Registered nurses’ experiences with master’s degree competence in the specialist health service: A qualitative descriptive study

The application of master’s degree competence in nursing practice has been a hot topic of debate in various forums in recent years. International findings suggest that nurses with master’s degrees can make a positive contribution to the quality of services and patient safety, and an association has been suggested between higher education in nursing and a reduced mortality rate in hospitals. Therefore, this study aimed to investigate registered nurses’ (RNs’) experiences with how a master’s level education affected their work in the specialist health service. An inductive qualitative study design was used. Data were collected through focus group interviews with 18 participants in five groups and analysed using content analysis. This study is reported in accordance with COREQ. The results showed an ‘expectation gap’ between the RNs with master’s degrees and their managers. Our findings also reflected the RNs’ ambivalent experiences of being both a threat and a resource. The application of the competence describes the desire to utilise and recognise the master’s qualification. Furthermore, expectations for the future in the specialist health service were focussed on more evidence-based practice. The results of this study highlight that enhanced competence is a priority area aimed at meeting current and future needs for evidence-based practice and effective services. Clinical master’s degrees place emphasis on both the RNs’ clinical skills and their ability to obtain and apply new knowledge.publishedVersio

The PTPN22 C1858T gene variant is associated with proinsulin in new-onset type 1 diabetes

<p>Abstract</p> <p>Background</p> <p>The protein tyrosine phosphatase nonreceptor type 2 (<it>PTPN22</it>) has been established as a type 1 diabetes susceptibility gene. A recent study found the C1858T variant of this gene to be associated with lower residual fasting C-peptide levels and poorer glycemic control in patients with type 1 diabetes. We investigated the association of the C1858T variant with residual beta-cell function (as assessed by stimulated C-peptide, proinsulin and insulin dose-adjusted HbA_1c), glycemic control, daily insulin requirements, diabetic ketoacidosis (DKA) and diabetes-related autoantibodies (IA-2A, GADA, ICA, ZnT8Ab) in children during the first year after diagnosis of type 1 diabetes.</p> <p>Methods</p> <p>The C1858T variant was genotyped in an international cohort of children (n = 257 patients) with newly diagnosed type 1 diabetes during 12 months after onset. We investigated the association of this variant with liquid-meal stimulated beta-cell function (proinsulin and C-peptide) and antibody status 1, 6 and 12 months after onset. In addition HbA_1cand daily insulin requirements were determined 1, 3, 6, 9 and 12 months after diagnosis. DKA was defined at disease onset.</p> <p>Results</p> <p>A repeated measurement model of all time points showed the stimulated proinsulin level is significantly higher (22%, p = 0.03) for the T allele carriers the first year after onset. We also found a significant positive association between proinsulin and IA levels (est.: 1.12, p = 0.002), which did not influence the association between <it>PTPN22 </it>and proinsulin (est.: 1.28, p = 0.03).</p> <p>Conclusions</p> <p>The T allele of the C1858T variant is positively associated with proinsulin levels during the first 12 months in newly diagnosed type 1 diabetes children.</p

Registered nurses’ experiences with master’s degree competence in the specialist health service: A qualitative descriptive study

The application of master’s degree competence in nursing practice has been a hot topic of debate in various forums in recent years. International findings suggest that nurses with master’s degrees can make a positive contribution to the quality of services and patient safety, and an association has been suggested between higher education in nursing and a reduced mortality rate in hospitals. Therefore, this study aimed to investigate registered nurses’ (RNs’) experiences with how a master’s level education affected their work in the specialist health service. An inductive qualitative study design was used. Data were collected through focus group interviews with 18 participants in five groups and analysed using content analysis. This study is reported in accordance with COREQ. The results showed an ‘expectation gap’ between the RNs with master’s degrees and their managers. Our findings also reflected the RNs’ ambivalent experiences of being both a threat and a resource. The application of the competence describes the desire to utilise and recognise the master’s qualification. Furthermore, expectations for the future in the specialist health service were focussed on more evidence-based practice. The results of this study highlight that enhanced competence is a priority area aimed at meeting current and future needs for evidence-based practice and effective services. Clinical master’s degrees place emphasis on both the RNs’ clinical skills and their ability to obtain and apply new knowledge

Registered nurses’ experiences with master’s degree competence in the specialist health service: A qualitative descriptive study

The application of master’s degree competence in nursing practice has been a hot topic of debate in various forums in recent years. International findings suggest that nurses with master’s degrees can make a positive contribution to the quality of services and patient safety, and an association has been suggested between higher education in nursing and a reduced mortality rate in hospitals. Therefore, this study aimed to investigate registered nurses’ (RNs’) experiences with how a master’s level education affected their work in the specialist health service. An inductive qualitative study design was used. Data were collected through focus group interviews with 18 participants in five groups and analysed using content analysis. This study is reported in accordance with COREQ. The results showed an ‘expectation gap’ between the RNs with master’s degrees and their managers. Our findings also reflected the RNs’ ambivalent experiences of being both a threat and a resource. The application of the competence describes the desire to utilise and recognise the master’s qualification. Furthermore, expectations for the future in the specialist health service were focussed on more evidence-based practice. The results of this study highlight that enhanced competence is a priority area aimed at meeting current and future needs for evidence-based practice and effective services. Clinical master’s degrees place emphasis on both the RNs’ clinical skills and their ability to obtain and apply new knowledge

Clinical and ethical aspects of palliative sedation with propofol—A retrospective quantitative and qualitative study

Background The anesthetic propofol is often mentioned as a drug that can be used in palliative sedation. The existing literature of how to use propofol in palliative sedation is scarce, with lack of information about how propofol could be initiated for palliative sedation, doses and treatment outcomes. Aim To describe the patient population, previous and concomitant medication, and clinical outcome when propofol was used for palliative sedation. Methods A retrospective study with quantitative and qualitative data. All patients who during a 4.5‐year period received propofol for palliative sedation at the Department of palliative medicine, Akershus University Hospital, Norway were included. Results Fourteen patients were included. In six patients the main indication for palliative sedation was pain, in seven dyspnoea and in one delirium. In eight of these cases propofol was chosen because of the pharmacokinetic properties (rapid effect), and in the remaining cases propofol was chosen because midazolam in spite of dose titration failed to provide sufficient symptom relief. In all patients sedation and adequate symptom control was achieved during manual dose titration. During the maintenance phase three of 14 patients had spontaneous awakenings. At death, propofol doses ranged from 60 to 340 mg/hour. Conclusions Severe suffering at the end of life can be successfully treated with propofol for palliative sedation. This can be performed in palliative medicine wards, but skilled observation and dose titration throughout the period of palliative sedation is necessary. Successful initial sedation does not guarantee uninterrupted sedation until death

Clinical and ethical aspects of palliative sedation with propofol—A retrospective quantitative and qualitative study

Background The anesthetic propofol is often mentioned as a drug that can be used in palliative sedation. The existing literature of how to use propofol in palliative sedation is scarce, with lack of information about how propofol could be initiated for palliative sedation, doses and treatment outcomes. Aim To describe the patient population, previous and concomitant medication, and clinical outcome when propofol was used for palliative sedation. Methods A retrospective study with quantitative and qualitative data. All patients who during a 4.5‐year period received propofol for palliative sedation at the Department of palliative medicine, Akershus University Hospital, Norway were included. Results Fourteen patients were included. In six patients the main indication for palliative sedation was pain, in seven dyspnoea and in one delirium. In eight of these cases propofol was chosen because of the pharmacokinetic properties (rapid effect), and in the remaining cases propofol was chosen because midazolam in spite of dose titration failed to provide sufficient symptom relief. In all patients sedation and adequate symptom control was achieved during manual dose titration. During the maintenance phase three of 14 patients had spontaneous awakenings. At death, propofol doses ranged from 60 to 340 mg/hour. Conclusions Severe suffering at the end of life can be successfully treated with propofol for palliative sedation. This can be performed in palliative medicine wards, but skilled observation and dose titration throughout the period of palliative sedation is necessary. Successful initial sedation does not guarantee uninterrupted sedation until death

Hypoglycemia-Associated EEG Changes in Prepubertal Children with Type 1 Diabetes

BACKGROUND: The purpose of this study was to explore the possible difference in the electroencephalogram (EEG) pattern between euglycemia and hypoglycemia in children with type 1 diabetes (T1D) during daytime and during sleep. The aim is to develop a hypoglycemia alarm based on continuous EEG measurement and real-time signal processing. METHOD: Eight T1D patients aged 6-12 years were included. A hyperinsulinemic hypoglycemic clamp was performed to induce hypoglycemia both during daytime and during sleep. Continuous EEG monitoring was performed. For each patient, quantitative EEG (qEEG) measures were calculated. A within-patient analysis was conducted comparing hypoglycemia versus euglycemia changes in the qEEG. The nonparametric Wilcoxon signed rank test was performed. A real-time analyzing algorithm developed for adults was applied. RESULTS: The qEEG showed significant differences in specific bands comparing hypoglycemia to euglycemia both during daytime and during sleep. In daytime the EEG-based algorithm identified hypoglycemia in all children on average at a blood glucose (BG) level of 2.5 ± 0.5 mmol/l and 18.4 (ranging from 0 to 55) minutes prior to blood glucose nadir. During sleep the nighttime algorithm did not perform. CONCLUSIONS: We found significant differences in the qEEG in euglycemia and hypoglycemia both during daytime and during sleep. The algorithm developed for adults detected hypoglycemia in all children during daytime. The algorithm had too many false alarms during the night because it was more sensitive to deep sleep EEG patterns than hypoglycemia-related EEG changes. An algorithm for nighttime EEG is needed for accurate detection of nocturnal hypoglycemic episodes in children. This study indicates that a hypoglycemia alarm may be developed using real-time continuous EEG monitoring