Patients' conceptions of quality care and barrier care.

AIM: To describe patients' conceptions of quality care and barrier care. METHODS: As this study concerned conceptions of care, a phenomenographic approach was chosen. Fourteen adult orthopaedic patients participated. Data-collection was performed by means of semi-structured interviews. The qualitative data were analysed with two foci, conceptions of quality care and conceptions of barrier care. Different categories of understanding, that is, conceptions, constitute the the essential outcome of phenomenographic analysis. The research was conducted in one county hospital and in one regional hospital situated in different cities in the south of Sweden. RESULTS AND CONCLUSIONS: Patients' conceptions of quality care resulted in six categories. When comparing the findings with previous research in this field, the findings of the present study confirmed to a large extent the findings from other studies of quality care. Patients' conceptions of barrier care resulted in five categoris. The conceptions of barrier care must be considered as elements in patients' conceptions of quality care, and this must be called atention to in efforts to measure patient satisfaction and in analyses of good care. It also can influence health care workers' compliance to guidelines in infection control procedures.

Blood exposure: factors promoting health care workers' compliance with guidelines in connection with risk.

BACKGROUND: Health care workers compliance with guidelines, universal precautions, in connection with tasks that could involve contact with patient's blood is unsatisfactory. In a previous paper, we identified different forces that undermine compliance. Socialization into infection control, routinization, stereotyping, perceptions of patients' wishes and the presence of competing values and norms are examples of such forces. AIMS AND OBJECTIVES: The aim of this article is to describe and analyse different forces that promote adherence to universal precautions. Behavioural variations are seen as a consequence of differences between wards with regard to the safety culture. Safety culture is conceptualized as the outcome of a constant interplay between deactivating and reactivating forces. In this article the focus is on the latter. METHOD: The grounded theory approach. Data were collected through interviews with nurses and assistant nurses. RESULTS: The charge nurse, informal leaders, students, infection control nurses, type of work, availability of equipment, blood-exposure incidents and media-coverage of infectious diseases are described as potentially important for compliance. The properties these agents must possess in order to be influential are also described. RELEVANCE TO CLINICAL PRACTICE: The outcome of an occupationally acquired infection can be fatal. Hence it is important that health care workers take protective measures. The results imply that mere information about safe practices alone is insufficient to achieve that goal. All factors of importance for compliance must be taken in to consideration in clinical work and in education.

Health care workers' action strategies in situations that involve a risk of blood exposure.

Previous research shows that health care workers (HCWs) often act in a risky way in blood-exposure situations, and thereby run the risk of becoming infected by blood-borne pathogens. A qualitative study was conducted in order to describe factors that influence HCWs' actions in such situations. Nurses and nursing assistants were interviewed. The analysis shows that HCWs perceive that there is a conflict among different demands. These demands are protecting the patient's privacy, protecting themselves from being infected and respecting the norms of the department. The process of managing this conflict is labelled 'balancing', which most often results in the choice of a diagnosis-related strategy.