Development of a Workplace-Based Training Program for Nurse-Led Ultrasound-Guided Femoral Nerve Blocks: A Feasibility Study with the Patients’ Perspective in Focus

Background. Task shifting is a systematic delegation of tasks in order to make more efficient use of the available human resources for health. Training programs and the quality of these are sparsely studied and specially they that include the patients’ perspectives to an even lesser degree. Aim. A single-center feasibility study with a convergent parallel mixed method approach, integrating quantitative and qualitative components, was conducted at an emergency department aimed to evaluate a training program for nurse-led ultrasound-guided femoral nerve block. Method. Registered nurses (RNs) (n = 5), supervising anesthesiologists (n = 7), and patients with hip fracture (n = 15) participated. The training consisted of a one-day program that included comprehensive theoretical and practical instruction in anatomy, hygiene, and the application of ultrasound. The one-day training program was evaluated through an objective structured clinical examination (OSCE). Following that, each registered nurse conducted three supervised procedures in the weeks that followed. These procedures were performed on patients admitted with hip fractures in the emergency department. The patients (n = 15) were interviewed regarding their experiences and perspectives of pain, safety, and information of the procedures in emergency department. Results. In questionnaire, the RNs and anesthesiologists agreed that the training procedures were beneficial for the patients due to pain relief. Pain intensity showed a mean baseline pain score of 6.0 (95% CI 4.9–7.1) decreasing to 2.5 (95% CI 1.4–3.6) at 30 minutes after needle extraction. The interviews revealed that all patients experienced pain relief after the in situ nerve block training procedures as well as they felt safe and taken care of. Conclusions. The training program for nurse-led ultrasound-guided femoral nerve blocks was considered feasible. All included RNs learned the procedure for task shifting in a satisfactory way.publishedVersio

Nurse-led ultrasound-guided femoral nerve block: A randomised controlled trial of two different patient flow systems in an emergency department

Introduction: Elderly with hip fractures present complex challenges. Effective pain management is crucial for recovery and quality of life. However, pain control can be difficult and requires customized care. Methods: We conducted an unblinded, randomised controlled trial investigating the effects of ultrasound-guided femoral nerve block in patients with hip fracture performed by specially trained nurses (Group Nurse) compared to anaesthesiologists (Group Anaesthesiologist). The hypothesis was that a single shot ultrasound-guided femoral nerve block would result in a total summarized lower dynamic numeric rating scale score for pain intensity during the first 120 min after admission for patients in Group Nurse compared to Group Anaesthesiologist measured in five timepoints. The primary outcome was measured by a cumulative numeric rating scale score for dynamic pain (with flexion of the hip until maximum 30◦ from bed surface) during the first 120 min after admission to the emergency department. Results: From February 2020 to June 2021, 263 patients were screened, of which 42 (16.0%) consented and were randomly allocated; 21 in each arm. The primary outcome was not different between groups (p = 0.24), and displayed no substantial superiority of specially trained nurses over anaesthesiologist. No complications or adverse effects were observed in either group. The use of systemic analgesics and the development of delirium was similar between the two groups. In the Nurse Group, patients were administered their ultrasound-guided femoral nerve block earlier. Conclusion: Our study did not demonstrate a statistically significant beneficial effect of specially trained nurses over anaesthesiologist on cumulative pain in performing ultrasound-guided femoral nerve blocks, while no side- effects/complications or adverse effects were observed in either group.publishedVersio

Norwegian translation, cultural adaption and testing of the Person-centred Practice Inventory - Staff (PCPI-S)

Background: Person-centred health care has widespread recognition, but there are few instruments aimed at measuring the provision of person-centred practice among health care professionals across a range of settings. The Person-centred Practice Inventory – Staff (PCPI-S) is a new instrument for this purpose, theoretically aligned with McCormack & McCance’s person-centred framework, which has been translated and culturally adapted into Norwegian. Methods: The study used a two-stage research design involving: translation and cultural adaption of the PCPI-S from English to Norwegian language (phase 1), and a quantitative cross sectional survey following psychometric evaluation (phase 2). Confirmatory factor analysis was used to examine the theoretical measurement model. Results: The translation and cultural adaption was carried out according to ten recommend steps. Discrepancies were addressed and revised by all translators until consensus was reached on a reconciled version of the translation. A sample of 258 health care staff participated in the survey. The model fit statistics were overall positive; the model requires minor modifications and these are mostly confined to correlated errors. Conclusions: The translation and cultural adaption process of the PCPI-S from English to Norwegian language was a demanding process in order to retain the conceptual meanings of the original instrument. Overall, the psychometric properties of the tool were acceptable, but testing on a larger sample size is recommended.publishedVersio

Nursing Older People - Competence Evaluation Tool. Development and psychometric evaluation of an instrument measuring community-based nursing staff competence

This study aims to contribute to the assessment of quality of municipal elderly care by developing an instrument for measuring nursing staff competence. Competence measurements are well known and frequently used within nursing education and practice but less common in municipal elderly care, and they have not been conducted in Norwegian municipal elderly care. Improving the competence of employed staff is at the essence of quality improvement processes, and quality of care requires that all staff members have sufficient competence to provide safe care to patients. Competence is understood as a contextual, multi-faceted concept consisting of knowledge, skills and personal attributes. The individual competence of a practitioner is seen as inherently bound to the competence of other practitioners. The purpose of this study was to develop and evaluate a competence measurement instrument for nursing staff working in nursing homes and home care services. The aims were achieved through three sub-studies: (1) A systematic literature review and evaluation of instruments measuring the competence of nursing staff in community health care, (2) Identification of the competence necessary to provide safe services to older people in Norwegian municipal elderly care, and (3) Questionnaire development, testing, and comprehensive evaluation. The finding in Sub-study 1 was All instruments reviewed employed self-assessment as the main source of information. Self-assessment is found to be less valid in groups with low competence compared to groups with higher competence, and should therefore be supplemented with other methods for assessing competence, like testing. Although some instruments were evaluated for reliability and validity, all instruments reviewed fell short in terms of comprehensive instrument evaluation. In Sub-study 2, the most relevant content of the new competence measurement instrument was found to be covered in 62 items within ten categories: health promotion and disease prevention, treatment, palliative care, ethics and regulation, assessment and taking action, covering basic needs, communication and documentation, responsibility and activeness, cooperation, and attitudes toward older people. Some competence items concerning advanced practices among nurses did not reach consensus, which conflicts with competence expected in government policy documents. The Nursing Older People - Competence Evaluation Tool (NOP-CET) was developed based on the items that reached consensus in Sub-study 2, and consists of a total of 346 questionnaire items. The NOP-CET measures the competence of registered nurses, assistant nurses, and assistants working with older patients in nursing homes and/or home care services. The questionnaire contains items of self-assessment and test-items, and employs seven different response formats. In Sub-study 3, the NOP-CET was tested on 1016 nursing staff in ten municipalities. The NOP-CET was evaluated and found appropriate for its purpose of measuring communitybased nursing staff competence. The NOP-CET was found to have good content validity and reliability, and acceptable construct validity. Precision was acceptable considering the wide range of competence – from registered nurses to assistants – that the NOP-CET measures. The scores of the NOP-CET are easily interpretable when reported either item-by-item or in sum-scores. The instrument, which was considered acceptable for RNs and ANs, can be improved for assistants. Filling out the NOP-CET was found feasible for the municipalities taking part in the first survey. This study contributes three aspects to the field of nursing practice, education and research. The first is a framework outlining what competence in municipal elderly care should consist of. Municipalities can use this framework to evaluate available competence and plan the competence to acquire in the future. The framework can be used when evaluating current education of nurses, and as a basis for international studies examining competence in community elderly care. The second contribution of this study is the new competence measurement instrument. The NOP-CET can be used to explore the competence of nursing staff employed in nursing homes, home care services, or entire municipalities. Finally, to decrease measurement error, this study advocates comprehensive instrument development procedures and instrument evaluation within nursing as a science

En kartlegging av klinisk vurderingskompetanse hos helsepersonell i sykehjem: en pilotstudie

Bakgrunn: Helsepersonellets kliniske vurderingskompetanse er avgjørende for helsehjelpen som gis til eldre pasienter. Derfor er det viktig at personalets kunnskap tilfredsstiller de kravene som virksomhetene stiller. Tverrfaglig klinisk vurderingskompetanse er i liten grad kartlagt i norske kommuner. Hensikt: Å kartlegge klinisk vurderingskompetanse blant helsepersonell fra skjermede avdelinger på et sykehjem og identifisere eventuelle behov for økt kompetanse i kliniske situasjoner. Vi ønsket også å utforske kartleggingsverktøyet for forbedringsområder. Metode: Spørreskjemaet inneholdt 19 kliniske spørsmål med ulik fasit for hver yrkesgruppe, og ti demografiske spørsmål. Datasamlingen foregikk i oktober 2018. Dataene er behandlet statistisk i SPSS med parametriske analyser, Spearmans rho og Cronbachs alfa. Resultat: Antallet inkluderte deltakere var 56. Gjennomsnittlig hadde sykepleierne (n = 15) 59 prosent rette svar, helsefagarbeiderne (n = 31) hadde 53 prosent rette svar, mens assistentene (n = 10) oppnådde 41 prosent rette svar. Antallet rette svar ble kun påvirket av yrkesbakgrunn (p-verdi 0,018), der assistentenes nivå var signifikant lavere sammenliknet med sykepleierne (p-verdi 0,013). Helsepersonellet hadde samlet flest rette svar ved tydelige symptomer på ny sykdom, og flest gale svar ved diffuse, komplekse tilstander og i to øyeblikkelige hjelp-situasjoner. Hele 62 prosent rapporterte om et behov for høyere klinisk vurderingskompetanse. Konklusjon: Helsepersonellet viste varierende grad av klinisk vurderingskompetanse, der sykepleierne hadde det høyeste kompetansenivået. Studien belyser viktigheten av godt og avklart samspill er mellom yrkesgruppene. Resultatet indikerer et behov for kompetanseheving på alvorlige, ofte komplekse kliniske situasjoner for alle yrkesgrupper. Spørreskjemaet bør videreutvikles for å minimere ulik tolkning av svaralternativene. Vi anbefaler å teste ut åpne tekstsvar på hvilke kliniske vurderinger som ligger til grunn for valg av respons. Fremtidige kompetansemålinger med samme verktøy bør utføres i større utvalg

Norwegian translation, cultural adaption and testing of the Person-centred Practice Inventory – Staff

Background: Person-centred health care has widespread recognition, but there are few instruments aimed at measuring the provision of person-centred practice among health care professionals across a range of settings. The Person-centred Practice Inventory – Staff (PCPI-S) is a new instrument for this purpose, theoretically aligned with McCormack & McCance’s person-centred framework, which has been translated and culturally adapted into Norwegian. Methods: The study used a two-stage research design involving: translation and cultural adaption of the PCPI-S from English to Norwegian language (phase 1), and a quantitative cross sectional survey following psychometric evaluation (phase 2). Confirmatory factor analysis was used to examine the theoretical measurement model. Results: The translation and cultural adaption was carried out according to ten recommend steps. Discrepancies were addressed and revised by all translators until consensus was reached on a reconciled version of the translation. A sample of 258 health care staff participated in the survey. The model fit statistics were overall positive; the model requires minor modifications and these are mostly confined to correlated errors. Conclusions: The translation and cultural adaption process of the PCPI-S from English to Norwegian language was a demanding process in order to retain the conceptual meanings of the original instrument. Overall, the psychometric properties of the tool were acceptable, but testing on a larger sample size is recommended

Introducing Nurse Practitioners Into Norwegian Primary Healthcare—Experiences and Learning

Background and Purpose: Nurse practitioners (NPs) are well established internationally, and Norway is now in the first phase of implementing their role. The aim of this study was to describe the reflections of nurse leaders and general practitioners (GPs) on the establishment of the new NP role in primary healthcare. Methods: This study was qualitative and longitudinal. Written reports and audio recordings from 11 meetings with nurse leaders and GPs during 3 years in 3 municipalities were analyzed by a thematic analysis. Results: Four themes were identified: the need for enhanced clinical competence among registered nurses, the need for reorganization of advanced practice, the need for negotiating professional barriers, and demanding economic situations. Nurse leaders and GPs were generally positive toward NPs, but they had difficulty in clarifying their roles and how to organize them in the existing work models. This was due to economic pressures, different needs in departments, and shift work. Nurse leaders and GPs agreed that NPs should not replace physicians but perform the tasks of advanced practice nursing in a more expert way. Nurse leaders also wanted NPs to be a resource for registered nurses. It was important to gain trust in the new role not only of GPs but also of registered nurses. Implications for Practice: It is extremely important that an implementation group is proactive in finding a suitable model for the implementation process. Clarification of the roles, tasks, and responsibilities of NPs at an early implementation stage could make the process easier