Being a nurse leader in bedside nursing in hospital and community care contexts in Norway and Sweden

This is an open access article. You can find it online by following this link: http://www.sciedu.ca/journal/index.php/jnep/article/view/3418The article is published under a Creative Commons Attribution 3.0 License: http://creativecommons.org/licenses/by/3.0/Background: The changes of health care that have been going on the latest decades have affected nurse leaders’ role in bedside nursing in hospitals and community care in Norway and Sweden as in many other countries. Aim: This study aimed at describing nurse leaders’ working situation, role experience and role performance in bedside nursing in hospital and community care contexts in Norway and Sweden. Methods: Twenty-four nurse leaders in three hospitals and ten nursing homes/sheltered accommodations in urban and rural areas in Norway and Sweden participated in qualitative interviews. Data was analyzed using inductive content analysis. In addition background information was used for providing deeper understanding of the leaders’ working situation. Findings: The leader responsibilities concerned safeguarding the quality in daily care, upholding a good workplace environment, developing nursing care, and keeping the budget in balance. Being in an ‘in-between’ position with more responsibility than authority in the role was common for all leaders. Four characteristic groups of leaders; ‘the patient guardian’, ‘the manager’, ‘the climber’, and ‘the unconscious’, illustrated different pattern found. Conclusion: Our study illuminates the necessity of improvement of competence requirements, authority-responsibility balance, administrative and emotional support, and competence development in regard to bedside nurse leaders

Grupphandledning för handledare i klinisk sjuksköterskeutbildning : Ett sammverkansprojekt inom UNISKA mellan Högskolan Dalarna, Högskolan i Gjövik, Högskolan i Hedmark och Karlstads universitet

Grupphandledning för handledare i klinisk utbildnin

Being a nurse in nursing home for patients on the edge of life

Nurses in nursing homes care for patients with complex health problems that need to be followed up by medical treatment. Most patients benefit from the treatment, but for some the treatment seems only to lengthen their death process. Sometimes questions are raised as to whether life‐sustaining treatment should be withheld/withdrawn. Decisions related to such questions are difficult to make as some patients are ‘on the edge of life’, which is understood as a transition between living and dying with an unpredictable outcome, whether the illness will lead to recovery or dying. The aim of this study was to acquire a deeper understanding of what it is to be a nurse in a nursing home for patients on the edge of life. The research design was qualitative, based on hermeneutic phenomenology. Fourteen nurses at two nursing homes were interviewed twice. The result shows that when facing a patient on the edge of life, the nurses were challenged as professionals and as human beings. Two main themes were identified, which included two sub‐themes each. The first main theme: ‘striving to do right and good for everyone’ included the sub‐themes ‘feeling certain, but accompanied by uncertainty’ and ‘being caught between too much responsibility and too little formal power’. The second main theme: ‘being a vulnerable helper – the prize and the price’, contained the sub‐themes ‘needing emotional protection in professional commitment’ and ‘feeling undervalued in spite of professional pride’. The essence was: ‘being a lonely and enduring struggler between opposite poles’. The findings revealed paradoxes in nurses’ work which might threaten nurses’ professional identity and put heavy demands on their professional performance. There is a need for formal involvement in end‐of‐life decisions from nurses, further education and support to nurses related to patients on the edge of life

Experiences of health and care when growing old in Norway - From the perspective of elderly immigrants with minority ethnic backgrounds

Background: Along with the growing population in Norway of older people with immigrant backgrounds from countries in Asia, Africa and Eastern Europe there is a need for a better understanding of trans-cultural aging, illness experiences and care preferences among minorities and their families. Aim: This study explored older ethnic minority immigrants’ experiences of growing old in Norway with a focus on health and care. Design: An explorative, descriptive design with a grounded theory approach was used. Method: The data was collected in Norway by means of open-ended interviews with nine ethnic minority immigrants representing an age span from 63 to 85 years. In total 15 interviews were conducted, with the sampling, data collection and analysis carried out simultaneously and guided by the constant comparative method. Results: This study showed that the most important issue when growing old in a new homeland as an ethnic minority immigrant was to be surrounded by one’s family. When the needs for care increased due to changes in age and health, the family was seen as the only possible solution. Feelings of fear and distrust, language barriers, and preferences for the familiar care were reasons for this. Due to cultural rules it was taken for granted that the younger generation took on responsibility for their older parents/relatives in need of care, which led to feelings of dependency and being a burden. A high price had been paid for finding a new homeland. Conclusions and Implications for Practice: The elderly immigrants’ expectations of care was found to be strongly connected with traditions from their native country, where it was taken for granted that the younger generation took the responsibility for their older parents/relatives in need of care. Our findings highlighted the dilemma of culturally determined controversies, as elderly immigrants’ beliefs and values about care within the family may be rather difficult to unite with a life in a new Western society. Nursing practice needs to implement a more family-oriented care perspective in order to meet the needs of elderly people with ethnic minority and immigrant backgrounds. Further it is important to increase elderly immigrants’ feelings of trust and cultural safety towards health-care services

Nursing care for patients on the edge of life in nursing homes: obstacles are overshadowing opportunities

Background. Patients in nursing homes have comprehensive needs for nursing care and medical treatment. Most patients benefit from the treatment, but some are ‘on the edge of life’‐in a borderland between living and dying with an unpredictable outcome, and questions are sometimes raised whether to withhold/withdraw curative treatment. Aim. The aim was to describe nurses’ conceptions of good nursing care, and how this could be carried out for patients on the edge of life in nursing homes. Design. In order to discover variations in the nurses’ understandings a phenomenographic approach was chosen. Phenomenography is concerned with qualitatively different ways of conceiving a phenomenon. Methods. Fourteen nurses from two nursing homes were individually interviewed twice. A phenomenographic analysis was used. Results. The outcome‐space included two main categories. The first, ‘good nursing care is to meet patients’ needs for dignity,’ included three description‐categories: needs for ‘preparedness’, ‘human relationship’ and ‘bodily comfort and safety’. The second, ‘opportunities were overshadowed by obstacles’ in carrying out nursing care encompassed three description‐categories: ‘organisational factors,’‘relational factors’ and ‘personal factors’. Conclusions. This study shows nurses’ conceptions of the importance of good nursing care for comforting patients on the edge of life. Implications for practice. Several obstacles related to resources, communication, cooperation and nurses' professional strength and power need to be overcome if good nursing care can be performed

Patient participation’ in everyday activities in special care units for persons with dementia in Norwegian nursing homes

Aim. The aim of this study was to explore ‘patient participation’ in everyday activities for persons with dementia living in special care units in nursing homes. Background. Studies about how ‘patient participation’ appears in the context of special care units for persons with dementia are lacking. Design. The study has an explorative design. Method. Grounded theory was chosen. Data collection was carried out by means of open observations and additional conversations with residents and personnel. Simultaneously, data analysis was performed with open, axial and selective coding. Findings. The findings showed that ‘patient participation’ concerned ‘A matter of presence’ as the core category. The other categories described as ‘presence of personnel’ and ‘presence of residents’, were strongly connected to the core category as well as to each other. Presence of personnel comprised three levels; being there in body, which required physical presence; being there in mind, which required presence with all senses based on knowledge and competence; and being there in morality which was understood as being fully present, as it was based on humanistic values and included the two other levels. Presence of residents comprised ‘ability and wish’ and ‘adaptation’. The presence of the personnel had a huge impact on the ability and will to participate of the residents. Organizational conditions concerning leadership, amount of personnel and routines as well as housing conditions concerning architecture and shared accommodation, could stimulate or hinder ‘patient participation’. Conclusions and implications. The study highlighted the great impact of the personnel’s presence in body, mind and morality on the participation capacity of the residents. The great importance of the nurse leaders was stressed, as they were responsible for organizational issues and served as role models. Group supervision of the personnel and their leaders would be an implication to propose, as these kinds of reflection groups offer opportunities to reflect on values, actions and routines

Patient participation in special care units for persons with dementia: A losing principle?

Målet med denne studien var å undersøke opplevelsen til pleiepersonell i forhold til pasientenes deltakelse i spesielle avdelinger for personer med demens i sykehjem, med fokus på hverdagsliv. Studien har et grounded theory design. Elleve pleiepersonell ble intervjuet to ganger. Brukermedvirkning anses å være basert på tanken om at det å være herre over sitt eget liv er avgjørende for verdighet og selvfølelse for alle mennesker. Pasientmedvirkning ble beskrevet på forskjellige nivåer: å la beboeren ta egne avgjørelser, justere valgene, ta beslutninger på vegne av beboere og tvinge beboerne. Utdanningsnivå og engasjement blant pleiepersonell og hvor ofte de var på vakt påvirket nivået av brukermedvirkning

Factors of importance to the development of pressure ulcers in the care trajectory: perceptions of hospital and community care nurses

Aim. The study aimed at describing contributing factors for the progression or regression of pressure ulcers in the care trajectory as they were understood by nurses working in hospitals or community care. Background. The development of pressure ulcers is considered to be connected with early prevention and awareness among nurses and some studies have indicated that the care trajectory may be a weak point. Design. The study was carried out with a qualitative design. Method. Fifteen nurses from two Swedish hospitals and 15 nurses from community care were interviewed during 2005. Qualitative content analysis was used to make an understanding of patterns possible. Findings. Three main categories arose, showing that pressure ulcers were considered to be affected in the care trajectory by factors related to the individual patient, to the healthcare personnel and to the healthcare structure. Hospital and community care nurses mostly had corresponding perceptions of these factors. Conclusion. The study both confirmed previous findings and added new knowledge about factors that may affect pressure ulcer in the trajectory of care. The informants’ views of nurses’ responsibilities and their attitudes towards the care of pressure ulcers could, along with their views on the organisation of care, increase the understanding of the occurrence of pressure ulcers. The need for development and clarification of the organisation and responsibility of pressure ulcer care in the care trajectory was stressed. Relevance to clinical practice. The study highlighted attitudes and values among registered nurses, as well as to how to preserve their commitment and increase their knowledge concerning prevention of pressure ulcers

Factors of importance to the development of pressure ulcers in the care trajectory : perceptions of hospital and community care nurses

Aim. The study aimed at describing contributing factors for the progression or regression of pressure ulcers in the care trajectory as they were understood by nurses working in hospitals or community care. Background. The development of pressure ulcers is considered to be connected with early prevention and awareness among nurses and some studies have indicated that the care trajectory may be a weak point. Design. The study was carried out with a qualitative design. Method. Fifteen nurses from two Swedish hospitals and 15 nurses from community care were interviewed during 2005. Qualitative content analysis was used to make an understanding of patterns possible. Findings. Three main categories arose, showing that pressure ulcers were considered to be affected in the care trajectory by factors related to the individual patient, to the healthcare personnel and to the healthcare structure. Hospital and community care nurses mostly had corresponding perceptions of these factors. Conclusion. The study both confirmed previous findings and added new knowledge about factors that may affect pressure ulcer in the trajectory of care. The informants' views of nurses' responsibilities and their attitudes towards the care of pressure ulcers could, along with their views on the organisation of care, increase the understanding of the occurrence of pressure ulcers. The need for development and clarification of the organisation and responsibility of pressure ulcer care in the care trajectory was stressed. Relevance to clinical practice. The study highlighted attitudes and values among registered nurses, as well as to how to preserve their commitment and increase their knowledge concerning prevention of pressure ulcers