Medication management in Swedish nursing homes: an ethnographic study of resistance, negotiation and control

Alftberg, Åsa

doi:10.1080/13691457.2020.1870214

Cited by 5 publications

(2 citation statements)

References 41 publications

(43 reference statements)

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“…Nurses are responsible for home healthcare but also have a consultative function of leading the social service team regarding patients' care [8,9]. The NA is Sweden's most common occupation [10], and nurses usually delegate tasks, such as medical administration, to NAs [11][12][13]. As of today, physicians are not employed in the sector.…”

Section: Introductionmentioning

confidence: 99%

Electronic medication administration record (eMAR) in Swedish home healthcare—Implications for Nurses' and nurse Assistants' Work environment: A qualitative study

Karnehed,

Pejner,

Erlandsson

et al. 2024

Scandinavian Caring Sciences

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BackgroundThe electronic medication administration record (eMAR) is an eHealth system that has replaced the traditional paper‐based medication administration used in many healthcare settings. Research has highlighted that eHealth technologies can change working methods and professional roles in both expected and unexpected ways. To date, there is sparse research that has explored how nurses and nurse assistants (NA) in home healthcare experience eMAR in relation to their work environment.AimThe aim was to explore how nurses and nurse assistants experienced their work environment, in terms of job‐demand, control, and support in a Swedish home healthcare setting where an electronic medication administration record had been implemented to facilitate delegation of medical administration.MethodWe took a qualitative approach, where focus groups were used as data collection method. The focus groups included 16 nurses and nine NAs employed in a Swedish municipality where an eMAR had been implemented 6 months before the first focus groups were performed. The analysis adapted the job‐demand‐control‐support model, by condensing the professionals' experiences into the three categories of demand, control, and support, in alignment with the model.ResultsNAs experienced high levels of job demand and low levels of job control. The use of the eMAR limited NAs' ability to control their work, in terms of priorities, content, and timing. In contrast, the nurses described demands as high but manageable, and described having a high level of control. Both professions found the eMar supportive.ConclusionNurses and NAs in home healthcare experienced changes in their work environment regarding demand, control, and support when an eMAR was implemented to facilitate delegation of medical administration. In general, nurses were satisfied with the eMAR. However, NAs felt that the eMAR did not cover all aspects of their daily work. Healthcare organisations should be aware of the changes that digitalisation processes entail in the work environment of nurses and NAs in home healthcare.

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Section: Introductionmentioning

confidence: 99%

Electronic medication administration record (eMAR) in Swedish home healthcare—Implications for Nurses' and nurse Assistants' Work environment: A qualitative study

Karnehed,

Pejner,

Erlandsson

et al. 2024

Scandinavian Caring Sciences

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“…These findings reflect recent suggestions for taking a systems approach with focus on organizational issues in terms of minimizing mistakes related to the medication management process [ 12 ]. Managing medication of nursing home residents is a highly complex task, often implicating a relatively invisible, multidisciplinary, and cross-sectoral team of health care professionals, providers, as well as the residents and their relatives [ 13 ]. However, existing literature remain sparse, heterogenous, and inconclusive when it comes to interventions to improve medication safety in nursing homes [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Safe Medication in Nursing Home Residents Through the Development and Evaluation of an Intervention (SAME): Protocol for a Fully Integrated Mixed Methods Study With a Cocreative Approach

Juhl¹,

Soerensen²,

Kristensen³

et al. 2023

JMIR Res Protoc

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Background Medication safety is increasingly challenging patient safety in growing aging populations. Developing positive patient safety cultures is acknowledged as a primary goal to improve patient safety, but evidence on the interventions to do so is inconclusive. Nursing home residents are often cognitively and physically impaired and are therefore highly reliant on frontline health care providers. Thus, interventions to improve medication safety of nursing home residents through patient safety culture among providers are needed. Using cocreative partnerships, integrating knowledge of residents and their relatives, and ensuring managerial support could be beneficial. Objective The primary aim of the Safe Medication of Nursing Home Residents Through Development and Evaluation of an Intervention (SAME) study is to improve medication safety for nursing home residents through developing an intervention by gaining experiential knowledge of patient safety culture in cocreative partnerships, integrating knowledge of residents and their relatives, and ensuring managerial support. Methods The fully integrated mixed method study will be conducted using an integrated knowledge translation approach. Patient safety culture within nursing homes will first be explored through qualitative focus groups (stage 1) including nursing home residents, their relatives, and frontline health care providers. This will inform the development of an intervention in a multidisciplinary panel (stage 2) including cocreators representing the medication management process across the health care system. Evaluation of the intervention will be done in a randomized controlled trial set at nursing homes (stage 3). The primary outcome will be changes in the mean scale score of an adapted version of the Danish “Safety Attitudes Questionnaire” (SAQ-DK) for use in nursing homes. Patient safety–related outcomes will be collected through Danish health registers to assess safety issues and effects, including medication, contacts to health care, diagnoses, and mortality. Finally, a mixed methods analysis on patient safety culture in nursing homes will be done (stage 4), integrating qualitative data (stage 1) and quantitative data (stage 3) to comprehensively understand patient safety culture as a key to medication safety. Results The SAME study is ongoing. Focus groups were carried out from April 2021 to September 2021 and the workshop in September 2021. Baseline SAQ-DK data were collected in January 2022 with expected follow-up in January 2023. Final data analysis is expected in spring 2024. Conclusions The SAME study will help not only to generate evidence on interventions to improve medication safety of nursing home residents through patient safety culture but also to give insight into possible impacts of using cocreativity to guide the development. Thus, findings will address multiple gaps in evidence to guide future patient safety improvement efforts within primary care settings of political and scientific scope. Trial Registration ClinicalTrials.gov NCT04990986; https://clinicaltrials.gov/ct2/show/NCT04990986 International Registered Report Identifier (IRRID) DERR1-10.2196/43538

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Human Rights and the Ways Relatives Interpret Participation for People with Dementia in Nursing Homes

Ingard,

Sjölund,

Trygged

2024

J. Hum. Rights Soc. Work

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The exercise of self-determination is a human right; however, for people with dementia (PWD), progressive physical and cognitive impairment negatively affects their decision-making processes. For PWD, it is often relatives who make such decisions. This qualitative study included interviews with sixteen relatives of PWD who live in nursing homes. Research questions are as follows: How do relatives understand the participation of PWD who live in nursing homes? How do co-researchers understand participation and the role of relatives? A co-researcher was consulted when the questions were designed. During the interviews with relatives, photos were used to stimulate discussion. Critical situations in nursing homes were discussed with relatives and later interpreted together with a co-researcher. The findings included an understanding of how relatives played a key role in PWD; however, relatives were concerned that PWD were unable to take part in decisions. In addition, relatives named ways that nursing homes opposed human rights, and the co-researchers also highlighted situations that conflicted with human rights. Classifying dementia as a disability at the policy level could strengthen the rights issues of PWD. The key findings of the study are essential for social workers arranging for placement of PWD in nursing homes.

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Medication management in Swedish nursing homes: an ethnographic study of resistance, negotiation and control

Cited by 5 publications

References 41 publications

Electronic medication administration record (eMAR) in Swedish home healthcare—Implications for Nurses' and nurse Assistants' Work environment: A qualitative study

Electronic medication administration record (eMAR) in Swedish home healthcare—Implications for Nurses' and nurse Assistants' Work environment: A qualitative study

Safe Medication in Nursing Home Residents Through the Development and Evaluation of an Intervention (SAME): Protocol for a Fully Integrated Mixed Methods Study With a Cocreative Approach

Human Rights and the Ways Relatives Interpret Participation for People with Dementia in Nursing Homes

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