Exploring health service preparation for the COVID-19 crisis utilizing simulation-based activities in a Norwegian hospital: a qualitative case study

Introduction The first wave of the COVID-19 pandemic caused stress in healthcare organizations worldwide. Hospitals and healthcare institutions had to reorganize their services to meet the demands of the crisis. In this case study, we focus on the role of simulation as part of the pandemic preparations in a large hospital in Norway. The aim of this study is to explore hospital leaders' and simulation facilitators' expectations of, and experiences of utilizing simulation-based activities in the preparations for the COVID-19 pandemic. Methods This is a qualitative case study utilizing semi-structured in-depth interviews with hospital leaders and simulation facilitators in one large hospital in Norway. The data were sorted under three predefined research topics and further analyzed by inductive, thematic analysis according to Braun and Clarke within these pre-defined topics. Results Eleven members of the hospital leadership and simulation facilitators were included in the study. We identified four themes explaining why COVID-19 related simulation-based activities were initiated, and perceived consequences of the activities; 1) a multifaceted method like simulation fitted a multifaceted crisis, 2) a well-established culture for simulation in the hospital was crucial for scaling up simulation-based activities during the crisis, 3) potential risks were outweighed by the advantages of utilizing simulation-based activities, and finally 4) hospital leaders and simulation facilitators retrospectively assessed the use of simulation-based activities as appropriate to prepare for a pandemic crisis. Conclusions The hospital leadership’s decision to utilize simulation-based activities in preparing for the COVID-19 crisis may be explained by many factors. First, it seems that many years of experience with systematic use of simulation-based activities within the hospital can explain the trust in simulation as a valuable tool that were easy to reach. Second, both hospital leaders and simulation facilitators saw simulation as a unique tool for the optimization of the COVID-19 response due to the wide applicability of the method. According to hospital leaders and simulation facilitators, simulation-based activities revealed critical gaps in training and competence levels, treatment protocols, patient logistics, and environmental shortcomings that were acted upon, suggesting that institutional learning took place.publishedVersio

Helserelatert livskvalitet hos pasienter med kronisk nyresykdom, nyretransplanterte vs. ikke-transplanterte pasienter

Master's thesis in Health and social sciencesPasienter med kronisk nyresykdom har redusert helserelatert livskvalitet sammenliknet med normal befolkningen. Ved ende stadiet nyresvikt er nyretransplantasjon den foretrukne nyreerstattende behandling og pasienter som er nyretransplanterte rapporterer bedre helserelatert livskvalitet enn pasienter i dialyse, men dårligere enn i den generelle befolkning. Hensikten med denne studien var å sammenlikne helserelatert livskvalitet samt utforske variabler for dette i to grupper av pasienter med stabilt redusert nyrefunksjon. En gruppe var nyretransplanterte og en gruppe ikke-transplanterte. Studien var designet som en singel senter tverrsnittstudie der 38 nyretransplanterte pasienter med moderat til alvorlig redusert nyrefunksjon ble alders- og kjønns matchet med 38 ikke-transplanterte pasienter med samme nyrefunksjon. Helserelatert livskvalitet ble evaluert med spørreskjemaet short form-36 og en visuell analog skala. Variabler med assosiasjon til helserelatert livskvalitet ble funnet ved bruk av backward multippel regresjonsanalyse. Det var ikke signifikante forskjeller i noen av helsedomenene eller oppsamlingsskårene i short form-36 mellom de to pasientgruppene, og skårene var ikke forskjellige fra norske normdata. Ikke-transplanterte skåret bedre enn transplanterte pasienter når helserelatert livskvalitet ble evaluert med visuell analog skala. Beck depression inventory skår og Davies comorbidity index skår var de viktigste uavhengige variablene for helserelatert livskvalitet. Funnene fra denne studien viser at helserelatert livskvalitet hos pasienter med stabil kronisk nyresykdom inkludert nyretransplanterte pasienter er generelt god og ikke dårligere enn i den generelle norske befolkningen. Videre evaluerer short form-36 og visuell analog skala muligvis ulike aspekt av en pasients helserelaterte livskvalitet, og verktøyene må sees på som komplementære i forhold til den aktuelle problemstilling.2014-06-0

Exploring health literacy in patients with chronic kidney disease: a qualitative study

Background Patients with chronic kidney disease make day-to-day decisions about how to self-manage their disease. Chronic kidney disease (CKD) includes a risk for progression towards end-stage renal disease and the development of comorbidities, such as cardiovascular disease, which represents the leading cause of death among these patients. To reduce these risks, CKD patients are recommended to follow a healthy lifestyle with physical activity, food and fluid restrictions, and adherence to complex medication regimes throughout all phases of the disease. To manage the complexity of this health situation, health literacy (HL) is considered essential. The current prevailing understanding is that HL is a multidimensional concept and comprises a range of cognitive, affective, social, and personal skills that determine the motivation and ability to gain access to, understand, and use health information. Recently, we investigated multiple aspects of HL in CKD patients in a quantitative cross-sectional study utilizing the Health Literacy Questionnaire (HLQ) and observed that finding good health information and appraising health information were the most challenging aspects of HL. This study aimed to explore CKD patients’ lived experiences of different dimensions of HL presented in the HLQ. Methods This qualitative study utilized in-depth semistructured interviews. Twelve patients with different levels of HL were included. The interviews were analyzed using thematic analysis as described by Braun and Clarke. Results We identified three main themes that were significant for CKD patients’ HL: 1. Variation in people’s attitudes and behavior as health information seekers, 2. The problem of fragmented healthcare in the context of multimorbidity makes the healthcare system challenging to navigate, and 3. The value of a good relationship with healthcare providers. Conclusion CKD patients take different approaches to health information. Limiting or avoiding health information may be a strategy used by some individuals to cope with the disease and does not necessarily mean that health information is inaccessible or difficult to understand. Comorbidity and a fragmented healthcare system can make the healthcare system challenging to navigate. A good and trusting relationship with healthcare providers seems to promote several aspects of HL and should be promoted to optimize CKD patients’ HL.publishedVersio

A cross-sectional study of health literacy in patients with chronic kidney disease: Associations with demographic and clinical variables

Aim The aim of this study was to investigate health literacy in patients with chronic kidney disease in a multidimensional perspective. Design A descriptive, cross‐sectional study. Methods Patients with chronic kidney disease at stages 3–5 were included in the study between February–August 2017 (N = 187). Health literacy was measured by the Health Literacy Questionnaire (HLQ). Multiple linear regression analysis was performed to identify associations between health literacy and demographic and clinical variables. Hierarchical cluster analysis was performed to identify characteristics of groups with high and low health literacy. Results Finding and critical appraise health information were the most challenging dimensions of health literacy. Female gender, lower level of education, greater number of prescribed medications and depressive symptoms were associated with lower health literacy. The group identified with lowest health literacy was further characterized by living alone and presence of comorbidity.publishedVersio

Health literacy in kidney disease, associations with quality of life and adherence

Background Health literacy (HL) is a multidimensional concept with significance for self‐management and health outcomes in patients with chronic kidney disease (CKD); however, research with a multidimensional perspective on HL is scarce. Objectives This study aimed to explore the relationship between multidimensional HL, quality of life (QoL) and adherence to long‐term therapy in CKD patients. Design A descriptive single‐centre cross‐sectional study. Participants Patients with CKD in stages 3–5 were recruited from the nephrology unit in a Norwegian hospital. Measurements The Health Literacy Questionnaire (HLQ) was used to assess HL, QoL was measured by the Short Form‐12 (SF‐12) and a Visual Analogue Scale (VAS‐QoL). Adherence to long‐term therapy was measured by the Medical Adherence Rating Scale 5 (MARS‐5), participants' prescription withdrawals from pharmacies, and a VAS (VAS‐adherence). Hierarchical cluster analysis was performed to group patients with similar HLQ scores, and multiple linear regression analysis was performed to identify the HL dimensions that were associated with QoL and adherence to long‐term therapy. Results A total of 187 patients were included, 65% were male, and the mean (SD) age was 67 (13) years. The high‐level HL group (N = 52) had significantly better QoL than patients in the mid‐level (N = 106) and low‐level (N = 27) HL groups. The HL dimensions “actively managing health,” “actively engage with healthcare providers,” “ability to find good health information” and “ability to understand health information” were predictive of QoL and adherence to long‐term therapy. Conclusion HL seems to be important for both QoL and adherence to long‐term therapy.publishedVersio

Exploring health service preparation for the COVID-19 crisis utilizing simulation-based activities in a Norwegian hospital: a qualitative case study

Introduction The first wave of the COVID-19 pandemic caused stress in healthcare organizations worldwide. Hospitals and healthcare institutions had to reorganize their services to meet the demands of the crisis. In this case study, we focus on the role of simulation as part of the pandemic preparations in a large hospital in Norway. The aim of this study is to explore hospital leaders' and simulation facilitators' expectations of, and experiences of utilizing simulation-based activities in the preparations for the COVID-19 pandemic. Methods This is a qualitative case study utilizing semi-structured in-depth interviews with hospital leaders and simulation facilitators in one large hospital in Norway. The data were sorted under three predefined research topics and further analyzed by inductive, thematic analysis according to Braun and Clarke within these pre-defined topics. Results Eleven members of the hospital leadership and simulation facilitators were included in the study. We identified four themes explaining why COVID-19 related simulation-based activities were initiated, and perceived consequences of the activities; 1) a multifaceted method like simulation fitted a multifaceted crisis, 2) a well-established culture for simulation in the hospital was crucial for scaling up simulation-based activities during the crisis, 3) potential risks were outweighed by the advantages of utilizing simulation-based activities, and finally 4) hospital leaders and simulation facilitators retrospectively assessed the use of simulation-based activities as appropriate to prepare for a pandemic crisis. Conclusions The hospital leadership’s decision to utilize simulation-based activities in preparing for the COVID-19 crisis may be explained by many factors. First, it seems that many years of experience with systematic use of simulation-based activities within the hospital can explain the trust in simulation as a valuable tool that were easy to reach. Second, both hospital leaders and simulation facilitators saw simulation as a unique tool for the optimization of the COVID-19 response due to the wide applicability of the method. According to hospital leaders and simulation facilitators, simulation-based activities revealed critical gaps in training and competence levels, treatment protocols, patient logistics, and environmental shortcomings that were acted upon, suggesting that institutional learning took place