Ida Torunn Bjørk

Targeting Risk Factors for Impaired Wound Healing and Wound Complications After Kidney Transplantation

BACKGROUND Because of potent immunosuppression, impaired wound healing and complications are frequent features after kidney transplantation (KTx). OBJECTIVE To investigate the incidence and nature of impaired wound healing and complications at a single transplantation center in Norway. PATIENTS Of 226 patients who underwent KTx, 199 (87%) were followed up prospectively for 1 year (2005) via close and meticulous wound inspection. RESULTS The study revealed a high rate of wound complications (200-250/y) in a high-volume center. Fifty-four patients (27%) experienced prolonged wound healing, defined as gaps, secretions, or wound complications, at 3 to 5 weeks posttransplantation, and 41 patients (21%) had impaired wound healing, defined as gaps, secretions, or wound complications after 5 weeks posttransplantation. In total, 50 patients (25%) required surgical or radiologic reintervention. Complications included lymphocele in 29 patients (14.6%), wound dehiscence in 16 (8.0%), bleeding or hematoma in 10 (5.0%), and infection in 9 (4.5%). Risk factors associated with wound complications included recipient older than 60 years, body mass index greater than 30, hemoglobin concentration less than 10 g/dL, albumin concentration less than 36 g/dL, duration of surgery more than 200 minutes, no subcutaneous sutures, and sirolimus or everolimus therapy. At nominal and logistic regression analysis, recipient older than 60 years, body mass index greater than 30, and no subcutaneous sutures were independent risk factors. CONCLUSION Risk factor analysis and previous documentation suggest that wound complications might be counteracted using the following measures: subcutaneous sutures, predialysis transplantation, sealing or ligation of lymphatic trunks, prophylactic fenestration, reduction of corticosteroid load, and avoiding sirolimus/everolimus therapy.

Analgesia and sedation of mechanically ventilated patients - a national survey of clinical practice.

The importance of balanced sedation and pain treatment in intensive care units (ICUs) is evident, but regimes and use of medication differ widely. Previous surveys have focused on the use of various medications and regimes. What has not been explored is the process by which nurses and physicians assess patients’ needs and work together toward a defined level of sedation and pain for the ICU patient. The purpose of the study was to determine the use of protocols and medications for sedation and analgesia in Norwegian ICUs and the degree of cooperation between nurses and physicians in using them.

Issues in nurses' practical skill development in the clinical setting.

Generally, it is assumed that nurses are reasonably skilled in the performance of practical nursing actions by the end of their first year of practice. This article contests this assumption based on empirical data from a longitudinal study of newly graduated nurses. Three issues are discussed: the notion that experience (per se) can guarantee a positive development in practical skill performance; the failure to relate to inherent complexities in practical skill performance during evaluation of skill; and the significance of acknowledging differences in skill complexity during skill development. A reinstated focus on practical skill in nursing education and collaboration between education and practice is needed to secure quality in a nurses actual performance.

Sufficient competence in community elderly care? Results from a competence measurement of nursing staff

BackgroundMulti-morbidity, poly-pharmacy and cognitive impairment leave many old patients in a frail condition with a high risk of adverse outcomes if proper health care is not provided. Knowledge about available competence is necessary to evaluate whether we are able to offer equitable and balanced health care to older persons with acute and/or complex health care needs. This study investigates the sufficiency of nursing staff competence in Norwegian community elderly care.MethodsWe conducted a cross-sectional survey of 1016 nursing staff in nursing homes and home care services with the instrument “Nursing Older People – Competence Evaluation Tool”. Statistical analyses were ANOVA and multiple regression.ResultsWe found that nursing staff have competence in all areas measured, but that the level of competence was insufficient in the areas nursing measures, advanced procedures, and nursing documentation. Nursing staff in nursing homes scored higher than staff in home care services, and older nursing staff scored lower than younger nursing staff.ConclusionsA reason for the relatively low influence of education and training on competence could be the diffuse roles that nursing staff have in community elderly care, implying that they have poor standards against which to judge their own competence. Clearer role descriptions for all groups of nursing staff are recommended as well as general competence development in geriatric nursing care.

From theoretical model to practical use: an example of knowledge translation

AIM To present a case of knowledge translation in nursing education and practice and discusses mechanisms relevant to bringing knowledge into action. BACKGROUND The process of knowledge translation aspires to close the gap between theory and practice. Knowledge translation is a cyclic process involving both the creation and application of knowledge in several phases. The case presented in this paper is the translation of the Model of Practical Skill Performance into education and practice. Advantages and problems with the use of this model and its adaptation and tailoring to local contexts illustrate the cyclic and iterative process of knowledge translation. DISCUSSION The cultivation of a three-sided relationship between researchers, educators, and clinical nurses was a major asset in driving the process of knowledge translation. The knowledge translation process gained momentum by replacing passive diffusion strategies with interaction and teamwork between stakeholders. The use of knowledge creates feedback that might have consequences for the refinement and tailoring of that same knowledge itself. With end-users in mind, several heuristics were used by the research group to increase clarity of the model and to tailor the implementation of knowledge to the users. IMPLICATIONS FOR NURSING This article illustrates the need for enduring collaboration between stakeholders to promote the process of knowledge translation. Translation of research knowledge into practice is a time-consuming process that is enhanced when appropriate support is given by leaders in the involved facilities. CONCLUSION Knowledge translation is a time-consuming and collaborative endeavour. On the basis of our experience we advocate the implementation and use of a conceptual framework for the entire process of knowledge translation. More descriptions of knowledge translation in the nursing discipline are needed to inspire and advise in this process.

What constitutes a nursing practical skill

Practical nursing skills ensure patients’physical comfort, hygiene, and safe medical treatment. The learning, performance, or significance of nursing practical skills are seldom a theme in theoretical and philosophical debate or the topic of research within nursing. This might be due to a long-standing behavioristic tradition in nursing of viewing nursing practical skills in a simplistic way, only as correctly sequenced motor movement. The purpose of this article is to bring forth an argument for a broader understanding of the constitution of nursing practical skills. This argument is substantiated by a review of past and present conceptualizations of nursing practical skills as well as by philosophical reflections on the value of practical skills in the nursing profession. Nursing practical skills embrace dimensions of performance, intention, and nursing “disciplined” understanding.

Experiences of donor families after consenting to organ donation: A qualitative study

AIM The aim of this study was to investigate the experience of Norwegian donor families during organ donation after brain death. METHODS This was a qualitative study using personal interviews. Twenty donor-family members from thirteen different situations were interviewed about their experience of being a close relative in an organ donation situation. The principles of qualitative content analysis were used. FINDINGS An experience of strain caused by the organ donation situation was identified. Lack of comprehension and awareness of the process of organ donation contributed to this, and continuing information after the consent was given appeared to be necessary. Reconciliation with the decision of organ donation and the subsequent situation was gained through understanding the organ donation process, through recognition of the increased strain and through satisfaction resulting from the contribution made by organ donation. Healthcare personnel were key persons in contributing to such understanding and recognition. CONCLUSION When attending to families in an organ donation situation, the focus must be on ensuring comprehension of the situation both through information provided in the hospital and during follow-up. It seems essential to arrange for a period of parting that can contribute to reconciliation, and to offer follow-up according to individual needs.

Developing supervision skills through peer learning partnership

Oslo University College, Faculty of Nursing places undergraduate students in peer learning partnerships: 3rd year students as tutors, and 1st year students as tutees during practical skill learning. A study was designed to investigate this peer learning project. One of the research questions in particular on the role of the tutors: How do 3rd year nursing students carry out their role as supervisors for 1st year students in the skills laboratory? The study had an exploratory design. Qualitative data was gathered by three members of a research team, using video recordings of the supervised sessions and focus group interviews with both 1st and 3rd year students. Data collection was repeated in 2006-2007-2008 in different groups of students. Four identified themes illustrate how the 3rd year students supervise during the performance of the procedures in the skills laboratory: Observe and guide, supportive attitude, identify with the patient, focus on theoretical knowledge. The results of this study indicate that apart from enhancing practical skill learning in 1st year students, the assignment in the skill laboratory also provided an arena for developing competence in supervision in third year students.

Change of focus: from intensive care towards organ donation

To progress from identifying a potential organ donor to implementing the actual organ donation effectively is a challenging process for all involved. The nurses might find the change of focus difficult, as the donor organ acquisition process often starts before the relatives had been informed and have had the time to reorient themselves about the severe situation of the patient and have been briefed on the option of organ donation. The purpose was to investigate the hospital‐based education in organ donation at the 28 Norwegian donor hospitals, and elicit the needs of the intensive care nurses for imparting of required knowledge and support in shifting their focus from intensive care towards the process of organ procurement. Hospital‐based education and guidelines in organ donation were analyzed by scrutinizing the documents available. Eleven units were found to have their own guidelines and only three hospitals had organ donation in their educational programme. Intensive care nurses at three hospitals participated in focus groups. The main finding was the need for collaboration and mutual understanding within the treatment team. Nurses expounded the multiple responsibilities that they discharged during the course of intensive care. In reorienting their focus from intensive care to donor organ procurement, the time of death was explained as the crucial turning point. The knowledge of intensive care staff and professional competence were crucial in winning the relatives’ trust and were central in the communication processes. Donor hospitals should implement systematic training and debriefing, where both nurses and physicians contribute to this process. Well‐prepared protocols for organ donation at hospitals can define responsibilities assigned to different members of the donor organ acquisition team.

Principle-based analysis of the concept of telecare

AIM To report a concept analysis of telecare. BACKGROUND Lately telecare has become a worldwide, modern way of giving care over distance by means of technology. Other concepts, like telemedicine, e-health, and telehealth, focus on the same topic though the boundaries between them seem to be blurred. DATA SOURCES Sources comprise 44 English language research articles retrieved from the database of Medline and Cinahl (1995-October 2011). DESIGN Literature Review. METHOD A principle-based analysis was undertaken through content analysis of the definitions, attributes, preconditions, and outcomes of the concept. RESULTS The attributes are well described according to the use of technology, caring activity, persons involved, and accessibility. Preconditions and outcomes are well described concerning individual and health political needs and benefits. The concept did not hold its boundaries through theoretical integration with the concept of telemedicine and telehealth. The definition of telecare competes with concepts like home-based e-health, telehomecare, telephonecare, telephone-based psychosocial services, telehealth, and telemedicine. Assessment of the definitions resulted in a suggestion of a new definition: Telecare is the use of information, communication, and monitoring technologies which allow healthcare providers to remotely evaluate health status, give educational intervention, or deliver health and social care to patients in their homes. CONCLUSION The logical principle was assessed to be partly immature, whereas the pragmatical and linguistical principles were found to be mature. A new definition is suggested and this has moved the epistemological principle forward to maturity.