Comparing didactic approaches for practical skills learning in Scandinavian nursing simulation centres: A qualitative comparative study.

AIM: To explore and compare the didactic approaches to practical skills learning at simulation centres in Scandinavian universities and university colleges. BACKGROUND: Academic simulation centres are an important arena for learning practical nursing skills which are essential to ensure competent performance regarding patient safety and quality of care. Knowledge of didactic approaches to enhance learning is essential in promoting the provision and retention of students' practical nursing skills. However, research on didactical approaches to practical nursing skills learning is lacking. DESIGN: A qualitative comparative design was used. METHODS: During November and December 2019, interviews were conducted with a total of 37 simulation centre directors or assistant directors, each of whom possessed in-depth knowledge of practical skills in teaching and learning. They represented bachelor nursing education in Denmark, Norway and Sweden. A qualitative deductive content analysis was conducted. RESULTS: The results revealed all five predetermined didactical components derived from the didactical relationship model. Twenty-two corresponding categories that described a variation in didactic approaches to practical skills learning in Scandinavian nursing simulation centres were identified. The didactical components of Learning process revealed mostly similarities, Setting mostly differences and Assessment showed only differences in didactic approaches. CONCLUSION: Although various didactic approaches were described across the countries, no common approach was found. Nursing educational institutions are encouraged to cooperate in developing a shared understanding of how didactic approaches can enhance practical skills learning. IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE: Cross-country comparisons of practical nursing skills learning in Scandinavian countries highlight the importance of educator awareness concerning the impact diverse didactic approaches may have on competent performance in nursing education. Competent performance is pivotal for ensuring patient safety and the provision of high-quality care. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. REPORTING METHOD: This study followed the Consolidated Criteria for Reporting Qualitative Research reporting guidelines.

"Please mind the gap": A secondary analysis of discomfort and comfort in intensive care.

AIMS AND OBJECTIVES: To explore in depth discomfort in intensive care as experienced by patients and attended to by critical care nurses. BACKGROUND: Discomfort in illness is complex and persistent, and its alleviation is a challenge for nurses working in intensive care units (ICU). In previous studies, we showed that ICU patients described little actual pain but suffer from much discomfort. Critical care nurses had a systematic approach to the treatment of pain, but were more haphazard in dealing with other types of discomfort. DESIGN: Secondary qualitative analysis of data from two previous exploratory studies. METHODS: Content analysis was used on existing data from 28 interviews with ICU patients, and 16 field notes and interviews with critical care nurses. Kolcaba's Comfort Theory was applied for further analysis. The COREQ checklist was used. RESULTS: Three themes, "Being deprived of a functioning body", "Being deprived of a functioning mind" and "Being deprived of integrity" characterised the discomfort experienced by ICU patients. The nurses appeared to attend to all areas of discomfort expressed by patients. In need of, and providing acknowledgment and alleviation became a common overarching theme. We identified a comfort gap caused by the discrepancy between the patients' needs and the nurses' achievements in fulfilling these needs. CONCLUSIONS: A gap exists between ICU patients' comfort needs and nurses' achievements in fulfilling these, indicating that discomfort currently is an inevitable part of the critical illness trajectory. Increased knowledge about how the brain is affected in ICU patients and more systematic approaches to assessing comfort needs and enhancing comfort may support nurses in fulfilling patient needs and possibly diminish the existing comfort gap. RELEVANCE FOR CLINICAL PRACTICE: An increased understanding of the complex experience of discomfort in ICU patients may bring about more systematic approaches to enhance comfort and direct for education and further research.

"Pain relieved, but still struggling"-Critically ill patients experiences of pain and other discomforts during analgosedation.

AIMS AND OBJECTIVES: To explore how critically ill patients treated according to a strategy of analgosedation experience and handle pain, other discomforts and wakefulness. BACKGROUND: Patients experience both pain and discomfort while in the intensive care unit. International guidelines recommend focused pain treatment and light sedation. An analgosedation protocol favouring pain management, light sedation and early mobilisation was implemented in our university hospital medical and surgical intensive care unit in Norway in 2014. The analgosedation approach may affect patients' experiences of the intensive care unit stay. DESIGN: Exploratory, descriptive design using semi-structured interviews. METHOD: Eighteen adult patients treated in intensive care unit >24 hr and receiving mechanical ventilation were interviewed 1-9 days after intensive care unit discharge. Ten patients were re-interviewed after 3 months. Data were analysed using the "systematic text condensation" approach. FINDINGS: Four main categories emerged from the analysis: "In discomfort, but rarely in pain," "Struggling to get a grip on reality," "Holding on" and "Handling emotionally trapped experiences." "Pain relieved, but still struggling" was the overarching theme. Analgosedation provided good pain relief, but patients still described frequent physical and psychological discomforts, in particular related to mechanical ventilation, not understanding what was going on, and experiences of delusions. To come to terms with their intensive care unit stay, patients needed to participate, trust in others and endure suffering. After hospital discharge, patients described both repression of experiences and searching for recognition of what they had gone through. RELEVANCE TO CLINICAL PRACTICE: Despite good pain relief during analgosedation, other discomforts were commonly described. Critically ill patients still experience an intensive care unit stay as a traumatic part of their illness trajectory. Nurses need to attend carefully also to discomforts other than pain.

"But Perhaps they could Reduce the Suffering?" Parents' Ambivalence toward Participating in Forced Peripheral Vein Cannulation Performed on their Preschool-Aged Children.

PURPOSE: The purpose of this study was to provide a better understanding of how parents experience the use of restraint during the performance of peripheral vein cannulation (PVC) on their child. DESIGN/METHODS: Qualitative, semi-structured interviews were performed with seven parents and one close relative who had accompanied their 3-5-year-old child while the child resisted the medical procedure of PVC. The analysis was guided by symbolic interactionism and resulted in two themes. RESULTS: The first theme that emerged, "Negotiating What Quality of Performance Should be Expected", was based on 1) Parents expected child-friendly encounters, 2) Performance of PVC caused unexpected and unnecessary suffering for the child, and 3) Parents explained and excused the performance of PVC. The second theme: "Negotiating One's Own Role and Participation in a Child's Suffering During the Procedure", was based on 1) Parents desired to be acknowledged and approached for suggestions regarding ways to ease the trauma surrounding the procedure, 2) Parents expressed uncertainty regarding the consequences that the procedure would have for the children, and 3) Parents desired to play a protective role, and they tended to engage in self-criticism. CONCLUSION: When the PVC was less child-friendly, poorly planned and chaotic or performed with lacking skills, the parents became unwilling partners in the unnecessary suffering of the child. A practical implication is that if pediatric health care providers are aiming for the reduction of restraint, they must better understand parents' expectations and experiences and ensure that the use of restraint is used as the last resort.

An exploration of factors associated with older persons' perceptions of the benefits of and satisfaction with a preventive home visit service.

BACKGROUND: Preventive home visits (PHVs) are healthcare services aimed at promoting the health of home-dwelling older people and to support their abilities to live independently. To enhance effectiveness, studies that explore older persons' experiences of PHVs are needed. OBJECTIVE: To assess older persons' perceived benefits and opinions of a PHV service and explore associations between perceived benefits from PHV and relevant sociodemographic/health-related factors. THEORY: The study was based on a comprehensive understanding of health, as including objective health/disease, subjective health/well-being and coping ability. METHODS: A cross-sectional survey was administered during spring 2013 in a Norwegian municipality where nurses had offered annual PHVs to residents aged 75 years and older since 1999. We invited a stratified random sample of 393 PHV users to participate; of these, 161 volunteered. The main outcome variables in the questionnaire were perceived benefits from PHV. Logistic regression models were used to analyse the associations between each benefit and sociodemographic/health-related background variables. RESULTS: Approximately 39% of the respondents reported that PHVs added to their feelings of safety; 66% reported support for ability to live at home; 72% reported support for having a good life, 83% were satisfied with the service, and 90% stated that PHVs are important for older people. Each benefit was associated with different sociodemographic/health-related factors. Support for feelings of safety increased with age. More support for living at home was associated with poor physical health and not living alone. Those without children perceived more support for a good life. Satisfaction with PHV increased with increasing scores on the Life Orientation Scale. Persons with poor mental health and those not living alone more often perceived PHV as important. CONCLUSIONS: Annual, comprehensive PHVs to a general older population may support older persons' health and independence. Low response rate restricts the possibility to generalise the results.

Defining and comparing learning actions in two simulation modalities: students training on a latex arm and each other's arms.

AIMS AND OBJECTIVES: To explore, describe and compare learning actions that nursing students used during peripheral vein cannulation training on a latex arm or each other's arms in a clinical skills centre. BACKGROUND: Simulation-based training is thought to enhance learning and transfer of learning from simulation to the clinical setting and is commonly recommended in nursing education. What students actually are doing during simulation-based training is, however, less explored. The analysis of learning actions used during simulation-based training could contribute to development and improvement of simulation as a learning strategy in nursing education. DESIGN: A qualitative explorative and descriptive research design, involving content analysis of video recordings, was used. METHODS: Video-supported observation of nine nursing students practicing vein cannulation was conducted in a clinical skills centre in late 2012. RESULTS: The students engaged in various learning actions. Students training on a latex arm used a considerably higher number of learning actions relative to those training on each other's arms. In both groups, students' learning actions consisted mainly of seeking and giving support. The teacher provided students training on each other's arms with detailed feedback regarding insertion of the cannula into the vein, while those training on a latex arm received sparse feedback from the teacher and fellow students. CONCLUSION: The teacher played an important role in facilitating nursing students' practical skill learning during simulation. The provision of support from both teachers and students should be emphasised to ensure that nursing students' learning needs are met. RELEVANCE TO CLINICAL PRACTICE: This study suggest that student nurses may be differently and inadequately prepared in peripheral vein cannulation in two simulation modalities used in the academic setting; training on a latex arm and on each other's arms.

Long-term, self-reported health outcomes in kidney donors.

BACKGROUND: The wide use of healthy persons as kidney donors calls for awareness of risks associated with donation. Live kidney donation may impair quality of life (QOL) and result in fatigue. Long-term data on these issues are generally lacking in the donor population. Thus we aimed to investigate long-term self-reported health outcomes in a nationwide donor cohort. METHODS: We assessed self-reported QOL, fatigue and psychosocial issues after donation in 217 donors representing 63 % of those who donated 8-12 years ago. QOL was measured using the generic Short Form-36 Health Survey (SF-36), fatigue using the Multidimensional Fatigue Inventory (MFI) and psychosocial issues using donor specific questions. For each of the 8 domains of SF-36 and the 5 domains of MFI, we performed generalized linear regression. RESULTS: Donors scored high on QOL with mean scores between 63.9 and 91.4 (scale 1-100) for the 8 subscales. Recognition from family and friends was associated with higher QOL scores in four domains. There were no significant gender differences. Fatigue scores were generally low. Females generally scored higher than males on all five dimensions of fatigue, although significantly only on two. Recipient still alive was associated with lower scores on mental fatigue. Regretting donors scored higher than average on all domains of fatigue. Recipient death, worries about own health and worsened relationship with the recipient influenced willingness to donate in retrospect. Donor age did not affect long-term health outcomes. CONCLUSIONS: Eight till 12 years after donation QOL scores were generally high and improved with recogniton from family and friends. Fatigue was independent of donor age and more pronounced in females and in those who regretted donation.

Parent-healthcare provider interaction during peripheral vein cannulation with resistive preschool children.

AIM: The aim of this study was to increase understanding of parent-healthcare provider interaction in situations where newly admitted preschool children resist peripheral vein cannulation. BACKGROUND: Parent-healthcare provider interaction represents an important context for understanding children's resistance to medical procedures. Knowledge about this interaction can provide a better understanding of how restraint is used and talked about. Symbolic interactionism informed the understanding of interaction. DESIGN: An exploratory, qualitative study was chosen because little is known about these interactions. METHODS: During 2012-2013, 14 naturalistic peripheral vein cannulation -attempts with six newly hospitalized preschool children were video recorded. Eight parents/relatives, seven physicians and eight nurses participated in this study. The analytical foci of turn-taking and participant structure were used. RESULTS: The results comprised three patterns of interactions. The first pattern, 'parents supported the interaction initiated by healthcare providers', was a response to the children's expressed resistance and they performed firm restraint together. The second pattern, 'parents create distance in interaction with healthcare providers', appeared after failed attempts and had a short time span. Parents stopped following up on the healthcare providers' interaction and their restraint became less firm. In the third pattern, 'healthcare providers reorient in interaction', healthcare providers took over more of the restraint and either helped each other to continue the interaction or they stopped it. CONCLUSION: Knowledge about the identified patterns of interactions can help healthcare providers to better understand and thereby prepare both parents and themselves for situations with potential use of restraint.

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

BACKGROUND: Multi-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. METHODS: We 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. RESULTS: We 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. CONCLUSIONS: A 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.

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

BACKGROUND: Children 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. METHODS: To 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. RESULTS: Fourteen 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. CONCLUSIONS: We 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.

Characteristics of the relationship that develops from nurse-caregiver communication during telecare.

AIMS AND OBJECTIVES: To explore the relationship between nurses and caregivers using a web camera and web forum as the communication methods. BACKGROUND: In Norway and other European countries, there is an increased focus on ageing at home, which is aided by technology, as well as formal and informal care. The literature reveals that caregivers endure physical and mental burdens. With computer-mediated communication, such as telecare, it is possible for nurses to provide supportive care to caregivers in their homes. DESIGN: An explorative design using qualitative content analysis. METHOD: Six nurses and nine caregivers with residential spouses suffering from stroke or dementia were interviewed two times over a six-month period. RESULTS: The nurses responded dynamically to the information they received and helped to empower the individual caregivers and to strengthen the interpersonal relationships between the caregivers. While some participants thought that meeting in a virtual room was close and intimate, others wanted to maintain a certain distance. The participants' altered their roles as the masters and receivers of knowledge and experience; this variation was based on a relationship in which mutual respect for one another and an interest in learning from one another allowed them to work together as partners to demonstrate the system and to follow-up with new caregivers. CONCLUSIONS: The flexibility of the service allows the possibility of engaging in a close, or to some extent, a more distant relationship, depending on the participants' attitudes towards using this type of service. RELEVANCE TO CLINICAL PRACTICE: Nurses can provide close care, support and information to caregivers who endeavour to master their everyday lives together with their sick spouses. The support seems to help the caregivers cope with their own physical and emotional problems.

Older users' perspectives on the benefits of preventive home visits.

In this article we explore older people's perspectives on the benefits of preventive home visits (PHVs), after long-term follow-up. PHVs are health services intended to promote older people's health and independence, prevent disease, and postpone functional decline. We applied an explorative and descriptive design and analyzed qualitative research interviews of 10 PHV users who had received multiple visits for at least 6 years. We sought manifest and latent content in our analysis. The participants reported benefits falling within four main categories: to feel safe, to manage everyday life, to live well, and to be somebody. Two latent themes emerged: living with an underlying, realistic concern about an uncertain future, and striving to maintain oneself as a person. The perceived benefits of PHVs differed significantly from the outcome measures commonly used in randomized, controlled trials. PHV interventions should have a longitudinal approach and support each person's current needs and valued goals.

Nursing older people-competence evaluation tool: development and psychometric evaluation.

BACKGROUND AND PURPOSE: To evaluate the quality of care provided to older people, the competence of the nursing staff must be measured. This study evaluates a new instrument called Nursing Older People-Competence Evaluation Tool (NOP-CET). METHODS: A 65-item questionnaire was completed by 1,016 community-based nursing staff and evaluated for validity, reliability, precision, interpretability, acceptability, and feasibility. RESULTS: The survey demonstrated good content validity; conceptually coherent factor structure explaining 54.98% (knowledge items), 65.03% (skills items), and 52.83% (personal attribute items) of the total variance; and internal consistency (.77-.93). CONCLUSIONS: The NOP-CET showed good validity and reliability as a measure of community-based nursing staff competence and may be used in further investigations of competence in older people nursing.

Experienced nurses' use of non-pharmacological approaches comprise more than relief from pain.

This study investigated the use of, and reasoning by, experienced nurses regarding non-pharmacological pain approaches to care for children in hospitals, with the aim of increasing our understanding, and hence optimizing, these approaches. Three focus-group interviews with 14 experienced nurses, were conducted in 2009. Our findings emphasized the role of non-pharmacological methods in building and maintaining cooperation with the child and in caring for the child by individualizing the use of non-pharmacological methods.

Adherence to oxygenation and ventilation targets in mechanically ventilated premature and sick newborns: a retrospective study.

BACKGROUND: Ventilator treatment exposes newborns to both hyperoxemia and hyperventilation. It is not known how common hyperoxemia and hyperventilation are in neonatal intensive care units in Norway. The purpose of this study was to assess the quality of current care by studying deviations from the target range of charted oxygenation and ventilation parameters in newborns receiving mechanical ventilation. METHODS: Single centre, retrospective chart review that focused on oxygen and ventilator treatment practices. RESULTS: The bedside intensive care charts of 138 newborns reflected 4978 hours of ventilator time. Arterial blood gases were charted in 1170 samples. In oxygen-supplemented newborns, high arterial pressure of oxygen (PaO2) values were observed in 87/609 (14%) samples. In extremely premature newborns only 5% of the recorded PaO2 values were high. Low arterial pressure of CO2 (PaCO2) values were recorded in 187/1170 (16%) samples, and 64 (34%) of these were < 4 kPa. Half of all low values were measured in extremely premature newborns. Tidal volumes above the target range were noted in 22% of premature and 20% of full-term newborns. CONCLUSIONS: There was a low prevalence of high PaO2 values in premature newborns, which increased significantly with gestational age (GA). The prevalence of low PaCO2 values was highest among extremely premature newborns and decreased with increasing GA. Further studies are needed to identify whether adherence to oxygenation and ventilation targets can be improved by clearer communication and allocation of responsibilities between nurses and physicians.

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.

Individuals living with a liver transplant - a follow-up study exploring mental, emotional and existential issues 10 years after transplantation.

BACKGROUND: Going through a liver transplantation is by many recipients considered mentally and emotionally burdensome. AIM: The aim of this study was to explore individuals' mental, emotional and existential experiences living with a liver transplant during a period of approximately ten years. METHODOLOGICAL DESIGN: The methodology in this study is based on Gadamer's hermeneutics. Galvin and Todres' conceptual framework on well-being was applied in the interpretation process. RESEARCH METHODS: Both researchers conducted interviews, which took the form of conversations. We made use of Brinkmann and Kvales' three types of interpretation. ETHICAL ISSUES AND APPROVAL: The study was approved by the Ombudsman for Privacy of the Norwegian Social Data Services and is based on informed consent and confidentiality. RESULTS: Three themes emerged through interpretation: 1. From great suffering to gratitude and a humble attitude towards life. 2. From living in uncertainty to leading a normal life. 3. From hopelessness and anxiety to an indifferent attitude towards life. CONCLUSION: This study showed that the process of receiving a new liver and living with it, had changed most of the participants' attitudes towards life in a humble way. Some persons struggled with life and experienced depression anxiety, as well as lack of energy.

Influence of simulation and clinical settings on peripheral vein cannulation skill learning in nursing education: A qualitative study.

Background: Peripheral vein cannulation is a complex yet common practical skill. Learning to insert a peripheral vein cannula is fundamental in nursing education; however, the most beneficial pedagogical approaches are yet to be elucidated. Objective: To explore and impart a deeper understanding of the learning conditions in nursing education for developing competency in peripheral vein cannulation. Design: Qualitative, explorative. and comparative research design. Settings: Two nursing educational settings in southern Norway: an academic setting for simulation-based peripheral vein cannulation skill learning, followed by a hospital setting that provided a 9 week clinical placement period. Participants: Nine student nurses in the second year of a bachelor's programme in nursing. Methods: Focus group interviews, individual interviews, and ad hoc conversations with the student nurses on their experiences during and after the process of developing competency in peripheral vein cannulation. Thematic analysis was used to identify categories and common themes. Results: Eight major themes were identified: 'Anatomical and physiological conditions related to the training modalities', 'Realism in training', 'Sequences in peripheral vein cannulation training', 'Different training modalities affording varied learning opportunities', 'Professional nursing assessments', 'Patients' and peers' emotional reactions', 'Student nurses' own emotional reactions', and 'Significance of the relationship between the student nurse and patient'. Conclusions: Simulation-based peripheral vein cannulation practice was an important starting point for the students' skill learning. However, the students experienced the complexity of the skill only in the clinical setting because it offered several learning opportunities. Nonetheless, our findings indicate a need to further review peripheral vein cannulation skill learning, especially patient contributing factors, to enhance the transfer of learning from the simulation setting to the clinical setting. Tweetable abstract: Clinical setting-based peripheral vein cannulation practice is vital for student nurses' skill learning because of the skill's complexity.

Intensive care nurses' perceptions of their professional competence in the organ donor process: a national survey.

AIMS: This paper is a report of a study that explored Norwegian intensive care nurses' perceptions of their professional competence to identify educational needs in the organ donor process. BACKGROUND: Intensive care professionals are requested to consider organ donation each time they care for patients with severe cerebral lesion to ensure donor organs for transplantation. The donor process challenges intensive care nurses' professional competence. Nurses' knowledge and experience may influence their professional competence in caring for organ donors and their relatives. METHODS.: A cross-sectional survey was conducted in all 28 Norwegian donor hospitals between October 2008 and January 2009. Intensive care nurses (N = 801) were invited to participate and the response rate was 71·4%. Dimensions of professional competence, learning needs and contextual and demographic variables were explored. Data were analysed using descriptive and inferential statistics. FINDINGS: Few intensive care nurses had extensive experience of or competence and training in organ donation. Nurses working at university hospitals had more experience, but lesser training than nurses in local hospitals. Experience of donor acquisition had an impact on intensive care nurses' perceptions of their professional competence in the donor process. Discussions on the ward and educational input were seen as important for the further development of professional competence. CONCLUSION: Training provided by experienced colleagues and a culture that encourages discussion about aspects of the donor process can develop nurses' professional competence and communally defined professional practice. Educational input that cultivates various types of knowledge can be beneficial in organ donation.

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.