Background

The aim of this paper is to develop a maturity model (MM) for demand and capacity management (DCM) processes in healthcare settings, which yields opportunities for organisations to diagnose their planning and production processes, identify gaps in their operations and evaluate improvements.

Methods

Informed by existing DCM maturity frameworks, qualitative research methods were used to develop the MM, including major adaptations and additions in the healthcare context. The development phases for maturity assessment models proposed by de Bruin et al. were used as a structure for the research procedure: (1) determination of scope, (2) design of a conceptual MM, (3) adjustments and population of the MM to the specific context and (4) test of construct and validity. An embedded single-case study was conducted for the latter two - four units divided into two hospitals with specialised outpatient care introducing a structured DCM work process. Data was collected through interviews, observations, field notes and document studies. Thematic analyses were carried out using a systematic combination of deductive and inductive analyses - an abductive approach - with the MM progressing with incremental modifications.

Results

We propose a five-stage MM with six categories for assessing healthcare DCM determined in relation to patient flows (vertical alignment) and organisational levels (horizontal alignment). Our application of this model to our specific case indicates its usefulness in evaluating DCM maturity. Specifically, it reveals that transitioning from service activities to a holistic focus on patient flows during the planning process is necessary to progress to more advanced stages.

Conclusion

In this paper, a model for assessing healthcare DCM and for creating roadmaps for improvements towards more mature levels has been developed and tested. To refine and finalise the model, we propose further evaluations of its usefulness and validity by including more contextual differences in patient demand and supply prerequisites.

This article presents a Swedish study on the potential of technology to transform teaching and learning practices in higher education. Sweden is at the forefront of technological innovation and digitalization and when it comes to technology in education this is not an exception. Technology Enhanced Learning (TEL) has emerged as an important pedagogical aspect within higher education in recent years. The term TEL is used to demonstrate teaching experiences that intend to improve such support. Previous research has recognized bottom-up initiatives from academic staff with specialists in technology often addressed by individual enthusiasts. Also, most internal processes regarding digitalization are identified as top-down initiatives driven by policy rather than influenced teachers. Hence, the main aim of this study is to analyse academic teachers´ experiences with digital technologies that support students’ learning in higher education. To support this aim, following research questions are posed: 1) What factors facilitate TEL in teaching in higher education and why? 2) What factors limit TEL in higher education and why? Focus group interviews with 36 academic teachers from two Swedish universities were conducted. Results show that on the one hand teachers experience both benefits and limitations with TEL. On the other hand, important organisational aspects of using TEL are highlighted. The choices that academic teachers face and give expression to do not appear to be a matter of individual choice or stance in teaching situations. These results have relevance globally for all involved in teaching and learning in higher education.

The aim of the study was to explore interprofessional learning among students from nursing, education, and social work programmes in Sweden. Four or five students from each programme participated in focus group interviews. Students were asked in homogenous and mixed groups to judge a fictitious case of a young schoolboy with multiple needs. Interviews were recorded, transcribed, and analysed with content analysis. We found that nursing students focused on nutrition and physi-cal well-being, education students on grades and course, and social work students on context, collaboration, and coordinating activities. Students in the mixed groups described the concept of interprofessional learning as opening their eyes to the need for later collaboration as professionals. To conclude, the study shows that students adopt a narrow professional way of thinking when socialized only within their own discipline as illu-strated by the theme: Body, Grade, Relation, with a risk of not taking full responsibility in a complex case such as a child in need. When exposed to other professions, students expand their perspectives and learn from each other to the benefit of their mutual clients.

BACKGROUND: Patient safety is a major part of nursing care and following patients' medication orders is considered one of the greatest responsibilities of individual nurses and nursing Failure to make safe drug calculations poses serious risks to patient safety. It is therefore important to strengthen nursing students' numeracy skills and conceptual abilities during their education. Research suggests that digital technologies play an increasingly important role in promoting nursing students' knowledge and medication dosage calculation (MDC) skills. The present review aims to identify and critically evaluate research investigating how the use of digital technologies informs the development of nursing students' MDC skills.

METHODS: A systematic literature review was performed within Scopus (Elsevier), Academic Search Elite (Ebsco), Cinahl (Ebsco), ERIC (Ebsco), Web of Science and PubMed. Research papers on MDC using digital technologies were considered for inclusion. Starting from 2843 sources, eighteen research articles met the inclusion criteria.

RESULTS: The results show that use of digital technologies can reduce nursing students' medication errors. Interestingly, web-based courses were the most commonly used digital technologies aimed at developing nursing students' MDC skills. However, such courses had limited impacts the development of these skills.

CONCLUSION: The present review concludes by mapping the current knowledge gaps and making suggestions for further research.

Background

Medical errors are reported as a malpractice claim, and it is of uttermost importance to learn from the errors to enhance patient safety. The Swedish national telephone helpline SHD is staffed by registered nurses; its aim is to provide qualified healthcare advice for all residents of Sweden; it handles normally about 5 million calls annually. The ongoing Covid-19 pandemic have increased call volume with approximate 30%. The aim of the present study was twofold: to describe all malpractice claims and healthcare providers’ reported measures regarding calls to Swedish Healthcare Direct (SHD) during the period January 2011–December 2018 and to compare these findings with results from a previous study covering the period January 2003–December 2010.

Methods

The study used a descriptive, retrospective and comparative design. A total sample of all reported malpractice claims regarding calls to SHD (n = 35) made during the period 2011–2018 was retrieved. Data were analysed and compared with all reported medical errors during the period 2003–2010 (n = 33).

Results

Telephone nurses’ failure to follow the computerized decision support system (CDSS) (n = 18) was identified as the main reason for error during the period 2011–2018, while failure to listen to the caller (n = 12) was the main reason during the period 2003–2010. Staff education (n = 21) and listening to one’s own calls (n = 16) were the most common measures taken within the organization during the period 2011–2018, compared to discussion in work groups (n = 13) during the period 2003–2010.

Conclusion

The proportion of malpractice claims in relation to all patient contacts to SHD is still very low; it seems that only the most severe patient injuries are reported. The fact that telephone nurses’ failure to follow the CDSS is the most common reason for error is notable, as SHD and healthcare organizations stress the importance of using the CDSS to enhance patient safety. The healthcare organizations seem to have adopted a more systematic approach to handling malpractice claims regarding calls, e.g., allowing telephone nurses to listen to their own calls instead of having discussions in work groups in response to events. This enables nurses to understand the latent factors contributing to error and provides a learning opportunity.

Abstract: Aim To describe how complexity science has been integrated into nursing.

Design: A scoping review. Data source/review method Academic Search Elite, Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, PubMed and Web of Science were searched November 2016, updated in October 2017 and January 2020. The working process included: problem identification, literature search, data evaluation, synthesizing and presentation. Results Four categories were found in the included 89 articles: 1) how complexity science is integrated into the nursing literature in relation to nursing education and teaching; 2) patients? symptoms, illness outcome and safety as characteristics of complexity science in nursing; 3) that leaders and managers should see organizations as complex and adaptive systems, rather than as linear machines; and 4) the need for a novel approach to studying complex phenomena such as healthcare organizations. Lastly, the literature explains how complexity science has been incorporated into the discourse in nursing and its development.

Conclusion: The review provided strong support for use in complexity science in the contemporary nursing literature. Complexity science is also highly applicable and relevant to clinical nursing practice and nursing management from an organizational perspective. The application of complexity science as a tool in the analysis of complex nursing systems could improve our understanding of effective interactions among patients, families, physicians and hospital and skilled nursing facility staff as well as of education.

Impact: Understanding complexity science in relation to the key role of nurses in the healthcare environment can improve nursing work and nursing theory development. The use of complexity science provides nurses with a language that liberates them from the reductionist view on nursing education, practice and management.

Purpose: Our aim was to describe Swedish Healthcare Direct (SHD) and its features as a complex system.

Methods: Qualitative interviews were conducted with 20 SHD telenurses, covering their experiences and skills when encountering and advising callers with mental illness. Complexity science was used as an a priori theoretical framework to enhance understanding of the complex nature of telenursing.

Results: SHD was described as a complex system as nurses were constantly interacting with other agents and agencies. During these interactions, dynamic processes were found between the agents in which the nurses adapted to every new situation. They were constantly aware of their impact on the care-seekers, and perceived their encounters with callers with psychiatric illness as "balancing on a thin line". SHD was also described as both an authority and a dumping ground. The openness of the system did not give the nurses possibility to control the number of incoming calls and the callers' intentions.

Conclusions: These new insights into SHD have important implications for organization developers and nursing management in terms of overcoming linear thinking.

The healthcare sector is fast-growing and knowledge-intensive, and to meet the demands associated with it, nursing students must have high levels of self-regulated learning (SRL), metacognition, and general self-efficacy (GSE). In this cross-sectional, correlational study, data were collected from 216 nursing students through a questionnaire. The aims were: 1) to describe the levels of SRL ability, metacognitive ability and GSE among second- and third-year nursing students; 2) to explore the relationships between the SRL ability, metacognitive ability and GSE of second- and third-year nursing students; 3) and to compare SRL ability, metacognitive ability and GSE between second- and third-year nursing students. Nursing students had moderate levels of SRL ability and metacognitive ability, but lower levels of GSE. Positive relationships between SRL ability, metacognitive ability, and GSE were observed. Third-year nursing students had a higher level of SRL ability but lower levels of GSE, compared to second-year students. In terms of metacognitive ability, no significant differences were observed between the student batches. Interventions are required for the improvement of nursing students’ SRL ability, metacognitive ability, and GSE.

AIMS AND OBJECTIVES: To describe telenurses' reflections on their work environment and how it impacts on their nursing care.

BACKGROUND: Telenursing is one of the largest healthcare settings in Sweden today; approximately 5.5 million care-seekers call the designated number-1177-each year. Telenursing is regarded as highly qualified nursing care, and providing care over the telephone is considered a complex form of nursing. Within other fields of nursing, the work environment has been shown to affect the outcome of care, patient safety, nurse job satisfaction and burnout.

DESIGN: The study used a descriptive design and followed the COREQ checklist.

METHODS: Twenty-four interviews were performed and analysed using qualitative content analysis.

RESULTS: The main theme concerned "feeling like a nursing care expert but sometimes being disrespected." The telenurses reported that their work environment supported their work as nursing care experts via the telephone in some respects, but also hindered them. Appreciation and respect they received from the vast majority of callers positively impacted the work environment and contributed to work satisfaction. However, they also felt disrespected by both their employers and healthcare staff; they sometimes felt like a dumping ground. Receiving support from colleagues seemed invaluable in helping them feel like and be a nursing care expert.

CONCLUSION: Work was perceived as cognitively demanding and sometimes exhausting, but appreciation from care-seekers and the feeling of being able to provide qualified nursing care made working as a telenurse worthwhile.

RELEVANCE TO CLINICAL PRACTICE: If telenurses are to perform good nursing care over the telephone, managers must provide them with resources, for example, support, education and opportunities for recovery during shifts. It seems that the role of the 1177 service has not been properly implemented and accepted within the healthcare system, and politicians need to anchor its mission within the healthcare organisation.