Development of a short form of the questionnaire quality from the patient’s perspective for palliative care (QPP-PC)

Purpose: Patients’ views on quality are important to improve person-centered palliative care. There is a lack of short, validated instruments incorporating patients’ perspectives of the multidisciplinary palliative care services. The aim of this study was to develop a short form of the instrument Quality from the Patient’s Perspective for Palliative Care (QPP-PC) and to describe and compare patients’ perceptions of the subjective importance (SI) of care aspects and their perceptions of care received (PR). Methods: A cross-sectional study was conducted in Norway including 128 patients (67% response rate) in four palliative care contexts. The QPP-PC, based on a person-centered theoretical framework, incorporating the multidisciplinary palliative care, comprises 4 dimensions; medical–technical competence, physical–technical conditions, identity-oriented approach and sociocultural atmosphere, 12 factors (49 items) and 3 single items. The instrument measures SI and PR. Development of the short form of the QPP-PC was inspired by previously published methodological guidelines. Descriptive statistics, paired t-tests, confirmatory factor analysis and Cronbach’s α were used. Results: The short form of QPP-PC consists of 4 dimensions, 20 items and 4 single items. Psychometric evaluation showed a root-mean-square error of approximation (RMSEA) value of 0.109 (SI). Cronbach’s α values ranged between 0.64 and 0.85 for most dimensions on SI scales. Scores on SI and PR scales were mostly high. Significantly higher scores for SI than PR were present for the identity-oriented approach dimension, especially on items about information. Conclusion: RMSEA value was slightly above the recommended level. Cronbach’s α was acceptable for most dimensions. The short form of QPP-PC shows promising results and may be used with caution as an indicator of person-centered patient-reported experience measures evaluating the multidisciplinary palliative care for patients in a late palliative phase. However, the short version of QPP-PC needs to be further validated using new samples of patients.publishedVersio

Public health nurses’ experiences working with children who are next of kin: a qualitative study

Background There are a substantial number of children who are the next of kin of parents suffering from illness or substance abuse. These children can experience emotional and behavioral problems and may need support from professionals. In Norway, the specialist health service in hospitals is required to have a designated practitioner in each department to ensure support for and follow up of children who are next of kin; however, this is not regulated by law in the health care in the municipalities. The aim of this study was to explore public health nurse’s experiences working with children who are next of kin. Methods Qualitative interviews were conducted with 10 public health nurses working in the child health clinic and the school health service in four municipalities. Data were analysed using content analysis. Reporting of this study is conducted in accordance to COREQ’s checklist. Results The analysis resulted in one main theme: ‘Lack of guidelines and routines among public health nurses working with children who are next of kin’. The main theme consisted of four categories: (1) identifying children who are next of kin are incidental; (2) public health nurses must be observant and willing to act; (3) communication is an important tool; and (4) follow up over time is not always provided. Conclusion The public health nurses experienced uncertainty concerning how to identify and follow up children who are next of kin but were vigilant and willing to act in the children’s best interest. Doing so necessitated collaboration with other professionals. The need for guidelines around the role and responsibilities for the public health nurse were emphasized. The knowledge provided by the current study offers valuable insight into strengths and limitations in the support of children who are next of kin and can inform stakeholders in organizing sustainable support for this group.publishedVersio

Healthcare professionals’ perceptions of palliative care quality in a combined acute oncology-palliative care unit: A cross-sectional study

It is a challenge to ensure high-quality palliative care. The aim was to investigate the perceptions of health care professionals (HCPs) working in a combined acute oncology-palliative care unit regarding the quality of the palliative care received by the patients and how important the care was to the patients. A Swedish total-survey cross-sectional study including 41 HCPs (54% response rate) was conducted with the 52 items Quality from the Patient’s Perspective – Palliative Care instrument, answered in two different ways: as actual care received and subjective importance. The STROBE-checklist was used. The areas for improvements were related to symptom relief, spiritual and existential needs, information, patient participation, continuity of care, care planning, cooperation and coordination of care, as subjective importance scores were higher than corresponding scores for care received (p ≤ .025). Providing high-quality palliative care alongside curative treatments for cancer patients is known to be challenging and could explain the results in this study. Implementation of a person-centred palliative care model based on the hospice philosophy could be a solution.publishedVersio

Preferences for home care to enable home death among adult patients with cancer in late palliative phase - a grounded theory study

Background: The wish to be cared for and to die at home is common among people with end‑stage cancer in the western world. However, home deaths are declining in many countries. The aim of this study was to explore the preferences for home care over time to enable home death among adult patients with cancer in the late palliative phase. Methods: A qualitative method was applied according to grounded theory (Corbin & Strauss, 2008). Data was collected using individual interviews (n= 15) with nine adult patients. One to two follow up interviews were conducted with four patients. Sampling, data collection and constant comparative analysis were undertaken simultaneously. Results: The findings are presented as a conceptual model of patients’ preferences for care to enable home death. The core category “Hope and trust to get the care I need to die at home” showed that the preference to die at home seemed stable over time and did not change with deterioration in health status and progression in illness. Five categories were related to the core category. The categories “being in the present”, “be safe and in charge” and “be seen and acknowledged” describe the patients’ preferences to live a meaningful life until death and be the same person as always. These preferences depended on the categories describing characteristics of healthcare personnel and the organisation of care: “reliable, compassionate and competent healthcare personnel” and “timely, predictive, continuous and adaptive organisation”. Conclusion: An important preference over time was to be here and now and to live as meaningful a life as possible until death. Moreover, the patients preferred to retain control over their lives, to be autonomous and to be seen as the person they had always been. To achieve this, person‑centred care provided by healthcare personnel with competence, skills and enough/ample time were required. In addition, home care needed to be organised in a way that ensured continuity and predictability. Systematic implementation of a person‑centred care model and the use of advanced home care plans with continued re‑evaluation for patients’ preferences of home care were proposed measures to enable home death. Keywords: Patients’ preferences, Cancer, Palliative care, End‑of‑Life (EOL) Care, Home death, Grounded TheorypublishedVersio

Virtual Reality som et tilbud til pasienter etter kirurgi Erfaringer fra en pilotutprøving

Dette er akseptert versjon av artikkelen. Artikkelen er fagfellevurdert, men inneholder ikke nødvendigvis tidsskriftets endelige layout, sidetall og rettelser.Bakgrunn: Det er økende interesse for å undersøke om Virtual Reality (VR) er egnet som avledning eller distraksjonsterapi ved smerter. Hovedmålet med denne studien var 1) å innhente praktiske erfaringer med tilrettelegging og bruk av VR i en sykehusavdeling, 2) å undersøke hvordan pasienter opplevde VR-tilbudet, og om VR-opplevelsen påvirket pasientens smerteopplevelse. Metode: Studien har et kvalitativt, beskrivende forskningsdesign, og ble gjennomført i to trinn. Det første trinnet (1) beskriver innhenting av forskernes praktiske erfaringer med utprøving av teknisk utstyr og virtuelt miljø i en sykehusavdeling. Det andre trinnet (2) beskriver innhenting av erfaringer med et tilbud om VR fra pasienter ved en ortopedisk avdeling. Utvalget her var syv smertepåvirkede postoperative pasienter. Datamaterialet ble analysert ved hjelp av innholdsanalyse. Resultater: Trinn 1) HTC Vive VR og VR-filmen the Blu fra Wevr ble valgt for videre utprøving på pasientene. Trinn 2): Følgende fire hovedkategorier beskrev pasientenes opplevelse med VR: Positiv sanseopplevelse;- en mental og kroppslig velvære som varte i flere timer. Smerteopplevelse under VR;- pasientene opplevde at VR gav smertelindring. Erfaring med kvalme eller ubehag;- VR-opplevelsen ga ikke kvalme og ubehag. Egenskaper ved VR-miljøet;- filmen opplevdes som interessant og beroligende, og gav en altoppslukende opplevelse av å være i en annen verden. Konklusjon: Pilotutprøvingen viser at VR kan se ut til å være et ikke-medikamentelt alternativ som sykepleiere kan tilby pasienter med postoperative smerter. Selv om denne studien viser lovende resultater, må VR videre testes ut i større intervensjonsstudier på ulike pasientgrupper og pasientsituasjoner. Det er også behov for å finne og utprøve mer brukervennlig utstyr. Nøkkelord: distraksjon, kvalitativ studie, pasient-opplevelser, smertelindring, voksenpublishedVersionacceptedVersio

«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

Quality in palliative care from the patient perspective : Instrument development, perceptions of care received and the importance of care

The overall aim was to investigate the quality of palliative care from the patient perspective, to adapt and psychometrically evaluate the Quality from Patients’ Perspective instrument specific to palliative care (QPP-PC) and investigate the relationship between the combination of person- and organization-related conditions and patients’ perceptions of care quality. Methods: In the systematic literature review (I), 23 studies from 6 databases and reference lists in 2014 were synthesized by integrative thematic analysis. The quantitative studies (II–IV) had cross-sectional designs including 191 patients (73% RR) from hospice inpatient care, hospice day care, palliative units in nursing homes and home care in 2013–2014. A modified version of QPP was used. Additionally, person- and organization-related conditions were assessed. Psychometric evaluation, descriptive and inferential statistics were used. Main findings: Patients’ preferences for palliative care included living a meaningful life and responsive healthcare personnel, care environment and organization of care (I). The QPP-PC was developed, comprising 12 factors (49 items), 3 single items and 4 dimensions: medical–technical competence, physical–technical conditions, identity–oriented approach, and socio-cultural atmosphere (II). QPP-PC measured patients’ perceived reality (PR) and subjective importance (SI) of care quality. PR differed across settings, but SI did not (III). All settings exhibited areas of strength and for improvement (II, III). Person-related conditions seemed to be related to SI, and person- and organization-related conditions to PR, explaining 18–30 and 22-29% respectively of the variance (IV). Conclusions: The patient perspective of care quality (SI and PR) should be integrated into daily care and improvement initiatives in palliative care. The QPP-PC can measure patients’ perceptions of care quality. Registered nurses and other healthcare personnel need awareness of person- and organization-related conditions to provide high-quality person-centred care.Knowledge about patients’ perceptions of palliative care is limited and valid instruments are needed. The aim of this thesis was to investigate quality of palliative care from the patient perspective, adapt and evaluate an instrument to measure patients’ perceptions of quality in palliative care (QPP-PC), and investigate the relationship between the combination of person- and organization-related conditions and patients’ perceptions of care quality. A systematic literature review and quantitative methods were used. Patients’ preferences in palliative care included help living a meaningful life and responsive personnel, care environment and organization of care. The QPP-PC was developed and identified patients’ perceptions of areas of strength and for improvement in hospice inpatient and day care, palliative units in nursing homes and home care settings. Perceptions of care quality seemed to be related to person- and organization-related conditions, and differed across settings, although subjective importance did not. The patient perspective of care quality should be integrated into daily care and quality work, and QPP-PC can be used in such work. Registered nurses and other healthcare personnel need awareness of person- and organization-related conditions to provide high-quality person-centred palliative care.Den overordnede hensikten var å undersøke kvalitet i palliativ behandling og omsorg fra pasientens perspektiv, å utvikle og psykometrisk evaluere spørreskjemaet Kvalitet ut fra Pasientens Perspektiv (KUPP) for palliativ omsorg (KUPP-PO), samt å undersøke sammenhengen mellom person- og organisasjonsrelaterte forhold og pasientenes erfaringer av kvalitet. Metode. I den systematiske oversiktsartikkelen (I) ble 23 studier fra seks databaser og referanselister syntetisert i 2014 med integrativ tematisk analyse. De kvantitative studiene (II-IV) hadde et tverrsnittsdesign som inkluderte 191 pasienter (svarprosent: 73) fra hospice-døgnavdeling, hospice-dagavdeling, lindrende enheter i sykehjem og hjemmetjeneste i 2013 til 2014. En modifisert versjon av KUPP ble brukt. I tillegg ble person- og organisasjonsorienterte forhold kartlagt. Deskriptiv og  inferensiell statistikk, samt psykometrisk evaluering ble anvendt. Hovedfunn. Pasientene ønsket at palliativ behandling og omsorg skulle omfatte hjelp til å leve et meningsfullt liv og at helsepersonell, omsorgsmiljø og organisering av omsorgen var lydhør for og handlet eller var tilrettelagt i samsvar med deres preferanser (I). KUPP-PO ble utviklet og omfattet 12 faktorer (49 spørsmål), 3 enkeltstående spørsmål og fire dimensjoner; medisinsk-teknisk kompetanse, fysisk-tekniske forhold, identitetsorientert tilnærmingsmåte og sosiokulturell atmosfære (II). KUPP-PO målte pasientenes erfaringer og subjektiv betydning av kvalitet. Pasientens erfaringer av kvaliteten med palliativ behandling og omsorg varierte utfra kontekst, men subjektiv betydning varierte ikke. Alle omsorgskontekstene viste styrker og forbedringsområder (II, III). Personrelaterte forhold så ut til å være forbundet med subjektiv betydning mens person- og organisasjonsorienterte forhold så ut til å være forbundet med erfaring med behandling og omsorg, og forklarte respektivt 18–30/22-29% av variansen (IV). Konklusjon: Kvalitet fra pasientens perspektiv (subjektiv betydning og erfaring) bør integreres i daglig behandling og omsorg og i forbedringstiltak i palliativ omsorg. KUPP-PO kan måle pasientenes erfaringer i kvalitetsutviklingsarbeid. Sykepleiere og annet helsepersonell trenger å være bevisst person- og organisasjonsrelaterte forhold for å utføre personsentrert behandling og omsorg av høy kvalitet

Hvordan oppfatter erfarne anestesi-, intensiv- og operasjonssykepleiere at kompetanseutvikling fremmes - en fenomenografisk studie

NORSK: Anestesi-, intensiv- og operasjonssykepleiere skal ha kompetanse og være funksjonsdyktige, til å ivareta akutt og kritisk syke pasienter og deres pårørende. Internasjonalt og nasjonalt finnes det noen studier på generell kompetanseutvikling, men ingen studier ser på hvordan kompetanseutvikling fremmes hos den erfarne AIO sykepleier. (...) Funnene i studien viser en variasjon av ulike oppfattninger av hvordan kompetanseutviking fremmes for den erfarne AIO-sykepleier. Kompetanseutviklingen fremmes på tre ulike nivåer, et individ-, gruppe- og systemnivå. Funnenes betydning for klinisk praksis kan være en økt bevissthet om, at for å fremme og tilrettelegge for læring og kompetanseutvikling for erfarne AIO- sykepleiere, vil det være av betydning å tilrettelegge både mot individet, mot praksisfellesskapet som gruppe og på systemer for kompetanseutvikling i avdelingen