Assessing an Educational Program to Improve Documentation and Reduce Pain in Hospitalized Patients

Few experimental studies have evaluated the efficacy of continuing educational programs aimed at the improvement of nurses’ pain-management skills. This study assessed whether a standardized educational program aimed at nurses could increase the use of the Numeric Rating Scale-11 in both documenting and reducing postoperative pain-intensity levels in hospitalized surgical patients. The study had a quasi-experimental pre- and post-intervention design. Data were collected from records of surgical patients prior to and after the standardized educational program was completed. There were no significant differences between pre- and post-intervention groups in terms of either pain-documentation frequency or pain-intensity level. The study showed no increase in the frequency of postoperative pain documentation and no reduction of surgical patients’ postoperative pain-intensity level. This finding indicates that the standardized educational program on postoperative pain management was insufficient to bring about changes in clinical practice

Intensive care nurses’ experiences using volatile anaesthetics in the intensive care unit: An exploratory study

Objective: To explore the experiences intensive care nurses have with volatile anaesthetics in the intensive care unit. Research methodology and design: A qualitative exploratory and descriptive design was used. Data were collected in 2019 from individual interviews with nine intensive care nurses, who were recruited using purposive sampling. Data were analysed using systematic text condensation. Setting: The study was undertaken in two general intensive care units from different university hospitals in Norway where volatile anaesthetics were utilised. Findings: Three categories emerged from the data analysis: experiencing the benefits of volatile anaesthetics; coping with unfamiliarity in handling volatile anaesthetics; and meeting challenges related to volatile anaesthetics in practice. Conclusion: The intensive care nurses had positive experiences related to administering volatile anaesthetics in the intensive care unit and responded positively to the prospect of using it more often. Because volatile anaesthetics were rarely used in their units, the participants felt uncertain regarding its use due to unfamiliarity. Collegial support and guidelines were perceived as pivotal in helping them cope with this uncertainty. The participants also experienced several challenges in using volatile anaesthetics in the intensive care unit, with ambient pollution being regarded as the main challenge.acceptedVersio

Studenterfaringer med veiledning og læring knyttet til deltagelse i et kvalitetsforbedringsprosjekt på sykehus med kunnskapsbasert praksis som arbeidsform, -en beskrivende og utforskende studie

Student experiences with supervision and learning through participation in a quality improvement evidence-baced practice project in a hospital, -a descriptive and explorative study A significant part of health care students’ education is provided through clinical placement supervised by practitioners with required education and experience. This study has been conducted to increase knowledge of students’ experiences with supervision and learning related to participation in a quality improvement project in a hospital using evidence-based practice tools. A descriptive and exploratory design with focus group interviews. Data was analysed using qualitative content analysis. Three main themes emerged: changed student role, understanding the importance of keeping professional knowledge updated and need for the facilitation of the clinical placement period. The study showed that supervision helped students become equals of their supervisors and part of the community of practice. The project contributed to students`' coping skills. Integrating evidence-based practice into practice taught students a method of professional knowledge updating and quality improvement

Sykepleieres erfaringer med oppstart av non-invasiv ventilasjonsbehandling på sengepost med intermediærstue: En kvalitativ studie

Non-invasiv ventilasjonsbehandling (NIV) er en behandlingsform som kan gjennomføres på sengepost med intermediærstue og er et tiltak som kan avlaste intensivavdelinger. Hensikten med denne studien var å belyse hva sykepleiere vurderer som viktige forutsetninger for vellykket oppstart av NIV-behandling på sengepost med intermediærstue. En kvalitativ metode med et eksplorerende og beskrivende design ble valgt. Det ble gjennomført individuelle, semistrukturerte intervjuer med syv sykepleiere. Datamaterialet ble analysert ved bruk av systematisk tekstkondensering. Sykepleierne vurderte at det å skape en trygg relasjon på pasientens premisser gjennom tilstedeværelse og oppmerksomhet og tilstrekkelig NIV-kompetanse hos sykepleierne som forutsetninger for vellykket oppstart av NIV-behandling. Videre vurderte sykepleierne at vellykket oppstart av NIV-behandling  forutsetter at sykepleiere er i stand til å utføre et bredt spekter av kliniske og etiske vurderinger for å  vurdere pasientens behov og effekt av NIVbehandlingen. Det som er nytt med denne studien er at den beskriver oppstart av NIV-behandling på sengepost med intermediærstue.

Ambulant oppfølgning i hjemmet til eldre kvinner med kols

Introduksjon: Forekomsten av kronisk obstruktiv lungesykdom (kols) er økende hos kvinner og ved stigende alder. Ved forverring av kols kan oppfølgning av sykepleiere i hjemmet være et trygt og gjennomførbart alternativ til at kols-pasienter forblir innlagt i sykehus. Få studier har undersøkt om kols-pasienters helserelaterte livskvalitet endrer seg ved oppfølgning av sykepleiere i hjemmet. Hensikt: Å undersøke om det er en endring i helserelatert livskvalitet hos eldre kvinner med kols etter oppfølging av sykepleier i hjemmet etter sykehusutskrivelse og få kunnskap om hvordan eldre kvinner med kols erfarer oppfølgning av sykepleier i hjemmet. Metode: Utviklingsprosjektet kombinerte kvantitativ og kvalitativ metode. Femten pasienters helserelaterte livskvalitet ble kartlagt på tre måletidspunkter i forbindelse med oppfølgning av sykepleier i hjemmet etter sykehusutskrivelse. Ni av pasientene ble dybdeintervjuet for å få kunnskap om deres erfaringer med å bli fulgt opp av sykepleier i hjemmet. Resultater: Pasientenes helserelaterte livskvalitet endret seg ikke signifikant i prosjektperioden. Tre temaer trådde frem i den kvalitative tekstanalysen: den personlige relasjonen til sykepleierne, kontinuitet i undervisning og veiledning fra sykepleierne og eget sosiale nettverk. Konklusjon: Resultatene fra prosjektet støtter implementering av ambulant oppfølgning hjemme for eldre kvinner med kols

Patients' experiences with a welfare technology application for remote home care: A longitudinal study

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Aims and Objectives: To explore the longitudinal experiences using an application named remote home care for remote palliative care among patients with cancer living at home. Background: Introducing welfare technology in home-based care for patients with cancer in the palliative phase is internationally suggested as a measure to remotely support palliative care needs. However, little is known about the experiences of patients utilising welfare technology applications to receive home-based care from healthcare professionals in a community care context. Although living with cancer in the palliative phase often presents rapidly changing ailments, emotions and challenges with patients' needs changing accordingly, no studies exploring the longitudinal experiences of patients were found. Design: A qualitative study with a longitudinal, exploratory design. Methods: Data were collected through individual interviews with 11 patients over 16 weeks. The data were analysed using qualitative content analysis. The COREQ checklist guided the reporting of the study. Results: Three themes were identified: (1) potential to facilitate self-governance of life-limiting illness in daily life, (2) need for interpersonal relationships and connections, and (3) experiences of increased responsibility and unclear utility of the Remote Home Care. Conclusion: The results showed that remote home care facilitated patients' daily routines, symptom control and improved illness-management at home. Interpersonal relationships with healthcare professionals were considered pivotal for satisfactory follow-up. Infrastructural glitches regarding data access, information sharing and lack of continuous adjustments of the application represented major challenges, with the potential to impose a burden on patients with cancer in the palliative phase Relevance to Clinical Practice: By exploring the experiences of patients in palliative care over time as the disease progresses, this study provides constructive insights for the design and development of welfare technology applications and optimal care strategies. Patient or Public Contribution: The remote home care was developed by interdisciplinary healthcare professionals.publishedVersio

Many patients with persistent pain one year after TKA report improvement by 5-7 years: A mixed methods study

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Background: Approximately 20% of patients report pain 12 months after TKA. No studies have investigated patients’ experiences of living with persistent postsurgical pain 5 to 7 years after TKA by combining a qualitative and quantitative methodology. Question/purpose: In a mixed-methods study, we explored patients’ experiences of living with persistent pain up to 7 years after primary TKA. We asked: In a subgroup analysis of patients who reported persistent pain 1 year after TKA surgery, how do patients live with persistent pain at the 5- to 7-year postoperative timepoint? Methods: This follow-up study was part of a longitudinal study of pain, symptoms, and health-related quality of life in patients who underwent TKA for osteoarthritis. The present study targeted a subgroup of patients (22% [45 of 202]) identified in the longitudinal study who reported no improvement in pain interference with walking at 12 months after surgery. Inclusion criteria were: all 31 patients in this subgroup who attended their 5-year follow-up at the hospital and lived within a 2-hour drive from the hospital. Eight patients declined or were unable to participate due to illness or death. Hence, the final sample consisted of 23 patients (13 women and 10 men). The participants’ mean age at surgery was 66 6 10 years. There were no differences in sociodemographic baseline data between the 23 included and the 22 excluded participants. A mixed-methods approach was employed, in which the quantitative data were followed up and investigated with qualitative interviews. Instruments used were the Brief Pain Inventory preoperatively, 12 months, and 5 years after surgery, as well as a semistructured interview guide. The individual interviews were conducted at one timepoint 5 to 7 years postsurgery to capture how pain was experienced at that timepoint. The interviews were audiorecorded, transcribed, and analyzed using qualitative content analysis. Meaning units were identified, condensed, and sorted into subthemes that were interpreted and abstracted into themes, guided by the research question. With a small sample, the quantitative analysis focused on descriptive statistics and nonparametric statistics when comparing demographics of included and nonincluded patients. In addition, two multivariate mixed models for repeated measures were employed to estimate within‐patient and between‐patient variations as well as to assess the effect of time on the pain outcomes. Results: Pain with walking decreased from 12 months to 5 years postoperatively (estimated mean score 7 versus 4, difference of means -3 [95% CI -5 to -2]; p < 0.001). Pain with daily activity decreased from 12 months to 5 years postoperatively (estimated mean score 6 versus 3, difference of means -3 [95% CI -4 to -1]; p < 0.001). Pain intensity (average pain) decreased from 12 months to 5 years postoperatively (estimated mean score 5 versus 4, difference of means -1 [95% CI -3 to 0]; p = 0.03). The results are presented as point estimates rounded up to whole numbers. The qualitative data analysis yielded three themes: persistent limitations after TKA, regained wellness over time, and complexity in physical challenges. Intermittent pain with certain movements resulted in limitations with some activities in everyday life and seemed to persist beyond 5 years. Multiple painful body sites and presence of comorbidities seemed to interfere with regained wellness over time. Conclusion: In this subgroup of patients experiencing postsurgical persistent pain 12 months after primary TKA, persistent postsurgical pain still limited certain activities for the participants, although pain seemed to be less influential in their everyday lives after 5 years to 7 years. Clinicians may use these findings to inform and guide patients with delayed improvements in pain into more realistic expectations for recovery, rehabilitation, and strategies for coping with pain and impaired function. However, it is imperative to rule out other reasons for pain in patients reporting pain 12 months and longer after surgery and to be attentive of possible changes in pain over time.publishedVersio

Sykepleierens funksjon og akutte smerter hos ryggmargsskadde : en teoretisk klargjøring og empirisk kartlegging av sykepleieres funksjon ved lindring av akutte smerter hos pasienter med ryggmargsskade

Hensikten med studien er å få kunnskap om sykepleiernes kliniske praksis med hensyn til smertelindring for pasienter med skade på ryggmargen i den akutte fasen. I første del av studien klargjøres teoretisk sykepleiernes funksjon og ansvar med smertelindring hos pasienter med ryggmargsskade i den akutte fasen. I den empiriske delen av studien kartlegges sykepleiernes funksjon og ansvar ved lindring av akutte smerter hos pasienter med ryggmargsskade. Studiens teoretiske rammeverk baseres på Kim's typologi om fire domener (1987). Sykepleiernes selvstendige funksjon og assistentfunksjon når det gjelder smertelindring klargjøres ut fra V. Henderson's teori. Ansvarsfordelingen mellom sykepleiere og leger på området smertelindring belyses ut fra lover og regler. En oversikt over nyere smertefysiologi presenteres og det redegjøres for smerter og behandling av disse hos ryggmargsskadde. Den empiriske delen av studien har et deskriptivt design. Utvalget bestod av 33 sykepleiere fra en postoperativ nevrokirurgisk avdeling og utgjør 89.2% av hele populasjonen (n=37). Sykepleierne samlet data om smerteintensitet, smertestillende medikamenter og effekt av smertelindringen ved hjelp av et registreringsskjema hos 21 pasienter med ryggmargsskade. De typiske sykepleierne ved denne nevrokirurgiske postoperative avdelingen var kvinner uten spesialutdanning i intensivsykepleie, mellom 25 og 35 år, og ansatt i 4 år eller mindre. Pasientkategorien bestod av 17 pasienter med tetraplegi og 4 med paraplegi (n=21). Gjennomsnittsalderen var 46.3 år (fra 20 til 79). De yngre var mest utsatt for trafikkulykker, de eldre for ulike typer fritidsulykker. Resultatene synes å vise at sykepleierne vurderte den gjennomsnittlige smerteintensiteten som lav (VAS < 2) og smertelindringseffekten som meget god. Den vanligste smertelindrende behandlingen pasientene fikk var tradisjonelle ikke opioide og opioide analgetika kombinert med anksiolytika. Nyere alternative smertelindrende medikamenter som antidepressiva og antiepileptika ble ikke benyttet hos disse 21 pasientene. Sykepleierne synes ikke å følge opp legenes forordninger av Paracet og Paralgin forte til faste tider, men synes heller å gi medikamentene ved behov. Ansvarsfordelingen mellom sykepleierne og legene ved avelingen når det gjelder å gi smertestillende medikamenter ble regulert ved en skriftlig delegering til sykepleierne, basert på lovverket. Det betydde at sykepleierne i tillegg til å ha ansvar for smertevurdering og evaluering av virkning og bivirkning av de smertestillende medikamentene, også hadde ansvar for valg av type medikament innenfor visse delegerte rammer. Ved tvil om pasientene fikk god nok smertelindring ble lege konsultert. Sykepleierne synes å formidle sin tvil og forvente respons i form av nye forordninger fra lege, heller enn å tilstrebe dialog og aktiv deltagelse i nye beslutninger. Videre studier anbefales

Sykepleierstudenters erfaringer med praksisstudier organsiert som studenttett post

Praksisstudier organisert som studenttett post innebærer at det er mange studenter på samme praksissted, at flere sykepleiere har veilederansvar og at studentene samarbeider med medstudent i par. Tidligere studier har vist at en slik praksisorganisering har både positive og negative sider. Studenttett post er en organisering av praksisstudier som studentene i hovedsak vurderte som positiv, og som tilsynelatende har tilfredsstillende betingelser med tanke på læring