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Bölenius, Karin
Publications (10 of 17) Show all publications
Bölenius, K., Lämås, K., Sandman, P.-O., Lindkvist, M. & Edvardsson, D. (2019). Perceptions of self-determination and quality of life among Swedish home care recipients - across-sectional study. BMC Geriatrics, 19, Article ID 142.
Open this publication in new window or tab >>Perceptions of self-determination and quality of life among Swedish home care recipients - across-sectional study
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2019 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, article id 142Article in journal (Refereed) Published
Abstract [en]

Background: It is acknowledged that preservation of self-determination is very important in order for older adults to experience good quality of life, but to what degree and in what areas people receiving help from home care service experience self-determination is unknown. Few studies have examined the perception of self-determination in relation to quality of life among older adults living at home with help from home care services. Thus, the aim of this study was to explore perceptions of self-determination among older adults living at home with the support of home care services, and to test whether older adults who perceive a higher degree of self-determination also feel they have a better quality of life.

Methods: This cross-sectional study was conducted in one municipality in northern Sweden. A total of 134 older adults (≥ 65 years) were included. Data were collected by means of a survey including questionnaires about background characteristics, self-determination, and health-related quality of life. Descriptive statistics regarding background characteristics for groups with high and low self-determination respectively were presented and the differences between the groups were analyzed using the Chi-square test and the Mann-Whitney U test.

Results: Our main finding shows that the majority of older adults with support from home care services experience self-determination in the dimensions use of time, and self-care. However, a wide variation was found in self-reported self-determination in all dimensions. Results also show that the group with higher self-reported self-determination also reported a greater degree of experienced quality of life in comparison with the group with lower self-reported self-determination.

Conclusions: In line with earlier research, our results found a positive relation between self-determination and quality of life. The results are relevant for the care of older adults and indicate a need of further research. The results presented in this paper could serve as a guide when planning for improved self-determination among older adults in home care service.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Aged care, Health, Home care services, Nursing care, Older adults, Older people, Self-determination, Quality of life
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-160298 (URN)10.1186/s12877-019-1145-8 (DOI)000468889900006 ()31126243 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2019-06-17 Created: 2019-06-17 Last updated: 2019-06-17Bibliographically approved
Gyllencreutz, L., Pedersen, I., Enarsson, E., Saveman, B.-I. & Bölenius, K. (2019). The experience of healthcare staff of incident reporting with respect to venous blood specimen collection practices’. Policy and Practice in Health and Safety, 17(2), 146-155
Open this publication in new window or tab >>The experience of healthcare staff of incident reporting with respect to venous blood specimen collection practices’
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2019 (English)In: Policy and Practice in Health and Safety, ISSN 1477-3996, E-ISSN 1477-4003, Vol. 17, no 2, p. 146-155Article in journal (Refereed) Published
Abstract [en]

Venous blood specimen collection is an important practical task that results in an analysis response that often leads to a clinical decision. Errors due to inaccurate venous blood specimen collection are frequently reported and can jeopardize patient safety because inaccurate specimens may result in a delayed or incorrect diagnosis and treatment. However, few healthcare personnel have written an error report regarding venous blood specimen collection practices. The aim of this study is to describe the experiences of healthcare personnel with incident reporting of venous blood specimen collection practices in primary health care. Our study is based on 30 individual interviews with healthcare personnel from 10 primary health care centres. Data were analysed using qualitative content analyses. Personnel experiences of incident reporting were summarized in three categories; Uncertainties in the planning and organization, High workload and low priority and, A need for support and guidance. More specifically, barriers hinder personnel in reporting mistakes. An interpretation based on the results is that surrounding circumstances within the organization influence whether personnel report mistakes or not. The result indicates a need for parallel systems, to identify and report errors or near-misses to prevent mistakes. Processed incidents should be returned promptly to the personnel to use as a learning experience. Having a valid questionnaire and a key person to write an incident report, might reduce the burden on the health care staff and increase the numbers of incident reports and patient safety.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Health care, incident reporting, patient safety, venous blood specimen collection
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-163716 (URN)10.1080/14773996.2019.1640963 (DOI)
Available from: 2019-10-02 Created: 2019-10-02 Last updated: 2019-10-08Bibliographically approved
Willman, B., Grankvist, K. & Bölenius, K. (2018). Evaluation of the clinical implementation of a large-scale online e-learning program on venous blood specimen collection guideline practices. Clinical Chemistry and Laboratory Medicine, 56(11), 1870-1877, Article ID /j/cclm.ahead-of-print/cclm-2018-0051/cclm-2018-0051.xml.
Open this publication in new window or tab >>Evaluation of the clinical implementation of a large-scale online e-learning program on venous blood specimen collection guideline practices
2018 (English)In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 56, no 11, p. 1870-1877, article id /j/cclm.ahead-of-print/cclm-2018-0051/cclm-2018-0051.xmlArticle in journal (Refereed) Published
Abstract [en]

BACKGROUND: When performed erroneously, the venous blood specimen collection (VBSC) practice steps patient identification, test request management and test tube labeling are at high risk to jeopardize patient safety. VBSC educational programs with the intention to minimize risk of harm to patients are therefore needed. In this study, we evaluate the efficiency of a large-scale online e-learning program on personnel's adherence to VBSC practices and their experience of the e-learning program.

METHODS: An interprofessional team transformed an implemented traditional VBSC education program to an online e-learning program developed to stimulate reflection with focus on the high-risk practice steps. We used questionnaires to evaluate the effect of the e-learning program on personnel's self-reported adherence to VBSC practices compared to questionnaire surveys before and after introduction of the traditional education program. We used content analysis to evaluate the participants free text experience of the VBSC e-learning program.

RESULTS: Adherence to the VBSC guideline high-risk practice steps generally increased following the implementation of a traditional educational program followed by an e-learning program. We however found a negative trend over years regarding participation rates and the practice to always send/sign the request form following the introduction of an electronic request system. The participants were in general content with the VBSC e-learning program.

CONCLUSION: Properly designed e-learning programs on VBSC practices supersedes traditional educational programs in usefulness and functionality. Inclusion of questionnaires in the e-learning program is necessary for follow-up of VBSC participant's practices and educational program efficiency.

Place, publisher, year, edition, pages
Walter de Gruyter, 2018
Keywords
clinical guideline, course evaluation, e-learning, questionnaire survey, venous blood specimen collection
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-147712 (URN)10.1515/cclm-2018-0051 (DOI)000446425900017 ()29750640 (PubMedID)
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2018-10-31Bibliographically approved
Bölenius, K. & Nilsson, K. (2018). Variations in the system influencing venous blood specimen collection practices: sources of pre-analytical errors. Journal of Laboratory and Precision Medicine, 3, Article ID 39.
Open this publication in new window or tab >>Variations in the system influencing venous blood specimen collection practices: sources of pre-analytical errors
2018 (English)In: Journal of Laboratory and Precision Medicine, ISSN 2519-9005, Vol. 3, article id 39Article, review/survey (Refereed) Published
Abstract [en]

Incorrect venous blood specimen collection (VBSC) practices might influence results from blood analyses and thus jeopardize patient safety. A large amount (60–80%) of important decisions in diagnosis, administration and medication are based on laboratory test results, therefore correct VBSC is of most importance. A harmonization of VBSC can lead to accurate collection procedures, rapid and correct diagnosis, and treatment. Correct test results contribute to increased patient safety and enhanced healthcare economy. VBSC errors might be consequences of both human mistakes and cultural factors in relation to the overall system. Variations in the system influencing VBSC practices might originate from international and national structures, local organizational and work cultures, and humans working in the frontline. In order to succeed in reducing sources of errors, it is of utmost importance that leaders and managers take the whole system into consideration when planning interventions in their mission to enhance practice. Thus, the aim of this article was to discuss variation in VBSC practices and how the variation might be a source of VBSC errors.

Place, publisher, year, edition, pages
AME Publishing Company, 2018
Keywords
culture, errors, phlebotomy, systems theory
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-147110 (URN)10.21037/jlpm.2018.04.05 (DOI)
Available from: 2018-04-27 Created: 2018-04-27 Last updated: 2018-11-23Bibliographically approved
Bölenius, K., Lämås, K., Sandman, P.-O. & Edvardsson, D. (2017). Effects and meanings of a person-centred and health-promoting intervention in homecare services: a study protocol of a non-randomised controlled trial. BMC Geriatrics, 17, Article ID 57.
Open this publication in new window or tab >>Effects and meanings of a person-centred and health-promoting intervention in homecare services: a study protocol of a non-randomised controlled trial
2017 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 57Article in journal (Refereed) Published
Abstract [en]

Background: The literature indicates that current home care service are largely task oriented with limited focus on the involvement of the older people themselves, and studies show that lack of involvement might reduce older people's quality of life. Person-centred care has been shown to improve the satisfaction with care and quality of life in older people cared for in hospitals and nursing homes, with limited published evidence about the effects and meanings of person-centred interventions in home care services for older people. This study protocol outlines a study aiming to evaluate such effects and meanings of a person-centred and health-promoting intervention in home aged care services. Methods/design: The study will take the form of a non-randomised controlled trial with a before/after approach. It will include 270 older people >65 years receiving home care services, 270 relatives and 65 staff, as well as a matched control group of equal size. All participants will be recruited from a municipality in northern Sweden. The intervention is based on the theoretical concepts of person-centredness and health-promotion, and builds on the four pedagogical phases of: theory apprehension, experimental learning, operationalization, and clinical supervision. Outcome assessments will focus on: a) health and quality of life (primary outcomes), thriving and satisfaction with care for older people; b) caregiver strain, informal caregiving engagement and relatives' satisfaction with care: c) job satisfaction and stress of conscience among care staff (secondary outcomes). Evaluation will be conducted by means of self-reported questionnaires and qualitative research interviews. Discussion: Person-centred home care services have the potential to improve the recurrently reported sub-standard experiences of home care services, and the results can point the way to establishing a more person-centred and health-promoting model for home care services for older people.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Aged care, Decision making, Health, Home care services, Older people, Person-centred, Quality of life
National Category
Nursing Gerontology, specialising in Medical and Health Sciences Geriatrics
Identifiers
urn:nbn:se:umu:diva-132087 (URN)10.1186/s12877-017-0445-0 (DOI)000397451700001 ()28209122 (PubMedID)
Available from: 2017-03-02 Created: 2017-03-02 Last updated: 2018-06-09Bibliographically approved
Lippi, G., Baird, G. S., Banfi, G., Bölenius, K., Cadamuro, J., Church, S., . . . Simundic, A.-M. (2017). Improving quality in the preanalytical phase through innovation, on behalf of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE). Clinical Chemistry and Laboratory Medicine, 55(4), 489-500
Open this publication in new window or tab >>Improving quality in the preanalytical phase through innovation, on behalf of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE)
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2017 (English)In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 55, no 4, p. 489-500Article in journal (Refereed) Published
Abstract [en]

It is now undeniable that laboratory testing is vital for the diagnosis, prognostication and therapeutic monitoring of human disease. Despite the many advances made for achieving a high degree of quality and safety in the analytical part of diagnostic testing, many hurdles in the total testing process remain, especially in the preanalytical phase ranging from test ordering to obtaining and managing the biological specimens. The Working Group for the Preanalytical Phase (WG-PRE) of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has planned many activities aimed at mitigating the vulnerability of the preanalytical phase, including the organization of three European meetings in the past 7 years. Hence, this collective article follows the previous three opinion papers that were published by the EFLM WGPRE on the same topic, and brings together the summaries of the presentations that will be given at the 4th EFLM-BD meeting “Improving quality in the preanalytical phase through innovation” in Amsterdam, 24–25 March, 2017.

Keywords
errors, innovation, laboratory medicine, preanalytical variability, quality
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-132394 (URN)10.1515/cclm-2017-0107 (DOI)000396011000012 ()
Available from: 2017-03-13 Created: 2017-03-13 Last updated: 2018-06-09Bibliographically approved
Bölenius, K., Vestin, C., Saveman, B.-I. & Gyllencreutz, L. (2017). Validating a questionnaire - prehospital preparedness for pediatric trauma patients. International Emergency Nursing, 34, 2-6
Open this publication in new window or tab >>Validating a questionnaire - prehospital preparedness for pediatric trauma patients
2017 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 34, p. 2-6Article in journal (Refereed) Published
Abstract [en]

In recent decades, prehospital emergency care has undergone extensive development. Today, prehospital emergency nurses (PENs) are well trained and provide advanced care to patients of all ages. Caring for pediatric trauma patients is considered to be particularly demanding. However, in Sweden and internationally, there is a lack of research regarding PENs' preparedness for caring for pediatric trauma patients.

Objective: The development and testing of a questionnaire on self-reported preparedness among PENs caring for pediatric trauma patients in a prehospital emergency setting.

Methods: Questionnaire development included face and content validity tests resulting in 38 questions. Eighteen of these questions were analyzed by test-retest. The content of the questionnaire was statistically analyzed.

Results: Fifteen questions were considered valid after reliability and validity tests. Three questions did not fulfill the stability criteria. The content analyses show a low degree of experience with pediatric trauma patients and half of the participants reported stress symptoms when responding to such alarms.

Conclusion: The questionnaire assessing PENs preparedness caring for pediatric trauma patients in Sweden is considered to be suitable for research and clinical practice to improve the care of pediatric trauma patients and the health of PENs, although further testing of the questionnaire is required.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2017
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-143596 (URN)10.1016/j.ienj.2017.05.003 (DOI)000417589600002 ()28545931 (PubMedID)
Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2018-06-09Bibliographically approved
Edvardsson, D., Backman, A., Bergland, Å., Björk, S., Bölenius, K., Kirkevold, M., . . . Winblad, B. (2016). The Umeå Ageing and health research programme (U-age): exploring person-centred care and health promoting living conditions for an ageing population. Nordic journal of nursing research, 36(3), 168-174
Open this publication in new window or tab >>The Umeå Ageing and health research programme (U-age): exploring person-centred care and health promoting living conditions for an ageing population
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2016 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 36, no 3, p. 168-174Article in journal (Refereed) Published
Abstract [en]

The aim of this article is to describe the Umeå ageing and health research programme that explores person-centred care and health-promoting living conditions for an ageing population in Sweden, and to place this research programme in a national and international context of available research evidence and trends in aged care policy and practice. Contemporary trends in aged care policy includes facilitating ageing in place and providing person-centred care across home and aged care settings, despite limited evidence on how person-centred care can be operationalised in home care services and sheltered housing accommodation for older people. The Umeå ageing and health research programme consists of four research projects employing controlled, cross-sectional and longitudinal designs across ageing in place, sheltered housing, and nursing homes. The research programme is expected to provide translational knowledge on the structure, content and outcomes of person-centred care and health-promoting living conditions in home care, sheltered housing models, and nursing homes for older people and people with dementia.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
health, home care services, housing for the elderly, nursing homes, residential facilities, sheltered housing
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-122764 (URN)10.1177/2057158516645705 (DOI)
Available from: 2016-06-22 Created: 2016-06-22 Last updated: 2018-06-07Bibliographically approved
Nilsson, K., Juthberg, C., Söderberg, J., Bölenius, K., Grankvist, K., Brulin, C. & Lindkvist, M. (2015). Associations between workplace affiliation and phlebotomy practices regarding patient identification and test request handling practices in primary healthcare centres: a multilevel model approach. BMC Health Services Research, 15, Article ID 503.
Open this publication in new window or tab >>Associations between workplace affiliation and phlebotomy practices regarding patient identification and test request handling practices in primary healthcare centres: a multilevel model approach
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2015 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, article id 503Article in journal (Refereed) Published
Abstract [en]

Background: Clinical practice guidelines aim to enhance patient safety by reducing inappropriate variations in practice. Despite considerable efforts to enhance the use of clinical practice guidelines, adherence is often suboptimal. We investigated to what extent workplace affiliation explains variation of self-reported adherence to venous blood specimen collection regarding patient identification and test request handling practices, taking into consideration other primary healthcare centre and individual phlebotomist characteristics. Methods: Data were collected through a questionnaire survey of 164 phlebotomy staff from 25 primary healthcare centres in northern Sweden. To prevent the impact of a large-scale education intervention in 2008, only baseline data, collected over a 3-month period in 2006-2007, were used and subjected to descriptive statistics and multilevel logistic analyses. Results: In two patient identification outcomes, stable high median odds ratios (MOR) were found in both the empty model, and in the adjusted full model including both individual and workplace factors. Our findings suggest that variances among phlebotomy staff can be largely explained by primary healthcare centre affiliation also when individual and workplace demographic characteristics were taken in consideration. Analyses showed phlebotomy staff at medium and large primary healthcare centres to be more likely to adhere to guidelines than staff at small centres. Furthermore, staff employed shorter time at worksite to be more likely to adhere than staff employed longer. Finally, staff performing phlebotomy every week or less were more likely to adhere than staff performing phlebotomy on a daily basis. Conclusion: Workplace affiliation largely explains variances in self-reported adherence to venous blood specimen collection guidelines for patient identification and test request handling practices among phlebotomy staff. Characteristics of the workplace, as well as of the individual phlebotomist, need to be identified in order to design strategies to improve clinical practice in this and other areas.

Keywords
Clinical practice guidelines, Guideline adherence, Nursing, Phlebotomy, Professional socialization, Venous blood specimen collection, Workplace affiliation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-112246 (URN)10.1186/s12913-015-1157-9 (DOI)000364771700001 ()26552430 (PubMedID)
Available from: 2015-12-08 Created: 2015-12-04 Last updated: 2018-06-07Bibliographically approved
Bölenius, K. (2014). Improving venous blood specimen collection practices: method development and evaluation of an educational intervention program. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Improving venous blood specimen collection practices: method development and evaluation of an educational intervention program
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Metoder för förbättrad venprovtagning : utvärdering av ett utbildningsprogram
Abstract [en]

Background: About 60%–80% of decisions regarding diagnosis and treatment are based on laboratory test results. Low adherence to venous blood specimen collection (VBSC) guidelines may lead to erroneous or delayed test results, causing patient harm and high healthcare costs. Educational intervention programs (EIPs) to update, improve and sustain VBSC practices are seldom evaluated. After testing a self-reported venous blood sampling questionnaire, the overall aim of this thesis was to evaluate the impact of a large-scale EIP on healthcare personnel’s VBSC practices.

Methods: The study settings were primary healthcare centres (PHCs) in northern Sweden. Participants were VBSC personnel. Data consisted of a VBSC questionnaire of self-reported practices, records of low-level haemolysis index in serum samples (specimen quality indicator), and interviews reflecting VBSC practices. First, experts on questionnaires and VBSC were consulted, and test-retest statistics were used when testing the VBSC questionnaire for validity and reliability. Thereafter, we evaluated the impact of a short, large-scale EIP with a before-after approach comparing self-reported VBSC questionnaire of two county councils. The personnel of the county councils (n = 61 PHCs) were divided into an intervention group (n = 84) and a corresponding control group (n = 79). In order to test changes in blood specimen quality we monitored haemolysis in serum samples (2008, n = 6652 samples and 2010, n = 6121 samples) from 11 PHCs. Finally, 30 VBSC personnel from 10 PHCs reported their experiences. The interview questions were open-ended with reflective elements and the interviews were analysed by qualitative content analysis.

Results: The VBSC questionnaire was found to be valid and could be used to identify risk of errors (near misses) and evaluate the impact of an EIP emphasising VBSC guideline adherence. The intervention group demonstrated several significant improvements in self-reported practices after the EIP, such as information search, patient rest, test request management, patient identification, release of venous stasis, and test tube labelling. The control group showed no significant improvements. In total, PHCs showed minor differences in blood specimen quality. Interviews summarized VBSC personnel experiences in the overall theme: education opened up opportunities for reflection about safety.  

Conclusion: This thesis is, to our knowledge, the first to evaluate the impacts of a large-scale EIP on VBSC practices. The VBSC questionnaire and monitoring for low-level haemolysis reflected VBSC practices. The frequently occurring near-miss markers made it possible to compare and benchmark VBSC practices down to the healthcare unit and hospital ward. The short, general EIP opened up opportunities for reflection about safety and improved VBSC practices in PHCs with larger deviations from guidelines. EIPs that provide time for reflection and discussion could improve VBSC further. Directed EIPs focused on specific VBSC flaws might be more effective for some near misses in VBSC practices, while some near misses must be changed at a different level in the system.

Clinical relevance: Our results indicate that monitoring and counteracting the near misses in VBSC practices is a well-functioning preventive action. We propose that the VBSC monitoring instruments (VBSC questionnaire & haemolysis index) we used and the EIP strategy proposed should be tested in additional countries with different healthcare settings. It is suggested that a national program intended to identify near misses and prevent VBSC errors be developed in the healthcare system. General e-learning programs may be cheaper than, and as effective as, the EIP program and may be performed everywhere and any time. Systematic planning, useful for reflection and with focus on the specific elements in a skill, together with VBSC guidelines, could probably increase improvements. Our studies have led to deeper and extended knowledge of the impact of an EIP on VBSC practices. Our results can be used when considering future VBSC practice interventions. Using a model for practical skills in nursing to describe VBSC in a more holistic and less technical way might highlight VBSC as a practical nursing skill.

Abstract [sv]

Bakgrund: Av kliniska beslut angående diagnostik och behandling baseras 60%–80% på laboratorieresultat. Därför är det helt nödvändigt att laboratorieresultat är tillförlitliga. Låg följsamhet till provtagnings anvisningar kan leda till felaktiga och fördröjda analysresultat, förorsaka skada och lidande för patienter och utgöra en stor kostnad för hälso- och sjukvården. Felaktiga provsvar beror till stor del på felaktig provtagning och provhantering och går oftast att undvika. Interventioner som avser att uppdatera och säkra korrekt venprovtagning kan leda till förbättringar men genomförda interventioner har sällan utvärderats. Efter att en enkät för självrapporterad venprovtagning testats för validitet och reliabilitet genomfördes ett omfattande interventionsprogram som utvärderades med hjälp av den testade enkäten och andra utvärderingsmått. Det övergripande syftet var att utvärdera i vilken utsträckning interventionsprogrammet påverkade provtagande personals praktiska utförande av venprovtagning.

Metoder: Studierna i denna avhandling omfattade provtagande personal vid hälsocentraler i norra Sverige. För datainsamling användes en enkät som mäter självrapporterad venprovtagning, förekomst av låggradig hemolys (indikator på blodprovets kvalitet) och intervjuer. Initialt testades enkätens förmåga att mäta vad som avsetts (validitet) och testades enkätens förmåga att vid upprepade mätningar vara tillräckligt stabil (reliabilitet) för att användas i interventionsstudier. Därefter utvärderades ett kort men storskaligt interventionsprogram i preanalys inkluderande venprovtagning med före och efter mätningar. Vi jämförde provtagande personal från två landsting vid 61 hälsocentraler. Landstingens personal delades upp i en interventionsgrupp (n=84) och en motsvarande kontrollgrupp (n = 79). För att mäta kvaliteten av blodproverna extraherades uppgifter om hemolys i serumprover (2008, n = 6652 blodprov) och (2010, n = 6121 blodprov) från elva hälsocentraler i ett landsting. Slutligen, intervjuades 30 provtagande personal från 10 hälsocentraler efter att de deltagit i interventionsprogrammet. Intervjuerna var öppna och genererade korta berättelser och analyserades med innehållsanalys.

Resultat: Venprovtagningsenkäten befanns vara valid och kan användas för att utvärdera personalens följsamhet till provtagningsanvisningar i venprovtagning och identifiera riskhändelser. Interventionsgruppen visade flera signifikanta förbättringar i självrapporterat utförande av venprovtagning såsom förbättrad informationssökning, vila inför provtagning, remissförfarande, kontroll av patientidentitet, användning av stas och etikettering av provrör. Kontrollgrupen visade inga signifikanta förbättringar. Blodprovskvaliteten visade små skillnader. Provtagande personals erfarenheter från intervjuerna sammanfattades i ett övergripande tema; utbildningsinsatsen öppnade upp möjligheter för reflektion om säkerhet.  

Slutsats: Avhandlingen är så vitt vi vet den första att utvärdera effekten av ett storskaligt interventionsprogram med hjälp av självrapporterat utförande av venprovtagning och blodprovers kvalitet (låggradig hemolys). Med dessa metoder ökar andelen riskhändelser så att jämförelser kunde göras även på enhetsnivå och avdelningsnivå. Utbildningsprogrammet öppnade upp för reflektioner om säkerhet och förbättrade utförande av venprovtagning vid enheter med större brister. Utbildningsprogram som öppnar upp för reflektion och diskussion kan leda till ökad patientsäkerhet i hälso- och sjukvården. Trots utfallet av resultaten, är riktade utbildningsinsatser för sjukvårdsenheter som uppvisar specifika brister troligtvis mer effektiva än breda utbildningsinsatser.

Klinisk betydelse: Interventionsprogram avseende preanalys och venös provtagning förbättrade personalens praktiska utförande. Monitorering av och åtgärder för att minska riskhändelser är väl fungerande preventiva åtgärder. Instrumenten (självrapporterande enkät och hemolys) bör också testas i andra kontexter inom hälso- och sjukvården. Ett externt nationellt program för att identifiera och förebygga riskhändelser bör utvecklas i hälso- och sjukvården. Interventioner i form av e-lärande kan då vara ett alternativ som är billigt och effektivt. Dessutom kan systematisk planering och genomförande med fokus på reflektion av specifika delar i en färdighet vara effektivt för att uppnå förbättringar. Våra studier har bidragit till en djupare och utökad kunskap om effekten av ett interventionsprogram på utförande av venprovtagning. Resultaten kan användas vid framtida planering av utbildningsinsatser. Modeller för praktiskt färdighetsutövande inom omvårdnad kan beskriva venprovtagning ur ett helhetsperspektiv och synliggöra venprovtagning som en viktig praktisk färdighet inom omvårdnad.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. p. 63
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1637
Keywords
Education, Experiences, Guideline adherence, Haemolysis, Intervention, Patient safety, Phlebotomy, Practical skills, Preanalytical errors, Primary healthcare, Questionnaires, Reliability and validity, Venous blood specimen collection
National Category
Nursing
Research subject
Caring Sciences; Clinical Chemistry
Identifiers
urn:nbn:se:umu:diva-87015 (URN)978-91-7601-023-5 (ISBN)
Public defence
2014-04-11, Vårdvetarhusets aula, Umeå universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Projects
Preanalys
Available from: 2014-03-21 Created: 2014-03-18 Last updated: 2018-06-08Bibliographically approved
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