Inger Jansson

Factors and Conditions That Have an Impact in Relation to the Successful Implementation and Maintenance of Individual Care Plans

BACKGROUND The gap between what is stated in legislation about written individualized nursing care plans (ICP) and how they are used in practice is still too wide. AIM To explore attitudes and experiences among nurses and managers in order to capture which factors and conditions impact on the successful implementation of individual care plans within hospital care, as well as the strategies that were adopted to ensure continued use. METHOD The study was carried out through directed content analysis guided by the Promoting Action on Research Implementation in Health Services framework. Interviews were conducted with 15 informants on different operational and decision levels at a hospital that is well known in Sweden for its work in the ICP area. FINDINGS Important factors for implementation on the wards were clear instructions from the hospital management at the start of implementation as well as clear roles and mandates for those involved. The work of internal facilitators was crucial for the continuation of the process. Clinical experience was important as the long-term driving force. IMPLICATIONS On the basis of the findings of this study, we argue that it is important for hospital managers to recruit leaders that focus on individual nursing care and can highlight needs and instigate change. It seems also important that the organization takes advantage of the potential of skilled facilitators.

Factors and Conditions that Influence the Implementation of Standardized Nursing Care Plans

Rationale and Aim: There is a lack of evidence about how to successfully implement standardized nursing care plans (SNCP) in various settings. The aim of this study was to use the “Promotion Action on Research Implementation in Health Services framework” (PARIHS) to explore important factors and conditions at hospital wards that had implemented SNCPs. Method: We employed a retrospective, cross-sectional design and recruited nurses from four units at a rural hospital and seven units at a university hospital in the western and southern region of Sweden where SNCPs had been implemented. Outcome was measured by means of a questionnaire based on the PARIHS-model. Result: In total, 137 nurses participated in the study. The main factors that had motivated the nurses to implement SNCPs were that they were easy to understand and follow as well as corresponding to organisational norms. The SNCPs were normally based on clinical experience, although research more frequently formed the basis of the SNCPs at the university hospital. Internal facilitators acted as important educators, who provided reminders to use the SNCP and feedback to the SNCP users. The patient experience was not considered valuable. Those who claimed that the implementation was successful were generally more positive in all measurable aspects. The use of SNCPs was rarely evaluated. Conclusions: Clinical experience was considered important by the nurses, while they attributed little value to the patient experiences. Successful implementation of research based SNCPs requires internal facilitators with knowledge of evidence-based nursing.

Obtaining a Foundation for Nursing Care at the Time of Patient Admission: A Grounded Theory Study

The nursing process can be viewed as a problem-solving model, but we do not know whether use of the whole process including care plans with interventions based on nursing diagnoses improves nurses’ ability to carry out assessments. Therefore, the aim of this study was to illuminate and describe the assessment and decision-making process performed by nurses who formulated individual care plans including nursing diagnosis, goals and interventions or who used standardized care plans when a patient was admitted to their ward for care, and those who did not. Data collection and analysis were carried out by means of Grounded theory. Nurses were observed while assessing patients, after which they were interviewed. The main concern of all nurses was to obtain a foundation for nursing care based on four strategies; building pre-understanding, creating a caring environment, collecting information on symptoms and signs and performing an analysis from different perspectives. It appeared that the most important aspect for nurses who did not employ care plans was the medical reason for the patient’s admission. The nurses who employed care plans discussed their decisions in terms of nursing problems, needs and risks. The results indicate that nurses who formulated care plans were more aware of their professional role.

Hannah Arendt’s vita activa: A valuable contribution to occupational science

ABSTRACT Occupational science is undergoing dynamic development and claims have been articulated that human occupation must be understood from multiple ontological standpoints. Hannah Arendt (1906–1975) is known for her work The Human Condition in which she explored human occupation from a philosophical and political standpoint. She distinguished the modalities labor, work and action, and labelled them vita activa. The aim of this paper is to present Arendt and her vita activa, in order to provide examples of its relevance for occupational science, showing how vita activa can assist occupational scientists to take a deeper perspective on human occupation. According to Arendt, human occupation is always conditioned. The condition for labor is necessity, which reflects human biological needs and represents the basics of life. The condition for work is utility, as something persistent and durable is produced. Action is the activity that takes place between people without the intermediary of things. Similar to occupational science, vita activa is concerned with human doing but their origins differ. Arendt also emphasized the public sphere as an arena for human occupation, a viewpoint that is shared with recent occupational science literature. The need to expand the scope of occupational science to encompass all aspects of human occupations, including the deleterious, has been expressed and vita activa can contribute to broadening this perspective. Examples of the need for sustainability in working life are also presented in this paper.

Double documentation in electronic health records

Documentation in the patient record must be systematic and rigorous. However, each health care profession documents parts of the electronic health record (EHR) separately. This system can lead to double documentation. The aim of the study was to describe the amount of double documentation in health records for in-patients. A retrospective descriptive review of 30 records for in-patients diagnosed with hip fracture was conducted. Double documentation occurred on all records reviewed during the stay in hospital and in or between all professions reviewed. In total, 822 instances of double documentation were found. The EHRs available today are not designed to monitor processes. Instead, they follow each health profession, which can lead to double documentation. It would be desirable to develop an EHR from a process perspective and not a record per profession.

Documentation of person-centred health plans for patients with acute coronary syndrome:

Background: Personalised care planning is argued for but there is a need to know more about what the plans actually contain. Aim: To describe the content of person-centred health, plans documented at three healthcare levels for patients with acute coronary syndrome. Design: Patients with acute coronary syndrome aged under 75 years and admitted to two coronary care units at a university hospital were enrolled in the study. This retrospective descriptive study documented 89 person-centred health plans at three healthcare levels: hospital, outpatient and primary care. In total, 267 health plans were reviewed and a quantitative content analysis conducted. The health plans included commonly formulated goals, patients’ own resources and support needed. Results: The health plan goals were divided into three categories: lifestyle changes, illness management and relational activities. The most frequently reported goal for better health was increased physical activity, followed by social life/leisure activities and return to paid professional work. In order to reach the goals, patients identified three ways: own resources, family and social support and healthcare system, in total three categories. The most frequently reported own capability was self-motivation. Spouses and children were important sources of family and social support. The most frequently reported healthcare support was cardiac rehabilitation. Conclusion: In traditional care and treatment plans devised by health professionals, patient goals often comprise behavioural changes. When patients identify their own goals and resources with the help of professionals, they include maintaining social relations and being able to return to important activities such as work.

Problem-Based Self-care Groups Versus Cognitive Behavioural Therapy for Persons on Sick Leave Due to Common Mental Disorders : A Randomised Controlled Study

Purpose To evaluate the interventional capacity of problem based method groups (PBM) regarding mental health and work ability compared to cognitive behavioural therapy (CBT) for persons on sick leave due to common mental disorders. Methods In a randomised controlled design the experimental group received PBM and the control group received CBT. Outcomes were measured by the Hospital Anxiety and Depression Scale (HADS), the Stress and Crisis Inventory 93 (SCI-93) and the Dialogue about Working Ability instrument (DOA). Results Twenty-two participants in the PBM group and 28 in the CBT group completed intervention. Both groups showed significant lower scores on the two HADS subscales. Regarding stress the PBM group showed significant decrease in one (out of three) subscales of SCI-93. The CBT group showed significant decrease on all subscales of SCI-93. Regarding work ability the PBM group showed significant higher scores on one of five subscales of DOA. The CBT group showed significant higher scores on four of five subscales of DOA. Between groups there were significant differences to the favour of CBT on one of two subscales of HADS, all three subscales of SCI-93 and on two of the five subscales of DOA. Conclusion PBM seem to be able to reduce anxiety- and depression symptoms. CBT showed to be superior to PBM in reducing symptoms in all aspects of mental health, except for anxiety, in which they seem equally effective. Regarding work ability CBT showed to be superior, with significant effect on more aspects compared to PBM.

Factors affecting the implementation process of clinical pathways : A mixed method study within the context of Swedish intensive care

RATIONALE, AIMS AND OBJECTIVES Clinical pathways (CPs) can improve quality of care on intensive care units (ICUs), but are infrequently utilized and of varying quality. Knowledge regarding factors that facilitate versus hinder successful implementation of CPs is insufficient and a better understanding of the activities and individuals involved is needed. The aim of this study was to explore the implementation process of CPs within the context of ICUs. METHODS An exploratory design with a sequential mixed method was used. A CP survey, including all Swedish ICUs, was used to collect quantitative data from ICUs using CPs (n = 15) and interviews with key informants (n = 10) were used to collect qualitative data from the same ICUs. Descriptive statistics and qualitative content analysis were used, and the quantitative and qualitative findings were integrated. RESULTS The CP implementation was conceptualized according to two interplaying themes: a process to realize the usefulness of CPs and create new habits; and a necessity of enthusiasm, support and time. Multiple factors affected the process and those factors were organized in six main categories and 14 subcategories. CONCLUSIONS Bottom-up initiatives, interprofessional project groups and small ICUs seem to enhance successful implementation of CPs while inadequate electronic health record systems, insufficient support and time constrains can be barriers. Support regarding the whole implementation process from centralized units at the local hospitals, as well as cooperation between ICUs and national guidance, has the potential to raise the quality of CPs and benefit the progress of CP implementation.

Adulthood transitions in health and welfare; a literature review

The aim of the literature review was to describe how adulthood transition is used in health and welfare.

Hannah Arendt’s thoughts in relation to occupational science : A response to Turnbull

ABSTRACT In his response to our article “Hannah Arendt’s vita activa: A valuable contribution to occupational science,” Turnbull (2018) outlined some tensions he perceived with our discussion of “her approach to philosophy, politics and science”. In our reply, we express appreciation of his interest in Arendt related to occupational science and the contribution his article makes, as well as clarifying some points in his critique. We argue that Turnbull’s main arguments do not address our primary purpose of presenting Arendt’s vita activa and provide examples of its relevance for occupational science. We thus focused on activity-related aspects of Arendt’s thoughts, to raise awareness of this work amongst occupational scientists. However, we are thankful for Turnbull’s reflections, which broaden the insights of Arendt’s thinking and contribute to a better understanding of human occupation.