Despite a growing awareness of the importance of interprofessional teamwork in relation to patient safety, many hospital units lack effective teamwork. The aim of this study was to explore if an interprofessional teamwork intervention in a surgical ward changed the healthcare personnel's perceptions of patient safety culture, perceptions of teamwork, and attitudes toward teamwork over 12 months. Healthcare personnel from surgical wards at two hospitals participated in a controlled quasi-experimental study. The intervention consisted of six hours of TeamSTEPPS team training and 12 months for the implementation of teamwork tools and strategies. The data collection was conducted among the healthcare personnel in the intervention group and the control group at baseline and at the end of the 12 month study period. The results within the intervention group showed that there were significantly improved scores in three of 12 patient safety culture dimensions and in three of five perceptions of teamwork dimensions after 12 months. When comparing between groups, significant differences were found in three patient safety culture measures in favor of the intervention group. The results of the study suggest that the teamwork intervention had a positive impact on patient safety culture and teamwork in the surgical ward.

Background: Patient safety in hospitals is being jeopardized, since too many patients experience adverse events. Most of these adverse events arise from human factors, such as inefficient teamwork and communication failures, and the incidence of adverse events is greatest in the surgical area. Previous research has shown the effect of team training on patient safety culture and on different areas of teamwork. Limited research has investigated teamwork in surgical wards. The aim of this study was to evaluate the professional and organizational outcomes of a team training intervention among healthcare professionals in a surgical ward after 6 and 12 months. Systems Engineering Initiative for Patient Safety 2.0 was used as a conceptual framework for the study. Methods: This study had a pre-post design with measurements at baseline and after 6 and 12 months of intervention. The intervention was conducted in a urology and gastrointestinal surgery ward in Norway, and the study site was selected based on convenience and the leaders' willingness to participate in the project. Survey data from healthcare professionals were used to evaluate the intervention. The organizational outcomes were measured by the unit-based sections of the Hospital Survey of Patient Safety Culture Questionnaire, and professional outcomes were measured by the TeamSTEPPS Teamwork Perceptions Questionnaire and the Collaboration and Satisfaction about Care Decisions in Teams Questionnaire. A paired t-test, a Wilcoxon signed-rank test, a generalized linear mixed model and linear regression analysis were used to analyze the data. Results: After 6 months, improvements were found in organizational outcomes in two patient safety dimensions. After 12 months, improvements were found in both organizational and professional outcomes, and these improvements occurred in three patient safety culture dimensions and in three teamwork dimensions. Furthermore, the results showed that one of the significant improved teamwork dimensions "Mutual Support" was associated with the Patient Safety Grade, after 12 months of intervention. Conclusion: These results demonstrate that the team training program had effect after 12 months of intervention. Future studies with larger sample sizes and stronger study designs are necessary to examine the causal effect of a team training intervention in this context.

Aim To translate "The Collaboration and Satisfaction About Care Decisions in Team" questionnaire (CSACD-T) into Norwegian and test it for psychometric properties. The further aim was to describe and compare healthcare personnel's collaboration and satisfaction about team decision-making (TDM) across hospital units. Design A cross-sectional study. Methods The questionnaire was translated into Norwegian. A total of 247 healthcare personnel at two hospitals responded to the questionnaire. An explorative factor analysis was performed to test the factor structure of the questionnaire, while a Cronbach's alpha analysis was used to test for internal consistency. A one-way ANOVA analysis and a Kruskal-Wallis test were applied to test for differences between hospital units. Results The results demonstrate that the Norwegian version of the CSACD-T has promising psychometric properties regarding construct validity and internal consistency. The mean score of the CSACD-T was significantly higher in the maternity ward group than in the emergency room group.

Introduktion: Inom de närmsta åren kommer fler personer att behöva hemsjukvård i Sverige och den blir alltmer avancerad. Detta ställer höga krav på all vårdpersonal. Distriktssköterskan som ansvarar för patientens sjukvård i hemmet delegerar mer än hälften av sjukvårdsuppgifterna till omvårdnadspersonal. För att detta ska fungera, inte minst patientsäkert, behöver hen ha ett fungerande ledarskap. Syfte: Att beskriva distriktssköterskans erfarenheter av att leda omvårdnadspersonal i hemsjukvård. Metod: Litteraturstudien utfördes på ett systematiskt sätt med stöd av Polit och Beck´s nyckelsteg och hade en induktiv design. Totalt framkom tolv artiklar som söktes fram i databaserna CINAHL, PsycInfo och PubMed. Data analyserades genom en tematisk analys efter Braun och Clarke´s beskrivning. Resultat: Huvudtemat Personrelaterade faktorer byggdes upp av följande underteman: Förtroendefull relation, Samarbete, Kommunikation samt Stress och oro. Huvudtemat Organisationsrelaterade faktorer byggdes upp av följande underteman: Fördela omvårdnadsuppgifter, Utbildning och kompetens samt Arbetsmiljö. Konklusion: Känna tillit och ha en förtroendefull relation till omvårdnadspersonalen underlättade ledarskapet för distriktssköterskan liksom ett fungerande samarbete dem emellan. Det behövs utbildad omvårdnadspersonal samt mer tid avsatt för distriktssköterskan till att träffa omvårdnadspersonalen, detta skulle underlätta ledarskapet.

Introduction: This study investigates the individual and combined impacts ofloneliness and social isolation on 20-year mortality risks among older men andwomen.Methods: Utilizing data from the Norwegian Life Course, Ageing, and Generationstudy (NorLAG) carried out in 2002, 2007 and 2017, we assessed loneliness viadirect and indirect questions, and social isolation through factors like partnershipstatus and contact frequency with family and friends. Yearly information onmortality was derived from the national registries and was available untilNovember 2022. Gender-stratified Cox regression models adjusted for age andother risk factors were employed.Results: Of the 11,028 unique respondents, 9,952 participants were includedin the study sample, 1,008 (19.8%) women and 1,295 (26.6%) men died. In thefully adjusted models including indirectly assessed loneliness, social isolationincreased the 20-year mortality risk by 16% (HR  =  1.16, 95% CI 1.09–1.24)for women and 15% (HR  =  1.15, 95% CI 1.09–1.21) for men. This effect wasprimarily driven by the absence of a partner and little contact with children forboth genders. Loneliness measured with indirect questions lost its significantassociation with mortality after adjusting for social isolation and other factorsin both genders. However, for men, reporting loneliness via a direct questionwas associated with a higher mortality risk, even in the fully controlled models(HR  =  1.20, 96% CI 1.06–1.36). Interactions between loneliness and socialisolation were not, or only borderline significantly, associated with mortalityrisks in the fully controlled models.Discussion: Social isolation, but not loneliness measured with indirect questionsare associated with a 15–16% higher mortality risk in both men and women.However, loneliness assessed with a direct question is associated with increasedmortality in men, even after controlling for social isolation and other relevantfactors, which might suggest that men may deny loneliness, unless it is (very)severe. These findings emphasize the importance of methodological precisionin the measurement of loneliness and social isolation.

In response to the “Leave No One Behind” principle (the central promise of the 2030 Agenda for Sustainable Development), reliable estimate of the total number of citizens living in slums is urgently needed but not available for some of the most vulnerable communities. Not having a reliable estimate of the number of poor urban dwellers limits evidence-based decision-making for proper resource allocation in the fight against urban inequalities. From a geographical perspective, urban population distribution maps in many low- and middle-income cities are most often derived from outdated or unreliable census data disaggregated by coarse administrative units. Moreover, slum populations are presented as aggregated within bigger administrative areas, leading to a large diffuse in the estimates. Existing global and open population databases provide homogeneously disaggregated information (i.e. in a spatial grid), but they mostly rely on census data to generate their estimates, so they do not provide additional information on the slum population. While a few studies have focused on bottom-up geospatial models for slum population mapping using survey data, geospatial covariates, and earth observation imagery, there is still a significant gap in methodological approaches for producing precise estimates within slums. To address this issue, we designed a pilot experiment to explore new avenues. We conducted this study in the slums of Nairobi, where we collected in situ data together with slum dwellers using a novel data collection protocol. Our results show that the combination of satellite imagery with in situ data collected by citizen science paves the way for generalisable, gridded estimates of slum populations. Furthermore, we find that the urban physiognomy of slums and population distribution patterns are related, which allows for highlighting the diversity of such patterns using earth observation within and between slums of the same city. 

Introduktion: En akutmottagning är avsedd för personer med akut sjukdom eller skada. Arbetet på en akutmottagning kan vara stressigt, ständigt omväxlande och oförutsägbart. Sjuksköterskans huvudansvar är omvårdnaden och förväntas göra snabba bedömningar samt ge adekvat vård. Arbetsrelaterad stress uppstår när kraven blir för höga jämfört med sjuksköterskans kompetens och förmåga. Långvarig arbetsrelaterad stress under en lång tid kan leda till problem med hälsan. Syfte: Syftet var att belysa vad som orsakar arbetsrelaterad stress hos sjuksköterskor på en akutmottagning. Metod: Litteraturstudien utfördes enligt Polit och Becks (2017) flödesschema i nio steg. Databassökningar i CINAHL, PsycINFO och PubMed utfördes där 12 artiklar var relevanta för litteraturstudiens syfte samt inklusion- och exklusionskriterierna. Sju var kvantitativa, fyra var kvalitativa och en mixad metod. Samtliga artiklar granskades med hjälp av granskningsmallar. Två huvudkategorier samt underkategorier identifierades under databearbetningen. Resultat: Orsakerna till arbetsrelaterad stress som belysts i den här litteraturstudien har presenterats i två huvudkategorier: Hög arbetsbelastning och påfrestande situationer samt underkategorier till hög arbetsbelastning: organisatoriska brister och tidsbrist. Slutsats: Sjuksköterskor på en akutmottagning träffar på en rad olika orsaker till arbetsrelaterad stress oavsett vilken akutmottagning. Överbeläggning och stort antal patienter bidrog till arbetsrelaterad stress hos sjuksköterskor. Resursen sjuksköterskor räcker inte till på akutmottagningen och orsakar en tidsbrist. Otillräckligt omhändertagande inom primärvården orsakar överbelastning på akutmottagningen.

Introduktion/Bakgrund: Sjuksköterskor möter patienter som talar olika språk i sitt dagliga arbete.  Kommunikationen är en viktig del i sjuksköterskors arbete och är avgörande för att kunna skapa förståelse mellan sjuksköterskor och patienter. Tolk är det vanligaste hjälpmedlet att använda vid språkbarriärer. Språkbarriärer är en hindrande kommunikationssvårighet. World Health Organisation rapporterar att kommunikationssvårigheter är en bidragande orsak till att vårdskador kan uppstå i vården. Syfte: Syftet är att belysa sjuksköterskors erfarenheter av tolkanvändning vid språkbarriärer inom slutenvården. Metod: Studien har genomförts genom att tillämpa Polit och Becks (2017) nio steg med ett induktivt förhållningssätt. Sökningarna efter litteratur har skett systematiskt i databaserna Cinahl och PubMed. Sökningarna genererade tio kvalitativa artiklar. Artiklarna kvalitetsgranskades genom SBU:s granskningsmall för kvalitativa studier.  Resultat: Litteraturstudiens resultat genererade fyra teman: tidskrävande, oro och osäkerhet, begränsningar i kommunikationen och ett stöd i omvårdnadsarbetet. Slutsats: Sjuksköterskor erfar att tolken är det effektivaste hjälpmedlet vid språkbarriärer, dock är tolkanvändning inte problemfri. Tolkningstjänsterna har begränsningar och är tidskrävande, vilket skapar oro och osäkerhet hos sjuksköterskor.

Den prehospitala akutsjukvården är ett komplext kunskapsfält som innebär att vårdaren skall kunna bemöta patient och närstående, bedöma skada, sjukdom och den aktuella situationen samt avgöra vilka vårdåtgärder som skall prioriteras.

Patientens lidande kan lindras genom att vårdaren tränar färdigheter i ett prehospitalt kontext. Detta främjar en god och säker vård samt stärker patientens möjligheter till överlevnad.

Resultatet visar på behovet av simulering inom prehospital akutsjukvård. Med simulering lär sig vårdaren att hantera realistiska, dynamiska och komplexa vårdsituationer, vilket skapar kunskaper, färdigheter och erfarenheter av omhändertagande av patient drabbad av högenergitrauma. Simuleringens utformning och miljö skapar förutsättningar för lärandet vilket framkommer i interventionsstudien.

Utifrån resultatet i föreliggande forskning utvecklas en modell för lärande med hjälp av simulering.

Purpose The purpose was to investigate what effect an intervention of low-dose, high-frequency cardiopulmonary resuscitation (CPR) training with feedback for one month would have on professionals' subjective self-assessment skill of CPR. Design/methodology/approach This study had a quantitative approach. In total, 38 firefighters performed CPR for two minutes on a Resusci Anne QCPR. They then self-assessed their CPR through four multiple-choice questions regarding compression rate, depth, recoil and ventilation volume. After one month of low-dose, high-frequency training with visual feedback, the firefighters once more performed CPR and self-assessed their CPR. Findings With one month of low-dose, high-frequency training with visual feedback, the level of self-assessment was 87% (n = 33) correct self-assessment of compression rate, 95% (n = 36) correct self-assessment of compression depth, 68% (n = 26) correct self-assessment of recoil and 87% (n = 33) correct self-assessment of ventilations volume. The result shows a reduced number of firefighters who overestimate their ability to perform CPR. Originality/value With low-dose, high-frequency CPR training with visual feedback for a month, the firefighters develop a good ability to self-assess their CPR to be performed within the guidelines. By improving their ability to self-assess their CPR quality, firefighters can self-regulate their compression and ventilation quality.

Purpose: The purpose of this paper is to investigate the effects of the intervention of low-dose, high-frequency cardiopulmonary resuscitation (CPR) training with feedback for firefighters for one month. Design/methodology/approach: The study had a quantitative approach. Data were collected through an intervention by means of simulation. The data collection consisted of a pre- and post-assessment of 38 firefighter’s CPR performance. Findings: There was a statistically significant improvement from pre- to post-assessment regarding participants’ compression rates. Compression depth increased statistically significantly to average 2 mm too deep in the group. Recoil decreased in the group with an average of 1 mm for the better. There was a statistically significant improvement in participants’ ventilation volume from pre- to post-assessment. Originality/value: Prehospital staff such as firefighters, police, and ambulance perform CPR under less than optimal circumstances. It is therefore of the utmost importance that these professionals are trained in the best possible way. The result of this study shows that low-dose, high-frequency CPR training with an average of six training sessions per month improves ventilation volume, compression depth, rate, and recoil. This study concludes that objective feedback during training enhances the firefighters’ CPR skills which in turn also could be applied to police and ambulance CPR training.

Introduction: Simulation creates the possibility to experience acute situations during nursing education which cannot easily be achieved in clinical settings. Aim: To describe how nursing students learn acute care of patients through simulation exercises, based on observation and debriefing. Design: The study was designed as an observational study inspired by an ethnographic approach.MethodData was collected through observations and interviews. Data was analyzed using an interpretive qualitative content analysis.Results: Nursing students created space for reflection when needed. There was a positive learning situation when suitable patient scenarios were presented. Observations and discussions with peers gave the students opportunities to identify their own need for knowledge, while also identifying existing knowledge. Reflections could confirm or reject their preparedness for clinical practice. The importance of working in a structured manner in acute care situations became apparent. However, negative feedback to peers was avoided, which led to a loss of learning opportunity.Conclusion: High fidelity simulation training as a method plays an important part in the nursing students' learning. The teacher also plays a key role by asking difficult questions and guiding students towards accurate knowledge. This makes it possible for the students to close knowledge gaps, leading to improved patient safety.

BACKGROUND: Ethics and dignity in prehospital emergency care are important due to vulnerability and suffering. Patients can lose control of their body and encounter unfamiliar faces in an emergency situation.

OBJECTIVE: To describe what specialist ambulance nurse students experienced as preserved and humiliated dignity in prehospital emergency care.

RESEARCH DESIGN: The study had a qualitative approach.

METHOD: Data were collected by Flanagan's critical incident technique. The participants were 26 specialist ambulance nurse students who described two critical incidents of preserved and humiliated dignity, from prehospital emergency care. Data consist of 52 critical incidents and were analyzed with interpretive content analysis.

ETHICAL CONSIDERATIONS: The study followed the ethical principles in accordance with the Declaration of Helsinki.

FINDINGS: The result showed how human dignity in prehospital emergency care can be preserved by the ambulance nurse being there for the patient. The ambulance nurses meet the patient in the patient's world and make professional decisions. The ambulance nurse respects the patient's will and protects the patient's body from the gaze of others. Humiliated dignity was described through the ambulance nurse abandoning the patient and by healthcare professionals failing, disrespecting, and ignoring the patient.

DISCUSSION: It is a unique situation when a nurse meets a patient face to face in a critical life or death moment. The discussion describes courage and the ethical vision to see another human.

CONCLUSION: Dignity was preserved when the ambulance nurse showed respect and protected the patient in prehospital emergency care. The ambulance nurse students' ethical obligation results in the courage to see when a patient's dignity is in jeopardy of being humiliated. Humiliated dignity occurs when patients are ignored and left unprotected. This ethical dilemma affects the ambulance nurse students badly due to the fact that the morals and attitudes of ambulance nurses are reflected in their actions toward the patient.

Introduction. We focus on trauma care conducted in the context of a simulated traumatic event. This is in this study defined as a four-meter fall onto a hard surface, resulting in severe injuries to extremities in the form of bilateral open femur fractures, an open tibia fracture, and a closed pelvic fracture, all fractures bleeding extensively. Methods. The simulated trauma care competence of 63 ambulance nurses in prehospital emergency care was quantitatively evaluated along with their perception of their sufficiency. Data was collected by means of simulated trauma care and a questionnaire. Results. Life-saving interventions were not consistently performed. Time to perform interventions could be considered long due to the life-threatening situation. In comparison, the ambulance nurses' perception of the sufficiency of their theoretical and practical knowledge and skills for trauma care scored high. In contrast, the perception of having sufficient ethical training for trauma care scored low. Discussion. This study suggests there is no guarantee that the ambulance nurses' perception of theoretical and practical knowledge and skill level corresponds with their performed knowledge and skill. The ambulance nurses rated themselves having sufficient theoretical and practical knowledge and skills while the score of trauma care can be considered quite low.

Background: Simulation participants are not dependent on learning during an actual clinical situation. This allows for a learning environment that can be constructed to meet the knowledge and experience needs of the participant. Simulations in a prehospital emergency are an ideal way to address these needs without risking patient safety. Method: Nurses in prehospital emergency care (n = 63) participated in simulation interventions. During the simulation, the performed trauma care was assessed in two groups of participants with different frequency of simulation. Results: Several statistically significant differences and clinical improvements were found within and between the groups. Differences were noted in specific assessments, examinations, care actions, and time from assessment to action. Conclusion: The result suggested that repeated simulation may contribute to a clinical improvement in trauma care, and more frequent simulation may led to even greater improvements. (c) 2017 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc.

BACKGROUND: Acquiring knowledge and experience on high-energy trauma is often difficult due to infrequent exposure. This creates a need for training which is specifically tailored for complex prehospital conditions. Simulation provides an opportunity for ambulance nurses to focus on the actual problems in clinical practice and to develop knowledge regarding trauma care. The aim of this study was to describe what ambulance nurses and paramedics in prehospital emergency care perceive as important for learning when participating in simulation exercises.

METHODS: An integrative literature review was carried out. Criteria for inclusion were primary qualitative and quantitative studies, where research participants were ambulance nurses or paramedics, working within prehospital care settings, and where the research interventions involved simulation.

RESULTS: It was perceived important for the ambulance nurses' learning that scenarios were advanced and possible to simulate repeatedly. The repetitions contributed to increase the level of experience, which in turn improved the patients care. Moreover, realism in the simulation and being able to interact and communicate with the patient were perceived as important aspects, as was debriefing, which enabled the enhancement of knowledge and skills. The result is presented in the following categories: To gain experience, To gain practice and To be strengthened by others.

CONCLUSION: Learning through simulation does not require years of exposure to accident scenes. The simulated learning is enhanced by realistic, stressful scenarios where ambulance nurses interact with the patients. In this study, being able to communicate with the patient was highlighted as a positive contribution to learning. However, this has seldom been mentioned in a previous research on simulation. Debriefing is important for learning as it enables scrutiny of one's actions and thereby the possibility to improve and adjust one's caring. The effect of simulation exercises is important on patient outcome.

Simulation provides the opportunity to learn how to care for patients in complexsituations, such as when patients are exposed to high-energy trauma such as motor vehicle accidents.The aim of the study was to describe nurses’ perceptions of high-energy trauma care through simulationin prehospital emergency care. The study had a qualitative design. Interviews were conductedwith 20 nurses after performing a simulated training series. Data were analyzed using a phenomenographicmethod. The result indicates that simulation establishes, corrects, and confirms knowledge andskills related to trauma care in prehosp ital emergency settings. Trauma knowledge is readily availablein memory and can be quickly retrieved in a future trauma situation.

Background:High energy trauma is rare and, as a result, training of prehospital care providers often takes placeduring the real situation, with the patient as the object for the learning process. Such training could instead becarried out in the context of simulation, out of danger for both patients and personnel. The aim of this study wasto provide an overview of the development and foci of research on simulation in prehospital care practice.Methods:An integrative literature review were used. Articles based on quantitative as well as qualitative researchmethods were included, resulting in a comprehensive overview of existing published research. For publishedarticles to be included in the review, the focus of the article had to be prehospital care providers, in prehospitalsettings. Furthermore, included articles must target interventions that were carried out in a simulation context.Results:The 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 prehospitalcare providers included: Intubation, Trauma care, Cardiac Pulmonary Resuscitation (CPR), Ventilation and Triage.Conclusion:Simulation were described as a positive training and education method for prehospital medical staff. Itprovides opportunities to train assessment, treatment and implementation of procedures and devices under realisticconditions. 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 integralrole in this. The current state of prehospital care, which this review reveals, includes inadequate skills of prehospital staffregarding ventilation and CPR, on both children and adults, the lack of skills in paediatric resuscitation and the lack ofknowledge in assessing and managing burns victims. These circumstances suggest critical areas for further training andresearch, at both local and global levels

Background: Caring for patients in the end-of-life is an emotionally and physically challenging task. Therefore, undergraduate nursing students (UNS) need opportunities to learn to care for the dying patient. This study aimed to describe UNS' experiences of caring for patients at end-of-life. Methods: Interviews with 16 UNS in their last semester of nursing education were conducted. Data were analyzed with a phenomenological approach. Results: The UNS created a professional relationship with the dying patient. It meant that when the patient was unable to speak for themselves, the UNS could still meet his/her wishes and needs. The UNS believed they could take responsibility for the patient who was no longer able to take responsibility for themselves. Meeting with the patient's family could be experienced with anxiousness but was dependent on the personal chemistry between the patient's family and the UNS. Conclusion: The UNS creates a relationship with the patient and their family. To be knowledgeable about the patient's physical and psychosocial needs means that the UNS can support the patient in the end-of-life phase. Being close to the patient and the family results in an intensity of emotions in the care situation. The UNS can receive support from their colleagues during processing their emotions and creating an experience from their encounters with patients in end-of-life care.

The medical nature of esthetic treatments is confusing, as the boundaries between medicine and beauty are unclear. A person's autonomous decision is an indicator for esthetic treatments that will improve their self-image, self-esteem and appearance to others. Robust ethical consideration is therefore necessary for the medical esthetician in each meeting with the client. This study aimed to describe medical estheticians' perceptions of ethics and esthetics in injection treatments with Botox and Filler. The results are described in Understanding what different clients desire, Reaching a mutual understanding of expectations and possibilities and Taking responsibility for beauty.

There are theoretical and methodological difficulties in measuring the concepts of quality of care and patient satisfaction, and the conditions associated with these concepts. A theoretical framework of patient satisfaction and a theoretical model of quality of care have been used as the theoretical basis in this thesis.

Aim. The overall aim was to describe and explore relationships between person-related conditions, external objective care conditions, patients’ perceptions of quality of care, and patient satisfaction with care in hospital.

Methods. Quantitative and qualitative methods were used. In the quantitative study (I-III), 528 patients (83.7%) from eight medical, three surgical and one mixed medical/surgical ward in five hospitals in Norway agreed to participate (10% of total discharges). Data collection was conducted using a questionnaire comprising four instruments: Quality from Patients’ Perspective (QPP); Sense of Coherence scale (SOC); Big Five personality traits – the Single-Item Measures of Personality (SIMP); and Emotional Stress Reaction Questionnaire (ESRQ). In addition, questions regarding socio-demographic data and health conditions were asked, and data from ward statistics were included. Multivariate statistical analysis was carried out (I-III). In the qualitative study 22 informants were interviewed (IV). The interviews were analysed by conventional content analysis.

Main findings. Patients’ perceptions of quality of care and patient satisfaction ranged from lower to higher depending on whether all patients or groups of patients were studied. The combination of person-related and external objective care conditions explained 55% of patients’ perceptions of quality of care (I). 54.7% of the variance in patient satisfaction was explained, and the person-related conditions had the strongest impact, explaining 51.7% (II). Three clusters of patients were identified regarding their scores on patient satisfaction and patients’ perceptions of quality of care (III). One group consisted of patients who were most satisfied and had the best perceptions of quality of care, a second group of patients who were less satisfied and had better perceptions, and a third group of patients who were less satisfied and had the worst perceptions. The qualitative study revealed four categories of importance for patients’ satisfaction: desire to regain health, need to be met in a professional way as a unique person, perspective on life, and need to have balance between privacy and companionship (IV).

Conclusions. Patients’ perceptions of quality of care and patient satisfaction are two different concepts. The person-related conditions seem to be the strongest predictors of patients’ perceptions of quality of care and patient satisfaction. Registered nurses need to be aware of this when planning and conducting nursing care. There is a need of guidelines for handling over‑occupancy, and of procedures for emergency admissions on the wards. The number of registered nurses on the wards needs to be considered. Healthcare personnel must do their utmost to provide the patients with person‑centred care.

Aims and objectives. To describe patients' perceptions of quality of care and to explore combinations of person-related and external objective care conditions as potential predictors of these perceptions. Background. Several studies have examined various single factors of person-related and external objective care conditions in relation to quality of care. None of these has included the effect of over-occupancy on patients' perception of quality of care. Furthermore, little is known about how combinations of different factors are related to each other and to the perception of quality of care using multivariate analysis. Design. A cross-sectional design. Method. A total of 528 patients (83·7%) from 12 medical, surgical or medical-surgical wards in five hospitals in Norway participated. Perceptions of quality of care and person-related conditions were measured with the 'Quality from Patient's Perspective' instrument. Data on external objective care conditions was collected from ward statistics provided by head nurses. Multivariate general linear modelling was used ( p < 0·05). Results. The combination of person-related and external objective care conditions revealed five factors that predict patients' perception of quality of care. Three of these are person-related conditions: sex, age and self-reported psychological well-being and two of them are external objective care conditions: RNs (headcount) on the wards and frequency of over-occupancy. These five factors explained 55% of the model. Patients rated the quality of care high. Conclusions. Sex, age, psychological well-being, frequency of over-occupancy and the number of RNs are important factors that must be emphasised if patients are to perceive the quality of care as high. Relevance to clinical practice. Head nurses and healthcare authorities must continually prepare the wards for over-occupancy and they must consider the number of RNs working on the wards.