Ingrid Rystedt

Mapping the use of simulation in prehospital care – a literature review

BackgroundHigh energy trauma is rare and, as a result, training of prehospital care providers often takes place during the real situation, with the patient as the object for the learning process. Such training could instead be carried out in the context of simulation, out of danger for both patients and personnel. The aim of this study was to provide an overview of the development and foci of research on simulation in prehospital care practice.MethodsAn integrative literature review were used. Articles based on quantitative as well as qualitative research methods were included, resulting in a comprehensive overview of existing published research. For published articles to be included in the review, the focus of the article had to be prehospital care providers, in prehospital settings. Furthermore, included articles must target interventions that were carried out in a simulation context.ResultsThe volume of published research is distributed between 1984- 2012 and across the regions North America, Europe, Oceania, Asia and Middle East. The simulation methods used were manikins, films, images or paper, live actors, animals and virtual reality. The staff categories focused upon were paramedics, emergency medical technicians (EMTs), medical doctors (MDs), nurse and fire fighters. The main topics of published research on simulation with prehospital care providers included: Intubation, Trauma care, Cardiac Pulmonary Resuscitation (CPR), Ventilation and Triage.ConclusionSimulation were described as a positive training and education method for prehospital medical staff. It provides opportunities to train assessment, treatment and implementation of procedures and devices under realistic conditions. It is crucial that the staff are familiar with and trained on the identified topics, i.e., intubation, trauma care, CPR, ventilation and triage, which all, to a very large degree, constitute prehospital care. Simulation plays an integral role in this. The current state of prehospital care, which this review reveals, includes inadequate skills of prehospital staff regarding ventilation and CPR, on both children and adults, the lack of skills in paediatric resuscitation and the lack of knowledge in assessing and managing burns victims. These circumstances suggest critical areas for further training and research, at both local and global levels.

Patients’ preferences in palliative care: A systematic mixed studies review

Background: It is necessary to develop palliative care to meet existing and future needs of patients and their families. It is important to include knowledge of patient preferences when developing high-quality palliative care services. Previous reviews have focused on patient preferences with regard to specific components of palliative care. There is a need to review research on patient’s combined preferences for all elements that constitute palliative care. Aim: The aim of this study is to identify preferences for palliative care among patients in the palliative phase of their illness, by synthesizing existing research. Data sources: Studies were retrieved by searching databases – the Cochrane Library, Medline, CINAHL, PsycINFO, Scopus and Sociological Abstracts – from 1946 to 2014, and by hand searching references in the studies included. Design: A systematic mixed studies review was conducted. Two reviewers independently selected studies for inclusion and extracted data according to the eligibility criteria. Data were synthesized using integrative thematic analysis. Results: The 13 qualitative and 10 quantitative studies identified included participants with different illnesses in various settings. Four themes emerged representing patient preferences for care. The theme ‘Living a meaningful life’ illustrated what patients strived for. The opportunity to focus on living required the presence of ‘Responsive healthcare personnel’, a ‘Responsive care environment’ and ‘Responsiveness in the organization of palliative care’. Conclusion: The four themes may be useful for guiding clinical practice and measurements of quality, with the overall goal of meeting future needs and improving quality in palliative care services to suit patients’ preferences.

Patients' perceptions of palliative care quality in hospice inpatient care, hospice day care, palliative units in nursing homes, and home care : a cross-sectional study

BackgroundPatients’ perceptions of care quality within and across settings are important for the further development of palliative care. The aim was to investigate patients’ perceptions of palliative care quality within settings, including perceptions of care received and their subjective importance, and contrast palliative care quality across settings.MethodA cross-sectional study including 191 patients in late palliative phase (73 % response rate) admitted to hospice inpatient care, hospice day care, palliative units in nursing homes, and home care was conducted, using the Quality from the Patients’ Perspective instrument-palliative care (QPP-PC). QPP-PC comprises four dimensions and 12 factors; “medical–technical competence” (MT) (2 factors), “physical–technical conditions” (PT) (one factor), “identity–orientation approach” (ID) (4 factors), “sociocultural atmosphere” (SC) (5 factors), and three single items (S); medical care, personal hygiene and atmosphere. Data were analysed using paired-samples t-test and analysis of covariance while controlling for differences in patient characteristics.ResultsPatients’ perceptions of care received within settings showed high scores for the factors and single items “honesty” (ID) and “atmosphere” (S) in all settings and low scores for “exhaustion” (MT) in three out of four settings. Patients’ perceptions of importance scored high for “medical care” (S), “honesty” (ID), “respect and empathy” (ID) and “atmosphere” (S) in all settings. No aspects of care scored low in all settings. Importance scored higher than perceptions of care received, in particular for receiving information. Patients’ perceptions of care across settings differed, with highest scores in hospice inpatient care for the dimensions; ID, SC, and “medical care” (S), the SC and “atmosphere” (S) for hospice day care, and “medical care” (S) for palliative units in nursing homes. There were no differences in subjective importance across settings.ConclusionStrengths of services related to identity–orientation approach and a pleasant and safe atmosphere. Key areas for improvement related to receiving information. Perceptions of subjective importance did not differ across settings, but perceptions of care received scored higher in more care areas for hospice inpatient care, than in other settings. Further studies are needed to support these findings, to investigate why perceptions of care differ across settings and to highlight what can be learned from settings receiving high scores.

Quality of life and sense of coherence in young people and adults with uncomplicated epilepsy: A longitudinal study.

OBJECTIVES The aim of the study was, in a ten-year follow-up, to describe and explore potential changes in quality of life and sense of coherence in relation to gender differences among persons with epilepsy in the transition from adolescence to adulthood. MATERIALS AND METHODS A longitudinal study of sense of coherence (SOC) and quality of life with repeated measurement design (1999, 2004, and 2009) was conducted in a population of persons (n = 69) who were aged 13-22 years in 1999 and 23-33 years in 2009. The Quality-of-Life Index (QLI) and the Sense of Coherence (SOC) scale were used. RESULTS There was a significant decrease (p ≤ 0.001) in seizures compared with the 2004 results, mainly among the women (p = 0.003). When comparing the total QLI scores, no significant differences were found between the three data collections and there were no differences in total scores between men and women. There was a decrease in the SOC total score over the 10-year period study. Total SOC was significantly higher among those being 30-33 years old compared to those being 23-29 years old (p = 0.014) and among those having a driving license (p = 0.029) compared to those not having a driving license. CONCLUSIONS Both quality of life and sense of coherence are important for maintaining health and well-being. Promoting health and well-being requires effective high-quality multidisciplinary person-centered care.

Implementation of patient-focused care: before-after effects

PURPOSE The purpose of this paper is to evaluate an organizationally oriented, patient-focused care (PFC) models effects on care quality and work climate. DESIGN/METHODOLOGY/APPROACH The study has a before-after (PFC implementation) design. The sample included 1,474 patients and 458 healthcare providers in six participating wards before and after PFC implementation, plus five additional randomly chosen wards, which only featured in the post-assessment. FINDINGS No pre-post differences were found regarding care perceptions or provider work climate evaluations. Statistically significant improvements were noted among provider care evaluations. Using aggregate-level ward data, multiple regression analyses showed that high adherence to PFC principles and a positive work climate contributed significantly to variance among care quality ratings. RESEARCH LIMITATIONS/IMPLICATIONS Among healthcare providers, questions related to specific PFC aspects during evenings, nights and weekends had to be dropped owing to a low response rate. PRACTICAL IMPLICATIONS An important requirement for both practice and research is to tailor PFC to various health and social care contexts. ORIGINALITY/VALUE The study is large-scale before-after PFC model review, where patient and provider data were collected using well-established measurements.

Preventive Strategies and Processes to Counteract Bullying in Health Care Settings: Focus Group Discussions

The aim of the present study was to explore preventive strategies and processes to counteract bullying in workplaces. Data were collected by individual interviews and focus group discussions at one hospital and two nursing home wards for elderly, a total of 29 participants. In the analysis of the interviews we were inspired by constructivist grounded theory. Persistent work with a humanistic value system by supervisor and coworkers, raising awareness about the bullying problem, strong group collaboration, and conflict management, along with an open atmosphere at the workplace, appears to be imperative for accomplishing a policy of zero tolerance for bullying.

Nurses' contributions to health: Perceptions of first-year nursing students in Scandinavia and Indonesia:

Nursing students need an understanding of how nurses care for peoples health from a global perspective. The aim of this study was to explore how nurses can contribute to health from the perspectives of first-year nursing students in Scandinavia (Sweden, Norway) and Indonesia. Data were collected using an open-ended question about nurses’ contribution to health, and analysed using qualitative content analysis. Three common categories emerged: ‘Promoting health and preventing disease’, ‘Performing care and treatment’, ‘Establishing a relationship with patients and being compassionate’. ‘Possessing and implementing knowledge and skills’ was common to Norway and Indonesia. ‘Being a team member’ was emphasised by the Indonesian participants. The Norwegian participants focused on health promotion, whereas those from Indonesia prioritised disease prevention. The Scandinavian participants emphasised individuality, while those from Indonesia focused on the community. The findings indicate that nursing education should take account of different cultures and include student exchange programmes.

Managing bullying in Swedish workplace settings: A concealed and only partially acknowledged problem

AIM The purpose of this article was to explore workplace routines and strategies for preventing and managing bullying in the context of health and elderly care. BACKGROUND Bullying is a serious problem in workplaces with consequences for the individual, the organisation and the quality of care. METHOD Open-ended interviews were conducted with 12 participants, including managers and specialists within one hospital and three municipalities. The interviews were analysed with qualitative content analysis. RESULTS Bullying was often concealed, due to avoidance, unclear definition and lack of direct strategies against bullying. No preventative work focusing on bullying existed. Psychosocial issues were not prioritized at workplace meetings. The supervisor had the formal responsibility to identify, manage and solve the bullying problem. The most common decision to solve the problem was to split the group. CONCLUSIONS The findings showed that bullying was a concealed problem and was first acknowledged when the problem was acute. IMPLICATIONS FOR NURSING MANAGEMENT Crucial strategies to prevent and combat bullying consist of acknowledgement of the problem, transformational leadership, prioritization of psycho-social issues, support of a humanistic value system and work through bullying problems to achieve long-term changes.

A Healthy Person The Perceptions of Indonesian and Scandinavian Nursing Students

The purpose of this exploratory study was to investigate how nursing students in Indonesia and Scandinavia characterize a healthy person. Two hundred thirty-two nursing students from Indonesia, 50 students from Sweden, and 119 students from Norway participated by answering an open-ended question. Qualitative content analysis was used to identify patterns of health in a cultural and national context. The characteristics of a healthy person were summarized in the theme “external and inner balance,” which are intertwined because of the wholeness of self-image and appearance. The subcategories were having a strong and positive body image, feeling well and having inner harmony, following the rules of life, coping with challenges, and acting in unison with the environment. There were more similarities than differences between the Indonesian and Scandinavian nursing students’ understanding of being a healthy person. The difference is that the Scandinavian students mentioned individuality, whereas the Indonesian students referred to collective values.

Implementation of patient-focused care : Before-after effects on work climate and quality of care in the eyes of patients and providers

PURPOSE The purpose of this paper is to evaluate an organizationally oriented, patient-focused care (PFC) models effects on care quality and work climate. DESIGN/METHODOLOGY/APPROACH The study has a before-after (PFC implementation) design. The sample included 1,474 patients and 458 healthcare providers in six participating wards before and after PFC implementation, plus five additional randomly chosen wards, which only featured in the post-assessment. FINDINGS No pre-post differences were found regarding care perceptions or provider work climate evaluations. Statistically significant improvements were noted among provider care evaluations. Using aggregate-level ward data, multiple regression analyses showed that high adherence to PFC principles and a positive work climate contributed significantly to variance among care quality ratings. RESEARCH LIMITATIONS/IMPLICATIONS Among healthcare providers, questions related to specific PFC aspects during evenings, nights and weekends had to be dropped owing to a low response rate. PRACTICAL IMPLICATIONS An important requirement for both practice and research is to tailor PFC to various health and social care contexts. ORIGINALITY/VALUE The study is large-scale before-after PFC model review, where patient and provider data were collected using well-established measurements.