Marie Häggström

Struggle with a gap between intensive care units and general wards.

Nursing critically ill patients includes planning and performing safe discharges from Intensive Care Units (ICU) to the general wards. The aim of this study was to obtain a deeper understanding of the main concern in the ICU transitional process—the care before, during, and after the transfer of ICU patients. Interviews were conducted with 35 Swedish nurses and analysed according to grounded theory. The main concern was the nurses’ “struggling with a gap.” The “gap” was caused by differences in the altered level of care and contributed to difficulties for nurses encountering an overlap during the transitional care. The categories: sheltering, seeking organizational intertwining and striving for control are related to the core category and were used to generate a theory. The nurses sought improved collaboration, and employed patient-centred routines. They wanted access to necessary tools; they relayed or questioned their own competence and sought assurance of the patients’ ability to be transferred. If the nurses felt a loss of control, lack of intertwining and lack of collaboration, they sheltered their patients and themselves. Intertwining was more difficult to perform, but actually even more important to do. With knowledge about ICU transitional care, collaboration, routines, and with an organization that provides an educational environment, the process could be improved.

To reduce technology prior discharge from intensive care –important but difficult? : A grounded theory

Aim:  The aim of this study was to provide a deeper understanding of the experience of intensive care staff regarding the reduction in the use of medical technology prior to patients’ transfer from the ICU. Background:  The goal of ICU transitional care, provided for intensive care patients before, during and after the transfer from the ICU to another care unit, is to ensure minimal disruption and optimal continuity of care for the patient. To smooth this transition, there is a need to prepare for a less technological environment and therefore also a need for a gradual reduction in the use of monitoring equipment. Method:  Group interviews and individual interviews, together with participant observations, were conducted with ICU staff in two hospitals in Sweden. The data were analysed using classic grounded theory. Results:  The main concern was the ICU staff’s ambiguity regarding whether and how to reduce the use of medical technology devices. Insecurity about weaning patients from medical equipment combined with a lack of standardized routines made it difficult for staff to reduce the technical support. The core category describes how the ambiguity was solved primarily by ‘prioritizing control’. However, this often caused the ICU staff to use advanced technology while the patients were in the ICU until the ward staff arrived, even if this should have been handled otherwise. Why and how the ICU staff used the strategy of ‘prioritizing control’ is further explained in the categories ‘being affected by cultural/contextual aspects’, ‘searching for guidance and a shared understanding’ and ‘weighing advantages with more v s less technology’. Conclusion:  It is important to consider ICU staff ambiguity concerning the reduction in technology and to establish strategies for a safe and structured transitional phase with step-down procedures in which technology and monitoring is gradually reduced prior to transfer from ICU.

Correlations between Clinical Judgement and Learning Style Preferences of Nursing Students in the Simulation Room

Background: Health care educators account for variables affecting patient safety and are responsible for developing the highly complex process of education planning. Clinical judgement is a multidimensional process, which may be affected by learning styles. The aim was to explore three specific hypotheses to test correlations between nursing students’ team achievements in clinical judgement and emotional, sociological and physiological learning style preferences. Methods: A descriptive cross-sectional study was conducted with Swedish university nursing students in 2012-2013. Convenience sampling was used with 60 teams with 173 nursing students in the final semester of a three-year Bachelor of Science in nursing programme. Data collection included questionnaires of personal characteristics, learning style preferences, determined by the Dunn and Dunn Productivity Environmental Preference Survey, and videotaped complex nursing simulation scenarios. Comparison with Lasater Clinical Judgement Rubric and Non-parametric analyses were performed. Results: Three significant correlations were found between the team achievements and the students’ learning style preferences: significant negative correlation with ‘Structure’ and ‘Kinesthetic’ at the individual level, and positive correlation with the ‘Tactile’ variable. No significant correlations with students’ ‘Motivation’, ‘Persistence’, ‘Wish to learn alone’ and ‘Wish for an authoritative person present’ were seen. Discussion and Conclusion: There were multiple complex interactions between the tested learning style preferences and the team achievements of clinical judgement in the simulation room, which provides important information for the becoming nurses. Several factors may have influenced the results that should be acknowledged when designing further research. We suggest conducting mixed methods to determine further relationships between team achievements, learning style preferences, cognitive learning outcomes and group processes.

Svensk översättning, kvalitativ relevansvärdering och kvantitativ reliabilitetstestning av Lasater Clinical Judgment Rubric Swedish translation, qualitative relevance evaluation and quantitative reliability test of Lasater Clinical Judgment Rubric

Newly graduated nurses show lacking skills and competences regarding the ability to make appropriate clinical assessment of acute, complex care situations. There is also a lack of translated, qualitative relevance-evaluated and reliability-tested rubrics in the Swedish language. The purpose of this method article was to translate, and conduct a relevance evaluation and reliability test of the identified Lasater Clinical Judgment Rubric (LCJR). In this article, the Swedish translation LCJR (S) is presented. The results showed that the LCJR (S) was both qualitatively relevant and quantitatively reliable. We claim that there are several advantages to systematic use LCJR (S) for assessment of nursing students’ clinical judgement in laboratory simulation environments with acute patient situations.

To integrate and manage diabetes in school: Youth’s experiences of living with Type 1 diabetes in relation to school – a qualitative study

In Sweden, each year approximately 700 children develop Type 1 diabetes. Living with the illness is a challenge for youth and requires adjustments to lifestyle, and to manage school. The aim was to describe youths’ experiences of living with Type 1 diabetes in relation to school. A qualitative research design was used and interviews were performed with eight girls and five boys with Type 1 diabetes. The interviews were subjected to qualitative content analysis. Three themes were identified: to be friends with the diabetes, striving for normality and receiving support from others. Results showed a need to increase the understanding of T1D and diabetic competence within the Swedish school system and knowledge of youths’ own experiences is vital in this work. Living with T1D was a struggle for normality, independency and the youth needed to be friends with diabetes to handle everyday self-management. Although there are demanding life and school circumstances, it eventually becomes possible for the youth to handle the illness and to integrate and manage diabetes in school.

Skolsköterskans rolltransformering till den nya hälsofrämjande positionen: The transformation of the school nurse’s role towards the new health-promoting position

Aim The aim of this study was to describe the role transformation of school nurses towards primary health promotion, and secondary preventive and health treatment work. Background According to the Swedish educational act, the school nurse profession has changed towards being mainly health promotion and secondary preventive and health treatment work. Method The study consisted of a qualitative study design with content analysis inspired by Elo and Kyngäs. Sixteen individual interviews were conducted with school nurses from across one county. Findings The role transformation towards a more health promotion was described by school nurses’ statements. The process of the transformation differed among the school nurses. Three categories illuminated their work; professional approach, student-centred and collaboration. Conclusion The role transformation process required enhanced relation and communicational skills. Structured collegial supervision might support the process.

Being Facilitators in a Challenging Context-school Personnel's Experiences of Caring for Youth with Diabetes Type 1

Purpose: The purpose of the study was to describe school personnels experiences of caring for youth with diabetes type 1. Design and Methods: A qualitative design was chosen for this study. Data were collected with individual interviews that were subjected to inductive qualitative content analysis. The sample consisted of 24 school personnel (teachers, principals and school nurses) from Swedish schools. All had experience with youth aged 6 to 18years old with diabetes type 1. Results: School personnel experienced caring for youth with diabetes type 1 as “Being facilitators in a challenging context” and described establishing trusting relationships, finding strategies to support self‐care, feeling uncertain and incapable in need of education, and dealing with unclear responsibility. Conclusions: School personnel (teachers, principals and school nurses) are key professionals supporting youth with diabetes type 1 and self‐care in school. Lack of education and unclear responsibility created feelings of uncertainty and insecurity for school personnel and a need for mandatory education of school personnel regarding T1DM and self‐care, including legislation was identified. Implications: Mandatory education should be provided for all school personnel regarding diabetes type 1, self‐care and current legislation. A liason position in form of a nurse specialist should manage the education. HIGHLIGHTSSchool personnel are key professionals for caring and supporting youth with diabetes type 1.A mandatory education regarding T1DM and self‐care is an important health and educational policy issue.The question of accountability for Swedish school personnel needs to be clarified.More collaboration between the healthcare and educational system is neededA liason position in form of a nurse specialist should manage the education.