Bakgrund: Dödligheten hos patienter som drabbats av hjärtstopp på vårdavdelningar är hög men med tidig hjärt-lungräddning (HLR) och tidig defibrillering så ökar chansen för överlevnad. Intensivvårdssjuksköterskan som ingår i akutteamet får ett larm om hjärtstopp och tillsammans med kollegor gör de en utryckning till patienten på avdelningen för att stötta och hjälpa till i den akuta situationen. Dessa situationer kan vara kaotiska och stressfyllda. Syfte: Syftet med studien var att beskriva intensivvårdssjuksköterskors upplevelser av hjärtstoppslarm och hjärtstopp på vårdavdelning som jobbat mindre än 5 år. Metod: En kvalitativ intervjustudie genomfördes på ett mindre länsdelssjukhus i norra Sverige. Data samlades in genom semistrukturerade intervjuer med nio intensivvårdssjuksköterskor med mindre än fem års yrkeserfarenhet som intensivvårdsjuksköterskor. Intervjuerna spelades in, transkriberades ordagrant och analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i fyra kategorier; Utmanande och spännande att bära hjärtstoppslarmet, Hjärtstoppslarm kräver planering och förberedelse, Övning och ett nära samarbete skapar trygghet och Stress påverkar handlingsförmågan. Resultatet visade att oerfarna intensivvårdssjuksköterskor upplever en viss form av stress men att de fann en trygghet i sina kollegor i akutteamet och att deras samarbete fungerar bra. Dock så kunde samarbetet med vårdavdelningens personal samt den medicinläkare som kommer till den patient som drabbats av hjärtstoppet fungera mindre bra och kommunikationen dålig. De upplevde ett behov av kontinuerlig HLR-träning dels med andra professioner samt mer scenarioövningar. Konklusion: Oerfarna intensivvårdssjuksköterskor kände sig trygga med hjärtstoppsteamet men upplevde otrygghet då de befann sig i en okänd miljö då en patient drabbats av hjärtstopp på vårdavdelning. Bristande rutiner och osäkerhet bland personalen kunde påverka den stress som uppstod negativt. Genom att utarbeta en gemensam rutin och träna tillsammans skulle arbetet kring hjärtstoppet kunna bli mindre stressfyllt och mer effektivt.

Abstract [en] Title: Discrepancies in medication lists at hospital wards identified by medication reconciliation Authors: Anderberg M. Institute: Uppsala University, Uppsala, Sweden Background and objective: An accurate medication list is essential for a correct assessment of a patient´s condition at hospitals. Previous studies have shown that patients in emergency departments often are affected by discrepancies in medication lists at hospital admission. Less research has been done regarding discrepancies after transferring patients to medical wards. The aim of this study was to identify discrepancies in the electronic medical record in hospital wards for patients admitted via the emergency department. Design: Observational study. Medication reconciliation was performed by a pharmacist shortly after the arrival of patients from the emergency department. This included a patient interview and the investigation of the patient’s medical record. The discrepancies identified at the wards were classified as either omitted drug, wrong dose, additional drug, incorrect frequency or duplicate therapy. Descriptive statistics were used and the proportion of medication lists with at least one discrepancy was presented with 95 % confidence interval. Setting: Three medical wards at Capio S:t Görans Hospital in Stockholm.  Main outcome measures: The proportion of medication lists with at least one discrepancy. The mean value of discrepancies among all patients. Classification and categorization of discrepancies regarding type and ATC index.  Results: In total, 63 patients were included with a mean age of 63 years. At least one discrepancy was identified in 43 % (95 % CI 31-55) of the medication lists. 52 discrepancies were found in total generating a mean value of 0,83 ± 1,17 discrepancies per medication list. The two most common categories were Omitted drug(33%) and Wrong dose(33%). The most frequent drug class associated with medication discrepancies was Drugs for obstructive airway diseases.  Conclusion: 43 % of the patients had at least one discrepancy in the medication list. This indicates the importance of medication reconciliations at medical wards even though the medication list has been updated at the emergency department.

The purpose of this study was to determine the contribution of nursing auxiliaries towards health care services against their scope of practice. Nursing auxiliaries practising within the Elim, Letaba, Malamulele, Nkhensani, Shiluvana and Tintswalo hospitals in the Gazankulu Health Administration, in the Northern Transvaal Province, constituted the target population. The findings revealed that nursing auxiliaries are not functioning strictly according to their scope of practice. They are an essential component of nursing services in Gazankulu by rendering a major contribution towards health care services in fulfilling their scope of practice-role. Apart from their prescribed practice-role, they are also engaged in activities that should be performed by enrolled and professional nurses as well as doctors and general assistants. There appears to be a need for education for all categories of nursing staff regarding the scope of practice of nursing auxiliaries for improving the effective utilisation of this category of nursing personnel / M.A. (Nursing Science) / Health Studies

The purpose of this study was to determine the contribution of nursing auxiliaries towards health care services against their scope of practice. Nursing auxiliaries practising within the Elim, Letaba, Malamulele, Nkhensani, Shiluvana and Tintswalo hospitals in the Gazankulu Health Administration, in the Northern Transvaal Province, constituted the target population. The findings revealed that nursing auxiliaries are not functioning strictly according to their scope of practice. They are an essential component of nursing services in Gazankulu by rendering a major contribution towards health care services in fulfilling their scope of practice-role. Apart from their prescribed practice-role, they are also engaged in activities that should be performed by enrolled and professional nurses as well as doctors and general assistants. There appears to be a need for education for all categories of nursing staff regarding the scope of practice of nursing auxiliaries for improving the effective utilisation of this category of nursing personnel / M.A. (Nursing Science) / Health Studies

The aim of this study was to investigate reasons for non–payment by residents for services rendered by the Vhembe District Municipality. The municipalities are responsible for delivering such services as water supply, electricity, road maintenance, refuse collection and sanitation. Multistage sampling techniques were employed. The subjects in the study were grouped into clusters and a sample was taken from each cluster. In this case the municipalities that took part in the study were selected first, followed by wards, villages and households. Households in the selected villages were selected randomly to participate in the study. The results showed that although the municipalities were making an effort to raise and send bills to the residents, the residents were not forthcoming with payments. The reasons advanced for the unwillingness to pay services by residents include ignorance, poverty and simple unwillingness to pay. / Public Administration & Management / M.P.A. (Master of Public Administration and Management)

The purpose of the study was to explore and describe the lived experiences of general nurses working at Standerton hospital medical wards which also admit psychiatric patients. A qualitative, descriptive phenomenological approach was used for the study. The study population consisted of seven general nurses working in medical wards at Standerton hospital. Purposive sampling was used to select participants who met the inclusion criteria. Researcher used in-depth face to face interviews to collect data until data saturation was achieved. Tesch’s method of qualitative data analysis was utilised to identify themes. Three themes and five sub-themes emerged from the study: theme1: perceived danger due to aggression sub-themes stress for medical patients, stress for medical patients’ families and stress for nurses. Theme 2: lack of skills in dealing with psychiatric patients’ sub- theme use of restrains. Theme 3: self fulfilling prophecy subtheme reported incidences. The study findings demonstrate the plight of general nurses who are not trained to work with psychiatric patients but continue to do so. Findings further accentuate what is already known about the labelling that goes with psychiatric patients and aggression as a resultant effect. Recommendations were made for future research, policy makers, nursing education and practice. / M.A. (Health Studies)

Wards occupy significant proportions of hospital floor areas and due to their constant use, represent a worthwhile focus of study. Single-bed wards are specifically of interest owing to the isolation aspect they bring to infection control, including airborne pathogens, but threats posed by airborne pandemics and family-involvement in hospital care means cross-infection is still a potential problem. In its natural mode, ventilation driven by combined wind and buoyancy forces can lead to energy savings and achieve thermal comfort and high air change rates through secure openings. These are advantageous for controlling indoor airborne pathogens and external air and noise pollution. However, there is lack of detailed evidence and guidance is needed to gain optimum performance from available natural ventilation systems. This research is a proof of concept investigation into the feasibility and impact of natural ventilation systems targeting airflow rates, thermal comfort, heating energy and control of pathogenic bio-aerosols in hospital wards. In particular, it provides insights into the optimal areas of vent openings which could satisfy the complex three-pronged criteria of contaminant dilution, low heating energy and acceptable thermal comfort for occupants in a naturally ventilated single bed ward. The main aim of this thesis is the structured study of four systems categorised into three groups: Simple Natural Ventilation (SNV) in which single and dual-openings are used on the same external wall; Advanced Natural Ventilation (ANV) which is an emerging concept; and finally Natural Personalised Ventilation (NPV) which is an entirely new concept borne out of the limitations of previous systems and gaps in literature. The focus of this research is in the exploratory study of the weaknesses and potentials of the four systems, based on multi-criteria performances metrics within three architecturally distinct single-bed ward designs. In contributing to the body of existing knowledge, this thesis provides a better understanding of the performances of three existing systems while presenting the new NPV system. The analysis is based on dynamic thermal modelling and computational fluid dynamics and in the case of the NPV system, salt-bath experiments for validation and visualisation of transient flows. In all cases, wards were assumed to be free of mechanical ventilation systems that might influence the natural flow of air. The thesis meets three major objectives which have resulted in the following contributions to current knowledge: An understanding of the limitations and potentials of same-side openings, especially why and how dual-openings can be useful when retrofitted into existing wards. Detailed analysis of bulk airflow, thermal comfort, heating energy and room air distribution achievable from existing SNV and ANV systems, including insights to acceptable trickle ventilation rates, which will be particular useful in meeting minimum dilution and energy requirements in winter. This also includes qualitative predictions of the airflow pattern and direction obtainable from both systems. The innovation and study of a new natural ventilation system called Natural Personalised Ventilation (NPV) which provides fresh air directly over a patient s bed, creating a mixing regime in the space and evaluation of its comfort and energy performances. A low-energy solution for airborne infection control in clinical spaces is demonstrated by achieving buoyancy-driven mixing ventilation via the NPV system, and a derivative called ceiling-based natural ventilation (CBNV) is shown. A comparative analysis of four unique natural ventilation strategies including their performance rankings for airflow rates, thermal comfort, energy consumption and contaminant dilution or removal using an existing single-bed ward design as case study. Development of design and operational recommendations for future guidelines on utilising natural ventilation in single-bed wards either for refurbishment or for proposed designs. These contributions can be extended to other clinical and non-clinical spaces which are suitable to be naturally ventilated including treatment rooms, office spaces and waiting areas. The findings signify that natural ventilation is not only feasible for ward spaces but that there is opportunity for innovation in its application through further research. Future work could focus on related aspects like: impacts of fan-assisted ventilation for a hybrid flow regime; pre-heating of supply air; integration with passive heat recovery systems as well the use of full-scale experiments to fine-tune and validate findings.

Aim: This study explores what type of information patients and nurses share with, or provide to, each other, and whether or not the information received was relevant and sufficient for their needs. Background: Information exchange, as part of shared decision-making, is advocated in policy and practice throughout the healthcare sector. Much of the literature on information exchange relates to one-to-one consultations with consultants or GPs. To date, no studies have explored information exchange between patients and nurses in ward settings. Nursing literature on patients’ information needs focuses on one-way information provision from nurses to patients, rather than on two-way information exchange between patients and nurses. Methods: Interactions between patients and nurses were observed and audio-recorded using a remotely controlled audio-recording system. Semi-structured individual face-to-face interviews were then conducted to clarify and add to the observation data. A multiple case study design was used for this study: each case comprised one patient, the nurses caring for that patient, and the interactions between them. A pilot study was undertaken to inform the methods for recruitment and data collection for the main study. Results: The pilot study comprised five cases (patients n=5, nurses n=3). Changes to the recruitment strategy for the main study included surgical patients being invited to participate in the same way as medical patients. There were no difficulties with the data collection methods. The main study comprised nineteen cases (patients n=19, nurses n=22). Information exchange seemed unfamiliar to ward-based nurses. The findings show that information exchange may not be a one-off event but a complex series of interactions. Patients did not distinguish between clinical and non-clinical information in the same way as nurses. Primary reasons for patients’ hospital admission were not discussed and nurses did not share information about nursing interventions. The relevance for patients and nurses differed; patients generally wanted information for reducing anxiety and socialization; nurses wanted information for assessment and care planning. In terms of sufficiency, observation sessions highlighted that insufficient information was provided, often due to lost opportunities and paternalistic practice. However, the majority of patients and nurses perceived that they had exchanged sufficient information. Conclusion: This multiple case study provides insights into the type, relevance and sufficiency of information for patients and nurses in ward settings. In ward settings, information exchange as conceptualised by Charles et al. (1997 and 1999) may be difficult to achieve due to the complexity of patient/nurse interactions. Therefore, there are implications for policy makers as policies are not context specific. However, information exchange may be helpful for reducing patients’ anxieties. The concepts of shared decision-making and information exchange are not part of ward-based cultures and philosophies, which suggests implications for patient and nurse education. Research on information exchange between patients and nurses in other ward contexts may contribute to further understanding of information exchange in ward settings.

Digitalisering och införandet av hälsoinformationssystem som digitala journalsystem har inneburit många fördelar inom sjukvårdssektorn jämfört med de äldre pappersjournalsystemen, exempelvis genom en ökad möjlighet både dela och spara patientinformation. Dock så har även en hel del problem uppkommit med deras införande, varav en av de större är att de digitala journalsystem som finns inte är anpassade efter klinisk sjukvård och vårdpersonalens arbetssätt. Sjuksköterskor är en av de största användargrupperna av dessa digitala journalsystem och de är även den arbetsgrupp som har hand om patienterna på vårdavdelning dygnet runt. Därmed är deras arbete även starkt knutet till patienternas säkerhet. Denna studie har undersökt vilka patientsäkerhetsrisker som användning av digitala journalsystem medför vid sjuksköterskearbete på vårdavdelning. Det gjordes med hjälp av en kvalitativ ansats där en litteraturstudie, intervjuer och deltagande observationer genomfördes. Studiens resultat har bidragit till en ökad förstående för de patientsäkerhetsrisker som användning av digitala journalsystem vid sjuksköterskearbete medför samt en ökad förståelse för den kontext som digitala journalsystem används i. / Digitalization and the introduction of health information systems (such as the electronic health records) has contributed to many advantages within the healthcare industry, especially compared to the old paper-based system. For instance, an electronic health record makes it easier to archive and share patient information, but the advances these systems contribute is also accompanied by its fair share of problems. One of the main problems being that there is a mismatch between the electronic health records in use and the way the healthcare personnel work. Nurses are one of the biggest user groups of the electronic health records and they are also providing healthcare to the patients admitted to hospital wards 24/7. That means that their work is tightly intertwined with patient safety. This study has examined risks for patient safety connected to the use of electronic health records during nursing practice at hospital wards. The study was conducted using a qualitative approach with a literature study, interviews and participatory observations. The result of the study has contributed to increased knowledge and insights regarding patient risks connected to the use of electronic health records during nursing practice at hospital wards as well as an increased understanding for the context in which the electronic health records are used.

La contractualisation de la relation tutélaire peut être envisagée comme un artifice qui fragilise la protection de la personne et instrumentalise le droit commun des contrats.Ce mouvement offre en effet une liberté et une sécurité qui peuvent sembler illusoires. Les défauts du nouveau contrat civil qu'est le mandat de protection future constituent un danger pour certaines personnes vulnérables, tandis que le contrat d'accompagnement, outil d'aide à la gestion, porte la marque du contrôle social.Les textes issus de la réforme de la protection juridique des majeurs instaurent de nouveaux modes de protection qui, en théorie, sont assez éloignés de la vision traditionnelle du contrat et, en pratique, sont sources d'interrogations, sinon d'inquiétudes.Ces contrats, si leur qualification n'est pas mise en cause, peuvent être analysés sous l'angle de leur parenté avec les contrats relationnels. Leur singularité justifie toutefois un régime propre. / The tutorship contractualization may be seen as an artifice weakening the individual protection and exploiting the law of contract.That movement actually provides a feeling of freedom and safety that might be illusory. The defects of this new civil contract, the mandate of future protection, are a danger for some vulnerable people, while the support contract, a management support tool, carries the mark of social control.Texts that result from the legal protection of adults reform establish new types of protection, which are theorically remoted from the traditionnal view of contract, and practically source of questions, if not of worries.These contracts, as long as their legal qualification is not questioned, can be analyzed from the angle of their similarities with relational contracts. Their singularity accounts for their own legal regime.