Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care : a cluster randomised study

BACKGROUND: Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention. METHODS: The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention. RESULTS: No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal. CONCLUSIONS: The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44819426.

Abilities and Cultural Understanding through Literature in the EFL Classroom : - A Literature Review

The English language can be seen as a lingua franca of contemporary times. Its spread and use in the globalized world has affected most levels of society and it can be argued that, in current times, English is synonymous with communication. This need for communication has shaped the English as a Foreign Language (EFL) syllabus, which is evident in the Swedish national steering documents for the educational system. For the upper secondary school these documents show an emphasis on communication, on cultural understanding, and also on the use of literature within the EFL classroom. The need to possess communicative abilities and cultural understanding, in connection with the use of literature, has sparked an interest to investigate if and how literature itself can be used as a tool to develop and improve EFL students’ communicative skills and cultural understanding. This literature review thesis analyzes five international research articles from different geographical parts of the Globe. The findings are categorized, compared, synthesized, and finally discussed in order to answer the research questions asked, and also compared with the English subject syllabus for the Swedish upper secondary school. The findings indicate that the analyzed articles share a consensus, to a varied degree, regarding the positive aspects of literature use in the EFL setting. The arguments are that communicative skills and cultural understanding are intertwined - enabling each other to exist, develop, and improve. One cannot exist fully without the other, and literature is a good tool to use to develop and improve these abilities. Literature can help develop all skills needed to acquire and produce both written and spoken English, and it also enables cultural understanding and a broadening of the mind. Where the articles differ somewhat is in the ideas of why literature is a good tool, how to implement literature in the classrooms, and what some of the negative aspects might be. The thesis also brings the lack of Swedish studies within EFL to the readers’ attention, as well as the need to do more research focusing on the students’ perspectives towards literature use in the EFL setting.

Older people's experience of utilisation and administration of medicines in a health- and social care context

BACKGROUND: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care. AIM: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care. DESIGN: A qualitative descriptive study. METHODS: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used. FINDINGS: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process. CONCLUSIONS: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine. RELEVANCE TO CLINICAL PRACTICE: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care.

Från nationsbyggare till global marknadsnomad : Om medborgarskap i svensk utbildningspolitik under 1990-talet

I den här avhandlingen är intresset riktat mot svensk utbildningspolitik och medborgarskap. I tider av globalisering, och med ett etablerat svenskt medlemskap i Europeiska unionen, har det nationella policyskapandet kring utbildningens medborgardanande funktion hamnat under ökat tryck. I studien undersöks hur detta hanteras i svensk utbildningspolitik under 1990-talet, en tid som utmärker sig genom betydande förändringar på utbildningsområdet i Sverige. Frågan är, mera precist, vilken riktning för skolans, enligt lag befästa, uppdrag att fostra demokratiska medborgare som utstakas i svensk utbildningspolitik vid denna tid. Genom att fästa vikt vid mål, visioner och motiv som formuleras i utbildningspolitiska 1990-talstexter klarläggs förståelser av medborgarskap som karaktäriserar svensk utbildningspolitik under denna tid. Även en bredare historisk analys görs, ur vilken historiska målsättningar med skolans medborgarfostran som föregår 1990-talets framträder. Studiens syfte är kritiskt. Förståelserna granskas utifrån vad de innesluter och vad de utesluter, vilka möjliga konsekvenser de kan tänkas få för olika individer och grupper i samhället, och om det finns öppningar för tänkbara alternativ. Studien visar på två historiska skiften vad gäller medborgarskapets innehåll och mening i det inhemska policyskapandet. Det första skiftet äger rum under 1990-talets tidiga del. Då bryts en etablerad samhällsbyggande medborgarroll upp, till förmån för andra mera marknadsorienterade medborgarroller. Under 1990-talets senare del, då marknadsorienteringen förstärks i neoliberal riktning, sker ett andra skifte; en historiskt vedertagen gemenskapstanke – nationen – bryts upp som grund för medborgerlig gemenskap. Denna tanke ersätts av en annan som är globaliseringsinriktad, vilken visar sig ha andra inne- och uteslutande mekanismer för olika individer och samhällsgrupper. Utifrån dessa forskningsrön tecknas avslutningsvis några konturer till ett alternativt sätt att tänka kring medborgarskap och gemenskap. Detta alternativ tar form i ambitionen att, i högre grad än vad som blir synligt i svensk utbildningspolitik, resonera kring möjligheter för ett medborgarskap bortom förhandstecknade indelningsgrunder för ett “vi”. Språk som politisk och samhällelig förändringskraft ges en central betydelse i avhandlingen. I analysen av texternas tal om skolans medborgarfostrande roll undersöks pågående politiska motsättningar när det gäller att vinna tal- och tolkningsföreträde till skolans fostransmål. Utgångarna av dessa motsättningar belyses genom tre områden för medborgarfostran som urskilts som centrala; ett politiskt, ett kulturellt samt ett ekonomi- och arbetslivsriktat. Genom dessa har rådande medborgarskapsdiskurser tagit form, ur vilka de utbildningspolitiska förståelserna av medborgarskap gestaltas och diskuteras.