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Implementation of a New Working Method in Psychiatric Care
University West, Department of Health Sciences, Specialist Nursing programme.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The implementation of evidence-based methods in hospital settings is challenging and multifaceted. There are several different factors that may affect implementation processes, of which the organisational culture may be one. It is well known that conservative organisational culture can hinder implementations; accordingly, a mix of different organisational cultures is preferable. Aim: The aim of this thesis was to follow the implementation process of an ICF-based assessment tool regarding cultural differences associated with the implementation in a psychiatric clinic. As part of the project, an assessment tool based on the International classifi cation of functioning disability and health (ICF) was developed and implemented. Method: In Study I, three Swedish expert groups participated and analysis of inter-rater reliability was conducted through simulated patient cases. In Study II, data were collected through focus group interviews pre- and post-implementation of the ICF-based assessment tool; thereafter, data were analysed using directed content analysis guided by Normalization Process Theory (NPT). Data from 109 nursing staff who completed the organisational values questionnaire (OVQ) and resistance to change (RTC) were investigated, and the association between the OVQ and RTC was examined with regression analysis (Study III). Patients n=50 representing the intervention hospital and n=64 representing the control hospital answered the Empowerment scale (ES) and Quality in psychiatric care (QPC-IP) (n=45 from intervention hospital and n=64 from control hospital). Staff n=37 at the control hospital answered the OVQ which was presented as descriptive data (Study IV). Results: Inter-rater reliability of the ICF-based assessment tool (DLDA) displayed acceptable kappa values (Study I). The DLDA tool showed the potential for empowering patients. Furthermore, it was considered useful for dialogues, refl ection and for identifying patients’ strengths. Nonetheless, it was diffi cult to implement it in practice due to contributing factors such as time pressure, heavy workload, stress and lack of routine in using the tool (Study II). The intervention hospital was characterised by an organisational culture of trust, belongingness and fl exibility, i.e. a human relation culture. One ward (I.W.3), however, was not dominated by a human relation culture. This ward had an almost equal mix of different cultures (human relation, open system, internal processes and rational goal) (Study III). The results of Study IV were non-signifi cant; however, it indicated that intervention ward 3 proved to be the most prominent ward regarding patient participation and empowerment among the intervention group. The results suggest hospital wards with equal mix of different cultures is more successful than cultural polarisation. Conclusion: Only one of fi ve wards succeeded in implementing the DLDA successfully (ward 5). Ward number three was the most successful of the inpatient intervention wards. The intent of the DLDA method was considered to be good and its use in a psychiatric nursing context can provide structured support in order to improve the dialogue with the patient, but it was not used in practice in all the studied wards. The organisational culture of the intervention hospital was dominated by human relation properties, however with one exception, ward number three. The results tentatively show that organisational culture may affect outcomes of implementation processes. Consequently, it appears that an equal mix of different cultures are more auspicious than cultural polarisations. The results seems to confi rm previous research, where one ward with a balanced mix of different cultures succeeded best to implement DLDA, of the wards representing psychiatric inpatient care. Ward number three did also show the best results in terms of empowerment and patient participation of the intervention wards. Further research aims to continue developing and conducting psychometric testing of the DLDA tool. The DLDAs impact on patient assessed empowerment and patient participation requires studies on larger populations than the current study

Place, publisher, year, edition, pages
Göteborg: Sahlgrenska akademin , 2015. , p. 66
Keywords [en]
Implementation, Organisational culture, Sweden, ICF, Psychiatric nursing care
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
URN: urn:nbn:se:hv:diva-7936ISBN: 978-91-628-9406-1 (print)OAI: oai:DiVA.org:hv-7936DiVA, id: diva2:847138
Opponent
Available from: 2015-08-19 Created: 2015-08-19 Last updated: 2015-08-19Bibliographically approved
List of papers
1. Culture as a predictor of resistance to change: A study of competing values in a psychiatric nursing context.
Open this publication in new window or tab >>Culture as a predictor of resistance to change: A study of competing values in a psychiatric nursing context.
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2014 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, ISSN 1872-6054 (Online), Vol. 114, no 2-3, p. 156-162Article in journal (Refereed) Published
Abstract [en]

It is well known that a conservative organizational culture can hinder the implementation of new organizational models. Prior to introducing something new it is important to identify the culture within the organization. This paper sets out to detect the feasibility of reform in a psychiatric clinic in a Swedish hospital prior to implementation of a new working method - a structured tool based on the International Classification of Functioning Disability and Health. A survey consisting of two instruments - an organizational values questionnaire (OVQ) and a resistance to change scale (RTC) - was distributed to registered and assistant nurses at the clinic. The association between the organizational subcultures and resistance to change was investigated with regression analysis. The results revealed that the dominating cultures in the outpatient centers and hospital wards were characterized by human relation properties such as flexibility, cohesion, belongingness, and trust. The mean resistance to change was low, but the subscale of cognitive rigidity was dominant, reflecting a tendency to avoid alternative ideas and perspectives. An instrument like the one employed in the study could be a useful tool for diagnosing the likelihood of extensive and costly interventions.

Place, publisher, year, edition, pages
Elsevier Ireland Ltd, Irland, 2014
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-5644 (URN)10.1016/j.healthpol.2013.07.014 (DOI)000331159300007 ()23932351 (PubMedID)2-s2.0-84892680385 (Scopus ID)
Note

Available online 7 August 2013

Available from: 2013-10-17 Created: 2013-10-17 Last updated: 2017-12-06Bibliographically approved
2. Daily Life Dialogue Assessment in Psychiatric Care—Face Validity and Inter-Rater Reliability of a Tool Based on the International Classification of Functioning, Disability and Health
Open this publication in new window or tab >>Daily Life Dialogue Assessment in Psychiatric Care—Face Validity and Inter-Rater Reliability of a Tool Based on the International Classification of Functioning, Disability and Health
2013 (English)In: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 27, no 6, p. 306-311Article in journal (Refereed) Published
Abstract [en]

This article describes the development of an assessment tool based on the International Classification of Functioning Disability and Health (ICF) adapted to a psychiatric nursing context where both the patient and the nurse assess the patient's ability to participate in various spheres of life. The aim was to test psychometric properties, focusing on face validity and inter-rater reliability. Three Swedish expert groups participated. Analysis of inter-rater reliability was conducted through simulated patient cases. The results of an unweighted kappa value of 0.38, a linear weighted kappa value of 0.65 and a quadratic weighted kappa value of 0.73 were considered as acceptable when using simulated patient cases.

National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-5650 (URN)10.1016/j.apnu.2013.08.005 (DOI)000327415500008 ()24238011 (PubMedID)2-s2.0-84887618647 (Scopus ID)
Available from: 2013-10-17 Created: 2013-10-17 Last updated: 2017-12-06Bibliographically approved
3. The process of implementing a new working method - a project towards change in a Swedish psychiatric clinic
Open this publication in new window or tab >>The process of implementing a new working method - a project towards change in a Swedish psychiatric clinic
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2014 (English)In: Journal of Hospital Administration, ISSN 1927-6990, E-ISSN 1927-7008, ISSN 1927-6990, Vol. 3, no 6, p. 174-189Article in journal (Refereed) Published
Abstract [en]

The implementation of evidence-based methods in hospital settings is difficult and complex. The aim of the present study was to highlight the implementation process concerning a new working method, i.e. a new assessment tool, based on the International Classification of Functioning Disability and Health (ICF), among psychiatric nursing staff on five participating wards at a Swedish county hospital. Descriptive, qualitative data were collected through focus group interviews pre- and post-implementation. Data were analysed using directed content analysis, guided by Normalization Process Theory (NPT). The results revealed that just one of the five participating wards met the criteria for a successful implementation process. The results confirm previous studies showing the difficulty of implementation. Although participants agreed with the intention of the model, they were reluctant to apply it in practice. The implementation process seemed to be influenced by factors such as: time pressure; heavy workload; stress; lack of routines in using the tool; lack of nursing staff; as well as cultural characteristics and resistance to change.

Place, publisher, year, edition, pages
Toronto / Canada: Sciedu Press, 2014
Keywords
Implementation, normalization process theory, psychiatric nursing, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nursing Other Social Sciences not elsewhere specified Public Administration Studies
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science; SOCIAL SCIENCE, Public administration
Identifiers
urn:nbn:se:hv:diva-7002 (URN)10.5430/jha.v3n6p174 (DOI)
Available from: 2014-11-17 Created: 2014-11-17 Last updated: 2017-12-05Bibliographically approved
4. A New Working Method in Psychiatric Care: the impact of implementation
Open this publication in new window or tab >>A New Working Method in Psychiatric Care: the impact of implementation
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2016 (English)In: International Journal of Public Administration, ISSN 0190-0692, E-ISSN 1532-4265, Vol. 40, no 3, p. 295-304Article in journal (Refereed) Published
Abstract [en]

An equal mix of organizational cultures is important for a successful implementation process. The aim of this study was to examine the implementation of a new working method in psychiatric hospital wards, representing different cultural characteristics. Descriptive quantitative data were collected at two hospitals (intervention and control). The results revealed one ward characterized by a mix of organizational cultures. This ward, compared with other intervention wards, showed the best results regarding patient assessed empowerment and participation. The result shows tentatively that organizational culture may have an impact on the implementation processes.

Keywords
Empowerment, implementation, organizational culture, patient participation, psychiatric care
National Category
Nursing Psychiatry
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-7935 (URN)10.1080/01900692.2015.1072557 (DOI)
Note

Ingår i avhandling. Published online: 30 Mar 2016

Available from: 2015-08-19 Created: 2015-08-19 Last updated: 2017-12-15Bibliographically approved

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