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Intensivvårdspersonalens följsamhet till riktlinjer och påverkande faktorer för omvårdnaden av patienter efter öppen hjärtkirurgi. : En fokuserad etnografisk observationsstudieLydebrant, Simon January 2024 (has links)
Bakgrund: Det finns flera faktorer som påverkar följsamheten till riktlinjer för sjuksköterskor och följsamheten varierar över tid från en implementering av en riktlinje. Sjuksköterskor beskriver ett samband mellan graden av missade omvårdnadshandingar och deras upplevelse av patientsäkerheten. Att använda riktlinjer anses som något positivt men för många skrivna riktlinjer kan för sjuksköterskan vara svårt att följa. Den personcentrerade vården är en viktig del av vården hos de patienter som genomgått öppen hjärtkirurgi. Syftet: Syftet med studien var att undersöka intensivvårdspersonalens följsamhet till riktlinjer, faktorer som påverkade och i vilken grad de följde riktlinjerna i omvårdnaden. Metod: Fokuserad etnografisk observationsstudie med kvalitativ och kvantitativ ansats. Urvalet var patienter som är vakna efter operation och som innan hjärtoperationen bedömdes ha en vårdtid på IVA som är mindre än 24 timmar samt vårdas av personal på en intensivvårdsavdelning. Resultat: 23 (61%) av 38 omvårdnadshandlingar bedömdes som säker följsamhet och 15 (39%) omvårdnadshandlingar bedömdes som bristande följsamhet. Faktorer som påverkade omvårdnadshandlingarna var den fysiska och psykiska arbetsmiljön samt personcentrerad vård. Observationerna resulterade i fem huvudkategorier: Säker följsamhet, Brist i följsamhet, Brist i hantering av teknisk apparatur, Arbetsmiljö och Personcentrerad följsamhet. Slutsats: Följsamheten till riktlinjer är lätt att mäta men att förstå följsamheten är en svår och multidimensionell fråga. Studien visar att anpassningar av riktlinjer kan hindra eller skapa risker samt att arbetsmiljön och personcentrerad vård påverkar omvårdnadshandlingar. / Background: There are several factors that affect adherence to guidelines for nurses and adherence varies over time from an implementation of a guideline. Nurses describe a correlation between the degree of missed nursing care and their experience of patient safety. Using guidelines is considered something positive, but too many written guidelines can be difficult for the nurse to follow. Person-centred care is important for the care of patients who have undergone open-heart surgery. Aim: The aim of the study where to identify the ICU staff's adherence to guidelines, factors that affected and to what extent they followed the guidelines. Method: Focused ethnographic study with a qualitative and quantitative approach. The sample was patients who are awake after surgery and who before the heart surgery were assessed to have a stay less than 24 hours in the ICU and are cared for by staff in an ICU ward. Main Result: 23 (61%) of 38 nursing care were assessed as safe adherence and 15 (39%) were inadequate adherence. Factors that affected the nursing care were the physical and mental work environment and person-centered care. The observations resulted in five main categories: Safe Adherence, Lack of Adherence, Lack of Handling of Technical Equipment, Work Environment and Person-centered Adherance. Conclusion: Adherence to guidelines is easy to measure, but understanding adherence is a difficult and multidimensional issue. The study shows that adaptations of guidelines can prevent or create risks and that the work environment and a person-centered approach affect nursing actions.
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Från ett fel till två rätt : en kvalitativ studie om ansatser för säkerhets- och tillsynsarbete inom svensk luftfart / From one wrong towards two right : A qualitative study of approaches to safety andsupervisory work in Swedish aviationArman, Oscar, Hall, Klara January 2017 (has links)
Luftfart har i takt med en ökad globalisering fått en naturlig roll i samhället. Samtidigt blir de teknologiska och automatiserade system som interagerar med människor och organisationer alltmer komplexa. I det fortsatta arbetet med att hålla en hög säkerhetsnivå inom civil luftfart arbetar tillsynsmyndigheter kontinuerligt med tillståndsprövning, tillsyn och analyser av luftfartens aktörer för att förhindra olyckor. För en fortsatt utveckling av säkerhetsarbetet är det av intresse att klargöra vilka säkerhetsperspektiv som i framtiden kan vara med och definiera säkerhets- och tillsynsarbetet. Teorin kring Safety-II föreslår en förändring i perspektiv på säkerhet från att så lite som möjligt skagå fel, till att fokusera på att så mycket som möjligt ska gå rätt. Safety-II definieras också som förmågan att lyckas under varierande förhållanden. Den här studiens syfte var att belysa möjligheter och utmaningar för en svensk tillsynsmyndighet att arbeta utifrån ett Safety-II-perspektiv vid tillsyn, där studien även ämnade att belysa tillämpbara beståndsdelar i Safety-II vid tillsynsarbete. För att svara på syftet genomfördes en undersökning med kvalitativ ansats genom semistrukturerade intervjuer med inspektörer vid Transportstyrelsens sjö- och luftfartsavdelning. En avgränsning mot tillsynsverksamheten drogs, där perspektiv från verksamhetsutövare uteslöts. Utmaningar som kunde identifieras med att arbeta utifrån ett Safety-II-perspektiv låg i regelverksstyrning, begreppsoklarhet och resurskrav. Även skillnader i föreskrivet och praktiserat arbete med rättvisekulturella aspekter, tvåvärdiga bedömningar och en byråkratisk tröghet kunde ses som potentiella utmaningar. Identifierbara möjligheter att arbeta utifrån Safety-II innefattade en diskret transformation av Safety-I-perspektivet, ökad dialog med verksamhetsutövare vid tillsyn samt tillgänglig kompetens internt vid myndigheten i tillägg till en positiv attityd hos inspektörer. Beståndsdelar i Safety-II tillämpbara i ett tillsynsarbete identifierades inom Transportstyrelsen i form av befintliga verktyg för fortsatt proaktivitet samt ett uppmärksammande av Resilience. En vid tillsynsmyndigheten intern människa-teknik-organisation-interaktion illustrerades även, samt en följande interaktion mellan tillsynsmyndigheten och den externa verksamhetsutövaren. Med bakgrund i studiens avgränsning, skulle en djupare insikt i problemområdet nås genom fortsatta studier som även inbegriper verksamhetsutövarens perspektiv på tillsyn och Safety-II. / As a result of increased globalization, the aviation sector has become an inherent part of society. At the same time, technological and automated systems that interact with people and organizations are becoming increasingly complex. In order to maintain a high level of safety within the aviation industry, civil aviation authorities together with other agencies continuously work towards developing safety aspects, trying to prevent accidents. It is therefore of interest to determine the safety perspectives which can be applied in the future, defining the work of civil aviation authorities and other regulatory bodies. The Safety-II perspective promotes a change of view regarding the way we look at safety – from focusing on what goes wrong, to what goes right, where Safety-II also is defined as the ability to succeed under varying conditions. The purpose of this study was to investigate possibilities and challenges of applying a Safety-II perspective on the work of a supervisory authority. The study also aimed to pinpoint possible components of Safety-II suitable within the line of work of a supervisory authority. A qualitative approach for the study was chosen in which semi-structured interviews were held with inspectors at the civil aviation authority of Sweden (Transportstyrelsen), providing the data for the research. The challenges identified for a supervisory authority working with a Safety-II perspective underlined regulatory frameworks, the need of concept clarification, resource requirements, differences in work as-imagined and work-as-done, conclusions of a binary nature, bureaucratic inertia and just culture aspects. Meanwhile, the possibilities identified were related to an already incipient shift away from a Safety-I way of thinking, increased dialogue with operators, and available internal competencies at thesupervisory authority. Components of Safety-II appropriate for a supervisory authority to initially work with, were proactive tools and discussions regarding Resilience. The study also highlighted Human-Technology-Organization interactions internally within the supervisory authority, as well as the interactions between the supervisory authority and the operators. Due to the delineation of the study, a deeper insight into the problem area can be achieved through further studies that include Safety-II from a perspective of the operator.
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Mapping the resilience performance of community pharmacy to maintain patient safety during the Covid-19 pandemicPeat, George W., Olaniyan, Janice, Fylan, Beth, Breen, Liz, Grindey, C., Hague, I., Alldred, David P. 27 January 2022 (has links)
Yes / Background
The first UK wave of the Covid-19 pandemic in 2020 placed unprecedented stress on community pharmacy. Various policies and initiatives were announced during this period to support community pharmacy to continue to perform in a manner that prioritised patient safety. However, little is understood about how these policies and initiatives were implemented by staff working in community pharmacy, and the system adaptions and responses that were initiated to maintain patient safety.
Objective
The study aimed to investigate how staff working in UK community pharmacy during the first waves of the COVID-19 pandemic in 2020 responded and adapted to system stressors to maintain patient safety.
Methods
We adopted a qualitative interview approach, underpinned by Resilient Healthcare theory, with interview data collected between July 2020 and January 2021. Data were synthesised and analysed using Framework Analysis.
Results
23 community pharmacy staff from England and Scotland were interviewed. We identified five themes supported by between two and six sub-themes: 1. Covid-19, an impending threat to the system. 2. Patient safety stressors during the first waves of Covid-19. 3. Altering the system, responding to system stressors. 4. Monitoring and adjusting. 5. Learning for the future.
Conclusion
Privileging the accounts of community pharmacy staff working on the frontline during the pandemic illuminated how responses and adaptions were developed and deployed, how continual monitoring occurred, and the factors that supported or hindered system resilience. The key learning derived from this study can serve to shorten the gap between ‘work as imagined’ and ‘work as done’, and in doing so, support the future resilience performance of community pharmacy during future outbreaks of Covid-19 or similar events. / This research was funded by the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC).
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"Önskar man hade två käftar och tre telefoner" : COCOM och kontroll inom flygledning / "Wish I had two mouths and three phones" : COCOM and Control in Air Traffic ControlRankin, Erik January 2015 (has links)
Denna magisteruppsats redogör för en anpassning av COCOM (Contextual Control Model) till flygledningsdomänen. COCOM är en modell som kan användas för att beskriva och förutse kontroll hos operatörer i komplexa system. En central del av modellen är begreppet kontrollnivå vilket beskriver hur graden av kontroll hos ett JCS (Joint Cognitive System) beror av och påverkar de parametrar som beskriver dess prestation. Fokus i denna uppsats ligger på det JCS som omfattar flygledaren i sin arbetsposition. I uppsatsen anpassas Hollnagels generella beskrivning av kontrollnivåer i COCOM till flygledningsdomänen. Till grund för anpassningen ligger en kvalitativ studie i form av observation och intervju av sju operativa flygledare vid en svensk kontrollcentral. De tre parametrarna målavvägning, subjektivt tillgänglig tid samt planering och prioritering befinns särskilt lämpliga för att beskriva kontroll inom flygledning. I uppsatsen identifieras också, med utgångspunkt i resilience engineering, tolv strategier som flygledare använder för att bibehålla kontroll i det vardagliga arbetet. Två exempel på strategier är att anpassa sig till kollegor och deras arbetssituation, samt användandet av ”extra ögon”, att låta en kollega övervaka arbetet. Valet av strategi kopplas i uppsatsen samman med vilken kontrollnivå flygledaren befinner sig på. Domänanpassningen av COCOM visar att modellen är lämplig för modellering av operatörer. COCOM för flygledning kan användas för att bättre klassificera prestation specifikt inom detta område, samt som stöd i samband med utvecklandet av nya verktyg och arbetsmetoder. Kunskap om kontrollstrategier kan med fördel utnyttjas vid utbildning av flygledare, som med denna typ av metakunskap kan få mer medvetna verktyg för att bibehålla kontroll.
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Abordagens de segurança operacional da usina hidrelétrica Itaipu Binacional sob a perspectiva da engenharia de resiliênciaPortela, Juliano Couto January 2016 (has links)
Acidentes graves em organizações com infraestruturas críticas, como a Usina Hidrelétrica Itaipu Binacional, embora raros, causam importantes impactos sociais e econômicos em sua área de influência. Portanto, eles devem ser evitados mesmo que, seja esperada uma taxa “normal” de acidentes por conta dos fatores de risco e complexidade da sua operação. Essa dissertação apresenta uma investigação das condições que levam a acidentes em casos específicos da operação da Itaipu Binacional sob o enfoque proativo da gestão da Segurança II de acordo com a Engenharia de Resiliência (ER). Ela se baseia na variabilidade da operação normal e, portanto, “no muito que dá certo”, em contraponto à visão tradicional da Segurança I, reativa, baseada na análise retrospectiva de acidentes e “no pouco que dá errado”. Com base em uma revisão da literatura quanto os requisitos, princípios e temas da ER e da Segurança-II e nas opiniões estruturadas de operadores foram desenvolvidos dois estudos: o primeiro traçou preocupações destes operadores em relação ao risco de incêndio em um transformador da Itaipu Binacional para desenvolver indicadores e planos de ação aderentes aos princípios da ER. O objetivo foi suplementar, com elementos de ER, uma análise de risco convencional baseada em árvore de falhas e árvore de eventos, e otimizar o plano de ação de emergência em caso de incêndio em transformador da unidade geradora Os resultados mostraram a oportunidade de melhoria para o desenvolvimento de indicadores proativos para a análise de risco. O segundo estudou, com base no método FRAM, a operação normal e a variabilidade de quatro manobras operacionais típicas selecionadas pelos operadores dentro dos quadrantes da matriz periodicidade-complexidade. Os resultados indicaram que as mesmas variabilidades influenciam nos passos operacionais, não importando a complexidade tampouco a periodicidade da manobra. Um comparativo entre a análise das variabilidades em situação normal e os relatórios das quatro falhas ocorridas entre 2006 e 2015 apontou que o sucesso e a falha advêm da mesma fonte, e que algumas variabilidades como “ambiente de manobra”, a “necessidade de confirmar os passos das manobras” e situações que tiram a atenção do operador atuam de forma decisiva em praticamente todas as manobras. Os resultados foram discutidos com os integrantes da equipe que propuseram adaptações necessárias para aumento da segurança operacional do trabalho normal sob a perspectiva de ER. / Serious accidents in organizations with critical infrastructures, such as the Itaipu Binacional Hydroelectric Power Plant, although rare, cause important social and economic impacts in their area of influence. Therefore, they must be avoided even if a "normal" rate of accidents is expected because of the risk factors and complexity of the operation. This dissertation presents an investigation on the conditions that lead to accidents in the operation of Itaipu Binacional under the proactive approach of Security II management according to Resilience Engineering (RE). It is based on the variability of the normal operation and, therefore, "in the many things that goes right", in contrast to the traditional and reactive view of Safety-I, based on the retrospective analysis of accidents and "the few things that went wrong". After a review of the literature on the requirements, principles and themes of RE and Security-II and on the structured opinions of the operational staff, two studies were developed: the first one brings the concerns of these operators in regard of the risk of fire in a transformer in order to develop indicators and action plans adherent to the RE principles. The objective was to supplement a conventional risk analysis based on fault tree and event trees with RE elements, optimizing the emergency action plan. The results showed the opportunity for improvement of proactive indicators for risk analysis The second one, inspired by the FRAM method, deals with the normal operation and variability of four typical operational maneuvers selected by operators within four quadrants of a periodicity-complexity matrix. The results indicated that the same variabilities influence the operational steps, regardless of the complexity or the periodicity of the maneuver. A comparison between the analysis of the variabilities in normal situation and the reports of the four operational failures occurred between 2006 and 2015 indicated that success and failure come from the same source, and that some variabilities such as “maneuver environment”, “necessity to confirm the maneuver steps” and “situations that take the attention of the operator” act decisively in virtually all maneuvers. The results were discussed with the team members who proposed the necessary adaptations to increase the operational safety of normal work from the RE perspective.
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Abordagens de segurança operacional da usina hidrelétrica Itaipu Binacional sob a perspectiva da engenharia de resiliênciaPortela, Juliano Couto January 2016 (has links)
Acidentes graves em organizações com infraestruturas críticas, como a Usina Hidrelétrica Itaipu Binacional, embora raros, causam importantes impactos sociais e econômicos em sua área de influência. Portanto, eles devem ser evitados mesmo que, seja esperada uma taxa “normal” de acidentes por conta dos fatores de risco e complexidade da sua operação. Essa dissertação apresenta uma investigação das condições que levam a acidentes em casos específicos da operação da Itaipu Binacional sob o enfoque proativo da gestão da Segurança II de acordo com a Engenharia de Resiliência (ER). Ela se baseia na variabilidade da operação normal e, portanto, “no muito que dá certo”, em contraponto à visão tradicional da Segurança I, reativa, baseada na análise retrospectiva de acidentes e “no pouco que dá errado”. Com base em uma revisão da literatura quanto os requisitos, princípios e temas da ER e da Segurança-II e nas opiniões estruturadas de operadores foram desenvolvidos dois estudos: o primeiro traçou preocupações destes operadores em relação ao risco de incêndio em um transformador da Itaipu Binacional para desenvolver indicadores e planos de ação aderentes aos princípios da ER. O objetivo foi suplementar, com elementos de ER, uma análise de risco convencional baseada em árvore de falhas e árvore de eventos, e otimizar o plano de ação de emergência em caso de incêndio em transformador da unidade geradora Os resultados mostraram a oportunidade de melhoria para o desenvolvimento de indicadores proativos para a análise de risco. O segundo estudou, com base no método FRAM, a operação normal e a variabilidade de quatro manobras operacionais típicas selecionadas pelos operadores dentro dos quadrantes da matriz periodicidade-complexidade. Os resultados indicaram que as mesmas variabilidades influenciam nos passos operacionais, não importando a complexidade tampouco a periodicidade da manobra. Um comparativo entre a análise das variabilidades em situação normal e os relatórios das quatro falhas ocorridas entre 2006 e 2015 apontou que o sucesso e a falha advêm da mesma fonte, e que algumas variabilidades como “ambiente de manobra”, a “necessidade de confirmar os passos das manobras” e situações que tiram a atenção do operador atuam de forma decisiva em praticamente todas as manobras. Os resultados foram discutidos com os integrantes da equipe que propuseram adaptações necessárias para aumento da segurança operacional do trabalho normal sob a perspectiva de ER. / Serious accidents in organizations with critical infrastructures, such as the Itaipu Binacional Hydroelectric Power Plant, although rare, cause important social and economic impacts in their area of influence. Therefore, they must be avoided even if a "normal" rate of accidents is expected because of the risk factors and complexity of the operation. This dissertation presents an investigation on the conditions that lead to accidents in the operation of Itaipu Binacional under the proactive approach of Security II management according to Resilience Engineering (RE). It is based on the variability of the normal operation and, therefore, "in the many things that goes right", in contrast to the traditional and reactive view of Safety-I, based on the retrospective analysis of accidents and "the few things that went wrong". After a review of the literature on the requirements, principles and themes of RE and Security-II and on the structured opinions of the operational staff, two studies were developed: the first one brings the concerns of these operators in regard of the risk of fire in a transformer in order to develop indicators and action plans adherent to the RE principles. The objective was to supplement a conventional risk analysis based on fault tree and event trees with RE elements, optimizing the emergency action plan. The results showed the opportunity for improvement of proactive indicators for risk analysis The second one, inspired by the FRAM method, deals with the normal operation and variability of four typical operational maneuvers selected by operators within four quadrants of a periodicity-complexity matrix. The results indicated that the same variabilities influence the operational steps, regardless of the complexity or the periodicity of the maneuver. A comparison between the analysis of the variabilities in normal situation and the reports of the four operational failures occurred between 2006 and 2015 indicated that success and failure come from the same source, and that some variabilities such as “maneuver environment”, “necessity to confirm the maneuver steps” and “situations that take the attention of the operator” act decisively in virtually all maneuvers. The results were discussed with the team members who proposed the necessary adaptations to increase the operational safety of normal work from the RE perspective.
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Abordagens de segurança operacional da usina hidrelétrica Itaipu Binacional sob a perspectiva da engenharia de resiliênciaPortela, Juliano Couto January 2016 (has links)
Acidentes graves em organizações com infraestruturas críticas, como a Usina Hidrelétrica Itaipu Binacional, embora raros, causam importantes impactos sociais e econômicos em sua área de influência. Portanto, eles devem ser evitados mesmo que, seja esperada uma taxa “normal” de acidentes por conta dos fatores de risco e complexidade da sua operação. Essa dissertação apresenta uma investigação das condições que levam a acidentes em casos específicos da operação da Itaipu Binacional sob o enfoque proativo da gestão da Segurança II de acordo com a Engenharia de Resiliência (ER). Ela se baseia na variabilidade da operação normal e, portanto, “no muito que dá certo”, em contraponto à visão tradicional da Segurança I, reativa, baseada na análise retrospectiva de acidentes e “no pouco que dá errado”. Com base em uma revisão da literatura quanto os requisitos, princípios e temas da ER e da Segurança-II e nas opiniões estruturadas de operadores foram desenvolvidos dois estudos: o primeiro traçou preocupações destes operadores em relação ao risco de incêndio em um transformador da Itaipu Binacional para desenvolver indicadores e planos de ação aderentes aos princípios da ER. O objetivo foi suplementar, com elementos de ER, uma análise de risco convencional baseada em árvore de falhas e árvore de eventos, e otimizar o plano de ação de emergência em caso de incêndio em transformador da unidade geradora Os resultados mostraram a oportunidade de melhoria para o desenvolvimento de indicadores proativos para a análise de risco. O segundo estudou, com base no método FRAM, a operação normal e a variabilidade de quatro manobras operacionais típicas selecionadas pelos operadores dentro dos quadrantes da matriz periodicidade-complexidade. Os resultados indicaram que as mesmas variabilidades influenciam nos passos operacionais, não importando a complexidade tampouco a periodicidade da manobra. Um comparativo entre a análise das variabilidades em situação normal e os relatórios das quatro falhas ocorridas entre 2006 e 2015 apontou que o sucesso e a falha advêm da mesma fonte, e que algumas variabilidades como “ambiente de manobra”, a “necessidade de confirmar os passos das manobras” e situações que tiram a atenção do operador atuam de forma decisiva em praticamente todas as manobras. Os resultados foram discutidos com os integrantes da equipe que propuseram adaptações necessárias para aumento da segurança operacional do trabalho normal sob a perspectiva de ER. / Serious accidents in organizations with critical infrastructures, such as the Itaipu Binacional Hydroelectric Power Plant, although rare, cause important social and economic impacts in their area of influence. Therefore, they must be avoided even if a "normal" rate of accidents is expected because of the risk factors and complexity of the operation. This dissertation presents an investigation on the conditions that lead to accidents in the operation of Itaipu Binacional under the proactive approach of Security II management according to Resilience Engineering (RE). It is based on the variability of the normal operation and, therefore, "in the many things that goes right", in contrast to the traditional and reactive view of Safety-I, based on the retrospective analysis of accidents and "the few things that went wrong". After a review of the literature on the requirements, principles and themes of RE and Security-II and on the structured opinions of the operational staff, two studies were developed: the first one brings the concerns of these operators in regard of the risk of fire in a transformer in order to develop indicators and action plans adherent to the RE principles. The objective was to supplement a conventional risk analysis based on fault tree and event trees with RE elements, optimizing the emergency action plan. The results showed the opportunity for improvement of proactive indicators for risk analysis The second one, inspired by the FRAM method, deals with the normal operation and variability of four typical operational maneuvers selected by operators within four quadrants of a periodicity-complexity matrix. The results indicated that the same variabilities influence the operational steps, regardless of the complexity or the periodicity of the maneuver. A comparison between the analysis of the variabilities in normal situation and the reports of the four operational failures occurred between 2006 and 2015 indicated that success and failure come from the same source, and that some variabilities such as “maneuver environment”, “necessity to confirm the maneuver steps” and “situations that take the attention of the operator” act decisively in virtually all maneuvers. The results were discussed with the team members who proposed the necessary adaptations to increase the operational safety of normal work from the RE perspective.
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