Sky-High Safety? A Qualitative Study of Physicians’ Experiences of Patient Safety in Norwegian Helicopter Emergency Services

Background Patients treated and transported by Helicopter Emergency Medical Services (HEMS) are prone to both flight and medical hazards, but incident reporting differs substantially between flight organizations and health care, and the extent of patient safety incidents is still unclear. Methods A qualitative descriptive study based on in-depth interviews with 8 experienced Norwegian HEMS physicians from 4 different bases from February to July 2020 using inductive qualitative content analysis. The study objectives were to explore the physicians’ experience with incident reporting and their perceived areas of risk in HEMS. Results/Findings The HEMS physicians stated that the limited number of formal incident reports was due to the “nature of the HEMS missions” and because reports were mainly relevant when deviating from procedures, which are sparse in HEMS. The physicians preferred informal rather than formal incident reporting systems and reporting to a colleague rather than a superior. The reasons were ease of use, better feedback, and less fear of consequences. Their perceived areas of risk were related to all the phases of a HEMS mission: the physician as the team leader, medication errors, the handover process, and the helicopter as a work platform. Conclusions The sparse, informal, and fragmented incident reporting provides a poor overview of patient safety risks in HEMS. Focusing on organizational factors and system responsibility and research on environmental and contextual factors are needed to further improve patient safety in HEMS.publishedVersio

Læring og kompetanseutvikling i kommunehelsetenesta – ein intervjustudie av kreftsjukepleiarar

The number of cancer patients is expected to increase 30% by 2020. To meet the needs of seriously ill and dying cancer patients the community health service must be strengthened. There is little knowledge about the development of competence in the community health service. The aim of this study was to get more knowledge about competence development of cancer nurses.The study has a phenomenological hermeneutical design. Data was based on eight qualitative interviews with cancer nurses. The content of daily work and the cooperation within the community of practice were found to be important. Experience, theoretical knowledge, expectations and attitudes were of importance in their learning, and this is accomplished in cooperation with others through trust, having enough time and responsibility. It will be a challenge to meet the demands to quality and competence in future cancer care. Employing advanced nurse practitioners can be a resource, strengthening quality, improving nursing and innovation

Kva skjer i praksisstudiet i somatiske sengeavdelingar?

Hensikta er å tilføre kunnskap om sjukepleiarstudentar si læring i praksisstudiet i somatiske sengeavdelingar. Forskingsspørsmåla er: Korleis lærer studentane ulike sjukepleiarfunksjonar?, Korleis samhandlar student og praksisrettleiar om læring? Observasjonar av sjukepleiarstudentar og intervju med studentar og praksisrettleiar er nytta for å samle det empiriske materialet. Studien viste at hjelperolla, den diagnostiske og overvakande funksjonen og den administrerande funksjonen til medisinsk behandling er tydelegast i materialet. Hjelperolla og samhandlinga med pasientane blir av studentane framheva som særleg verdfulle og synest å ha stor betyding for utviklinga av sjukepleiaridentitet. Rettleiing bidrar til at studentane tileignar seg avdelinga sitt repertoar

Helsepersonells erfaringer med pasientforløp i kommuner i Vest-Norge

Health services in Norway have been described as fragmented with weak coordination between different care levels with respect to patient pathways. The Coordination Reform’s aim was to improve patient pathways and strengthen user participation. The aim of this study was to investigate health personnel ́s experiences with patient pathways in municipalities in Western Norway. A qualitative design was chosen. Six focus group interviews with health personnel working in municipalities in Western Norway were conducted in 2013 and 2014. The interviews revealed that health personnel experienced that local health services gave cohesive patient pathways and strengthened user participation. Cohesive patient pathways and locally adapted pathways were considered important. Coordination and electronic communication between primary and specialist health care services were seen as inadequate. Trust, teamwork, competence and necessary resources were considered vital. Health personnel ́s experiences indicated that the intended aim of cohesive patient pathways near the patient was met.

Mapping interaction quality for nursing and medical students in primary care placement in municipal emergency care units: a systematic observational study

IntroductionPrimary care placement for nursing and medical students is vital for developing the competence to accommodate the increasing number of patients with multimorbid and complex conditions. Prior studies have suggested that interaction quality in primary care placement empowers learning. However, research mapping interaction quality in primary care placements in municipal emergency care units is lacking. This study aimed to systematically map interaction quality for nursing and medical students in primary care placement in two municipal emergency care units.Materials and methodsThis study adopted a systematic descriptive observational design. Systematic observations (n = 201 cycles) of eight nursing students (n = 103 cycles) and six medical students (n = 98 cycles) were used to map interaction quality across six learning situations between March and May 2019. Observations were coded using the Classroom Assessment Scoring System-Secondary (CLASS-S). Data were analyzed using descriptive statistics and Spearman correlations.ResultsInteraction quality is described in three domains: (I) emotional support, (II) framework for learning, and (III) instructional support, and the overall measure, student engagement. The results indicated middle-quality interactions in the emotional and instructional support domains and high quality in the framework for learning domain and student engagement. Correlations exhibited similar patterns and ranged from non-significant to strong correlations.ConclusionThe interaction qualities indicated a generally positive and supportive learning environment contributing to nursing and medical students’ learning and active participation in work tasks related to their professional roles. Thus, this new form for primary care placement for nursing and medical students in the municipal emergency care units was found to be a positive learning arena. These results may enhance nursing and medical education programs in countries with similar health services and education. Health education, supervisors, peers, and others contributing to students’ learning should recognize which interaction qualities may affect learning and how to improve quality, thus affecting supervisors’ approach to training students. While the CLASS-S showed potential for mapping interaction qualities for nursing and medical students in primary care placement in municipal emergency care units, further studies are needed to validate the CLASS-S for use in clinical placement settings

Å vere kreftsjukepleiar i kommunehelsetenesta - ein intervensjonsstudie om funksjonar og yrkesrolle

Background: Several Norwegian local authorities have established positions for cancer nurses, but we have little knowledge of what functions they have and what expertise they provide. Aim: The purpose of this study was to get more knowledge about what functions cancer nurses have in their local communities and how they experience and assess their professional role. Methods: Information was collected through research interviews with eight cancer nurses. Findings: The cancer nurses expressed that they had both patient-oriented and system-oriented functions. Central, patient-oriented functions covered almost anything from assessing patient condition, treatment, alleviate pain and symptoms, patient care, and information and counselling to patients and their next of kin. One of the most important system-oriented functions was the coordination of various health services. Some experienced that documenting the way working hours had been used was a task that had to be done after working hours. Others had experienced a higher degree of freedom in developing their different roles as cancer nurse. In assessing their own competence, the cancer nurses highlighted their patient-oriented functions and professional knowledge. To supervise colleagues and work for higher professional quality were also found to be important. Conclusion: The cancer nurses expressed that positions of a prescribed percentage as a cancer nurse may create a space of freedom that opens up for professional judgement both with respect to patient- and system-oriented functions

Læring og kompetanseutvikling i kommunehelsetenesta – ein intervjustudie av kreftsjukepleiarar

The number of cancer patients is expected to increase 30% by 2020. To meet the needs of seriously ill and dying cancer patients the community health service must be strengthened. There is little knowledge about the development of competence in the community health service. The aim of this study was to get more knowledge about competence development of cancer nurses.The study has a phenomenological hermeneutical design. Data was based on eight qualitative interviews with cancer nurses. The content of daily work and the cooperation within the community of practice were found to be important. Experience, theoretical knowledge, expectations and attitudes were of importance in their learning, and this is accomplished in cooperation with others through trust, having enough time and responsibility. It will be a challenge to meet the demands to quality and competence in future cancer care. Employing advanced nurse practitioners can be a resource, strengthening quality, improving nursing and innovation

Læring og kompetanseutvikling i kommunehelsetenesta - ein intervjustudie av kreftsjukepleiarar

Learning and competence development in community health service – an interview study of cancer nurses The number of cancer patients is expected to increase 30% by 2020. To meet the needs of seriously ill and dying cancer patients the community health service must be strengthened. There is little knowledge about the development of competence in the community health service. The aim of this study was to get more knowledge about competence development of cancer nurses.The study has a phenomenological hermeneutical design. Data was based on eight qualitative interviews with cancer nurses. The content of daily work and the cooperation within the community of practice were found to be important. Experience, theoretical knowledge, expectations and attitudes were of importance in their learning, and this is accomplished in cooperation with others through trust, having enough time and responsibility. It will be a challenge to meet the demands to quality and competence in future cancer care. Employing advanced nurse practitioners can be a resource, strengthening quality, improving nursing and innovation