Med rena händer i kampen mot VRI : Sjuksköterskors följsamhet till riktlinjer om handhygien: främjande och hindrande faktorer En litteraturöversikt

Bakgrund: Uppkomsten av vårdrelaterade infektioner (VRI) är ett globalt problem. Den vanligaste smittvägen är via personalens händer. Bra handhygien är väsentligt för att minska VRI. Med bättre följsamhet till handhygien kan uppkomsten av VRI minskas, därför har forskning om följsamhet till handhygien och faktorer som inverkar, stort betydelse. Syfte: Syftet var att sammanställa och beskriva aktuell forskning om sjuksköterskors följsamhet till handhygien och vilka faktorer främjar respektive hindrar följsamheten till handhygien. Metod: En litteraturöversikt som baserades på artiklar publicerade de senaste fem åren, från länder som följer Världshälsoorganisationens (WHO) handhygieniska riktlinjer. Sexton artiklar valdes efter kvalitetsgranskning för analys och beskrivning. Artiklarna bearbetades med innehållsanalys. Resultat: Sjuksköterskors följsamhet till handhygien var låg. Följande främjande faktorer identifierades: handhygien efter patientkontakt, materialtillgång, förebilder, utbildning, verbala och visuella påminnelser, positiva individuella attityder, kvinnlig könstillhörighet, yrkesgrupp, specialitet, patientens skydd, arbetskultur och samhällets inställning till handhygien. Följande hindrande faktorer identifierades: hög arbetsbelastning, bristande utbildning, kunskapsbrist, individuella attityder, hudpåverkan, materialtillgång, arbetskultur och samhällets inställning till handhygien, manlig könstillhörighet, yrkesgrupp, specialitet. Slutsats: Enligt resultat rekommenderas: samspelet med kollegor och patienter, stöd av teamarbete ledare, förebilder, materialtillgång, utbildning, påminnelser, intervention med tillgång till information, stöd, resurser och möjligheter för regelbunden kunskapsuppföljning, motivera till handhygien före patientkontakt, involvera patienter.

Must teachers be social workers, as well …? : Reflections on the current teacher role in the Swedish upper secondary school and how it affects teacher training

The Swedish upper secondary school has made a transition from a school for the elite to be a school for everybody. When almost every youth nowadays chooses to continue studying, for some of them this is not what they want to do most of all. However, as there in practice is no choice, there come up problems and many upper secondary school teachers experience a growing frustration. We will here discuss some aspects of the following questions: -  How do upper secondary schoolteachers handle their working-conditions in a new situation? - What possible consequences do this have on teacher education?

Insuring cleaner oceans: the economics of oil pollution prevention

The current system of controlling oil spills involves a complex relationship of international, federal and state law, which has not proven to be very effective. The multiple layers of regulation often leave shipowners unsure of the laws facing them. Furthemore, nations have had difficulty enforcing these legal requirements. This thesis deals with the role marine insurance can play within the existing system of legislation to provide a strong preventative influence that is simple and cost-effective to enforce. In principle, insurance has two ways of enforcing higher safety standards and limiting the risk of an accident occurring. The first is through the use of insurance premiums that are based on the level of care taken by the insured. This means that a person engaging in riskier behavior faces a higher insurance premium, because their actions increase the probability of an accident occurring. The second method, available to the insurer, is collectively known as cancellation provisions or underwriting clauses. These are clauses written into an insurance contract that invalidates the agreement when certain conditions are not met by the insured The problem has been that obtaining information about the behavior of an insured party requires monitoring and that incurs a cost to the insurer. The application of these principles proves to be a more complicated matter. The modern marine insurance industry is a complicated system of multiple contracts, through different insurers, that covers the many facets of oil transportation. Their business practices have resulted in policy packages that cross the neat bounds of individual, specific insurance coverage. This paper shows that insurance can improve safety standards in three general areas -crew training, hull and equipment construction and maintenance, and routing schemes and exclusionary zones. With crew, hull and equipment, underwriting clauses can be used to ensure that minimum standards are met by the insured. Premiums can then be structured to reflect the additional care taken by the insured above and beyond these minimum standards. Routing schemes are traffic flow systems applied to congested waterways, such as the entrance to New York harbor. Using natural obstacles or manmade dividers, ships are separated into two lanes of opposing traffic, similar to a road. Exclusionary zones are marine areas designated off limits to tanker traffic either because of a sensitive ecosystem or because local knowledge is required of the region to ensure safe navigation. Underwriting clauses can be used to nullify an insurance contract when a tanker is not in compliance with established exclusionary zones or routing schemes.