Beate André

Experiences with the Implementation of Computerized Tools in Health Care Units: A Review Article

Demands for improved patient care as well as improved efficiency in the delivery of health care have increased dramatically in recent years. New technologies, including computers, are expected to play an important role in meeting these demands. The aim of this review is to identify the main challenges to the introduction of computer technology in health care and to identify what kinds of factors may promote or hamper the implementation process. A systematic search of relevant databases resulted in 299 hits related to implementation of computer technology in health care, of which 17 met all criteria for inclusion in this review. The following barriers to the adoption of computer technology were identified: negative attitudes, lack of knowledge, role adjustment related to the disruption of traditional work habits, and changes in established work roles. The dual needs to both assess and change attitudes were identified as crucial factors in allowing for the successful implementation of these new technologies. The challenges for future clinical work and research will be to influence the behavior and intentions of health care personnel, to focus on the benefits of introducing computer technology (CT) in health care units, and to make certain that the institutions leadership is fully supportive of the change. Furthermore, this review showed that if the introduction of computerized tools is going to succeed, an adequate training program is imperative.

The importance of key personnel and active management for successful implementation of computer-based technology in palliative care: results from a qualitative study.

Symptom assessment is an important issue in palliative care. Computer technology is now available for use in such assessments. The aims of the present study were to investigate the factors that can promote implementation of computer technology in a palliative care unit. Symptom assessment by use of handheld computers combined with a database for storing the assessments and other clinical data were introduced in 2001 at the Palliative Medicine Unit of Trondheim University Hospital. Seventeen respondents (nurses, physicians, and physiotherapists) participated in an in-depth interview. The themes presented in this article are perceived aims, training, information, and communication. A qualitative approach was used in analyzing the data. All the respondents expressed a wish for a resource person, and the expectations regarding this person differed, because this person had to be present at the unit, should provide quick help, should be a driving force, and should be responsible for training and teaching. There is a need for skilled and motivated key personnel in the unit if implementation is to be successful.

The impact of work culture on quality of care in nursing homes – a review study

AIM The main aim of this review study was to identify which factors that characterise the relationship between work culture and quality of care in nursing homes. METHOD This review study was structured through systematic search methods to identify articles that describe the relationship between work culture and quality of care in nursing homes. The database search yielded 14510 hits. Closer examination showed that 10401 of these hits were duplicates. Of the remaining 4109 articles, only 10 were related to our aim for the study. A qualitative method were used to explain and understand phenomena of work culture and quality if care in nursing homes. FINDINGS Nine out of 10 articles in this review study emphasise the importance of leadership style and supportive management to increase quality of care in nursing homes. Increased empowerment, participation and influence were important factors for improving quality of care. Significant associations between work culture and quality of care and between empowerment and quality of care were reported. CONCLUSION Nursing management and leaders must take in consideration that work culture is crucial for improving quality of care in nursing homes, and this study can be used to increase the focus on the work culture among healthcare personnel in nursing homes. Changes are necessary to increase healthcare personnels job satisfaction, empowerment, autonomy and influence in nursing homes. Giving empowerment to the healthcare personnel working in nursing homes is both an organisational and an interpersonal issue. Being given empowerment and influence over their own work situation, the healthcare workers can be more committed and involved in the goal of obtaining best possible care to the residents.

Managing innovation in eldercare: A glimpse into what and how public organizations are planning to deliver healthcare services for their future elderly

Abstract Eldercare policies are being dramatically reshaped due to demographic shifts worldwide. The elderly are living longer and healthier, and their infrastructural impacts on society are well-known among researchers. It is known that most countries will be experiencing unprecedented growths in their elder population, but what is less known is what and how public-entities are going to meet these upcoming challenges. The aim of this paper is to analyze eldercare innovations in light of the increasing numbers of elderly, with the support of eldercare theory. This empirical study will deepen the understanding of eldercare by showing the current strategic direction of leaders in this field. We found a lack of innovation strategy in formal innovation training, recruitment of workers, and knowledge-sharing channels between municipalities. Its clear that Norways innovation strategy is to facilitate healthy aging for the elderly in their own homes as long as possible. Most developments have been smart, in-home technology. Accordingly, eldercare theory would urge Norwegian municipalities to strive for more balance in their eldercare system, inter alia, by developing innovation processes, improving recruitment, or reshaping social responsibility. We have enumerated, in the conclusion, how municipalities and other public-entities can learn from this study.

Demystifying eldercare: Managing and innovating from a public-entity's perspective

Abstract The aim of this paper is to help managers in public positions make better sense out of the exponential developments currently surfacing in eldercare. This industry has been blessed and cursed by its rapid development; blessed as there is a plethora of both technological and service type innovations, but cursed because there is so much development that trying to understand, organize, and stay updated with it all becomes nearly impossible. This article will help demystify these innovations, making it easier for public organizations to manage this process. A review of the literature yielded 1384 relevant hits, 207 articles had substantial relevance, and 67 articles were selected as fitting within the framework of this study. We found that when these 67 articles are reviewed together, in the framework of eldercare, and from the lens of a public-entity, a typology for managing innovation within eldercare emerges. When viewing eldercare in this framework, suddenly managing eldercare innovation becomes simpler as one can understand where existing and new developments fit within the overall system. The core of this typology is contingent on maintaining an appropriate balance between three facets; the quality of care, the working environment, and societal efficiency. This balance is extremely important as these three facets are generally inversely proportional to each other. When a problem or opportunity emerges within a municipality, managers can now predetermine the impact that the proposed solution will have on the overall system, and likely make better decisions on what to invest in.

Can group climate explain innovative readiness for change

Purpose Globally, elderly populations are increasing at unprecedented rates. This has precipitated change in the way practitioners are thinking of delivering eldercare services, especially in the public sector. In Norway, innovation scholars, the Norwegian government, and most municipalities delivering eldercare services agree that they must innovate to meet upcoming demands. However, infrastructural impacts are not expected for 15 years. Thus, the more difficult question becomes when a change is so distant, when or with whom should you innovate? The purpose of this paper is to determine innovative readiness by looking at group climate. Design/methodology/approach The study will explore the differences between two groups within an organization: one group that participated (participant group) in formal innovation training and and the other group (nonparticipant group that did not participate in the training). The differences in each group’s climate will be explored using a t-test. Findings There exist two identifiable group climates within the same organization. The participant group’s climate indicated that their members are ready for innovative change by showing that they are task oriented (C2), engaged (S1), and have an overall positive attitude toward innovation (A1 and A2). On the contrary, the nonparticipant group’s climate indicates that their members are not ready for innovative change. This group has a dominant role of acceptance (D2), rather than pursuing ideas or causes they believe in, they accept those tasks given to them. Each group’s level of innovation understanding was relatively similar prior to any formal training. Originality/value This research shows that even though a manager within an organization is championing or encouraging innovative behavior, there can still exist two different group climates: a group that is genuinely interested in innovation and one that is not. Should participation in innovation training be mandatory or voluntary? This study showed the latter that the participant group’s climate indicated its members were more ready for innovative change, while the nonparticipant group’s climate indicated its members were not. This could be an important group dynamic for managers to consider when building a new innovative initiative, especially if that organization struggles with maintaining engagement and positivity for that change.

Dietary Patterns Characterized by High Meat Consumption Are Associated with Other Unhealthy Life Styles and Depression Symptoms

Objective We aimed to identify dietary patterns (DPs) of Portuguese adults, to assess their socioeconomic, demographic, lifestyle determinants, and to identify their impact on health. Design EpiDoC 2 study included 10,153 Portuguese adults from the EpiDoC Cohort, a population-based study. In this study, trained research assistants using computer-assisted telephone interview collected socioeconomic, demographic, dietary, lifestyles, and health information from March 2013 to July 2015. Cluster analysis was performed, based on questions regarding the number of meals, weekly frequency of soup consumption, vegetables, fruit, meat, fish, dairy products, and daily water intake. Factors associated with DP were identified through logistic regression models. Results Two DPs were identified: the “meat dietary pattern” and the “fruit & vegetables dietary pattern.” After multivariable adjustment, women (OR = 0.52; p < 0.001), older adults (OR = 0.97; p < 0.001), and individuals with more years of education (OR = 0.96; p = 0.025) were less likely to adopt the “meat dietary pattern,” while individuals in a situation of job insecurity/unemployment (OR = 1.49; p = 0.013), Azores island residents (OR = 1.40; p = 0.026), current smoking (OR = 1.58; p = 0.001), daily alcohol intake (OR = 1.46; p = 0.023), and physically inactive (OR = 1.86; p < 0.001) were positively and significantly associated with “meat dietary pattern.” Moreover, individuals with depression symptoms (OR = 1.50; p = 0.018) and the ones who did lower number of medical appointments in the previous year (OR = 0.98; p = 0.025) were less likely to report this DP. Conclusion Our results suggest that unhealthy DPs (meat DP) are part of a lifestyle behavior that includes physical inactivity, smoking habits, and alcohol consumption. Moreover, depression symptoms are also associated with unhealthy DPs.

Impact of an education intervention on nursing diagnoses in free-text format in electronic health records: A pretest–posttest study in a medical department at a university hospital:

Discussions on how nursing documentation should be carried out have been ongoing for the last decade. In this study, free-text format for nursing diagnoses was introduced to nursing staff at a university hospital in Norway. The aim of the study was to investigate the impact of an education intervention introducing nursing diagnoses in a free-text format following a problem-etiology-symptom structure. A pretest–posttest design was performed to assess changes in quality and quantity in the nursing documentation using the audit instrument N-Catch II. Several elements in the nursing documentation had statistically significant changes; the largest was found for quantity in nursing diagnoses. Education interventions aimed to improve nurses’ documentation in the electronic health record may have an effect on more complete and accurate nursing documentation. The presented education intervention showed a significant impact of more accurate nursing diagnoses and significant improvements in nursing documentation.

What characterizes the work culture at a hospital unit that successfully implements change – a correlation study

BackgroundTo successfully achieve change in healthcare, a balance between technology and “people ware”, the human recourses, is necessary. However, the human aspect of the change implementation process has received less attention than the technological issues. The aim was to explore the factors that characterize the work culture in a hospital unit that successfully implemented change compared with the factors that characterize the work culture of a hospital unit with unsuccessful implementation.MethodThe Systematizing Person-Group Relations method was used for gathering and analyzing data to explore what dominate the behavior in a particular work environment identifying challenges, limitations and opportunities. This method applied six different dimensions, each representing different behavior in a work culture: Synergy, Withdrawal, Opposition, Dependence, Control and Nurture. We compared two different units at the same hospital, one that successfully implemented change and one that was unsuccessful.ResultsThere were significant statistical differences between healthcare personnel working at a unit that successfully implemented change contrasted with the unit with unsuccessful implementation. These significant differences were found in both the synergy and control dimensions, which are important positive qualities in a work culture.ConclusionThe results of this study show that healthcare personnel at a unit with a successful implementation of change have a working environment with many positive qualities. This indicates that a work environment with a high focus on goal achievement and task orientation can handle the challenges of implementing changes.

Sykepleieres erfaringer med innføring av sykepleiediagnoser

Nurses’ experiences with introduction of nursing diagnoses Background: Studies have shown that use of nursing diagnoses can improve quality of documented assessments, quality of described interventions and outcomes, and that they facilitate communication and continuity between practitioners in the health care services. Collaboration between a hospital and a university college was established to study the implementation of nursing diagnoses. Purpose: This study intends to investigate the feasibility of the study and the experiences nurses in clinical practice have after an implementation of nursing diagnoses. Method: A focus group interview with six participants was conducted. The researchers’ experiences upon the intervention feasibility were logged as notes. Results: The participants found the intervention helpful and educational, but also frustrating. Nursing diagnoses seems to be useful in clinical work, but the intervention period may have been too short to achieve changes in the documentation work. Conclusion: There is need for further studies so that nursing documentation can be a good tool to support nurses in their working process.