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Leder
(side 166)
av Olle Söderhamn
Vitenskapelig publikasjon
(side 167-179)
av Bjørg Balteskard, Sissel Lisa Storli & Kari Martinsen
SammendragEngelsk sammendrag

Artikkelen handler om betydningen av å gjøre tilværelsen rommelig for pasienter på sykehjem og er et forskningsarbeid basert på materiale framkommet gjennom fokusgruppeintervju med sykehjemsansatte i fire kommuner. Disse har deltatt i forskjellige fagutviklingsprosjekt i regi av det som tidligere ble kalt Undervisningssykehjem. I en tid hvor sykdom og oppbrudd fra det kjente og hjemlige er det dominerende, kan meningsfullt samvær bidra til en oppstand mot tiden, et begrep hentet fra filosofen K. E Løgstrup. Gjennom å samle seg om noe felles hjelpes en til å holde verdifull tid fast, og også reflektere sammen med andre over hendelser i eget liv. Slik gjenskaper den gamle seg selv i en fremmed verden. Gode øyeblikk skaper engasjement og fellesskap og er slik et opprør mot tidens uunngåelige bevegelse mot livets avslutning, døden. Det foregår et kontinuerlig tydningsarbeid mellom sansning og forståelse. Sanse-hage, minnerom, arbeidsstue og velværebad tilrettelegges for sansemessig mottakelse av inntrykk som kan gjøre tilværelsen forståelig. Gjennom oppmerksomt nærvær og tilrettelegging gis de gamle rom til å utfolde seg. Forståelige omgivelser kan bety styrket identitetsfølelse og mestringsevne, noe som igjen skaper livsmot og et verdig liv.

Nøkkelord: fokusgrupper,K. E. Løgstrup,sansning,undervisningssykehjem

The hands remember

The article is based on material from focus group interviews with nursing home personnel in Norway. The participants shared experiences from different nursing projects that they had participated in. At a time in life when illness and moving away from one’s home is inevitable, meaningful gatherings can represent a necessary «counterweight against time», as expressed by the Danish philosopher K. E. Løgstrup. By reflecting with others on incidents and memories from events in their lives, patients can hold on to time as a value. In this way each patient can recognize himself or herself in a new and strange world. Reliving important events can help create a meaningful environment and a feeling of community, and thus represent a revolt against the constant movement of time towards the end of life, death. «A spacious living» for the old person emerged as a main theme. Gardens for people with dementia, remembrance-rooms, places of activity and spa-baths help create a meaningful world for the old patient. Being in a safe and secure environment with attentive caregivers can strengthen the patients’ sense of identity and their ability to cope, and give them the courage to live purposeful lives.

Vitenskapelig publikasjon
(side 180-196)
av Bo Smith & Lisbeth Rostgård
SammendragEngelsk sammendrag

Har man altid ret til at melde sig syg? Er der nogen som misbruger den ret? Skal man gå på arbejde, selvom man er syg? Hvilken rolle spiller hensynet til kollegerne og arbejdspladsen? Hvornår er sygefravær rimeligt? Sygefravær på arbejdspladsen er emnet for denne artikel. Både de sygemeldte og deres kolleger gør sig mange tanker i forbindelse med sygemeldinger. Deres handlinger og holdninger er under indflydelse af både moralske forskrifter, som blev grundlagt i barndommen, og den aktuelle samfundsdebat. En kritisk diskurspsykologisk analyse beskæftiger sig med, hvordan betydninger omkring sygefravær bliver til, dels i samtaler mellem mennesker, dels i samspillet mellem sociale aktører og samfundsmæssige strukturer. Med sådan en diskurspsykologisk tilgang er sygefravær blevet undersøgt empirisk, gennem seks kvalitative interview med sygeplejersker på et universitetshospital og rådgivere i en bank. Artiklen omhandler kritisk diskurspsykologisk metodologi og beskriver fremgangsmåden i nævnte undersøgelse. Resultater af undersøgelsen fremlægges og diskuteres, idet elementer fra interviewene sættes ind i en bredere samfundsmæssig sammenhæng, og de sammenholdes med resultater fra andre, overvejende nordiske undersøgelser vedrørende sygefravær.

Nøkkelord: aktiv interviewteknik,medarbejderperspektiv,mestring,misbrug,sygenærvær

A critical discursive psychology analysis of sickness absence

Do you always have the right to report sickness absence? Could anybody be abusing this right? Do you have to go to work even if you feel sick? What about the consideration for colleagues and the workplace? When is sickness absence reasonable? Sickness absence at the workplace is the subject of this article. The person who is absent, as well as his/her colleagues, will be thinking a lot about the situation. Their actions and attitudes are influenced by moral ethics shaped in childhood as well as the current social debate. A critical discursive psychology analysis discusses the shaping of thoughts about sickness absence, partly through conversations between people and partly through the interaction between social parties and societal structures. This discursive psychological approach has been applied in an empirical sickness absence study through six qualitative interviews with nurses at a university hospital and bank advisors. The article discusses critical discursive psychological methodology and describes the method applied in this study. Results of the study are presented and discussed, as elements from the interviews are put into a broader societal context and compared with results from other, primarily Nordic, sickness absence studies.

Vitenskapelig publikasjon
(side 197-209)
av Anne Storaker & Solveig Hauge
Engelsk sammendrag

This paper reports a study about professional relationships between physicians and nurses. The aim of the study was to describe and discuss the dialogue on sedation and pain relief between nurses and physicians in an intensive care unit. The chosen context was how professionals assessed the sedation needs of patients on mechanical ventilation. Four intensive care nurses and four anesthesiologists from a major hospital in Norway participated in qualitative interviews. Analysis and interpretation of the interview transcripts were performed in line with the qualitative design. The results of the study showed poor and incomplete nurse-physician communication. Both groups were responsible for their failure to discuss their different approaches to reaching a common goal for patients. Nurses are confronted by a lack of clear and systematic communication and the greater power and prestige of physicians, who can use their countervailing authority to override nurse decision making.

Vitenskapelig publikasjon
(side 210-221)
av Birgitta Jöhnemark, Ingegerd Fagerberg & Gabriella Engström
Engelsk sammendrag

In Sweden the number of old people is increasing, and there will be a shortage of nurses working within the field of care for older people in the future. It can be a challenge to recruit new nurses, and especially clinical nurses specialized in gerontological care. The aim of the study was to gain knowledge about attitudes towards older people and towards working in the field of care for older people among a group of Swedish nursing students. The study included 490 nursing students at four universities in Sweden. The participants completed the Swedish version of the Kogan's Old People Scale that measures attitudes towards older people and working within the field of care for older people. The results showed that students 31 years and older had the highest positive median attitude scores. Furthermore, significant differences in positive and negative scores were found related to education levels. Progression in the nursing students’ education contributes to more positive attitudes and less negative attitudes toward older people.

(side 222-232)
av Nanna S. Hellesø & Hildfrid V. Brataas
SammendragEngelsk sammendrag

Pasientforflytning og forflytningsteknikk dreier seg om både tjenestekvalitet og ivaretakelse av personellets helse. Artikkelen beskriver personellets perspektiver på en ettårig flerkomponentintervensjon på pasientforflytning i en kommune i Midt-Norge. Intervensjonen omfattet tiltak i forebygging av belastningsskader samt tiltak rettet mot psykososiale faktorer og kompetansehøyning hos staben. Det ble gjennomført teoriundervisning, utstyrsoppgradering og opplæring på bruk av utstyr og teknikker, og veiledningsopplegg på hver praksisenhet på ergonomisk pasientsentrert forflytningspraksis. Deltagelse på tiltakene motiverte til kvalitetsutvikling i forflytningspraksis og samarbeid mellom ansatte om gode forflytningsløsninger. Prosjektets fokus på både praksiskvalitet og arbeidsmiljø, samt tidsutstrekning over et år synes å være viktig for lærings og endringsprosessen. Dessuten indikerer resultatene at veiledning på praksisstedet bør videreføres ut over et år. Forskning er nødvendig for å få kunnskap om kvalitetseffekter og kostnadseffektivitet på flerkomponentintervensjoner på forflytningspraksis.

Nøkkelord: arbeidsmiljø,ergonomi,forebygging,forflytningsteknikk,helsetjenestekvalitet

Quality development with focus on patient transfer and staff health

Patient transfer and transfer techniques involve both service quality and preventive workplace interventions. The article describes the personnel’s perspectives on a one-year multi-component intervention, conducted in one municipality in Mid-Norway. Measures to prevent staff injuries and measures focusing on psychosocial factors and staff’s competence included theoretical instructions, equipment upgrades, training on use of equipment and techniques. Counseling programs at each health service section focused on ergonomic patient-centered movement practices. Project activities motivated the staff’s work on quality development and their cooperation to find the best patient lift and/or mobility solutions for patients. The project's focus on both quality of the care and work environment, and the one year extension of the project seemed necessary to secure the staff’s learning and quality development of practice. Moreover, the results indicate that guidance provided at each care unit should be continued beyond a year. Research is needed to gain knowledge about effects and cost effectiveness of patient transfer interventions.

(side 233-246)
av Ingrid Liodden & Anne Moen
Engelsk sammendrag

Evidence based practice is a strategy to utilize research findings in clinical practice and stimulate discussion of what counts as evidence, and whether findings from RCT-trials constitute valid and objective knowledge. Findings from studies conducted under conditions far from reality may not produce results relevant for practice, and opponents claim that findings from RCT-trials are not applicable to complex interventions common in health care, including nursing. The pragmatic RCT-trial complements the traditional RCT-trial and is part of the suite of designed controlled studies that contribute to methodologically sound research findings. The pragmatic RCT design is more flexible than the traditional RCT-trial, allowing complex and context-dependent interventions to be performed under natural conditions. This paper presents the pragmatic RCT- design, depicting the flexibility of the pragmatic approach by explaining the dimensions in the tool «PRECIS-wheel». We exemplify our discussions using findings from an empirical study and discuss inherent weakness and strength of the design in terms of internal and external validity. We believe the pragmatic RCT-design will be instrumental and contribute to highly relevant findings for best practice development in nursing.

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