Fra sygeplejerske til leder- At blive leder indenfor en profession

Artiklen belyser, hvordan afdelingssygeplejersker ændrer deres arbejdsidentitet i overgangen fra sygeplejerske til leder. Ændringen af arbejdsidentitet udspiller sig primært1 som nogle bevægelser ud af professionens stærke fællesskab. Den ny leder etablerer en distance til medarbejderne, som er nødvendig for at varetage sine ledelsesopgaver. Hun ændrer sit perspektiv på, hvordan en sygehusafdeling skal ledes, og hun ændrer sin placering i fællesskabet til mere perifere eller marginale positioner. Medarbejdernes anerkendelse og lederens måde at præge forhandlingen af mening har en stor betydning for, hvorvidt lederen bevæger sig ud i periferien eller marginaliseres. Det første lederår kan være en smertefuld proces, men samtidig en overgangsperiode præget af stort læringspotentiale og udviklingsmuligheder

Assessing firefighters’ tourniquet skill attainment and retention – A controlled simulation-based experiment

Background: The aim of this study was to train and assess firefighters’ skill attainment in the use of tourniquets, and to assess their skill retention after three months. The purpose is to show whether firefighters can successfully apply a tourniquet after a short course based on the new national recommendation for civilian prehospital tourniquet use. Material and methods: This was a prospective experimental study. The study population was firefighters in Oslo and Tromsø, and the inclusion criterion was any on-duty firefighter. The first phase consisted of baseline pre-course testing, a short tourniquet course based on the new national tourniquet recommendation, followed by immediate retesting. The second phase consisted of retesting of skill retention after 3 months. Primary outcome was absent distal pulse (confirmed with doppler ultrasound), correct placement (i.e. 5-10cm proximal to wound) and application time. Results: There were 109 participants pre-course (T1), 105 immediately after the course (T2) and 62 participants at the three-months re-test (T3). The firefighters achieved a significantly greater proportion of successful tourniquet applications immediately after the course (91.4%, 96 of 105) as well as three months later (87.1%, 54 of 62) compared to 50.5% (55 of 109) pre-course (p=0.009). Mean application time was 59.6s (55.1-64.2) in T1, 34.9s (33.3-36.6) in T2 and 37.7s (33.9-41.4) in T3. The firefighters were significantly slower pre-course compared to both T2 (mean difference 24.7s, p<0.000) and T3 (mean difference 22.0s, p<0.000), but not between T2 and T3 (mean difference 2.7s, p=0.983). Conclusion: Firefighters are able to successfully apply a tourniquet after a 45-minute course based on the new recommendation for civilian prehospital tourniquet use. Skill retention after three months was satisfactory for both successful application and application time. We strongly recommend that tourniquets should be a part of firefighters’ hemorrhage control kit, but they should not be implemented without proper training. We recommend that tourniquet use is standardized in all prehospital medical providers across the country, including both the fire service and emergency medical service (EMS)

Farm workers and farm dwellers in Limpopo, South Africa: struggles over tenure, livelihoods and justice

In the late 1990s land and agrarian issues remained a barrier to the enjoyment of human rights and justice for millions of South Africans. With funding from the Norwegian government, the Norwegian Centre for Human Rights decided to support collaboration between PLAAS and Noragric to explore human rights in South Africa’s land and agrarian reform. PLAAS is the Institute of Poverty, Land and Agrarian Studies at the University of the Western Cape, and Noragric is the Department of International Environment and Development Studies at the Norwegian University of Life Sciences. Our collaboration from 1999 to 2010 has involved joint research and graduate training (MA and PhD) in rural areas of South Africa and Norway. Our joint programme ‘Land Rights and Agrarian Change in South Africa’ initiated in 2007 focused on the Limpopo Province and its context of rural poverty and inequality. The programme aimed to enhance the understanding of the problems facing rights-based approaches to land and agrarian reform in South Africa; to influence land reform policy and implementation in a positive way; and to strengthen applied social science research capacity within land and agrarian studies in South Africa. One of the teams in the collaboration from 2007 to 2010 studied farm worker and farm dweller issues on commercial farms in Limpopo, and produced this book.The Norwegian government, the Norwegian Centre for Human Rights decided to support collaboration between PLAAS and Noragric to explore human rights in South Africa’s land and agrarian reform.Web of Scienc

Trauma research in low- and middle-income countries is urgently needed to strengthen the chain of survival

Trauma is a major - and increasing - cause of death, especially in low- and middle income countries. In all countries rural areas are especially hard hit, and the distribution of physicians is skewed towards cities. To reduce avoidable deaths from injury all links in the chain of survival after trauma needs strengthening. Prioritizing in each country should be done by local researchers, but little research on injuries emerges from low- and middle income countries. Researchers in these countries need support and collaboration from their peers in industrialized countries. This partnership will be of mutual benefice

Dispatch guideline adherence and response interval—a study of emergency medical calls in Norway

Background: The Emergency Medical Communication Centre (EMCC) operators in Norway report using the Norwegian Index for Medical Emergency Assistance (Index), a criteria-based dispatch guideline, in about 75 % of medical emergency calls. The main purpose of a dispatch guideline is to assist the operator in securing a correct response as quickly as possible. The effect of using the guideline on EMCC response interval is as yet unknown. We wanted to ascertain an objective measure of guideline adherence, and explore a possible effect on emergency medical dispatch (EMD) response interval. Methods: Observational cross-sectional study based on digital telephone recordings and EMCC records; 299 random calls ending in acute and urgent responses from seven strategically selected EMCCs were included. Ability to confirm location and patient consciousness within an acceptable time interval and structural use of criteria cards were indicators used to create an overall guideline adherence variable. We then explored the relationship between different levels of guideline adherence and EMD response interval. Results: The overall guideline adherence was 80 %. Location and patient consciousness were confirmed within 1 min in 83 % of the caolls. The criteria cards were used systematically as intended in 64 % of the cases. Total median response interval was 2:28, with 2:01 for acute calls and 4:10 for urgent calls (p < 0.0005). Lower guideline adherence was associated with higher EMD response interval (p < 0.0005). Conclusion: The measured guideline adherence was higher than previously reported by the operators themselves. Patient consciousness was rapidly confirmed in the majority of cases. Failure to use Index criteria as intended result in delayed ambulance dispatch and a potential risk of undertriage

Norwegian trauma team leaders - training and experience : a national point prevalence study

The treatment of trauma victims is a complex multi-professional task in a stressful environment. We previously found that trauma team members perceive leadership as the most important human factor. The aim of the present study was to assess the experience and education of Norwegian trauma team leaders, and allow them to describe their perceived educational needs. We conducted an anonymous descriptive study using a point prevalence methodology based on written questionnaires. All 45 hospitals in Norway receiving severely injured trauma victims were contacted on a randomly selected weeknight during November 2009. Team leaders were asked to specify what trauma related training programs they had participated in, how much experience they had, and what further training they wished, if any. Response rate was 82%. Slightly more than half of the team leaders were residents. The median working experience as a surgeon among team leaders was 7.5 years. Sixty-eight percent had participated in multiprofessional training in non-technical skills, while 54% had passed the advanced trauma life support(ATLS) course. Fifty-one percent were trained in damage control surgery. A median of one course per team leader was needed to comply with the new proposed national standards. Team leaders considered training in damage control surgery the most needed educational objective. Level of experience among team leaders was highly variable and their educational background insufficient according to international and proposed national standards. Proposed national standards should be urgently implemented to ensure equal access to high quality trauma care

The development of a tool to assess medical students’ non-technical skills–The Norwegian medical students’ non-technical skills (NorMS-NTS)

Purpose - New physicians need to master non-technical skills (NTS), as high levels of NTS have been shown to increase patient safety. It has also been shown that NTS can be improved through training. This study aimed to establish the necessary NTS for Norwegian medical students to create a tool for formative and summative assessments. Methods - Focus group interviews were conducted with colleagues and patients of newly graduated physicians. Interviews were then analyzed using card sort methods, and the identified NTS were used to establish a framework. Focus groups commented on a prototype of an NTS assessment tool. Finally, we conducted a search of existing tools and literature. The final tool was developed based on the combined inputs. Results - We created Norwegian medical students’ non-technical skills (NorMS-NTS) assessment tool containing four main categories; together comprising 13 elements and a rating scale for the NTS of the person observed. Conclusions - The NorMS-NTS represents a purpose-made tool for assessing newly graduated physicians’ NTS. It is similar to existing assessment tools but based on domain-specific user perspectives obtained through focus group interviews and feedback, integrated with results from a literature search, and with consideration of existing NTS tools

Differences in time-critical interventions and radiological examinations between adult and older trauma patients: A national register-based study

BACKGROUND Older trauma patients are reported to receive lower levels of care than younger adults. Differences in clinical management between adult and older trauma patients hold important information about potential trauma system improvement targets. The aim of this study was to compare prehospital and early in-hospital management of adult and older trauma patients, focusing on time-critical interventions and radiological examinations. METHODS Retrospective analysis of the Norwegian Trauma Registry for 2015 through 2018. Trauma patients 16 years or older met by a trauma team and with New Injury Severity Score of 9 or greater were included, dichotomized into age groups 16 years to 64 years and 65 years or older. Prehospital and emergency department clinical management, advanced airway management, chest decompression, and admission radiological examinations was compared between groups applying descriptive statistics and appropriate statistical tests. RESULTS There were 9543 patients included, of which 28% (n = 2711) were 65 years or older. Older patients, irrespective of injury severity, were less likely attended by a prehospital doctor/paramedic team (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.57–0.71), conveyed by air ambulance (OR, 0.65; 95% CI, 0.58–0.73), and transported directly to a trauma center (OR, 0.86; 95% CI, 0.79–0.94). Time-critical intervention and primary survey radiological examination rates only differed between age groups among patients with New Injury Severity Score of 25 or greater, showing lower rates for older adults (advanced airway management: OR, 0.60; 95% CI, 0.47–0.76; chest decompression: OR, 0.46; 95% CI, 0.25–0.85; x-ray chest: OR, 0.54; 95% CI, 0.39–0.75; x-ray pelvis: OR, 0.69; 95% CI, 0.57–0.84). However, for the patients attended by a doctor/paramedic team, there were no management differences between age groups. CONCLUSION Older trauma patients were less likely to receive advanced prehospital care compared with younger adults. Older patients with very severe injuries received fewer time-critical interventions and radiological examinations. Improved dispatch of doctor/paramedic teams to older adults and assessment of the impact the observed differences have on outcome are future research priorities

Geographical risk of fatal and non-fatal injuries among adults in Norway

Introduction: A rural gradient in trauma mortality disfavoring remote inhabitants is well known. Previous studies have shown higher risk of traumatic deaths in rural areas in Norway, combined with a paradoxically decreased prevalence of non-fatal injuries. We investigated the risk of fatal and severe non-fatal injuries among all adults in Norway during 2002–2016. Methods: All traumatic injuries and deaths among persons with a residential address in Norway from 2002–2016 were included. Data were collected from the Norwegian National Cause of Death Registry and the Norwegian Patient Registry. All cases were stratified into six groups of centrality based on Statistics Norway's classification system, from most urban (group one) to least urban/most rural (group six). Mortality and injury rates were calculated per 100,000 inhabitants per year. Results: The mortality rate differed significantly among the centrality groups (p Conclusions: Fatal and non-fatal injury risks increased in parallel with increasing rurality. The lowest risk was in the second most urban region, followed by the most urban (capital) region, yielding a J-shaped risk curve. Transport injuries had the steepest urban–rural gradient