I need to be who I am : a qualitative interview study exploring the needs of people with dementia in Norway

Objective Many people with dementia receive community services. These services are often based on the needs of informal caregivers and professional caregivers’ assessment. User involvement and participation are main objectives in the Norwegian National Dementia Plan 2020. To enhance user involvement and individual tailoring of healthcare services, more information is required about the needs of people with dementia. The aim of this study was to explore the experienced needs of people with dementia in order to facilitate user involvement in provided services. Methods An explorative cross-sectional study design was used. We performed semistructured interviews with people with dementia who were recruited from all regions of Norway. The sample comprised 35 participants diagnosed with dementia. The interviews were audio-recorded and transcribed, and the data material was analysed using a qualitative content analysis. Results Three main categories emerged from the interviews: (1) to stay connected; (2) to be active and participate; and (3) to live for the moment. The overarching theme was: the need to be who I am. Conclusions People with dementia participating in the study were heterogeneous regarding wants and requirements. Most of them expressed the need and wish to hold on to who they are. Close and robust relations with family and friends can give significant support to people with dementia. However, living with dementia might put considerable strain on relations. Services should provide support to enhance relationships, encourage existing networks to remain stable and facilitate participation in meaningful activities for people living with dementia.publishedVersio

Clinical expressions, characteristics and treatments of confirmed COVID-19 in nursing home residents : a systematic review

Background: The coronavirus 2019 (COVID-19) pandemic has led to a high rate of infections, frequent outbreaks, and high mortality rates in nursing homes (NH) worldwide. To protect and improve the treatment and care of the vulnerable NH population, it is pivotal to systematise and synthesise data from cases of COVID-19 among NH residents. In our systematic review, we therefore aimed to describe the clinical expressions, characteristics, and treatments of NH residents confirmed to have COVID-19. Methods: We conducted two comprehensive literature searches in several electronic databases: (1) PubMed, (2) CINAHL, (3) AgeLine, (4) Embase, and (5) PsycINFO in April and July 2021. Of the 438 articles screened, 19 were included in our sample, and we used the Newcastle–Ottawa Assessment Scale to assess the quality of the reported studies. A weighted mean (Mweighted), was calculated to account for the large variation in sample sizes of the studies, and due to heterogeneity among the studies, we report our findings in a narrative synthesis. Results: According to the mean weights (Mweighted), common symptoms and signs in NH residents confirmed to have COVID-19 were fever (53.7%), cough (56.5%), hypoxia (32.3%), and delirium or confusion (31.2%). Common comorbidities were hypertension (78.6%), dementia or cognitive impairment (55.3%), and cardiovascular diseases (52.0%). Six studies presented data concerning medical and pharmacological treatments, such as inhalers, oxygen supplementation, anticoagulation, and parenteral/enteral fluids or nutrition. The treatments were used to improve outcomes, as part of palliative care, or as end-of-life treatment. Transfers to hospital for NH residents with confirmed COVID-19 were reported in six of the included studies, and the rate of hospital transfers ranged from 6.9% to 50% in this population. In the 17 studies reporting mortality, 40.2% of the NH residents died during the studies’ observation periods. Conclusions: Our systematic review allowed us to summarise important clinical findings about COVID-19 among NH residents and to identify the population’s risk factors for serious illness and death caused by the disease. However, the treatment and care of NH residents with severe COVID-19 warrant further investigation.publishedVersio

Nurses’ ethical challenges when providing care in nursing homes during the COVID-19 pandemic

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity anddeath from COVID-19. The social restrictions proved challenging for the residents, their relatives, and thecare staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge abouthow the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethicaldifficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban andrural areas. Ethical considerations: Oral and written information about the study was provided before the participantsgave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) usingmedication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact ondecision-making. Conclusions: The nurses’ethical challenges were intertwined with external factors, such as national andlocal guidelines, and the nurses’own internalized factors, which were connected to their subjective pro-fessionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in aprofessionally sound and safe manner. Keywords: COVID-19, nursing home, nursing, ethical challenges. © The Author(s) 2022, Article Reuse Guidelines: https://doi.org/10.1177/09697330221105631Nurses’ ethical challenges when providing care in nursing homes during the COVID-19 pandemicpublishedVersio

Farm-based day care services – a prospective study protocol on health benefits for people with dementia and next of kin

Introduction: The increasing number of people with dementia will place a considerable challenge on the health care system and will necessitate innovation and new solutions. Day care services aim to provide meaningful activities and coping experiences for the target group. The aim of the present study is to explore the experience and potential health benefits for people with dementia attending farm-based day care services in Norway and their next of kin. Methods and design: The present study is a prospective study organized into several qualitative and quantitative sub-studies. Study period will last from 2016–2020. We use a multi-method approach and both an empirical and a constructivist view on knowledge to explore this multi-facetted phenomenon. Discussion: Several challenges are expected, for instance, the ability to include participants with dementia and keep them within the study for the whole study period. The functioning level of participants regarding language and understanding could challenge their ability to answer. Despite having several limitations, we believe that this study with its different approaches and methods will add important knowledge to the field. Knowledge from our study could be essential for creating day care services of good quality for people with dementia and such services could reduce the burden of care for their next of kin.publishedVersio

Promoting psychosocial well-being following stroke: study protocol for a randomized, controlled trial

Source at https://doi.org/10.1186/s40359-018-0223-6.Background: Stroke is a major public health threat globally. Psychosocial well-being may be affected following stroke. Depressive symptoms, anxiety, general psychological distress and social isolation are prevalent. Approximately one third report depressive symptoms and 20% report anxiety during the first months or years after the stroke. Psychosocial difficulties may impact significantly on long-term functioning and quality of life, reduce the effects of rehabilitation services and lead to higher mortality rates. The aim of the study is to evaluate the effect of a previously developed and feasibility tested dialogue-based psychosocial intervention aimed at promoting psychosocial well-being and coping following stroke among stroke survivors with and without aphasia. Methods: The study will be conducted as a multicenter, randomized, single blind controlled trial with one intervention and one control arm. It will include a total of 330 stroke survivors randomly allocated into either an intervention group (dialogue-based intervention to promote psychosocial well-being) or a control group (usual care). Participants in the intervention group will receive eight individual sessions of supported dialogues in their homes during the first six months following an acute stroke. The primary outcome measure will be psychosocial well-being measured by the General Health Questionnaire (GHQ). Secondary outcome measures will be quality of life (SAQoL), sense of coherence (SOC), and depression (Yale). Process evaluation will be conducted in a longitudinal mixed methods study by individual qualitative interviews with 15–20 participants in the intervention and control groups, focus group interviews with the intervention personnel and data collectors, and a comprehensive analysis of implementation fidelity. Discussion: The intervention described in this study protocol is based on thorough development and feasibility work, guided by the UK medical research council framework for developing and testing complex interventions. It combines classical effectiveness evaluation with a thorough process evaluation. The results from this study may inform the development of further trials aimed at promoting psychosocial well-being following stroke as well as inform the psychosocial follow up of stroke patients living at home. Trial registration: NCT02338869; registered 10/04/2014 (On-going trial).</p

Rapport fra 25. juni-utvalget: Evaluering av PST og politiet

Source at https://www.politiet.no/om-politiet/organisasjonen/sarorganene/politidirektoratet/

Bruk av skjermbaserte medier blant eldre under covid-19-pandemien : en HUNT studie

Bakgrunn: Eldre er spesielt sårbare for alvorlig sykdom og død ved covid-19 og har blitt oppfordret til selvisolering under koronapandemien. Skjermbaserte medier og telefon har blitt fremhevet som viktige hjelpemidler for å unngå ensomhet, opprettholde kontakten med venner og familie samt sikre oppfølging av nødvendig helsehjelp. Det har imidlertid manglet kunnskap om hvordan eldre har brukt skjermbaserte medier under pandemien. Hensikt: Formålet med studien var å undersøke hvordan eldre over 70 år har benyttet skjermbaserte medier til underholdning, informasjon og kontakt med venner, sosialt nettverk og helsepersonell. Videre ønsket vi å se på hvordan kjønn og alder påvirket bruken. Metode: I januar 2021 sendte vi et spørreskjema i posten til 12 772 personer som var 70 år eller eldre da de deltok i den fjerde runden av Helseundersøkelsen i Nord-Trøndelag (HUNT 4) i perioden 2017–19. Deltakerne ble bedt om å angi hvor mye tid per dag de hadde brukt på henholdsvis underholdning, kontakt med venner eller nettverk og innhenting av kunnskap eller informasjon på skjermbaserte medier. Resultat: Totalt 9391 personer (73,5 prosent) (72–106 år) svarte på spørreundersøkelsen. Av disse brukte 83,9 prosent skjermbaserte medier til å holde kontakten med venner og sosialt nettverk. Åtte prosent svarte at de hadde hatt kontakt med helsepersonell på skjermbaserte medier. Flere kvinner enn menn og flere under 80 år enn over holdt kontakten med andre via skjerm. Konklusjon: En stor andel eldre har brukt skjermbaserte medier under pandemien. Studien avdekket at det har vært lite kontakt mellom eldre og helsepersonell via telefon eller skjerm. Slik kontakt bør styrkes, samtidig som det må settes søkelys på de i den eldste delen av befolkningen som ikke benytter seg av kommunikasjonsteknologi.publishedVersio

Associations between unit workloads and outcomes of first extubation attempts in extremely premature infants below a gestational age of 26 weeks

Objective: The objective was to explore whether high workloads in neonatal intensive care units were associated with short-term respiratory outcomes of extremely premature (EP) infants born <26 weeks of gestational age. Methods: This was a population-based study using data from the Norwegian Neonatal Network supplemented by data extracted from the medical records of EP infants <26 weeks GA born from 2013 to 2018. To describe the unit workloads, measurements of daily patient volume and unit acuity at each NICU were used. The effect of weekend and summer holiday was also explored. Results: We analyzed 316 first planned extubation attempts. There were no associations between unit workloads and the duration of mechanical ventilation until each infant’s first extubation or the outcomes of these attempts. Additionally, there were no weekend or summer holiday effects on the outcomes explored. Workloads did not affect the causes of reintubation for infants who failed their first extubation attempt. Conclusion: Our finding that there was no association between the organizational factors explored and short-term respiratory outcomes can be interpreted as indicating resilience in Norwegian neonatal intensive care units.publishedVersio

Optimizing access to and use of formal dementia care: Qualitative findings from the European Actifcare study

This paper reports on qualitative data from the Actifcare study investigating experiences, attitudes, barriers and facilitators concerning access to and use of formal care. A total of 85 semi-structured in-depth interviews were conducted in eight European countries. Results were analysed with a deductive content analysis, first within country and then integrated in a cross-national analysis. Overall, analysis of the in-depth interviews revealed two major themes with five subcategories. The results can be summarised in an optimal pathway for access to dementia care. This pathway includes fixed factors such as disease-related factors and system-related factors. In addition there are personal factors that are subject to change such as attitudes towards care. An important finding consisted of the necessity of having sufficient information about the disease and available care and having a key contact person to guide you through the process of finding suitable care while monitoring your needs. In addition, it is important to involve your social network as they can take on care-giving tasks. It is helpful to have a diagnosis (in most countries). Concerning decision-making, the person closest to the person with dementia is in the majority of cases the one who makes the ultimate decision to access and use services and he/she should therefore be supported in this process. These results provide insight into the factors that influence the pathway to formal care use and help professionals to enhance access to formal dementia care by focusing on factors that can be modified

Perspectives of policy and political decision makers on access to formal dementia care:Expert interviews in eight European countries

Background: As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Methods: Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. Results: The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Conclusions: Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.publishersversionpublishe