Undergraduate Nursing Students' Evaluation of the Debriefing Phase in Mental Health Nursing Simulation.

The debriefing phase in mental health nursing simulation promotes a reflexive learning process with the opportunity to develop metacognitive and nontechnical skills. The aim of this quantitative study was to describe undergraduate nursing students' evaluation of their experience during the debriefing phase following high fidelity human simulation (HFHS). Data was collected using the "Debriefing Experience Scale" and analysed with descriptive and comparative tests. The debriefing phase was evaluated as very good. Background data and group size revealed few significant differences. Students with little clinical praxis evaluated having time to acknowledge feelings as important. Differences between groups revealed that groups should consist of up to eighteen students.

Relatives of Inpatients Suffering from Severe Depression: Their Burden and Encounters with the Psychiatric Health Services.

The aim was to investigate relatives of inpatients with severe depression - their perceptions of encountering psychiatric specialist health services and their degree of burden. Sixty-eight relatives recruited via hospital wards and community specialist health centers responded to a questionnaire, with questions from the Quality from the Patients Perspective modified to relatives and the Burden Assessment Scale. Relatives recruited via community specialist health centers perceived less received information and support than those recruited via hospital wards. Higher burden was reported among relatives receiving less information and support than they needed from the psychiatric specialist health services. Healthcare professionals are recommended to give relatives the information and support according to their needs.

Parental perception of family functioning in everyday life with a child with ADHD.

AIM: The aim of this study was to describe and investigate family characteristics in relation to support, behaviour of the child, family functioning and sense of coherence from the parents' perspective in families with a child with attention deficit hyperactivity disorder (ADHD). A further aim was to explore predictors of family functioning. METHODS: The study population consisted of 1964 parents of children with ADHD aged 15 years old and younger. In all, 265 parents responded to a questionnaire (response rate 48.2%; 217 mothers and 48 fathers). In addition to questions about the parents, children, family characteristics and support from health services, the questionnaire included the Family Assessment Device (FAD), the Strengths and Difficulties Questionnaire (SDQ), Sense of Coherence (SOC) and Social Cohesion and Support Index (SCS). Data were analysed with descriptive, comparative and standard multiple regression analyses. RESULTS: Parents with ADHD reported a weaker SOC and poorer FAD in the family than parents without ADHD. Parents with children medicated for ADHD were significantly more satisfied with social support (SCS), rated their children's behaviour as less problematic and reported better family functioning. Parents' age, SOC, SCS, SDQ and support from the community health services explained 46.2% of the variation in FAD. CONCLUSIONS: A strong SOC, social support and support from the community health services were strongly associated with a positive effect on family functioning. Parents with ADHD reported a weaker SOC and poorer family functioning than parents without ADHD. This knowledge may be useful and should be taken into account when planning support for such families.

Preceptors' Expectations of Nursing Students' Preparation before Placement in Psychiatry: Ability and Will to Reflect on and Exercise Knowledge.

Nursing students must be prepared to provide nursing care regardless of the patient's illness. This requires that nursing education, including clinical placements, strengthen knowledge and skills in mental health nursing. The aim of this qualitative study was to describe 15 preceptors' expectations of nursing students' preparedness before they entered the psychiatric field. Data was collected with focus group interviews and analysed using conventional content analysis. The findings show that preceptors are concerned about the nursing students' will and ability to reflect on and exercise knowledge for managing the student role and themselves; for adapting their perspective on humanity; for their understanding of illness and how they are interacting with persons with mental illness. The conclusion is that the preceptors expect the educators to give sufficient theoretical knowledge and assess the students' personal maturity prior to entering the psychiatric field.

Living in a family with a child with attention deficit hyperactivity disorder: a phenomenographic study.

AIMS AND OBJECTIVES: To describe experiences of everyday life in families with a child with attention deficit hyperactivity disorder. BACKGROUND: Attention deficit hyperactivity disorder is a highly prevalent, clinically heterogeneous disorder characterised by behavioural symptoms of inattention, hyperactivity and impulsivity that creates impairments for the child and affects the family life. The impairments vary with age and context, and the same symptoms do not necessarily have the same effects in different contexts and persons. DESIGN: A qualitative design with a phenomenographic approach. METHODS: Family members, mothers, fathers, siblings and children with attention deficit hyperactivity disorder (n = 17) were interviewed individually. RESULTS: The findings include two descriptive categories 'safeguarding a functioning family' and 'fighting for acceptance and inclusion'. To create a stable and structured family life to avoid conflicts within the family and manage their daily life were crucial. The child with attention deficit hyperactivity disorder and their parents developed special skills and strategies to live with attention deficit hyperactivity disorder in the family sphere and the social context. To apply for help before the problems in the family become too severe and to share responsibility with professionals, who have competence, to meet the families in their worries were stressed. The striving in the family strengthened the companionship in the families, and they conceived growth. CONCLUSIONS: This study contributes to knowledge of the parents, siblings and children with attention deficit hyperactivity disorder experiences of everyday life with a child with attention deficit hyperactivity disorder. All family members need support before their problems become too severe. RELEVANCE TO CLINICAL PRACTICE: There is a need of family-focused approach with a dialogue with family members to share the view of their situation and identify their individual resources and needs. Nurses should help these families with family supervision.

Public health nurses' conceptions of their role related to families with a child having attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder is one of the most common behavioural disorders diagnosed in children. Children who have this disorder have difficulties regarding regulation of their emotions, maintaining attention and impulse control. Parents may need guidance in creating structure and predictable boundaries. One of the personnel who meet these families is the public health nurse. The aim of this study was to explore the public health nurses role in relation to these families. A qualitative explorative design with a phenomenographic approach was used. Interviews were performed with 19 nurses, six in group and one individual. In the data analyses, three descriptive categories emerged: 'supporting the family-unit', which describes the nurses supervising the parents and the child in everyday challenges; 'understanding the child', which describes how the public health nurses use professional competence and choose the time and arena to observe the child and; 'collaborating multidisciplinary', which describes how the public health nurses define their own role and conceive their collaboration with other professionals. The public health nurse (PHN)'s support for the parents and the entire family is important, and the PHN is the first encounter and trustful follower throughout the course of diagnosis and care.

Relatives of patients with depression: experiences of everyday life.

The aim of this study was to describe experiences of everyday life as a relative of a person diagnosed with depression. A qualitative and descriptive design with a phenomenographic approach was chosen, and individual interviews with 24 relatives were carried out. Approval was given by the Regional Committee for Medical and Health Research Ethics, Norway (South East) ref 2010/126. The findings show the main category 'Living on the other person's terms', which may be expressed in terms of consideration for the next of kin, thus presenting a challenge and a need to be balanced against taking care of oneself. In addition, three descriptive categories emerged: 'Ambivalent relationship', 'Adjusting daily life' and 'Managing the situation'. In conclusion, the relatives of persons with depression may be in danger of developing their own health problems and in need for attention from health personnel.

Exploring intensive care nurses' team performance in a simulation-based emergency situation, - expert raters' assessments versus self-assessments: an explorative study.

BACKGROUND: Effective teamwork has proven to be crucial for providing safe care. The performance of emergencies in general and cardiac arrest situations in particular, has been criticized for primarily focusing on the individual's technical skills and too little on the teams' performance of non-technical skills. The aim of the study was to explore intensive care nurses' team performance in a simulation-based emergency situation by using expert raters' assessments and nurses' self-assessments in relation to different intensive care specialties. METHODS: The study used an explorative design based on laboratory high-fidelity simulation. Fifty-three registered nurses, who were allocated into 11 teams representing two intensive care specialties, participated in a videotaped simulation-based cardiac arrest setting. The expert raters used the Ottawa Crisis Resource Management Global Rating Scale and the first part of the Mayo High Performance Teamwork Scale to assess the teams' performance. The registered nurses used the first part of the Mayo High Performance Teamwork Scale for their self-assessments, and the analyses used were Chi-square tests, Mann-Whitney U tests, Spearman's rho and Intraclass Correlation Coefficient Type III. RESULTS: The expert raters assessed the teams' performance as either advanced novice or competent, with significant differences being found between the teams from different specialties. Significant differences were found between the expert raters' assessments and the registered nurses' self-assessments. CONCLUSIONS: Teams of registered nurses representing specialties with coronary patients exhibit a higher competence in non-technical skills compared to team performance regarding a simulated cardiac arrest. The use of expert raters' assessments and registered nurses' self-assessments are useful in raising awareness of team performance with regard to patient safety.

Intensive care unit nurses' evaluation of simulation used for team training.

AIM: To implement a simulation-based team training programme and to investigate intensive care nurses' evaluations of simulation used for team training. BACKGROUND: Simulation-based training is recommended to make health care professionals aware of and understand the importance of teamwork related to patient safety. DESIGN: The study was based on a questionnaire evaluation design. METHODS: A total of 63 registered nurses were recruited: 53 from seven intensive care units in four hospitals in one hospital trust and 10 from an intensive care postgraduate education programme. After conducting a simulation-based team training programme with two scenarios related to emergency situations in the intensive care, the participants evaluated each simulation activity with regard to: (i) outcome of satisfaction and self-confidence in learning, (ii) implementation of educational practice and (iii) simulation design/development. RESULT: Intensive care nurses were highly satisfied with their simulation-based learning, and they were mostly in agreement with the statements about self-confidence in learning. They were generally positive in their evaluation of the implementation of the educational practice and the simulation design/development. Significant differences were found with regard to scenario roles, prior simulation experience and area of intensive care practice. CONCLUSION: The study indicates a positive reception of a simulation-based programme with regard to team training in emergency situations in an intensive care unit. RELEVANCE TO CLINICAL PRACTICE: The findings may motivate and facilitate the use of simulation for team training to promote patient safety in intensive care and provide educators with support to develop and improve simulation-based training programmes.

Life-sharing experiences of relatives of persons with severe mental illness - a phenomenographic study.

Relatives of those suffering from severe mental illness experience multiple challenges and a complex life situation. The aim of this study was to describe life-sharing experiences from the perspective of relatives of someone with severe mental illness. A qualitative, descriptive study was performed, and interviews were carried out with eighteen relatives of persons with severe mental illness. A phenomenographic analysis, according to the steps described by Dahlgren and Fallsberg, was used to describe the relatives' conceptions of their situation. The findings show that the experiences of these relatives can be summarized in one main category: 'The art of balancing between multiple concerns'. Two descriptive categories emerged: 'Making choices on behalf of others and oneself' and 'Constantly struggling between opposing feelings and between reflections'. Relatives report that they have to manoeuvre between different ways to act and to prioritize between different wishes and needs. In addition, they face a wide range of strong feelings and they search for hope and meaning. Relatives of someone with severe mental illness have to balance multiple concerns, which induce ethical dilemmas. They felt love, compassion or sense of duty towards the mentally ill person. The changeable situation made it difficult for the relatives to establish a balance in their lives. To be able to prioritize some private time was important. Relatives need own support and sufficient follow-up of the mentally ill next of kin from the mental health services.

Nurses' dilemmas concerning support of relatives in mental health care.

Relatives of persons with severe mental illness face a straining life situation and need support. Exclusion of relatives in mental health care has long been reported. The aim of this study was to describe conceptions of nurses in mental health care about supporting relatives of persons with severe mental illness. Focus group interviews with nurses from all levels of mental health care in Norway were performed. A phenomenographic approach was used. The nurses found that their responsibility first and foremost was the patient, especially to develop an alliance with him or her. Additional premises for supporting relatives were the context framing the nursing care, aspects of the actors, and relational concerns between them. Competing or contradictory demands were found within these premises. Two paths were identified concerning the nurses' support of relatives: seeing the relative in the shadow of the patient or as an individual person.

Nursing students' concerns about end of life in California, Norway, and Sweden.

AIM: To investigate concerns about dying for newly admitted nursing students from California, Norway, and Sweden. METHOD: A total of 389 undergraduate nursing students who had just started their nursing programme participated. Data was collected with a questionnaire that included two instruments-the Concerns about Dying instrument and the Sense of Coherence instrument-and background questions. The data was analysed using statistical and content analysis. RESULTS: There were statistically significant differences between the three groups of students in terms of their age, their experience in health care, whether they had previously attended a dying patient, the age at which they first encountered the death of a loved one, and their concerns about dying. Two main categories emerged from the analysis of the open questions: 'attending to dying and grieving persons' and 'thinking about one's own death'. CONCLUSION: The study provides important insights into the concerns that newly admitted students bring to the nursing programme.

"Left alone with straining but inescapable responsibilities:" relatives' experiences with mental health services.

Relatives of persons with severe mental illness experience burden and straining changes in their lives that put their health at risk. Consequently, they need support from health professionals. The aim of this study was to describe experiences from encounters with mental health services as seen from the point of view of relatives of persons with severe mental illness. A qualitative, explorative study was performed, based on two open-ended questions in a cross-sectional study of relatives' health, burden, and sense of coherence (n = 216). A manifest qualitative content analysis was used to describe the relatives' experiences. The findings show that some relatives had experienced positive encounters with health personnel, but the majority of experiences reported were negative. The encounters can be summarized into one main category: "Left Alone with Straining but Inescapable Responsibilities." Two categories emerged: "Striving for Involvement for the Sake of the Mentally Ill Person," and "Wanting Inclusion for the Sake of Oneself." There is a gap between relatives' needs for support in order to handle their own situation in relation to their mentally ill next of kin, and what they actually receive from the mental health services. The findings suggest that health professionals should collaborate with and support these relatives.

Contending and adapting every day: norwegian parents' lived experience of having a child with ADHD.

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders, and little attention has been paid to the parents and their experiences. The aim of this study was to gain a deeper understanding of the Norwegian parents' lived experiences of having a child with an ADHD diagnosis. A descriptive design using phenomenological approach was chosen as the research method. Individual qualitative interviews with nine parents, who were members of the ADHD Association, were conducted. The interviews were analyzed according to Colaizzi's method. The essential structure of the parents' experiences was Contending and Adapting Every Day-Windsurfing in unpredictable waters which was embedded in the interrelated main themes: Maintaining the Self and Parenthood, and Interacting With the Surrounding World. Being the parent of a child with ADHD is a demanding situation. Nurses need to address the needs of these parents and focus on the family unit.

Burden and health in relatives of persons with severe mental illness: a Norwegian cross-sectional study.

This study describes and investigates burden to and health of relatives of persons with severe mental illness in relation to background variables, everyday life with the mentally ill person, and sense of coherence. A cross-sectional design was used. The respondents were 226 relatives from the Norwegian National Association for Families of Mentally Ill Persons. In addition to background variables and variables about everyday life with the mentally ill person, the questionnaire was comprised of the Burden Assessment Schedule (BAS), Short Form Health Survey (SF-36), and Sense of Coherence Instrument (SOC). This study shows that the relatives were burdened and also reported poor health. Greater burden was experienced by women and by relatives who did not have anyone with whom to share the caregiving of the mentally ill person. For relatives who were single, divorced, or widowed, burden was greater and health was poorer; likewise for relatives who reported financial problems and frequent phone calls with the mentally ill person. Burden and poor health were associated with low SOC. The findings suggest a need for the health services to include and support these relatives in order for them to sustain health.

Being a nurse in nursing home for patients on the edge of life.

Nurses in nursing homes care for patients with complex health problems that need to be followed up by medical treatment. Most patients benefit from the treatment, but for some the treatment seems only to lengthen their death process. Sometimes questions are raised as to whether life-sustaining treatment should be withheld/withdrawn. Decisions related to such questions are difficult to make as some patients are 'on the edge of life', which is understood as a transition between living and dying with an unpredictable outcome, whether the illness will lead to recovery or dying. The aim of this study was to acquire a deeper understanding of what it is to be a nurse in a nursing home for patients on the edge of life. The research design was qualitative, based on hermeneutic phenomenology. Fourteen nurses at two nursing homes were interviewed twice. The result shows that when facing a patient on the edge of life, the nurses were challenged as professionals and as human beings. Two main themes were identified, which included two sub-themes each. The first main theme: 'striving to do right and good for everyone' included the sub-themes 'feeling certain, but accompanied by uncertainty' and 'being caught between too much responsibility and too little formal power'. The second main theme: 'being a vulnerable helper--the prize and the price', contained the sub-themes 'needing emotional protection in professional commitment' and 'feeling undervalued in spite of professional pride'. The essence was: 'being a lonely and enduring struggler between opposite poles'. The findings revealed paradoxes in nurses' work which might threaten nurses' professional identity and put heavy demands on their professional performance. There is a need for formal involvement in end-of-life decisions from nurses, further education and support to nurses related to patients on the edge of life.

A supportive nursing care clinic: conceptions of patients with head and neck cancer.

Patients with head and neck cancer have complex long-lasting physical and psychosocial needs due to illness and treatment, and studies have shown deficiencies concerning support in these respects. The purpose of this study was to describe how head and neck cancer patients with eating problems conceived the significance of a supportive nursing care clinic before, during and after completion of radiotherapy. Thematic interviews were carried out in an open dialogue with 12 patients treated with radiotherapy for head and neck cancer. The phenomenologischer method was used in the analyses. The findings showed that the nurse clinic could meet head and neck cancer patients' needs of safety and security, which was especially important before and after completion of treatment when no other regular contacts in the health care system existed. The significance of the nurse clinic varied depending on where in the trajectory the patients were, what needs and problems they experienced, and how severe these were experienced by the individual patient. The supportive nursing care clinic could meet these patients' needs of knowledge, care and support both concerning practical measures related to the disease and its treatment, and emotional needs. This way of organising the care can contribute to these patients' health and wellbeing.

Good nursing care to ICU patients on the edge of life.

Critically ill patients are admitted to intensive care units (ICUs) to receive advanced technological and medical treatment. Some patients seem not to benefit from the treatment, and sometimes questions are raised as to whether treatment should be withheld or withdrawn. This study was conducted using ICU nurses' experiences with the aim of acquiring a deepened understanding of what good nursing care is for these patients. The study was performed at an adult ICU in Norway, where 14 ICU female nurses were included as participants. The research design was based on interpretative phenomenology and data was collected by group interviews inspired by focus-group methodology. The participants were divided into two groups and each group was interviewed four times. Colaizzi's model was used in the process of analysis. The results show that good nursing care depended on several basic conditions: continuity, knowledge, competence and cooperation, and included clear goals to give appropriate life-saving -- or end-of-life treatment and care. Cornerstones in good nursing care were nurses' verbal communication and nurses' use of their hands. The study emphasises several consequences for future ICU nursing practice and education to enhance good nursing care to patients on the edge of life.

Eating problems and weight loss for patients with head and neck cancer: a chart review from diagnosis until one year after treatment.

This descriptive study aimed to examine the occurrence and treatment of eating problems, and their causes and consequences during the trajectory of care for patients with head and neck cancer treated with radiotherapy. The method used was a review of patient records, conducted by means of an audit instrument developed for the study. The instrument audits demographic data and documented eating problems, their causes and consequences, and undertaken interventions in medical and nursing records from diagnosis until 1 year after completion of treatment. Data were collected prior to treatment, each week during radiotherapy and at the follow-up visits to the physician 1, 6, and 12 months after completion of treatment. The results show that eating problems were common before treatment started, and at the end of radiotherapy every patient suffered from eating problems. One year after treatment the majority still had eating problems. Weight loss occurred early during radiotherapy and became aggravated after treatment, but was not treated to an adequate extent. Implications of this study are that nutritional interventions must be initiated before the treatment starts and they need to be ongoing after completion of treatment.

Psychometric testing of the Norwegian version of the questionnaire, student satisfaction and self-confidence in learning, used in simulation.

Simulation is increasingly being used as an approach to learning in nurse education. There is a need for frameworks and valid evaluation tools to help guide educators in implementing the method. The questionnaire, Student Satisfaction and Self-Confidence in Learning, which consists of two subscales, has been developed by the National League for Nursing in the US for evaluating simulation used in nurse education. The aim of the present study was to test the questionnaire, Student Satisfaction and Self-Confidence in Learning, for psychometric properties in a Norwegian nurse education context. A sample consisting of 130 nursing students participated in a simulation situation, and 123 responded. When the questionnaire was tested in its entirety, psychometric testing conducted with a principal component analysis did not reveal a stable factor solution. The two subscales were then tested separately. The analysis for Satisfaction with Current Learning suggested a one-component solution, thereby explaining 62.8% of the variance, and the internal reliability was 0.84. With regard to Self-Confidence in Learning, no stable solution was achieved, and an alpha value of 0.64 was shown. To further validate the questionnaire, Student Satisfaction and Self-Confidence in Learning, more studies by various nursing programmes in different cultural contexts are recommended.