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Staff pooling in healthcare systems–results from a mixed-methods study
No full textThis study examines how staff pooling can be used to create a higher service level at a predetermined total capacity in the healthcare sector. We develop new empirical knowledge through a systematic empirical study, using a mixed-methods approach, with a preliminary interview study followed by a principal quantitative survey study, with data from a multihospital system. The purpose was to explore practical barriers for a staff pooling strategy in healthcare systems. Three barriers were identified:recruitment difficulties, community view, and specialisation. Significant differences in perceived height among these barriers were found. The results from this study have important managerial implications for healthcare systems when implementing a staff pooling approach. This study contributes to the existing literature since, to the best of our knowledge, no previous research has been done where barriers to staff pools are systematically identified using a holistic approach that includes all healthcare professions in a multihospital system. This work was supported by the Jan Wallanders och Tom Hedelius Stiftelse samt Tore Browaldhs Stiftelse [P2017-0052:1].</p
Understanding nursing personnel's health while working in end-of-life care-A hermeneutical study.
No full textAIM: This study aimed to explore nursing personnel's health while working in end-of-life care. INTRODUCTION: End-of-life care is challenging both for nursing personnel and for the healthcare organisation, as retaining nursing staff is difficult. Although end-of-life care involves the risk of burnout, it also encompasses protective factors that can lead to personal and professional development and satisfaction, and that can enable personnel to encounter their own inner selves. In order to focus on the health of nursing personnel we chose the theory of caritative caring as our theoretical perspective. METHOD: A qualitative inductive research design with a hermeneutical approach was chosen to explore nursing personnel's health while working in end-of-life care. Two assistant nurses and six registered nurses with experience in end-of-life care at a palliative care unit participated. The study was approved by a Regional Ethical Review Board. RESULTS: The results are presented on three levels: rational, structural and existential. In the rational level, fellowship and togetherness with colleagues, as well as being able to distinguish between private life and work were important for nursing personnel's strategies for maintaining their health. At the structural level, social togetherness, sharing emotions and being involved in each other's emotions were important for nursing personnel's health. The existential level showed that the nursing personnel's own existential situation was affected when their inner self was emotionally affected by the patients' suffering. The awareness of suffering, life and death made the nursing personnel feel inner security, both as nursing professionals and as human beings. CONCLUSION: A common perspective based on a theory of caritative care may be helpful for retaining nursing personnel. While the study highlights nursing personnel's health while working in an end-of-life care context, the results may also be applicable to nursing professionals' health in other contexts.CC-BY 4.0</p
Gaining acceptance, insight and ability to act : A process evaluation of a preventive stress intervention as part of a transition-to-practice programme for newly graduated nurses
No full textAim: To investigate how NGNs perceived and applied an intervention for preventing stress-related ill health embedded in a transition-to-practice programme when enter-ing their professional life. Design: A qualitative exploratory descriptive design was selected for this study to gain insights and perspectives on the adoption and utilization of the intervention. Methods: In this qualitative methodology process evaluation, semi-structured and audio-recorded interviews were conducted with a sample of 49 nurses. Data were collected between December 2016 and July 2017, and were sorted in NVivo 12 Plus, followed by thematic analysis. Results: The analysis resulted in three change processes stimulated by the intervention: (a) Building acceptance of being new; (b) Gaining insight into professional devel-opment and health and (c) Practical steps for skills development, healthy habits and better-organized work. In addition to the three themes, barriers that hindered the progression of the processes were also described. Each process influenced the development of the others by stimulating a deeper understanding, motivation to change and courage to act. Several barriers were identified, including the use of cognitively demanding intervention tools, fatigue, high work demands, inconvenient work hours and a hostile social climate on the ward. Conclusion: This process evaluation showed that newly graduated nurses used knowledge from the intervention and adopted new behaviours largely in accordance with how the intervention was intended to work. Impact: When entering a new profession, it is crucial to receive a well-thought-out, structured and targeted introduction to the new professional role, tasks and work group. Nurses stated that the intervention increased their understanding of the role as new nurses and their insight into how to develop skills that promoted better functioning and recovery. The intervention also stimulated the development of new health behaviour and some new learning strategies.CC BY 4.0</p
Psychometric Properties of Update Arabic Version of the Trait Hope Scale and the Rosenberg Self-Esteem Scale
No full textHope and self-esteem are crucial components of positive psychology, and there is a lack of tools to assess these concepts in Morocco. Therefore, this study aims to provide the necessary instruments for evaluating hope and self-esteem among Moroccan college students. A total of 1150 college students (444 males, 703 females) completed an updated Arabic version of the Trait Hope Scale (THS) and the Rosenberg Self-Esteem Scale (RSES). The data underwent factorial and reliability analyses, with test-retest reliability assessed using responses from 26 students. Both the THS and RSES revealed a two-factor solution, and Multigroup Confirmatory Factor Analysis (MGCFA) demonstrated measurement invariance with respect to gender. Furthermore, the results indicated good and acceptable internal consistency (α = .85 for THS and α = .70 for RSES) and acceptable temporal stability (r = .72 for THS and r = .76 for RSES). In conclusion, the updated Arabic versions of the THS and RSES exhibited strong psychometric properties and stability. They have been established as valid and reliable tools for assessing hope and self-esteem among Moroccan college students.CC BY 4.0</p
Logistics optimization with 3PL-Integration
No full text Bakgrund – Essity, en framstående aktör inom hygien- och hälsobranschen, står inför utmaningar gällande logistikflödet för konsumentprodukter från produktionsanläggningen i Lilla Edet till kunder i Danmark. Den nuvarande logistikprocessen involverar intern transport med egna lastbilar till externa lager. I detta sammanhang är det av yttersta vikt att säkerställa snabba och kostnadseffektiva leveranser, samtidigt som kundtillfredsställelse upprätthålls. Syfte – Projektet syftar till att analysera och optimera Essitys nuvarande logistikflöde för konsumentprodukter. Fokus ligger på att identifiera potentiella förbättringar för att säkerställa smidiga och effektiva leveranser till den danska marknaden. En central del av studien innefattar även övervägandet av att integrera en tredjepartslogistikpartner (3PL) för att ytterligare förbättra logistikstrukturen. Metod – En omfattande metodik har använts, där både kvalitativa och kvantitativa aspekter har analyserats. Genom intervjuer och observationer har data samlats in för att skapa en holistisk förståelse för nuvarande logistikflöde och eventuella alternativa lösningar. Resultat och diskussion – Den omfattande analysen av Essitys nuvarande logistikflöde avslöjar viktiga insikter. Den befintliga metoden, med intern transport till externa lager, visar sig vara ekonomiskt gynnsam, särskilt när kontrakterade kostnader för externa lager och andra projektrelaterade utgifter för år 2023 beaktas. Det är värt att notera att de ekonomiska data för en alternativ lösning från en potentiell 3PL-leverantör gäller för år 2025. För att förstå möjliga förändringar i kostnader över tid har hänsyn tagits till den potentiella ökningen av kostnaderna för den befintliga metoden. Diskussionen inkluderar också miljöaspekter, där olika lösningar övervägs för att identifiera den mest hållbara och lönsamma strategin för Essitys logistik. Lösning 2, som involverar byggandet av ett nytt lager (green warehouse) och användning av elfordon och HVO-drivna lastbilar, presenterar sig som en hållbar inriktning som kan minska CO2-utsläppen och bidra till Essitys övergripande mål att minska miljöpåverkan. Rekommendationer för Essity – Baserat på resultaten av analysen rekommenderas Essity att genomföra en benchmarking för att undersöka erbjudanden från andra potentiella 3PL- leverantörer. Förhandlingar med det nuvarande externa lagret för att förbättra prisstrukturen bör övervägas, särskilt med tanke på de betydande totala kostnaderna för båda lösningarna. Slutligen bör Essity överväga att göra en strategisk investering i att bygga ett utökat manuellt lager nära det befintliga, vilket kan möjliggöra ökad flexibilitet och kostnadseffektivitet över tiden.Background – Essity, a prominent player in the hygiene and health industry, faces challenges regarding the logistics flow for consumer products from its production facility in Lilla Edet to customers in Denmark. The current logistics process involves internal transportation with company-owned trucks to external warehouses. In this context, ensuring swift and cost- effective deliveries while maintaining customer satisfaction is of utmost importance. Purpose – The project aims to analyze and optimize Essity's current logistics flow for consumer products. The focus is on identifying potential improvements to ensure smooth and efficient deliveries to the Danish market. A central part of the investigation also involves considering the integration of a third-party logistics partner (3PL) to further enhance the logistics structure. Method – A comprehensive methodology has been employed, analyzing both qualitative and quantitative aspects. Through interviews and observations, data has been collected to gain a holistic understanding of the current logistics flow and potential alternative solutions. Results and Discussion – The extensive analysis of Essity's current logistics flow reveals crucial insights. The existing method, involving internal transport to external warehouses, proves to be economically advantageous, especially when considering contracted costs for external warehouses and other project-related expenses for the year 2023. It is worth noting that the economic data for an alternative solution from a potential 3PL provider applies to the year 2025. To understand possible changes in costs over time, considerations have been made for the potential increase in costs for the existing method. The discussion also includes environmental aspects, where different solutions are considered to identify the most sustainable and profitable strategy for Essity's logistics. Solution 2, involving the construction of a new warehouse (green warehouse) and the use of electric vehicles and HVO-driven trucks, presents itself as a sustainable approach that can reduce CO2 emissions and contribute to Essity's overall goal of reducing environmental impact. Recommendations for Essity – Based on the results of the analysis, Essity is recommended to conduct a more in-depth benchmarking to explore offerings from other potential 3PL providers. Negotiations with the current external warehouse to improve the price structure should be considered, especially considering the significant total costs for both solutions. Finally, Essity should contemplate making a strategic investment in building an expanded manual warehouse near the existing one, enabling increased flexibility and cost-effectiveness over time
At the end of life - Nurses’ experience of caring for patients with dementia at a palliative stage
No full textBackground: Caring for patients with dementia at the end of life can be challenging because of the complex nature of the disease. In the later stages of dementia, the patient loses many cognitive functions like communicative skills which leads to difficulties in understanding the patients’ symptoms and needs. Due to these communicative challenges, pain management can be a challenge for the nurse to manage as well. Nurses have the primary responsibility in the care of these patients which is why it is valuable to understand the nurses’ experience of caring for patients with dementia in palliative care. Aim: To describe nurses experience of caring for patients with dementia in palliative care. Method: The study was a literature study with a qualitative approach. Nine scientific articles were chosen from the databases Cinahl and PubMed. The articles were analyzed using Friberg’s five step analysis model. Results: Four major themes were identified during the analysis: Challenging to read and inter-pret non- verbal communication; Challenging to relieve suffering; Relatives both an asset and a challenge and The structure of the organization affected the possibility of good care. Conclusion: The nurses experienced challenges in understanding the patients’ needs because of the patients’ lack of verbal communication, which is why the nurses used their observational skills to read the patients’ non-verbal signs. The nurses felt that there was a need for more training and education for the health care professionals in general to be able to provide a good care to the patients. The relatives of the patients were an asset in understanding the person behind the disease
Directed Energy Deposition Additive Manufacturing and Welding of Duplex Stainless Steel using Laser Beam
No full textDuplex stainless steels (DSSs), with a ferritic-austenitic microstructure, are used in a wide range of applications thanks to their high corrosion resistance and good mechanical properties. However, efficient and successful production and joining of DSS require precise control of processes and an in-depth understanding of the relations between composition, processing thermal cycles, resulting microstructures and properties. In this study welding and direct energy deposition of DSS using a laser beam, resulting weld and component microstructures, and properties are explored. In the first part a lean FDX 27 DSS, showing the transformation-induced plasticity (TRIP) effect, was autogenously laser welded and laser reheated using pure argon or pure nitrogen as shielding gas. The weld metal austenite fraction was 22% for argon-shielding and 39% for nitrogen-shielding in the as-welded conditions. Less nitrides were found with nitrogen-shielding compared to argon-shielding. Laser reheating did not significantly affect nitride content or austenite fraction for argon-shielding. However, laser reheating of the nitrogen shielded weld removed nitrides and increased the austenite fraction to 57% illustrating the effectiveness of this approach. Phase fraction analysis is important for DSS since the balance between ferrite and austenite affects the properties. For TRIP steels the risk of austenite-to-martensite transformation during sample preparation also has to be considered. Ferrite, austenite and martensite were identified and quantified using light optical microscopy (LOM) and electron backscatter diffraction (EBSD) analysis. It was found that mechanical polishing produced up to 26% strain-induced martensite, while no martensite was observed after electrolytic polishing. In the second part a systematic four-stage methodology was applied to develop procedures for additive manufacturing of standard 22% Cr DSS components employing direct energy deposition using a laser beam and wire feedstock (DED-LB/w) combined with the hot wire technology. In the four stages, single-bead passes, a single-bead wall, a block, and finally a cylinder with an inner diameter of 160 mm, thickness of 30 mm, and height of 140 mm were produced. Implementing this methodology with a stepwise increase in the deposited volume and geometrical complexity can successfully be used when developing additive manufacturing procedures for significantly sized metallic components. The as-deposited microstructure was inhomogeneous and repetitive including highly ferritic regions with nitrides and regions with high fractions of austenite. Heat treatment for 1 hour at 1100°C homogenized the microstructure, dissolved the nitrides, and almost balanced the ferrite and austenite phase fractions. Strength, ductility, and toughness were at a high level for the cylinder, comparable to those of wrought type 2205 steel, both as-deposited and after heat treatment. The pitting corrosion resistance revealed that microstructural differences, including ferrite-to-austenite ratio, alloying element distribution in ferrite and austenite , and the presence of nitrides, affected the corrosion resistance of DED-LB/w DSS. It was also shown that alongside the decomposition of ferrite into Fe-rich (α) and Cr-rich (αʹ) phases, clustering of Ni, Mn, and Si atoms are contributing to the 475°C -embrittlement of DSS manufactured by DED-LB/w. This study has illustrated that a laser beam can successfully be used as heat source in processing of DSS both for welding and additive manufacturing. However, challenges like nitrogen loss, low austenite fractions and nitride formation have to be handled by precise process control and/or heat treatment.Duplexa rostfria stål (DSS) med en ferritisk-austenitisk mikrostruktur används inom ett brett spektrum av tillämpningar tack vare hög korrosionsbeständighet och goda mekaniska egenskaper. Effektiv och framgångsrik produktion och sammanfogning av DSS kräver noggrann kontroll av processer och en djupgående förståelse av sambanden mellan kemisk sammansättning, termiska cykler, resulterande mikrostrukturer och egenskaper. I detta arbete studerades svetsning och metalldeponering (direct energy deposition) av DSS med hjälp av laseroch resulterande mikrostrukturer samt egenskaper utvärderades. I den första delen svetsades ett lägre legerat FDX 27 duplex rostfritt stål, som har en TRIP-effekt (transformation-induced plasticity), med laser och laseruppvärmdes med ren argon eller ren kvävgas som skyddsgas. Svetsgodsets austenitandel var 22% för argonskydd och 39% för kvävgasskydd under svetsningen. Färre nitrider observerades med kvävgasskydd jämfört med argonskydd. Laseruppvärmning påverkade inte signifikant nitrid- eller austenitandelen för argonskydd. Dock resulterade laseruppvärmningen av svetsen med kvävgasskydd i minskad nitridandel samtidigt som austenitandelen ökade till 57%, vilket visar effektiviteten av detta tillvägagångssätt. Analys av fasfraktion är viktig för DSS eftersom balansen mellan ferrit och austenit påverkar egenskaperna. För TRIP-stål måste risken för martensitomvandling av austenit under provberedningen också beaktas. Ferrit, austenit och martensit identifierades och kvantifierades med hjälp av ljusoptisk mikroskopi (LOM) och analys med hjälp av diffraktion av bakåtspridda elektroner (EBSD electron backscatter diffraction). Det visade sig att mekanisk polering gav upp till 26% deformationsinducerad martensit, medan ingen martensit observerades efter elektrolytisk polering. I den andra delen användes en systematisk metodik i fyra steg för att utveckla procedurer för additiv tillverkning av standardkomponenter i 22% krom DSS med metalldeponering och laser med svetstråd som tillsatsmaterial (DED-LB/w), kombinerad med varmtrådteknologi. I de fyra stegen tillverkades enkelsträngar, enkelväggar, ett block och slutligen en cylinder med en inre diameter på 160 mm, tjocklek på 30 mm och höjd på 140 mm. Genom att implementera denna metodik med en stegvis ökning av den deponerade volymen och geometrisk komplexitet kan additiva tillverkningsprocedurer framgångsrikt användas för utveckling av metallkomponenter med betydande storlekar. Den deponerade mikrostrukturen var ojämn och innehöll upprepade områden med hög ferrithalt och nitrider samt områden med hög andel av austenit. Värmebehandling i 1 timme vid 1100°C homogeniserade mikrostrukturen, löste upp nitriderna och jämnade nästan ut ferrit- och austenitandelarna. Hållfasthet, duktilitet och seghet var goda för cylindern, jämförbara med de av smidda typer av 2205 DSS, både som deponerad och efter värmebehandling. Gropfrätning och korrosionsmotstånd visade att mikrostrukturella skillnader, inklusive förhållande ferrit till austenit, fördelning av legeringselement i ferrit och austenit och närvaro av nitrider, påverkade korrosionsmotståndet för DED-LB/w DSS. Det visades också att, tillsammans med sönderfallet av ferrit till Fe-rika (α) och Cr-rika (αʹ) faser, bidrar kluster av Ni, Mn och Si-atomer till sprödhet vid 475°C hos DSS tillverkade av DED-LB/w. Detta arbete har visat att en laser framgångsrikt kan användas som värmekälla vid tillverkning av DSS både för svetsning och additiv tillverkning. Utmaningar som kväveutarmning, låga austenitandelar och bildning av nitrider måste dock hanteras genom noggrann processtyrning och/eller värmebehandling.All papers are CC BY 4.0Paper F is submitted.</p
Young men in socially vulnerable residential areas : A qualitative study on young men committing drug-related crimes
No full textUr ett socialarbetarperspektiv ämnar studien att utforska vilka levnadsvillkor som kan bidra med att unga män involveras i drogrelaterad brottslighet i socialt utsatta bostadsområden, där frågor om skyddsfaktorer och riskfaktorer är förekommande. Studien använder sig av stämplingsteorin som ett ramverk. Studien använder en kvalitativ metod genom semistrukturerade intervjuer med socialarbetare för att förstå deras perspektiv på arbetet med unga män som påverkas av drogrelaterad brottslighet. Resultaten tyder på att de vanligaste anledningarna till att unga män engagerar sig i drogrelaterad brottslighet är en bristande föräldraroll, bristande motivation samt svart ekonomi och status. Studien visar också att unga män stigmatiseras och stämplas som "droganvändare" och "brottslingar" av samhället. Stämplingarna kan ha en betydande påverkan på deras identitetsutveckling, självkänsla och livsbana. Studien betonar vikten av att kunna förstå de underliggande orsakerna till drogrelaterad brottslighet, istället för att enbart fokusera på unga mäns avvikande beteenden. Således belyser studien det komplexa samspelet som finns mellan sociala sammanhang och drogrelaterad brottslighet bland unga män i socialt utsatta bostadsområden, vilket uppmanar till en mer nyanserad förståelse av frågan
Integration of Research on Immersive Learning Environments and Education in Welding
No full textThe integration of virtual reality (VR) laboratories into welding education presents an array of potential advantages. It can be used at campus or in distance, and it offers an alternative when access to traditional laboratories is challenging. The economic benefits, including savings on material preparation and energy costs, along with the environmental, health and safety advantages of mitigating exposure to welding fumes, arc radiation, and electrical hazards, add further value and contribute to sustainability in welding education. The work presented here is an example of the integration of education in the areas of welding and informatics and research on immersive learning. A multidisciplinary team worked on the development of an immersive learning environment, including virtual laboratory areas for welding processes as well as for microstructural inspection of welds. During the project, this learning environment, and the contained virtual laboratories, have been implemented by the researchers with the support from IT students, and tested, and improved with the feedback provided by students in welding technology, materials science, and manufacturing courses. Overall, more than twenty students from Informatics have been involved throughout the project, resulting in five bachelor theses, three master theses, three course projects in Immersive computing, and two course projects focusing on web development. The involvement of IT students has not only supported the development of the virtual learning environment, but it has also created new avenues for future research and developments in immersive computing.CC BY NC 4.0</p
Gandalf’s transformation in J. R. R. Tolkien’s The Lord of the Rings : An analysis according to Jung’s individuation theory
No full textIntroduction: Gandalf’s transformation from Grey to White is an impactful moment in The Lord of the Rings (LOTR) trilogy by J. R. R. Tolkien. Gandalf’s reunion with Aragorn, Legolas and Gimli in The Two Towers (642-652), after being assumed dead by the hands of a Balrog in “The Fellowship of the Ring” (Tolkien, The Fellowship of the Ring, 429-431), comes as a surprise both for the fictional characters in question and the reader. It is not only revealed that Gandalf is alive, but that he has returned stronger and wiser than prior to his battle with Balrog. This emerges mainly from his change in attire, from Grey to White: “They all gazed at him. His hair was white as snow in the sunshine; and gleaming white was his robe; the eyes under his deep brows were bright, piercing as the rays of the sun; power was in his hand. Between wonder, joy, and fear theystood and found no words to say” (Tolkien, The Two Towers, 645