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Leder
(side 218)
av Olle Söderhamn
Vitenskapelig publikasjon
(side 219-235)
av Brigitte Bang og Bente Martinsen
SammendragEngelsk sammendrag

I disse år diskuteres evidensbegrebet af sygeplejersker på forskellige niveauer, og betydningen synes at være uklar. Denne artikel er en begrebsanalyse af evidens i nordisk sygepleje, hvori Walker and Avants metode er anvendt. Analysen er baseret på definitioner i danske opslagsværker og nordisk sygeplejelitteratur og viser, at evidens ser ud til at være et flertydigt begreb, som har en stærk medbetydning af «bevis». Hvis begrebet alene forstås ud fra et naturvidenskabeligt perspektiv, er evidens forskningsbaseret og bygger på metoder, som giver målbare resultater. Evidens kan her klassificeres og opstilles i et hierarki, hvor metodevalg er afgørende for den videnskabelige værdi, resultatet tillægges. I en humanvidenskabelig forståelse er evidens perspektivrig, mangfoldig og kontekstafhængig. Det betyder, at evidensbegrebet er dynamisk og ikke afhænger af hvilken metode, der er anvendt. Derimod er begrebets indhold et spørgsmål om, hvorvidt de ontologiske aspekter i en given situation vægtes i den enkelte situation. Når begrebet evidens anvendes i sygeplejen, kan forståelsen enten være baseret på en naturvidenskabelig eller en humanvidenskabelig forståelse uden at det ekspliciteres hvilken af de to tilgange, der lægges til grund.

Nøkkelord: begreb, bevis, flertydighed, ontologi, perspektiv

A concept analysis of evidence in Nordic nursing

The term «evidence» is discussed in Nordic nursing literature. However, the true acceptation of the word seems to be difficult to define. This article is an illumination of «evidence» in Nordic nursing. The method by Walker and Avant for concept analysis was used to illuminate the meaning of evidence in a nursing perspective. The concept analysis is performed in the light of definitions found in Nordic works of reference and Nordic nursing literature. Evidence was found to be a polysemantic concept, which depends on the context in which it is used and is strongly linked to proof. When the concept is used in the tradition of natural science, evidence is based on methods, which are measurable and where the evidence can be classified and put into a hierarchy where the research method is determined by the scientific value of the result. In the tradition of the humanities, evidence is rich on perspectives, multitudinous and depends on the context. Although evidence is not static, «evidence» in one situation can appear as «not evidence» in another. The concept of evidence in Nordic nursing is based on traditions of natural science and humanities.

Vitenskapelig publikasjon
(side 236-252)
av Pia Riis Olsen og Ingegerd Harder
SammendragEngelsk sammendrag

Netværksfokuseret sygepleje er et nyt begreb, der er genereret i et grounded theory studie af sygeplejersker, teenagere og unge voksne med kræft og deres nærmeste pårørende. Denne artikel udforsker og præciserer begrebet for at sikre, at det bliver forstået og vil blive anvendt korrekt i hverdagens kliniske praksis og i litteraturen, og dermed ikke begrænses i dets udvikling og dets betydningsindhold. Meleis’ integrerede tilgang kombineret med Hybrid Modellen af Schwartz-Barcott og Kim er anvendt i analysen. Forudsætninger, kendetegn, konsekvenser, og ligheder og forskelle med beslægtede begreber bliver identificeret. Netværksfokuseret sygepleje har potentiale til at udvikles gennem sygeplejeforskning og til at blive implementeret indenfor flere områder af patientomsorgen.

Nøkkelord: begrebsudvikling,kræftsygepleje,socialt netværk,social støtte,teenagere,unge voksne

Network focused nursing. Development of a new concept

Network focused nursing – a new concept – was generated in a grounded theory study of nurses, teenagers and young adults with cancer and their significant others. This article explores and clarifies the concept in order to prevent it from being normalized and taken for granted in everyday clinical practice and in the literature, and from being limited in growth and meanings. The integrated approach by Meleis combined with the Hybrid Model by Schwartz-Barcott and Kim are used for analysis. Antecedents, attributes, consequences, and similarities and differences from related concepts are identified. Network focused nursing has potential to be further developed through advanced nursing science and to be implemented in other areas of patient care.

Vitenskapelig publikasjon
(side 254-268)
av Elisabeth Hessevaagbakke, Anne Grethe Johansen, Solveig Gudjonsdottir og Bjørg Christiansen
SammendragEngelsk sammendrag

Bakgrunn: Studier om medstudentbaserte studieopplegg i klinikken har først og fremst konsentrert seg om studentenes erfaringer, mens vi vet mindre om hvordan praksisveilederens funksjon erfares i denne sammenheng. Hensikt: Dokumentere hvordan et medstudentbasert studieopplegg påvirker praksisveiledernes funksjon. Metode: En kvalitativ studie. Datakilder er refleksjonsnotater, logger og fokusgruppeintervju. Datamateriale er strukturert i forhold til tematiske overskrifter. Resultat: Resultatene ga innsikt i hvordan et medstudentbasert studieopplegg påvirket praksisveiledernes funksjon tematisert ved «hvordan utformet praksisveilederne veilederfunksjonen?», «hvilke forventninger hadde praksisveilederne til studentene?», « hva erfarte praksisveilederne som utfordrende?» og «hva erfarte praksisveilederne som lærerikt?» Konklusjon: Funnene viste at praksisveilederne opplevde det både utfordrende og stimulerende å veilede studentpar hvor tredjeårsstudenten også hadde et veiledningsansvar. Det som imidlertid ikke fungerte helt etter intensjonen var etterveiledning og tilbakemelding til studenter, særlig når noe var svakt. Til tross for forberedende veiledningskurs og gruppeveiledning med lærer underveis, virket det som om en kombinasjon av mangel på tid og usikkerhet i forhold til egen veilederkompetanse hindret dem i å realisere egen funksjon på disse områdene.

Nøkkelord: praksisstudier, sykepleier, sykepleierutdanning, veileder, veiledning

The tutors’ function in a peer-based study period in clinical practice

Background: Studies of peer-based study periods in clinical practice have mainly focused on students' experiences. There is less knowledge about the practice supervisor's function. Objective: To demonstrate how a peer-based study period affected the tutors’ function. Method: Qualitative study. Data sources were reflection notes, logs and focus group interviews. Data was structured under thematic headings. Results: Results provided insights into how a peer-based study period influenced the tutors’ function. The following themes were focused on: «How did the supervisors form their function?», «Which expectations did the supervisors have to students?», «What did the supervisors experience as challenging?» and «What did they experience as instructive in their function as supervisors?» Conclusion: The results showed that practice supervisors found it both challenging and stimulating to guide student pairs who also had supervisory responsibility. However, the guidance and feedback to students did not function as intended especially when there were weaknesses in the students’ performance. Despite preparatory guidance courses and group counseling with college teachers, it seemed as if lack of time and uncertainty in relation to their own supervisory skills prevented them from realizing their own function in these areas.

Vitenskapelig publikasjon
(side 269-286)
av Robert Dean Luke, Karin Anna Petersen og Oscar Tranvåg
Engelsk sammendrag

Previous studies based on reminiscence suggest temporary relief from common dementia symptoms, yet the impact of memory stimulating surroundings has not been adequately addressed. An environmental reminiscence approach was organized in a Norwegian nursing home. Artifacts and furnishings relating to the cultural and historical past of local residents were displayed within four residential posts and adjoining hallway, totaling five in all. Considering the urgent need for research based dementia care, the aim of this study was to explore the experiences of a group of caregivers using environmental reminiscence approach (ERA) in the daily lives of nursing home residents with moderate dementia. The results indicate how this memory stimulating approach assisted caregiver’s efforts toward reconnecting nursing home residents’ to personal resources and help restore wellbeing. Some residents responded negatively to one of the displays when burdensome memories were recalled. The overall findings however suggest meaningful outcomes in cognitive activation, emotional stimulation and social participation for most residents with moderate dementia. While additional research is needed, this study indicates environmental reminiscence approaches may be a promising, practical reminiscence approach towards dignity preserving dementia care.

Vitenskapelig publikasjon
(side 287-299)
av Toril Agnete Larsen og Liv-Berit Knudsen
SammendragEngelsk sammendrag

Forekomst av smerte øker med alderen, følsomhet for akutt smerte reduseres, mens følsomhet for kroniske smerter øker. Smerten blir ofte utilstrekkelig utredet og behandlet. Studiens hensikt er å beskrive system for prosedyrer og rutiner for å avdekke smerte i virksomheter som har utviklingssenter for sykehjem og hjemmetjeneste. Virksomhetene studien bygger på har 780 pasienter/brukere (flest kvinner). I sykehjem har 51,5 % og i hjemmetjenester 30,5 % av pasientene smerter. Av pasientene med demensdiagnose har over 60 % smerter. Personell i enhetene er i hovedsak sykepleiere, hjelpepleiere/omsorgsarbeidere og leger. Seks virksomheter har forhåndsdefinert smerte i pasientjournalsystemet. Seks virksomheter benytter ikke kartleggingsverktøy for smerte. Seks virksomheter registrerer smerte ved innkomst. Kartleggingsverktøy og oppfølging av smerteproblematikk er ikke implementert som en del av kvalitetssystemet i flertallet av virksomhetene. Dette kan medføre vilkårlig pleie og behandling som vil avhenge av den enkelte ansattes individuelle kunnskap om smerteavdekking. Systemer hvor flere tilnærmingsmåter i smertevurdering inngår vil bidra til bedre kvalitet i diagnostikk og behandling. Utviklingssentrene skal være pådrivere for fag- og tjenesteutvikling. Basert på resultatene i denne studien bør prosedyrer og rutiner for smertevurdering videreutvikles.

Nøkkelord: demenssykdom, pleie- og omsorgstjenester, prosedyrer, rutiner, smertekartleggingsverktøy

Systems for pain detection in older patients in nursing homes and home care

With increasing age, pain and sensitivity for chronic pain increase while sensitivity for acute pain is reduced. Pain is often inadequately investigated and treated. The purpose of this study is to describe procedures and routines to detect pain in nursing homes and homecare designated as development centers. The units in the study include 780 patients. Among nursing home patients 51.5 % have pain while the percentage among home care patients is 30.5 %. The number of patients diagnosed with dementia and pain amounts to more than 60 %. In six units pain was a predefined category in the patient journal. Six units did not use assessment tools for pain detection. Assessment tools for pain detection and follow-up of pain problems have not been implemented in the majority of the units included. This may lead to random care and treatment as it will depend on the individual employee’s skills rather than on common knowledge and pain assessment. Systems where several approaches in pain assessment are included will contribute to improved quality in diagnostics and treatment. The development centers are intended to promote professional and service development. Based on the findings in this study the development of systems of procedures and routines for pain assessment are recommended.

Vitenskapelig publikasjon
(side 300-312)
av Linda Rydmell, Anders Ringnér, Camilla Lagerfors og Inger Öster
Engelsk sammendrag

Equal opportunities for children are in general regarded as crucial; nevertheless, children are still often treated differently due to their sex. This could limit a child’s inherent way of expressing him/herself. Nurses need to be aware of how gender constructions influence their interactions with children. The aim of this study was to illuminate interpretative repertoires that a group of nurses use when communicating with children during blood test procedures in two children’s hospitals in Sweden. Data was collected by semi-structured observations of nurses conducting blood test procedures on children, and the observations were analyzed using discourse psychology. Two main groups of interpretative repertoires were found. In one group the repertoires were supporting gender stereotyping and in the other group the repertoires were weakening gender stereotyping. In conclusion, nurses’ interactions with children during procedures offer the children different socially and culturally constructed interpretative repertoires about gender. Increased consciousness of gender issues is needed among nurses to enable children to be and act freely, without being forced into limited gendered expectations.

(side 313-325)
av Åshild Slettebø, Maj-Britt Råholm, Birte Hedegaard Larsen og Anna Löfmark
Engelsk sammendrag

Aim: The aim of this study is to describe the doctoral programs for PhD in nursing and caring sciences and compare them within the Scandinavian countries (Denmark, Finland, Norway and Sweden). Design: The design is a review of selected doctoral programs in the Scandinavian countries. In Berlin in 2003, the Ministers in Europe decided to adopt a third cycle in the common educational system in the Bologna process, the doctoral education. Data sources: A review of educational programs in doctoral studies at different universities in Scandinavian countries is presented, namely Denmark, Finland, Norway and Sweden with an analysis of the programs and comparing them with general requirements for doctoral education in the different countries and the Bologna process requirements. Results: There are differences in length (3–4 years / 180 – 240 ECTS) which is in accordance with Bologna declaration that recommends 3–4 years for doctoral programs / third cycle. In addition the length of requirements for doctoral courses varies. A difficulty in deciding which scientific paradigm the programs support is discussed.Conclusion: Different structure may create problems for mobility. Possible lack of scientific paradigm in the programs may cause difficulties in building nursing as a discipline.

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