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- Tosterud, Randi, 1955-
(författare)
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Simulation used as a learning approach in nursing education : Students’ experiences and validation of evaluation questionnaires
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to investigate bachelor nursing students’ experiences with simulation as a learning approach conducted under various conditions. Additionally, the aim was to translate and validate questionnaires for the evaluation of simulation in a Norwegian context.Methods: Quantitative and qualitative methods were used. Nursing students responded to three questionnaires after attending either low- or high-fidelity simulation. Data were analyzed with statistics (I). Two evaluation questionnaires were subjected to a principal components analysis (II, III). Data were obtained from nursing students through focus group interviews, and analyzed with a qualitative content analysis (IV). Main findings: Independent of the fidelity level in the simulation and educational level, the students reported satisfaction and that the emphasized features in learning were present. Those who had used a paper/pencil case study were the most satisfied (I). Debriefing was reported to be crucial for learning, but in particular by attending the large groups, also as a stressful and intrusive situation (IV).The Norwegian version of the questionnaire, the Student Satisfaction and Self-Confidence Scale, revealed no stable factor solution (II). The translated version of the Debriefing Experience Scale was shown to hold a good potential for evaluating debriefing, but benefited from reducing the subscales (III). To ensure safety and security were reported to be a prerequisite for learning, with the students requesting a more frequent use of simulation and a higher degree of familiarity with active learning in their program in general (IV).Conclusions: Simulation at all fidelity levels should be used in nursing education. To exploit the potential, the learning approaches should be integrated into the program in general through a systematic and structured building of a learning community. A further validation and testing of the questionnaires in different programs and contexts is needed.
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| 2. |
- Larsen Moen, Øyfrid, 1969-
(författare)
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Everyday life in families with a child with ADHD and public health nurses’ conceptions of their role
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- ADHD is one of the most common behavioral disorders diagnosed in children. These children have difficulties regarding the regulation of emotions, maintaining attention and impulse control, all of which influence family and social life. The aim of this study was to describe and explore the everyday life of families with a child with ADHD and public health nurses’ role in relation to these families. The parents were contending with- and adapting to the parental role and social network. The family attempted to safeguard a functioning family in managing their everyday life, tuning themselves in on the child’s shifting moods, using strict boundaries and developing special skills. The family fought for acceptance and inclusion when interacting with their social network and professionals. Parents with ADHD and families with non-medicated children reported more problems in family functioning. Characteristics in parents and the child with ADHD, as well as support from the social network and community health services, all influenced family functioning. The PHNs described their role as both a peripheral and collaborating partner, asking for guidelines and multidisciplinary collaboration. The public health nurse is in a unique position to support and supervise these families.
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| 3. |
- Ballangrud, Randi, 1959-
(författare)
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Building patient safety in intensive care nursing : Patient safety culture, team performance and simulation-based training
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing.Methods: Quantitative and qualitative methods were used. In Study I, 220 RNs from ten ICUs responded to a patient safety culture questionnaire analysed with statistics. Studies II-IV were based on an evaluation of a simulation-based team training programme. Studies II-III included 53 RNs from seven ICUs and ten RNs from a post-graduate programme (II). The data were collected with questionnaires (II) and measurement scales (III), and analysed with statistics. In Study IV, 18 RNs were interviewed and the data were analysed with a qualitative content analysis.Main findings: The RNs had positive perceptions of the overall patient safety culture in the ICUs. Hence, a potential for improvements was identified at both the unit and hospital level. Differences between types of ICUs and between hospitals were found. The dimensions at the unit level were predictors for the outcome dimensions (I). The RNs evaluated the simulation-based team training programme in a positive way. Differences with regard to scenario roles, prior simulation experience and area of intensive care practice were found (II). The expert raters assessed the teams’ performance as advanced novice or competent. There were differences between the expert raters’ assessments and the RNs’ self-assessments (III). One main category emerged to illuminate the RNs’ perceptions of simulation-based team training for building patient safety: Regular training increases the awareness of clinical practice and acknowledges the importance of structured work in teams (IV).Conclusions: Patient safety culture measurements have the potential to identify areas in need of improvement, and simulation-based team training is appropriate to create a common understanding of structured work in teams with regard to patient safety.
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| 4. |
- Larsson, Maria, 1968-
(författare)
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Eating problems in patients with head and neck cancer treated with radiotherapy : Needs, problems and support during the trajectory of care
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to acquire knowledge about daily life with focus on eating problems during the trajectory of care for patients with head and neck cancer treated with radiotherapy. Method: The data in study I were gained from medical and nursing records of 50 patients. Documented parameters of eating problems, their causes and consequences, and undertaken interventions were collected before treatment, during radiotherapy, and one, six, and twelve months after completion of treatment, using a study-specific audit instrument. Data were analysed with descriptive and inferential non-parametric statistics. In study II eight patients were interviewed during the radiotherapy treatment period with focus on experiences of eating problems. In study III nine patients were interviewed six to twelve weeks after treatment with the focus on experiences of daily life during the trajectory of care having eating problems. In study IV twelve patients were interviewed about their conceptions of the significance of a supportive nursing care clinic during the whole trajectory of care. Data were analysed with interpretative phenomenology (II, III) and phenomenography (IV). Findings: The four studies showed that being a patient in the trajectory of care often meant that life was disturbed and threatened. This was partly due to the eating problems and their consequences, which could occur during the whole trajectory of care (I, III, IV) but was experienced as most intense and severe during radiotherapy (II) and the nearest weeks after completion of radiotherapy (III, IV). The disturbances and threats experienced due to eating problems could affect the whole person as they were physical (I-IV), psychological, social and existential (II, III). The experiences of eating problems due to the tumour and its treatment and the experience of having cancer per se were strongly connected as one phenomenon, which disturbed and threatened the informants’ daily life. The other part that disturbed the patients’ life was the waiting in suspense. A long and trying waiting in uncertainty was experienced due to lack of knowledge and support, practical as well as emotional. This was most pronounced during pauses in radiotherapy (III) and after completion of the treatment when the lack of support from the health care was obvious (I, II, III). The patients were then most often left to their own devices. In order to endure, they needed both inner strength, described as own coping strategies, and strength from outside, described as support from family, friends and health care professionals (II, III). The nurse clinic was found to give a hand to hold during the whole trajectory of care (IV). It could meet these patients’ needs of knowledge, care and support, both concerning practical measures related to the eating problems and other side-effects of the treatment, and concerning their emotional needs. In addition the nurse clinic could support the relatives in their worries and anxiety (IV). Conclusion: This thesis showed the necessity of continuous assessment, treatment and evaluation of patients’ problems, and the patients’ needs of information and support throughout the trajectory of care.
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| 5. |
- Weimand, Bente Margrethe, 1961-
(författare)
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Experiences and Nursing Support of Relatives of Persons with Severe Mental Illness
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to illuminate experiences of relatives of persons with severe mental illness, and their need for support from formal care. Furthermore, to illuminate nursing support of relatives of persons with severe mental illness.Methods: A mixed methods design was used. In study I, data was collected with a questionnaire responded by 226 relatives and analysed with statistics. In study II, data was gathered with interviews with a strategic sample of 18 relatives, analysed with phenomenography. Study III gathered data from 216 relatives using open-ended questions in the questionnaire (I), analysed with qualitative content analysis. In study IV, data was collected by means of focus-group interviews with 4 groups of nurses, working in mental healthcare and analysed with phenomenography.Main findings: The relatives experienced that their lives were intertwined with the life of their severely mentally ill next of kin. The relatives experienced burden and a poor health, and there were associations between burden and health (I). The relatives had to balance between multiple concerns and make choices on behalf of others and themselves, constantly struggling between opposing feelings and between reflections (II). Relatives’ encounters with mental health personnel were mainly negative, although some had positive experiences. They strived for involvement in mental healthcare for the sake of their severely mentally ill next of kin, and wanted inclusion and support for their own sake, but mostly felt left alone with straining but inescapable responsibilities (III). The nurses conceived that their responsibility was first and foremost the patient and to develop an alliance with him or her. The nurses often felt they had to exclude relatives, but were sometimes able to support them (IV).Conclusions: Relatives’ lives are intertwined with the life of their severely mentally ill next of kin. Relatives’ overall demanding life situation means that the mental health services must involve relatives for the sake of the severely mentally ill person but also include them for their own sake. They need practical and emotional support. Guidelines must be designed to address relatives’ needs, and support must be adapted to the individual relative.
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| 6. |
- Hov, Reidun, 1947-
(författare)
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Nursing care for patients on the edge of life : Nurses’ experiences of nursing care in intensive and nursing home related to questions of withholding or withdrawing curative treatment
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to deepen the understanding of nursing care for seriously ill patients on the edge of life in intensive care unit (ICU) and nursing home when questions were raised whether to withhold or withdraw curative treatment. Method: All studies were conducted in a qualitative frame of reference with interviews of nurses in two contexts in Norway; group interviews of 14 nurses in an ICU (study I, III), and individual interviews of 14 nurses in two nursing homes (study II, IV). Data were analysed with interpretative phenomenology (I, III, IV) and phenomenography (II). Findings: The nurses’ descriptions of the patients on the edge of life were interpreted as ‘being in a twilight zone’, a state between living and dying. The patients’ situation were understood to be very burdensome as they were mostly ‘voiceless’ and unable to call for, or refuse help and totally surrendered to other people’s devices. Their state was strained by extensive suffering; pains and bodily afflictions, loneliness, confusion and without control and dignity (I). Their need for nursing care was comprehensive (I, II) with an overall need for dignity (II), which included having the needs for preparedness, human relationship, comfort and safety met (II). The patients’ inabilities to express themselves clearly involved major challenges for nursing care (I - IV). Good nursing care was described as caring for the individual patient based on his/her situation and needs. The nurses experienced themselves to be of imperative importance for the patient’s living or dying (III, IV) and their interpretation of the patient’s condition was crucial (III). Their commitment and drive to help was high, they knew what good nursing care was for the patients (I - IV), and they were proud when they succeeded in their care (III, IV). An outstanding finding was the nurses’ experiences of ambiguity of both certainty and uncertainty. Being certain mostly seemed to concern nursing care related to the patient’s needs and situation (I, II), and uncertainty to what was ‘right’ to do with regards to withholding or withdrawing treatment (III, IV). They often experienced loneliness, too much responsibility, a vulnerable professional pride, and being pulled between opposite poles when they struggled to give good nursing care (I - IV), but too often they failed (II, IV). This demanding situation sometimes led to the nurses’ use of several self-protecting strategies. Whether the patients could receive good nursing care or not did not only depend on the single nurse, but was also anchored in opportunities and hindrances on a relational and an organisational level (I – IV). There were many congruities in patterns in the experiences of ICU - and nursing - home - nurses with regards to the situation and needs of patients on the edge of life, and good nursing care. Congruities were also found regarding being a nurse when caring for these patients, and nurses’ opportunities and hindrances for carrying out good nursing care. Conclusion: This thesis shows that nursing care was experienced as being of crucial importance to the patients on the edge of life, and the nurses knew very well what good nursing care was for them. However, the nurses’ opportunities to perform good nursing care depended on several preconditions and were restricted by hindrances on different levels, which have to be overcome in order to fulfil patients’ needs and nurses’ ambitions of giving good nursing care. As such, this thesis highlights a wide-ranging understanding of nursing care for these patients, which should challenge individual nurses, but also other health care workers, leaders and politicians.
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| 7. |
- Skundberg Kletthagen, Hege, 1971-
(författare)
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Everyday life of relatives of persons suffering from severe depression : Experiences of health, burden, sense of coherence and encounters with psychiatric specialist health services
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to investigate and describe everyday life among relatives of inpatients with severe depression and their encounter with the psychiatric specialist health services (PSHS).Methods: A descriptive design with a qualitative and quantitative approach was used. Data was collected by means of a questionnaire responded to by 68 relatives and analysed with descriptive statistics (I, III). Individual interviews with 24 relatives were carried out and analysed with phenomenography (II, IV).Main findings: The everyday life of relatives to persons suffering from severe depression was affected. They reported burden and influence on their own health to a various degree (I). The relatives experienced that they were, “Living on the other person’s terms”. Relatives described ambivalent relationships, as they had to adjust their daily life in attempting to manage the situation (II). When the relatives encountered the PSHS, it may have been a long time of worries and struggles for help. They wanted to be a resource and a participant, and to be confident with the health care (IV). The need for support from the PSHS was greater than what they received. Relatives who reported receiving less information had higher burden scores than the others (III).Conclusions: Everyday life of relatives of persons suffering from severe depression is demanding. To be acknowledged as a resource in the treatment and care for the person suffering from depression is important. The mental health nurses being present at the wards 24 hours a day, are in a unique position to support the relatives.
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