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Leder
(side 78)
av Pia Dreyer
Vitenskapelig publikasjon
(side 79-92)
av Anna Smedman, Kerstin Gustafsson & Gullvi Flensner
SammendragEngelsk sammendrag

I och med Ädelreformens införande i Sverige 1992 har vården av äldre personer förändrats. Vården av de som befinner sig i livets slutskede har i stor utsträckning flyttats från sluten vård till det egna ordinära boendet eller till särskilda boendeformer. Detta har inneburit att allt fler avslutar sina liv på ett individuellt och behovsprövat boende, s k särskilt boende, där personen kan erhålla omfattande omsorg och vård, även vård i livets slutskede. I särskilda boenden har kommunerna ansvaret för vården. Förändringen har lett till ändrade och ökade krav på omvårdnadspersonalen, vårdbiträden och undersköterskor. Syftet med detta arbete var att belysa innebörden av att vårda äldre personer i livets slutskede för personalen på särskilt boende. Kvalitativa intervjuer genomfördes med åtta undersköterskor. Intervjuerna transkriberades ordagrant och analyserades med kvalitativ innehållsanalys. För undersköterskorna innebar att vårda äldre personer i livets slutskede: ’Att vårda en vän’, ’Att skapa en lugn och fridfull död’, ’Att ge närstående stöd’ och ’Att pendla mellan maktlöshet och tillfredsställelse’. Vid den boendes bortgång sörjde undersköterskorna den boende som en vän. De upplevde en trygghet i sin arbetsgrupp, vilket medförde en öppenhet att våga diskutera och reflektera under vården, men även efter dödsfallet. Behov fanns dock att få mer tid att sörja.

Nøkkelord: Innehållsanalys, omvårdnad, palliativ vård, personal, upplevelse, äldre

Caring for older people living in special housing at end-of-life stage – From the perspectives of assistant nurses

In Sweden, reforms in health and social care for older people were implemented in 1992 (Ädel-reformen) and provided older people with the opportunity to be cared for in their own homes, under the responsibility of the local municipality. Most of the older people choose to live in their own home or in sheltered housing, a so-called special housing, for rest of their lives and are able to receive extensive nursing care, including palliative care. Thus, palliative care has shifted from care at hospitals to care in own homes or special housing, which has increased the demands placed on nursing staff. The aim of this study was to elucidate the meanings the nursing staff expressed as regards caring for older persons in special housing in a palliative stage. Qualitative interviews with eight assistant nurses were performed. The interviews were recorded, transcribed verbatim and analysed using qualitative content analysis. To care for an old person in the palliative stage means “Caring for a friend”, “Creating a calm and peaceful death”, “Giving support to relatives” and “Alternating between feelings of powerlessness and satisfaction”. When an old person died, the assistant nurses mourned him or her as they would a friend. Amongst the colleagues, the assistant nurses experienced a sense of security, which meant openness and the courage to discuss and reflect upon their feelings, both during the care and after the death. Despite this, there was a need for more time to grieve after the death.

Vitenskapelig publikasjon
(side 93-103)
av Anna Löfmark, Åshild Slettebø, Maj-Britt Råholm & Birte Hedegaard Larsen
Engelsk sammendrag

Nursing education in Europe has undergone two reforms, the EU Directives and the Bologna Declaration, during the last decades aimed to create a unified European platform and integration of nursing education into the higher education system. The aim of this study was to describe the adjustment of the nursing education in the Scandinavian countries and especially the clinical parts of the education to these reforms. A review was done of the EU Directives and the Bologna Declaration and overall nationally regulating documents for nursing education in each of the Scandinavian countries with focus on the clinical parts described in for each country. The results show that there were more similarities than differences in the way the Scandinavian countries have adjusted clinical nursing education to the reforms. Denmark, Finland and Norway fulfil according to each qualification ordinance the EU Directives, while the Swedish qualification ordinance contains parts of this information. All Scandinavian countries meet the requirements in the Bologna Declaration e.g. offer a Bachelor´s degree and all have a national accreditation system for quality assurance of the education.

Vitenskapelig publikasjon
(side 106-120)
av Pennie Teglborg, Ida Hovdenak Jakobsen & Linda Kragelund
SammendragEngelsk sammendrag

Formålet med aktionsforskningsprojektet 'Udvikling af læringsmiljø i psykiatrien: læremuligheder, kompetenceudvikling og innovation' var, at sygeplejersker, der var kliniske vejledere, udviklede deres kompetencer, og at hospitalsafdelinger blev udviklet som læringsmiljø for sygeplejestuderende. I artiklen bliver metodologiske resultater og erfaringer diskuteret. Et centralt element i projektet var arbejdsseminarer, hvor de 93 kliniske vejledere, 17 uddannelsesansvarlige og projektlederen mødtes og diskuterede aktioner samt generering og analyse af data. Deltagerne mødtes også i lokale arbejdsgrupper, hvor de drøftede generering af data og udvekslede erfaringer. Data blev genereret via to fokusgruppeinterviews med vejlederne, samt ved at de kliniske vejledere skrev logbøger over deres praksis og observerede hinandens vejledningspraksis. Projektets aktioner, generering og analyse af data blev planlagt, koordineret og udført af en styregruppe. Konklusionen er, at aktionsforskningsmetoden viste sig at være velegnet til udvikling af de kliniske vejlederes kompetencer og udvikling af hospitalsafdelingernes læringsmiljø. Metoden fremmede desuden deltagernes motivation for at udvikle praksis. Endelig er konklusionen også at, vejlederne blev mindre involveret i projektet, end der var lagt op til fra starten.

Nøkkelord: Aktionsforskning, kliniske vejledere, kompetenceudvikling, læring, psykiatrisk sygepleje

Action research method – strengths and barriers: lessons from a research project in nursing

The action research project 'Development of regional Psychiatric Institutions as Learning Environments' aimed to develop nurses' competences as mentors and hospital wards as clinical learning environments for student nurses. In this paper methodological results and experiences are discussed. Central to the project was working seminars where the 93 mentors, 17 education coordinators and the leader of the project met to discuss methods for generating data and results of the data analysis. The mentors and education coordinators also met in local working groups, where they exchanged experiences and discussed how to generate data. Data was generated through two focus group interviews with the mentors, the mentors writing log books about mentoring and the mentors observing each other's practice. A steering committee coordinated the project. The committee prepared the actions, planned the data generation and undertook the analysis of data. In conclusion the action research method showed useful in developing mentors’ competences and learning environments in hospital wards. Furthermore the project strengthened the mentors' motivation for developing practice. Part of the conclusion is also that mentors got less involved in the project than they were meant to.

Vitenskapelig publikasjon
(side 121-132)
av Inger Beate Larsen & Michael Hohl
Engelsk sammendrag

The article focuses on the relationship between people and places from the perspective of a participant observer. We use examples of assisting living facilities in the mental health field, and demonstrate how the process of understanding a research setting as language and text, may allow for new perspectives to emerge. Mainly by introducing the Norwegian architect Christian Norberg-Schulz’s phenomenology of place, and complementing it with the French philosopher Paul Ricoeur’s theory of interpretation; we demonstrate how these understandings help us to include the physical environment. Norberg-Schultz describes places by following characteristics: a) The place's basic language, b) The place's material language and c) The history of the place. Inspired by Ricoeur, a place becomes a text which has d) emancipated itself from its origin and e) is living its own life. The discussion relates to how, by taking the material surroundings into account, the researcher becomes able to better understand the way people live. The conclusions show the importance of the role of the researchers’ personal experiences and emotions when being present together with the participants in the same physical environment.

Vitenskapelig publikasjon
(side 133-150)
av Nils Henriksen, Aud-Mari Sohini Fjelltun, Hans Ketil Normann & Astrid Norberg
Engelsk sammendrag

To determine the characteristics of older people assigned to nursing home placement and to illuminate the factors emphasised in the assignments, thirty-two home health care leaders in a Norwegian municipality completed a questionnaire regarding their assessment of the levels of functioning of the assigned individuals. These assessments were compared with assessments of individuals who had been placed on a waiting list to receive an assignment and of residents who had already been admitted to a nursing home. The individuals who had received assignments had higher rates of cognitive impairment, memory disturbances, disorientation and psychiatric symptoms compared with the individuals awaiting placement. The individuals with assignments had better motor function and a greater ability to accomplish daily activities without assistance than those in the other two groups. The physical workloads were the lowest for the carers of older people assigned to placement. Individuals without cognitive impairment and with low/worse motor function had to wait longer for nursing home placement than individuals with cognitive impairment. Older people with low/worse motor function required more assistance with their daily activities from informal carers. The implications for nursing are to recognise the physical workloads of carers and the necessity of offering them respite and support.

Vitenskapelig publikasjon
(side 151-164)
av Gry Nina Ilje Tveit & Ulrika Söderhamn Ulrika Söderhamn
SammendragEngelsk sammendrag

Umiddelbart etter fødsel må førstegangsmødre tilegne seg nye ferdigheter om barnestell på kort tid. Det er et gap mellom utskrivelse fra barselavdelingen og helsestasjonens mulighet til å gi tilpasset oppfølging av mor og barn. Hensikten med studien var å undersøke hva førstegangsmødre gjør for å mestre barnestellet de første to ukene etter fødsel. Et kvalitativt design med hermeneutisk tilnærming ble valgt. Syv førstegangsmødre ble intervjuet individuelt. Intervjuene ble analysert etter en Gadamer-basert hermeneutisk metode. Analysen viste at det var tre måter å mestre barnestellet: «å være forberedt», «å søke hjelp og støtte» og «å bli kjent med barnet». Nærhet til barnet var viktig for å få kontroll. Å amme barnet hadde størst betydning for mestringsfølelsen. Førstegangsmødre bør få hensiktsmessig hjelp og støtte til å mestre barnestellet fra jordmor eller helsesøster. Denne innsatsen bør starte før barnet blir født, blant annet ved å tilrettelegge for å knytte relasjoner mellom førstegangsmødre og flergangsmødre i nærmiljøet og mellom fastlege/jordmor og helsesøster. Barselomsorgen bør tilby tidlig kontakt med jordmor eller helsesøster etter utskrivelse fra barselavdelingen.

Nøkkelord: barselomsorgen, erfaring, svangerskapsomsorgen

What do first-time mothers do to cope with child care in early postnatal period?

First-time mothers have to acquire new skills about child care in a short time. There is a gap between discharge from maternity ward and health station’s ability to provide customized monitoring of mother and child. The aim of this study was to investigate first-time mothers’ coping with child care the first two weeks after birth. A qualitative design with hermeneutic approach was chosen. Seven first-time mothers were interviewed individually. The analysis revealed three strategies for achievement of child care: “to be prepared”, “to seek help and support”, “to get to know the baby”. To feel proximity to the child was important to gain control. To accomplish breastfeeding gave the biggest sense of achievement. First-time mothers should receive appropriate help and support to cope with the child care from midwife or health visitor. These efforts should begin before the child is born by facilitating relationships between first-time mothers and multiparous mothers in the community and between the doctor/midwife and health visitor. The maternity care should offer early contact with midwife or health visitor after discharge from the maternity ward.

Vitenskapelig publikasjon
(side 166-178)
av Irene Sjursen, Eva Gjengedal & Kari Kvigne
SammendragEngelsk sammendrag

Bakgrunn: Alvorleg brannskade er livstruande og kan føra til uuthaldelege smerte og kroppsendringar. Brannskade gir også eksistensielle utfordringar som kan trua pasienten sitt livsmot. Sjukepleie til desse pasientane byr derfor på praktiske, moralske og relasjonelle utfordringar. Føremål: Å utforska sjukepleiarane sine erfaringar med å oppnå og halda ved like ein tillitsfull relasjon i samhandling med alvorleg brannskadde. Metode: Fem sjukepleiarar med erfaring frå sjukepleie til brannskadde vart intervjua. Sjølvvalte forteljingar var fokuset for intervjuet. Dataanalysen er inspirert av Giorgi sin fenomenologiske analyse. Funn: Sjukepleiarane erfarte mot til å sanse lidinga, møte og respondere på appellen i pasientsituasjonen som vesentleg for tillitsskapande relasjonar i møte med alvorleg brannskadde. Følgjande tema peikar seg ut: Mot til å vera nær pasienten i hans eksistensielle krise, mot til å utfordra pasienten sitt livsmot og meistringsevne og mot til å erkjenna overtramp i dialog med pasienten. Konklusjon: Denne studien gir eit grunnlag for å reflektere over forholdet mellom tillit og mot der tillit som livsytring styrkar både pasienten og sjukepleiaren sitt mot.

Nøkkelord: Brannskade, erfaringskunnskap, mot, møte liding, nærleik, omsorg, skape tillit

The courage of the nurse is critical to strengthen the trust and courage of major burn patients

Background: Major burn injury is life-threatening and may lead to unbearable pain and changes of the body. Burn injury may also present the patient with challenges of a more existential nature and threaten the patient’s courage to go on living. Nursing these patients means meeting with practical as well as moral and relational challenges. Purpose: To explore the relation and development of trust between nurses and patients with major burns. Method: Five experienced nurses have been interviewed, drawing from their own background of working with burn injured patients. The phenomenological analysis of Giorgi has formed the basis of the data analysis. Results: The nurse’s ability to truly observe and respond to the suffering and need of the patient is the fundamental element of building trust. The following aspects were particularly significant: the courage to acknowledge and be close to the existential crisis of the patient, the courage to make the patient face his or her own ability to cope and find strength to carry on and finally, the courage to acknowledge any violation of confidence of the nurse – patient relationship. Conclusion: This study gives a fundament to reflect about the relation between trust and courage where trust is a factor strengthening both the patient and the nurse’s courage.

Vitenskapelig publikasjon
(side 179-192)
av Charlotte D. Bjørnes, Birgitte S. Laursen, Charlotte Delmar, Elizabeth Cummings & Christian Nøhr
Engelsk sammendrag

Short-stay hospital treatments reduce patients’ opportunity to meet each other and share experiences. Therefore an application for online social support was integrated into a health informatics tool developed to meet the information and communication needs for men with prostate cancer. This paper reports on the men’s experience of using the application for online social support. The findings demonstrate that older Danish men with cancer find it quite natural to communicate with each other using the Internet. However, the study signifies the complexity in designing online social support groups. When designing such applications, it is necessary to consider different types of users, and see these different users’ involvement, and their different stages of user activities, as a central part of the design strategy. Thus, a core element appears to be the need to always see the user involvement as a central part of the design strategy. It is essential to constantly learn more about the users and their needs, to continuously redesign the applications. From that perspective the term Patient 2.0 only illustrates one phase in an on-going evolution of roles between the partners in the healthcare sector as these roles are constantly being influenced by new technologies.

Vitenskapelig publikasjon
(side 193-207)
av Frederik A. Gildberg, Stephen K. Bradley, Ellen B. Tingleff & Lise Hounsgaard
Engelsk sammendrag

Text analysis is not a question of a right or wrong way to go about it, but a question of different traditions. These tend to not only give answers to how to conduct an analysis, but also to provide the answer as to why it is conducted in the way that it is. The problem however may be that the link between tradition and tool is unclear. The main objective of this article is therefore to present Empirical Testing Thematic Analysis, a step by step approach to thematic text analysis; discussing strengths and weaknesses, so that others might assess its potential as an approach that they might utilize/develop for themselves. The advantage of utilizing the presented analytic approach is argued to be the integral empirical testing, which should assure systematic development, interpretation and analysis of the source textual material.

(side 208-217)
av Brit Bårdsen Drange, Karen Johanne Vae & Anne Lise Holm
SammendragEngelsk sammendrag

Artikkelen omhandler erfaringer fra et praksisutviklingsprosjekt der en geriatrisk sykehusavdeling, somatisk sykehjemsavdeling, sykepleierstudenter og høgskolens praksislærere samarbeidet om å forbedre praksisrutiner med å forebygge trykksår hos eldre pasienter. Formålet er å beskrive erfaringer relatert til sykepleiedokumentasjon ved trykksårforebygging. Metoden var kvalitativ der erfaringer fra gruppeintervju med pleiere og studenter samt notater fra pleierne i prosjektgruppen utgjorde datamaterialet. Pleierne i prosjektgruppen hadde videreutdanning i sårsykepleie og var ressurspersoner i avdelingene. Resultatene viste at dokumentasjonskompetansen var ulik hos pleierne, og de nedprioriterte å dokumentere ved tidsmangel. Sjekklister ble en hjelp til konkretisering av prosedyretiltakene. En av konklusjonene er at praksisfeltet har behov for ytterligere kompetanseheving i sykepleiedokumentasjon, og sykepleierutdanningen må øke fokus på elektronisk sykepleiedokumentasjon i undervisningen.

Nøkkelord: dokumentasjonskompetanse, kvalitetsforbedring, samarbeidslæring, sykepleiepraksis, trykksår

Nursing documentation – challenges related to prevent pressure ulcer

This article discusses the experiences of a practice development project where a geriatric ward in a hospital, a ward in a nursing home, nursing students and the university college's teachers worked together to improve practice procedures to prevent and document pressure ulcers for elderly patients. The intention is to describe the experiences related to nursing documentation. The method was qualitative where experiences from group interviews with nurses and nurse students, as well as notes from the participants in the project group. The nurses were also experts in the ward. The results showed that documentation skills differed among the nurses, and they downgrade to document when lack of time. Checklists were a help to the specification of procedural measures. One conclusion is that the practice field needs further competence in nursing documentation, and nursing education must increase focus on electronic nursing documentation in class.

(side 218-227)
av Ann-Chatrin Linqvist Leonardsen
SammendragEngelsk sammendrag

På sykehus er operasjonsstuen det hyppigst rapporterte sted for feil behandling og avvik. Godt samarbeid er essensielt for trygg pasientomsorg og behandling av høy kvalitet. Ulik opplevelse av samarbeid beskrives som en barriere til godt tverrfaglig samarbeid. Forskning har påvist en diskrepans mellom ulike profesjoner i opplevd samarbeid innad i operasjonsteam, men sier ikke noe om årsakene. Hensikt med studien var å belyse ulike forhold som kan forklare dette. Data ble samlet gjennom en intensiv casestudie med kvalitative, individuelle dybdeintervjuer av 8 respondenter. Materialet ble bearbeidet og fortolket innenfor en hermeneutisk tradisjon. Funn viser at mulige forklaringer til denne diskrepans kan ha utgangspunkt i profesjonsgruppering, med en hierarkisk inndeling av teamet, ulik deltagelse i arbeidsprosessen, ulik forståelse av samarbeidets komponenter og ulik opplevelse av stress. Studien setter fokus på faktorer som bidrar til ulik opplevelse av samarbeid. Flere av disse er av strukturell karakter, med mulighet for å iverksette tiltak slik at de ulike profesjonene kan tilpasses hverandre. Dette vil igjen gi et bedre utgangspunkt for godt tverrfaglig samarbeid. Studien gir også et godt utgangspunkt for videre arbeid med Trygg Kirurgi Sjekkliste.

Nøkkelord: diskrepans, intervju, kvalitativ studie, pasientsikkerhet, årsak

Interprofessional collaboration in the surgical team

The hospital's operating room is the most reported scene for adverse events and errors. Good interprofessional collaboration is essential for safe patient care and high quality treatment. Discrepancies in the perceptions of collaboration are described in theory as barriers to good interprofessional collaboration. Research has shown a discrepancy in perceived collaboration in the surgical team, but says nothing about the causal factors for this discrepancy. The purpose of this study was to examine various explanations of discrepancies in the perception of collaboration. Data was gathered through an intensive case study, using 8 qualitative individual interviews. Data was analysed using a hermeneutic approach. Findings indicates that causal factors for the discrepancy in the perception of collaboration are based in the professional group itself, with a hierarchical division of the team, unequal participation in the work process, various perceptions of collaborative components and different perceptions of stress. Hence, the study focuses on a number of factors that contribute to discrepancy in the perception of collaboration. Several of these factors are of a structural nature, possible to take action against, so that the perceptions in the various professional groups can be better adjusted. The study can also be used to further development and use of the Surgical Safety Checklist.

(side 228-236)
av Berit Johannessen
Engelsk sammendrag

Community health nurses experiences with tea tree and aloe vera in wound healing

The purpose of this study was to gain experience with the use of Tea tree and Aloe Vera in wound healing. It was an action research study, involving 10 community health nurses and 12 patients with different wounds. The action part of the project was to implement an intervention: Clean the wound with 2–5 drops of Tea tree oil in 20 –50 ml water, add Aloe Vera gel to the wound, cover with appropriate dressing. The research component consisted of three focus group interviews with the responsible nurses, as well as an analysis of the wound journals/reports. The nurses experienced that the best results were obtained in superficial wounds, but also smaller pressure ulcers were healed. Further, they found it stimulating to use natural remedies and experienced that it was a simple procedure to implement. The nurses revealed a positive attitude towards alternative wound treatment, but they lack knowledge. They want to include these herbal remedies into their nursing practice.

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