Balancing life and death during the golden minute – midwives’ experiences of performing newborn resuscitation

Brendan McCormack - ORCID: 0000-0001-8525-8905 https://orcid.org/0000-0001-8525-8905Purpose: To explore midwives’ experiences in performing newborn resuscitation on maternity wards.Patients and Methods: It was a qualitative study, using a phenomenological hermeneutic approach. Individual interviews with 16 clinical midwives working in Norwegian maternity wards were conducted from August 2018 to January 2019.Results: The complexity underlying how midwives balance responsibility and vulnerability when performing newborn resuscitation during the Golden Minute was revealed. Midwives described the stress they experienced during resuscitation events and their need for support and confirmation after performing newborn resuscitation.Conclusion: The vulnerability and responsibility that midwives bear for mothers and newborns simultaneously affected midwives in several ways. We saw that midwives need support and confirmation to be prepared for newborn resuscitation. We also found that a lack of knowledge, skills and experience were barriers to midwives feeling prepared. Simulation training, including tailored programs, are suggested to improve midwives’ skills and help them feel prepared for real-life resuscitations. The importance of midwives’ assessment during the Golden Minute and further investigation from other perspectives are needed to understand fully this clinical complexity.https://doi.org/10.2147/JMDH.S2689592020pubpub1

"Med mobilen i lomma" : pårørendes erfaringer når en av deres nære dør

I dag og i årene fremover har helsevesenet store omsorgsutfordringer knyttet til økningen av antall eldre i befolkningen. En stor andel eldre avslutter livet i sykehjem, og de fleste har pårørende hos seg i tiden rundt dødsfallet. Hensikten med studien var å øke forståelsen for hvordan det erfares å være pårørende ved livets slutt i sykehjem, og å få kunnskap om hvordan helsepersonell kan bistå familien i prosessen. Data ble samlet ved hjelp av semistrukturerte, individuelle intervju av seks pårørende som nylig erfarte å miste en av sine nære i sykehjem. De pårørende ble rekruttert fra to forskjellige sykehjem. Resultatet viser at pårørende opplever at døden i sykehjem kan være uforutsigbar og fremmed. Svingninger i sykdomsforløp og usikkerhet i forhold til tidsaspektet i forventet levetid, førte til at pårørende alltid måtte være tilgjengelig. Når møte med døden for mange er fremmed, beskriver pårørende behovet for trygghet i en ukjent situasjon.publishedVersio

”Med mobilen i lomma” Pårørendes erfaringer når en av deres nære dør i sykehjem

I dag og i årene fremover har helsevesenet store omsorgsutfordringer knyttet til økningen av antall eldre i befolkningen. En stor andel eldre avslutter livet i sykehjem, og de fleste har pårørende hos seg i tiden rundt dødsfallet. Hensikten med studien var å øke forståelsen for hvordan det erfares å være pårørende ved livets slutt i sykehjem, og å få kunnskap om hvordan helsepersonell kan bistå familien i prosessen. Data ble samlet ved hjelp av semistrukturerte, individuelle intervju av seks pårørende som nylig erfarte å miste en av sine nære i sykehjem. De pårørende ble rekruttert fra to forskjellige sykehjem. Resultatet viser at pårørende opplever at døden i sykehjem kan være uforutsigbar og fremmed. Svingninger i sykdomsforløp og usikkerhet i forhold til tidsaspektet i forventet levetid, førte til at pårørende alltid måtte være tilgjenglig. Når møte med døden for mange er fremmed, beskriver pårørende behovet for trygghet i en ukjent situasjon

Nurse-led ultrasound-guided femoral nerve block: A randomised controlled trial of two different patient flow systems in an emergency department

Introduction: Elderly with hip fractures present complex challenges. Effective pain management is crucial for recovery and quality of life. However, pain control can be difficult and requires customized care. Methods: We conducted an unblinded, randomised controlled trial investigating the effects of ultrasound-guided femoral nerve block in patients with hip fracture performed by specially trained nurses (Group Nurse) compared to anaesthesiologists (Group Anaesthesiologist). The hypothesis was that a single shot ultrasound-guided femoral nerve block would result in a total summarized lower dynamic numeric rating scale score for pain intensity during the first 120 min after admission for patients in Group Nurse compared to Group Anaesthesiologist measured in five timepoints. The primary outcome was measured by a cumulative numeric rating scale score for dynamic pain (with flexion of the hip until maximum 30◦ from bed surface) during the first 120 min after admission to the emergency department. Results: From February 2020 to June 2021, 263 patients were screened, of which 42 (16.0%) consented and were randomly allocated; 21 in each arm. The primary outcome was not different between groups (p = 0.24), and displayed no substantial superiority of specially trained nurses over anaesthesiologist. No complications or adverse effects were observed in either group. The use of systemic analgesics and the development of delirium was similar between the two groups. In the Nurse Group, patients were administered their ultrasound-guided femoral nerve block earlier. Conclusion: Our study did not demonstrate a statistically significant beneficial effect of specially trained nurses over anaesthesiologist on cumulative pain in performing ultrasound-guided femoral nerve blocks, while no side- effects/complications or adverse effects were observed in either group.publishedVersio

Development of a Workplace-Based Training Program for Nurse-Led Ultrasound-Guided Femoral Nerve Blocks: A Feasibility Study with the Patients’ Perspective in Focus

Background. Task shifting is a systematic delegation of tasks in order to make more efficient use of the available human resources for health. Training programs and the quality of these are sparsely studied and specially they that include the patients’ perspectives to an even lesser degree. Aim. A single-center feasibility study with a convergent parallel mixed method approach, integrating quantitative and qualitative components, was conducted at an emergency department aimed to evaluate a training program for nurse-led ultrasound-guided femoral nerve block. Method. Registered nurses (RNs) (n = 5), supervising anesthesiologists (n = 7), and patients with hip fracture (n = 15) participated. The training consisted of a one-day program that included comprehensive theoretical and practical instruction in anatomy, hygiene, and the application of ultrasound. The one-day training program was evaluated through an objective structured clinical examination (OSCE). Following that, each registered nurse conducted three supervised procedures in the weeks that followed. These procedures were performed on patients admitted with hip fractures in the emergency department. The patients (n = 15) were interviewed regarding their experiences and perspectives of pain, safety, and information of the procedures in emergency department. Results. In questionnaire, the RNs and anesthesiologists agreed that the training procedures were beneficial for the patients due to pain relief. Pain intensity showed a mean baseline pain score of 6.0 (95% CI 4.9–7.1) decreasing to 2.5 (95% CI 1.4–3.6) at 30 minutes after needle extraction. The interviews revealed that all patients experienced pain relief after the in situ nerve block training procedures as well as they felt safe and taken care of. Conclusions. The training program for nurse-led ultrasound-guided femoral nerve blocks was considered feasible. All included RNs learned the procedure for task shifting in a satisfactory way.publishedVersio

Improving quality in clinical placement studies in nursing homes (QUALinCLINstud): The study protocol of a participatory mixed-methods multiple case study design

Brendan McCormack - ORCID: 0000-0001-8525-8905 https://orcid.org/0000-0001-8525-8905Introduction Improved quality in clinical supervision and assessment of student nurses in nursing home clinical placements is vitally important to effective recruitment and preparation for this healthcare sector. Knowledge regarding supervision and assessment practices within these settings is limited. Also, knowledge of evolving e-learning tools on the quality and effectiveness of these educational practices seems to be absent.Methods and analysis The aim of the “Improving quality in clinical placement studies in nursing homes” (QUALinCLINstud) study is to develop and evaluate how a web-based programme can optimise supervision, assessment and learning during nursing home placements. The study applies a participatory, mixed-methods case study design, organised in four work packages (WPs). WP1 will explore how the nurse education institution address the quality of student nurses’ clinical placements in nursing homes. In WP2, clinical supervision and assessment practices will be explored, and described from multiple stakeholder perspectives. In WP3, based on the findings from WP1 and WP2, a web-based pedagogical supervision and assessment programme will be developed through a developmental co-productive process between nurse education institutions, practice settings and student nurses. In WP4, the web-based programme will be pilot-tested and evaluated through a mixed-methods approach. A range of data collection procedures will be used throughout the project, for example, questionnaires, interviews, observations and workshops.Ethics and dissemination The ethical conduct of the study is approved by the Norwegian Centre for Research Data (2018/61309 and 489776). The results will be disseminated through scientific articles, three PhD theses, presentations at national and international conferences, and through publicly accessible trade journals and newspapers. The results will generate knowledge to inform supervision and assessment practices in nursing home placements. Moreover, the study will generate knowledge concerning the developmental process of a web-based supervision and assessment programme, and the value of e-learning tools applied in clinical nursing education.This work is supported by The Research Council of Norway (RCN) grant number 273558 and by the University of Stavanger, the University of South-Eastern Norway and the University of Agder.https://doi.org/10.1136/bmjopen-2020-04049110pubpu

Improving quality in clinical placement studies in nursing homes (QUALinCLINstud):the study protocol of a participatory mixed methods multiple case study design

Introduction Improved quality in clinical supervision and assessment of student nurses in nursing home clinical placements is vitally important to effective recruitment and preparation for this healthcare sector. Knowledge regarding supervision and assessment practices within these settings is limited. Also, knowledge of evolving e-learning tools on the quality and effectiveness of these educational practices seems to be absent. Methods and analysis The aim of the “Improving quality in clinical placement studies in nursing homes” (QUALinCLINstud) study is to develop and evaluate how a web-based programme can optimise supervision, assessment and learning during nursing home placements. The study applies a participatory, mixed-methods case study design, organised in four work packages (WPs). WP1 will explore how the nurse education institution address the quality of student nurses’ clinical placements in nursing homes. In WP2, clinical supervision and assessment practices will be explored, and described from multiple stakeholder perspectives. In WP3, based on the findings from WP1 and WP2, a web-based pedagogical supervision and assessment programme will be developed through a developmental co-productive process between nurse education institutions, practice settings and student nurses. In WP4, the web-based programme will be pilot-tested and evaluated through a mixed-methods approach. A range of data collection procedures will be used throughout the project, for example, questionnaires, interviews, observations and workshops.publishedVersio

Review of developments in person-centred healthcare

Brendan McCormack - ORCID: 0000-0001-8525-8905 https://orcid.org/0000-0001-8525-8905Tanya McCance - ORCID: 0000-0002-9787-2627 https://orcid.org/0000-0002-9787-2627In recent years, there has been a shift in orientation towards person-centredness as part of a global move towards humanising and centralising the person within healthcare. Person-centredness, underpinned by robust philosophical and theoretical concepts, has an increasingly solid footprint in policy and practice, but research and education lag behind. This article considers the emergence of person-centredness, including person-centred care, and how it is positioned in healthcare policy around the world, while recognising a dominant philosophical positioning in Western philosophy, concepts and theories. Second, the evolution of person-centred healthcare over the past five years is reviewed. Published evidence of person-centred healthcare developments is drawn on, as well as information gathered from key stakeholders who engaged with the partner organisations in an Erasmus+ project to develop a European person-centred healthcare curriculum framework. Five themes are identified, which underpin the literature and stakeholder perspectives: Policy development for transformation Participatory strategies for public engagement Healthcare integration and coordination strategies Frameworks for practice Process and outcome measurement These themes reflect the World Health Organization’s global perspective on people-centred and integrated healthcare, and give some indication of development priorities as person-centred healthcare systems continue to be developed.https://doi.org/10.19043/ipdj.10Suppl2.00310pubpubSuppl

Developing philosophical and pedagogical principles for a pan-European person-centred curriculum framework

Brendan McCormack - ORCID: 0000-0001-8525-8905 https://orcid.org/0000-0001-8525-8905Background: In the associated article in this special issue of the International Practice Development Journal, Phelan et al. (2020) offer an analysis of the global positioning of person-centredness from a strategic policy perspective. This second article, an international person-centred education curriculum development initiative, builds on that foundational work. It outlines the systematic, rigorous processes adopted by academics from five European countries to analyse stakeholder data, theoretically frame the data, and thereby identify philosophical and pedagogical principles to inform the development of person-centred curriculum frameworks.Aim: To identify key principles that have the potential to create an international curriculum framework for the education of person-centred healthcare practitioners.Methods: A hermeneutic praxis methodological approach was used, where multiple rounds of data analyses were conducted. These were initially undertaken in each country, then collaboratively with partners, while engaging with other forms of evidence.Findings: The project group generated a set of principles embedded in four philosophical dimensions: (i) transformative; (ii) co-constructed; (iii) relational; and (iv) pragmatic. The purpose of the curriculum was identified as being transformative, facilitating journeying through knowing, doing, being and becoming a competent and committed person-centred practitioner. A person-centred curriculum is built on a philosophy of pragmatism, adopts a co-constructionist approach to curriculum design and implementation, and encourages connectivity with self, other persons and contexts. Pedagogical principles, aligned to the four philosophical dimensions, identified the required learning environment, and the learning, teaching and assessment approaches required to educate person-centred healthcare practitioners.Conclusion: This article represents steps to foster a more focused and engaging way of implicitly and explicitly embedding person-centred care in curricula. Our theoretical framework has enabled us to consider the different layers of practice while staying true to the purpose of curriculum design. The presentation of the framework in this article makes it available for wider critique to those with an interest in this area of study.Implications for practice: The draft framework provides an opportunity for curriculum teams to critically reflect on and have dialogue around current curricula Person-centred curricula have the potential to improve service-user experiences of care Prepared person-centred practitioners will contribute to person-centred cultures Students and practitioners will experience person-centredness Practitioners will be bold and innovativehttps://doi.org/10.19043/ipdj.10Suppl2.00410pubpubSuppl

Krävande beteenden i samband med demens : Förekomst och olika förhållningssätt

This thesis based on five studies conducted within community care sought to I) study demanding symptoms and behaviour in persons > 65 years in home care or sheltered housing and work load from a staff perspective over a decade, II) study caregiver reflections when dealing with Behavioural and Psychiatric Symptoms of Dementia (BPSD), III) illuminate interactions between individuals with BPSD and caregivers who reported problems dealing with such behaviour and caregivers who did not, IV) obtain insight into their reasoning from their respective interactions with the residents. A further aim was to discuss their reasoning in relation to each other and V) describe documented experiences from giving tactile stimulation to five randomly selected residents with BPSD and changes seen in these persons during the intervention period. Demanding symptoms and behaviours of older adults > 65 years in home care or sheltered housing were assessed from a staff perspective together with workloads in 1993 (= 1187 older adults) and 2002 (= 1017 older adults). Data for the qualitative studies were obtained by interviewing 15 formal caregivers at three care units, one unit where caregivers (n=5) (group 1) felt they were able to deal with aggressive behaviour and two units where an unexpected high level of aggressive behaviour had been reported (study I) and the caregivers felt the BPSD was problematic (n=10) (group 2). Videotaping of caregivers at a unit who felt they were able to interact in a positive way (group 1) respectively recordings from a unit where the caregivers had experienced aggressiveness as difficult to handle (group 2) were conducted during morning care sessions (=6 video recordings). One resident and three caregivers (group 1), and one resident and six caregivers (group 2) participated. The interviews and the videotapes were transcribed and analysed using a phenomenological-hermeneutic approach. Individual 'stimulated recall' interviews were carried out with all the caregivers who had been videotaped (n=9). Thematic content analysis was used to analyse the interviews. Study V followed the caregivers' documentations from five randomly selected residents living in a sheltered housing facility for persons with BPSD that received tactile stimulation for 28 weeks. The documentations were analysed by qualitative content analysis. Findings indicated that demanding symptoms had in general increased from 1993 to 2002, as well as the physical and the psychological workloads (I). The interviews indicated the importance of balance between demands and competence for the residents as well as for the caregivers if a positive relationship is to develop. Support was crucial, not only for the residents but also for caregivers if they were expected to deal with demanding situations (II). The interactions indicated as either being in a positive (group 1) or a negative spiral (group 2). Group 2 caregivers focused on accomplishing the task, which was the goal itself, while group 1 caregivers focused on how they could reach their goal in the best way, based on the resident's demands and wishes. Power in different ways was central, either in a positive way, as a way to involve the other (group 1) or in a more negative way, making decisions over the other (group 2) (III). Group 2 focused on their duties and seemed unwittingly to prevent positive interactions with the resident. Group 1 seemed to be accustomed to being able to reflect and sustain positive interactions with the residents (IV). Residents displayed signs of positive feelings and relaxation and fell asleep almost every time they received tactile stimulation. The caregivers felt they were able to interact with the residents in a more positive way and that they had a warmer relationship with them (V). Indicators are that caregivers who strive to understand the meanings behind behaviours, who master the necessary care-giving skills, and can implement them, will be much more successful at curbing distressing behaviour, than caregivers who merely act in a task oriented fashion. The caregivers are, however, also dependent on effective organisational, managerial and collegial support if the are to be able to achieve positive relationships and a high quality of nursing care that is also experienced as positive by the persons with dementia