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Patients’ conceptions of quality care and barrier care
Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
2006 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 12, no 6, 682-691 p.Article in journal (Refereed) Published
Abstract [en]

Aim  To describe patients’ conceptions of quality care and barrier care.

Methods  As this study concerned conceptions of care, a phenomenographic approach was chosen. Fourteen adult orthopaedic patients participated. Data-collection was performed by means of semi-structured interviews. The qualitative data were analysed with two foci, conceptions of quality care and conceptions of barrier care. Different categories of understanding, that is, conceptions, constitute the the essential outcome of phenomenographic analysis. The research was conducted in one county hospital and in one regional hospital situated in different cities in the south of Sweden.

Results and Conclusions  Patients’ conceptions of quality care resulted in six categories. When comparing the findings with previous research in this field, the findings of the present study confirmed to a large extent the findings from other studies of quality care. Patients’ conceptions of barrier care resulted in five categoris. The conceptions of barrier care must be considered as elements in patients’ conceptions of quality care, and this must be called atention to in efforts to measure patient satisfaction and in analyses of good care. It also can influence health care workers’ compliance to guidelines in infection control procedures.

Place, publisher, year, edition, pages
2006. Vol. 12, no 6, 682-691 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-35740DOI: 10.1111/j.1365-2753.2006.00636.xLocal ID: 28386OAI: diva2:256588
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2012-10-25Bibliographically approved
In thesis
1. Blood exposure in health care: health care workers' and patients' experiences
Open this publication in new window or tab >>Blood exposure in health care: health care workers' and patients' experiences
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis was to describe and analyse health care workers' blood-exposure incidents, protective measures, and the motives behind decision making about risks and protective measures. The aim was also to procure knowledge about patients' conceptions about their care, and if precautions taken by the health care workers were included in quaiity care. The methods used were: in study I quantitative method, in studies II and III grounded theory method, and in study IV phenomenographic method.

The aims of study I were to describe and analyse blood-exposure incidents and compliance in relation to recommended serological investigations, universal precautions and incident reporting routines and also to follow up a campaign against blood-exposure. Instruments used were incident report forms (n=473) and questionnaires (n=132), (n=108), (n=517). The majority of the 473 reported blood-exposure incidents came from nurses and the minority from physicians. Incidents occurred most often on hospital wards, the most commonly reported incident being needle-stick injuries, 35% ofwhich occurred during recapping the needle. Medicallaboratory technicians reported significantIy more mucocutaneous incidents than other professionaIs (P<0,01). Serological investigations post-exposure varied and 35% of individuaIs were not tested. In an anonymous questionnaire, the respondents recalled 1180 incidents, although onIy 9% of these were reported. Physicians reported onIy 3% of these, medical laboratory technicians reporting 36%. The under reporting was most common in operation theatres and in anaesthesia. Eighty-one percent believed that the accident could have been avoided if they had followed the recommended clinical practice. Despite knowledge of universal precautions, professionaIs continue to behave in a risky manner, which can result in blood exposure incidents and possibly a blood-borne viral infection.

The aim of study II was to identify factors that influenced health care workers' actions in situations involving a risk of blood-exposure. Nurses and assistant nurses were interviewed (n=15). The analysis showed that there was a conflict between different demands involving protecting the patient's privacy, protecting themselves from being infected and respecting the norms of the department. The process of managing this conflict was labelled 'balancing', which most often resulted in the choice of a diagnosis-related strategy, i.e. a non-compliant behaviour. The underlying causes of how patterns of action are formed by individual and socio-cultural forces resulted in five categories, which were seen as forces that could underrnine compliance.

The aim of study III was to describe and analyse different forces that promote adherence to universal precautions. Nurses and assistant nurses were interviewed (n=15, the same as in study II). The charge nurse, informal leaders, students, infection controi nurses, type of work., availability of equipment, blood-exposure incidents and media-coverage of viral blood-borne infections were described as potentially irnportant for compliance. The properties these agents must possess in order to be influential were also described. The results irnply that information about safe practices alone is insufficient to achieve that goal. All factors of importance for compliance must be taken into consideration in clinical work and in education.

The aim in study IV was to identify and describe patients' conceptions of quality care and of barrier care. The patients (n=14) were adult and treated for orthopaedic reasons. Included in their conceptions of quality care were: Nice manners, mutual achievement, being involved, being cured, being cared for, and having safe care. When comparing these conceptions with previous research about patients' views of quaIity care, the findings confirmed, to a large extent, the findings from other studies. Included in patients' conceptions of barrier care were: Regular use of gloves, regular use of masks and eye-shields, use of gloves in special situations, use of masks and eye-shields in special situations, and keeping clean. The conceptions were of an interpersonal, as well as of a medical-technical nature. Patients' conceptions of barrier care could be included in the category: Having safe care. The frequentIy expressed opinion, among nurses and assistant nurses, that patients may be offended by the use of protective equipment could be refuted.

This thesis has contributed to an improved understanding of the occurrence and handling of blood-exposure incidents. The dynamics of compliance and non-compliance with universal precautions have also been described by means of an attempt to uncover the interplay between deactivators and re-activators in the safety culture on wards. Patients' conceptions about barrier care were shown to be an integrated part of quality care.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2004. 47 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 874
Blood-exposure, needle-stick, compliance, universal precautions, balancing, quaIity care, nursing, patients' conceptions, grounded theory, phenomenography
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-23978 (URN)3529 (Local ID)91-7373-854-9 (ISBN)3529 (Archive number)3529 (OAI)
Public defence
2004-12-09, Berzeliussalen, Hälsouniversitetet, Campus Valla, Linköpings universitet, Linköping, 13:00 (Swedish)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-25Bibliographically approved

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Lymer, Ulla-BrittRicht, Bengt
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