Psychometric properties of the Norwegian version of the clinical learning environment comparison survey

Aim: To translate The Clinical Learning Environment Comparison Survey (CLECS) into Norwegian and to evaluate the psychometric properties of the Norwegian version. Design: A cross-sectional survey including a longitudinal component. Methods: The CLECS was translated into Norwegian following the World Health Organization guidelines, including forward translation, expert panel, back-translation, pre-testing and cognitive interviewing. Nursing students at a Norwegian university college were invited to participate in the study (psychometrical testing) based on informed consent. Reliability and validity of the translated version of CLECS were investigated using a confirmatory factor analysis (CFA), Cronbach's alpha and test–retest analysis. Results: A total of 122 nursing students completed the questionnaire and Cronbach alphas for the CLECS subscales ranged from 0.69 to 0.89. CFA goodness-of-fit indices (χ2/df = 1.409, CFI = 0.915, RMSEA = 0.058) showed acceptable model fit. Test–retest ICC ranged from 0.55 to 0.75, except for two subscales with values below 0.5.publishedVersio

Integrating simulation training during clinical practice in nursing homes: An experimental study of nursing students´ knowledge acquisition, self-efficacy and learning needs

Background Limited access to supervision, feedback and quality learning experiences pose challenges to learning in the clinical setting for first-year nursing students who are beginning their clinical experiences. Prior studies have indicated that simulation training, as a partial replacement of clinical practice hours, may improve learning. However, there has been little research on simulation training integrated as a partial replacement during first-year students’ clinical practice in nursing homes. The primary aim of this study was to examine first-year nursing students’ knowledge acquisition and self-efficacy in integrating a partial replacement of clinical hours in nursing homes with simulation training. Its secondary aim was to examine perceptions of how learning needs were met in the simulated environment compared with the clinical environment. Design The primary aim was addressed using an experimental design that included pre- and post-tests. The secondary aim was investigated using a descriptive survey-based comparison. Methods First-year students at a Norwegian university college (n = 116) were asked to participate. Those who agreed (n = 103) were randomly assigned to the intervention group (n = 52) or the control group (n = 51). A knowledge test, the General Self-efficacy Scale and the Clinical Learning Environment Comparison Survey were used to measure students’ outcomes and perceptions. The data were analysed using independent samples t-tests, chi-square tests and paired samples t-tests. Results Knowledge scores from pre- to post-tests were significantly higher in the intervention group than in the control group with a medium to large effect size (p < 0.01, Hedges’ g = 0.6). No significant differences in self-efficacy were identified. Significant differences (p <  0.05) were observed between the simulated and the clinical environment with regard to meeting learning needs; effect sizes ranged from small and medium to large (Cohen’s d from 0.3 to 1.0). Conclusion Integrating the partial replacement of clinical hours in nursing homes with simulation training for first-year nursing students was positively associated with knowledge acquisition and meeting learning needs. These findings are promising with regard to simulation as a viable partial replacement for traditional clinical practice in nursing homes to improve learning.publishedVersio

Associations between unit workloads and outcomes of first extubation attempts in extremely premature infants below a gestational age of 26 weeks

Objective: The objective was to explore whether high workloads in neonatal intensive care units were associated with short-term respiratory outcomes of extremely premature (EP) infants born <26 weeks of gestational age. Methods: This was a population-based study using data from the Norwegian Neonatal Network supplemented by data extracted from the medical records of EP infants <26 weeks GA born from 2013 to 2018. To describe the unit workloads, measurements of daily patient volume and unit acuity at each NICU were used. The effect of weekend and summer holiday was also explored. Results: We analyzed 316 first planned extubation attempts. There were no associations between unit workloads and the duration of mechanical ventilation until each infant’s first extubation or the outcomes of these attempts. Additionally, there were no weekend or summer holiday effects on the outcomes explored. Workloads did not affect the causes of reintubation for infants who failed their first extubation attempt. Conclusion: Our finding that there was no association between the organizational factors explored and short-term respiratory outcomes can be interpreted as indicating resilience in Norwegian neonatal intensive care units.publishedVersio

Anne-Marie Motard (dir.), Identité et diversité : créations, discours, représentations

À la recherche de concepts identitaires qui s’adapteraient aux nouvelles réalités sociales générées par les flux migratoires et la mondialisation, se dessine une tendance à concilier les deux termes, « identité » et « diversité », qui figurent dans le titre de l’ouvrage dirigé par Anne-Marie Motard (université Montpellier 3). Pourtant, Le Petit Robert (éd. 2011) définit « identité », du latin identitas de idem « le même », comme le « caractère de deux objets de pensée identique » et « de ce q..

An observational study: associations between nurse-reported hospital characteristics and estimated 30-day survival probabilities

Background There is a growing body of evidence for associations between the work environment and patient outcomes. A good work environment may maximise healthcare workers’ efforts to avoid failures and to facilitate quality care that is focused on patient safety. Several studies use nurse-reported quality measures, but it is uncertain whether these outcomes are correlated with clinical outcomes. The aim of this study was to determine the correlations between hospital-aggregated, nurse-assessed quality and safety, and estimated probabilities for 30-day survival in and out of hospital. Methods In a multicentre study involving almost all Norwegian hospitals with more than 85 beds (sample size=30, information about nurses’ perceptions of organisational characteristics were collected. Subscales from this survey were used to describe properties of the organisations: quality system, patient safety management, nurse–physician relationship, staffing adequacy, quality of nursing and patient safety. The average scores for these organisational characteristics were aggregated to hospital level, and merged with estimated probabilities for 30-day survival in and out of hospital (survival probabilities) from a national database. In this observational, ecological study, the relationships between the organisational characteristics (independent variables) and clinical outcomes (survival probabilities) were examined. Results Survival probabilities were correlated with nurse-assessed quality of nursing. Furthermore, the subjective perception of staffing adequacy was correlated with overall survival. Conclusions This study showed that perceived staffing adequacy and nurses’ assessments of quality of nursing were correlated with survival probabilities. It is suggested that the way nurses characterise the microsystems they belong to, also reflects the general performance of hospitals

Retningslinjer økte bruk av enteral ernæring til intensivpasienter

Bakgrunn: Ernæringsstøtte i form av enteral eller parenteral ernæring er viktig for å unngå underernæring hos intensivpasienten. Riktig ernæringsstøtte har vært assosiert med redusert dødelighet, færre infeksjoner og forbedret helserelatert livskvalitet. En registrering av ernæringspraksis har vist at denne ikke er i tråd med med retningslinjene. Det er behov for å finne måter som sikrer en ernæringspraksis som er basert på oppdaterte anbefalinger. Hensikt: Å undersøke om en intervensjon for å implementere retningslinjer for ernæring til intensivpasienten fører til tidligere oppstart av enteral fremfor parenteral ernæring, og om kalori- og proteinbehovet blir bedre dekket med enteral ernæring. Metode: Studien er en prospektiv observasjonsstudie før og etter en intervensjon. Resultat: Etter intervensjonen ble tidlig oppstart av enteral ernæring iverksatt hos flere intensivpasienter. Det var færre pasienter som fikk parenteral ernæring, og den ble oftere startet senere i pasientoppholdet etter intervensjonen. Som følge av at intensivpasientene fikk mer enteral og mindre parenteral ernæring etter intervensjonen, ble større andel av kalori- og proteinbehovet dekket med enteral ernæring. Konklusjon: Intervensjonen bidro til implementering av retningslinjer og en endring i praksis, som førte til at intensivpasientene fikk mer enteral og mindre parenteral ernæring

Retningslinjer økte bruk av enteral ernæring til intensivpasienter

Bakgrunn: Ernæringsstøtte i form av enteral eller parenteral ernæring er viktig for å unngå underernæring hos intensivpasienten. Riktig ernæringsstøtte har vært assosiert med redusert dødelighet, færre infeksjoner og forbedret helserelatert livskvalitet. En registrering av ernæringspraksis har vist at denne ikke er i tråd med med retningslinjene. Det er behov for å finne måter som sikrer en ernæringspraksis som er basert på oppdaterte anbefalinger. Hensikt: Å undersøke om en intervensjon for å implementere retningslinjer for ernæring til intensivpasienten fører til tidligere oppstart av enteral fremfor parenteral ernæring, og om kalori- og proteinbehovet blir bedre dekket med enteral ernæring. Metode: Studien er en prospektiv observasjonsstudie før og etter en intervensjon. Resultat: Etter intervensjonen ble tidlig oppstart av enteral ernæring iverksatt hos flere intensivpasienter. Det var færre pasienter som fikk parenteral ernæring, og den ble oftere startet senere i pasientoppholdet etter intervensjonen. Som følge av at intensivpasientene fikk mer enteral og mindre parenteral ernæring etter intervensjonen, ble større andel av kalori- og proteinbehovet dekket med enteral ernæring. Konklusjon: Intervensjonen bidro til implementering av retningslinjer og en endring i praksis, som førte til at intensivpasientene fikk mer enteral og mindre parenteral ernæring.Increased use of enteral nutrition for critical care patients after implementation of guidelines Background: Nutritional support with enteral or parenteral nutrition is important to avoid malnutrition in critically ill patients. Proper nutritional support to critically ill patients can lead to reduced mortality,fewer infections and improved health-related quality of life. A survey of the nutrition practices revealed that feeding practices were not in adherence with the guidelines. Objective: The purpose of this study is to examine whether an intervention to implement nutrition guidelines for critical care patients leads to earlier initiation of enteral nutrition instead of parenteral nutrition, and improved adequacy of calorie and protein requirements with enteral nutrition. Method: The study is a prospective observational study before and after an intervention. Result: More critical-care patients received an early initiation of enteral nutrition after the intervention. Fewer patients received parenteral nutrition which was more often initiated after day four following the intervention. Critical care patients received more enteral and less parenteral nutrition after the intervention. As a result of improved nutrition practices, a higher average percentage of calorie and protein requirements were met. Conclusion: The intervention led to implementation of guidelines and a change in practice that led to more enteral and less parenteral nutrition to critical-care patients. Key words: Critical care, nutrition, quantitative study, evidence based nursing, qualit

Retningslinjer økte bruk av enteral ernæring til intensivpasienter

Bakgrunn: Ernæringsstøtte i form av enteral eller parenteral ernæring er viktig for å unngå underernæring hos intensivpasienten. Riktig ernæringsstøtte har vært assosiert med redusert dødelighet, færre infeksjoner og forbedret helserelatert livskvalitet. En registrering av ernæringspraksis har vist at denne ikke er i tråd med med retningslinjene. Det er behov for å finne måter som sikrer en ernæringspraksis som er basert på oppdaterte anbefalinger. Hensikt: Å undersøke om en intervensjon for å implementere retningslinjer for ernæring til intensivpasienten fører til tidligere oppstart av enteral fremfor parenteral ernæring, og om kalori- og proteinbehovet blir bedre dekket med enteral ernæring. Metode: Studien er en prospektiv observasjonsstudie før og etter en intervensjon. Resultat: Etter intervensjonen ble tidlig oppstart av enteral ernæring iverksatt hos flere intensivpasienter. Det var færre pasienter som fikk parenteral ernæring, og den ble oftere startet senere i pasientoppholdet etter intervensjonen. Som følge av at intensivpasientene fikk mer enteral og mindre parenteral ernæring etter intervensjonen, ble større andel av kalori- og proteinbehovet dekket med enteral ernæring. Konklusjon: Intervensjonen bidro til implementering av retningslinjer og en endring i praksis, som førte til at intensivpasientene fikk mer enteral og mindre parenteral ernæring.Increased use of enteral nutrition for critical care patients after implementation of guidelines Background: Nutritional support with enteral or parenteral nutrition is important to avoid malnutrition in critically ill patients. Proper nutritional support to critically ill patients can lead to reduced mortality,fewer infections and improved health-related quality of life. A survey of the nutrition practices revealed that feeding practices were not in adherence with the guidelines. Objective: The purpose of this study is to examine whether an intervention to implement nutrition guidelines for critical care patients leads to earlier initiation of enteral nutrition instead of parenteral nutrition, and improved adequacy of calorie and protein requirements with enteral nutrition. Method: The study is a prospective observational study before and after an intervention. Result: More critical-care patients received an early initiation of enteral nutrition after the intervention. Fewer patients received parenteral nutrition which was more often initiated after day four following the intervention. Critical care patients received more enteral and less parenteral nutrition after the intervention. As a result of improved nutrition practices, a higher average percentage of calorie and protein requirements were met. Conclusion: The intervention led to implementation of guidelines and a change in practice that led to more enteral and less parenteral nutrition to critical-care patients. Key words: Critical care, nutrition, quantitative study, evidence based nursing, qualit

Supplementing Clinical Practice in Nursing Homes With Simulation Training: A Qualitative Study of Nursing Students’ Experiences

Introduction Limited access to nurse supervisors, insufficient learning support and staff with high workloads are well documented in the research literature as barriers to nursing students´ learning in clinical practice in nursing homes. Due to these barriers nursing students may benefit from additional learning support from nurse educators during their clinical practice period. Objective The study aimed to explore nursing students’ experiences of supplementary simulation training as a tool to support learning during clinical practice in nursing homes. Methods A descriptive qualitative design was used. Twenty-seven first-year nursing students from a university college in Norway were interviewed after attending a seven-week practice period in nursing homes with supplementary simulation training. Three semi-structured focus group interviews were audio recorded, transcribed, and analysed using systematic text condensation. Findings Three categories of student experiences were identified: enhancing the reasoning behind care, transferring knowledge and experiences between the learning environments and enhancing the sense of mastery. Conclusion The supplementary simulation training seemed to complement clinical practice by consolidating the students’ learning during the clinical practice period, enhance the students’ motivation and sense of mastery, and consequently their efforts to seek out new challenges, explore and learn both in the clinical and the simulated environment.publishedVersio