Britt Sætre Hansen

Risk factors of post‐operative urinary retention in hospitalised patients

Background: Post‐operative urinary retention (POUR) is most accurately determined by using ultrasound to measure bladder volume. The aim of this study was to define the risk factors of POUR in the recovery room in hospitalised patients.

Mechanical ventilation in the ICU- is there a gap between the time available and time used for nurse-led weaning?

BackgroundMechanical ventilation (MV) is a key component in the care of critically ill and injured patients. Weaning from MV constitutes a major challenge in intensive care units (ICUs). Any delay in weaning may increase the number of complications and leads to greater expense. Nurse-led, protocol-directed weaning has become popular, but it remains underused. The aim of this study was to identify and quantify discrepancies between the time available for weaning and time actually used for weaning. Further, we also wished to analyse patient and systemic factors associated with weaning activity.MethodsThis retrospective study was performed in a 12-bed general ICU at a university hospital. Weaning data were collected from 68 adult patients on MV and recorded in terms of ventilator-shifts. One ventilator-shift was defined as an 8-hour nursing shift for one MV patient.ResultsOf the 2000 ventilator-shifts analysed, 572 ventilator-shifts were available for weaning. We found that only 46% of the ventilator shifts available for weaning were actually used for weaning. While physician prescription of weaning was associated with increased weaning activity (p < 0.001), a large amount (22%) of weaning took place without physician prescription. Both increased nursing workload and night shifts were associated with reduced weaning activity. During the study period there was a significant increase in performed weaning, both when prescribed or not (p < 0.001).ConclusionOur study identified a significant gap between the time available and time actually used for weaning. While various patient and systemic factors were linked to weaning activity, the most important factor in our study was whether the intensive care nurses made use of the time available for weaning.

Factors that influence user satisfaction: tracheotomised home mechanical ventilation users' experiences.

AIMS AND OBJECTIVES To describe the self-reported life situation of users totally dependent on home mechanical ventilation (HMV) after tracheotomy and to identify factors associated with user satisfaction. BACKGROUND HMV users are a small but growing group in society and among the most vulnerable individuals with chronic disabilities. The participants in the present study belong to an even more susceptible minority of this group, as they require round the clock ventilation at home through a tracheostomy, implying the need for continuous care. Their testimonies are important for the generation of new knowledge. DESIGN A qualitative design using interviews. METHODS Individual interviews were conducted with six participants and analysed by qualitative content analysis. RESULTS The main theme that emerged different individual needs require a range of approaches was based on three sub-themes: (1) Tailored information (2) Sensitivity in decision-making and (3) Building trust and confidence. Information was perceived as crucial and participants described different experiences of receiving optimal information to not receiving information at all. Successful collaboration was perceived when the user was given the opportunity to participate in decision-making about her/his treatment and care, where to live and how to organise daily life. Trust and confidence in the caregivers were important. CONCLUSION The participants highlighted the need for strategies to improve satisfaction. Their experiences varied depending on age, where they lived, who they encountered in the healthcare system and the level of family support. Our findings suggest that patients who perceive themselves as well informed at an early stage are more satisfied with treatment, decisions about their tracheotomy and their life situation. RELEVANCE TO CLINICAL PRACTICE There is a lack of knowledge among healthcare providers, thus tailored, high competence and guidelines are required.

Interprofessional training for nursing and medical students in Norway: Exploring different professional perspectives

ABSTRACT This article presents an explorative case study focusing on interprofessional training for medical and nursing students in Norway. Based on interviews with, and observations of, multiple stakeholder groups—students, university faculty, and hospital staff—content analysis was applied to investigate their perspectives regarding the design of such educational training. The findings revealed a positive perspective amongst stakeholders while voicing some concerns related to how communication issues, collaboration, workflow, and professional role patterns should be reflected in such training. Based on our data analysis we derive three themes that must be considered for successful interprofessional training of nursing and medical students: clinical professionalism, team performance, and patient-centered perspective. These themes must be balanced contingent on the students’ background and the learning objectives of future interprofessional training efforts.

Shared Decision-Making—Balancing Between Power and Responsibility as Mental Health-Care Professionals in a Therapeutic Milieu:

Background Shared decision-making (SDM) is supposed to position patient and expert knowledge more equal, in which will have an impact on how mental health-care professionals relate to their patients. As SDM has not yet been widely adopted in therapeutic milieus, a deeper understanding of its use and more knowledge of interventions to foster its implementation in clinical practice are required. Aim To explore how mental health-care professionals describe SDM in a therapeutic milieu as expressed through clinical supervision. The research question was “What are prerequisites for mental health-care professionals to practice SDM in a therapeutic milieu?” Methods A qualitative content analysis of data from focus groups dialogues in 10 clinical supervision sessions where eight mental health-care professionals participated was performed. Findings The theme, practicing SDM when balancing between power and responsibility to form safe care, was based on three categories: internalizing the mental health-care professionals’ attributes, facilitating patient participation, and creating a culture of trust. Conclusion SDM is a complex and arduous process requiring appropriate interventions. Clinical supervision is necessary for reflection on SDM and for improving practice in a therapeutic milieu.

How do Tanzanian hospital nurses perceive their professional role? A qualitative study

To describe the experiences of Tanzanian nurses, how they perceive their role as a professional nurse and their experience with nursing care in a general hospital.

Medication administration and interruptions in nursing homes: A qualitative observational study

AIMS AND OBJECTIVES To contribute in-depth knowledge of the characteristics of medication administration and interruptions in nursing homes. The following research questions guided the study: How can the medication administration process in nursing homes be described? How can interruptions during the medication administration process in nursing homes be characterized? BACKGROUND Medication administration is a vital process across healthcare settings, and earlier research in nursing homes is sparse. The medication administration process is prone to interruptions that may lead to adverse drug events. On the other hand, interruptions may also have positive effects on patient safety. DESIGN A qualitative observational study design was applied. METHODS Data were collected using partial participant observations. An inductive content analysis was performed. RESULTS Factors that contributed to the observed complexity of medication administration in nursing homes were the high number of single tasks, varying degree of linearity, the variability of technological solutions, demands regarding documentation and staffs apparent freedom as to how and where to perform medication-related activities. Interruptions during medication administration are prevalent and can be characterised as passive (e.g., alarm and background noises), active (e.g., discussions) or technological interruptions (e.g., use of mobile applications). Most interruptions have negative outcomes, while some have positive outcomes. CONCLUSIONS A process of normalisation has taken place whereby staff put up with second-rate technological solutions, noise and interruptions when they are performing medication-related tasks. Before seeking to minimise interruptions during the medication administration process, it is important to understand the interconnectivity of the elements using a systems approach. RELEVANCE TO CLINICAL PRACTICE Staff and management need to be aware of the normalisation of interruptions. Knowledge of the complexity of medication administration may raise awareness and highlight the importance of maintaining and enhancing staff competence.