Primary healthcare in transition--a qualitative study of how managers perceived a system change.

BACKGROUND: Primary healthcare in Sweden has undergone widespread reforms in recent years, including freedom of choice regarding provider, freedom of establishment and increased privatisation. The key aims of the reforms were to strengthen the role of the patient and improve performance in terms of access and responsiveness. The aim of this study was to explore how managers at publicly owned primary healthcare centres perceived the transition of the primary healthcare system and the impact it has had on their work. METHODS: In this qualitative study, 24 managers of publicly owned primary healthcare centres in the metropolitan region of Gothenburg were recruited. Semi-structured interviews were conducted and data were analysed using content analysis inspired by Silverman. RESULTS: The analysis revealed two core themes: The transition is perceived as a rapid change, enforced mainly through financial incentives and Prioritisation conflicts arise between patient groups with different needs, demands and levels of empowerment. The transition has produced powerful and rapid effects that were considered to be both positive and negative. While the new financial incentives were seen as a driving force and a tool for change, they also became a stress factor due to uncertainty, competition with other primary healthcare centres and negative feelings associated with staff cutbacks. The shift in power towards the patient improved access and service but also led to more patients with unreasonable demands. Managers found it difficult to prioritise correctly between patient groups with different needs, demands and levels of empowerment and they were concerned about potentially negative effects on less empowered patients, e.g. multi-morbid patients. Managers also experienced shortcomings in their change management skills. CONCLUSIONS: This qualitative study shows the complexity of the system change and describes the different effects and perceptions of the transition from a manager's perspective. This suggests a need for improved follow-up and control in order to monitor and govern system changes and ensure development towards a more effective and sustainable primary healthcare system.

Registered nurses' everyday activities in municipal health care: a study of diaries.

This study described the work content of registered nurses (RNs) employed in municipal health care. Diary notes of three working days from 34 RNs were analysed using content analysis, and a total of 3185 activities were identified. Of these, 2807 were analysed further and grouped by comparing similarities and differences. The content of the RNs' nursing activities consisted of assessing health, giving treatments and conducting check-ups, handling pharmaceuticals and teaching. In the administration category, the content comprised planning and reporting, followed by documentation. The RNs' role in municipal health care is consultative, which reinforces their need for competence in advanced nursing, as well as in leadership and pedagogy. RNs mostly work without colleagues and they are responsible for many seriously ill patients. In order to be confident in providing qualified nursing, specialist nursing education in elderly care is needed.

Nurses' everyday activities in hospital care.

AIM: This study aims at examining nurses' work in somatic and psychiatric wards in a hospital in Sweden. BACKGROUND: It is asked whether the humanistic ideology, emphasizing holistic care and human interaction more than practical skills, which has become widespread in the Swedish nursing education programmes, fits with the actual work that nurses carry out. METHOD: In this study, diaries on work activities were written during 5 days by 30 nurses. RESULTS: It turned out that the nurses generally spend 38% of their working time with patients (nursing) and the remaining time on other activities. Discussion There are certain differences between clinics and they can to some extent be explained by differences in work organization. CONCLUSION: The results in this piece of research indicate that a relatively small proportion of nurses' working time is used for general and specific nursing. It should be asked whether or to what extent the humanistic and holistic perspective taught in nursing education will be utilized in practical nursing.

Registered Nurses' views on their professional role.

AIM: The aim is to study Registered Nurses' opinions and reflections about their work tasks, competence and organization in acute hospital care. BACKGROUND: The definition of the role of nurses has changed over time and it is often discussed whether Registered Nurses have a professional status or not. METHOD: A qualitative research design was used. Data were derived from written reflections on diaries and from focus group interviews. RESULTS: All respondents had difficulties in identifying the essence of their work. It can be argued that being 'a spider in the web' is an important aspect of the nursing profession. CONCLUSION: Registered Nurses tend to regard their professional role as vague. Managers must be considered key persons in defining the professional role of Registered Nurses. IMPLICATIONS FOR NURSING MANAGEMENT: This study contributes to an understanding of the managers' and the importance of nursing education in Registered Nurses professional development.

The everyday work at a Swedish emergency department--the practitioners' perspective.

UNLABELLED: In the everyday work at emergency departments (EDs), the patients being cared for have different needs and perceived symptoms. To meet their need for emergency care, knowledge of the work is important. The aim of this study is to explore the everyday work at a Swedish ED from a practitioner's perspective. METHOD: This study has a qualitative, exploratory design with observations and interviews at two EDs. Data were analysed by content analysis. FINDINGS: The everyday work is characterised by a rapid, short and standardised encounter with limited scope to provide individualised care, which leads to a mechanical approach. It is also characterised by an adaptive approach in which practitioners strive to be adaptable by structuring everyday work and cooperation to achieve a good workflow. CONCLUSIONS: The study shows that the practitioners' encounter with patients and relatives is rapid and of limited duration. The care activities that practitioners mainly perform comprise standard medical management and are performed more mechanically than in a caring way. The practitioners strive to balance the requirements and the realisation of the everyday work through structures and in cooperation with other practitioners, although they work more in parallel than in integrated teams.

The consultative work of occupational therapists working in municipal healthcare.

The work of occupational therapists (OTs) in municipal healthcare has become more consultative in recent years. The aim of this study is to explore the content of the OTs' consultative role in everyday activities in municipal healthcare. The study is based on data consisting of diary notes with additional reflections made by 23 OTs during three days. The data were subjected to content analysis. OTs are contacted via referrals (telephone calls or personal communication) to arrange consultations with patients, relatives, assistant staff, and colleagues. The OTs' consultative work consists of discussion, negotiation, information, or instruction, in relation to the advice and recommendations given. They also provide supervision and support to patients, relatives, and assistant staff. The advice and recommendations are evaluated. Thus, OTs' counselling consists of more than assessments and advice, as it also includes information, instruction, supervision, support, and evaluation. Further investigations are necessary in order to understand the competence that is needed and used in the consultative role of OTs in municipal healthcare. An implication for practice is that the healthcare managers need to support the OTs' possibility to provide supervision and support, especially in relation to assistant staff as they are responsible for everyday rehabilitation.

Impact of the Bologna process in Bachelor nursing programmes: The Swedish case.

The higher education reform in Europe known as the "Bologna Process" implies further harmonisation and integration of nursing programmes into the higher education system. This study explores this process in Sweden, where the development of nursing education into an undergraduate programme started in 1977. The aim of this study was to analyse characteristics of the major subject and its relationship to other subject areas, such as medical sciences and social sciences, in Bachelor level nursing programmes in Sweden following initial implementation of the Bologna process. A constructivist approach and descriptive content analysis were employed to analyse the 2008 nursing curricula and syllabi of 27 undergraduate programmes at 26 Swedish universities and university colleges. The results revealed variation in terms and concepts used for the major subject as well as its scientific foundation, demarcation between the major subject and other subjects included in the study programmes and its relationship to the profession. These variations are linked to the variety of research orientations under debate in the Scandinavian countries: Nursing Science and Caring Science; representing different knowledge domains, focus, challenges and visions for the discipline. Potential implications of basing curricula on a major subject other than Nursing Science in a Bachelor level nursing programme are highlighted.