lene stavnar nhprc2013
TRANSCRIPT
Good practice: how nurses in a rehabilitation unit are coping with
differing views on the nature of knowledge
Vestfold University CollegeMaster in health promotion
Lene Stavnar and Monica Vestå
Theoretical framework
• Bolman, Lee G. & Deal, Terrence E. Reframing organizations. Artistry, Choice and Leadership
• Hanson, Anders. Workplace health promotion • Green, Jackie & Tones, Keith. Health Promotion.
Planning and strategies• Grimen, Harald & Terum, Lars I. Evidence based
professional practice• Schön, Donald A. The reflective practitioner. How
professionals think in action
Research questions
• How can internal control systems and clinical judgements promote good nursing practice in a rehabilitation unit?
1. How is the internal control system in the unit organized?2. In what way do the nurses in the unit use their clinical
judgement? 3. How do the internal control system and the clinical
judgement interact?
Health promotion perspectives
The settings approachRe-orienting health service (Ottawa-charter)
Reseach setting
Sample:• A municipal rehabilitation centre for hospital patients• Informants: nurses, nurse assistants, physiotherapist,
occupational therapist, leader
Methods
• Observation • Interdisciplinary workshop• Individual interviews of six nurses
Data analysis
• Inductiv approach• Main categories: - Internal control system
- Clinical judgement
Codes
•Competance and experience•Comprehension of clinical judgement•Course of treatment•Documentation•Relatives and family•Decisions •Targets•Interdisiplinary collaboration•Patient in focus•Patient participation
• The nurse`s role • Time• Communication and
information• Leadership• Ethical perspectives• Culture• Quality• Good practice• Coordination reform• Correct patient group
Results. The internal control system
•Management ensured that employees had necessary knowledge and competence and that both employees and patients participated in practical work. Routines adapted to rehabilitation were used in daily activities
•The unit has systems for identifying possible failure, and the procedures were regularly evaluated. Targets were evaluated to initiate change
•Based on clear goals and role descriptions the activities in the rehabilitation unit were planned according to the directives in the Regulations of Internal Control
•Procedures were regularly adjusted according to the evaluations and improvement s were made
Acth
Plan a,b
Do c,d,e
Checkf,g
Results. The use of clinical judgement
• Comprehension: The combination of theoretical knowledge, experience and intuition
• Used continuously• Reflection in- and over- action, both
individually and together • Reflection on ethical values and dilemmas
Results. Good nursing practice based on the interaction between the internal control system and the nurses clinical judgement
The nurse`s role Organizational factors
• Primary contact
• Cooperation partner
• Coordinator
• The nurse`s basic values
• Leadership
• Decisions and targets
• Good routines
• Time and resources
Concluding remarks
• Structural balance : The internal control system included an appropriate distribution of top-down and bottom-up elements. Decisions based on experiences and clinical judgement could take place.
• Future challenge: The internal control system will determine the nature of the clinical judgements and the way health professionals develop their competence.
Workshop