Dalarna University's logo and link to the university's website

With the purpose of getting an overview of the current research and development in information systems and terminology for nursing practice and outline strategies for the future, an initiative for a workshop was taken at the national level in Sweden by the Section for Nursing Informatics, the Society of Nursing and the Association of Health Professionals in 2007. For the workshop around 30 nurses were invited, representing clinical practice, education, and research. The workshop resulted in recommendations for future strategies to support the development of nursing informatics in Sweden.

STUDY OBJECTIVE: We describe the association between emergency department (ED) crowding and 10-day mortality for patients triaged to lower acuity levels at ED arrival and without need of acute hospital care on ED departure.

METHODS: This was a registry study based on ED visits with all patients aged 18 years or older, with triage acuity levels 3 to 5, and without need of acute hospital care on ED departure during 2009 to 2016 (n=705,699). The sample was divided into patients surviving (n=705,076) or dying (n=623) within 10 days. Variables concerning patient characteristics and measures of ED crowding (mean length of stay and ED occupancy ratio) were extracted from the hospital's electronic health records. ED length of stay per ED visit was estimated by the average length of stay for all patients who presented to the ED during the same day and shift and with the same acuity level. The 10-day mortality after ED discharge was used as the outcome measure. Multivariable logistic regression analyses were conducted.

RESULTS: The 10-day mortality rate was 0.09% (n=623). The event group had larger proportions of patients aged 80 years or older (51.4% versus 7.7%) and triaged with acuity level 3 (63.3% versus 35.6%), and greater comorbidity (age-combined Charlson comorbidity index median interquartile range 6 versus 0). We observed an increased 10-day mortality for patients with a mean ED length of stay greater than or equal to 8 hours versus less than 2 hours (adjusted odds ratio 5.86; 95% confidence interval [CI] 2.15 to 15.94) and for elevated ED occupancy ratio. Adjusted odds ratios for ED occupancy ratio quartiles 2, 3, and 4 versus quartile 1 were 1.48 (95% CI 1.14 to 1.92), 1.63 (95% CI 1.24 to 2.14), and 1.53 (95% CI 1.15 to 2.03), respectively.

CONCLUSION: Patients assigned to lower triage acuity levels when arriving to the ED and without need of acute hospital care on departure from the ED had higher 10-day mortality when the mean ED length of stay exceeded 8 hours and when ED occupancy ratio increased.

Objectives: To explore the type and frequency of activities and multitasking performed by emergency department clinicians.

Methods: Eighteen clinicians (licensed practical nurses, registered nurses and medical doctors), six from each occupational group, at two Swedish emergency departments were followed in their clinical work for 2 h each to observe all their activities and multitasking practices. Data were analysed using qualitative and quantitative content analysis.

Results: Fifteen categories of activities could be identified based on 1882 observed activities during the 36 h of observation. The most common activity was information exchange, which was most often performed face-to-face. This activity represented 42.1% of the total number of observed activities. Information exchange was also the most common activity to be multitasked. Registered nurses performed most activities and their activities were multitasked more than the other clinicians. The nurses’ and doctors’ offices were the most common locations for multitasking in the emergency department.

Conclusion: This study provides new knowledge regarding the activities conducted by clinicians in the emergency department. The most frequent activity was information exchange, which was the activity most often performed by the clinicians when multitasking occurred. Differences between clinicians were found for activities performed and multitasked, with registered nurses showing the highest frequencies for both.

OBJECTIVE: Describe the longitudinal development of crowding and patient/emergency department (ED) characteristics at a Swedish University Hospital.

METHODS: A retrospective longitudinal registry study based on all ED visits with adult patients during 2009-2016 (N = 1,063,806). Patient characteristics and measures of ED crowding (ED occupancy ratio, length-of-stay [LOS], patients/clinician's ratios) were extracted from the hospital's electronic health record. Non-parametric analyses were conducted.

RESULTS: The proportion of unstable patients (triage level 1-2) increased while the proportion of admitted patients decreased. All crowding variables were stable, except for LOS, which increased by 9 min/visit/year (95% CI: 8.8-9.1). LOS for visits by patients ≥ 80 years increased more compared to those 18-79 (248 min vs. 190 min, p < 0.001). Unstable patients increased their median LOS compared to stable patients (triage level 3-5). LOS for discharged patients increased with an average of 7.7 min/year (95% CI: 7.5-7.9) compared to 15.5 min/year (95% CI: 15.2-15.8) for those being admitted.

CONCLUSION: Fewer admissions, despite an increase of unstable patients, is likely related to lack of in-hospital beds and contributes to ED crowding. The increase in median ED LOS, especially for patients in the subgroups unstable, ≥80 years and admitted to in-hospital care reflects this problem.

OBJECTIVE: Emergency department team members frequently need to interact with each other, a circumstance causing multiple interruptions. However, information is lacking about the motives underlying these interruptions and this study aimed to explore clinicians' reasons to interrupt colleagues during emergency department work.

METHOD: Semi-structured interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. The interviews were analyzed inductively using content analysis.

RESULTS: The working conditions to some extent sustained the clinicians' need to interrupt, for example different routines. Another reason to interrupt was to improve the initiator's work process, such as when the initiators perceived that the interruption had high clinical relevance. The third reason concerns the desire to influence the work process of colleagues in order to prevent mistakes and provide information for the person being interrupted to improve patient care.

CONCLUSION: The three identified categories for why emergency department clinicians interrupt their colleagues were related to working conditions and a wish to improve/influence the work processes for both initiators and recipients. Several of the reasons given for interrupting colleagues were done in order to improve patient care. Interruptions perceived as negative to the recipient were mostly related to the working conditions.

OBJECTIVE: Emergency departments consist of multiple systems requiring interaction with one another while still being able to operate independently, creating frequent interruptions in the clinical workflow. Most research on interruptions in health care settings has focused on the relationship between interruptions and negative outcomes. However, there are indications that not all interruptions are negatively perceived by those being interrupted. Therefore, this study aimed to explore factors that influence when a clinician perceives interruptions as non-disturbing or disturbing in an emergency department context.

METHOD: Explorative design based on interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. Data were analyzed using qualitative content analysis.

RESULT: Factors influencing whether emergency department clinicians perceived interruptions as non-disturbing or disturbing were identified: clinician's constitution, external factors of influence and the nature of the interrupted task. The clinicians' perceptions were related to a complex of attributes inherent in these three factors at the time of the interruption. Thus, the same type of interruption could be perceived as either non-disturbing or disturbing contingent on the surrounding circumstances in which the event occurred.

CONCLUSION: Emergency department clinicians' perceptions of interruptions as non-disturbing or disturbing were related to the character of identified influencing factors.

Objectiv.e Frequent interruptions are assumed to have a negative effect on healthcare clinicians’ working memory that could result in risk for errors and hence threatening patient safety. The aim of this study was to explore interruptions occurring during common activities of clinicians working in emergency departments.

Method. Totally 18 clinicians, licensed practical nurses, registered nurses and medical doctors, at two Swedish emergency departments were observed during clinical work for 2 h each. A semistructured interview was conducted directly after the observation to explore their perceptions of interruptions. Data were analysed using non-parametric statistics, and by quantitative and qualitative content analysis.

Results. The interruption rate was 5.1 interruptions per hour. Most often the clinicians were exposed to interruptions during activities involving information exchange. Calculated as percentages of categorised performed activities, preparation of medication was the most interrupted activity (28.6%). Face-to-face interaction with a colleague was the most common way to be interrupted (51%). Most common places for interruptions to occur were the nurses’ and doctors’ stations (68%). Medical doctors were the profession interrupted most often and were more often recipients of interruptions induced by others than causing self-interruptions. Most (87%) of the interrupted activities were resumed. Clinicians often did not regard interruptions negatively. Negative perceptions were more likely when the interruptions were considered unnecessary or when they disturbed the work processes.

Conclusions. Clinicians were exposed to interruptions most often during information exchange. Relative to its occurrence, preparation of medication was the most common activity to be interrupted, which might increase risk for errors. Interruptions seemed to be perceived as something negative when related to disturbed work processes.

Introduction: Dalarna University and the Nursing programme have performed eLearning for a long time and our feeling was that we are good in providing high quality eLearning. However, we wanted to benchmark the education against quality standards for a more objective quality assessment and thus as one of the first Nursing programme in Europe we performed an analysis of the education with support of European Association of Distance Education Universities (EADTU) system. Background and aim: Today, e-learning becomes more established in higher education providing new pedagogical possibilities and support for competence development. This has impacts on students’ and teachers’ roles and responsibility for learning, creation of learning content and activities and forms for interaction. However, it is necessary to assure the quality of eLearning environment and experience provided to the students. The aim of this paper is to describe a quality improvement process regarding eLearning of a Nursing Programme conducted in a blended learning environment. Methods: A systematic Benchmarking process with a bottom-up approach developed by EADTU was used to assess the quality of eLearning. Results: A need of strategies and work processes regarding management, development, implementation and evaluation of eLearning was identified as well as directions regarding teachers’ competence and continuing learning. The awareness of strengths and weaknesses in the nursing programme in relation to eLearning has provided incitement for a continuous quality work. Conclusions: It is essential to have knowledge about the quality of higher education concerning structures, processes and results. Benchmarking can function as a tool to initiate a process of heightened awareness and ongoing quality work. Benchmarking with a bottom-up approach could be a fruitful way of enforcing and maintaining high quality in higher education.

Bakgrund: Behovet av att göra verksamhetsuppföljningar som bland annat grundar sig på individrelaterade åtgärder är stort inom hälso- och sjukvård och omsorg. Inom omvårdnadsområdet finns ett antal klassifikationer främst framtagna i USA. Inom medicinska området finns specialitetsspecifika klassifikationer som till exempel Klassifikation av kirurgiska åtgärder. Någon patientrelaterad, vårdgivaroberoende klassifikation har emellertid inte funnits i Sverige. Socialstyrelsen påbörjade därför ett arbete att utveckla en svensk klassifikation, oberoende av vårdgivarkategori och medicinska specialiteter. Ett första förslag till klassifikation av medicinska åtgärder, KMÅ, presenterades år 2000. Förslaget ansågs inte representera en tillräcklig bredd av åtgärder varför Svensk sjuksköterskeförening, Förbundet Sveriges arbetsterapeuter och Legitimerade sjukgymnasters förbund år 2004 fick ett uppdrag att komplettera och utveckla denna klassifikation att också gälla andra vårdåtgärder än rent medicinska. Syfte: Att utveckla en tvärprofessionell klassifikation som beskriver patientrelaterade åtgärder inom omvårdnad, arbetsterapi och sjukgymnastik. Arbetet skulle inkluderas i en redan fastställd klassifikation med medicinsk inriktning. Metod: En arbetsgrupp bestående av sjuksköterskor, arbetsterapeuter och sjukgymnaster har utvecklat ett förslag till åtgärdsklassifikation – en testmodul - som utgår från komponenterna i WHO:s Klassifikation av funktionstillstånd, funktionshinder och hälsa, ICF. Valet av struktur grundar sig på att åtgärder inom arbetsterapi, omvårdnad och sjukgymnastik sällan har som fokus kroppsstruktur utan snarare individens funktioner, aktiviteter och delaktighet samt omgivningsfaktorer. Ett protokoll för prövning av testmodulen har utformats. Resultat: Socialstyrelsen antog arbetsgruppens förslag i november 2005. I december 2005 publicerade Socialstyrelsen förslaget i form av en testmodul som skall prövas bland annat i klinisk verksamhet under år 2006. Förslaget omfattar ca 250 centrala åtgärder på aggregerad nivå inom de tre verksamhetsområdena. Utifrån resultaten från prövningarna skall förslaget justeras och ytterligare utvecklas. Detta arbete beräknas vara klart under våren 2007 för att integreras till en gemensam tvärprofessionell åtgärdsklassifikation som kan tas i bruk årsskiftet 2007/2008.

The overall aim of the thesis was to study clinical decision making in nursing. This was performed by evaluation of the quality of nurses’ diagnostic statements and comparison of the concordance between nurses and patients’ perceptions of the patients’ nursing needs, as well as patient preferences for participation in clinical decision making. Further, predictors regarding patients’ active participation were investigated. Quasi-experimental, comparative and cross-sectional descriptive study designs were used to collect data in acute care settings from randomly selected patient records (n = 140), nurse-patient dyads (n = 80), and patients discharged from hospital care (n = 428). Data were gathered using questionnaires and review of patient records. The quality of nurses’ diagnostic statements improved by the means of education directed to nurses and implementation of new forms for recording supporting nursing care planning (I). Discrepancies were found concerning patients and nurses’ perceptions about what constitutes a problem for the patient as well as the severity and importance of acting on the problem (II). Further, nurses perceived that their patients preferred to be more active in clinical decision making compared with the patients’ own preferences for participation (III). Gender, education, living situation, and occupation were identified as predictors for preferring an active role in clinical decision making (IV). The conclusions are that the accuracy of diagnostic statements needs to be addressed and validated further through systematic assessment of the patients’ perceptions and preferences concerning the health situation and preferences for participation in clinical decision making. Clinical implications are that nurses need to involve patients in identifying patient problems of relevance for nursing. Further, nurses also need to be aware of patients’ preferences for participation in clinical decision making in order that they can plan care in accordance with patient preferences and allow participation to the degree preferred by the patient

Bakgrund: Patientens delaktighet i planering och genomförande av sin egen vård betonas och ur ett etiskt perspektiv har delaktigheten ett värde i sig själv, som en förutsättning för autonomi och integritet. En samsyn mellan patient och sjuksköterska om patientens roll i beslutsfattandet ökar möjligheten att optimera omvårdnadsinsatserna och främjar en hög kvalitet på vården. Syfte: undersöka patientens delaktighet i beslutsfattande inom omvårdnad, överensstämmelsen mellan patienters och sjuksköterskors uppfattningar, samt prediktorer för att föredra en mer aktiv delaktighet. Material och metod: jämförande design, 15 avdelningar inom sjukhusvård. Urvalet var 80 patient-sjuksköterskepar (studie I) samt 428 nyss utskrivna patienter (studie II). Data insamlad via enkäter. Resultat: Patienterna föredrog att ha en mer passiv roll i kliniskt beslutsfattande om omvårdnad än vad sjuksköterskorna uppfattade. Totalt 37 % av patienterna uppfattade sig ha varit mer passiva och 34 % mer aktiva än vad de själva hade föredragit(studie I). En majoritet av patienterna föredrog att inta en passiv roll i kliniskt beslutsfattande om omvårdnad (studie II) medan 22 % föredrog en aktiv roll. Predicerade faktorer för att inta en aktiv roll var att vara kvinna, ha hög utbildning, bo ensam samt att vara pensionär. Slutsatser: Skillnaden i uppfattningar antyder att sjuksköterskor i högre grad behöver involvera patienterna i en diskussion om patientens preferenser för att nå en samsyn. Mötet och dialogen mellan patient och sjuksköterska är en förutsättning för en god omvårdnad och det bästa sättet att identifiera det individuella perspektivet är genom en systematisk bedömning i dialog.

I ett demokratiskt samhälle är möjligheten till delaktighet och inflytande viktiga frågor vilket också visat sig påverka folkhälsan. Patientens delaktighet i sin egen vård framhålls ofta som en viktig del av en vård med god kvalitet. Vården syftar bl a till att stärka patientens förmåga att hantera sin egen hälsosituation. Men frågan är hur patienterna själva ser på att vara delaktiga. Vill de alltid vara det? Hur överens är patienten och vårdpersonalen om respektive roller? Resultat från en enkätundersökning på 80 respektive 428 patienter kommer att redovisas. Ett resonemang kommer att föras utifrån studier inom somatisk vård.

Patientens delaktighet i planering och genomförande av sin egen vård ses som ett betydelsefullt kännetecken på vårdens kvalitet. Att vara delaktig i beslutsfattande om vård är framförallt viktigt eftersom vård ofta omfattar procedurer och ingrepp som kan utgöra ett hot mot patientens autonomi och integritet. Det är dock inte helt klarlagt hur patienter ser på sin delaktighet och vilken roll i samband med beslutsfattande som de föredrar att ha. Det finns en del beskrivet i litteraturen kring delaktighet i samband med medicinska beslut om vård, men inte så mycket i relation till omvårdnad. Frågan är hur väl vi känner våra patienter i detta avseende, vilken roll vill de ha i beslutsfattandet om sin egen vård. Resultat från två studier om patientens delaktighet i beslutsfattande kommer att diskuteras för att belysa: (1) patientens preferenser för delaktighet, (2) överens-stämmelsen mellan patientens preferenser och upplevd grad av delaktighet, (3) överenstämmelse mellan patientens och sjuksköterskans uppfattning, samt (4) karakteristika som kan predicera patientens preferenser för delaktighet De två studierna har genomförts inom akut somatisk vård. De viktigaste undersökningsvariablerna var önskvärd och upplevd grad av delaktighet i beslutsfattande inom områden som kan stöttas med omvårdnad, studerat utifrån personliga bakgrundsfaktorer som t ex ålder, kön, utbildning, boende- och civilstånd. Det ses som värdefullt att öka kunskapen om hur patienter själva ser på att vara delaktiga i samband med planering av sin egen vård, och om vilka faktorer som kan predicera patienternas preferenser för delaktighet. Den kunskapsbasen är betydelsefull för sjuksköterskor som grund för planering och genomförande av individuellt anpassad omvårdnad. Valet av förhållningssätt och omvårdnadsåtgärder, och sättet åtgärderna genomförs på, torde påverkas om patientens preferenser för delaktighet bejakas i beslutsprocessen.

The primary aim was to conduct a psychometric evaluation of the Attitude towards Pressure ulcer Prevention (APuP) instrument in a Swedish context. A further aim was to describe and compare attitudes towards pressure ulcer prevention between registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs). In total, 415 RNs, ANs and SNs responded to the questionnaire. In addition to descriptive and comparative statistics, confirmatory factor analyses were performed. Because of a lack of support for the instrument structure, further explorative and consecutive confirmatory tests were conducted. Overall, positive attitudes towards pressure ulcer prevention were identified for all three groups, but SNs reported lower attitude scores on three items and a higher score on one item compared to RNs and ANs. The findings indicated no support in this Swedish sample for the previously reported five-factor model of APuP. Further explorative and confirmative factor analyses indicated that a four-factor model was most interpretable: (i) Priority (five items), (ii) Competence (three items), (iii) Importance (three items) and (iv) Responsibility (two items). The five-factor solution could not be confirmed. Further research is recommended to develop a valid and reliable tool to assess nurses' attitudes towards pressure ulcer prevention working across different settings on an international level.

Background: Existing classifications in Sweden of health care interventions used for quality assurance issues and for decisions on resource allocation does not capture all types of health care interventions. The work of professional groups like nurses, physiotherapists, and occupational therapists is partly invisible. There is a need to develop a classification of health care interventions that comprise all activity within the health care sector.

Aim: To describe a multi-professional collaborative work on classification development and to provide suggestions for an organizing structure that can capture interventions in the health care services incorporating different professional per spectives.

Results: The professional groups reached a common understanding about the use of the classification of The International Classification of Functioning, Disability and Health (ICF) as a unifying framework in the classification of health care interventions. Proposal was made for a revised structure of a current classification of interventions using ICD as unifying framework.

Conclusion: The use of ICF as a unifying framework is seen as a fruitful way of overcoming professional differences, and by that supporting the process of reaching a common understanding and use of a common language when describing interventions in health care.

Vad ska vi ha informationen i patientjournalen till? Vad är det för information vi vill få ut av systemen och vad ställer det för krav på den information vi lägger in i systemen? Elektroniska informationssystem införs inom hälso- och sjukvården i en ökad omfattning och inom en relativt snar framtid kommer all vårdverksamhet att dokumenteras med stöd av elektroniska journalsystem. Fördelar med detta är bl a en ökad tillgänglighet till information för såväl vårdens personal som patienten själv oavsett tid och rum, en bättre läsbarhet och även ökad möjlighet att hämta ut information ur systemen - information som kan utgöra underlag för uppföljning och utvärdering av den sjukvårdande verksamheten men även bidra till kunskapsutvecklingen inom ämnet omvårdnad. Svenska sjuksköterskor behöver av flera skäl intressera sig i högre grad för ut-data och för resultatet av vården (outcomes). Två frågor är viktiga att ställa oss: Vilken information vill vi kunna få ut av de elektroniska systemen? Vad är det för syfte med den information vi vill kunna hämta ut ur systemen? En förutsättning för att på ett organiserat sätt kunna hämta ut information från elektroniska system är att informationen är systematiserad redan från början. Innehållet som läggs in i systemet behöver vara organiserat på ett sådant sätt att det går att hitta igen, men innehållet behöver även vara definierat och beskrivet på ett sådant sätt att betydelsen och innebörden av texten inte kan misstolkas. Standardiserade termer och begrepp vid journalföring av vård ses som en absolut nödvändig förutsättning för att möjliggöra en sådan användning av informationen i journalsystemet. I det sammanhanget är det viktigt att sträva efter att hitta den gemensamma nämnaren för de olika professioner som är inblandade i vården av en patient. Patienten är i fokus för våra ansträngningar oavsett om vi är sjuksköterskor, arbetsterapeuter, sjukgymnaster eller läkare. Det finns en gemensam kärna som behöver kompletteras med mer professionsspecifikt innehåll, och med gemensam Vid seminariet kommer arbetet med utveckling av KVÅ (klassifikation av vårdåtgärder), en nationell multiprofessionell klassifikation att beskrivas och diskuteras. Vidare kommer diskussioner att hållas om möjligheter och vinster med ett multiprofessionellt samarbete och vilken roll vårdinformatiken kan komma att spela.

Aim. To investigate predictors of patients' preferences for participation in clinical decision-making in inpatient nursing care. 

Background. Patient participation in decision-making in nursing care is regarded as a prerequisite for good clinical practice regarding the person's autonomy and integrity. 

Design. A cross-sectional survey of 428 persons, newly discharged from inpatient care. Methods. The survey was conducted using the Control Preference Scale. Multiple logistic regression analysis was used for testing the association of patient characteristics with preferences for participation. 

Results. Patients, in general, preferred adopting a passive role. However, predictors for adopting an active participatory role were the patient's gender (odds ratio = 1.8), education (odds ratio = 2.2), living condition (odds ratio = 1.8) and occupational status (odds ratio = 2.0). A probability of 53% was estimated, which female senior citizens with at least a high school degree and who lived alone would prefer an active role in clinical decision-making. At the same time, a working cohabiting male with less than a high school degree had a probability of 8% for active participation in clinical decision-making in nursing care. 

Conclusions. Patient preferences for participation differed considerably and are best elicited by assessment of the individual patient. Relevance to clinical practice. The nurses have a professional responsibility to act in such a way that patients can participate and make decisions according to their own values from an informed position. Access to knowledge of patients' basic assumptions and preferences for participation is of great value for nurses in the care process. There is a need for nurses to use structured methods and tools for eliciting individual patient preferences regarding participation in clinical decision-making.

Aims and objectives. The aim of this study was to compare the degree of concordance between patients and Registered Nurses' perceptions of the patients' preferences for participation in clinical decision-making in nursing care. A further aim was to compare patients' experienced participation with their preferred participatory role. 

Background. Patient participation in clinical decision-making is valuable and has an effect on quality of care. However, there is limited knowledge about patient preferences for participation and how nurses perceive their patients' preferences. 

Methods. A comparative design was adopted with a convenient sample of 80 nurse-patient dyads. A modified version of the Control Preference Scale was used in conjunction with a questionnaire developed to elicit the experienced participation of the patient. 

Results. A majority of the Registered Nurses perceived that their patients preferred a higher degree of participation in decision-making than did the patients. Differences in patient preferences were found in relation to age and social status but not to gender. Patients often experienced having a different role than what was initially preferred, e.g. a more passive role concerning needs related to communication, breathing and pain and a more active role related to activity and emotions/roles. 

Conclusions. Registered Nurses are not always aware of their patients' perspective and tend to overestimate patients' willingness to assume an active role. Registered Nurses do not successfully involve patients in clinical decision-making in nursing care according to their own perceptions and not even to the patients' more moderate preferences of participation. 

Relevance to clinical practice. A thorough assessment of the individual's preferences for participation in decision-making seems to be the most appropriate approach to ascertain patient's involvement to the preferred level of participation. The categorization of patients as preferring a passive role, collaborative role or active role is seen as valuable information for Registered Nurses to tailor nursing care.

Aim. This paper reports a study to determine the degree of agreement or disagreement between nurses and patients in their perceptions of the presence, severity, and importance of nursing problems. 

Background. Patient experiences, values and preferences are increasingly acknowledged as important factors underpinning healthcare decision-making. The ability to identify patient problems accurately is an important prerequisite for planning and implementing individualized high quality care. 

Methods. A convenience sample of patients (n = 80) and Registered Nurses (n = 30) in an acute care setting responded to a 43-item questionnaire. 

Findings. Nurses identified patients' problems with a sensitivity of 0.53 and a positive predictive value of 0.50. Patients identified several severe problems that were not identified by nurses, particularly problems with nutrition, sleep, pain, and emotions/spirituality. Nurses underestimated the severity in 47% of mutually-identified problems. An overall level of agreement of 44% was found on the importance of patient problems. Low levels of agreement on severity and importance were related more to individual differences than to systematic differences. 

Conclusions. Nurses need to be more aware that patients and nurses often hold disparate views of the priorities in nursing care. To plan individualized nursing care effectively, nurses need to elicit and use individual patients' preferences more systematically in care planning.

Patient participation in decision making concerning nursing needs is an important aspect of high quality care, of interest for both planning and implementing care. However, patients' perspective on participation in clinical decision making has not been studied extensively and the literature is inconclusive of what roles patients prefer to adopt. The aim was to investigate associations between patient demographics and preferences for participation in clinical decision making and to compare patients and RNs perceptions of the patients' preferences for participation. A cross sectional study including 80 nurse-patient dyads was adopted. The Control Preference scale was used to collect data. The findings showed that younger and more educated patients preferred to be more active in some aspects of decision making than older and less educated patients did. Further, in comparison with RNs inference of patient preferences for participation, patients preferred to be more passive in decision making in relation to nursing needs in general, as well as for physical and psychosocial needs. Differences in perceptions between patients and RNs concerning patient participation could hamper high quality care and need to be addressed.

Patient participation in decision making concerning nursing needs is an important aspect of high quality care, of interest for both planning and implementing care. However, patients' perspective on participation in clinical decision making has not been studied extensively and the literature is inconclusive of what roles patients prefer to adopt. The aim was to investigate associations between patient demographics and preferences for participation in clinical decision making and to compare patients and RNs perceptions of the patients' preferences for participation. A cross sectional study including 80 nurse-patient dyads was adopted. The Control Preference scale was used to collect data. The findings showed that younger and more educated patients preferred to be more active in some aspects of decision making than older and less educated patients did. Further, in comparison with RNs inference of patient preferences for participation, patients preferred to be more passive in decision making in relation to nursing needs in general, as well as for physical and psychosocial needs. Differences in perceptions between patients and RNs concerning patient participation could hamper high quality care and need to be addressed.