Anne Moen

Constructing standards: a study of nurses negotiating with multiple modes of knowledge

Purpose – The aim of the paper is to explore how multiple modes of knowledge play out in the consolidation of nursing procedures in construction of “local universality”. The paper seeks to explore processes where nurses negotiate universal procedures that are to become local standards in a hospital.Design/methodology/approach – The paper is based on a case study design. Working group sessions, where the activity was to consolidate different versions of nursing procedures were observed and videotaped. For this paper, transcribed videotaped observations, where tension‐laden situations were identified, are subject to interaction analysis.Findings – In the negotiations to construct standards, multiple modes of knowledge play out; personal experience, collective expertise and formalized knowledge. The paper demonstrates the contributions these modes of knowledge make in a process of standardization. This shows that standards, as such, do not stay universal for very long, but are constructed as “local universal...

Graduate Education in Nursing Leadership Through Distance Technologies: The Canada-Norway Nursing Connection

The Canada-Norway Nursing Connection was a collaborative project designed to provide an international educational experience for graduate students in nursing via distance technology. Computer-conferencing and video-teleconferencing were used to address nursing leadership content through case studies. The same technologies were employed to develop the project. The processes of planning and implementing the international linkage are described. Agreement about goals, content, context for online discussion, delivery methods, academic expectations, language support, and logistics was essential. The media proved to be effective for students to gain understandings about nursing leadership, health care, and the forces influencing the nursing profession globally. Insights from the project provided a basis for the development of a model for interactive, international graduate education that will be of value to educators dedicated to helping students gain a global understanding of nursing and health care issues.

Introducing a Module for Laboratory Test Order Entry and Reporting of Results at a Hospital Ward: An Evaluation Study Using a Multi-Method Approach

The medical record system DocuLive EPR was installed at a “typical” ward at the Central Hospital of Akershus. Modules for laboratory order entry and reporting of results were evaluated prospectively using several information sources (hospital information systems, telephone records, user survey, semi-structured interviews with key informants). The main findings are discussed, and the lessons learned from the evaluation project are presented.

Resistive expressions in preschool children during peripheral vein cannulation in hospitals: a qualitative explorative observational study.

BackgroundChildren may resist common medical procedures, and this may lead to the use of restraint. This can be challenging to all of the involved parties, but empirical research is scarce on children’s expressions during these procedures.MethodsTo explore preschool children’s resistive expressions during peripheral vein cannulation we video recorded and performed an in-depth analysis of naturally occurring situations with six newly hospitalized preschool children.ResultsFourteen attempts of peripheral vein cannulation were recorded. A typology of resistive expressions was developed consisting of: protest, escape, and endurance. During the expression of protest, the children showed an insistent attitude where they were maintaining their view. The expression of escape was when children were panicked, avoiding hands of adults when being approached. When expressing endurance the children were stiff, motionless and introverted. Less physical restraint is required during endurance, but children still appear to refuse participation.ConclusionsWe identified three types of resistive expressions that can be used to better understand the individual child and inform clinical judgment in challenging procedural situations. This knowledge can help to sensitize health care providers in their attempt to arrange for children’s participation.

“Time’s up” – staff’s management of mealtimes on inpatient eating disorder units

BackgroundRefeeding and normalizing eating behaviour are main treatment aims for individuals admitted to inpatient eating disorder units. Consequently, mealtime activities are specific, everyday activities, serving a clear therapeutic purpose, despite numerous challenges for both staff and patients. Few studies have specifically addressed staff involvement, interactions, and management activities to structure mealtimes. In this study, we investigated the structure of mealtime activities on inpatient eating disorder units, and identified associated staff behaviour.MethodsDescriptive and exploratory qualitative study using video observations to investigate the structure of mealtimes and staff management of mealtime activities. Forty main meals were video recorded and the observational data were analysed using interaction analysis.ResultsAn initial analysis during data screening identified three main parts of the meal: ‘pre-eating’, ‘eating’, and ‘meal completion’. For each part, a regular pattern of activities occurred which were associated with staff behaviour.ConclusionsIncreased awareness amongst staff regarding how they manage the meal and act through a clear internal structure can help staff members to further explore their behaviours and collaboration during mealtimes, and also contribute to improved interaction with patients during the various phases of the meal.

Exploring perspectives on restraint during medical procedures in paediatric care: a qualitative interview study with nurses and physicians

ABSTRACT The aim of this study was to explore nurses’ and physicians’ perspectives on and reasoning about the use of restraint during medical procedures on newly admitted preschoolers in somatic hospital care. We analysed qualitative data from individual interviews with a video recall session at the end with seven physicians and eight nurses. They had earlier participated in video recorded peripheral vein cannulations on preschool children. The data were collected between May 2012 and May 2013 at a paediatric hospital unit in Norway. The analysis resulted in three main themes: (1) disparate views on the concept of restraint and restraint use (2), ways to limit the use of physical restraint and its negative consequences, and (3) experience with the role of parents and their influence on restraint. Perspectives from both healthcare professions were represented in all the main themes and had many similarities. The results of this study may facilitate more informed and reflective discussions of restraint and contribute to higher awareness of restraint in clinical practice. Lack of guidance and scientific attention to restraint combined with conflicting interests and values among healthcare providers may result in insecurity, individual dogmatism, and a lack of shared discussions, language, and terminology.

To bend or not to bend? Rule adherence among staff at an eating disorder unit

ABSTRACT On inpatient eating disorder units, resolving under-nutrition and reestablishing normal eating behavior are key treatment aims. Consequently, the provision of support at mealtimes is a core work task for patients with severe eating disorders. The purpose of this study was to explore staff deliberations and actions, as observed during staff-patient interactions at mealtimes on an inpatient eating disorder unit (EDU). We specifically aimed to characterize how and why staff members intervene during staff-patient interactions in which a refeeding script is activated. This exploratory qualitative study combined non-participant observation and in-depth interviews. Content analysis was used to categorize and abstract the data material. Through the described analysis, we identified two main types of patterns which were categorized as rule adherence and rule bending, describing how staff chose how to intervene in situations where refeeding scripts were activated. The current findings may contribute to enhanced insight and awareness regarding staff behavior and deliberations when providing meal support, and thus help staff members to better understand how meal time support is practiced on inpatient EDUs.

Unmet information and communication needs in the intermediate recovery from coronary artery bypass surgery

Aim: This paper draws attention to information and communication needs reported by convalescents in the intermediate recovery period following coronary artery bypass graft (CABG). Background: CABG is a common surgical procedure to treat coronary heart disease (CHD). For successful recovery convalescents are encouraged to engage in a set of activities to regain health and a ‘sense of coherence’. Methods: In this descriptive-exploratory study, ten informants (6 women and 4 men) were interviewed three months post-CABG. Data were analysed by content analysis techniques, and synthesised as core themes. Findings: Undergoing CABG is indeed a challenging experience that influences the ‘sense of coherence’ in the everyday living and recovery process. The analysis revealed three core themes: ‘The drama’, ‘Unexpected challenges’ and ‘Information experiences’ and point to existential issues in addition to just physical healing. The information provided by health care providers largely focus on physical healing, also in the immediate recovery period. Based on our findings, we suggest that information and teaching resources should cover a more extensive recovery period, and recognize each phases special challenges for daily living and ‘sense of coherence’ as the recovery progresses.

Research Strategies for Biomedical and Health Informatics. Some Thought-provoking and Critical Proposals to Encourage Scientific Debate on the Nature of Good Research in Medical Informatics

Summary Background Medical informatics, or biomedical and health informatics (BMHI), has become an established scientific discipline. In all such disciplines there is a certain inertia to persist in focusing on well-established research areas and to hold on to well-known research methodologies rather than adopting new ones, which may be more appropriate. Objectives To search for answers to the following questions: What are research fields in informatics, which are not being currently adequately addressed, and which methodological approaches might be insufficiently used? Do we know about reasons? What could be consequences of change for research and for education? Methods Outstanding informatics scientists were invited to three panel sessions on this topic in leading international conferences (MIE 2015, Medinfo 2015, HEC 2016) in order to get their answers to these questions. Results A variety of themes emerged in the set of answers provided by the panellists. Some panellists took the theoretical foundations of the field for granted, while several questioned whether the field was actually grounded in a strong theoretical foundation. Panellists proposed a range of suggestions for new or improved approaches, methodologies, and techniques to enhance the BMHI research agenda. Conclusions The field of BMHI is on the one hand maturing as an academic community and intellectual endeavour. On the other hand vendor-supplied solutions may be too readily and uncritically accepted in health care practice. There is a high chance that BMHI will continue to flourish as an important discipline; its innovative interventions might then reach the original objectives of advancing science and improving health care outcomes.BACKGROUND Medical informatics, or biomedical and health informatics (BMHI), has become an established scientific discipline. In all such disciplines there is a certain inertia to persist in focusing on well-established research areas and to hold on to well-known research methodologies rather than adopting new ones, which may be more appropriate. OBJECTIVES To search for answers to the following questions: What are research fields in informatics, which are not being currently adequately addressed, and which methodological approaches might be insufficiently used? Do we know about reasons? What could be consequences of change for research and for education? METHODS Outstanding informatics scientists were invited to three panel sessions on this topic in leading international conferences (MIE 2015, Medinfo 2015, HEC 2016) in order to get their answers to these questions. RESULTS A variety of themes emerged in the set of answers provided by the panellists. Some panellists took the theoretical foundations of the field for granted, while several questioned whether the field was actually grounded in a strong theoretical foundation. Panellists proposed a range of suggestions for new or improved approaches, methodologies, and techniques to enhance the BMHI research agenda. CONCLUSIONS The field of BMHI is on the one hand maturing as an academic community and intellectual endeavour. On the other hand vendor-supplied solutions may be too readily and uncritically accepted in health care practice. There is a high chance that BMHI will continue to flourish as an important discipline; its innovative interventions might then reach the original objectives of advancing science and improving health care outcomes.

IKT og internasjonalt samarbeid: Erfaringer med Internett konferansesystem som del av studiet i sykepleievitenskap

Current development and use of Information Technology (IT) enables new learning experiences and international collaboration. In this article we present experiences from the joint project «Canada-Norway Nursing Connection: International Computer Conferencing in Graduate Nursing Education» where we used an interactive, asynchronous Internet conferencing system to facilitate communication and learning. To provide context and framework for discussion and interaction we developed three cases to address issues of interest. The cases focused on leadership, organizational change and team-building. Students of health care management at the Institute of Nursing Science at the University of Oslo, Norway and nursing management at School of Nursing at the University of Western Ontario, Canada engaged in focused discussion framed by the cases over a project period of 6 weeks. In evaluation of the project, experience with learning, collaboration with other students, technology and satisfaction was emphasized. The students viewed international collaboration as the most important and meaningful leaning experience. Further they also found the technology feasible to facilitate learning over a distance. In addition, the students would have liked more time to allow in-depth discussions and analysis of each case.