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(side 2-3)
av Olle Söderhamn
Vitenskapelig publikasjon
(side 3-14)
av Randi Maria Hanghøj Tei, Pia Dreyer & Lone Nikolajsen
Engelsk sammendrag

Postoperative pain relief is especially challenging in chronic pain patients. Some of these patients are already using strong analgesics, including opioids, before surgery, and may have markedly increased opioid requirements after surgery. In addition, they often need special psychological attention. Only few studies have, however, focused on the patients’ perspectives. The aim of this study was to describe self-reported experiences of inadequate pain relief after surgery in a group of chronic pain patients. Eight patients with chronic pain who had reported having experienced inadequate pain relief after surgery were interviewed using a semi-structured interview guide 1–2 weeks after discharge from hospital. Meaning condensation and interpretation were used in the analysis according to the approach of Kvale and Brinkmann. Three major themes emerged from the condensation and interpretation of the natural meaning units: 1) distrust towards the patient, 2) disrespect towards the patient, and 3) lack of knowledge about pain treatment among health care professionals. Our findings indicate a lack of knowledge of pain management in chronic pain patients. Special training of health care professionals is required in order to improve pain relief after surgery and, ultimately, patient satisfaction and quality of care in this vulnerable group of patients.

Vitenskapelig publikasjon
(side 15-28)
av Anita Kristin Gabrielsen & Randi Nord
SammendragEngelsk sammendrag

Innleggelse i sykehus for kirurgisk behandling vil for mange pasienter være forbundet med usikkerhet og engstelse. Det er funnet få studier som fokuserer på pasienters erfaring med preoperativ informasjon om tidlig postoperativ fase. Studiens hensikt var å beskrive en gruppe kreftpasienters erfaringer med preoperativ informasjon om hendelser i tidlig postoperativ fase. Studien har et utforskende-beskrivende design, der metoden er intervju basert på temaguide. Ni pasienter ble inkludert i studien og de var innlagt til planlagt kirurgi for kreft, med minst ett døgns opphold ved postoperativ avdeling. Intervjuene ble gjennomført fra fem til 11 dager etter operasjonen. Funnene viste at erfaringer var sentrert rundt: 1) informasjon før operasjonen, 2) informasjon like etter operasjonen samt 3) uventede opplevelser som kraftløshet, heshet og forvirring. Noen av pasientene var ikke forberedt på ubehag og smerter, fysisk aktivitet tidlig etter operasjonen og opplevelser knyttet til miljøet ved postoperativ avdeling. Pasientene fikk i hovedsak muntlig informasjon som oftest ble gitt dagen før operasjonen. Anbefalinger for praksis er at muntlig informasjon støttes av skriftlig materiell, for å bedre pasienters oppfattelse av informasjonen.

Cancer patients’ experiences with preoperative information

Admittance to hospital for surgical treatment is for many patients linked with feelings of insecurity and anxiety. Few studies have addressed patients’ experiences with preoperative information about the early postoperative phase. The aim of this study was to describe a group of cancer patients’ experiences with preoperative information about events in the early postoperative phase. The study design was exploratory-descriptive. Semi-structured interviews based on a thematic guide were conducted. Nine patients admitted to elective surgery for cancer and a stay in the postoperative unit of at least 24 hours were included in the study. The interviews were conducted five to 11 days after surgery. The findings showed that the experiences with information before surgery and information in the early postoperative phase were centered around: 1) preparation for surgery, 2) the time just after surgery, and 3) unexpected experiences of feelings of powerlessness, hoarseness and confusion. Some patients were not prepared for discomfort and pain, early physical activity and experiences with the environment of the postoperative unit. The patients received mainly oral information and most of it was given the day before surgery. Implications for practice are to combine oral information with written information.

Vitenskapelig publikasjon
(side 29-44)
av Ingrid Leiknes & Sevald Høye
Sammendrag

Family caregivers constitute an important part of the day-to-day service for persons with Parkinson’s disease. As the disease progresses, the need for municipal home care assistance will increase. The aim of this study was to explore how family caregivers of persons with Parkinson’s disease (PD-caregivers) experience their situation when they share caring with the home care services. Nine family PD-caregivers who were enrolled in home care units in one region in Norway were interviewed. Interpretive analysis was used. The main interpretation of the caregivers’ experiences was labelled: «Being on call around the clock despite providing home care». Three interpretations that highlight the meanings identified in different aspects of the informants’ experiences contribute to the main interpretation: Challenges with clarifying and delimiting responsibility, Relief is not equivalent to feeling safe and satisfied, and Correct management of Parkinson’s disease medication does not fit in with the routines of home care. This study suggests that taking advantage of professional home care does not excuse family PD-caregivers from their experience of being the overall responsible for the care and well-being of the care-recipient.

Vitenskapelig publikasjon
(side 45-55)
av Randi Nord, Heidi Jerpseth & May Solveig Fagermoen
SammendragEngelsk sammendrag

Sykepleiere har uttrykt behov for et instrument for vurdering og oppfølging av etterlevelse av helseråd for hjertesviktpasienter. I USA er det utviklet to spørreskjemaer som tar sikte på å vurdere etterlevelse av helseråd innenfor rammen av saltfattig mat og å ta medisiner som forordnet. Disse instrumentene ble oversatt til norsk. To pilotundersøkelser ble gjennomført med hensikt å sikre kulturell tilpasning av instrumentene og kartlegging av rekrutterings- og datasamlingsprosedyre. Kulturell tilpasning av instrumentene ble gjort gjennom et fokusgruppeintervju med fire pasienter. Kartlegging av ønskede prosedyrer for rekruttering av pasienter, og elementer i datasamlingsprosessen ble gjennomført med strukturerte intervju og åpne spørsmål med 16 pasienter. Fokusgruppeintervjuet resulterte i noen endringer i formuleringer. Det strukturerte intervjuet avdekket sentrale elementer: Under halvparten av informantene ville ha svart på et tilsendt spørreskjema. De ville heller bli intervjuet enn å fylle ut svarene selv. Et entydig funn var at de ikke ville delta om det dreide seg om forpliktelser til flere undersøkelser eller tester. Deltagelse måtte helst skje i forbindelse med et sammenfallende ærend på sykehuset.

The importance of a pilot study before validation of translated instruments

Nurses have expressed the need of an instrument to score factors influencing compliance in patients with heart failure (HF). Two questionnaires based on the Health Belief Model measuring benefits and barriers related to medication and diet for patients with heart failure have been developed in USA. The instruments were translated into Norwegian. Two pilot studies were implemented with the purpose of cultural adaption of the instruments and exploration of recruiting and data collection procedures. A focus group interview was performed with four HF patients for cultural adaption, and a combination of structural and open interviews with 16 HF patients were done regarding recruitment and data collection procedures. The focus group patients’ comments led to some changes in the questions to make them more applicable to Norwegian culture. Most of the patients would have declined to participate if the questionnaires had been sent to them by mail. Furthermore, they preferred to be interviewed rather than filling out the questionnaire. The patients’ main concern about participating in research was to commit themselves to too many projects and tests, and they would not come for an interview if it was not combined with other undertakings at the hospital.

(side 56-63)
av Mette Strømfeldt Lind
SammendragEngelsk sammendrag

Formålet med denne artikel er at belyse begrebet sårbarhed i forhold til forskellige definitioner på og forståelse af begrebet. Analysemetoden er inspireret af Morses beskrivelse af «The Pragmatic Utility Method». Data udledt fra otte videnskabelige sygeplejeartikler analyseredes. Alle artiklerne omhandler og forholder sig til begrebet sårbarhed, men med forskelligt perspektiv og med forskellig forståelse af og definitioner på begrebet. To gennemgående perspektiver i artiklerne var en diskussion om, hvorvidt sårbarhed var en følelse eller oplevelse, som lå i den enkelte, eller om sårbarhed var et udefrakommende begreb, påstemplet grupper af mennesker, samt hvem og hvornår mennesker eller grupper kunne betragtes som sårbare. Forståelsen af og definitionen på sårbarhed fremstår ikke enslydende i de otte artikler. Hver artikel giver gode forslag til definition, forståelse og anvendelse af begrebet, hvilket styrker brugen af begrebet i sygeplejen. Sårbarhed må betragtes som et delvist modent begreb som man i sygeplejen må forsøge at definere i forhold til den situation, hvor vi anvender det.

Vulnerability

The purpose of this article was to elucidate some definitions and understandings of the concept vulnerability. The analysis was inspired by «The Pragmatic Utility Method» by Morse and based on a review of eight scientific nursing articles presenting different perspectives, understandings and definitions of vulnerability. All articles discussed whether vulnerability is a feeling or an experience of the individual person or whether vulnerability is an external concept imposed on groups of people. Moreover, it was discussed who and when people or groups could be considered vulnerable. The understanding and definition of vulnerability differed in the eight articles. Each article offers a definition, understanding and use of the concept that is strengthening the use of the concept within nursing. Vulnerability must be considered as a partly mature concept. In nursing it must be attempted to define the concept within the context it is used.

(side 64-73)
av Liv Fegran & Åshild Slettebø
SammendragEngelsk sammendrag

Teorien om Constructive Alignment (CA) beskriver hvordan samsvar mellom læringsaktiviteter, læringsutbytte og vurderingsformer påvirker studentens læring og forståelse av fagstoff. Forfatterne ønsket å evaluere om et slikt samsvar er til stede i to valgte mastergradsemner. Studiens hensikt var å vurdere samsvar mellom læringsutbytte, læringsaktiviteter og vurderingsformer i emnene vitenskapsteori og forskningsmetode ved et masterprogram i helsefag. Data ble innsamlet gjennom to fokusgruppeintervjuer med henholdsvis fire og fem studenter som hadde gjennomført de to emnene, og data ble analysert ved kvalitativ innholdsanalyse. Studentenes forkunnskaper har stor betydning for samsvar mellom læringsutbytte, læringsaktiviteter og vurderingsformer. Manglende forkunnskaper spesielt i kvantitativ metode medfører at læringsaktivitetene ikke alltid samsvarte med studentenes behov, mens tilstrekkelige forkunnskaper i vitenskapsteori gjorde læringsaktivitetene meningsfulle. Hjemmeeksamen i forskningsmetode ble sett på som en videreføring av læringsprosessen, mens skoleeksamen i vitenskapsteori opplevdes lite samsvarende med undervisningens fokus på dialog og refleksjon. Justering av taksonominivå på læringsutbytte, igangsetting av tiltak for å bedre forkunnskaper og endring av vurderingsform kan være aktuelt for å bedre manglende samsvar.

Alignment between learning outcomes, learning activities and assessment in two master courses

The theory of Constructive Alignment (CA) describes how accordance between learning activities, learning outcomes and assessment influence students’ learning. The aim of this study was to evaluate the agreement between learning outcomes, learning activities and assessment in a Philosophy of Science and a Research Method course in a Master Program in Health Sciences. Data were collected by two focus group interviews with respectively four and five students who had attended the courses, and analyzed by a qualitative content analysis. The students’ previous knowledge has great importance for the accordance between learning outcomes, learning activities and assessment. Lack of previous knowledge, especially in quantitative methods caused an imbalance between students’ needs and the learning activities, while sufficient previous knowledge in philosophy of science made the learning activities meaningful. Home examination in research method was experienced as a positive continuation of the learning process, while school examination in philosophy of science was experienced as less meaningful as the lessons focused on dialogue and reflection. Adjusting the taxonomy of learning outcomes, offering introduction courses in research method, and changing the type of assessment could increase the level of agreement.

(side 74-86)
av Marthe Fensli, Ragnhild Skaar & Ulrika Söderhamn
SammendragEngelsk sammendrag

Bakgrunn: Hjemmeboende eldre med oppfølging fra hjemmetjenesten opplever begrensninger med å få dekket sitt behov for praktisk hjelp og sosial kontakt. For disse kan frivillige tjenester være et viktig supplement. Det er derfor behov for å øke samarbeidet mellom offentlig helsetjeneste og frivillige tjenester. Hensikt: Å beskrive erfaringer med utvikling og utprøving av arbeidsformer mellom helse- og omsorgstjenesten og frivilligsentral i et distrikt i en kommune i Sør-Norge. Metode: Et kvalitativt design ble valgt. Det ble gjennomført ett fokusgruppeintervju med en gruppe ansatte i hjemmetjenesten og frivilligsentralen for å få deres erfaringer med å utvikle og utprøve arbeidsformer for formidling og koordinering av frivillige tjenester for praktisk hjelp og sosial kontakt. Intervjuteksten ble analysert ved hjelp av kvalitativ innholdsanalyse. Funn: Gjennom analysen fremkom to hovedkategorier «Samhandling» og «Nytteverdi» med et felles overordnet tema «Supplere hverandre til brukers beste». Konklusjon: Et enkelt kartleggingsskjema og en samarbeidsprosedyre førte til økt samhandling mellom personalet i hjemmetjenesten og frivilligsentralen og bidro til en positiv holdning om å arbeide sammen til brukers beste.

Voluntary services and public care services – interaction in the patient’s best interest

Background: Home-dwelling older people in need of attention from home care services experience limitations in satisfying their needs for practical help and social contact. Voluntary services can be an important supplement to public health care services. There is, therefore, a need to further develop the cooperation between home care services and voluntary services. Purpose: To describe the experience of collaboration between the home care and a voluntary center in a district in a municipality in southern Norway. Method: A qualitative design was used. A focus group interview with a group of employees from the home care services and a voluntary center was conducted to explore the employees’ experiences in developing and testing a way of communication and coordination of voluntary services. The interview text was analyzed using qualitative content analysis. Findings: In the analysis two main categories emerged: «Interaction» and «Usability», with the common overall theme: «Complement each other in the patient’s best interest.» Conclusion: A simple mapping chart and related cooperation procedure were perceived as useful and led to increased interaction between the home care services and the voluntary centre and contributed to a positive attitude to work together in the patient’s best interest.

(side 87-92)
av Marit Trandum Gilhuus & June Jacobsen Steen
Engelsk sammendrag

Almost half of all Tanzanian women deliver at home, alone, assisted by family members or traditional birth attendants. The aim of this article was to expand existing knowledge on how pregnant and laboring women’s preferences and decisions of birth place and type of assistance are influenced. A qualitative study with semi-structured interviews, with two traditional birth attendants and one midwife, and a participatory observation was conducted at a health clinic in Tanga District, Tanzania. It was found that the interaction between pregnant women and birth attendants is significant to the womenŽs preferences and choice of birth place and type of assistance during labor. The traditional birth attendants have a high social position and are available in the villages. The financial burden attached to a professionally attended birth is at the same time reduced with the choice of a home delivery. It appears that scarcity of recourses within the maternal care reinforces ethical dilemmas and negative behavior among health personnel, which influence women’s preferences of birth place and assistance in labor and consequently maternal health and safety.

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