BackgroundEvery year, 14 % of patients in Norwegian hospitals experience adverse events, which often have health-damaging consequences. The government, hospital management and health personnel attempt to minimize such events. Limited research on the first-hand experience of the patients affected is available. The aim of this study is to present patients’ perspectives of the occurrence of, disclosure of, and healthcare organizations’ responses to adverse events. Findings are discussed within a social constructivist framework and with reference to principles of open disclosure policy.MethodsThis qualitative study with an explorative descriptive design included fifteen in-depth interviews with former patients recruited by the Health and Social Services ombudsmen in the two northernmost counties of Norway. Inclusion criteria were as follows: 1) experience of adverse events in connection with surgical, orthopedic or medical treatment in general hospitals; 2) men and women; 3) aged 20–70; and 4) a minimum of one year since the event occurred. Transcribed audio-recorded interviews were analyzed through qualitative content analysis.ResultsThe analysis revealed three main topics regarding patients’ experiences of adverse events: 1) ignored concerns or signs of complications; 2) lack of responsibility and error correction; and 3) lack of support, loyalty and learning opportunities. Patients had to struggle to demonstrate the error that had occurred and to receive the necessary treatment and monitoring in the aftermath of the events.ConclusionsPatient narratives reveal a lack of openness, care and responsibility in connection with adverse events. Conflicting power structures, attitudes and established procedures may inhibit prevention, learning and patient safety work in spite of major efforts and good intentions. Attitudes in day-to-day patient care and organizational procedures should be challenged to invite patients into open disclosure processes and include them in health and safety work to a greater extent. The study’s small sample of self-selected participants limits the generalizability of the findings, and future studies should include a larger number of patients as well as professional perspectives.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3101-2) contains supplementary material, which is available to authorized users.
ObjectivesThis article is based on a pilot study of Finnmark University College's off-campus bachelor programme (BA) for nurses, organised in rural areas. The objectives were to explore whether these courses had contributed to reduced vacancies; whether the learning outcome of the off-campus courses was the same as the on-campus programme, and how the education had influenced the nurses’ professional practice in local health services.Study designIn the study we used mixed strategies in data collection and analyses.MethodsData about course completion, average age, average grades and retention effect were collected in 2009/2010 from 3 off-campus classes and their contemporary on-campus classes. Then 7 of the off-campus nurses were interviewed. A content analytical approach to the data was employed.ResultsWith retention of 93%, the off-campus BA course for nurses has been one of the most effective measures, particularly in rural areas. The employers’ support for further education after graduating seems to be an important factor for the high retention rate. Teaching methods such as learning activities in small local groups influenced the nurses’ professional development. Local training grants, supervision and a local learning environment were important for where they chose their first job after graduation.ConclusionsThe study confirms that nurses educated through off-campus courses remain in the county over time after graduating. The “home-grown” nurses are familiar with the local culture and specific needs of the population in this remote area. The study confirms findings in other studies, that further education is an important factor for nurses’ retention.
This article is based on a study of 20 adults with persistent non-malignant pain histories lasting from three to more than 30 years. A narrative approach was used to investigate how the participants experienced their daily life with persistent pain. Data were collected by in-depth interviews, transcribed verbatim and analysed using a hermeneutic phenomenological approach. The study revealed disjunctions in the participants' lives between the temporal structure of pain experience, and the common, social time. The results were, first, the temporal unpredictability of the informants' pain experience, which constituted an obstacle to communicating the pain; second, the importance in health care provision of the patients' pain history. Pain invaded the participants' lives insidiously, and forced their consciousness episodically away from the common world. This temporal ''confinement'' caused problems of relating their pain experiences in objective time. The participants used narratives, metaphors, and emphatic expressions. When health care providers focussed on the here-and-now situation, the unpredictable though long-term character of the pain was disregarded. Several participants told of disappointing meetings with professionals, and of ineffective treatments. The importance of telling the whole pain history was emphasized. Through exploring and explicating their experiences in narratives, some participants expressed that their temporal perspective was being extending to future possibilities. The article concludes that professionals should give attention to the temporal development of pain, by listening with empathy and imagination to gain an understanding of how their patients' lives have evolved. When patients are given time to ''tell the whole story'', the professionals and the patients may develop and share a temporally continuous perspective that spans past, present and future.
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