård trots farhågor. Följt av den sista kategorin: Yrket står inför en utveckling med subkategorierna, En delad syn gällande AI:s påverkan på arbetsrollen, En främst positiv skiftning i jobbmöjlighet samt långsiktiga förhoppningar för professionerna. Resultatet diskuteras sedan mot kompetensbeskrivningen som teori. Konklusion: Det fanns en positiv inställning till AI, trots farhågor och ovissheter. Dock krävs mer forskning för att fastslå AI:s påverkan på verksamheten och professionen. Något som är tydligt är att personalen kräver ytterligare kunskaper men också mer tid till att läsa på om forskning gällande AI för att kunna arbeta evidensbaserat. / Background: Artificial intelligence is expected to solve a number of different problem areas in healthcare, including the radiography department. Both radiologists and radiographers are expected to absorb new information and research and bring the field forward. Despite this, there is relatively little information regarding the staff's perceptions of artificial intelligence. Aim: The aim of the study was to illustrate radiographers and radiologists’ perceptions of artificial intelligence Methods: A qualitative literature study. Searches were performed in Pubmed, Cinahl, Web of Science and Google Scholar. Eight articles were analyzed and quality reviewed. Results: The results where divided into the categories: There are uncertainties about AI:s full meaning with the subcategories: A desire for more training, Uncertainties about the value of AI in radiography and improved care despite the concerns. Followed by the last category: The professions are facing a development with the subcategories, A divided view regarding the impact of AI on the work role, A mainly positive shift in job opportunities and long-term hopes for the professions. The result is then discussed against the competence description as theory. Conclusion: There was a positive attitude towards AI, despite the concerns and uncertainties. However, more research is required to decide AI's full impact on the profession. Something that is clear is that personnel requires additional knowledge but also more time to study research regarding AI in order to be able to work based on evidence.

Bakgrund:Klaustrofobi är en form av ångest och rädsla som kännetecknas av kraftig rädsla för trånga eller instängda utrymmen. MR-maskinens trånga utrymme kan framkalla klaustrofobiska och ångestreaktioner. Effekterna av klaustrofobi och ångest vid MR-undersökningar kan resultera i tidigt avbrutna undersökningar och ha ekonomiska konsekvenser. Röntgensjuksköterskan möter dessa reaktioner och underlättar för patienten genom hela undersökningen. Syfte:Syftet med denna studie var att beskriva strategier som röntgensjuksköterskan använder för att hjälpa patienter att hantera ångest och klaustrofobiska reaktioner vid MR-undersökningar. Metod: En kvalitativ metod valdes och datainsamlingen utfördes genom semistrukturerade intervjuer, som sedan analyserades med manifest innehållsanalys. Resultat:Två identifierade kategorier är: att ge individuellt anpassad förberedelse med subkategorier undersöknings genomgång, avslappnande metoder, behov av lugnande läkemedel, bemötande, större tunnel och patientpositionering, samt att förmedla kunskap och öka patientens förståelse av proceduren med subkategorier informationsöverföring genom kommunikation och röntgensjuksköterskans erfarenheter. Slutsats: I studien presenterades olika metoder som röntgensjuksköterskan använder för att hjälpa patienter som upplever klaustrofobiska och ångestrelaterade reaktioner. Dessa metoder inkluderar bland annat kommunikation, sedering, användning av större tunnel samt andra lindrande metoder. / Baground: Claustrophobia is a form of anxiety and fear characterized by intense fear of confined or enclosed spaces. The narrow space of an MRI machine can trigger claustrophobic and anxiety reactions. The effects of claustrophobia and anxiety during MRI examinations can result in early termination of scans and have economic consequences. Radiographers face these reactions and facilitate patients throughout the examination. Aim: The purpose of this study was to describe strategies that radiographers use to help patients manage anxiety and claustrophobic reactions during MRI examinations. Method: A qualitative method was chosen, and data collection was conducted through semi-structured interviews, which were then analyzed using manifest content analysis. Result:Two identified categories are: providing individually tailored preparation with subcategories examination review, relaxation methods, need for sedative medication, approach, larger tunnel and patient positioning , and conveying knowledge and increasing the patients understanding of the procedure with subcategories for information dissemination through communication and radiographers experiences. Conclusion:The study presented various methods that radiographers use to assist patients experiencing claustrophobic and anxiety reactions. These methods include communication, sedation, use of larger tunnels, and other relieving methods.

No / The misinterpretation of radiographs is recognised as a key source of emergency department (ED) errors, regardless of clinician profession. This article compares ENP and medical staff accuracy in the interpretation of musculoskeletal trauma X-rays between immediate and delayed radiology reporting pathways. The data for this study was drawn from a larger pragmatic randomized controlled trial of immediate reporting. Patients were recruited and randomly assigned to immediate or delayed reporting arms and treated according to group assignment. Image interpretive accuracy between ED staff groups and arms was undertaken together with an assessment of the influence of immediate reporting on patient pathways and journey times. Six hundred and seventy-four radiographic examinations were performed (598 patients). There was a significant reduction in the interpretive errors in the immediate reporting arm for all ED clinicians (proportional difference = 4.2%; 95% CI [0.017,0.068]; p = 0.001), but no significant difference in proportion of interpretive errors was evident between ENPs and medical staff. Patient journey times, discharge and referral rates were not significantly different between study arms, although admission rates varied for medical staff collectively. ENP X-ray interpretation accuracy is comparable with that of medical staff, but immediate reporting was seen to reduce errors without increasing patient journey times.

Yes / Objectives To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Methods Using the World Health Organisation definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs and data were systematically extracted using electronic data extraction proforma. Results 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n=7) focussing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The papers were generally considered to be of low to moderate quality with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No papers reported data relating to time to diagnosis, time to recovery or patient mortality. Conclusions Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. Advances in knowledge This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality. Powered by

Yes / Whilst there is increasing demand on radiology services in the UK, pressures are restricting the expansion of the multi-professional workforce. A pilot academy for radiography reporting was established to augment the traditional university and clinical education in a simulated environment using focussed teaching and real image worklists in a dedicated environment away from departments. Methods: Located at a facility to replicate the clinical reporting environment, the emphasis of the nine-month pilot was to provide extensive ‘hands-on’ training to eight trainees. Evaluation of the academy was undertaken through focus groups, telephone interviews, and online surveys to consider the experiences of the trainees and their managers and mentors. Results: There was overwhelming support for the academy from trainees, mentors, and managers. Key benefits included relieving pressures on department and mentors; providing an intense, structured, and safe environment to learn; and, perhaps most importantly, an extensive and cohesive peer-support network. Issues identified included conflict within departments due to differences in reporting style and the need for greater collaboration between the university, academy, and departments. Conclusion: The use of simulation in education is widely researched, however, there are a number of key factors that need to be considered when implementing it into practise. Peer-support and reflection is seen as essential for its success. Extensive dedicated time to focus on reporting alongside peers can support the development of these skills away from the clinical environment and as such can reduce pressure on service delivery and positively influence learner outcomes. / The pilot academy received funding from the NHS Vanguard scheme (Working Together NHS Vanguard) for purchase of equipment and the salaries of the clinical educator (pro-rata). The university fees and backfill payments were funded by Health Education England.

No / Non-medical consultant posts are a relatively new addition to the National Health Service (NHS) workforce, the role first being announced for nurses in 1998 followed by the Allied Health Professions in 2000. They have been described as multidimensional positions that encompass the four core functions of consultant practice: expert clinical practice; professional leadership and consultancy; practice and service development, research and evaluation; education and professional development. Consequently, the purpose of non-medical consultants is to promote and develop practice at the clinical, strategic and policy level. Despite the professional drive to develop consultant radiographer roles, by the end of 2005 only 15 were in post. One of the reasons for this poor appointment rate is the deficiency in suitably qualified and experienced candidates, a finding acknowledged to be an issue across all the non-medical professions. Further, the development of potential consultant practitioners has been hampered by the lack of clearly defined clinical and educational pathways. This paper acknowledges the limited published material available to radiographers wishing to advance to consultant positions. Yet while recognising the need to establish a true consultant career pathway underpinned by an appropriate education and research strategy, it explores the requirements of consultant practice, identifying some opportunities available to radiographers to develop appropriate consultant level skills.

No / The terms ‘extended’ and ‘advanced’ practice are commonly used to describe clinical practitioner roles. However, these terms have not been clearly defined within the context of modern radiography practice despite their fundamental importance to establishing the 4 tier structure, implementing Agenda for Change and promoting a coherent clinical radiography career structure. This paper discusses the terms ‘extension’ and ‘advancement’ in relation to radiography practice and, using evidence from the debates of other health professions, attempts to offer some clarity to the terminology, presenting one interpretation of its possible application to the radiographer role in the United Kingdom.