From scared to prepared? : Identifying important areas in the educational preparation of nursing students with respect to palliative care

Formål: Identifisering av viktige områder sykepleierstudenter trenger kunnskap om innenfor lindrende behandling. Overordnet mål er at denne informasjonen kan bidra til å utvikle strategier for optimalisering av sykepleierutdanningen. Litteraturgjennomgang: Oppgaven gir bakgrunnsinformasjon i forhold til økt etterspørsel etter kompetanse innen lindrende behandling. I tillegg gis en oversikt over eksisterende litteratur angående innhold og evaluering av ulike utdanningsprogram. Metode: Studien har et kvalitativt, eksplorativt design med elementer av kvantitativ metode. Datainnsamling ble foretatt gjennom en spørreundersøkelse med ett åpent spørsmål. Undersøkelsen ble besvart av 140 respondenter fra tre ulike grupper, sykepleierstudenter, sykepleiere og lærere som underviste i lindrende behandling. Det ble utført innholdsanalyse av innsamlet data med utgangspunkt i Crabtree og Miller’s ”Editing analysis style”. Funn: Følgende syv ulike områder med 25 tilhørende underkategorier ble identifisert som viktige i forhold til lindrende behandling: Relasjonskompetanse, symptomhåndtering, smertehåndtering, generell kunnskap om lindrende behandling, kontekstuelle forhold, psykisk helse og døden som fenomen. Det ble identifisert et essensielt område som i stor utstrekning ikke ble gjort rede for i sykepleierutdanningen: Betydningen av personlige egenskaper og erfaring og holdninger til død og døende. Konklusjon: Det er behov for et felles utdanningsprogram innen lindrende behandling for implementering i sykepleierutdannelsen i Norge. Et slikt utdanningsprogram bør gjennomføres gjentatte ganger i løpet av utdanningen, og ta for seg de ulike områder identifisert i studien. Det bør være fokus på at egenskaper ved studenten er spesielt viktige, som personlige erfaringer, holdninger til døden og dødsangst. Nøkkelord: Lindrende behandling, sykepleierutdanning, sykepleierstudenter, døden

The aftermath of surviving a sudden cardiac arrest for young exercisers- a qualitative study in Norway

Background: When surviving a sudden cardiac arrest (SCA), physical, cognitive, and emotional efects of surviving may be present for months or years. The survivors’ family and colleagues are also highly afected by the incident. There is little knowledge about experiences of surviving SCA in individuals who prior to the incident were young and reported to exercise regularly. Consequently, the aim of this study was to explore the aftermath of surviving a SCA in young, regular exercisers. Methods: The study had a qualitative design, conducting in-depth individual interviews with SCA survivors<50 years of age reporting to exercise≥5 h/week and/or who sufered SCA during or less than 60 min after exercise. The data were analysed using systematic text condensation in-line with recommendations from Malterud. Results: 18 of 31 eligible participants were included in the study. Through analysis we identifed ‘Establishing a new everyday life’ as superordinate category, with subordinate categories a) being part of my surroundings, b) expecting normality but facing a new reality and c) lucky to be alive! Conclusion: This study adds knowledge about young and regular exercisers’ experiences after surviving a SCA. The obligations of everyday life in young survivors of SCA often imply a high work load and complex tasks, e.g. due to being in the beginning of their career or even still studying. Healthcare personnel, as well as the society, need to acknowledge that although lucky to be alive and apparently well-functioning, young survivors of SCA may have per‑sistent challenges that cause frustration and reduced quality of life.publishedVersio

Experiences of cardiac arrest survivors among young exercisers in Norway: A qualitative study

Aim: To explore how young exercisers experience surviving sudden cardiac arrest (SCA), focusing on interpretation of warning signs and experi-ences with the healthcare system. Methods: The study had a qualitative design, and data was collected using individual, semi-structured interviews. Inclusion criteria were SCA sur-vivors aged 18–50 years old who reported at least five hours of exercise/week prior to SCA, or who suffered SCA during or 60 min after exercise. Results: 18 interviews were performed (4 females), age range 19–49 years old. Analysis identified the themes [1] neglected warning signs, [2] fluc-tuating between gratitude and criticism and [3] one size does not fit all. When young exercisers experienced symptoms such as fainting, chest pain, arrythmia, shortness of breath and fatigue, these were often ignored by either the participants, healthcare personnel or both. SCA survivors were grateful to the healthcare system and for the efforts made by healthcare personnel, but experienced a mismatch between what patients needed and could utilize, and what they actually received regarding both information and individualised services. Being young exercisers, the participants reported to have individual needs, but treatment and rehabilitation were not adapted and were mainly targeted to rehabilitation of older patients. Conclusion: Patients and healthcare personnel should be aware of cardiac related symptoms and warning signs for SCA, and these should be properly assessed in the population of young exercisers. SCA survivors need useful and repeated information. The needs of SCA survivors among young exercisers require individualisation of servicespublishedVersio

Exploring individual and work organizational peculiarities of working in emergency medical communication centers in Norway- a qualitative study

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Development and validation of a questionnaire to assess Healthcare personnel competence in cardiac arrest and resuscitation in pregnancy

acceptedVersionpublishedVersio

Description of call handling in emergency medical dispatch centres in Scandinavia: recognition of out-of-hospital cardiac arrests and dispatcher-assisted CPR

Background The European resuscitation council have highlighted emergency medical dispatch centres as an important key player for early recognition of Out-of-Hospital Cardiac Arrest (OHCA) and in providing dispatcher assisted cardiopulmonary resuscitation (CPR) before arrival of emergency medical services. Early recognition is associated with increased bystander CPR and improved survival rates. The aim of this study is to describe OHCA call handling in emergency medical dispatch centres in Copenhagen (Denmark), Stockholm (Sweden) and Oslo (Norway) with focus on sensitivity of recognition of OHCA, provision of dispatcher-assisted CPR and time intervals when CPR is initiated during the emergency call (NO-CPRprior), and to describe OHCA call handling when CPR is initiated prior to the emergency call (CPRprior). Methods Baseline data of consecutive OHCA eligible for inclusion starting January 1st 2016 were collected from respective cardiac arrest registries. A template based on the Cardiac Arrest Registry to Enhance Survival definition catalogue was used to extract data from respective cardiac arrest registries and from corresponding audio files from emergency medical dispatch centres. Cases were divided in two groups: NO-CPRprior and CPRprior and data collection continued until 200 cases were collected in the NO-CPRprior-group. Results NO-CPRprior OHCA was recognised in 71% of the calls in Copenhagen, 83% in Stockholm, and 96% in Oslo. Abnormal breathing was addressed in 34, 7 and 98% of cases and CPR instructions were started in 50, 60, and 80%, respectively. Median time (mm:ss) to first chest compression was 02:35 (Copenhagen), 03:50 (Stockholm) and 02:58 (Oslo). Assessment of CPR quality was performed in 80, 74, and 74% of the cases. CPRprior comprised 71 cases in Copenhagen, 9 in Stockholm, and 38 in Oslo. Dispatchers still started CPR instructions in 41, 22, and 40% of the calls, respectively and provided quality assessment in 71, 100, and 80% in these respective instances. Conclusions We observed variations in OHCA recognition in 71–96% and dispatcher assisted-CPR were provided in 50–80% in NO-CPRprior calls. In cases where CPR was initiated prior to emergency calls, dispatchers were less likely to start CPR instructions but provided quality assessments during instructions.publishedVersio

Veien inn til sykehus for pasienter innlagt ved mistanke om akutt hjerneslag

Bakgrunn: Hjerneslag er en tidskritisk tilstand, men fremdeles ankommer under halvparten av pasientene sykehus innen fire timer fra symptomdebut. En mulig forklaring på forsinkelsen kan være at første kontakt med helsevesenet er hos legevakten eller fastlegen. Hensikt: Hensikten med denne studien var å kartlegge innleggende instans for pasienter ved mistanke om akutt hjerneslag før de kom til akuttmottaket ved Oslo universitetssykehus OUS på Ullevål. Vi ville også kartlegge hvorvidt innleggelsesinstans kunne korreleres til slagdiagnose ved utskrivelse. Metode: En retrospektiv observasjonsstudie identifiserte alle pasienter der mistanke om hjerneslag var innleggelsesårsaken på akuttmottaket ved Ullevål i 2018. Vi grupperte pasientene etter innleggende instans: ambulanse, legevakt, fastlege eller direkte kontakt. Vi sammenliknet utskrivelsesdiagnoser «hjerneslag» eller «ikke hjerneslag» etter innleggende instans og fordelte på alder ved å bruke kjikvadrattest. Resultat: Totalt 1399 pasienter med mistanke om hjerneslag ble innlagt, hvorav 594 42 prosent) fikk en hjerneslagdiagnose. Medianalderen var 72 år, og 52 prosent var kvinner. Halvparten ble innlagt direkte med ambulanse, en tredel via legevakten og 12 prosent fra fastlegen. Signifikant flere pasienter av de som ble innlagt med ambulanse 51 prosent), fikk hjerneslag som utskrivelsesdiagnose sammenliknet med pasienter som kom via henholdsvis legevakt 29 prosent) eller fastlege 40 prosent) (kjikvadrat p < 0,001. Pasientene som ble innlagt med ambulanse, var signifikant eldre enn pasientene som kom via legevakten 72 år versus 65 år, p < 0,001. Konklusjon: Kun halvparten av pasientene med symptomer på mistenkt hjerneslag ble innlagt med ambulanse. Pasientene som ble innlagt direkte med ambulanse, ble oftere utskrevet med en hjerneslagdiagnose. Vi trenger mer kunnskap om årsakene til at de resterende pasientene kom via fastlegen eller legevakten.publishedVersio

When time counts: Emergency medical dispatch. Exploring, understanding and addressing issues that impact upon timely and adequate allocation of prehospital medical assistance and resources to cardiac arrest patients

When an out-of-hospital cardiac arrest (OHCA) occurs, patient outcome can be influenced by bystanders ability to start cardiopulmonary resuscitation (CPR) before ambulance arrival. Recognition of cardiac arrest and provision of telephone-assisted CPR (T-CPR) by emergency medical dispatchers (EMDs) are key process measures that have been associated with improved survival after OHCA. The aims of this thesis were to provide a comprehensive description and analysis of factors impacting on EMDs when handling cardiac arrest calls. Voice logs of actual cardiac arrest calls in four different emergency medical communication centres (EMCC) were analysed and compared and EMDs were interviewed and observed. A bundle of targeted interventions were performed and evaluated in one EMCC. All included EMCCs faced similar challenges with agonal breathing as the main barrier to recognition of cardiac arrest. Few differences were observed when comparing two commonly used dispatch tools in use in Norway (Criteria Based Dispatch -CBD) and USA (Medical Priority Dispatch-MPD), but T-CPR were offered faster and more frequently in the CBD system. Some variations in performance standards were seen when comparing three different EMCCs in Norway, despite similar organisation, professional backgrounds and dispatch tool/protocols. A mixed-methods approach is effective to explore the challenges regarding OHCA calls in an EMCC, and revealed both use and non-use of protocols, inaccuracy of definition of cardiac arrest and differences in interrogation strategies, in particular concerning assessment of breathing. Monitoring key quality indicators helped identify the challenges to the system, and enabled development of effective strategies to improve quality of care. Targeted simulation, education and feedback significantly increased recognition of OHCA, delivery of T-CPR and reduced time to first chest compression

Experiences of cardiac arrest survivors among young exercisers in Norway: A qualitative study

Aim: To explore how young exercisers experience surviving sudden cardiac arrest (SCA), focusing on interpretation of warning signs and experi-ences with the healthcare system. Methods: The study had a qualitative design, and data was collected using individual, semi-structured interviews. Inclusion criteria were SCA sur-vivors aged 18–50 years old who reported at least five hours of exercise/week prior to SCA, or who suffered SCA during or 60 min after exercise. Results: 18 interviews were performed (4 females), age range 19–49 years old. Analysis identified the themes [1] neglected warning signs, [2] fluc-tuating between gratitude and criticism and [3] one size does not fit all. When young exercisers experienced symptoms such as fainting, chest pain, arrythmia, shortness of breath and fatigue, these were often ignored by either the participants, healthcare personnel or both. SCA survivors were grateful to the healthcare system and for the efforts made by healthcare personnel, but experienced a mismatch between what patients needed and could utilize, and what they actually received regarding both information and individualised services. Being young exercisers, the participants reported to have individual needs, but treatment and rehabilitation were not adapted and were mainly targeted to rehabilitation of older patients. Conclusion: Patients and healthcare personnel should be aware of cardiac related symptoms and warning signs for SCA, and these should be properly assessed in the population of young exercisers. SCA survivors need useful and repeated information. The needs of SCA survivors among young exercisers require individualisation of service

Healthcare personnel self‐assessed competence and knowledge following implementation of a new guideline on maternal resuscitation in Norway. A repeated measure study

Abstract Introduction Cardiac arrest in pregnancy is a rare, yet extremely challenging condition to manage for all healthcare personnel involved. Knowledge deficits and poor resuscitation skills can affect outcomes in cardiac arrest in pregnancy, but research exploring healthcare personnel competence and knowledge about maternal resuscitation is limited. Aims The aim of this study was to explore (1) healthcare personnel self‐assessed competence and knowledge about cardiopulmonary resuscitation (CPR) in pregnancy as well as perimortem caesarean section, before and after implementation of a new guideline, (2) whether there were any interprofessional differences in knowledge about maternal resuscitation, and (3) potential differences between different implementation strategies. Research Methodology The study had a prospective repeated measure implementation design, utilizing a questionnaire before and after implementation of a new guideline on maternal resuscitation after cardiac arrest. Setting All healthcare personnel potentially involved in CPR in six hospital wards, were invited to participate (n = 527). The guideline was implemented through either simulation, table‐top discussions and/or an electronical learning course. Results In total, 251 (48%) participants responded to the pre‐questionnaire, and 182 (35%) to the postquestionnaire. The need for education and training/simulation concerning maternal resuscitation were significantly lowered after implementation of the guideline, yet still the majority of respondents reported a high to medium need for education and training/simulation. Participants' self‐assessed overall competence in maternal resuscitation increased significantly postimplementation. Regardless of professional background, knowledge about CPR and perimortem caesarean section increased significantly in most items in the questionnaire after implementation. Differences in level of knowledge based on implementation strategy was identified, but varied between items, and was therefore inconclusive. Conclusion This study adds knowledge about healthcare personnel self‐assessed competence and knowledge about maternal resuscitation and perimortem caesarean section in pregnancy. Our findings indicate that there is still a need for more education and training in this rare incident