Conceptions of professional work in contemporary health care-Perspectives from registered nurses in somatic care: A phenomenographic study.

AIMS AND OBJECTIVES: To explore the variation of registered nurses' conceptions of the professional work in contemporary somatic health care. BACKGROUND: The turnover of registered nurses has consistently been high in recent years. This implies that competence is at risk of disappearing from patient care, which might lead to an increase in organisational costs and a decreased quality of care. Therefore, management at all levels within healthcare organisations is trying to find ways to make use of available nursing resources more efficiently. This could imply new views on nurses' professional work in future. DESIGN: Qualitative design with a phenomenographic approach. METHODS: Semistructured interviews with registered nurses in somatic care. RESULT: Four descriptive categories emerged: registered nurse as an expert in nursing, registered nurse as a close collaborator to the patients, registered nurse as a coordinator and leader and registered nurse as an administrator. CONCLUSIONS: The registered nurses' conception of their work is being experts in nursing and having a key role in leading the care forward. They perceive that they are important in coordinating the care to guarantee that the patient receives the right competence. Registered nurses perceive their work to be most important when working in close interaction with the patients, whereas the organisation is perceived as an obstacle to achieve this. RELEVANCE TO CLINICAL PRACTICE: This result may be a contribution to understand what registered nurses conceive is their work. The result can also help identifying factors influencing registered nurses intent to stay. Thus, it is of importance for managers to involve the professionals in the development of clinical care, as well as allowing professionals to influence higher-level organisational changes to ensure quality in care and patient safety.

Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth-a randomized controlled trial.

The aim of this study was to analyse the effects of trauma-focused guided Internet-based cognitive behaviour therapy for relieving posttraumatic stress disorder (PTSD) symptoms following childbirth, a problem that about 3% women encounter postpartum. Following inclusion, 56 traumatized women were randomized to either treatment or to a waiting list control group. Primary outcome measures were the Traumatic Event Scale (TES) and Impact of Event Scale-Reversed (IES-R). Secondary measures were Beck depression inventory II, Patient Health Questionnaire (PHQ-9), Beck Anxiety Inventory, Quality Of Life Inventory and the EuroQol 5 Dimensions. The treatment was guided by a clinician and lasted eight weeks and comprised eight modules of written text. The between-group effect size (ES) was d = .82 (p < .0001) for the IES-R. The ES for the TES was small (d = .36) and not statistically significant (p = .09). A small between-group ES (d = .20; p = .02) was found for the PHQ-9. The results from pre- to post-treatment showed large within-group ESs for PTSD symptoms in the treatment group both on the TES (d = 1.42) and the IES-R (d = 1.30), but smaller ESs in the control group from inclusion to after deferred treatment (TES, d = .80; IES-R d = .45). In both groups, the treatment had positive effects on comorbid depression and anxiety, and in the treatment group also on quality of life. The results need to be verified in larger trials. Further studies are also needed to examine long-term effects.

Patients' perceptions of drug dispensing in a rheumatological in-patient unit.

INTRODUCTION: The dispensing of drugs in medical care systems is, in most countries, strictly regulated, and nurses are responsible for distributing drugs to in-patients. AIM: To describe the perceptions of patients with rheumatic diseases regarding traditional drug dispensing during in-patient care and rehabilitation in a specialized rheumatological care unit. METHOD: Twenty in-patients who stayed in the Spenshult Hospital unit for 3-4 weeks and who were on continuous medication were chosen for the study. The phenomenographic approach was used for the collection and analysis of data. FINDINGS: Three descriptive categories emerged - Relief, Active Participation and Dependence. These descriptive categories comprised: three perceptions for Relief (to experience security, to be 'served', to dare to bother), two for Active Participation (to rely on one's own ability, to search for knowledge) and two for Dependence (lack of independence, lack of information). CONCLUSION: The patients experienced relief due to the nurse assuming responsibility for the medication and its dispensation. Patients expressed a wish to be more active in the management of their medication, as they trusted their own ability. The patients articulated that they were dependent on the nurse to give them the correct medication and they also asked for more information about their medication.