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  • 1.
    Ballangrud, Randi
    et al.
    Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), Institutionen för hälsovetenskaper (from 2013).
    Husebo, Sissel Eikeland
    University of Stavanger, Norway; Stavanger University Hospital, Norway.
    Hall-Lord, Marie Louise
    Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), Institutionen för hälsovetenskaper (from 2013). Stavanger University Hospital, Norway.
    Cross-cultural validation and psychometric testing of the Norwegian version of the TeamSTEPPS (R) teamwork perceptions questionnaire2017Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, s. 1-10, artikel-id 799Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Teamwork is an integrated part of today's specialized and complex healthcare and essential to patient safety, and is considered as a core competency to improve twenty-first century healthcare. Teamwork measurements and evaluations show promising results to promote good team performance, and are recommended for identifying areas for improvement. The validated TeamSTEPPS (R) Teamwork Perception Questionnaire (T-TPQ) was found suitable for cross-cultural validation and testing in a Norwegian context. T-TPQ is a self-report survey that examines five dimensions of perception of teamwork within healthcare settings. The aim of the study was to translate and cross-validate the T-TPQ into Norwegian, and test the questionnaire for psychometric properties among healthcare personnel. Methods: The T-TPQ was translated and adapted to a Norwegian context according to a model of a back-translation process. A total of 247 healthcare personnel representing different professionals and hospital settings responded to the questionnaire. A confirmatory factor analysis was carried out to test the factor structure. Cronbach's alpha was used to establish internal consistency, and an Intraclass Correlation Coefficient was used to assess the test - retest reliability. Result: A confirmatory factor analysis showed an acceptable fitting model (chi(2) (df) 969.46 (546), p < 0.001, Root Mean Square Error of Approximation (RMSEA) = 0.056, Tucker-Lewis Index (TLI) = 0.88, Comparative fit index (CFI) = 0.89, which indicates that each set of the items that was supposed to accompany each teamwork dimension clearly represents that specific construct. The Cronbach's alpha demonstrated acceptable values on the five subscales (0.786-0.844), and test-retest showed a reliability parameter, with Intraclass Correlation Coefficient scores from 0.672 to 0.852. Conclusion: The Norwegian version of T-TPQ was considered to be acceptable regarding the validity and reliability for measuring Norwegian individual healthcare personnel's perception of group level teamwork within their unit. However, it needs to be further tested, preferably in a larger sample and in different clinical settings.

  • 2.
    Burström, Lena
    et al.
    Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden.
    Starrin, Bengt
    Karlstads universitet, Fakulteten för humaniora och samhällsvetenskap (from 2013), Institutionen för sociala och psykologiska studier.
    Engström, Marie-Louise
    Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden.
    Thulesius, Hans
    Department of Clinical Sciences Malmö, Division of Family medicine, Lund University, R&D, Kronoberg County Council, Växjö, Sweden .
    Waiting management at the emergency department - a grounded theory study2013Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, nr 95Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    An emergency department (ED) should offer timely care for acutely ill or injured persons that require the attention of specialized nurses and physicians. This study was aimed at exploring what is actually going on at an ED.

    Methods

    Qualitative data was collected 2009 to 2011 at one Swedish ED (ED1) with 53.000 yearly visits serving a population of 251.000. Constant comparative analysis according to classic grounded theory was applied to both focus group interviews with ED1 staff, participant observation data, and literature data. Quantitative data from ED1 and two other Swedish EDs were later analyzed and compared with the qualitative data.

    Results

    The main driver of the ED staff in this study was to reduce non-acceptable waiting. Signs of non-acceptable waiting are physical densification, contact seeking, and the emergence of critical situations. The staff reacts with frustration, shame, and eventually resignation when they cannot reduce non-acceptable waiting. Waiting management resolves the problems and is done either by reducing actual waiting time by increasing throughput of patient flow through structure pushing and shuffling around patients, or by changing the experience of waiting by calming patients and feinting maneuvers to cover up.

    Conclusion

    To manage non-acceptable waiting is a driving force behind much of the staff behavior at an ED. Waiting management is done either by increasing throughput of patient flow or by changing the waiting experience.

  • 3.
    Finbråten, Hanne Søberg
    et al.
    Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), Institutionen för hälsovetenskaper (from 2013). Inland Norway University of Applied Sciences.
    Wilde-Larsson, Bodil
    Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), Institutionen för hälsovetenskaper (from 2013). Inland Norway University of Applied Sciences, Norway.
    Nordström, Gun
    Inland Norway University of Applied Sciences, Norway.
    Pettersen, Kjell Sverre
    Oslo Metropolitan Universitet, Norway.
    Trollvik, Anne
    Inland Norway University, Norway.
    Guttersrud, Öystein
    University of Oslo, Norway.
    Establishing the HLS-Q12 short version of the European Health Literacy Survey Questionnaire: Latent trait analyses using Rasch modelling and confirmatory factor modelling2018Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, nr 506Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    The European Health Literacy Survey Questionnaire (HLS-EU-Q47) is widely used in assessing health literacy (HL). There has been some controversy whether the comprehensive HLS-EU-Q47 data, reflecting a conceptual model of four cognitive domains across three health domains (i.e. 12 subscales), fit unidimensional Rasch models. Still, the HLS-EU-Q47 raw score is commonly interpreted as a sufficient statistic. Combining Rasch modelling and confirmatory factor analysis, we reduced the 47 item scale to a parsimonious 12 item scale that meets the assumptions and requirements of objective measurement while offering a clinically feasible HL screening tool. This paper aims at (1) evaluating the psychometric properties of the HLS-EU-Q47 and associated short versions in a large Norwegian sample, and (2) establishing a short version (HLS-Q12) with sufficient psychometric properties.MethodsUsing computer-assisted telephone interviews during November 2014, data were collected from 900 randomly sampled individuals aged 16 and over. The data were analysed using the partial credit parameterization of the unidimensional polytomous Rasch model (PRM) and the 'between-item' multidimensional PRM, and by using one-factorial and multi-factorial confirmatory factor analysis (CFA) with categorical variables.ResultsUsing likelihood-ratio tests to compare data-model fit for nested models, we found that the observed HLS-EU-Q47 data were more likely under a 12-dimensional Rasch model than under a three- or a one-dimensional Rasch model. Several of the 12 theoretically defined subscales suffered from low reliability owing to few items. Excluding poorly discriminating items, items displaying differential item functioning and redundant items violating the assumption of local independency, a parsimonious 12-item HLS-Q12 scale is suggested. The HLS-Q12 displayed acceptable fit to the unidimensional Rasch model and achieved acceptable goodness-of-fit indexes using CFA.ConclusionsUnlike the HLS-EU-Q47 data, the parsimonious 12-item version (HLS-Q12) meets the assumptions and the requirements of objective measurement while offering clinically feasible screening without applying advanced psychometric methods on site. To avoid invalid measures of HL using the HLS-EU-Q47, we suggest using the HLS-Q12. Valid measures are particularly important in studies aiming to explain the variance in the latent trait HL, and explore the relation between HL and health outcomes with the purpose of informing policy makers.

  • 4.
    Johansson, N.
    et al.
    Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Jakobsson, Niklas
    Karlstads universitet, Fakulteten för ekonomi, kommunikation och IT, Avdelningen för nationalekonomi och statistik. Karlstads universitet, Fakulteten för humaniora och samhällsvetenskap (from 2013), Handelshögskolan (from 2013). Norwegian Social Res NOVA, Oslo, Norway.
    Svensson, Mikael
    Karlstads universitet, Fakulteten för humaniora och samhällsvetenskap (from 2013), Handelshögskolan (from 2013). Karlstads universitet, Fakulteten för ekonomi, kommunikation och IT, Avdelningen för nationalekonomi och statistik. Williams Coll, Dept Econ, Williamstown, MA 01267 USA.
    Regional variation in health care utilization in Sweden: The importance of demand-side factors2018Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, nr 1, artikel-id 403Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Differences in health care utilization across geographical areas are well documented within several countries. If the variation across areas cannot be explained by differences in medical need, it can be a sign of inefficiency or misallocation of public health care resources. Methods: In this observational, longitudinal panel study we use regional level data covering the 21 Swedish regions (county councils) over 13 years and a random effects model to assess to what degree regional variation in outpatient physician visits is explained by observed demand factors such as health, demography and socio-economic factors. Results: The results show that regional mortality, as a proxy for population health, and demography do not explain regional variation in visits to primary care physicians, but explain about 50% of regional variation in visits to outpatient specialists. Adjusting for socio-economic and basic supply-side factors explains 33% of the regional variation in primary physician visits, but adds nothing to explaining the variation in specialist visits. Conclusion: 50-67% of regional variation remains unexplained by a large number of observable regional characteristics, indicating that omitted and possibly unobserved factors contribute substantially to the regional variation. We conclude that variations in health care utilization across regions is not very well explained by underlying medical need and demand, measured by mortality, demographic and socio-economic factors.

  • 5.
    Molarius, Anu
    et al.
    Karlstads universitet. Vastmanland Cty Council, Competence Ctr Hlth, S-72189 Vasteras, Sweden.;Karlstad Univ, Dept Publ Hlth Sci, Karlstad, Sweden..
    Simonsson, Bo
    Vastmanland Cty Council, Competence Ctr Hlth, S-72189 Vasteras, Sweden..
    Linden-Bostrom, Margareta
    Orebro Cty Council, Dept Community Med & Publ Hlth, Orebro, Sweden..
    Kalander-Blomqvist, Marina
    Varmland Cty Council, Dept Publ Hlth & Community Med, Karlstad, Sweden..
    Feldman, Inna
    Uppsala Cty Council, Dev Unit, Uppsala, Sweden.;Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden..
    Eriksson, Hans G.
    Uppsala Univ, Ctr Clin Res Sormland, Eskilstuna, Sweden..
    Social inequalities in self-reported refraining from health care due to financial reasons in Sweden: health care on equal terms?2014Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, artikel-id 605Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The main goal of the health care system in Sweden is good health and health care on equal terms for the entire population. This study investigated the existence of social inequalities in refraining from health care due to financial reasons in Sweden. Methods: The study is based on 38,536 persons who responded to a survey questionnaire sent to a random sample of men and women aged 18-84 years in 2008 (response rate 59%). The proportion of persons who during the past three months due to financial reasons limited or refrained from seeking health care, purchasing medicine or seeking dental care is reported. The groups were defined by gender, age, country of origin, educational level and employment status. The prevalence of longstanding illness was used to describe morbidity in these groups. Differences between groups were tested with chi-squared statistics and multivariate logistic regression models. Results: In total, 3% reported that they had limited or refrained from seeking health care, 4% from purchasing medicine and 10% from seeking dental care. To refrain from seeking health care was much more common among the unemployed (12%) and those on disability pension (10%) than among employees (2%). It was also more common among young adults and persons born outside the Nordic countries. Similar differences also apply to purchasing medicine and dental care. The odds for refraining from seeking health care, purchasing medicine or seeking dental care due to financial reasons were 2-3 times higher among persons with longstanding illness than among persons with no longstanding illness. Conclusions: There are social inequalities in self-reported refraining from health care due to financial reasons in Sweden even though the absolute levels vary between different types of care. Often those in most need refrain from seeking health care which contradicts the national goal of the health care system. The results suggest that the fare systems of health care and dental care should be revised because they contribute to inequalities in health care.

  • 6.
    Simonsen, Bjoerg O.
    et al.
    Innlandet Hosp Trust, Dept Qual & Patient Safety, N-2381 Brumunddal, Norway.;Norwegian Univ Sci & Technol, Fac Med, Unit Appl Clin Res, N-7034 Trondheim, Norway..
    Daehlin, Gro K.
    Gjoevik Univ Coll, Fac Hlth Care & Nursing, Gjoevik, Norway..
    Johansson, Inger
    Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), Institutionen för hälsovetenskaper.
    Farup, Per G.
    Norwegian Univ Sci & Technol, Fac Med, Unit Appl Clin Res, N-7034 Trondheim, Norway.;Innlandet Hosp Trust, Dept Res, N-2381 Brumunddal, Norway..
    Differences in medication knowledge and risk of errors between graduating nursing students and working registered nurses: comparative study2014Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, artikel-id 580Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Nurses experience insufficient medication knowledge; particularly in drug dose calculations, but also in drug management and pharmacology. The weak knowledge could be a result of deficiencies in the basic nursing education, or lack of continuing maintenance training during working years. The aim of this study was to compare the medication knowledge, certainty and risk of error between graduating bachelor students in nursing and experienced registered nurses. Methods: Bachelor students in closing term and registered nurses with at least one year job experience underwent a multiple choice test in pharmacology, drug management and drug dose calculations: 3x14 questions with 3-4 alternative answers (score 0-42). Certainty of each answer was recorded with score 0-3, 0-1 indicating need for assistance. Risk of error was scored 1-3, where 3 expressed high risk: being certain that a wrong answer was correct. The results are presented as mean and (SD). Results: Participants were 243 graduating students (including 29 men), aged 28.2 (7.6) years, and 203 registered nurses (including 16 men), aged 42.0 (9.3) years and with a working experience of 12.4 years (9.2). The knowledge among the nurses was found to be superior to that of the students: 68.9%(8.0) and 61.5%(7.8) correct answers, respectively, (p < 0.001). The difference was largest in drug management and dose calculations. The improvement occurred during the first working year. The nurses expressed higher degree of certainty and the risk of error was lower, both overall and for each topic (p < 0.01). Low risk of error was associated with high knowledge and high sense of coping (p < 0.001). Conclusions: The medication knowledge among experienced nurses was superior to bachelor students in nursing, but nevertheless insufficient. As much as 25% of the answers to the drug management questions would lead to high risk of error. More emphasis should be put into the basic nursing education and in the introduction to medication procedures in clinical practice to improve the nurses' medication knowledge and reduce the risk of error.

  • 7.
    Simonsen, Björg O.
    et al.
    Norway.
    Johansson, Inger
    Karlstads universitet, Fakulteten för samhälls- och livsvetenskaper, Avdelningen för omvårdnad. Norway.
    Daehlin, G
    Norway.
    Osvik, Lene Merete
    Norway.
    Farup, Per G.
    Norway.
    Medication knowledge, certainty, and risk of errors in health care:: a cross- sectional study2011Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 11, artikel-id 175Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Medication errors are often involved in reported adverse events. Drug therapy, prescribed by physicians, is mostly carried out by nurses, who are expected to master all aspects of medication. Research has revealed the need for improved knowledge in drug dose calculation, and medication knowledge as a whole is poorly investigated. The purpose of this survey was to study registered nurses' medication knowledge, certainty and estimated risk of errors, and to explore factors associated with good results. Methods: Nurses from hospitals and primary health care establishments were invited to carry out a multiple-choice test in pharmacology, drug management and drug dose calculations (score range 0-14). Self-estimated certainty in each answer was recorded, graded from 0 = very uncertain to 3 = very certain. Background characteristics and sense of coping were recorded. Risk of error was estimated by combining knowledge and certainty scores. The results are presented as mean (+/- SD). Results: Two-hundred and three registered nurses participated (including 16 males), aged 42.0 (9.3) years with a working experience of 12.4 (9.2) years. Knowledge scores in pharmacology, drug management and drug dose calculations were 10.3 (1.6), 7.5 (1.6), and 11.2 (2.0), respectively, and certainty scores were 1.8 (0.4), 1.9 (0.5), and 2.0 (0.6), respectively. Fifteen percent of the total answers showed a high risk of error, with 25% in drug management. Independent factors associated with high medication knowledge were working in hospitals (p < 0.001), postgraduate specialization (p = 0.01) and completion of courses in drug management (p < 0.01). Conclusions: Medication knowledge was found to be unsatisfactory among practicing nurses, with a significant risk for medication errors. The study revealed a need to improve the nurses' basic knowledge, especially when referring to drug management.

  • 8.
    Thomas, Steve
    et al.
    Trinity College Dublin, Ireland.
    Foley, Conor
    University College Cork, Cork, Ireland.
    Kane, Bridget
    University College Cork, Cork, Ireland.
    Johnston, Bridget M
    University College Cork, Cork, Ireland.
    Lynch, Brenda
    University College Cork, Ireland.
    Smith, Susan
    Royal College of Surgeons, Dublin, Ireland.
    Healy, Orla
    University College Cork, Ireland.
    Droog, Elsa
    University College Cork, Ireland.
    Browne, John
    University College Cork, Ireland.
    Variation in resource allocation in urgent and emergency Care Systems in Ireland2019Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 9, nr 1, artikel-id 657Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A key challenge for most systems is how to provide effective access to urgent and emergency care across rural and urban populations. Tensions about the placement and scope of hospital emergency services are longstanding in Irish political life and there has been recent reform to centralise hospital services in some regions. The focus of this paper is a system approach to examine the geographic variation in resourcing and utilisation of such care across GP practices, out-of-hours care, ambulance services, Emergency Departments and Local Injury Units in Ireland.

    Methods: We used a cross-sectional study design to evaluate variation in resource allocation by aggregating geographic funding to various elements of the urgent and emergency care system and assessing patterns in hospital resource utilisation across the population. Expenditure, staffing, access and activity data were gathered from government sources, individual facilities and service providers, health professional bodies, private firms and central statistics. Data on costs and activity in 2014 are collated and presented at both county and regional levels. Analyses focus on resources spent on urgent and emergency care across geographic areas, the role of population concentration in allocation, the relationship between pre-hospital spending and in-hospital spending, and the utilisation of hospital-based emergency care resources by residents of each county.

    Results: An array of funding mechanisms exists, resulting in a fragmented approach to the resourcing of urgent and emergency care. There are large differences in spending per capita at the county-level, ranging from between €50 and €200 per capita; however, these are less pronounced regionally. Distribution of hospital emergency care resources is highly skewed to the North East of the country, and away from the recently reconfigured South and Mid-West regions.

    Conclusions: This analysis advances the traditional approach of evaluating individual services or hospital resourcing. There are notable differences in utilisation of hospital-based emergency care resources at the regional level, indicating that populations within those regions which have been reconfigured have lower utilisation of hospital resources. There is a clear case for more integration in decision-making around funding and consideration of key principles, such as equity, to guide that process.

1 - 8 av 8
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