Family caregivers experiences of provided home care to persons with Parkinson's disease

Dette er forfatters versjon av artikkelen. Forlagets versjon finnes på http://www.idunn.no/ts/nsf/2012/01/art01Engelsk sammendrag (abstract): Family caregivers constitute an important part of the day-to-day service for persons with Parkinson’s disease. As the disease progresses, the need for municipal home care assistance will increase. The aim of this study was to explore how family caregivers of persons with Parkinson’s disease (PD-caregivers) experience their situation when they share caring with the home care services. Nine family PD-caregivers who were enrolled in home care units in one region in Norway were interviewed. Interpretive analysis was used. The main interpretation of the caregivers’ experiences was labelled: «Being on call around the clock despite providing home care». Three interpretations that highlight the meanings identified in different aspects of the informants’ experiences contribute to the main interpretation: Challenges with clarifying and delimiting responsibility, Relief is not equivalent to feeling safe and satisfied, and Correct management of Parkinson’s disease medication does not fit in with the routines of home care. This study suggests that taking advantage of professional home care does not excuse family PD-caregivers from their experience of being the overall responsible for the care and well-being of the care-recipient

Multicultural family members’ experiences with nurses and the intensive care context: A hermeneutic study

The original publication is available at: http://dx.doi.org/10.1016/j.iccn.2009.10.003Background: The aim of this study was to illuminate the experiences of multicultural family members in intensive care units in hospitals, when a loved one was critically ill. An increasing migration from non-Western countries to Norway and potential double-stress for multicultural families experiencing critical illness are pre-understandings. Methods: The study utilised a Gadamerian hermeneutic design. Data were collected through indepth- interviews (n = 5) and interpreted, inspired by Lindseth and Norberg’s phenomenological hermeneutical method. Findings: Multicultural family members’ experiences of their encounters with nurses were understood as: ‘Struggling to preserve the families’ cultural belonging within the health care system’, based on four themes: (a) filtering information to reduce concern; (b) understanding and being understood; (c) protecting cultural traditions and (d) interaction between roles, rules and expectations. Conclusion: Family members with a non-Western ethnic background experienced several challenges within the complex ICU environment. Multicultural family members had distinct strategies to deal with the hospitalisation of a critically ill loved one. Interaction difficulties and cultural traditions were not influenced by the environment alone, however the challenges seemed to deal with universal human interaction independent of the context. Nurses need to be sensitive to the families’ cultural customs in order to meet their expectations in a respectful way

Aspiring for competence in a multifaceted everyday life: A qualitative study of adult students’ experiences of a blended learning master programme in Norway

Aim: To gain knowledge of how adult students experienced the first year of a blended learning master programme to better understand their learning process. Methods: A qualitative, exploratory, descriptive study based on data from two focus group interviews with students attending a blended learning Master programme. Qualitative content analysis based on Graneheim and Lundman’s procedures was applied. Findings: Our analyses revealed one main theme: aspiring for competence in a multifaceted everyday life and four main categories: acquiring professional competence, struggling to manage diverse forms of communication, demanding task juggling and confused student role. Conclusions: The participants experienced that the programme enabled them to acquire professional competence relevant to practice. Despite the challenges, the programme is recommended for prospective students who live in both urban and rural areas, who are working and also responsible for children and other family taskspublishedVersio

Intensive care nurses’ encounters with multicultural families in Norway: An exploratory study

The original publication is available at: http://dx.doi.org/10.1016/j.iccn.2008.03.007The aim of this study was to explore nurses’ perceptions of their encounters with multicultural families in intensive care units in Norwegian hospitals. Immigrants from non-Western countries make up 6.1% of the population in Norway. When a person suffers an acute and critical illness the person's family may experience crises. Nurses’ previous experiences of caring for culturally diverse patients and families is challenging due to linguistic differences, and contextual factors. Family members should be near their critically ill spouse to reduce the impact from a frightening environment. The study had a descriptive exploratory qualitative design with a retrospective focus. Three multistage focus groups consisting of 16 nurses were set up in intensive care units. The data were analysed by interpretive content analysis. The theme ‘Cultural diversity and workplace stressors’ emerged. This theme was characterised by four categories: ‘impact on work patterns’; ‘communication challenges’; ‘responses to crises’ and ‘professional status and gender issues’. In conclusion, nurses’ perception of their encounters with multicultural families in intensive care units seem to be ambiguous with challenges in interaction, and the nurses’ stressors emanating from linguistic, cultural and ethnic differentness. To diminish cultural diversity the nurses strive for increased knowledge of different cultures and religions

Overvekt hos gravide – en utfordring i svangerskapsomsorgen

The purpose of this study is to gain knowledge about the challenges midwives and public nurses are experiencing in health prevention and health promotion to obese pregnant women, and their reflections regarding the need for change in practice.Method: The study has a qualitative exploratory design. Data was created by multistage focus group interviews and analyzed inspired by Lundman and Granheim’s content analysis. The focus groups consisted of midwives and public health nurses.Results: The informants were aware that obesity in pregnancy may cause complications for both mother and child, but they experienced obesity and lifestyle changes as challenging in antenatal care. Weight and body were perceived as something vulnerable. Informants found it hard to talk about weight because they were afraid of reactions from the pregnant women. They also expressed insecurity regarding their own expertise when it comes to communication and nutrition. Informants expressed the need for more interdisciplinary cooperation between different health workers in community health. They experienced such cooperation difficult to achieve

Overvekt hos gravide: en utfordring i svangerskapsomsorgen

The purpose of this study is to gain knowledge about the challenges midwives and public nurses are experiencing in health prevention and health promotion to obese pregnant women, and their reflections regarding the need for change in practice. Method: The study has a qualitative exploratory design. Data was created by multistage focus group interviews and analyzed inspired by Lundman and Granheim’s content analysis. The focus groups consisted of midwives and public health nurses. Results: The informants were aware that obesity in pregnancy may cause complications for both mother and child, but they experienced obesity and lifestyle changes as challenging in antenatal care. Weight and body were perceived as something vulnerable. Informants found it hard to talk about weight because they were afraid of reactions from the pregnant women. They also expressed insecurity regarding their own expertise when it comes to communication and nutrition. Informants expressed the need for more interdisciplinary cooperation between different health workers in community health. They experienced such cooperation difficult to achieve

Mat, måltider og ernæring på sykehjem – erfaringer fra et aksjonsforskningsprosjekt

Den overordnede målsetting for dette samarbeidsprosjektet mellom Høgskolen i Hedmark og seks sykehjem hvor sykepleierstudenter gjennomfører sine praksisstudier, var å forbedre kvaliteten på sykepleien til pasientene innen området mat, måltider og ernæring. Hensikten var videre å styrke sykepleiepersonalet og studentene sin kompetanse i kritisk granskning av egen praksis, i tillegg til å gi erfaring i å søke etter forskningsresultater, vurdere disse og implementere endringer i praksis. Prosjektet hadde en aksjonsforskningsorientert tilnærming, og det ble benyttet både prosess- og summativ evaluering. Sykepleiepersonalet valgte selv forbedringsområder relatert til to hovedområder: 1) ro og trivsel rundt måltidene, og 2) kartlegging og oppfølging av pasientenes ernæringsstatus. Gjennom arbeid i et sykepleienettverk, og ved å følge den kunnskapsbaserte arbeidsprosessen, ble en rekke tiltak iverksatt, bl.a. gjennom at personalet ble mer bevisst eget ansvar for ro og trivsel under måltidene, tilrettelegging av spisesituasjonen, flere mellommåltider, energiberiket kost, og individuell kartlegging og oppfølging av pasientene. Prosjektet medførte verdifulle endringer innen området mat, måltider og ernæring på sykehjem. Personalet utviklet sin kompetanse i kritisk å granske egen virksomhet, og ble gradvis mer orientert mot forskningsbasert kunnskap

«Working together for quality improvement». Competence development to prevent VAP (Ventilator Associated Pneumonia)

Norsk: Bakgrunn: Ventilator assosiert pneumoni (VAP), forårsaker flere dødsfall enn noen annen sykehusassosiert infeksjon, gir økt antall liggedøgn og medfører høye kostnader. Mellom 10–20 % av pasienter som er intubert lenger enn 48 timer, utvikler VAP. Intensivavdelingene manglet en overbyggende prosedyre og erkjente ulik praksis i de ulike intensivavdelingene i forhold til å forebygge VAP. Studenter ved videreutdanning i intensivsykepleie ved Høgskolen ga tilbakemelding på ulikheter mellom det de lærer på skolen og det de lærer i praksis. Hensikt: Hensikt med samarbeidsprosjektet er å fremme sykepleiere i intensiv­avdelingene og studenter i videreutdanning i intensivsykepleie sin kompe­tanse i å forebygge VAP for oralintuberte respiratorpasienter. Metode: Et fagutviklende prosjekt med en kvantitativ og kvalitativ tilnærming, som er inspirert av handlingsorientert forskningssamarbeid. Det ble utarbeidet kunnskapsbaserte prosedyrer for VAP forebygging som så ble implementert i avdelingene ved hjelp av følgende intervensjon: Fagdag for studenter og ansatte, med teoretisk innføring og simulering og innføring av diskusjonsgrupper i avdelingene. Data fra et spørreskjema til ansatte og studenter (før og etter intervensjon), dybdeintervjuer og et evalueringsskjema fra fagdagen, dannet grunnlaget for å evaluere intervensjonen. Resultater: Både studenter og ansatte ser ut til å ha økt sin kompetanse i løpet av prosjektperioden. Ansatte og studenter legger vekt på at økt fokus i avdelingen, fagdag og diskusjon med kollegaer innad og på tvers av avdelinger, har bidratt til økt bevissthet og felles praksis i de to intensivavdelingene. Konklusjon: Kompetansebygging ser ut til å bedre studenter og ansatte til å forbygge VAP. Ved implementering av ny VAP forebyggende prosedyre kan en intervensjon basert på fagdag og diskusjonsgrupper være nyttig for å øke ansatte og studenter sin kompetanse i å forebygge VAP.English: Background: Ventilator associated pneumonia (VAP), causes more deaths than any other hospital acquired infection, increases the number of patient days and involves high costs. Between 10–20 % of patients who are intubated for more than 48 hours, develop VAP. The two intensive care units (ICU) in this project lacked a nurse-led care pathway based on the best available evidence to prevent VAP. They also, acknowledged that different practices were used in the ICUs in relation to the prevention of VAP. Students who were studying in- tensive care nursing at the College gave feedback on the differences between what they learned in theory and what they learned in practice. Aim: The aim of the study was to improve competence in the prevention of VAP for oral intubated patients of two groups of nurses: nurses working in ICUs and students studying through continuing professional education in intensive care nursing. Method: This study had a quantitative and a qualitative approach, informed by action-oriented research. The evidenced-based care pathway for VAP prevention was developed and implemented in the ICU using the following inter- vention process: a one day seminar for students and staff, which included a theoretical introduction and simulation, and the introduction of discussion groups in the two ICUs. To evaluate staff and students` competence and the intervention process, data were collected using a questionnaire (before and af- ter the intervention process), depth interviews and a questionnaire to evaluate the seminar. Results: The data show that both students and staff had developed their competence during the study period. Staff and students emphasized that the increased focus in the ICU, the seminar and discussion groups with colleagues within and across the ICU, have contributed to their increased awareness and development of common practices in the two intensive care units. Conclusion: The intervention used in this study improved the competence of students and staff to prevent VAP. When development and implementing new VAP care pathways, an intervention based on a seminar and discussion groups may be benefcial in increasing staff and student competence in preventing VAP

Evidence‐based practice integration in hospital wards—The complexities and challenges in achieving evidence‐based practice in clinical nursing

Abstract: Aim: Exploring the processes involved in two different strategies to integrate evidence‐based practice into nursing practice. Design: Classical grounded theory methodology was used. Methods: Data were collected through 90 hr of observation and 4 focus groups among clinical nurses in two different hospital wards. Results: We identified a multidimensional evidence‐based practice integration framework that illuminates the complexities involved in the integration process. The dimensions were approaches to evidence‐based practice, positions of evidence‐based practice and levels of evidence‐based practice. The interactions between the dimensions gave five combinations; an explicit evidence‐based practice performed as a parallel to daily work at the systems level, an implicit evidence‐based practice integrated into daily work at the systems level, an explicit evidence‐based practice integrated into daily work at the individual level, an explicit evidence‐based practice integrated into daily work at the systems level and an implicit evidence‐based practice integrated into daily work at the individual level.publishedVersio