Det övergripande syftet var att beskriva och jämföra sjuksköterskors och underskö­terskors bedömningar av patienters smärta, näringstillstånd och hudkostym samt de­ras uppfattningar om att använda bedömningsinstrument. Vidare att beskriva sjuk­sköterskors och undersköterskors uppfattningar om hur de bedömer patienters smärta, näringstillstånd och hudkostym. Metod: Etthundrasjuttio pati­entjournaler granskades. Intervjuer med sjuksköterskor (n=9) och undersköterskor (n=9) genomfördes. Resultatet av sjuksköterskors (n=34) och undersköterskors (n=43) bedömningar jämfördes. Interbedömarreliabilitet undersöktes när sjuk­sköterskor (n=50) och undersköterskor (n=61) använde bedömningsinstrument.  Resultat: Sextio pro­cent av patientjournalerna vid inskrivningen och 78 % vid utskrivningen innehöll do­kumentation om patientens hudstatus. Det fanns dokumentation om trycksår i 15 % respektive 20 % av patientjournalerna. Patienter som var i risk för trycksårutveckling enligt Modifierad Nortonskala (MNS) erhöll i medeltal 4,6 omvårdnadsåtgärder och patienter som ej var i risk erhöll i medeltal 3,8. Det var inte några tydliga grän­ser för hur sjuksköterskor och undersköterskor genomförde bedömningar, vem som gjorde vad och på vilket sätt det gjordes. Det var inga skillnader mellan sjukskö­terskors och undersköterskors bedömningar av risk för undernäring och trycksår när det gäller poäng för initial bedömning och totalpoäng. Det var dock skillnader i deras bedömningar av enskilda delskalor och smärta. Sjuksköterskors och undersköterskors uppfattning om hur det var att använda bedömningsinstrument varierade. Inter­bedömarreliabiliteten avseende MNS, Short- Form Mini Nutritional Assessment och trycksårkortet varierade mellan och inom sjuksköterskegruppen och undersköterskegruppen. Konklusioner: Sjuksköterskor dokumenterar inte alltid bedömning av patienters hudkostym och risk för trycksårutveckling. Det är såväl likheter som skillnader mellan sjuksköterskor och undersköterskor när det gäller hur de genomför bedömningar och resultatet av deras bedömningar. Interbedömarreliabilite­ten mellan och inom sjuksköterske- och undersköterskegruppen varierar vid deras bedömning med olika bedömningsinstrument och trycksårkort. Ett viktigt led i arbetet med att säkerställa patientsäkerhet och hög vårdkvalitet är att vara steget före och fortlö­pande bedöma patienters smärta, näringstillstånd och hudkostym. / The overall aim was to describe and compare registered nurses’ (RNs’) and enrolled nurses’ (ENs’) assessments of pain, nutrition and skin and their perceptions of using assessment tools. Further to describe RNs’ and ENs’ perceptions of how they assess patients’ pain, nutrition and skin. Methods: One hundred and seventy patient records were reviewed for patients with hip fracture. Interviews were conducted with RNs (n=9) and ENs (n=9). Results of the RNs’ (n=34) and ENs’ (n=43) assessments of patients with hip fracture were compared. Interrater reliability was examined between and among RNs (n=50) and ENs (n=61) using assessment tools for assessments (n=228) of patients with hip fracture and stroke. Results: Sixty percent of patient records on admission and 78% at discharge had documentation of the patient’s skin status. Pressure ulcers were documented in 15% and 20% of patient records respectively. Patients at risk for developing pressure ulcers according to the Modified Norton Scale (MNS) received a mean of 4.6 nursing interventions, while those not at risk received a mean of 3.8. There were no established boundaries between RNs’ and ENs’ assessment who performed it and in what way it was done. There were no differences between RNs’ and ENs’ as­sessments of risk for malnutrition and pressure ulcer regarding screening or total scores. However, there were differences regarding their assessments on the subscales and patients’ pain.  RNs’ and ENs’ perceptions of using assessment tools varied. Interrater reliability regarding MNS total score was very good among RNs, good among ENs and between RNs and ENs. For Short- Form Mini Nutritional Assessment screening score, interrater reliability was good between RNs and ENs and among RNs, while it was moderate among ENs. Interrater reliability between and among RNs and ENs varied for Pressure Ulcer Card. Conclusions: RNs do not always document assessment of patients’ skin and risk for pressure ulcer. Patients at risk for pressure ulcers receive more nursing interventions than patients not at risk. There are both similarities and differences between RNs and ENs regarding how they perform their assessments and what the results of their assessments are. Interrater reliability between and among RNs and ENs varies regarding the different assessment tools. An important part of the work in establishing patient safety and high quality of care is to be one step ahead and continuously assess the patients’ pain, nutrition and skin.

This study focused on Registered Nurses (RNs) working in Acute Trust surgical wards in the context of their role development, role expansion and role extension. The study originated from concerns raised by RNs undertaking the surgical pathway of the BSc Hons in clinical nursing practice, who alerted me to their dissatisfaction with their working conditions and their role. This revelation was made at a time when modernization was cascading into Acute Trusts as a result of the NHS plan (DOH 2000); simultaneously the European Working Time Directive (EWTD) was being implemented, sequentially reducing Junior Doctor’s hours of work. NHS modernization and the EWTD were the two initiatives which led the researcher to the assumption that RNs working in surgical wards were the labour force who would be absorbing the additional workload brought about by these changes, because RNs are the only health professionals in acute surgical wards with twenty-four hour contact with, and responsibility for, ward-based surgical patient care. The study was conducted in one clinical directorate of an Acute Trust hospital, comprising six in-patient surgical wards and five specialist nursing services. The methodology was ethnography, where the researcher worked as an RN for fifteen months, collecting data through Spradley’s (1980) descriptive, selective and focused phases of fieldwork. Data was analysed using what Miles and Huberman (1994) refer to as a set of ‘choreographed / custom built’ techniques. The descriptive phase of fieldwork revealed an apparent ‘staffing illusion’ on the surgical wards and RNs were found to be under tremendous pressure to manage ‘patient throughput’, and an ever increasingly dependent case mix of surgical patients, within the existing, or if possible diminishing Senior / experienced RN labour force due to the emergent evidence of a ‘cycle of staff change’ with non-clinical managers backfilling Senior RN posts with Junior RNs. For Senior RNs this backdrop meant additional support and supervision demands on their role. To get through the workload many RNs held ‘dual roles’ to enable maintenance of the surgical services within the directorate. The selective phase of fieldwork re-focused the ethnographic lens on the RNs in the context of their role development, role expansion and role extension, from which six perspectives were found: 1) role development from Junior to Senior RN, 2) role expansion dependent on shift of the day, day of the week – the co-ordinator role, 3) role extension confusion and boundary disputes, 4) hidden [role expansion and extension] talents of surgical nurses, 5) role contraction – a feeling Nursing is going backwards, and finally, 6) ‘if only I could’ – role expansion aspirations of surgical RNs. The third phase of fieldwork, described by Spradley (1980) as the focused phase, was spent validating the findings and conducting the ethnographic interviews. The findings are interpreted locally [from the perspective of RN’s working within Rodin] as ‘working to full capacity’ through ‘doing more for more with less’, as a result of the RN with the surgical directorate being sandwiched between two agendas, that of Junior Doctors EWTD and NHS modernisation. Braverman’s skill substitution / degradation of skilled work thesis is then used as an interpretative framework to conclude the thesis, the outcome of which reports a ‘triple substitution’ agenda.

Patients with mental illness experience dissatisfaction with their care due to lack of understanding and ignorance from the nurses. The nurses’ approach might influence these patients' experience of their care. The purpose of the literature review was to describe nurses' approach in care of patients with mental illness. The literature review is based on an inductive approach and the result is based on 14 scientific papers, of which eight used a qualitative design and sex used a quantitative design. A simpler form of content analysis was used, which resulted in four themes: the importance of knowledge, preconceived perceptions, neglect and feelings of responsibility. Nurses' attitudes to mental illness are both positive and negative. Positive approaches include feelings of responsibility for patient care. Negative approaches include neglect and negative feelings such as distrust and fear. The result of the literature review indicates a need for more education about mental illness in order to reduce stigma and knowledge gaps among registered nurses in public health services. As many results articles were related to abuse problems the area seems limited, therefore more research directed toward other mental illnesses, is recommended. / Patienter med psykisk ohälsa upplever missnöje med sin omvårdnad på grund av brist på förståelse och negligering från sjuksköterskorna. Sjuksköterskorna kan påverka dessa patienters upplevelser av omvårdnaden genom sitt förhållningssätt. Syftet med litteraturstudien var att beskriva sjuksköterskors förhållningssätt i omvårdnaden av patienter med psykisk ohälsa. Litteraturstudien grundas på en induktiv ansats och resultatet baseras på 14 vetenskapliga artiklar, varav åtta artiklar är kvalitativa och sex artiklar är kvantitativa. En enklare form av innehållsanalys användes, vilket resulterade i fyra teman: kunskapens betydelse, förutfattade uppfattningar, negligering samt känslor av ansvar. Sjuksköterskors förhållningssätt till psykisk ohälsa är både positiv och negativ. Positiva förhållningssätt inkluderar känslor av ansvar för patienternas omvårdnad. Negativa förhållningssätt inbegriper bland annat negligering samt negativa känslor som misstro och rädsla. Litteraturstudiens resultat påvisar ett behov av mer utbildning om psykisk ohälsa för att reducera stigmatisering och kunskapsluckor hos legitimerade sjuksköterskor i den allmänna hälso- och sjukvården. Området upplevdes begränsat då många funna resultatartiklar berör missbruksproblematik, därför rekommenderas mer forskning riktad mot andra psykiska sjukdomar.

Bakgrund: Hjärt- och kärlsjukdomar är ett globalt växande folkhälsoproblem som dessutom är en ekonomisk last på samhället. Forskning har uppskattat att majoriteten av dödsfall kommer att bero på hjärt- och kärlsjukdomar vid år 2030. Några riskfaktorer för att utveckla hjärt- och kärlsjukdom är ett högt BMI, rökning och låg fysisk aktivitet. Forskning har visat att primärpreventivt arbete med livsstilsförändringar är något som minskar riskfaktorerna och är kostnadseffektivt för samhället. Syftet: var att beskriva vilka primärpreventiva metoder sjuksköterskan använder för att uppmuntra till livsstilsförändringar hos patienter med risk för  hjärt- och kärlsjukdom samt att beskriva hur dessa primärpreventiva metoder påverkar riskfaktorerna. Syftet var också att beskriva urvalsgrupperna i de valda vetenskapliga artiklarna. Metod: För att besvara syftet och frågeställningarna hade denna litteraturstudie en beskrivande design där tolv vetenskapliga artiklar har analyserats. Databaserna PubMed och CINAHL användes vid sökningen för att finna de vetenskapliga artiklarna. Resultat: Sjuksköterskor använde olika metoder för att uppmuntra till livsstilsförändring hos hjärt- och kärlsjuka patienter. Dessa metoder innebar att sjuksköterskan antingen fungerar som en informationsgivare eller samarbetspartner gentemot patienten. Effekten av metoderna varierade och enligt vissa studier gav de ej gav någon effekt. Slutsats: Utifrån litteraturstudiens resultatet går det ej med säkerhet att säga vilka metoder som är mest effektiva. Sammanfattningsvis kan sjuksköterskan i sitt kliniska arbete ta hänsyn till båda förhållningssätt i mötet med patienterna och anpassa metoden utifrån ett individuellt perspektiv. / Background: Coronary heart disease is a growing health issue from a global perspective. Research has estimated that coronary heart disease will stand for the majority of deaths by the year 2030.  Risk factors include a high BMI, smoking and low level physical activity. Research has also shown that lifestyle change can decrease the risk factors and is cost-effective for the society. Aim: The aim with the litterature study was to describe which primary prevention methods nurses use to encourage lifestyle change for patients at  risk of developing coronary heart disease, and to describe how these methods affect the risk factors. The purpose was also to describe the sample groups in the chosen articles. Method: To answer the study questions, the literature study had a descriptive design where twelve scientific articles were analysed and categorized. The databases PubMed and CINAHL were used to find the scientific articles. Results: Nurses use an array of different methods to encourage life style change in patients with coronary heart disease. These methods include the nurse either acting as a information giver or a collaboration partner towards the patient. The effect of these methods varied and some of the studies didn’t show any effect whatsoever. Conclusion: On the basis of the literature study, the methods nurses use and their effectiveness are inconclusive. In conclusion, the nurse can consider all of the methods in the work place, and decide which method is adequate based on the individual variations of the patients.

No description available.

Improving patient safety through reduction of medical errors is a national priority. One of the strategies widely utilized to address this issue is the use of incident reporting systems. The purpose of this study was to describe factors that predict the likelihood that Certified Registered Nurse Anesthetists (CRNAs) will use incident reporting systems, guided by the theory of planned behavior (Ajzen, 1991). A non-experimental, correlational research design was utilized to achieve the study aims. Following IRB approval, a cross-sectional survey was administered electronically to a random sample of practicing CRNAs. Correlational analyses and a standard logistic regression were utilized to determine the relationship between cognitive factors and CRNAs' use of incident reporting systems. Two hundred and eighty-three practicing CRNAs participated in this study. These CRNAs value incident reporting, perceive social pressure to report, and feel in control over reporting, yet had not consistently used existing incident reporting systems in the past 12 months. A CRNA’s attitude toward reporting and the degree to which he or she perceived social pressure to report, were determined to be significant predictors of the likelihood that a CRNA would use an incident reporting system. Social pressure to report was the most important factor in the prediction model. The results of this study revealed that there are missed opportunities for learning from patient safety incidents in anesthesia practice. The information gained in this study has the potential to assist organizations in the design of strategies to promote incident reporting by practicing CRNAs.

Den här avhandlingen handlar om vårdlärares arbete med simulering av arbetsuppgifter i metodrum Ett metodrum kan ses som en hybrid mellan klassrum och sjukhussal. I denna skolmiljö övas arbetsuppgifter som förekommer inom vård och omsorg. Det saknas patienter att öva på och ibland sjukvårdsmaterial, vilket innebär en utmaning för vårdläraren att skapa en autentisk miljö. Syftet med studien är att undersöka hur vårdlärare arbetar med simulering av arbetsuppgifter i metodrumsundervisning för vuxna elever. Avhandlingen grundar sig på ett sociokulturellt perspektiv och har analyserats med hjälp av kvalitativ innehållsanalys. Tre metodrumslektioner från tre olika skolor ljudinspelades digitalt : venprovtagning, urinkatetrisering och såromläggning. Resultatet visar att vårdlärarna arbetar med tre olika simuleringsaktiviteter: Tekniskt utförande, Tolkande och Bemötande. Simuleringsaktiviteternas utförande varierar med lektionsinnehållet. Studien visar vilka redskap i metodrumsundervisningen som är vanligt förekommande och hur de används. Ingela Leibring har bakgrund som barnmorska och arbetar för närvarande som vårdlärare inom kommunal vuxenutbildning i Karlstad samt är utbildningsledare för Yrkeshögskolans utbildning till barnspecialiserad undersköterska. / This study centres on clinical skills laboratory teaching in municipal adult education. This type of teaching takes place in a school setting and is hybrid of a nursing and healthcare environment. Future professional tasks are simulated and practised here. Three different schools were visited and three clinical skills laboratory lessons were recorded with a digital audio recorder. The following tasks were included in the study: venipuncture, urinary catheterisation, and wound dressing. The analysis was performed as a qualitative content analysis informed by a sociocultural perspective. The aim of the study is to extend the knowledge of how teachers approach the simulation of tasks in clinical skills laboratory training. The study identifies three simulation activities and their application: technical performance, interpretation, and treatment.  The main teaching tools used in the lessons were the teacher’s body/hands, different physical tools specific to the respective laboratory session and the teacher’s language. All the simulation tasks – venipuncture, urinary catheterisation and wound dressing ­– were included in the sessions. A similarity was that technical performance on the whole was the most common feature in all the laboratory lessons. A difference emerged when the clinical skills laboratory lesson was divided into the components: introduction, students practise themselves, and conclusion. The lesson introduction included treatment to nearly the same extent as technical performance. Differences related to lesson content were evident in the activities interpretation and treatment. A common pattern was that the teachers shifted between everyday language and professional language when they worked with simulation. They named their patients and gave the students immediate response.

Bakgrund: Omvårdnad är ett ord som kan ha flera olika betydelser, det kan vara ett verb som något man utövar eller en synonym med kunskap som något som erhålls. Syfte: Syftet med studien var att beskriva vad sjuksköterskor och undersköterskor ansåg inbegripas av begreppet omvårdnad och “god omvårdnad” samt vad för arbetsuppgifter de olika yrkeskategorierna utförde inom ramen för omvårdnad. Metod:Individuella intervjuer av tre sjuksköterskor och fyra undersköterskor. Innehållet analyserades med hjälp av kvalitativ innehållsanalys. Fem teman och 21 kategorier framkom. Resultat: Respondenterna uttryckte att den basala omvårdnaden hade en central roll inom begreppet omvårdnad. Vid diskussion om vad god omvårdnad innebar framhävde de flesta att ett gott bemötande var avgörande, att utföra arbetsuppgifter med omtanke och respekt. Att bedriva personcentrerad vård ansågs även ge god omvårdnad. Förutom basal omvårdnad och bemötande framkom det att medicinsk teknik var en stor del av arbetet inom omvårdnaden och att samarbete var en viktig del. Det rådde få meningsskiljaktigheter angående sjuksköterskans respektive undersköterskans arbetsuppgifter. Slutsats: Sjuksköterskorna och undersköterskorna som intervjuats har till stor del en samlad bild utav vad begreppet omvårdnad innebär. Det fokuserades mest på basal omvårdnad och gott bemötande vilket båda är två viktiga och centrala delar inom omvårdnaden. Att det inte fanns många meningsskiljaktigheter mellan undersköterskorna och sjuksköterskan kan ses som ett resultat av en tydlig arbetsfördelning. / Background: Nursing is a word that can have several meanings, it can be a verb or be synonymous with knowledge. Aim: The aim with this study was to describe what registered nurses (RN) and certified nursing assistant (CNA) perceived by the expressions nursing  and “qualitative nursing ” and what tasks at work these two different professions performed within the limits of nursing. Method: Qualitative interview study with individual interviews with three RN's and four CNA's. The content was analyzed through qualitative content analysis. Five themes and 21 categories arose. Results: The respondents expressed that the basal nursing care had a central role within the concept; nursing. At discussions about what good nursing meant, it was brought forth that a good interaction was decisive, to perform work related tasks with consideration and respect. To exercise person centered care was also considered to be good nursing. Besides basal nursing care and interactions it became apparent that medical technique is a big part of the job within nursing and that cooperation is an important part as well. There were few differences in opinions concerning RN respectively CNA job tasks. Conclusion: RN's and CNA's that were interviewed have the same general idea about what the concept nursing implies. It mainly focused on basal nursing care and good interactions, which were both considered as important parts within nursing. It can be seen that the lack of differences in opinion between CNA's and RN's is brought forth by a clear division of work between the two.

Registered nurses are the first contact for individuals seeking medical attention in the health system. These nurses have leaders who encourage them and they have goals and dreams to reach. The leadership of a hospital are responsible for creating a positive working environment so as to maintain job satisfaction for all. When subordinates are satisfied with their job they tend to stay and become more productive in their workplace. Leadership has an influence on the level of job satisfaction and therefore influences whether they leave or stay in the workplace. The objectives of the study were to describe the status of leadership, job satisfaction and the intention to leave among registered nurses in hospitals in the North-West and Free State Provinces. The relationship between leadership, job satisfaction and intention to leave among registered nurses in hospitals in the North-West and Free State Provinces was also investigated. The research design in this study was quantitative, descriptive, explanatory and contextual in nature. The sample included registered nurses (RNs) in medical and surgical units in both private and public hospitals in the North-West and Free State provinces of South Africa, (n = 204). Data was collected using the RN4CAST questionnaire. EpiData and SPSS statistical programmes were used to analyze data. The results of the study showed that most registered nurses were satisfied with the items of leadership except for the praise and recognition item (55.7%). Most registered nurses showed high levels of overall job satisfaction (70.5%), but were dissatisfied with wages (50%), study leave (40.9%) and opportunity for advancement (40.1%). Furthermore, the registered nurses showed high intention to leave their current hospitals (46.1%). The results also indicated a relationship between leadership, job satisfaction and intention to leave among registered nurses in medical and surgical wards in both private and public hospitals. Recommendations for policy, education, practice and future research were made. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Registered nurses are the first contact for individuals seeking medical attention in the health system. These nurses have leaders who encourage them and they have goals and dreams to reach. The leadership of a hospital are responsible for creating a positive working environment so as to maintain job satisfaction for all. When subordinates are satisfied with their job they tend to stay and become more productive in their workplace. Leadership has an influence on the level of job satisfaction and therefore influences whether they leave or stay in the workplace. The objectives of the study were to describe the status of leadership, job satisfaction and the intention to leave among registered nurses in hospitals in the North-West and Free State Provinces. The relationship between leadership, job satisfaction and intention to leave among registered nurses in hospitals in the North-West and Free State Provinces was also investigated. The research design in this study was quantitative, descriptive, explanatory and contextual in nature. The sample included registered nurses (RNs) in medical and surgical units in both private and public hospitals in the North-West and Free State provinces of South Africa, (n = 204). Data was collected using the RN4CAST questionnaire. EpiData and SPSS statistical programmes were used to analyze data. The results of the study showed that most registered nurses were satisfied with the items of leadership except for the praise and recognition item (55.7%). Most registered nurses showed high levels of overall job satisfaction (70.5%), but were dissatisfied with wages (50%), study leave (40.9%) and opportunity for advancement (40.1%). Furthermore, the registered nurses showed high intention to leave their current hospitals (46.1%). The results also indicated a relationship between leadership, job satisfaction and intention to leave among registered nurses in medical and surgical wards in both private and public hospitals. Recommendations for policy, education, practice and future research were made. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.