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Planerad processorienterad omvårdnad - nytta och implementering
Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
2010 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

To ensure the provision of good and safe nursing care in the ward, the nursing needs of each patient should be established and clearly documented in the form of care plans in his/her medical record. There is a lack of scientific evidence of the benefits of this method of working as well as why this part of the nursing process is not always successful. The main aim of this thesis was to describe the assessment and decision-making process pertaining to nursing needs performed by nurses, to evaluate the consequences of planned, process oriented nursing care and to identify the factors and conditions that have had an impact on the implementation of individual care plans (ICP) and standardized care plans (SCP).

 

In studies I and III, qualitative methods were used. In study I, data collection and analysis were carried out by means of Grounded theory. Study III was conducted by means of directed content analysis and guided by “The Promoting Action on Research Implementation in Health Services framework”. In studies II and IV, quantitative methods were employed.

 

The benefits of a planned, process oriented method of working involving documentation of care plans have been investigated from the perspective of both the patient and the nurse. Nurses who applied the process oriented method adopted a nursing perspective in the assessment of and decision making pertaining to the patient’s nursing needs, which was not the case with nurses who did not work in this way and who instead exhibited a more medical approach (I). Patients cared for in wards where care plans were documented reported being more involved and that the care was more tailored to their individual needs compared to those not cared for in this manner (II). Leadership that prioritises the development of nursing care is essential for the implementation and continued use of ICPs and SCPs. Another important factor was the presence of internal facilitators in the ward in the form of nurses with a clear mandate to work with these issues. The nurses reported that they did not discuss scientific evidence as a basis for performing planned process oriented nursing care and that they did not listen to patient experiences to any great extent (III, IV).

 

The conclusion is that structured, process oriented nursing care based on written care plans probably promotes the nursing perspective and enables patient participation. Leadership as well as facilitators with a clear role and mandate are important factors in the implementation of this method of working and scientific evidence is of less importance.

Place, publisher, year, edition, pages
Göteborg: Göteborgs Universitet , 2010. , 67 p.
Keyword [en]
Nursing process, assessment, judgment, individual care plans, standardized care plans, implementation, PARIHS framework
National Category
Nursing
Identifiers
URN: urn:nbn:se:hh:diva-5612ISBN: 978-91-628-8043-9 OAI: oai:DiVA.org:hh-5612DiVA: diva2:349522
Public defence
2010-05-07, Göteborg, 13:00 (Swedish)
Supervisors
Available from: 2010-09-07 Created: 2010-09-07 Last updated: 2012-11-06Bibliographically approved
List of papers
1. Obtaining a Foundation for Nursing Care at the Time of Patient Admission: A Grounded Theory Study
Open this publication in new window or tab >>Obtaining a Foundation for Nursing Care at the Time of Patient Admission: A Grounded Theory Study
2009 (English)In: Open Nursing Journal, ISSN 1874-4346, Vol. 3, 56-64 p.Article in journal (Refereed) Published
Abstract [en]

The nursing process can be viewed as a problem-solving model, but we do not know whether use of the whole process including care plans with interventions based on nursing diagnoses improves nurses' ability to carry out assessments. Therefore, the aim of this study was to illuminate and describe the assessment and decision-making process performed by nurses who formulated individual care plans including nursing diagnosis, goals and interventions or who used standardized care plans when a patient was admitted to their ward for care, and those who did not. Data collection and analysis were carried out by means of Grounded theory. Nurses were observed while assessing patients, after which they were interviewed. The main concern of all nurses was to obtain a foundation for nursing care based on four strategies; building pre-understanding, creating a caring environment, collecting information on symptoms and signs and performing an analysis from different perspectives. It appeared that the most important aspect for nurses who did not employ care plans was the medical reason for the patient's admission. The nurses who employed care plans discussed their decisions in terms of nursing problems, needs and risks. The results indicate that nurses who formulated care plans were more aware of their professional role.

Place, publisher, year, edition, pages
Hilversum: Bentham Science Publishers, 2009
Keyword
Nursing process, Assessment, judgement, decision-making process, critical thinking
National Category
Social Sciences
Identifiers
urn:nbn:se:hh:diva-2899 (URN)10.2174/1874434600903010056 (DOI)19746207 (PubMedID)2082/3301 (Local ID)2082/3301 (Archive number)2082/3301 (OAI)
Available from: 2009-09-02 Created: 2009-09-02 Last updated: 2012-11-12Bibliographically approved
2. Evaluation of documented nursing care plans by the use of nursing-sensitive outcome indicators
Open this publication in new window or tab >>Evaluation of documented nursing care plans by the use of nursing-sensitive outcome indicators
2010 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 3, 611-618 p.Article in journal (Refereed) Published
Abstract [en]

Abstract Rationale and aim: There is a lack of evidence that nursing care plans affect patient outcomes. The aim of the present study was to evaluate whether documented nursing care plans affect patient outcomes by the use of nursing-sensitive outcome indicators. Method: A retrospective, cross-sectional design with patients surveyed at time of discharge from two hospital units for patients with stroke and after 2-3 weeks at home. The control unit (A) did not employ care plans. The intervention unit (B) used care plans on a daily basis. Outcome was measured by 'the National Stroke Register' and the two questionnaires: 'Quality of patients' perspective' and 'Euroquol five dimensions'. Data were collected over a 5-month period (October 2007-February 2008). Results: In total, 87 patients were included in the study. Patient characteristics in the two groups at admission and the health-related quality of life 2 to 3 weeks after discharge were similar. The patients from unit B were more satisfied with individual care (P = 0.03) and participation (P = 0.007). Unit B also had a shorter length of stay (P = 0.004). Conclusions: The effects of documented care plans are difficult to evaluate from a patient perspective, as many factors can improve the outcome. However, documentation of care plans is a prerequisite for measuring the quality and outcome of the care provided. This small study indicates that documented care plans may affect patient satisfaction regarding individual care, participation and length of hospital stay.

Place, publisher, year, edition, pages
Oxford: Blackwell Publishing, 2010
Keyword
Care plans, Empirical research report, Nursing diagnosis, Outcome, Stroke
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-3709 (URN)10.1111/j.1365-2753.2009.01233.x (DOI)000278077900034 ()20039996 (PubMedID)2-s2.0-77952940643 (Scopus ID)
Available from: 2010-01-21 Created: 2010-01-21 Last updated: 2012-11-12Bibliographically approved
3. Factors and Conditions That Have an Impact in Relation to the Successful Implementation and Maintenance of Individual Care Plans
Open this publication in new window or tab >>Factors and Conditions That Have an Impact in Relation to the Successful Implementation and Maintenance of Individual Care Plans
2011 (English)In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 8, no 2, 66-75 p.Article in journal (Refereed) Published
Abstract [en]

Background: The gap between what is stated in legislation about written individualized nursing care plans (ICP) and how they are used in practice is still too wide. Aim: To explore attitudes and experiences among nurses and managers in order to capture which factors and conditions impact on the successful implementation of individual care plans within hospital care, as well as the strategies that were adopted to ensure continued use. Method: The study was carried out through directed content analysis guided by the Promoting Action on Research Implementation in Health Services framework. Interviews were conducted with 15 informants on different operational and decision levels at a hospital that is well known in Sweden for its work in the ICP area. Findings: Important factors for implementation on the wards were clear instructions from the hospital management at the start of implementation as well as clear roles and mandates for those involved. The work of internal facilitators was crucial for the continuation of the process. Clinical experience was important as the long-term driving force. Implications: On the basis of the findings of this study, we argue that it is important for hospital managers to recruit leaders that focus on individual nursing care and can highlight needs and instigate change. It seems also important that the organization takes advantage of the potential of skilled facilitators.

Place, publisher, year, edition, pages
Oxford: Blackwell Publishing, 2011
Keyword
Individual care plans, Implementation, In-patient, Interview, PARIHS framework
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-5610 (URN)10.1111/j.1741-6787.2010.00195.x (DOI)000292292200003 ()20604910 (PubMedID)2-s2.0-79958774083 (Scopus ID)
Available from: 2010-09-07 Created: 2010-09-07 Last updated: 2012-11-12Bibliographically approved
4. Factors and conditions that influence the implementation of standardized nursing care plans
Open this publication in new window or tab >>Factors and conditions that influence the implementation of standardized nursing care plans
2010 (English)In: Open Nursing Journal, ISSN 1874-4346, Vol. 4, 25-34 p.Article in journal (Refereed) Published
Abstract [en]

Rationale and aim: There is a lack of evidence about how to successfully implement standardized nursing care plans (SNCP) in various settings. The aim of this study was to use the “Promotion Action on Research Implementation in Health Services framework” (PARIHS) to explore important factors and conditions at hospital wards that had implemented SNCPs.

Method. We employed a retrospective, cross-sectional design and recruited nurses from four units at a rural hospital and seven units at a university hospital in the western and southern region of Sweden where SNCPs had been implemented. Outcome was measured by means of a questionnaire based on the PARIHS-model.

Result: In total, 137 nurses participated in the study. The main factors that had motivated the nurses to implement SNCPs were that they were easy to understand and follow as well as corresponding to organisational norms. The SNCPs were normally based on clinical experience, although research more frequently formed the basis of the SNCPs at the university hospital. Internal facilitators acted as important educators, who provided reminders to use the SNCP and feedback to the SNCP users. The patient experience was not considered valuable. Those who claimed that the implementation was successful were generally more positive in all measurable aspects. The use of SNCPs was rarely evaluated.

Conclusions: Clinical experience was considered important by the nurses, while they attributed little value to the patient experiences. Successful implementation of research based SNCPs requires internal facilitators with knowledge of evidence-based nursing.

Place, publisher, year, edition, pages
Hilversum: Bentham Science Publishers, 2010
Keyword
Implementation, standardized nursing care plans, PARIHS, questionnaire
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-5611 (URN)10.2174/1874434601004010025 (DOI)21283733 (PubMedID)
Available from: 2010-09-07 Created: 2010-09-07 Last updated: 2014-03-26Bibliographically approved

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