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

The aim of this study was to describe the reported experiences of Indonesian nursing teachers who participated in a two-year cross-cultural project designed to build pedagogical and professional competence after the tsunami in Aceh province in 2004. Eleven Indonesian teachers who had participated in the competence project answered an open-ended questionnaire in November 2007. The data were analyzed by qualitative content analysis, and the main theme "an empowered nursing teacher" emerged. The teachers expressed positive experiences, as having more self confidence, feeling inspired to develop one's potentiality and feeling strength and happiness in one's work. The theme constituted four categories: "encouraged by collaboration and teamwork", "more independent as a teacher", "encouraged by more active students" and, "inspired to develop further competence". The overall result showed that the teachers in the competence developing project reported mostly positive experiences by participating in the project. However, two years is a short time to develop both pedagogical and professional competence. They expressed a desire to continue building their competence, especially in direct clinical practice.

Nursing students need an understanding of how nurses care for people’s health from a global perspective. The aim of this studywas 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 analysedusing qualitative content analysis. Three common categories emerged: ‘Promoting health and preventing disease’, ‘Performingcare and treatment’, ‘Establishing a relationship with patients and being compassionate’. ‘Possessing and implementing knowledgeand 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. TheScandinavian participants emphasised individuality, while those from Indonesia focused on the community. The findings indicatethat nursing education should take account of different cultures and include student exchange programmes.

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.

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 13-22years in 1999 and 23-33years 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 30-33years old compared to those being 23-29years 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.

Abstract 

Workplace bullying in the health and social care systems in Sweden. A descriptive study.

Aims

This study aims to map and describe the problem of bullying within the health and social care systems as a foundation for an intervention. In this presentation we will present the study and preliminary results concerning negative acts and work-place health in Sweden.   

Methods

Baseline data for this quantitative study was collected at nursing wards at five hospitals and five wards for eldercare in municipalities. Questionnaires were sent by post to 2810 employees.  Response-rate was 55% (n=1550).

Bullying was measured both with an operationalized and a self-labelling method. The instrument used in the former were The Negative Acts Questionnaire, NAQ-R, and bullying was assessed according to the operational criterion suggested  by Leyman (1996) “exposure to at least one negative act/week during six months” and a stricter criterion by Mikkelsen & Einarsen, (2001)  suggesting 2 negative acts/week during six months.  

As for the self-labelling of bullying a definition of bullying was presented and questions were asked whether the person had been bullied or had witnessed bullying the last 6 months. A further question was asked regarding previous life-time experiences of bullying.

To assess work-place environment the Nordic Questionnaire for Psychological and Social Factors at work, QPSNordic34+ was utilized. In addition a questionnaire made for this study concerning demographic information and specific workplace related questions were included.

Primarily descriptive statistics was used.

Results

Bullying measured by NAQ-R, using the operational criterion, reported results of bullying at 18,5 % (Leyman) and for the stricter criterion 6.8% (Mikkelsen & Einarsen). Four percent (4 %) reported bullying relating to the self-labelling question. A higher proportion, 22%, had witnessed bullying and an even higher proportion, 38%, reported having experienced bullying earlier in life.

 An association was shown between having been bullied earlier in life and experiencing bullying at the work-place at the present time. Also work-place environment, age, where you were born, living in a relationship, education and length of employment were, respectively, associated to more negative acts in the workplace.

Conclusion

The operationalized method yields a higher percent of bullying compared to the self-labelling method. This is also shown in earlier studies and might be due to bullying being stigmatizing and shameful and therefore difficult to express in a straight-forward way.

A significant relationship was observed between being bullied earlier in life-time and current exposure. As far as we know this represents new knowledge and should be further investigated.

Workplace bullying is a taboo event which occurs worldwide, although the prevalence varies significantly between and within countries. Nurses have been regarded an occupational risk group for bullying at the work place. Bullying in health and social care contexts is sometimes reported as frequent and, other times, as not occurring, which sparked our interest in mapping the occurrence of bullying in the health and social care system in Sweden. Thus, the purpose of the study was to examine the prevalence of bullying, and to discuss cultural traditions and environmental factors that affect bullying in workplaces. The sample (n = 2810) consisted of employees at inpatient wards at four hospitals, and employees at municipal eldercare wards in Sweden. A questionnaire including NAQ‐22 R was distributed and subsequently analysed with descriptive statistics using SPSS. The youngest group of respondents scored higher than the older groups. Using contrasting estimates of bullying, the prevalence varied between 4.1 and 18.5%, with the lowest prevalence in regards to self‐reported exposure. According to the cut‐off scores, NAQ‐22 R, 8.6% of the respondents were occasionally exposed to bullying while 2.3% were considered to be victims of severe bullying. Work‐related negative acts were more common than personal negative acts. The variations in prevalence of bullying as a result of contrasting estimation strategies are discussed from perspective of the 'law of Jante', the 'tall poppy syndrome' and shame. Bullying deteriorates the working conditions which may have an impact on quality of patient care.

Integrating an action program in daily practice to stop and prevent bullying

Background & Context: Bullying is a public health problem that negatively affects health at workplaces. In the public sectors, including health care, it is more common with bullying problems compared to other sectors. Earlier research has primarily focused on incidence, prevalence, risk factors and relationships between bullying and ill-health.  To a much lesser degree, research has focused on prevention. The aim of this study was to develop and implement an intervention to stop and prevent bullying at workplaces in collaboration with employees.

Methodology

This intervention study is integrated in a larger research project. Based on results from questionnaires targeting bullying, three workplaces in the healthcare sector were invited to participate. After approval from superiors, employees were invited to participate in focus-groups (FG), resulting in groups of 6-8 participants at one psychiatric ward in a county council, and two elderly care wards in respective municipalities. FG interviews were conducted twice; the first interview captured views on bullying, the second interview prepared for and developed the intervention. No superior participated in the first interview in order to have employees feel free expressing their views. Instead the department head was interviewed individually. The second included both employees and department heads. The FG interviews were analysed according to Grounded Theory.

Findings: The first interview revealed that the employees had insufficient knowledge about bullying and how to manage it. The second FG demonstrated that there were insufficient opportunities for reflections about bullying problems.  Employees also expressed that they did not feel recognized and valued by superiors in higher levels of the organization.

Given this, the researchers have, as part of the intervention, held half-day lectures on the phenomena of bullying, conflict management, communication and shame. The intervention also contained discussions in small groups focused around game-cards that were specifically designed to initiate discussions about specific situations where bullying may occur and how one may prevent or manage this.

In the FGs, it was furthermore suggested to write a contract that ensured that everyone treats each other with tolerance and respect at the workplace. Both interviews revealed that managers play key roles in preventing workplace bullying.  Appropriate leadership creates safety at the work-places, whereas inappropriate leadership creates fear.

Building on these findings from the FGs, next steps include plan of action, targeting e.g., compulsory, continuing discussions concerning bullying improved contact with the superior level and a workplace contract of mutual respect.

Suggestions for the action plan will be discussed in one additional FG, upon which the plan will be introduced to the directors of the workplaces for their support.

 In summary the results of the findings are a developed intervention/action program consisting of lectures, game card-discussions and an action plan in collaboration with employees and managers.

 Implications for practice, training and organization: 

Systematic longitudinal workplace interventions is one way of shouldering the responsibility of tackling bullying in workplaces, highlighting this often hidden problem.

3 learning objectives:

• Bullying in the workplace is prevalent, and yet  not acknowledged
• Managers play key roles in preventing workplace bullying
• Leadership can contribute to safety as well as fear in the workplace

Samsjuklighet bland personer med missbruk och/eller beroende är vanligt förekommande. Exempelvis är psykiska sjukdomar tre gånger så vanligt hos de som missbrukar alkohol, jämfört med hos personer som inte gör det. Särskilt vanligt förekommande är samsjuklighet av missbruk och psykiska sjukdomar bland klienter som befinner sig i missbruksvårdens sammanhang. Tidigare forskning har visat att behandling av missbruk och beroende med psykiatrisk samsjuklighet är mest effektiv när insatserna integreras. Trots detta saknas sådan behandling på bred basis. Syftet med föreliggande projekt var att pilottesta integrerad behandling i LVM-vårdens kontext, med huvudfokus på genomförbarhet och hållbarhet. Ett underordnat syfte var att beskriva effekterna av sådan behandling. Två behandlingsmodeller pilottestades vid tre SiS-institutioner. Den ena modellen, Integrating Combined Therapies (ICT), pilottestades vid två institutioner och den andra modellen, Enhanced Illness Management and Recovery (E-IMR), testades vid en institution. Totalt ingick 70 klienter i ICT-behandlingsgruppen, och elva klienter i E-IMR-gruppen. Utöver detta intervjuades 14 anställda vid de tre olika institutionerna. Implementeringen av E-IMR tog inte fäste, huvudsakligen på grund av yttre organisatoriska omständigheter. Vad gäller ICT, tyder resultaten på att modellen är genomförbar inom LVM-vården. Likaså föreligger goda tecken på hållbarhet. Det är dock viktigt att beakta att denna pilotimplementering är en relativt liten studie där det inte funnits någon kontrollgrupp. Utifrån designen på forskningsprojektet går det därför inte att dra säkra slutsatser om de positiva effekter av ICT som observera

BACKGROUND: Patients' 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.

METHOD: A 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.

RESULTS: Patients' 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.

CONCLUSION: Strengths 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.

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.

Background:Little is known about the combination of person- and organization- related conditions and the relationshipswith patients'perspectives of care quality. Such a combination could contribute knowledge reflecting the complexity ofclinical practice, and enhance individualized care. The aim wasto investigate the relationships between the combination ofperson- and organization-related conditions and patients'perceptions of palliative care quality.Methods:A cross-sectional study, including 191 patients in the latepalliative phase (73% response rate) admitted to hospiceinpatient care (n= 72), hospice day care (n= 51), palliative units in nursing homes (n= 30) and home care (n=38),wasconducted between November 2013 and December 2014, using the instrument Quality from the Patients'Perspectivespecific to palliative care (QPP-PC). Data were analysed, using analysis of covariance, to explore the amount of the variancein the dependent variables (QPP-PC) that could be explained by combination of the independent variables–Person- andorganization-related conditions,−while controlling for differences in covariates.Results:Patients scored the care received and the subjective importance as moderate to high. The combination of person-and organization - related conditions revealed that patients with a high sense of coherence, lower age (person–relatedconditions) and being in a ward with access to and availabilityof physicians (organization-related condition) might beassociated with significantly higher scores for the quality ofcare received. Gender (women), daily contact with family andfriends, and low health-related qualityof life (person-related conditions) might be associated with higher scores forsubjective importance of the aspects of care quality.Conclusion:Healthcare personnel, leaders and policy makers need to pay attention to person- and organization-relatedconditions in order to provide person-centered palliative care ofhigh quality. Further studies from palliative care contexts areneeded to confirm the findings and to investigate additional organizational factors that might influence patients'perceptions of care quality.

Background: Instruments specific to palliative care tend to measure care quality from relative perspectives or have insufficient theoretical foundation. The instrument Quality from the Patient's Perspective (QPP) is based on a model for care quality derived from patients' perceptions of care, although it has not been psychometrically evaluated for use in palliative care. The aim of this study was to adapt the QPP for use in palliative care contexts, and to describe patients' perceptions of the care quality in terms of the subjective importance of the care aspects and the perceptions of the care received. Method: A cross-sectional study was conducted between November 2013 and December 2014 which included 191 patients (73 % response rate) in late palliative phase at hospice inpatient units, hospice day-care units, wards in nursing homes that specialized in palliative care and homecare districts, all in Norway. An explorative factor analysis using principal component analysis, including data from 184 patients, was performed for psychometric evaluation. Internal consistency was assessed by Cronbach's alpha and paired t-tests were used to describe patients' perceptions of their care. Results: The QPP instrument was adapted for palliative care in four steps: (1) selecting items from the QPP, (2) modifying items and (3) constructing new items to the palliative care setting, and (4) a pilot evaluation. QPP instrument specific to palliative care (QPP-PC) consists of 51 items and 12 factors with an eigenvalue >= 1.0, and showed a stable factor solution that explained 68.25 % of the total variance. The reliability coefficients were acceptable for most factors (0.79-0.96). Patients scored most aspects of care related to both subjective importance and actual care received as high. Areas for improvement were symptom relief, participation, continuity, and planning and cooperation. Conclusion: The QPP-PC is based on a theoretical model of quality of care, and has its roots in patients' perspectives. The instrument was developed and psychometrically evaluated in a sample of Norwegian patients with various diagnoses receiving palliative care in different care contexts. The evaluation of the QPP-PC shows promising results, although it needs to be further validated and tested in other contexts and countries.

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. © 2018 John Wiley & Sons Ltd

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.

PurposeThe purpose of this paper is to evaluate an organizationally oriented, patient-focused care (PFC) model's 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.FindingsNo 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/valueThe study is large-scale before-after PFC model review, where patient and provider data were collected using well-established measurements.