Homecare professionals’ observation of deteriorating, frail older patients: A mixed-methods study

Aim and objectives To develop knowledge about homecare professionals’ observational competence in early recognition of deterioration in frail older patients. Background The number of frail older patients in homecare has been rising, and these patients are at higher risk of deterioration and mortality. However, studies are scarce on homecare professionals’ recognition and response to clinical deterioration in homecare. Design This study applies an explorative, qualitative, mixed‐methods design. Methods The data were collected in two homecare districts in 2018 during 62 hr of participant observation, as well as from six focus group interviews. The data were subjected to qualitative content analyses. The Standards for Reporting Qualitative Research (SRQR) checklist was used to report the results. Results The data analyses revealed two main themes and five sub‐themes related to homecare professionals’ observational practices. The first main theme entailed patient‐situated assessment of changes in patients’ clinical condition, that is, the homecare professionals’ recognised changes in patients’ physical and mental conditions. The second theme was the organisational environment, in which planned, practical tasks and collaboration and collegial support were emphasised. Conclusions The homecare professionals in the two districts varied in their ability to recognise signs of patient deterioration. Their routines are described in detailed work plans, which seemed to affect assessment of their patients’ decline. Relevance for clinical practice The results can inform homecare services on how homecare professionals’ observational competence and an appropriate organisational system are essential in ensuring early detection of deterioration in frail older patients. What does this paper contribute to the wider global clinical community? Homecare professionals’ observational practice of detecting early deterioration in frail older patients is variable, and vital signs are measured infrequently. Improving homecare professionals’ observational competence by organising for timely and appropriate treatment is essential in successful recognition of deteriorating, frail older patients. This first known Norwegian study of homecare professionals’ observational competence in deteriorating frail older patients provide new knowledge to health professionals and policymakers engaged in homecare globally.publishedVersio

A competence improvement programme for the systematic observation of frail older patients in homecare: qualitative outcome analysis

Background The growth of frail older patients with extensive care needs in homecare creates a need for competence development. Improvement programmes are essential to fill this knowledge gap. However, the outcomes of such programmes remain unknown. Therefore, the aim of this study is to describe the outcomes of a competence improvement programme for the systematic observation of frail older patients in homecare. Methods This study applied a qualitative mixed-method design. Data were collected in two homecare districts using participant observation, focus group interviews, and individual interviews. Results The analysis revealed five concepts characterising the outcomes of the competence improvement programme: 1) frequency of vital sign measurements, 2) situational awareness, 3) expectations and coping level, 4) activities for sustained improvement, and 5) organisational issues affecting CIP focus. Substantial differences were revealed across the two homecare districts in how homecare professionals enacted new knowledge and routines resulting from the competence improvement programme. The differences were related to the frequency of vital sign measurements, coping levels, and situational awareness, in which successful outcomes were shaped by implementation issues and contextual setting. This involved whether routines and planned activities were set to follow up the improvement programme, or whether organisational issues such as leadership focus, resources, and workforce stability supported the programme. Conclusions This study documents the differences entailed in creating sustainable outcomes of an improvement programme for homecare professionals’ competence in recognising and responding to deteriorating frail older patients. Depending on the implementation process and the homecare context, professionals enact the activities of the improvement programme differently.publishedVersio

Expanding the non-technical skills vocabulary of operating room nurses: a qualitative study

Background Operating room nurses have specialised technical and non-technical skills and are essential members of the surgical team. The profession’s dependency of tacit knowledge has made their non-technical skills difficult to access for researchers, thus, creating limitations in the identification of the non-technical skills of operating room nurses. Non-technical skills are categorised in the crew resource management framework, and previously, non-technical skills of operating room nurses have been identified within the scope of the framework. The purpose of this study is to explore operating room nurses’ descriptions of their practices in search for non-technical skills not included in the crew resource management framework. Methods This study has a qualitative design. An expert panel of experienced operating room nurses (N = 96) in Norway provided qualitative descriptions of their practice in a Delphi survey. The data were analysed in an inductive thematic analysis. This study was conducted and reported in line with Standards for Reporting Qualitative Research (SRQR). Results The inductive thematic analysis developed two themes, ‘Ethical competence’ and ‘Professional accountability’, that encompass operating room nurses’ novel descriptions of their non-technical skills. The participants take pride in having the patients’ best interest as their main objective even if this may threaten their position in the team. Conclusions This study has identified novel non-technical skills that are not described in the crew resource management framework. These findings will contribute to the development of a new behavioural marker system for the non-technical skills of operating room nurses. This system will facilitate verbalisation of tacit knowledge and contribute to an increased knowledge about the operating room nursing profession.publishedVersio

Implementing simulation in a nursing education programme: a case report from Tanzania

This paper presents a description of, and some reflections around, the experience of implementing simulation-based education within a nursing education programme in a low-income context. The students in the nursing education programme found the simulation sessions to be useful, motivating and a realistic learning method. Our experience may provide useful insight for other nursing education programmes in low-income contexts. It looks like a deeper knowledge about the feasibility of simulation-based education from both the teacher and student perspective is necessary.publishedVersio

Lessons learned through developing and implementing simulation-based education in nursing education programmes in sub-Saharan Africa

Based on the authors’ experiences, this paper aims to describe and reflect on the project of developing and implementing simulation-based education in two nursing education programmes in Tanzania and Madagascar. The project lasted from August 2017 to December 2019. The essential aspects that contributed to the project’s achievements were the school’s interest in developing and implementing simulation-based education and the many opportunities for sharing theoretical knowledge and practicing simulation. Notably, the teachers adapted simulation-based education as a pedagogical method to their own context, developing scenarios related to their local culture and national curriculum. In the debriefing session, the teachers asked open-ended questions to promote reflection, however, they mostly used directive feedback to highlight performance issues and correct performance gaps. The students also expected directives to learn from their mistakes. Overall, the reflection on the experience may provide new insights into developing and implementing simulation-based education in low-resource settings.publishedVersio

Bi-lingual content validation of the Non-Technical Skills for Operating Room Nurses (NOTSORN) tool: A Delphi Study

Background The primary responsibility of the operating room nurse is to prevent adverse events and patient harm during surgery. Since most preventable adverse events are the result of breakdowns in communication and teamwork, or non-technical skills, training such skills should strengthen the operating room nurses’ error prevention abilities. Behavioural marker systems operationalise non-technical skills; however, previous systems for operating room nurses do not cover the full extent of non-technical skills used by operating room nurses. Thus, the Non-technical Skills for Operating Room Nurses (NOTSORN) behavioural marker system was developed. Objective The objective of this study was to establish face and content validity of the Non-Technical Skills for Operating Room Nurses behavioural marker system. This multi-item scale measures individual non-technical skills in operating room nursing. Participants A purposive sample of operating room nursing researchers, educators, and senior clinicians from nine countries worldwide. Methods A two round, Delphi panel with international experts in operating room nursing. The survey was administered online. Content validity index (CVI) was used to measure agreement among panel members. Results 25 operating room nurse experts participated in the online Delphi study. After round 1, 56 items were accepted, 26 items were revised, and 1 item was dropped. Following round 2, all items (6 with minor revisions) were accepted. Thus, the Non-technical Skills for Operating Room Nurses tool comprise 81 items. The scale level CVI score for the final 81 item tool was 0.99. The individual item level CVI scores ranged from 0.9 to 1.0. Conclusions The Non-Technical Skills of Operating Room Nurses behavioural marker system is a nuanced tool with a myriad of non-technical skills operating room nurses need to undertake their work safely. The tool's intended use includes student/trainee supervision, supervision of novice operating room nurses, self-reflection for performance reports, and in operating room nursing education. Over time, use of the tool has the potential to contribute to patient safety in the operating room.publishedVersio

Norwegian nursing students' evaluation of vSim® for Nursing

Background: vSim® for Nursing is the first web-based platform linked to the nursing education curriculum. It is an American simulation tool, developed in 2014 through a collaboration between Wolters Kluwer Health, Laerdal Medical and the National League for Nursing. To our knowledge, no studies have evaluated vSim® for Nursing from the nursing students’ perspective in Norway. The aim of the study was to evaluate second year Norwegian nursing students’ experiences with the virtual clinical simulation scenario in surgical nursing from vSim® for Nursing. Methods: A descriptive and a convergent mixed method design was utilised. The method comprised a 7-item questionnaire with five open-ended questions. Sixty-five nursing students participated in the study. Results: The majority of Norwegian nursing students evaluated the virtual clinical scenario in surgical nursing from vSim® for Nursing useful, realistic and educational in preparing for clinical placement in surgical care. However, a small portion of the nursing students had trouble understanding and navigating the American vSim® for Nursing program. Conclusions: Introducing virtual simulation tools into the nursing education encompasses faculty and student preparation, guidance from faculty members during the simulation session and support for students who are facing difficulties with the simulation program.publishedVersio

Challenges in sharing knowledge: reflections from the perspective of an expatriate nurse working in a South Sudanese hospital

This is an author-accepted manuscript of the article. Please refer to http://onlinelibrary.wiley.com/doi/10.1111/j.1466-7657.2012.01020.x/full for the final version.Aim: This account, based on the experience of the first author, aims to describe an example of practice from a hospital in South Sudan. The example illustrates a cross-cultural encounter and the challenges that a Sudanese nurse and an expatriate nurse face in sharing knowledge when providing patient care. Content: The constructed practical example between nurses with different knowledge bases and experiences was characterized by the expatriate nurse giving her instructions and not allowing the Sudanese nurse to respond to them. This ‘one-way’ communication demonstrated that the expatriate nurse considered herself to have the better knowledge of nursing care. These aspects of the encounter formed the basis for the following discussion, which sheds light on how the expatriate nurse ideally could have worked by using a dialogue instead of one-way communication. The importance of having knowledge and understanding of the context in cross-cultural encounters was also emphasized. Conclusions: The discussion of this practical example can provide insight for other nurses when working in cultures other than their own into the importance of using a dialogue when sharing knowledge in a cross-cultural encounter. In addition, expatriates can be made aware of the importance of acquiring knowledge about the context for ‘the other’ when working cross culturally. Finally, it should be noted that the description and discussion of the experience reflect only the perspective of the expatriate nurse

Building clinical practice in the Palestine Red Crescent operation theatres in Lebanon: reflections from the perspective of an expatriate nurse

This is the peer reviewed version of the following article: Tjoflåt, I. and Karlsen, B. (2013), Building clinical practice in the Palestine Red Crescent operation theatres in Lebanon: reflections from the perspective of an expatriate nurse. International Nursing Review, 60: 545–549. doi: 10.1111/inr.12054, which has been published in final form at 10.1111/inr.12054. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Aim: This paper, based on the experience of the first author as an expatriate nurse, aims to describe and discuss some aspects of collaboration that contributed to the building of clinical practice when implementing an operating theatre programme in the Palestine Red Crescent Society (PRCS) hospitals in Lebanon. Background: The operation theatre programme lasted for 8 months: 6 months in 2008 and 2 months in 2009. The programme was part of the partnership project ‘Quality of care in the five PRCS hospitals in Lebanon’ between the International Committee of the Red Cross and the PRCS Lebanon (PRCS-L) branch. Findings: The essential aspects that may have contributed to the building of clinical practice in the operation theatre programme included the expatriate nurse and the Palestine Red Crescent operating theatre nurses working together over time as colleagues, the socio-cultural pedagogic perspective selected for the implementation and the collaboration with the management of the hospitals and counterparts in the PRCS-L branch. One should also note the human and structural issues that seemed to influence the implementation of the programme in a more negative way. Conclusions: This experience may provide insight for other nurses into the importance of working as colleagues, selecting an appropriate pedagogic perspective and establishing productive collaboration with all partners when building clinical practice during a humanitarian mission

Systematic Observation of Frail Older Patients in Homecare - Implementing a Competence Improvement Program

Background: The early recognition of deterioration in frail older patients is a vital competence of homecare professionals, yet there is a gap between competence demands and actual competence. The aim of this study is therefore to describe and analyse the implementation of a competence improvement program for the systematic observation of frail older patients, developed and implemented in two homecare settings in Norway. Methodology: The study applied a descriptive qualitative design consisting of observation, focus group interviews, and individual interviews. Results: Homecare professionals described the competence improvement program differently both within and across the two homecare districts. They gave diverse explanations for the purpose of the program, most of them involving positive expectations towards improving the current observational practice. The content of the competence improvement program was complex and consisted of multiple components, which the participating homecare professionals experienced as demanding. The process of implementing the competence improvement program was influenced by the difficult flow of information, limited available time, and challenges related to simulation. Conclusion: The implementation of a complex competence improvement program for the systematic observation of frail older patients in homecare requires careful planning with regard to content, process, and context.publishedVersio