Sykepleieres erfaringer med innføring av sykepleiediagnoser

Nurses’ experiences with introduction of nursing diagnosesBackground: Studies have shown that use of nursing diagnoses can improve quality of documented assessments, quality of described interventions and outcomes, and that they facilitate communication and continuity between practitioners in the health care services. Collaboration between a hospital and a university college was established to study the implementation of nursing diagnoses. Purpose: This study intends to investigate the feasibility of the study and the experiences nurses in clinical practice have after an implementation of nursing diagnoses. Method: A focus group interview with six participants was conducted. The researchers’ experiences upon the intervention feasibility were logged as notes. Results: The participants found the intervention helpful and educational, but also frustrating. Nursing diagnoses seems to be useful in clinical work, but the intervention period may have been too short to achieve changes in the documentation work. Conclusion: There is need for further studies so that nursing documentation can be a good tool to support nurses in their working process

Chronic pain self-management: Expectations towards and effect of chronic pain self-management intervention at a Healthy Life Centre in public primary care

Sammendrag Bakgrunn Kroniske smerter rammer en betydelig del av befolkningen, og omtrent en tredjedel av norske voksne har opplevd smerter i tre måneder eller mer. Kronisk smerte er en kompleks tilstand med både fysiologiske, psykologiske og sosiale konsekvenser. Kronisk smerte har også samfunnsøkonomiske konsekvenser i form av redusert produktivitet og høye kostnader innen helse. Behandling for kronisk smerte gir i beste fall beskjedne forbedringer, noe som fører til at for mange er det å egenmestre en hverdag med kroniske smerter viktig. Mestringsintervensjoner har blitt viktige tiltak for å styrke personer med kronisk smerte til å aktivt kunne ta del i det å håndtere helsen sin. De norske frisklivssentralene er en del av kommunenes helsetjeneste for personer med økt risiko for, eller som allerede har utviklet sykdom og som har behov for å endre levevaner og mestre helseutfordringer. Frisklivssentralene tar sikte på å være lett tilgjengelige ved at folk selv kan ta kontakt for å delta på aktivitetene som tilbys. Ved enkelte frisklivssentraler har mestringsintervensjoner blitt en del av de tjenestene som tilbys. Hensikt Hovedhensikten med avhandlingen var å bidra med kunnskap om forventninger til og effekt av, mestringstilbud for personer med kronisk smerte utviklet og tilbudt av frisklivssentral i en norsk bykommune. Mer spesifikt var hensikten å utforske forventninger til lett tilgjengelige smertemestringstilbud, og å undersøke korttids- og langtidseffekt av et mestringskurs for personer med kronisk smerte ved frisklivssentral. Metode En kvalitativ intervjustudie og en randomisert kontrollert studie ble gjennomført. I den randomisert kontrollerte studien ble intervensjonsgruppen tilbudt et gruppebasert kurs om mestring av kronisk smerte. Kurset besto av teori, øvelser med fokus på bevegelighet, samt gruppediskusjoner og utveksling av erfaringer. Kontrollgruppen ble tilbudt lett fysisk aktivitet i gruppe som besto av gåtur og enkle styrkeøvelser. Aktivitetene hadde ukentlige økter over en periode på seks uker, og resultatene ble målt etter tre, seks og 12 måneder. Det primære utfallsmålet var pasientaktivering målt med Patient Activation Measure (PAM). Dataene ble analysert ved bruk av «linear mixed models». Den kvalitative studien inkluderte individuelle semi-strukturerte intervju ved baseline før randomisering med et utvalg av deltakerne fra den randomisert kontrollerte studien. Deltagerne ble stilt åpne spørsmål om forventningene til deltakelse i intervensjonene, hvordan smerte virket inn på hverdagen deres, hva de gjorde for å håndtere et liv med kroniske smerter, og hvilke helsetjenester de tidligere hadde prøvd på grunn av kroniske smerter. De kvalitative dataene ble analysert med bruk av systematisk tekst kondensering. Resultat Totalt ble 121 deltakere inkludert i den randomisert kontrollerte studien. Av disse deltok 21 i den kvalitative studien. I den kvalitative studien ble det funnet at deltakerne hadde forventninger som hovedsakelig gjaldt et håp om at deltakelse kunne føre til en bedre hverdag. Forventningene hadde sammenheng med at dette var et tilbud de ikke hadde prøvd før, de så det som en mulighet til å friske opp og få ny kunnskap, til å utvikle seg som menneske, til å møte andre som var i en lignende situasjon og til å få tilgang til helsepersonell på en enkel måte. I den randomisert kontrollerte studien ble det funnet at mestringskurset ikke hadde noen effekt etter tre måneder i forhold til den lette fysiske aktiviteten tilbudt kontrollgruppen. Etter 12 måneder var det en forskjell i det primære utfallsmålet, pasientaktivering, men forskjellen var ikke statistisk signifikant. Begge gruppene hadde forbedringer med hensyn til opplevd smerte siste uke, egenrapportert helse og bedre skåre på en 30-sekunder sitte-stå test. Konklusjon Deltagernes håp om en bedre hverdag var en viktig faktor for å engasjere seg i nye tiltak og helsetjenester. Ingen statistisk signifikante forskjeller ble funnet mellom kurset om mestring av kronisk smerte og den lette fysiske aktiviteten tilbudt kontrollgruppen, verken på det primære utfallsmålet pasientaktivering, eller på noen av de sekundære utfallsmålene

‘A lifebuoy’ and ‘a waste of time’: patients’ varying experiences of multidisciplinary pain centre treatment- a qualitative study

Background: The recognition of chronic pain as a biopsychosocial phenomenon has led to the establishment of multidisciplinary pain treatment facilities, such as pain centres. Previous studies have focussed on inpatient, groupbased or time-limited multidisciplinary pain programmes. The aim was to investigate variation in patients’ experiences of attending individual outpatient multidisciplinary treatment at pain centres in Norway. Methods: This was a qualitative study using semi-structured individual interviews with 19 informants. The informants were recruited among persons who after referral by their general practitioners 12 months prior had attended multidisciplinary pain treatment at a pain centre. The data were analysed thematically using systematic text condensation. Results: The informants had received different treatments at the pain centres. Some had undergone only one multidisciplinary assessment in which a physician, a psychologist and a physiotherapist had been present, whereas others had initially been to a multidisciplinary assessment and then continued treatment by one or more of the professionals at the centre. Their experiences ranged from the pain centre as being described as a lifebuoy by some informants who had attended treatment over time, to being described as a waste of time by others who had only attended one or two multidisciplinary sessions. Prominent experiences included being met with understanding and a perception of receiving the best possible treatment, but also included disappointment over not being offered any treatment and perceiving the multidisciplinary approach as unnecessary. Conclusions: There were large variations in the informants’ experiences in the pain centres. The findings indicate that the pain centres’ multidisciplinary approach can represent a new approach to living with chronic pain but may also not provide anything new. Efforts should be devoted to ensuring that the pain centres’ multidisciplinary treatment approach is aligned with their patients’ actual needs

Participants’ views and experiences from setting up a shared patient portal for primary and specialist health services- a qualitative study

Background Recently, there has been an increasing focus among healthcare organisations on implementing patient portals. Previous studies have mainly focussed on the experiences of patient portal use. Few have investigated the processes of deciding what content and features to make available, in particular for shared portals across healthcare domains. The aim of the study was to investigate views on content and experiences from the configuration process among participants involved in setting up a shared patient portal for primary and specialist health services. Methods A qualitative study including 15 semi-structured interviews with persons participating in patient portal configuration was conducted from October 2019 to June 2020. Results Whether a shared patient portal for all the health services in the region should be established was not questioned by any of the informants. It was experienced as a good thing to have numerous participants present in the discussions on configuration, but it also was said to increase the complexity of the work. The informants considered a patient portal to be of great value for patient care, among other things because it would lead to improvements in patient follow-up and increased patient empowerment. Nevertheless, some informants advocated caution as they thought the patient portal possibly could lead to an increase in healthcare providers’ workloads and to anxiety and worries, as well as to inequality in access to health care among patients. The findings were categorized into the themes ‘A tool for increased patient involvement’, ‘Which information should be available for the patient’, ‘Concerns about increased workload’, ‘Too complex to use versus not interesting enough’, ‘Involving all services’ and ‘Patient involvement’. Conclusions Establishing a shared patient portal for primary and specialist health services was considered unproblematic. There was, however, variation in opinions on which content and features to include. This variation was related to concerns about increasing the workload for health care providers, causing anxiety and inequality among patients, and ensuring that the solution would be interesting enough to adopt

Interest in using patient portals among adolescents in mental health care - a cross-sectional study

Abstract Introduction Adolescents in mental health care may benefit from using patient portals to access personalised information about their health and treatment. While no studies have considered the interest in using patient portals among adolescents in mental health care, factors such as patient activation, self-reported health, depressive symptoms, diagnosis, healthcare utilisation, and eHealth literacy have been found to be associated with interest in and use of patient portals in other patient groups. Therefore, the aim was to explore the associations between interest in using patient portals and patient activation, self-reported health, depressive symptoms, diagnosis, healthcare utilisation and eHealth literacy among adolescents in specialist mental health care. Methods A cross-sectional study among adolescents between 12 and 18 years of age receiving or having received treatment at four different specialist child and adolescent mental healthcare services across Norway. The adolescents´ answers to the questionnaire were linked to data on their healthcare utilisation and ICD-10 diagnoses from the Norwegian Patient Registry. The data were analysed using descriptive statistics and bivariate tests. Results The 53 adolescents who participated, had a mean age of 15 years and 68% of them identified as female. Two out of three (64%) were interested in using patient portals. Most of the factors were not associated with interest in using patient portals. However, adolescents with mental and behavioural disorders (F diagnoses, 75% interested) were more interested in using patient portals compared to those with symptoms and signs involving cognition, perception, emotional state, and behaviour (R diagnoses, 31% interested). Conclusion Except for mental health diagnosis, this study did not identify any specific factors likely to impact patient portal interest among adolescents in specialist mental health care

Implementation of Free Text Format Nursing Diagnoses at a University Hospital’s Medical Department. Exploring Nurses’ and Nursing Students’ Experiences on Use and Usefulness. A Qualitative Study

Background. Nursing documentation has long traditions and represents core element of nursing, but the documentation is often criticized of being incomplete. Nursing diagnoses are an important research topic in nursing in terms of quality of nursing assessment, interventions, and outcome in addition to facilitating communication and continuity. Aim. The aim of this study was to explore the nurses’ and nursing students’ experiences after implementing free text format nursing diagnoses in a medical department. Method. The study design included educational intervention of free text nursing diagnoses. Data was collected through five focus group interviews with 18 nurses and 6 students as informants. The data was analyzed using qualitative content analysis. Results. The informants describe positive experiences concerning free text format nursing diagnoses’ use and usefulness; it promotes reflection and discussion and is described as a useful tool in the diagnostic process, though it was challenging to find the diagnosis’ appropriate formulation. Conclusion. Our findings indicate a valid usability of free text format nursing diagnoses as it promotes the diagnostic process. The use seems to enhance critical thinking and may serve as valuable preparation towards an implementation of standardized nursing diagnoses. Use and support of key personnel seem valuable in an implementation process

Short-term effect of a chronic pain self-management intervention delivered by an easily accessible primary healthcare service: a randomised controlled trial

Abstract Objectives To investigate the effects on persons with chronic pain after 3 months of a group-based chronic pain self-management course compared with a drop-in, lowimpact outdoor physical group activity on patient activation and a range of secondary outcomes. Design An open, pragmatic, parallel group randomised controlled trial. Analyses were performed using a two-level linear mixed model. Setting An easily accessible healthcare service provided by Norwegian public primary healthcare. Participants A total of 121 participants with self-reported chronic pain for 3 months or more were randomised with 60 participants placed in the intervention group and 61 placed in the control group (mean age 53 years, 88% women, 63% pain for 10 years or more). Interventions The intervention group was offered a group-based chronic pain self-management course with 2.5-hour weekly sessions for a period of 6 weeks. The sessions consisted of education, movement exercises and emphasised group discussions. The control group was offered a low-impact outdoor group physical activity in 1-hour weekly sessions that consisted of walking and simple strength exercises for a period of 6 weeks. Main outcomes The primary outcome was patient activation assessed using the Patient Activation Measure. Secondary outcomes measured included assessments of pain, anxiety and depression, pain self-efficacy, sense of coherence, health-related quality of life, well-being and the 30 s chair to stand test. Results There was no effect after 3 months of the groupbased chronic pain self-management course compared with the control group for the primary outcome, patient activation (estimated mean difference: −0.5, 95% CI –4.8 to 3.7, p=0.802). Conclusions There was no support for the selfmanagement course having a better effect after 3 months than a low-impact outdoor physical activity offered the control group. Trial registration number NCT02531282; Results

Twelve-month effect of chronic pain self-management intervention delivered in an easily accessible primary healthcare service - a randomised controlled trial

Background: To investigate the effects after twelve months related to patient activation and a range of secondary outcomes on persons with chronic pain of a chronic pain self-management course compared to a low-impact outdoor physical activity, delivered in an easily accessible healthcare service in public primary care. Methods: An open, pragmatic, parallel group randomised controlled trial was conducted. The intervention group was offered a group-based chronic pain self-management course with 2.5-h weekly sessions for a period of six weeks comprising education that included cognitive and behavioural strategies for pain management, movement exercises, group discussions and sharing of experiences among participants. The control group was offered a drop-in, low-impact, outdoor physical activity in groups in one-hour weekly sessions that included walking and simple strength exercises for a period of six weeks. The primary outcome was patient activation assessed using the Patient Activation Measure (PAM-13). Secondary outcomes included assessments of pain, anxiety and depression, pain self-efficacy, sense of coherence, health-related quality of life, well-being and the 30-s Chair to Stand Test. Analyses were performed using a linear mixed model. Results: After twelve months, there were no statistically significant differences between the intervention group (n=60) and the control group (n=61) for the primary or the secondary outcomes. The estimated mean difference between the groups for the primary outcome PAM was 4.0 (CI 95% -0.6 to 8.6, p=0.085). Within both of the groups, there were statistically significant improvements in pain experienced during the previous week, the global self-rated health measure and the 30-s Chair to Stand Test. Conclusions: No long-term effect of the chronic pain self-management course was found in comparison with a low-impact physical activity intervention for the primary outcome patient activation or for any secondary outcome.publishedVersion© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/