Patient Safety Culture Change over Time-Health Care Staffs’Perceptions

Rationale and Aim: Patient safety is of great interest in health care organisations, worldwide. In Sweden, a national patient safety initiative was launched in 2011. The aim of this study was to examine and compare patient safety culture change over time from health care staffs’ perspective. A further aim was to examine factors that have had an effect on patient safety culture. Methods: Patient safety culture was assessed in 2009, 2011 and 2013 using the Swedish version of the Hospital Survey of Patient Safety Culture. Respondents in this study were registered nurses (n = 2149), enrolled nurses (n = 959), physicians (n = 355) and managers (n = 159) working in three health care divisions in a Swedish county council. Results: Patient safety culture decreased significantly over time for all but two dimensions. The dimension “Information to Patients/Relatives” was the only dimension to increase significantly over time. Health care staffs’ profession and health care division belonging had significant main effects on 14 and 8 dimensions, respectively. Managers and enrolled nurses scored patient safety culture significantly higher than registered nurses and physicians. Health care staff working in a mixed medical-surgical health care division scored significantly higher than those working in medical or surgical divisions did. Conclusions: Despite efforts for patient safety work in the county council, health care staffs’ perceptions of patient safety culture decreased over time. To improve hospital patient safety culture, managers and staff groups must meet and communicate with each other in order to create a common view of patient safety.

Psychometric evaluation of a Swedish version of Krantz Health Opinion Survey

The purpose of this study was to evaluate the psychometric properties of a Swedish version of The Krantz Health Opinion Survey (KHOS). A convenience sample of 79 persons (47 men and 32 women) was recruited from The Heart and Lung Patients’ National Association at ten local meeting places in different areas in Sweden. The questionnaire was examined for face and content validity, internal consistency and test-retest reliability. The findings showed that the Swedish version of KHOS is acceptable in terms of face and content validity, internal consistency and test-retest reliability over time among 79 individuals >65 years of age and with a cardiac disease. In conclusion, wider evaluations of the psychometric use of KHOS for other populations and settings are recommended.

Validation and adaptation of the Physical Activity Enjoyment Scale (PACES) in fitness group exercisers

Background:Recently,Mullen et al.(2011)presented an 8-item version of the Physical Activity Enjoyment Scale(PACES)that provides a valid instrument for assessing enjoyment in physical activity.The present paper investigated the psychometric properties of a Portuguese adaptation of PACES.Methods:After a process of back-to-back translation into Portuguese,395 members of fitness centers who ranged in age from 18 to 66 years(31.11§8.90,mean§SD)completed the translated version of the PACES.On average,participants had 3.2 years of experience in fitness group classes and practiced for approximately 3.3 times per week.Results:An initial exploratory factor analysis(n=139)revealed a unidimensional structure with factor loadings ranging from 0.79 to 0.89.Results also showed acceptable internal consistency.A confirmatory factor analysis in an independent sample(n=256)provided additional support for the unidimensional structure of the questionnaire.In addition,moderate positive correlations between enjoyment and intrinsic and identified regulation,and moderate negative correlations between enjoyment and external and amotivation,demonstrate the convergent validity of the instrument.Finally,measurement invariance between 2 independent samples was also found.Conclusion:The 8-item Portuguese version of PACES is a valid and reliable instrument for measuring enjoyment of physical activity in Portuguese adult fitness exercisers,and it is therefore suitable to use as a measure of affect in exercise adherence interventions studies.

Heart failure with preserved ejection fraction

Progressive aging of the population and prolonga tion of life expect ancy have led to the ris ng prevalence of heart failure (HF)。Despitethe improvements in medical therapy，the mortality rate of this condition has remained unaccept ably high，becoming t heprimary cause ofdeath in the elderly popul at ion。Almost half of patient swith signs and symptoms of HF are f ound to have a nearly normal ejection fraction，which delineates a distinctclinical syndrome 。known as HF with preserved ejection fraction(HF-PEF) 。While early research focused on the importance of diastolicdys function，more recent studies reported the pathophysological compl exity of the disease with multiple cardiovas 。cular abnormalities contributing to its development and progression。HF-PEF is a challenging maj or health problem with yet no solution as there is no evidence。Based treatment which improves clinical out comes。This review summarizes the state of current knowledge on diagnosis，prognosis and treatment of HF。PEF，with particul ar insights on the pathological characteristics in the elderly population。

The prevalence of depression amongst outpatients with multimorbidity

Objectives: Depression may be under-diagnosed and under-treated amongst older adults with multiple chronic illnesses. The current study explores the prevalence of depression diagnosis and Geriatric Depression Scale (GDS) symptoms amongst older multimorbid outpatients, and agreement between GDS scores and doctor-diagnosed depression. Method: Deidentified data from the files of 452 patients aged over 64, with chronic conditions present in two or more organ domains, were extracted from the clinical database of a tertiary referral hospital multidisciplinary outpatient clinic in South Australia between 2005 and 2011. Frequency calculations determined the prevalence of depression diagnosis and GDS categories. Logistic regression, cross-tabulation, kappa and ROC graphs explored relationships between variables. Results: A depression diagnosis had been recorded for 71 (15.7%) patients. Using the recommended cut-off scores for the GDS, 225 (49.8%) patients met criteria for mild-severe depressive symptoms, and 96 (21.3%) met criteria for moderate-severe symptoms. Poor agreement was found between doctor diagnosis of depression and a positive screen for depression using a GDS cut-off score of either 5, k = 0.112 (p = 0.001), or 9, k = 0.189 (p < 0.001), although logistic regression found an association between severity of depression and depression diagnosis, OR = 1.15, p < 0.001 (CI = 1.08 - 1.22). Con-clusion: A much higher proportion of patients with multimorbidities reported threshold level depression symptoms than had a recorded diagnosis of depression, suggesting that although likelihood of diagnosis increases with symptom severity, depression often goes undetected in this population. Depressions’ negative impact on prognosis calls for further investigation of the barriers to screening and diagnosis of depression in multimorbid patients.

Medicine and Literature. An Example of Literary Creativity in the Medical Field: A Psychological Investigation about <i>The Typhus</i>by A. &Ccaron;hekhov

An increasing proportion of health professionals and scholars of the humanities is interesting to the Narrative Based Medicine. The terms used indicate a mode of coping with the disease aims to understand its meaning in an overall, systematic, broader and more respectful of the patient. The Narrative Based Medicine fortifies clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and become aware of the stories of the disease. Health professionals can acquire these skills through courses of medical humanities that include the use of different types of narrative text. Narrative medicine uses also literary texts in order to improve narrative and empathic ability of clinicians. This perspective also allows considering the Chekhovian literary work within a holistic vision linking scientific background and literary creativity. The material used for this study is the tale The Typhus by A. &Ccaron;hekhov adapted from Novels and Theater. The text analysis is conducted with the logical and conceptual tools derived from the Psychology of Art and Creativity and in the perspective of narrative based medicine. In the story we are examining the Russian writer, who never gave up being a medical officer throughout his life, manages to make a perfect synthesis between the scientific background and his literary creativity, combining a careful clinical description of the symptoms of the typhus with evocative depictions of the characters and the environment he captured with brushstrokes capable of creating a picture having a purely artistic value and meaning. Narrative based medicine, which also makes use of narrative about the disease written by physicians or patients or even by medical patients, is a good opportunity for the medicine to go beyond the technocratic vision of the scientific evidence and draw closer to the wholeness of the experience of individual patients.

Serenity—Uses in the Care of Chronically Ill Older Patients: A Concept Clarification

Serenity is an emotional experience that contributes to the acceptance of a situation. One phenomenon in the care of chronically ill older patients and patients in end of life care is that too much focus is placed on the patient’s disease. This can contribute to anxiety, sadness or sense of isolation. For older people that are chronically ill or in care at the end of life, it is important that the registered nurse can help them to find serenity. Further knowledge is needed about how the concept of serenity is used in relation to the care of older chronically ill patients. Aim: The purpose of this concept analysis was to clarify how serenity is used in nursing and in relation to the care of chronically ill older patients. Method: The study follows Rodgers’ evolutionary method of concept analysis. Findings: Serenity is a state of physical, mental, emotional and spiritual balance when life conditions can be managed or accepted. Through the experience of serenity the chronically ill older patient is able to find or develop the self in order to continue with dignity. The concept is most used at the lowest described levels of the self, including a perception of personal safety. The highest level involves a sense of wholeness and awareness. Conclusion: The concept of serenity is used in relation to chronically ill older patients as a condition where the patient finds balance and thus can manage or accept their situation. Chronically ill older patients will not recover. For that reason it needed a better understanding about what factors to experience serenity are needed. Further research is also needed to examine how registered nurses can support older chronically patients in finding serenity with the help of nursing interventions.

Intoxicated Eyewitnesses: The Effects of Alcohol on Eyewitness Recall across Repeated Interviews

The study evaluated the usefulness of repeat-interviewing of witnesses to crimes who were intoxicated by alcohol at the time of the incident and their first interview, and then re-interviewed when not intoxicated the following day. Sixty young, social drinkers were divided into three groups. One group was given a “placebo” (alcohol-like) beverage, a second was given a “low dose” of alcohol (0.2 g/kg men;0.17 g/kg women), and a third was given a “high dose” of alcohol (0.6 g/kg men;0.52 g/kg women) over a 15 minute period. Twenty minutes later they viewed a 4-minute video of a crime, and afterwards they were given two opportunities to recall everything that they could remember from the incident;the first opportunity was immediately after the event, and the second was 24 hours later. Analyses of the quantity and accuracy of the details recalled revealed no overall increase in the total amount of information recalled between the first and second recall opportunities. However, on average, 18% of the details recalled by participants in the second test were new and accurate. The incidence of contradictions between the first and second recall opportunities was less than 1%. Surprisingly, none of the effects were influenced by alcohol, even at the highest dose. The results imply that 1) memory for at least some incidents observed under the influence of alcohol is resilient even up to relatively high blood-alcohol levels;and 2) the repeated interviewing of witnesses who were intoxicated at the time of the crime can reveal additional, reliable information that is not present at the initial interview, just as is the case for non-intoxicated witnesses.

The demands of the extra-time period of soccer:A systematic review

Background:Soccer match-play is typically contested over 90 min;however,in some cup and tournament scenarios,when matches are tied,they proceed to an additional 30 min,which is termed "extra-time^(ET).This systematic review sought to appraise the literature available on 120-min of soccer-specific exercise,with a view to identifying practical recommendations and future research opportunities.Methods:The review was conducted according to the PRISMA guidelines.Independent researchers performed a systematic search of PubMed,CINAHL,and PsycINFO in May 2019,with the following keywords entered in various combinations:"soccer","football","extra-time","extra time","extratime","120 minutes","120 min","additional 30 minutes",and "additional 30 min".Results:The search yielded an initial 73 articles.Following the screening process,11 articles were accepted for analyses.Articles were subsequently organized into the following 5 categories:movement demands of ET,performance responses to ET,physiological and neuromuscular response during ET,nutritional interventions,and recovery and ET.The results highlighted that during competitive match-play,players cover5%-12% less distance relative to match duration(i.e.,meters per minute) during ET compared to the preceding 90 min.Reductions in technical performance(i.e.,shot speed,number of passes and dribbles) were also observed during ET.Additionally,carbohydrate provision may attenuate and improve dribbling performance during ET.Moreover,objective and subjective measures of recovery may be further compromised following ET when compared to 90 min.Conclusion:Additional investigations are warranted to further substantiate these findings and identify interventions to improve performance during ET.

Creativity and Madness:Some Psychological Considerations onČechov’s The Black Monk and Ward no.6 and Ludwig II of Bavaria

The aim of this research is to identify the relationship between the concept of creativity and psychopathology.The characters depicted in the short stories by the Russian writer AntonČechov,Ward no.6 and The Black Monk,and the historical figure of King Ludwig II of Bavaria will be given particular consideration.This paper aims to show how inČechov’s characters Efymič,Dmitričand Kovrin,the concept of madness plays a negative function,as the protagonists of the abovenamed tales are unable to be creative.Their psychic discomfort leads to pathology by means of hallucinosis and events that,although they induce and promote a function of mental equilibrium in the individual,they do not lead to creativity.The latter constitutes a peculiar,fundamental and present aspect of Ludwig in the poetic,literary and artistic spheres,which specifically led to the realisation of his castles in Bavaria,products of his particular creativity and today admired by visitors from all over the world.

Use of a National Clinical Final Examination in a Bachelor’s Programme in Nursing to Assess Clinical Competence—Students’, Lecturers’ and Nurses’ Perceptions

Objective: The objective of this study was to evaluate the perceptions of students, lecturers, nurses and clinical lecturers regarding the ability of the National Clinical Final Examination (NCFE) to assess clinical competence, and whether the assessment was consistent with the qualifications for a Bachelor of Science in Nursing as outlined by the Swedish Higher Education Authority. The NCFE is divided into two parts (written and bedside) and aims to evaluate third-year nursing students’ clinical competence. Methods: Data were collected at 10 universities using study-specific questionnaires. The total response rate was 84% (n = 1652). Results: The clinical lecturers indicated that there was a need for improvement in the written part of the examination in order to adequately assess clinical competence. Regarding the bedside part the clinical lecturers, nurses and students perceived that the bedside part of the examination assessed whether the student had the clinical competence required by a newly registered nurse. Conclusion: The two-part examination described in this study was perceived as useful for assessing clinical competence and for the qualification requirements for a Bachelor of Science in Nursing as outlined by the Swedish Higher Education Authority. However, especially the written part requires further development. The model and form of assessment ought to be applicable to graduate nursing programme internationally.

Factors influencing female patients’ recovery after their first myocardial infarction as experienced by cardiac rehabilitation nurses

Background: In the developed part of the world, coronary heart disease is the major cause of death and is one of the leading causes of disease burden. In Sweden, more than 30,000 people per year are affected by myocardial infarction and out of these approximately 40% are women. Nearly 70% of the women survive and after a myocardial infarction a recovery process follows. Today’s health care focuses more on treatment, symptoms and risk factors than on the individuals’ perceptions of the recovery process. Aim: To explore cardiac rehabilitation nurses’ experiences of factors influencing female patients’ recovery after their first myocardial infarction. Methods: Twenty cardiac rehabilitation nurses were interviewed. The study was conducted using qualitative content analysis. Results: The cardiac rehabilitation nurses experienced that women’s recovery after a first myocardial infarction was influenced whether they had a supportive context, their ability to cope with the stresses of life, if they wanted to be involved in their own personal care and how they related to themselves. Conclusions: Women’s recovery after a myocardial infarction was influenced by factors related to surroundings as well as own individual factors. The underlying meaning of women’s recovery can be described as the transition process of a recovery to health. Our findings suggest that a focus on person-centered nursing would be beneficial in order to promote the every woman’s personal and unique recovery after a myocardial infarction. Finally, the cardiac rehabilitation nurses’ experiences of factors influencing male patients’ recovery after their first myocardial infarction should be important to investigate.

Implementation of evidence-based practice by standardized care plans: A study protocol

Background: Patient records should both transfer and create knowledge about patients and their health care. A standardized care plan could be a way to implement evidence-based care directly in practice and improve the documentation in patient records. The aim of this study is to investigate and compare the development and implementation process of a standardized care plan in hospital and primary health care. A further aim is to evaluate the effects on the quality of documentation and the care given in two contexts. Methods and Analysis: Realistic evaluation will be used as a framework to investigate the implementation process. According to this framework, possible contexts, mechanisms, and outcomes in the study will be considered. The study will be performed in two contexts: an orthopedic clinic and primary health care centers. In both contexts, the two key mechanisms will be the same: the implementation process will be driven by internal facilitators (practitioners at the units) and the process will be guided by the Rules and Regulations for interoperability in the Health and Social Care specification, “National information structure for standardized care plans”. Two outcomes of the study will be studied: to investigate the development and implementation process by an evaluation of fidelity and to evaluate how a standardized care plan affects the quality of documentation and the use of evidence-based care. Discussion: Implementation of the SCP will probably meet the same resistance as implementation of guidelines. Documentation of care is an important but resource-consuming requirement in health care, a more standardized method of documenting is requested by health professionals. This project can provide insight into the complex process of developing and implement an SCP in different contexts, which will be useful in further implementation processes.

Effects of a shift from a mixed diet to a lacto-vegetarian diet on some coronary heart disease risk markers

Background: There is convincing evidence that vegetarians have lower incidence of coronary heart disease, but there is a debate as to why this is the case. Objective: The aim of the study was to investigate whether a shift from a mixed diet to a lacto-vegetarian diet would lead to a decrease in risk for coronary heart diseases indicated by surrogate markers. Design: Twenty volunteers participated in the study (4 men and 16 women, mean age 44 years, range 27 - 61) from a town in western Sweden. Clinical examinations were performed, blood samples were drawn and dietary survey, i.e. repeated 24-h recalls were carried out before (0 months) and 3, 6 and 12 months after the change from a mixed diet to a lacto-vegetarian diet. A dietician educated the volunteers with regard to the vegetarian dietary regimen, organized and taught the vegetarian cooking courses. Results: The dietary shift lead to an increase in the intake of total carbohydrates and fibre and a decrease in fat, protein and sucrose. The coronary heart disease risk markers body weight, body mass index, systolic and diastolic blood pressure, total cholesterol and low-density lipoptrotein cholesterol decreased significantly. Conclusions: There was a decrease in disease risk markers even though the ratio polyunsaturated to saturated fatty acids was unchanged. The main finding in this study is that there was a weight loss, sustained for one year, without any recommendation to decrease the energy intake or any focus on weight reduction.

Referrals to Emergency Departments—— The Processes and Factors That Influence Decision-Making among Community Nurses

The aim of the study was to describe the basis on which municipal care registered nurses (RN) make decisions and their experiences when referring older persons from nursing homes to emergency departments (EDs). RNs in the community are to ensure that older adults receive good care quality in nursing home. This study used a descriptive design with a qualitative content analysis. The analysis of the data from the 13 interviews revealed one theme “Shared responsibilities in the best interests of the older person reduce feelings of insufficiency”. The content was formulated, which revealed the RNs’ feelings, reasoning and factors influencing them and their actions in the decision-making situation, before the patients were referred to an emergency department. Complex illnesses, non-adapted organizations, considerations about what was good and right in order to meet the older person’s needs, taking account of her/his life-world, health, well-being and best interests were reported. Co-worker competencies and open dialogues in the “inner circle” were crucial for the nurses’ confidence in the decision. Hesitation to refer was associated with previous negative reactions from ED professionals. The RN sometimes express that they lacked medical knowledge and were uncertain how to judge the acute illness or changes. Access to the “outer circle”, i.e. physicians and hospital colleagues, was necessary to counteract feelings of insecurity about referrals. When difficult decisions have to be made, not only medical facts but also relationships are of importance. To strengthen the RNs’ and staff members’ competence by means of education seems to be important for avoiding unnecessary referrals. Guidelines and work routine need to be more transparent and referrals due to the lack of resources are not only wasteful but can worsen the older persons’ health.

Behavioral involvement and preference for information among male and females with cardiac disease

The aim of this pilot study was to explore and compare preferences for involvement and preferences for information among men and women who had suffered from cardiac disease. A convenience sample of 79 respondents (47 men and 32 women) was recruited from The National Association of Heart and Lung Patients in Sweden at ten local meeting places in different areas. Krantz Health Opinion Survey, KHOS, a 16-item self-rating questionnaire, was used to measure patients’ desire for involvement in healthcare. The results indicate that patients’ information preferences and behavioural preferences are not very high though the total score in KHOS was 5.47. A difference between the genders was also found, seen as higher scores in females than males;5.93 vs 4.44, p = 0.032, indicating that women prefer a more active role in decision making than men do. The main practical conclusion drawn from this empirical study is that patients are still not as active in seeking information or in behavioural involvement as is desirable.