Interprofessional simulation to improve patient participation in transitional care

This is an accepted version of the article. The original is available at http://onlinelibrary.wiley.com/doi/10.1111/scs.12341/abstract;jsessionid=1AF42118605EDBD498F7DFCF4900C430.f03t01.Background: Educating and training healthcare professionals is known to improve the quality of transitional care for older adults. Arranging interprofessional meetings for healthcare professionals might be useful to improve patient participation skills in transitional care. Aim: To describe the learning activities used in The Meeting Point programme, focusing on patient participation in transitional care, and assess whether they increase healthcare professionals’ awareness of and competencies relating to patient participation in the transitional care of older patients. Design: Data were collected as part of an educational intervention programme, The Meeting Point, including three seminars on ‘Patient participation in the transitional care of older patients’ and four follow-up meetings. Participants were nurses, care assistants, doctors, physiotherapists, patient coordinators and administrative personnel from hospital, nursing homes and home-based care services. Method: The Meeting Point was organised around four pillars: introduction, teaching session, group work activity and plenary discussion. Qualitative data included log reports, summaries of meetings, notes from group work activities, and reports from participants and from follow-up meetings. Results: Feedback from participants shows that they were satisfied with meeting healthcare professionals from other units of care. A film scenario was perceived relevant for group work activity and useful in focusing participants’ attention to patient participation. Follow-up meetings show that some nursing home wards, the emergency department and one medical ward at the hospital continued with ongoing work to improve quality of care. Efforts included implementation of an observational waiting room with comfortable chairs, planning for discharge in hospital admission, a daily patient flow registration system and motivational interviewing during admission to nursing home. Conclusions: The description of the learning activities used at The Meeting Point seminars shows that they were useful to increase awareness of and competencies on patient participation in transitional care.acceptedVersio

An observational study of older patients' participation in hospital admission and discharge - exploring patient and next of kin perspectives

Aims and objectives. To explore older patients’ participation during hospital admission and discharge. Background. Patient participation is suggested as a means to improve the quality of transitional healthcare. Older people with chronic diseases, physical disabilities and cognitive impairments often need to transfer from primary to hospital healthcare and vice versa. Design. This study adopts a participant observational research design. Methods. Participant observations of 41 older patients (over 75 years of age) during hospital admission and discharge were conducted in two hospitals in Norway (in 2012). The observations included short conversations with the patient and their next of kin to capture their participation experiences. Systematic text condensation was used to analyse the data material from the field notes. Results. Varying degrees of information exchange between healthcare professionals and patients, and a lack of involvement of the patient in decision-making (in admission and discharge) were observed and experienced by patients and their next of kin. The next of kin appeared to be important advocates for the patients in admission and provided practical support both during admission and discharge. Data suggest that patient participation in admission and discharge is influenced by time constraints and the heavy workloads of healthcare professionals. Patients’ health conditions and preferences also influence participation. Conclusions. Several issues influence the participation of the older patients during hospital admission and discharge. Participation of the older patients needs continuous support from healthcare professionals that acknowledges both the individual patient’s preferences and their capacity to participate. Relevance to clinical practice. Study findings report discrepancies in the involvement of older people and their next of kin. There is a need to increase and support older patients’ participation in hospital admission and discharge.publishedVersio

Assessment methods and tools to evaluate postgraduate critical care nursing students' competence in clinical placement: An integrative review

Aim To provide an overview of assessment methods and tools to evaluate postgraduate critical care nursing students’ competence in clinical placement and to identify recommendations for future assessment methods. Background The purpose of postgraduate critical care nursing education is to educate professional, competent and caring critical care nurses and high-quality assessment strategies in clinical placement are of most importance. Design An integrative review following Whittemore and Knafl’s framework and Prisma 2020 guidelines for systematic reviews. Methods Systematic searches were performed in June 2020 with an update in April 2021 using the following: Academic Search Premier, British Nursing Index, CINAHL, MEDLINE, SveMed+, Web of Science and the Joanna Briggs Institute databases. The systematic literature search and hand search yielded 380 studies. After screening and checking for eligibility, fifteen studies published between 2005 and 2020 were included in this review. The included studies were critically appraised using the Mixed Methods Appraisal Tool for empirical studies and the Joanna Briggs Institute Critical Appraisal tool for literature reviews. Results Four qualitative, six quantitative, three mixed-methods and two literature review studies were included in this review. We identified that competence in postgraduate critical care nursing is a multidimensional concept and it is recommended to use a combination of assessment methods like self-assessment, observation and mentor evaluation. It is necessary to have discussions and reflections between the student, preceptor and lecturer, as well as written self- and mentor evaluation to provide formative and summative feedback to the students. The need to provide consistency and objectivity resulted in the development of competency assessment tools and they were mostly developed and validated as a collaboration between clinical sites and educational institutions. Most of the assessment tools consisted of domains reflecting holistic nursing, including both technical and non-technical skills. Domains reflecting evidence-based nursing practice were less common. Conclusions We need valid and reliable instruments to assess postgraduate critical care nursing student’s competence in placement. Innovation and further research regarding effective and accessible assessment methods, such as digital assessment tools, are needed to meet future needs. This may also stimulate collaboration to improve the international inconsistency in critical care nursing educations. We should be working towards common, international educational competence descriptions and assessment tools that are in line with the ever-changing critical care environment, including holistic nursing and continuous learning.publishedVersio

Quality and safety in the transitional care of the elderly (phase 2): the study protocol of a quasi-experimental intervention study for a cross-level educational programme

Introduction: Transitional care and patient handover are important areas to ensure quality and safety in elderly healthcare services. Previous studies showed that healthcare professionals have little knowledge of the setting they are transferring patients to and a limited understanding of roles and functions; these constitute barriers to effective communication and shared care responsibilities across levels of care. Aim: The main objective is to implement a cross-level education-based intervention programme with healthcare professionals aimed at (1) increasing professionals’ awareness and competencies about quality and safety in the transitional care of the elderly; (2) creating a discussion platform for knowledge exchange and learning across levels and units of care and (3) improving patient safety culture, in particular, in transitional care. Methods and analysis: A quasi-experimental control group study design with an intervention group and a control group; this includes a pretest, post-test and 1-year follow-up test assessment of patient safety culture. Qualitative data will be collected during the intervention programme and between the measurements. The study design will be beneficial for addressing the effects of the cross-level educational intervention programme on reports of patient safety culture and for addressing the feasibility of the intervention measures. Ethics and dissemination: The study has been approved by the Regional Committees for Medical and Health Research Ethics in Norway, Ref. No. 2011/1978. The study is based on informed written consent; informants can withdraw from the study at any point in time. The results will be disseminated at research conferences, in peer review journals and through public presentations outside the scientific community.Norges Forskningsråd: 204637.publishedVersio

Quality in transitional care of the elderly: Key challenges and relevant improvement measures

Introduction: Elderly people aged over 75 years with multifaceted care needs are often in need of hospital treatment. Transfer across care levels for this patient group increases the risk of adverse events. The aim of this paper is to establish knowledge of quality in transitional care of the elderly in two Norwegian hospital regions by identifying issues affecting the quality of transitional care and based on these issues suggest improvement measures. Methodology: Included in the study were elderly patients (75+) receiving health care in the municipality admitted to hospital emergency department or discharged to community health care with hip fracture or with a general medical diagnosis. Participant observations of admission and discharge transitions (n = 41) were carried out by two researchers. Results: Six main challenges with belonging descriptions have been identified: (1) next of kin (bridging providers, advocacy, support, information brokering), (2) patient characteristics (level of satisfaction, level of insecurity, complex clinical conditions), (3) health care personnel's competence (professional, system, awareness of others’ roles), (4) information exchange (oral, written, electronic), (5) context (stability, variability, change incentives, number of patient handovers) and (6) patient assessment (complex clinical picture, patient description, clinical assessment). Conclusion: Related to the six main challenges, several measures have been suggested to improve quality in transitional care, e.g. information to and involvement of patients and next of kin, staff training, standardisation of routines and inter-organisational staff meetings.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

Patient participation in transitional care of older patients

PhD thesis in Health, medicine and welfareBackground: Older patients often have several health challenges, with multiple medications, which leads to a need of treatment and care from diverse healthcare services. These patients are often in need of transitions from different levels of care, specifically during hospital admission and discharge. Patient participation is highlighted and stated in patients’ rights and healthcare directives, with patients being informed and involved in all treatment and care processes. Nevertheless, literature reveals a lack of patient participation, with minimal information in transitional care. Aims: The overall aims of this thesis were 1) to give an overview of the research literature on older patients’ participation in transitional care, 2) to explore older patients’ perspectives on participation during hospital admission and discharge, 3) to explore healthcare professionals’ perspectives on patient participation and identify factors influencing older patients’ participation during hospital admission, and 4) to conduct and describe interprofessional simulation to improve competencies about patient participation in transitional care. Methods: The study comprises several qualitative methods, applied in four partial studies. First, a literature review was written involving 30 studies, 15 exploring older patients’ participation in transitional care and 15 studies on experiences with tools to support patient participation. In 2012, 41 older patients were included in participant observations, 21 in hospital admission and 20 in hospital discharge. Further, 27 personal interviews with different healthcare professionals (ambulance workers, nurses, doctors) were conducted. In November 2013, interprofessional simulation was carried out. Results: Paper 1 reveals variable information and patient participation among older patients during hospital discharge in the literature review. Results show that older patients often were excluded and not participating in discussions about discharge. When present, they often felt they were not being seen or heard by healthcare professionals, and a paternalistic approach was revealed. Several tools to support patient participation in transitional care have been implemented, with variable results. Most successful were family meetings, checklists and education programs. Paper 2 identifies variable degrees of information exchange between healthcare professionals and patients, and a lack of involvement of the patient in decision- making were observed and experienced by the patients. Next of kin appeared to be important advocates for the patients in admission and provided practical support both during hospital admission and discharge. Data suggests that patient participation in admission and discharge is influenced by time constraints and heavy workloads of healthcare professionals. Patients’ health conditions also influenced participation. Paper 3 shows the interviews with healthcare professionals, wherein it was found that patient participation in hospital admissions was influenced by five main factors: routine treatment and care during hospital admission, particularly procedures like medical examinations; the frail and thankful older patients, with the compound picture of their medical needs; hospital resources, such as available staff and beds; healthcare professionals’ attitude towards patients’ experiences; and the presence of a supportive and demanding next of kin, acting as an advocate for the patient. Paper 4 describes interprofessional simulation focusing patient participation of older patients in transitional care. Healthcare professionals from one hospital and one municipality participated in the simulation, with a film scenario, which was based on findings from the observational study. Results show that healthcare professionals did not have any common arenas to meet and discuss work issues and specific or general challenges related to transitions. The film scenario emotionally affected several participants, revealing a lack of information and lack of care, with decisions taken by healthcare professionals. Log reports show that all participants were concerned to provide sufficient information to patients and next of kin and vice versa, as well as involving the patient in treatment, care and discharge planning. Several suggestions came up and the follow-up meetings showed that some wards had continued their work to improve the quality of transitional care

Hjemmerespiratorbrukere og medvirkning : brukernes erfaringer med innflytelse og medvirkning i planlegging og oppfølging av egen behandling, pleie og hjemmesituasjon

Master's thesis in Health and social sciencesAntall hjemmerespiratorbrukere er stadig økende i Norge. Et mindretall av disse har behov for respirator store deler av eller hele døgnet og ventileres via trakeostomi. Denne brukergruppen har alvorlige kroniske og progredierende lidelser, er avhengig av medisinsk teknisk utstyr og må ha tilsyn og pleie hele døgnet. Politiske lover og forskrifter fremhever retten til medvirkning både i utforming av og innhold i tjenesten for dem som blir berørt. Hensikten med studien var å frembringe en dypere innsikt i hjemmerespiratorbrukernes erfaringer med medvirkning i utforming av behandlingstilbudet fra behandlingsstart i sykehuset og prosessen fram til nåværende situasjon. Begrunnelsen for å undersøke dette var å finne ut om brukere blir tatt med på beslutninger og får innflytelse, slik at de kan være delaktig og oppnå brukermedvirkning. Studien har en kvalitativ forskningsdesign med intervju som redskap. Det er gjennomført halvstrukturerte dybdeintervju med seks voksne hjemmerespiratorbrukere. Disse hadde trakeostomi og bodde hjemme, i omsorgsbolig eller på sykehjem. Intervjuguide ble brukt under samtalene. Intervjuene ble tapet, transkribert og analysert ved hjelp av innholdsanalyse. Funn i studien viste at medvirkning i form av valgmuligheter i startfasen vedrørende trakeostomi og bosituasjon var viktig. For at brukeren kunne ha medvirkning var det også nødvendig med et godt samarbeid mellom bruker og helsepersonell. Analyse av funn resulterte i to tema: Tema 1. Muligheten til å velge selv. Dette fremkom som tema ut fra kategoriene: å bestemme selv i eget liv, å bli tatt på alvor og å være trygg når kreftene svikter. Tema 2. Samarbeid mellom bruker og helsepersonell. Temaet var basert på kategoriene: betydningen av informasjon og oppfølging, samt brukerens rolle i et tverrfaglig samarbeid. Konklusjonen i studien var viktigheten av at brukernes stemme blir hørt, slik at de kan ha mulighet til å velge selv med tanke på trakeostomi og boforhold. Delaktighet i tverrfaglig samarbeid hadde stor betydning for prosessen fra sykehusoppholdet med informasjon om og anleggelse av trakeostomi, utskrivelsesprosessen til hjemmet og brukermedvirkningen i dag. Implikasjoner for bruker og praksis vil være økt bevissthet om rettigheter og muligheter for brukerne. Dette kan også bevisstgjøre helsepersonell sin plikt til å gi informasjon og legge forholdene til rette for medvirkning i planlegging og oppfølging av behandling, pleie og hjemmesituasjon. For at dette skal skje er det viktig å lytte til brukerne selv og deres opplevelser og ønsker. På den måten kan vi som helsearbeidere legge til rette for og bidra til at brukeren skal oppleve å ha innflytelse og medvirkning i eget liv

Older patients’ participation in hospital admissions through the emergency department: an interview study of healthcare professionals

This article was originally published in BMC Health Services Research. It is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Background: Patient participation is an important aspect of healthcare quality and may be one way to improve the quality of transitional care for older patients. Research reveals minimal awareness about patient participation in hospital admissions. Hospital admissions require attention to individuals’ specific needs beyond patient frailty, and to involve patients and their families in shared decision-making. The aim of this study was to identify factors influencing patient participation by exploring healthcare professionals’ views on patient participation during the hospital admission of older patients through the emergency department (ED). Methods: The study used a qualitative and descriptive design with face-to-face interviews. A total of 27 interviews were conducted with 15 healthcare professionals from one hospital and 12 from another. The data were analyzed using systematic text condensation. Results: Healthcare professionals thought that patient participation in hospital admissions was influenced by five main factors: 1) routine treatment and care during hospital admission, and in particular certain procedures such as medical examinations; 2) the frail and thankful older patients, and the overall picture of their medical needs; 3) hospital resources, such as available staff and beds; 4) healthcare professionals’ attitude towards finding out about older patients’ experiences; and 5) the presence of a supportive and demanding next of kin acting as an advocate for the patient. Conclusions: Patient participation in hospital admissions of older patients is dependent on the way the service is organized, the patients’ condition, hospital resources, healthcare professionals’ attitudes, and support from patients’ next of kin. Some of the participants had high expectations of themselves and actively involved patients, but others did not find patient participation relevant in the emergency department. Some used crowded wards as a reason not to engage older patients in their own care

Quality and safety in transitional care of the elderly: The study protocol of a case study research design (Phase 1)

This is an article originally published in BMJ Open; and distributed under Creative Commons Attribution Non Commercial (CC BY-NC 3.0). See doi: 10.1136/bmjopen-2013-003506.Introduction: Although international studies have documented that patients ’ transitions between care providers are associated with the risk of adverse events and uncoordinated care, research directed towards the quality and safety of transitional care between primary and secondary health and care services, especially for the elderly receiving care from multiple healthcare providers due to complex health problems, is lacking. This study investigates how different aspects of transitional care can explain the quality and safety of elderly healthcare services in Norway. The overall aim of the study was to explore different aspects of transitional care of the elderly, in different contexts and how they might explain the quality and safety of care. Methods and analysis: The study applies a case study design. Two cases are chosen: one city-based hospital and one rural hospital with associated nursing homes and home-based nursing services. Admission and discharge to/from hospital to/from nursing homes or home-based nursing services constitute the main focal areas of the study, including the patient, next-ofkin and the professional perspective. The qualitative methods employed include participant observation, individual interviews and document analysis. To ensure trustworthiness in the data analysis, we will apply analyst triangulation and member checks. A total impression of the data material will first be created in a systematic text condensation approach. Second, the qualitative data analysis will involve in-depth analyses of two specific themes: the risk perspective and the patient perspective in transitional care. Ethics and dissemination: The study is approved by the Norwegian Regional Committees for Medical and Health Research Ethics. The study is based on informed written consent, and informants can withdraw from the study at any point in time. Interview and observation data material will be managed confidentially. Results: It will be disseminated at research conferences, in peer-reviewed journals and through public presentations to people outside the academic community