Nurse Manager's Responsibilities in Creating Supportive Working Conditions Post Implementation of Everyday Coping: A Hermeneutic Research Study of District Nurses' Experiences.

Aim: To gain knowledge about how district nurses experience changes in working conditions and discuss nursing manager's responsibility in facilitating working conditions for district nurses following the implementation of everyday coping. Background: To overcome the challenges related to the sustainability of the healthcare sector, everyday coping was implemented in district nursing. The implementation was set by the government and implemented by the municipality. The nursing manager has an overall responsibility to facilitate working conditions so that everyday coping can be applied into district nursing practice. Method: This descriptive and interpretative study involved 19 interviews and 19 observations on 10 nurses. Kvale and Brinkmann's three levels of understanding were employed in the analysis. Results: Three categories were established based on the results of the data analyses: (i) time and space are not considered, (ii) crossfire of conflicting expectations, and (iii) nursing manager's commitment to everyday coping. Conclusion: The working conditions of district nurses are not adapted for them to work according to the everyday coping mindset. The nursing manager has a key role in supporting nurses and addressing challenges the nurses meet in their daily work, where everyday coping is implemented. The study highlights the importance for healthcare managers, at various levels in the healthcare sector, to be conscious of the district nursing practice, its complexity, and quality of health services when implementing change. This knowledge is important when planning future healthcare and nursing practice.

Caring for a home-dwelling older parent with mental health problems: a narrative analysis of family caregivers' experiences.

PURPOSE: To gain knowledge regarding family caregivers of home-dwelling older adults with mental health problems and the meaning-making of the caregiver's role. DESIGN: An explorative qualitative study involving narrative analysis. METHODS: Semi-structured individual interviews were conducted among eight adult children. Interview data were analysed using narrative analysis. The reporting adhered to consolidated criteria for reporting qualitative studies. RESULTS: Each participant narrated unique and nuanced stories of the caregiver role, but their stories also revealed prominent themes across participants' experiences and meaning-making. The analysis revealed three themes: family relationships through a long life, a demanding and difficult caregiver role, and reconstructing the caregiver's role by leaving the responsibility to healthcare services. CONCLUSION: Family caregivers experienced the role as purposeful and demanding. Mostly, psychological reactions to behaviour symptoms and duration of caregiving were considered difficult and demanding. They described that they lacked knowledge of the illness and how to perform care. Sharing care responsibility with healthcare services had the potential to ease family caregivers' burden. However, based on a long life as caregivers, some experienced difficulties when reconstructing and adjusting the role to their life situation.

Alternative Clinical Practice During the COVID-19 Pandemic: A Qualitative Study of Nursing Students' Potential Loss of Experience.

Introduction: During the COVID-19 pandemic, the lockdown of nursing institutions changed nursing students' learning conditions in clinical practice. They were removed from their ordinary clinical practice and isolated in their homes for one week before resuming an alternative clinical practice. Owing to the changed learning conditions, nursing students had to readjust and find new and different solutions to manage their own learning. Objectives: This study aimed to investigate the impact of removing first-year nursing students from clinical practice during the COVID-19 pandemic on their perceived learning and development. Methods: A qualitative descriptive and interpretative design based on group and individual interviews was used. Eleven first-year nursing students from a university college in Norway participated in the study. They were interviewed from their homes, after completing their first 10-week clinical practice. Three group interviews and two individual interviews were recorded using the digital live video aid Zoom and analyzed using systematic text condensation. Results: The main theme "loss of experience," summarized how the nursing students experienced their first clinical practice during the COVID-19 lockdown. The nursing students shifted from a predictable to an unpredictable clinical practice without supervision from the nurse supervisor or the nurse educator. The organization and planning of the practice were left to the students, who bore the responsibility of achieving the learning outcomes. Three categories were identified: unpredictable learning situations, compensating learning activities, and achieving learning outcomes. Conclusions: Nursing students faced difficulties in their first clinical practice during the COVID-19 lockdown, which made a challenging study situation. Too much autonomy and responsibility for their own learning reinforced a loss of experience. The uncertainty of the study situation potentially harmed their professional development, learning outcomes, and self-efficacy, especially concerning basic nursing skills.

Giving Voice to People with Dementia and Perspectives Regarding a Dementia-Friendly Society: A Synthesis of Qualitative Studies.

Introduction: The World Health Organization [WHO] and governments worldwide envision the development of dementia-friendly societies that are based on a person-centered culture. A limited number of studies have described the features of dementia-friendly societies based on the viewpoints of people with dementia. Purpose: To synthesize qualitative empirical research that expands the knowledge of what people with dementia consider to be essential for daily living in a dementia-friendly society. Methods: The authors searched phrases in the databases AgeLine, CINAHL, EMBASE, MedLine, PsycINFO, PubMed, ORIA, SveMed+, and Cochrane Library. Research articles that involved people with dementia and were conducted in Western countries, written in English, published in peer-reviewed academic journals using qualitative methods, and published within the past decade were included. The research included was critically and systematically appraised using the critical appraisal skills program checklist for qualitative research, and the findings were analyzed according to Graneheim and Lundman's method of qualitative content analysis. Results: Overall, 1122 records-561 from 2019 and 561 from 2021-were identified through the search, and nine studies were included in the final synthesis. The studies included were from the United Kingdom (five studies), Australia (three studies), and New Zealand (one study). Through the analysis process, the following main theme emerged: giving voice to people with dementia, which summarizes the essence of what people with dementia believe is essential for daily living in a dementia-friendly society. The main theme covered two themes: a sense of being valued and a sense of being safeguarded, each of which contained subthemes. Conclusion: To meet the WHO's and the governments worldwide intention to develop dementia-friendly societies, further research should focus on the voices of people with dementia. By including those concerned, the political goals of a dementia-friendly society can be achieved.

Politically Engaged Mindset of Everyday Coping in Relation to Nursing Values: A Phenomenological-Hermeneutic Study of District Nurses' Experiences.

Introduction: To accommodate challenges threatening the healthcare sector's sustainability, district nursing in Norway implemented the rehabilitative and health promoting mindset of everyday coping. When implementing new ideas and practices in nursing care, understanding the significance of this mindset on patient care and whether it corresponds to nursing values are important to ensure healthcare quality. Objective: This study aimed to understand how nurses practice care where everyday coping is implemented in district nursing and their experience of everyday coping as a mindset in relation to nursing values. Methods: A qualitative study was conducted including 19 observations and 19 narrative interviews with 10 district nurses, during two data collection periods. Data were analyzed using a phenomenological-hermeneutic method. The analysis process consisted of three steps: naïve reading, structural analysis, and comprehensive understanding. Results: The following two main themes and four sub-themes emerged from the data analyses: (i) Understanding individual patient situations; "Creating a nurse-patient relationship to understand the patient landscape" and "providing care based on individual patient needs," (ii) knowing when and how to motivate or help patients; "distinction between motivating patients and causing stress" and "realistic and desirable demands to motivate patients to perform tasks." Conclusion: Participants determined how to provide care to patients based on their values, professional knowledge, and individual patient situations. The patient landscape is diverse and everyday coping is unable to capture the diversity of patient groups. Thus, everyday coping is not expressed as an overall mindset in nursing practice.

Working in a minefield; Nurses' strategies for handling medicine administration interruptions in hospitals, -a qualtiative interview study.

BACKGROUND: Administering medicines is one of the most high-risk tasks in health care. However, nurses are frequently interrupted during medicine administration, which jeopardises patient safety. Few studies have examined nurses' experiences and the strategies they adopt to cope with interruptions during medicine rounds. This paper identifies nurses' strategies for handling and reducing interruptions and ensuring safety during medicine rounds, within the confines of the hospitals' organisational systems. METHODS: This descriptive and exploratory research study was undertaken with experienced nurses in Norwegian hospitals in 2015 using semi-structured interviews. Interviews were designed to elicit experiences and strategies used for handling interruptions to medicine rounds. Data were analysed using qualitative content analysis based on inductive reasoning to identify meaningful subjects and reach an interpretive level of understanding regarding nurses' experiences. RESULTS: All 19 senior nurses who were approached were interviewed. From 644 condensed meaning units, we identified eight interpretative units and three themes: 'working in environments of interruptions', 'personal coping strategies', and 'management-related strategies'. Nurses' working environments were characterised by interruptions and distractions, which often threatened patient safety. To handle this unpredictability and maintain ward organisation, nurses developed their own personal strategies to overcome inherent problems with their working conditions, the absence of effective management, and colleagues' reluctance to assume responsibility for minimising interruptions. CONCLUSIONS: Administration of medicines in hospitals can be described as 'working in a minefield'. Our findings indicate that the hospital management, in cooperation with nurses and other healthcare professionals, should take responsibility for improving the routine process of medicine administration by minimising avoidable interruptions. Patient safety can be improved when the hospital management takes steps to protect nurses' work environments and assumes responsibility for resolving these challenges.

"Human Flourishing with Dignity": A Meta-Ethnography of the Meaning of Gardens for Elderly in Nursing Homes and Residential Care Settings.

This study aims to identify and synthesize qualitative research regarding residents' experiences of gardens while living in nursing homes and residential care facilities. To provide an optimal nursing environment inspired by nature, we need to derive knowledge from the residents' perspective. An interpretive meta-synthesis approach, a meta-ethnography, was chosen for this study. Altogether, six articles representing three continents and comprising 124 participants were included. The six articles that fulfilled the inclusion criteria were analyzed and synthesized according to Noblit & Hare's seven phases of meta-ethnography and the recent eMERGe guidelines. Four themes were identified: (1) The garden-a place to feel a connection with life, (2) the garden-a place to sense and find comfort, (3) the garden-a place to feel healthy and alive, and (4) the garden-a place to relate past and present. An overarching metaphor, "human flourishing with dignity," offers a deeper understanding of the meaning of the garden for older people in nursing homes and residential care. This meta-ethnography provides a reflective, systematic, data-driven synthesis based on literature spanning ten years. Rather than simply relying on retelling, the narration of experiences according to the primary researcher's descriptions and interpretations results in new knowledge. The significance of gardens for older people's health and well-being needs to be given greater attention and space in nursing practice, education, and health policies.

Rehabilitation of the frail older adults in primary healthcare in rural areas: a scoping review protocol.

INTRODUCTION: Frail older adults are particularly vulnerable to functional decline and adverse outcomes because they lack the necessary resistance and ability to cope. Rehabilitation services for the frail older adults are thus vital and require clarification. The aim of this review is to identify and map the scope and breadth of literature regarding rehabilitation of the frail older adults to develop a holistic rehabilitation service in primary healthcare in rural areas. The concept of rehabilitation, how rehabilitation services are organised, how patients and next of kin are involved in planning and evaluating services during rehabilitation, as well as reported results will be identified and mapped. METHODS AND ANALYSIS: This scoping review will be conducted based on the methodology developed by Arksey and O'Malley. The search strategy will aim to locate both published and unpublished studies in relevant databases. Key information sources include CINAHL, MEDLINE, Embase, ProQuest and Google Scholar. Data will be extracted from papers that all three reviewers have chosen to include in the review. All three reviewers will participate in screening, assessment and selection of studies against the inclusion criteria for the review and work in teams of two. The full text of selected citations will be assessed in detail against the inclusion criteria by the same teams. Data will be extracted from papers included in the scoping review by two of the reviewers. Modifications will be detailed in the full review report. Any disagreements that arise between two reviewers will be resolved through discussion or with the third reviewer's mediation. A narrative summary of the findings will be presented accompanied by tables that reflect the objective of the review. ETHICS AND DISSEMINATION: Data will be obtained only from already publicly available materials. Special ethical approval is, therefore, not required.

Development and Psychometric Properties Evaluation of a Care Needs Questionnaire in Phase 1 Cardiac Rehabilitation for Patients with Coronary Artery Disease: CNCR-Q.

Introduction: Cardiovascular diseases (CVDs) are one of the most common chronic illnesses and the leading cause of mortality worldwide. This study aimed to design and assess the psychometric properties of questionnaire to examine the care needs of patients with coronary artery disease (CAD) in phase 1 of cardiac rehabilitation (CR). Methods: This sequential exploratory study used a mixed method with two phases. In the first phase, qualitative study was performed by analyzing the concept of Schwartz-Barcott-Kim hybrid model; and in the second phase, quantitative data were obtained and analyzed for the psychometric parameters of the designed tool. Results: The questionnaire for care needs was based on the indicators of measurement, which was identified in the qualitative phase of the study, as a tool with 40 items. After conducting face validity qualitatively, all tool items were considered important and were retained for the next steps. After completing the steps for determining the content validity ratio (CVR) and content validity index (CVI) of 40 items, they were preserved for decision making at a later stage. The results of exploratory factor analysis revealed four factors; the factor analysis of three items was eliminated and the final version of the questionnaire CNCR-Q (Care Needs Cardiac Rehabilitation-Questionnaire) with 37 items remained. Conclusion: The findings indicated that the questionnaire with properties, such as simple scoring, reliability and validity, is an appropriate tool for assessing care needs in Iranian patients with CAD. Moreover, the CNCR-Q is an effective instrument for assessing patient needs before discharge.

Narratives in student nurses' knowledge development: A hermeneutical research study.

BACKGROUND: Knowledge development, and how student nurses learn to be nurses, is essential in nurse education and has implications for quality of care. There is a lack of research concerning how student nurses' knowledge development is expressed through narratives and how they deal with challenges in patient situations in professional learning. OBJECTIVES: To clarify the usefulness of narratives in student nurses' knowledge development and the narratives implications for learning in clinical training. DESIGN AND METHODS: The study has a qualitative design with field methodology. Data consisted of observations, interviews, and fieldnotes. The data was analysed, and narratives were developed using Gadamer's hermeneutical circle. PARTICIPANTS AND SETTINGS: Seven first- and second-year student nurses from a bachelor programme were closely followed in different patient situations during their eight weeks of clinical studies in nursing homes. RESULTS: In a sample narrative, a student nurse explained how she reflected on her actions and decisions made when she shielded a patient who was in a difficult situation. CONCLUSION: Narratives are useful for the development of student nurses' knowledge in clinical training. Student nurses' decisions and actions in the patient situation are made evident through narratives. Nursing educators and student nurses awareness of the relevance of this knowledge for understanding student nurses learning processes is of importance in professional education. Nursing educators should be more open minded to narratives as a starting point for reflection. Increased use of narratives in professional education will contribute to development of knowledge so that student nurses can manage to face patient situations as long as the situation themselves demands. Areas for further studies are other professional educations, for examples, doctor, physiotherapist, and occupational therapist.

Appreciative inquiry in a Norwegian nursing home: a unifying and maturing process to forward new knowledge and new practice.

PURPOSE: Appreciative inquiry (AI) studies have proven to be useful in developing nursing knowledge and changing nursing practice. However, few AI studies have examined the meaning of participation over time among collaborating healthcare providers. Our aim was to explore and illuminate healthcare providers' participation over time in a Norwegian nursing home to develop new knowledge and practice, focusing on sensory gardens. METHOD: Twenty healthcare providers participated in the 3 year AI study. Data were collected in fieldwork, interviews, and interventions. Saldañas' longitudinal analysis was applied. RESULTS: The collaboration between the researcher and participants created insight of a relational room, which was named "the room of closeness". Participants' search for new arenas to apply the meaning of the room of closeness was found when focusing on the sensory garden. Their desire for joint development created a bottom-up perspective, the hallmark of successful AI. CONCLUSION: Knowledge of participants' experiences may contribute to developing AI as a useful and transferable method, especially regarding co-creating participation, and may have implications for research and society. AI's strength-based approach may, however, lead to the neglect of data that are associated with problems, and complicate the assessment of success. Further research is therefore needed to develop AI.

Conflicting priorities: Observation of medicine administration.

AIMS AND OBJECTIVES: To identify sources of interruptions and distractions to medicine administration rounds in hospitals. BACKGROUND: Nurses are frequently interrupted during medicine administration. There is no systematic description of nurses' behaviours and interruptions during administration of medicines to patients. DESIGN: Exploratory nonparticipant observational study. METHODS: Three hundred and fifty-one episodes of medicine administration with 32 nurses from three hospitals in Norway were observed using paper-based observation grids between December 2013 and March 2014. RESULTS: Nurses were frequently interrupted and distracted, mainly by nurses and other healthcare professionals. One-third of the nurses interrupted their medicine administration: They prioritised helping patients with direct patient care. When the nurses were interrupted, they left the round and re-entered the procedure. Even so, they managed to refocus and continue to administer the medicines: Interruptions and disturbances made little difference to most behaviours and actions, possibly because nurses double-checked more frequently. Some differences were seen in behaviours potentially affecting the safety of the medicine administration, such as leaving medicines at the bedside and not helping patients take their medicines. Some interruptions were avoidable, such as those by other nurses and professionals. CONCLUSIONS: This study offers insights into nurses' behaviours and actions when they are interrupted and distracted during medicine administration. The findings highlight a conflict for nurses administering medicines. Nurses are forced to prioritise between two important activities: direct patient care and medicine administration. Management and education providers need to recognise that nurse interrupting each other is a potential threat to patient safety. RELEVANCE TO CLINICAL PRACTICE: Our data indicate that nurses and other healthcare professionals should be warned not to interrupt colleague administering medicines and managers should ensure other staff are available to respond to patients' immediate needs during medicine rounds.

Relationship between High School Mathematics Grade and Number of Attempts Required to Pass the Medication Calculation Test in Nurse Education: An Explorative Study.

In Norwegian nurse education, students are required to achieve a perfect score in a medication calculation test before undertaking their first practice period during the second semester. Passing the test is a challenge, and students often require several attempts. Adverse events in medication administration can be related to poor mathematical skills. The purpose of this study was to explore the relationship between high school mathematics grade and the number of attempts required to pass the medication calculation test in nurse education. The study used an exploratory design. The participants were 90 students enrolled in a bachelor's nursing program. They completed a self-report questionnaire, and statistical analysis was performed. The results provided no basis for the conclusion that a statistical relationship existed between high school mathematics grade and number of attempts required to pass the medication calculation test. Regardless of their grades in mathematics, 43% of the students passed the medication calculation test on the first attempt. All of the students who had achieved grade 5 had passed by the third attempt. High grades in mathematics were not crucial to passing the medication calculation test. Nonetheless, the grade may be important in ensuring a pass within fewer attempts.