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.

Det personliga nätverkets funktion : Etablering och underhåll av presonliga nätverk inom ljuddesign för rörlig bild

The aim of this paper was to discover the functions and workings of personal networks and their advantages for self-employed sound designers and producers whose focus was upon the moving image (film, advertising, tv, etc). Investigations on how entrepreneurs develop their networks were made, as well as inquiries on how these networks are used for generating work. Another important aspect perused was whether or not the networks are dependent on specific geographical locations in order to function. A case study and comparative analysis was undertaken, based upon three qualitative interviews with entrepreneurs whose operations shared several similar characteristics. The results pointed out the importance of constantly making new contacts, and maintaining and managing current ones. There was no evidence that traditional marketing strategies or advertising were used by the interviewees. New commissions were often gained from former clients or acquaintances, or through referrals from them. There are definite advantages to having one's business in the geographical area where one's contacts exist. This also makes it easier to keep up these contacts for future prospects. However, it is very feasible to take on contracts, do the job, and to deliver work to clients in far away locations, due to the high speed internet connections available today.Målet med denna uppsats var att ta reda på hur personliga nätverk fungerar och verkar till fördel för egenföretagande ljuddesigers för rörlig bild (Film, Reklam och tv etc.). Hur entreprenörerna utvecklar nätverken utforskades, även hur de används för att generera arbete samt om nätverken bör vara lokaliserade på en speciell plats för att fungera. En fallstudie och komparativ analys utfördes, baserad på tre kvalitativa intervjuer med entreprenörer vars verksamheter liknade varandra på flera plan. Resultatet påvisade vikten av att hela tiden skapa nya kontakter och underhålla befintliga sådana. Inget tydde på att traditionell marknadsföring eller reklam används. Nya uppdrag uppkommer oftast genom tidigare kunder, kontakter eller rekommendationer från dessa. Det finns klara fördelar med att bedriva sin verksamhet i det område där kontakterna finns och det är även lättare att underhålla dem i dessa fall. Det är dock fullt möjligt att åta sig, utföra och leverera uppdrag för befintliga kontakter på långt håll tack vare dagens snabba internetuppkopplingar.

Från generell bild till individuellt ansikte : att hantera oförståelse och stereotypt bemötande i fyra lågstatusyrken

From general images to individual features: managing lack of understanding and stereotypes in four low-status occupations Individuals shape an image of themselves and their surroundings in relation to how they assume that others regard them. In these situations occupation is essential. Categorizations, valuations and rewards associated with occupations are among the most fundamental instruments used for domination in the social world. Hence it is interesting to study how groups and individuals who experience low occupational status manage their social positions. This article, based upon interviews with workers in food industry, waitresses/waiters, storesmen and dustmen, analyzes how the interviewees handle low respect, here expressed as lack of understanding and stereotyping. Three different positions are distinguished, arguing that one of them implies a stronger identification with the occupation than do the other two, which to a greater extent agree with stereotyped images. In the first position, the workers disagree with stereotypes of low-status jobs as apathetic, heavy or simple, and assert that their occupation has specific values such as self-development, qualifications or advantage to society. In the second position, low recognition is avoided through little identification with the occupation. The interviewees separate themselves and who they are from their jobs, and find it ridiculous to speak about it in terms of self-development or qualifications when so many are able to do the job. In the third position, the interviewees emphasize that their own place of work is less heavy than the job in general. Through the third strategy their particular tasks are seen as exceptional and their identification with the occupation is local rather than embedded in a wider occupational identity.

Gravitational self-localization for spherical masses

In this work, I consider the center-of-mass wave function for a homogenous sphere under the influence of the self-interaction due to Newtonian gravity. I solve for the ground state numerically and calculate the average radius as a measure of its size. For small masses, M≲10−17 kg, the radial size is independent of density, and the ground state extends beyond the extent of the sphere. For masses larger than this, the ground state is contained within the sphere and to a good approximation given by the solution for an effective radial harmonic-oscillator potential. This work thus determines the limits of applicability of the point-mass Newton Schrödinger equations for spherical masses. In addition, I calculate the fringe visibility for matter-wave interferometry and find that in the low-mass case, interferometry can in principle be performed, whereas for the latter case, it becomes impossible. Based on this, I discuss this transition as a possible boundary for the quantum-classical crossover, independent of the usually evoked environmental decoherence. The two regimes meet at sphere sizes R≈10−7 m, and the density of the material causes only minor variations in this value.

The Passionate Combining Entrepreneurs

Entrepreneurs are portrayed as salient drivers of regional development and for a number of years nascent entrepreneurs have been studied in a large number of countries as part of the Global Entrepreneurship Monitor project and the Panel Study of Entrepreneurial Dynamics. Scholars have devoted much effort to investigating factors that determine how individuals engage in entrepreneurial activities, with most of the discussion limited to business start-ups. However, since this type of project does not follow identical nascent entrepreneurs over time, limited knowledge exists about their development and whether they stay in this nascent phase for a long time. In practice, it is common for entrepreneurs to run a business and at the same time work in wage work, so-called combining entrepreneurs. In Sweden, almost half of all business owners combine wage work with a business. However, not all combining entrepreneurs will eventually decide to leave the wage work and invest fully in the business. Consequently, much research has focused on the first step of entering entrepreneurship full time, but less has focused on the second step, the transition from the combining phase to full-time self-employment. The aim of this thesis is therefore to contribute to the theory of entrepreneurship by gaining a deeper understanding of combining entrepreneurs and their motives and intentions.   In the context of combining entrepreneurs, the theory of identity, resources and choice overload has been used to examine how entrepreneurs’ age (when starting the business), entrepreneurial tenure (the length of engagement in the side-business), hours spent (weekly involvement in the side-business), involvement in entrepreneurial teams (leading the business with one or more partners) and involvement in networks (business networks) influence their passion for engaging in entrepreneurship while sustaining wage work. Different categories of combining entrepreneurs and their intentions have also been examined.   A survey was administered to 1457 entrepreneurs within the creative sector in two counties in Sweden (Gävleborgs County and Jämtlands County). Since there were no separate mailing lists to only combining entrepreneurs, the survey was sent to all entrepreneurs within the chosen industry and counties. The total response rate was 33.5 percent and of them 57.6 percent combined, yielding 262 combining entrepreneurs who answered the questionnaire. The survey was then followed up with eight focus group interviews and two single interviews to validate the answers from the questionnaire.   The results indicate three types of combining entrepreneurs: nascent – with the intention to leave the combining phase for a transition into full-time self-employment, lifestyle – with the intention to stay in the combining phase, and occasional – with the intention to leave the combining phase for full-time wage work and close down the business. Transitioning fully to self-employment increases with the individual’s age. Also, a positive interactive effect exists with involvement in entrepreneurial networks. The results also indicate that the ability to work with something one is passionate about is the top motive for combining wage work with a side-business. Passion is also more likely to be the main motive behind the combining form among individuals who are older at business start-up, but passion is less likely to be the main motive behind the combining form among individuals who spend more time on the business. The longer the individual has had the side-business, the less likely passion is the main motive behind the combining form, and passion is less likely to be the main motive among those who are part of an entrepreneurial team.

Sjukvårdspersonals upplevelser av underlättande och försvårande faktorer vid förskrivning av fysisk aktivitet på recept, FaR : Intervjustudie

Inledning: Studier påvisar att livsstilsrelaterade sjukdomar ständigt ökar och att fysisk inaktivitet bidrar till detta, likaså att FaR ej används i den utsträckning som det skulle behövas. Syfte: Att belysa för distriktssköterskor vilka underlättande och försvårande faktorer sjukvårdspersonal kan uppleva vid förskrivning av fysisk aktivitet på recept, FaR. Metod: En empirisk fenomenografisk intervjustudie med kvalitativ ansats. Fokusgruppsintervjuer med nio deltagare utfördes på tre vårdcentraler. Huvudresultat: Underlättande och försvårande faktorer framkom inom organisation samt i mötet mellan sjukvårdspersonal och patient, exempelvis stöd från cheferna, utbildning och motiverade patienter var underlättande faktorer. Försvårande faktorer var exempelvis tidsbrist, avsaknad av teamarbete samt negativ inställning till FaR. Konklusion: Chefernas engagemang samt patienternas inställning till fysisk aktivitet och FaR var områden som framkom vara av stor betydelse när sjukvårdspersonal skulle förskriva FaR. Att chefer gav sjukvårdspersonalen resurser för att möjliggöra arbetet med FaR, i form av tid, utbildning och teamarbete ansågs vara en grundläggande faktor. Hälsofrämjande synsätt och prioritering av FaR hos cheferna ger spridning och förankring hos sjukvårdspersonalen. Patienternas inställning till egenvård och fysisk aktivitet var en betydande faktor vid förskrivning av FaR. Där har distriktssköterskor en huvuduppgift i att motivera patienterna till livsstilsförändringar och egenvård samt informera om fysisk aktivitets inverkan på hälsan.

Self-reported conflict management competence among nursing students on the point of graduating and registered nurses with professional experience

Objective: It has been shown that specific competence is necessary for preventing and managing conflicts in healthcare settings. The aim of this descriptive and correlation study was to investigate and compare the self-reported conflict management competence (CMC) of nursing students who were on the point of graduating (NSPGs), and the CMC of registered nurses (RNs) with professional experience. Methods: The data collection, which consisted of soliciting answers to items measuring CMC in the Nurse Professional Competence (NPC) Scale, was performed as a purposive selection of 11 higher education institutions (HEIs) in Sweden. Three CMC items from the NPC Scale were answered by a total of 569 nursing students who were on the point of graduating and 227 RN registered nurses with professional experience. Results: No significant differences between NSPGs and RNs were found, and both groups showed a similar score pattern, with the lowest score for the item: “How do you perceive your ability to develop the group and strengthen competence in conflict management and problem-solving, based on knowledge of group dynamics?”. RNs with long professional experience (>24 months) rated their overall CMC as significantly better than RNs with short (<24 months) professional experience did (p = .05). NSPGs who had experience of international studies during their nursing education reported higher CMC, compared with those who did not have this experience (p = .03). RNs who reported a high degree of utilisation of CMC during the previous month scored higher regarding self-reported overall CMC (p < .0001). Conclusions: Experience of international studies during nursing education, or long professional experience, resulted in higher self-reported CMC. Hence, the CMC items in the NPC Scale can be suitable for identifying self-reported conflict management competence among NSPGs and RNs

Geoprocessing journey-to-work data : delineating commuting regions in Dalarna, Sweden

Delineation of commuting regions has always been based on statistical units, often municipalities or wards. However, using these units has certain disadvantages as their land areas differ considerably. Much information is lost in the larger spatial base units and distortions in self-containment values, the main criterion in rule-based delineation procedures, occur. Alternatively, one can start from relatively small standard size units such as hexagons. In this way, much greater detail in spatial patterns is obtained. In this paper, regions are built by means of intrazonal maximization (Intramax) on the basis of hexagons. The use of geoprocessing tools, specifically developed for the processing ofcommuting data, speeds up processing time considerably. The results of the Intramax analysis are evaluated with travel-to-work area constraints, and comparisons are made with commuting fields, accessibility to employment, commuting flow density and network commuting flow size. From selected steps in the regionalization process, a hierarchy of nested commuting regions emerges, revealing the complexity of commuting patterns.