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  • 1. Good practice: how nurses in a rehabilitation unit are coping with differing views on the nature of knowledge Vestfold University College Master in health promotion Lene Stavnar and Monica Vestå
  • 2. Theoretical framework • Bolman, Lee G. & Deal, Terrence E. Reframing organizations. Artistry, Choice and Leadership • Hanson, Anders. Workplace health promotion • Green, Jackie & Tones, Keith. Health Promotion. Planning and strategies • Grimen, Harald & Terum, Lars I. Evidence based professional practice • Schön, Donald A. The reflective practitioner. How professionals think in action
  • 3. Research questions • How can internal control systems and clinical judgements promote good nursing practice in a rehabilitation unit? 1. How is the internal control system in the unit organized? 2. In what way do the nurses in the unit use their clinical judgement? 3. How do the internal control system and the clinical judgement interact?
  • 4. Health promotion perspectives The settings approach Re-orienting health service (Ottawa-charter)
  • 5. Reseach setting Sample: • A municipal rehabilitation centre for hospital patients • Informants: nurses, nurse assistants, physiotherapist, occupational therapist, leader
  • 6. Methods • Observation • Interdisciplinary workshop • Individual interviews of six nurses
  • 7. Data analysis • Inductiv approach • Main categories: - Internal control system - Clinical judgement
  • 8. Codes •Competance and experience •Comprehension of clinical judgement •Course of treatment •Documentation •Relatives and family •Decisions •Targets •Interdisiplinary collaboration •Patient in focus •Patient participation •The nurse`s role •Time •Communication and information •Leadership •Ethical perspectives •Culture •Quality •Good practice •Coordination reform •Correct patient group
  • 9. Results. The internal control system •Management ensured that employees had necessary knowledge and competence and that both employees and patients participated in practical work. Routines adapted to rehabilitation were used in daily activities •The unit has systems for identifying possible failure, and the procedures were regularly evaluated. Targets were evaluated to initiate change •Based on clear goals and role descriptions the activities in the rehabilitation unit were planned according to the directives in the Regulations of Internal Control •Procedures were regularly adjusted according to the evaluations and improvement s were made Act h Plan a,b Do c,d,e Check f,g
  • 10. Results. The use of clinical judgement • Comprehension: The combination of theoretical knowledge, experience and intuition • Used continuously • Reflection in- and over- action, both individually and together • Reflection on ethical values and dilemmas
  • 11. Results. Good nursing practice based on the interaction between the internal control system and the nurses clinical judgement The nurse`s role Organizational factors •Primary contact •Cooperation partner •Coordinator •The nurse`s basic values •Leadership •Decisions and targets •Good routines •Time and resources
  • 12. Concluding remarks • Structural balance : The internal control system included an appropriate distribution of top-down and bottom-up elements. Decisions based on experiences and clinical judgement could take place. • Future challenge: The internal control system will determine the nature of the clinical judgements and the way health professionals develop their competence.
  • 13. Workshop