Kreftsykepleie og kompetanseutvikling fra utdanning til klinikk : en evaluering av videreutdanning i kreftsykepleie

Background: In order to improve the quality of care for cancer patients, The Norwegian Radium Hospital established in 1982 an advanced programme in cancer nursing. During the period 1982 – 2000, 366 cancer nurses were graduated. Purpose: The aim of this study was to evaluate how the cancer nurses implement their competence into clinical practice after graduating from the programme. The Research questions answered were: 1) Do the cancer nurses utilise their competence in clinical practice, 2) Is there conformity between the cancer nurses own evaluation of their competence and the skills needed for managing their duties in clinical practice and 3) Did the advanced programme in cancer nursing become of importance for their skills development? Methods: This study is a part of a larger study with a survey design and the study sample consists of 188 cancer nurses out of 366 (response rate 53 %). Data was collected through a semi-structured questionnaire; this study is based on the quantitative data. A Numeric Rating Scale (NRS) was used to collect data from six areas of competence. Data analysis includes frequency- , correlation-, and cross table analysis. Chronbach’s alpha coefficient was used for measuring internal consistency. Results: The majority of the cancer nurses are working in bedside nursing, still 20 years after graduation. They evaluate their own competence as highly favourable regarding issues in care, medicine, education, collaboration, professional development and prevention. They considered the advanced programme as being very important for the development of their competence. The programme contributed to its main objective: to prepare cancer nurses for clinical practice. The advanced programme recruits nurses from the clinical practice and the cancer nurses go back to bed side nursing after completing the programme

On verb second and the så-construction in two Mainland Scandinavian contact situations

Data from areas of long term language contact situations between a non-V2 language and a V2 language in Northern Norway reveal unstable use of V2. Furthermore, in a substantial portion of the data there is a notable presence of the particle så. These facts are discussed in light of data on the så-construction in Standard Norwegian and Finland Swedish, and the particle ni in Finnish. We suggest that some aspects of så in the data may be explained as one trait of L1 transfer, where the acquirer recruits existing L2 elements and assigns to them new tasks in the grammar. The data reveal interesting variation patterns, which may be taken to support the “Underspecified CP” hypothesis put forth in recent language acquisition research

Mobile Health Care and Health Behavior Change : Development of a System for Virtual Counseling based on Written Diary Questionnaires and Situational Feedback

In the future virtual e-health counseling through the mobile phones will be an important feature of health care. Patients are shortly in face to face contact with health care personal. Many patients face challenges living with chronic diseases and the patients have to change health behavior and life style to life as healthy as possible with a high degree of quality of life. Development of new ways of health counseling should also apply principles of universal design as accessibility for all and ease of use. We have designed a system for virtual counseling through written questionnaire diaries and situational feedback – the www.wsf.hio.no that is delivered to the patient through an internet enabled mobile phone. The system is applied in a pilot study with patients with widespread chronic musculoskeletal pain and is currently running in a randomized controlled study within the same patient group. The system ensures safe contact with the patients and has been running successfully for 30 month. The patients are able to use the cell phone with a short f2f instruction. The therapists can easy follow patients’ responses independent of place. The researcher can easily extract data from the system. At the present moment the 2nd generation of the system will be redesigned in order to improve the functionality further and to be tested out in other patient samples – contributing to increase the universal accessibility of new methods in health counseling

Trust-based service innovation of municipal home care. A longitudinal mixed methods study

Background: In Scandinavia, various public reforms are initiated to enhance trust in the healthcare services and the public sector in general. This study explores experiences from a two-step service innovation project in municipal home care in Norway, coined as the Trust Model (TM), aiming at developing an alternative to the purchaser-provider split (PPS) and enhancing employee motivation, user satisfaction, and citizen trust. The PPS has been the prevalent model in Norway since the 1990s. There is little empirical research on trust-based alternatives to the PPS in health- care. The overall objectives of this study were to explore facilitators and barriers to trust-based service innovation of municipal homecare and to develop a framework for how to support the implementation of the TM. Methods: The TM elements were developed through a comprehensive participatory process, resulting in the deci- sion to organize the home care service in small, self-managed and multidisciplinary teams, and trusting the teams with full responsibility for care decisions and delivery within a limited area. Through a longitudinal mixed methods case study design a) patients’ expressed values and b) factors facilitating or preventing the service innovation process were explored through two iterations. The first included three city districts, three teams and 80 patients. The second included four districts, eight teams and 160 patients. Results: The patient survey showed patients valued and trusted the service. The team member survey showed increased motivation for work aligned with TM principles. Both quantitative and qualitative methods revealed a series of facilitators and barriers to the innovation process on different organizational levels (teams, team leaders, system). The key message arising from the two iterations is to keep patients’ values in the centre and recognize the multilevelled organizational complexity of successful trust-based innovation in homecare. Synthesizing the results, a framework for how to support trust-based service innovation was constructed. Conclusions: Trust-based innovation of municipal homecare is feasible. The proposed framework may serve as a tool when planning trust-based innovation, and as a checklist for implementation and improvement strategies. Further research is needed to explore the validity of the framework and its replicability in other areas of healthcare

Volunteering in dementia care – a Norwegian phenomenological study

Introduction: The number of people suffering from dementia will increase dramatically in the future, and this will be a great challenge and concern for health care services. It is assumed that volunteers will strengthen community health care services more in the future than they do today. Aim: The aim of this study was to elucidate lived experiences of working as a volunteer in an activity center with adapted activities for home-dwelling people with early stage dementia. Methods: Qualitative interviews were implemented in a group of nine female volunteers from an activity center in southern Norway. The interviews were recorded, transcribed verbatim, and analyzed with a descriptive phenomenological method. Results: Volunteering in an activity center for home-dwelling people with early stage dementia was reported to provide experiences of being useful and feeling satisfied with performing a good job. It was an advantage for the volunteers to have had experiences from life in general, but also as a health professional or as being the next of kin of a dementia sufferer. It was important for the volunteers to focus on the dementia sufferer and show caring behavior, and interaction with and the appreciation of the health care professionals were also important. The volunteers were motivated by being able to have influence and participate in the planning of the work, to be a part of the social setting, and to learn. However, for some volunteers it was difficult to adjust to an appropriate role. Conclusion: In order to promote volunteering in a caring context, mutual trust and freedom should be emphasized. Being conscious of important volunteer characteristics like their experiences, knowledge, and caring behavior, as well as a focus on the staff showing appreciation and providing feedback, may be the difference between success and failure

Tillitsmodellen – hovedpilotering i Oslo kommune 2017-18

Bakgrunn, prosess og antagelser For å møte fremtidens utfordringer når det gjelder hjemmebaserte helsetjenester på en god måte er det behov for innovasjon og fornyelse. Formålet med prosjekt Tillitsmodellen har vært å utvikle et tillitsbasert alternativ til bestiller/utfører-modellen som • tar utgangspunkt i hva en enkelte tjenestemottager opplever som viktig, • gir økt ansvar og myndighet til fagpersonene, og • forenkler og forbedrer kontroll- og rapporteringsrutiner. Tillitsmodellen for de hjemmebaserte tjenestene i form av selvstyrende tverrfaglige team ble utviklet gjennom en omfattende nedenfra-og-opp-prosess i fire bydeler, med medvirkning fra representanter for brukere, fagorganisasjoner og medarbeidere i bydelene. Resultatet ble et nytt tjenestedesign og en ny forvaltningsmodell med saksbehandling i lokale team, med helhetlig ansvar for et avgrenset geografisk område. Man ønsket å oppnå følgende resultater med den nye forvaltningsmodellen: • økt trygghet, tilfredshet og selvbestemmelse for brukerne •økt motivasjon og arbeidsglede for fagpersonalet • økt fleksibilitet, effektivitet og kvalitet i tjenestene. Denne nye forvaltningsmodellen, «Tillitsmodellen», ble forpilotert i tre bydeler høsten 2017 og deretter videreutviklet og hovedpilotert i fire bydeler 2017-18

Understanding the role of positive emotions in healthcare communication - A realist review

Aim: To explore how the expression of positive emotions during the interaction between patients and providers can cultivate the patient-provider relationship. Design: We conducted a realist review guided by the Realist and Metanarrative Evidence Syntheses: Evolving Standards. Methods: We systematically searched CINAHL, MEDLINE, PsychINFO and Scopus from inception to March 2019. Study selection and data extraction were performed blinded in pairs. From 3146 abstracts blinded in pairs, 15 papers were included and analysed. From each included paper, we extracted contexts, mechanisms and out-comes that were relevant to answer our research questions, creating a configuration between these elements (CMO configuration). Results: Our findings suggest that in the contexts of person orientation and positive outlook, patient-provider relationships improve by communication conveying and eliciting positive emotions. We found six underlying mechanisms for this that form either direct or indirect pathways between the context and the outcome.publishedVersio

Sleepiness among personnel in the Norwegian Air Ambulance Service

Purpose. To examine the effects of shift work and extended working hours on sleepiness among pilots and Helicopter Emergency Medical Service (HEMS) crew members in the Norwegian Air Ambulance. Methods. This field study investigated sleepiness during 3 consecutive weeks: the week before work, the work week, and the week after work. The pilots and HEMS crew members (N = 50) kept a wake diary during all 3 weeks and completed reaction time tests during the work week. Results. The overall sleepiness scores were low during all 3 weeks. When comparing the 3 weeks, the lowest sleepiness levels were found for the work week. There was a small difference across work days, in which subjective sleepiness scores were highest the first duty day. No change in the reaction time tests was evident during the work week. The crew members reported being most sleepy at midnight, compared to all the other timepoints over the course of a duty day. Regarding workload and total work time, having larger workload was associated with lower sleepiness scores, while having higher total work time was associated with higher sleepiness score, both compared to the medium category. Conclusions The findings indicate that the work schedules and setting for this distinct occupational group do not seem to negatively affect the sleepiness levels.publishedVersio

Psychological health in preschool children with underweight, overweight or obesity: a regional cohort study

Objective To examine if underweight (UW), overweight (OW) or obesity (OB), or body mass index (BMI) expressed as its SD score (BMI SDS), were associated with psychological difficulties in preschool children. Design Regional cohort study. Setting Oppland County, Norway. Methods At the routine school entry health assessment at 5–6 years of age, parents were invited to participate by local public health nurses. The parents completed questionnaires on sociodemographic, health and lifestyle factors of the child and the family, and on the child’s neurocognitive development. They assessed psychological health with the Strengths and Difficulties Questionnaire (SDQ). Public health nurses measured weight and height on all eligible children and reported age, sex, height and weight anonymously for the children who declined to participate. Participants We obtained information on 1088 of 1895 (57%) eligible children. The proportion of UW, OW and OB was slightly higher among the children who declined. Main outcome measures SDQ subscale and Total Difficulties Scores. Results The mean SDQ scores and proportion of scores ≥the 90th percentile had a curvilinear pattern from UW through normal weight (NW), OW and OB with NW as nadir, but the pattern was only significant for the mean Emotional problems, Peer problems and Total SDQ Scales, and for the Total SDQ Score ≥the 90th percentile (TDS90). After adjusting for relevant social, developmental, health and behavioural characteristics, TDS90 was only significantly associated with UW in multiple logistic regression analyses, and only with the lowest quartile of BMI SDS in a linear spline regression analysis. Conclusions The study suggests that UW and low BMI, but not OW, OB or higher BMI, are independent risk factors for having psychological symptoms in preschool children.publishedVersio

Personal factors associated with health-related quality of life in persons with morbid obesity on treatment waiting lists in Norway

Purpose To explore relationships of socio-demographic variables, health behaviours, environmental characteristics and personal factors, with physical and mental health variables in persons with morbid obesity, and to compare their health-related quality of life (HRQoL) scores with scores from the general population. Methods A cross-sectional correlation study design was used. Data were collected by self-reported questionnaire from adult patients within the first 2 days of commencement of a mandatory educational course. Of 185 course attendees, 142 (76.8%) volunteered to participate in the study. Valid responses on all items were recorded for 128 participants. HRQoL was measured with the Short Form 12v2 from which physical (PCS) and mental component summary (MCS) scores were computed. Other standardized instruments measured regular physical activity, social support, self-esteem, sense of coherence, self-efficacy and coping style. Results Respondents scored lower on all the HRQoL subdomains compared with norms. Linear regression analyses showed that personal factors that included self-esteem, self-efficacy, sense of coherence and coping style explained 3.6% of the variance in PCS scores and 41.6% in MCS scores. Conclusion Personal factors such as self-esteem, sense of coherence and a high approaching coping style are strongly related to mental health in obese persons