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Article
Publication date: 3 August 2011

Brigitte S. Cypress

This qualitative phenomenological study examined the experiences of patients, their family members, and the nurses in the intensive care unit during critical illness. Five…

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Abstract

This qualitative phenomenological study examined the experiences of patients, their family members, and the nurses in the intensive care unit during critical illness. Five participants from each category participated in two interviews over a period of five months. Content analysis of the interview transcripts revealed five integrating common themes, each reflecting concepts from the Roy Adaptation Model (RAM). The ICU experience among all participants is interdependence. Adaptation in the ICU integrated family as a unit, physical care/comfort, physiological care and psychosocial support, resulting in transformation.

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Qualitative Research Journal, vol. 11 no. 2
Type: Research Article
ISSN: 1443-9883

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Article
Publication date: 1 January 2003

Richard Renaud and Sarah Phillips

Public Works and Government Services Canada (PWGSC) is the federal department responsible for housing over 190,000 Canadian federal public servants. During Y2K…

Abstract

Public Works and Government Services Canada (PWGSC) is the federal department responsible for housing over 190,000 Canadian federal public servants. During Y2K preparations, it became apparent that a single source or form of integrated, emergency response information at the infrastructure level did not exist. A process had to be created and developed that would serve as a single vehicle and source for building‐based emergency response. These preparations for Y2K saw the creation of the Infrastructure Continuity Unit (ICU) and a system for the creation, validation, and maintenance of Infrastructure Continuity Plans (ICPs). An ICP is an event‐management document that contains a series of procedures and protocols to be used during a building‐based incident or disruption of services. The ICU is supported nationally by a network of Regional Coordinators who oversee the gathering of information needed to create ICPs for their own parts of the country. This paper demonstrates how this system, along with the ICU’s recent certification by the Canadian General Standards Board (CGSB) to the ISO 9000 standard, have contributed to the ICU’s success. This paper takes the reader through an in‐depth exploration of the ICU’s processes, methodologies and procedures and demonstrates why, in a post‐September 11th world, the ICU has begun to attract international attention.

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Journal of Facilities Management, vol. 1 no. 4
Type: Research Article
ISSN: 1472-5967

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Article
Publication date: 25 February 2019

Kimberley Holmes and Kara Sealock

The purpose of this paper is to explore storytelling in post-secondary instruction and to reflect upon the authors’ experiences as instructors in two diverse areas of…

Abstract

Purpose

The purpose of this paper is to explore storytelling in post-secondary instruction and to reflect upon the authors’ experiences as instructors in two diverse areas of study. Both nursing and education promote a theory-based approach that is disconnected from the practical application of skills required.

Design/methodology/approach

The authors propose that using storytelling in the undergraduate classroom promotes an emotional engagement with the material, creates authentic human connections and demonstrates a practical application of content. The sharing of personal narratives creates a portal through which we understand the meaningful human element of the work, and the collective essence of our world. The authors believe that these outcomes are essential for the development of an empathetic and compassionate professional who understands the significance of the emotional, social and cognitive component of holistic learning that is required for the eventual acquisition of mastery in our disciplines.

Findings

Based on the authors’ experiences, the authors have found that storytelling creates a bridge between the curriculum theory and the implementation of that theory in the living world within the respective disciplines.

Practical implications

As instructors at the University of Calgary, in the Faculty of Education and Nursing, the authors see many intersections in the work and the instructional methodologies that the authors implement in the undergraduate classrooms to allow for authentic learning experiences. These cross-curricular connections have caused us to reflect on the use of storytelling in the humanities to promote emotions, create connections and demonstrate a practical and authentic application of theoretic concepts in both the undergraduate education and nursing programs.

Originality/value

This is an original piece of duo-ethnographic work composed by two researchers who were reflecting on praxis.

Details

Qualitative Research Journal, vol. 19 no. 2
Type: Research Article
ISSN: 1443-9883

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Article
Publication date: 3 March 2014

Marie Häggström, Kenneth Asplund and Lisbeth Kristiansen

Admission to and transfer from an intensive care unit affects not only the patient but also his or her relatives. The authors aimed to investigate relatives' perceptions…

Abstract

Purpose

Admission to and transfer from an intensive care unit affects not only the patient but also his or her relatives. The authors aimed to investigate relatives' perceptions of quality of care during a patient's transfer process from an intensive care unit to a general ward.

Design/methodology/approach

The study had a mixed method design that included quantitative data and answers to open questions. The participants were 65 relatives of patients who received care in an ICU. They were recruited from two hospitals in Sweden.

Findings

A majority perceived the transfer process as important, but analysis also showed that the participants rated it as an area for improvements. The relatives wanted participation, personal insight and control, respectful encounters, proximity, reassurance, continuous quality, reconnection and feedback. The relatives' participation in the transfer process was perceived as inadequate by 61 per cent, and the support that was received after the ICU discharge was perceived as inadequate by 53 per cent. The patients' length of stay in the ICU affected the relatives' perceptions of the quality of care. Overall, the relatives seemed to desire that the transfer process includes a continuous care, a competent staff, available information throughout the transfer process and personal involvement in the care, both before and after the transfer from the ICU.

Research limitations/implications

The conclusion of this study is that relatives' needs and seeking for a well-planned ICU transitional process organisation with continuous quality before and after transfer, informational strategies that encourage the relatives to be involved and an organisation with competence throughout the healthcare chain are vital for quality.

Practical implications

The conclusion of this study is that relatives' needs and seeking for a well-planned ICU transitional process organisation with continuous quality before and after transfer, informational strategies that encourage the relatives to be involved and an organisation with competence throughout the healthcare chain are vital for quality.

Originality/value

The findings have important implications for nursing and nursing management. A relative's perception of the quality of care before and after transfer from ICU may be a valuable source to evaluate the ICU transitional care.

Details

International Journal of Health Care Quality Assurance, vol. 27 no. 2
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 5 January 2021

Alessa Leila Andrade, Zenewton André da Silva Gama, Marise Reis de Freitas, Wilton Rodrigues Medeiros, Kelienny de Meneses Sousa, Edna Marta Mendes da Silva and Tatyana Souza Rosendo

Obstetric adverse outcomes (AOs) are an important topic and the use of composite measures may favor the understanding of their impact on patient safety. The aim of the…

Abstract

Purpose

Obstetric adverse outcomes (AOs) are an important topic and the use of composite measures may favor the understanding of their impact on patient safety. The aim of the present study was to estimate AO frequency and obstetric care quality in low and high-risk maternity hospitals.

Design/methodology/approach

A one-year longitudinal follow-up study in two public Brazilian maternity hospitals. The frequency of AOs was measured in 2,880 randomly selected subjects, 1,440 in each institution, consisting of women and their newborn babies. The frequency of 14 AOs was estimated every two weeks for one year, as well as three obstetric care quality indices based on their frequency and severity as follows: the Adverse Outcome Index (AOI), the Weighted Adverse Outcome Score and the Severity Index.

Findings

A significant number of mothers and newborns exhibited AOs. The most prevalent maternal AOs were admission to the ICU and postpartum hysterectomy. Regarding newborns, hospitalization for > seven days and neonatal infection were the most common complications. Adverse outcomes were more frequent at the high-risk maternity, however, they were more severe at the low-risk facility. The AOI was stable at the high-risk center but declined after interventions during the follow-up year.

Originality/value

High AO frequency was identified in both mothers and newborns. The results demonstrate the need for public patient safety policies for low-risk maternity hospitals, where AOs were less frequent but more severe.

Details

International Journal of Health Care Quality Assurance, vol. 34 no. 1
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 1 February 2003

Eva Lindberg and Urban Rosenqvist

Describes 12 members of staff’s views of their job and tasks in an intensive care unit of a middle‐sized Swedish hospital. Open‐ended questions were asked and the…

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713

Abstract

Describes 12 members of staff’s views of their job and tasks in an intensive care unit of a middle‐sized Swedish hospital. Open‐ended questions were asked and the interviews were analysed using thematic technique. The character of the work and the work tasks was the key variable in the analysis. The participants thought of intensive care as turbulent and ambiguous, powerful but also menacing and a concept comprised of a dichotomy of fundamental values. The work task of the participants was conceptualised in terms of managing the health status of the patient, seeking to appreciate the patient’s needs and ensuring that the staff worked harmoniously and effectively as a team. Speculates that the existence of a real dichotomy in fundamental values might be caused by the difficult medical reality on the ward. The study confirms a necessity for a two‐dimensional quality system where the deeper dimension deals with the disparate set of meaning status in the future perspective.

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International Journal of Health Care Quality Assurance, vol. 16 no. 1
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 20 March 2009

Roslyn Sorensen and Rick Iedema

This paper aims to understand the impact of emotional labour in specific health care settings and its potential effect on patient care.

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2791

Abstract

Purpose

This paper aims to understand the impact of emotional labour in specific health care settings and its potential effect on patient care.

Design/methodology/approach

Multi‐method qualitative ethnographic study undertaken in a large ICU in Sydney, Australia using observations from patient case studies, ward rounds and family conferences, open ended interviews with medical and nursing clinicians and managers and focus groups with nurses.

Findings

Clinician attitudes to death and dying and clinicians' capacity to engage with the human needs of patients influenced how emotional labour was experienced. Negative effects were not formally acknowledged in clinical workplaces and institutional mechanisms to support clinicians did not exist.

Research limitations/implications

The potential effects of clinician attitudes on performance are hypothesised from clinician‐reported data; no evaluation was undertaken of patient care.

Practical implications

Health service providers must openly acknowledge the effect of emotional labour on the care of dying people. By sharing their experiences, multidisciplinary clinicians become aware of the personal, professional and organisational impact of emotional labour as a core element of health care so as to explicitly and practically respond to it.

Originality/value

The effect of care on clinicians, particularly care of dying people, not only affects the wellbeing of clinicians themselves, but also the quality of care that patients receive. The affective aspect of clinical work must be factored in as an essential element of quality and quality improvement.

Details

Journal of Health Organization and Management, vol. 23 no. 1
Type: Research Article
ISSN: 1477-7266

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Book part
Publication date: 5 December 2007

Wayne Shelton

How many textbooks or introductory articles in bioethics begin with a section on ethical theory? Of the many that do, the relevance of basic theories of utilitarianism…

Abstract

How many textbooks or introductory articles in bioethics begin with a section on ethical theory? Of the many that do, the relevance of basic theories of utilitarianism, deontology, virtue ethics, feminist ethics, casuistry and so on, is assumed. These theories are also considered in light of the well-accepted principles of medical ethics: (1) respect for patient autonomy, (2) beneficence, (3) non-maleficence and (4) justice. Those of us trained in philosophy find these sections on theory terse summations of complex philosophical views. Physicians and nurses, and others not trained in philosophy, sometimes struggle to get their gist, and end up with an ability to make a basic analysis and formulate arguments about ethical problems from each of these perspectives, and to write and discuss the issues that arise with fellow ethicists. But how essential are these theoretical perspectives to the real work of clinical ethics consultants? It is important that we do not forget just how applied and practical that work is.

Details

Empirical Methods for Bioethics: A Primer
Type: Book
ISBN: 978-0-7623-1266-5

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Article
Publication date: 11 April 2016

Annette Boaz, Glenn Robert, Louise Locock, Gordon Sturmey, Melanie Gager, Sofia Vougioukalou, Sue Ziebland and Jonathan Fielden

The potential for including patients in implementation processes has received limited attention in the literature. The purpose of this paper is to explore the different…

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Abstract

Purpose

The potential for including patients in implementation processes has received limited attention in the literature. The purpose of this paper is to explore the different roles adopted by 63 patients that emerged during and after four participatory quality improvement interventions, and the nature of their impact upon implementation processes and outcomes.

Design/methodology/approach

A cross-case ethnographic comparison of Experience-based Co-design in two clinical pathways in two UK NHS Trusts.

Findings

Two key themes emerge from the data. First, the authors found a range of different roles adopted by patients within and across the four projects; some were happy to share their experiences, others also helped to identify improvement priorities alongside staff whilst others were also involved in developing potential solutions with the staff who had cared for them. A few participants also helped implement those solutions and became “experts by experience” through engaging in the whole co-design process. Second, in terms of the impact of patient engagement with the co-design process whilst the changes championed by patients and carers were often small scale, as co-designers patients provided innovative ideas and solutions. Through their involvement and contributions they also acted as catalysts for broader change in the attitudes of staff by providing a motivation for wider organisational and attitudinal changes.

Research limitations/implications

The research was conducted in two clinical pathways in two NHS trusts. However, the findings complement and add to the growing body of knowledge on experience based co-design.

Practical implications

Patient engagement is likely to require support and facilitation to ensure that patients can play a meaningful role as partners and co-designers in service improvement and implementation. Different roles suited particular individuals, with participants stepping in and out of the co-design process at various stages as suited their needs, capacities and (albeit sometimes perceptions re) skills. In this context, facilitation needs to be sensitive to individual needs and flexible to support involvement.

Social implications

Patients and carers can play active roles in service improvement, particularly where the approach facilitate active engagement as co-designers.

Originality/value

Analysis of the role patients and carers in implementation and improvement.

Details

Journal of Health Organization and Management, vol. 30 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 4 January 2018

Gudbjörg Erlingsdottir, Anders Ersson, Jonas Borell and Christofer Rydenfält

The purpose of this paper is to describe five salient factors that emerge in two successful change processes in healthcare. Organizational changes in healthcare are often…

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2279

Abstract

Purpose

The purpose of this paper is to describe five salient factors that emerge in two successful change processes in healthcare. Organizational changes in healthcare are often characterized by problems and solutions that have been formulated by higher levels of management. This top-down management approach has not been well received by the professional community. As a result, improvement processes are frequently abandoned, resulting in disrupted and dysfunctional organizations. This paper presents two successful change processes where managerial leadership was used to coach the change processes by distributing mandates and resources. After being managerially initiated, both processes were driven by local agency, decisions, planning and engagement.

Design/methodology/approach

The data in the paper derive from two qualitative case studies. Data were collected through in-depth interviews, observations and document studies. The cases are presented as process descriptions covering the different phases of the change processes. The focus in the studies is on the roles and interactions of the actors involved, the type of leadership and the distribution of agency.

Findings

Five factors emerged as paramount to the successful change processes in the two cases: local ownership of problems; a coached process where management initiates the change process and the problem recognition, and then lets the staff define the problems, formulate solutions and drive necessary changes; distributed leadership directed at enabling and supporting the staff’s intentions and long-term self-leadership; mutually formulated norms and values that serve as a unifying force for the staff; and generous time allocation and planning, which allows the process to take time, and creates room for reevaluation. The authors also noted that in both cases, reorganization into multi-professional teams lent stability and endurance to the completed changes.

Originality/value

The research shows how management can initiate and support successful change processes that are staff driven and characterized by local agency, decisions, planning and engagement. Empirical descriptions of successful change processes are rare, which is why the description of such processes in this research increases the value of the paper.

Details

Journal of Health Organization and Management, vol. 32 no. 1
Type: Research Article
ISSN: 1477-7266

Keywords

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