Language Requirements, Information Security and Journal Review

This article is written from a Swedish perspective, hopefully it can also inspire people in other countries.

Strong Swedish language skills among staff in elderly care are crucial to ensure high-quality care and a positive care environment. By offering language training, creating an environment that promotes the use of Swedish, and providing continuous feedback and support, nursing homes can effectively strengthen the Swedish language for staff with Swedish as a second language. This will benefit both the elderly and the staff and create a more inclusive and high-quality care environment. This is necessary for staff to be able to communicate with the residents, document what is happening, understand instructions, and be able to inform, for example, nurses and ambulances.

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Understanding and making oneself understood


The operation must have routines to follow up that those who are employed in the operation have sufficient knowledge to be able to understand and talk to the residents and relatives. Likewise, they should be able to document what happens and describe changes in the health status for example a nurse during on-call hours.

There are employees who do not master Swedish in speech and writing. In some cases, even though they have undergone nursing assistant training. This may mean that they cannot understand what the resident is expressing or that they cannot document what needs to be documented. They have difficulty describing what needs to be done and the residents cannot make themselves understood.

For a person with dementia, it must be terrible not to be able to make oneself understood and understand people in the surroundings. A confused world risks becoming even more frightening and incomprehensible. Employees with poor language skills can unwittingly subject the residents to insult or even dangerous situations.

Those who cannot express themselves find it difficult to motivate, inform and instruct. This entails a risk that residents receive more help than they need and thus lose functions that are essential for daily life.

Writing and reading daily notes


Knowledge of the Swedish language must always be a basic competence for independent work in elderly care. The staff must master the Swedish language in speech and writing. At the same time, people with poor language skills sometimes have a fantastic aptitude for care work. There are operations that offer support from language representatives or further training in the Swedish language to give suitable people the opportunity to develop their language skills and other competence needed for the job.

Elderly care must employ more in the future as well. The challenge is to help those who have the aptitude to become fantastic care staff, with the language and give them a solid vocational education. There are also municipalities that require language competence from the staff in procurement. The contractor must report in the tender how they ensure the requirement. Many operations find creative ways to help people with deficient language skills to learn to understand and speak Swedish better.

Knowledge development in care and care is fast. All care providers must further train their staff so that they keep up and can deliver the quality that residents and relatives have the right to expect. Licensed staff can to some extent contribute to ongoing knowledge transfer to care staff, but must then themselves have the opportunity to update their knowledge.

When events or changes in health status are not documented, the residents are at risk of harm. Likewise, when the evening staff cannot make themselves understood to the nurse when a resident becomes ill.

Knowledge control


Delegation is an opportunity to get an idea of the knowledge of the Swedish language. Then control questions can be asked in connection with training to get an idea of how much the person has understood and can explain in dialogue. The delegation should include written moments and questions to meet the requirements of the Patient Safety Act. It is particularly necessary when delegating medication management. Working with mentorship, clear instructions and closer follow-ups regarding delegated tasks can be good ways to follow up employees.

Handling of personal data


In nursing homes, personal data is handled in several situations. Regardless of how and why they are handled, they should be noted in a personal data register. That the journal systems are included is obvious for most. The difficulty is to catch all papers, data files and other things that can contain personal data on residents, employees or others.

We occasionally read about employees at care providers who have read in journals that they are not authorized to read. Those who work in a nursing home do not automatically have the right to access everyone's journals. As an employee, you are only allowed to read journals where you have a care relationship. The Privacy Authority requires the operation to do a needs and risk analysis before giving employees access to enter the journal system

There is a secrecy between the floors about what happens to the residents if it is not knowledge that is necessary for the employee to be able to perform his work. You must not forget this in the staff room. Personal data is handled in many other contexts and if you handle personal data outside the journal system, they should be noted in a summary of where you have personal data. Storage of personal data must be able to be justified, as well as stated with the support of which law the storage takes place.

Journal review


There are several methods to conduct a journal review and the purpose of the journal review can vary. The selection is usually random, but needs to include journal entries by all employees.

Collegial review often means that employees print out and anonymize journals that a colleague then goes through and gives feedback on. This is to avoid breaches of confidentiality as only the person responsible for a patient/resident has the right to access the journal. The reviewer notes good examples and suggestions for improvements.

Self-control of journaling


There are different templates for reviewing Patient record. When it comes to social documentation, there are often guidelines that describe how social documentation should be conducted in the municipality. Some units have someone who is a documentation representative or quality representative who reviews journaling and provides advice and support to colleagues in journaling.

The red thread


One way to review the journaling and collaboration between the different professional groups is to try to follow the red thread. Are there events or courses that should occur in both patient journals and social documentation journals in both journals?

Log control


Means that the appointed person in the operation, often the operations manager, regularly goes in and reviews who has read in which journal and at what time. Thus, it is checked that no one out of curiosity goes in and reads in journals.

Review of quality responsible


Quality managers often gain insight into journaling in connection with investigations. In addition, quality managers can review the journaling. Often it is done from a template to ensure that essential information for safe and secure care is in the journals.

Marker-based journal review


There is a method called "Marker-based journal review in home health care". Marker-based journal review is based on a strict method and involves collaboration between doctor and nurse.

Journal requirements


The journal kept by the care is the resident's journal. The resident can at any time request a copy of his or her journal and read what the staff writes. As a resident, you have the right to access your journal. The operations manager or nurse responsible for quality can make a harm assessment but there must be very strong reasons for you not to be allowed to access the journal. If the operation denies, you can turn to responsible authorities to request your right.

Relatives do not have the same right to request a journal, but can still often assert the right to obtain journal documents for a person in a nursing home. Especially if the resident has difficulty speaking for themselves. Information about a resident can thus be disclosed if there is no doubt that the resident or relative suffers harm from it. When such an assessment is to be made, the starting point must always be the current person's situation.

Journals should be factual and based on what actually happens in the operation. There is no room for subjective opinion. It happens that the person reviewing a journal sees that there is a whole novel of irrelevancies. Other times, the only note for several months is that the resident has slept at night. It is a clear sign that the documentation is not working.

The journal should be written in comprehensible Swedish. Handwritten journals can consist of more or less incomprehensible crow's feet and computer-written journals can sometimes be difficult to understand. With this said, we can probably still conclude that most journals are well written, that it is possible to see a context and understand how the care has been planned and carried out.

One occasion when it may be of interest to read one's journal is after a care injury. Something may have happened that caused unnecessary suffering. It may be that you are considering claiming compensation from the patient insurance or the resident's liability insurance.

It is good to know that there are three different journals in the nursing home. The nursing assistants document in a social journal and work from an implementation plan. Nurses, occupational therapists and physiotherapists make health plans and document in a health and medical care journal. The doctor employed by the region documents in the health center's journal system.

Strengthening the Swedish language within elderly care and achieving effective communication and care


In today's aging society, elderly care plays a critical role in providing care and support to older citizens. In this context, the communication between staff and the elderly is of utmost importance to ensure high-quality care and quality of life. A challenge that nursing homes sometimes face is that employees may have Swedish as a second language, which can affect communication. This article will explore how nursing homes can work to strengthen the Swedish language for employees with Swedish as a second language and why it is so important.

The importance of strengthening the Swedish language


The Swedish language is an important tool in elderly care. It enables effective communication between staff and the elderly, which is crucial for understanding their needs and wishes.
Better communication A strong competence in the Swedish language enables clearer and more mutual communication between staff and the elderly. This makes it easier to understand and meet the needs and wishes of the elderly.
Security and trust When the elderly feel that they can communicate effectively with the staff, their sense of security and trust increases. This is crucial for creating a positive care environment.
Reduced risk of mistakes Good language understanding reduces the risk of misunderstandings and errors in care. It can prevent potential problems and increase patient safety.
Cultural sensitivity By improving Swedish language skills, staff can better understand and respect the elderly's cultural background and individual needs.

How nursing homes can work with language strengthening


Language education Offer employees opportunities for language education in Swedish. It can be courses in cooperation with local education providers or online courses.
Language training in the workplace Create an environment where employees are encouraged to use Swedish in their daily work. This may mean communicating with colleagues and the elderly in Swedish as much as possible. One way is to train language representatives who are tasked with helping their colleagues develop their language skills.
Support and feedback Provide continuous feedback and support to employees in their language development. This may include offering opportunities for practice and correction of pronunciation and grammar.
Cultural competence Also integrate cultural competence training into the program to increase awareness of the elderly's cultural background and needs.
Multilingual staff Try to have staff who speak different languages to facilitate communication with older citizens who have other mother tongues than Swedish.

Reflection - language requirements, safety and journal review
Care staff:
• What can you as colleagues do to help the language weak?
• Is there a risk that unauthorized persons will have access to personal data at your unit?
• Do you do a journal review sometimes?

Manager, nurse, occupational therapist and physiotherapist:
• How do you check the language skills of those who start working with you?
• Are all personal data stored so that unauthorized persons cannot get them?
• Do you set aside time and have a method for journal review?
• How often do you do log check?

Residents and relatives:
• Are there employees who cannot make themselves understood?
• Do you have to tell the same thing several times?
• Have you been in situations where you have requested access to journal documents?


Erland Olsson
Specialist Nurse
Sofrosyne
Better care every day

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