Nurse Anesthetist Practice Over 40 Years: A Repeated Cross-Sectional Study in Norway.

Research focusing on the scope of practice by nurse anesthetists (NAs) is limited. The purpose of this study was to examine NAs' scope of practice in Norway, and to explore whether and how this has changed during the period from 1979 to 2018. The study had a repeated crosssectional design. All members of the Norwegian Association of Nurse Anesthetists at the four time-points (1979, 1989, 1999 and 2018) were invited to participate in a questionnaire study. Inclusion criteria were education and work as an NA and currently working in Norway. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Findings indicate that the scope of NAs' practice in Norway has been increasingly restricted from 1979 to 2018 (N = 2171, P < .001). Additionally, the presence of an anesthesiologist when performing anesthesia had significantly increased during that time (39% in 1979 vs 90% in 2018). However, NAs' independent practice significantly increased in some areas, such as handling of acute situations, (i.e., handling of laryngospasm/bronchospasm [41% in 1979 versus 54% in 2018]). International and national standards underline the independent role of NAs. The development shown in our results should be addressed to avoid further restrictions of NAs' scope of practice.

Barriers and facilitators for leading nursing homes through the COVID-19 pandemic: A focus group study in Norway.

BACKGROUND: During the COVID-19 pandemic, nursing home leaders implemented infection control to protect residents and staff. AIM: To understand the barriers and facilitators for leading nursing homes through the COVID-19 pandemic. METHODS: We invited 34 nursing homes to participate, and 20 leaders (59%) attended focus group interviews. The COM-B model and the theoretical domains framework were used in design and analysis of the study. RESULTS: The barriers for infection control were organisational unpreparedness, high volumes of information, lack of clinical skills, protective equipment, and testing capacity, the nursing home's architectural design, health authorities' low priority of nursing homes, staff's fear, and mental pressure on the leaders over time. The facilitators were having a customised corona plan, change of routines, certification of new skills, access to the municipal quality system, the ability for crisis leadership, loyalty to the nursing home, and support from the environment. The number of part-time positions and the opportunity to outsource parts of the services were also important determinants for infection control. CONCLUSIONS: The results identify several barriers and facilitators for nursing home leaders' behaviour for infection control. The results confirm the importance of supporting the leaders' resilience and crisis leadership while working in the pressurised environment of a pandemic. RELEVANCE TO CLINICAL PRACTICE: The study provides important insights into barriers and facilitators for leading nursing homes through the COVID-19 pandemic, which could help to inform future strategies for infection control. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Salutogenic nursing home care: Antonovsky's salutogenic health theory as a guide to wellbeing.

The nursing home (NH) population is characterized by a high symptom burden resulting from chronic illnesses and functional impairments that cannot be cured. Most long-term NH residents are in the last phase of life and in need of palliative care. Hence, health and wellbeing are important aims of salutogenic NH care, which includes more than the treatment of residents' diseases and symptoms. Research shows that cognitively intact long-term NH residents with a high score on sense of coherence (SOC) experience better wellbeing. Therefore, NH care should be developed in a salutogenic direction, promoting residents' health and wellbeing by identifying general and specific resistant resources and facilitating residents' perceived SOC. Based on Antonovsky's salutogenic health theory and focusing on SOC comprising comprehensibility, manageability and meaningfulness along with resistance resources, this article discusses how nurses can apply salutogenic knowledge as a guide to promote wellbeing among long-term NH residents.

How nursing care is expressed among nurse anaesthetists in the perioperative context: A meta-ethnographic synthesis.

AIM: To develop a conceptual framework describing nursing care from the anaesthesia nurse's perspective in the perioperative context. BACKGROUND: Surgical patients find themselves in a vulnerable situation in need of advanced treatment and care. Nurse anaesthetists have a central role in reducing harm and enhance patient safety, in which person-centred care has been identified as a key component. However, they are challenged by productivity and efficiency demands leading to a potential risk to patient safety. DESIGN: Noblit and Hare's interpretative meta-ethnography, directed by the eMERGe reporting guidance. METHODS: A comprehensive systematic search of nine databases without year limitation. Fifteen studies published between 2002 and 2021 were found eligible for inclusion. Quality appraisal was performed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. RESULTS: Four themes were identified: being vigilant to keep safe from harm, strengthening patients' confidence, expressing courage to act and speak up, and endorsing team collaboration to achieve best practice. The themes were synthesised into the metaphor, 'Continuously assessing and acting according to the patients' needs in a holistic perspective'. A conceptual framework was developed, illustrating the interconnection between the different nursing expressions, as the nurse anaesthetists seek to care for the patient as a whole person. CONCLUSIONS: Nurse anaesthetists aim to deliver holistic nursing care. Nursing care is expressed at two levels, foregrounding and backgrounding anaesthetic nursing, in line with the philosophy of person-centred care. Nursing care in anaesthesia is a matter of how and why it is performed, expressed in attitudes toward the recipients of care. RELEVANCE TO CLINICAL PRACTICE: The framework may be used to inform educational programs and clinical practice in nurse anaesthesia and to promote person-centred care as a shared value across all levels involved in perioperative patient care. NO PATIENT OR PUBLIC CONTRIBUTION: Data were retrieved from already published literature.

The effect of transitions intervention to ensure patient safety and satisfaction when transferred from hospital to home health care-A systematic review.

AIM: The aim of this systematic review is to describe and evaluate the effectiveness of transition interventions to safeguard patient safety and satisfaction during patients' transition from hospital to home health care. DESIGN: Systematic review. DATA SOURCES: MEDLINE, Ovid Nursing Database, PsycINFO, EMBASE, CINAHL, Clinical Trials and SveMed+ was systematic searched in January 2019 and September 2020 to identify peer-reviewed papers. No language, geographical or publication date restrictions. REVIEW METHODS: Cochrane Handbook for Systematic Reviews of Interventions was used. Data analysis focused on aggregated data and a descriptive synthesis. Risk of bias was rated using Cochrane risk-of-bias tool. RESULTS: In total, 10,524 references were identified in the literature search, twenty-six articles were included. The interventions were divided into three main groups: (i). systematic patient education pre-discharge; (ii). establishment of contact with the local healthcare services pre-discharge and (iii). follow-up initiated by nurses from the hospital at home post-discharge. The studies either used one intervention or combined two or three interventions. We considered the intervention to improve patient safety or satisfaction when they reported statistically significant results. Only four interventions increased both patient safety and satisfaction, seven interventions increased patient safety and thirteen increased patient satisfaction. Interventions that appear to be quite similar, with the same duration, measured different effects on patients' satisfaction and safety. Interventions that ensured patient safety did not necessarily facilitate patient satisfaction and vice versa. CONCLUSION: Interventions can improve patient safety and satisfaction during transfer. However, interventions that improve patient safety or satisfaction do not always match. IMPACT: This review suggests that transition interventions can improve patients' safety and satisfaction. However, to compare the impact of future interventions is it important to use standardized measurement tools of satisfaction. There is a need to try out tailored interventions, where interventions are customized to the needs of each patient.

Development of the Breast Cancer Survivors Symptom Checklist for Use in Follow-Up Multidisciplinary Appointments.

Background: Breast cancer survivors are primarily followed up to monitor the effectiveness of treatment and complications and to detect recurrences. Many breast cancer survivors may experience prolonged adverse physical and psychological effects, which should also be addressed at follow-ups. The objective of this study was to develop a brief symptom assessment tool for breast cancer survivors to be used as a guideline for the survivors and all health care professionals conducting the routine follow-up. The second objective was to describe the women's individual experiences with follow-ups. Methods: A literature review, a focus group of 6 healthcare professionals using a nominal group technique process, and the experience and feedback via qualitative interviews with 16 breast cancer survivors was used to develop the Breast Cancer Survivors Symptom Assessment Checklist (BCS-SC). Results: The BCS-SC consists of a set of 13 symptoms/burdens and one question. On a scale from 0 (no symptom) to 10 (worst imaginable), survivors indicated the extent to which they experience each symptom. All survivors perceived the annual follow-ups as important, but none prepared for them. Eight of the 16 survivors reported that they had 2 or more of the symptoms/burdens listed in the BCS-SC. However, only one of the survivors had mentioned her symptom to the doctor at follow-up. Conclusion: The BCS-SC is a comprehensive assessment tool for symptoms/burdens that are common among breast cancer survivors and can aid efforts to optimize their follow-up. Furthermore, the BCS-SC allows for a more patient-initiated and focused consultation, leading to more patient-centered quality care.

Nursing Education: Students' Narratives of Moral Distress in Clinical Practice.

BACKGROUND: Research indicates that newly graduated nurses are often unprepared for meeting challenging situations in clinical practice. This phenomenon is referred to as a "reality shock". This gap in preparedness may lead to moral distress. The aim of this article is to provide knowledge of moral distress in clinical nursing practice. METHODS: Bachelor and further education nursing students were invited to write a story about challenging situations from their own clinical practice, resulting in 36 stories. Analysis was based on hermeneutical reading inspired by a narrative method; therefore, six stories were selected to represent the findings. RESULTS: A finding across the stories is that the students knew the right thing to do but ended up doing nothing. Four themes were related to moral distress: (a) undermining of professional judgement, (b) disagreement concerning treatment and care, (c) undignified care by supervisors, and (d) colliding values and priorities of care. CONCLUSION: Nursing education should emphasize to a greater extent ethical competency and training for the challenging situations students will encounter in clinical practice.

Quality of life of women living with metastatic breast cancer and receiving palliative care: A systematic review.

The quality of life (QoL) of women living with metastatic breast cancer and receiving palliative care needs more attention. We reviewed published studies (1992-2019) examining QoL of women receiving palliative care. The findings were interpreted according to the World Health Organization's (WHO) definition of palliative care. Four themes emerged: (1) the impact of medical treatment on pain relief; (2) the need for psychosocial attention and support; (3) the necessity of an interdisciplinary approach; (4) ambiguous understanding of the term palliative care. A common understanding of the term palliative care and more research is needed to enhance the QoL of women living with metastatic breast cancer.

"I Have Both Lost and Gained." Norwegian Survivors' Experiences of Coping 9 Years After Primary Breast Cancer Surgery.

BACKGROUND: Increased breast cancer survival means that many women live with long-term consequences of their cancer and treatment. Knowledge about their coping is important. OBJECTIVE: This qualitative follow-up study describes survivors' coping experiences 9 years after primary breast cancer surgery. METHODS: Seventeen of the 21 women interviewed 9 years earlier were invited to participate. Fifteen agreed and were interviewed individually between January and June 2015. Qualitative meaning condensation analysis was used. RESULTS: Three themes emerged: (1) Changed life: some felt healthy and beyond cancer; others suffered from reduced energy, joy of life, and self-esteem. Being affected by a life-threatening illness made their fundamental values clearer. Using cancer experiences to help others was emphasized. (2) Positive thinking, distancing the negative: striving to maintain positive thinking and distancing themselves from insecurity and fear of recurrence. A step-by-step strategy was important to cope with their new life situation. (3) Need for understanding and recognition: support was experienced as necessary and challenging. Recognition of posttreatment ailments was emphasized. Being more socially selective and preferring positive people were essential. CONCLUSIONS: Cancer experiences changed the women's lives. Their coping varied. Fewer but selected supporters were preferred. Understanding and recognition from others for the women's changed life situation was essential. IMPLICATIONS FOR PRACTICE: Healthcare professionals should prepare women for a changed life situation because of illness experiences and the adverse effects of treatments. The support and information offered must be adjusted to each woman's individual needs, coping capacity, and life situation. Further clinical intervention studies are needed.

"I just have to move on": Women's coping experiences and reflections following their first year after primary breast cancer surgery.

PURPOSE: The purpose of this qualitative follow-up study was to describe women's individual coping experiences and reflections following their first year after primary breast cancer surgery. METHODS: Using a qualitative descriptive design, we collected data through individual interviews with ten women at a Norwegian university hospital between August 2007 and April 2008. We employed Kvale's method of qualitative meaning condensation analysis. RESULTS: Themes identified were: existential concerns and finding meaning, ways of thinking and feeling about the disease, taking action, and returning to normal life. Most women experienced an increased appreciation of life and greater confidence in themselves, were more caring and compassionate towards others, and focused more on their life priorities. Their family and close relationships became more important. They accepted their situation and made the best of it. Positive thinking, physical activity, self-care, nature, hobbies and work helped. Generally, they were optimistic despite a fear of cancer recurrence and uncertainty about their future. The women wanted to return to a "normal" and healthy life by distancing themselves from both the cancer environment and information about cancer. CONCLUSION: Uncertainty and anxiety about a potential future cancer relapse was a major undercurrent one year following surgery. Our findings emphasize the richness in these women's coping strategies, their different coping profiles and different needs, as well as some general adaptive strategies, which all fluctuated over time. Not all managed to cope equally well. Through awareness of these women's individual experiences and coping strategies, healthcare professionals can enhance these women's coping endeavours.

Women's experiences of social support during the first year following primary breast cancer surgery.

AIM: The aim of this qualitative follow-up study was to describe women's individual experiences of social support during their first year after primary breast cancer surgery. METHOD: Individual semi-structured interviews with 10 women 1 year after surgery analysed by Kvales' meaning condensation method. FINDINGS: Sharing experiences, being understood as an individual, continuity, and information and explanations were themes identified. Sharing mutual experiences increased the women's knowledge regarding cancer, increased experience of support and minimised rumination. After 1 year, the women felt that the network around them had 'normalised' and was less supportive. Being seen as a person, not as 'a diagnosis being treated', and continuity of professional support were important, giving feelings of security and trust. The women felt uncertainty after loss of professional support post-treatment. Information and explanations regarding treatment and treatment-related problems were essential. CONCLUSIONS: Mutual sharing of experiences is an important part of social support. Continuity, availability, information and respect were essential aspects of experienced professional support.

"The support I need": women's experiences of social support after having received breast cancer diagnosis and awaiting surgery.

BACKGROUND: Social support is associated with a better adjustment to breast cancer, whereas inadequate social support increases psychological distress. However, the period between diagnosis and surgery is particularly stressful, and few studies have addressed the significance of social support in this period. OBJECTIVE: The purpose of this study was to describe women's individual experiences of social support after having received a breast cancer diagnosis and awaiting surgery. METHODS: A qualitative descriptive design was used. Individual semistructured interviews were conducted the day before surgery with 21 women aged 41 to 73 years with newly diagnosed breast cancer at a Norwegian university hospital. RESULTS: Methods of qualitative meaning condensation analysis revealed 5 themes: available support, information and advice, care, having confidants, and balancing distance and closeness. Knowing that both family and healthcare professionals were available and caring gave a sense of security. Social support gave strength, although too much could be experienced as difficult and frightening. The women needed a balance between distance from and closeness to their social network. Both professional information and someone professional with whom to talk personally were essential. CONCLUSIONS: Social support is an important resource for women with breast cancer but can be a double-edged sword as the network's offered support can sometimes be a burden. IMPLICATIONS FOR PRACTICE: Healthcare professionals could call each patient, encourage the patients to call if they want, and, if preferred, offer face-to-face consultations for women with breast cancer awaiting surgery. This contact should be a supportive, informative, and confidential available resource.

Being in suspense: women's experiences awaiting breast cancer surgery.

AIM: This article is a report of a qualitative study of women's experiences after having received a breast cancer diagnosis and awaiting primary surgery. BACKGROUND: Breast cancer is experienced as an important stressor and a major challenge. How women appraise the diagnosis affects their postsurgery adaptation. Although studies have documented the presurgery period as stressful, in-depth understanding of women's experiences while awaiting surgery studied during this stressful period is still needed. METHOD: Twenty-one women with newly diagnosed breast cancer were interviewed individually the day before surgery at a Norwegian university hospital, between February 2006 and February 2007. Interviews were analysed using the qualitative meaning condensation method. FINDINGS: Feeling healthy, but having to adapt to disease, waiting, uncertainty, having to tell and existential awareness were themes identified. Having to wait was experienced as frightening, painful, long and difficult - but also necessary. Some expressed apprehension because they could not do anything about their situation. Others emphasized that it was good to have some time between diagnosis and surgery to become personally prepared and spend time with loved ones. Informing others about the diagnosis was a great burden for most of them. Social networks could both give and crave support. CONCLUSION: Healthcare professionals need to be sensitive to the individual experiences of women awaiting breast cancer surgery to give support to ease their situation. Setting the date for surgery will alleviate anxiety. Follow-up studies about the potential impact of presurgery experiences on later experiences of living with breast cancer and intervention studies are needed.

Coping with breast cancer: between diagnosis and surgery.

AIM: This paper is a report of a descriptive study of coping strategies used by women between diagnosis of breast cancer and surgery. BACKGROUND: Although research has suggested that the initial phase of breast cancer is important in the overall process of coping, there have been few qualitative studies conducted in the period between diagnosis and surgery to describe women's experiences and coping efforts in the midst of stress. METHOD: Individual interviews were conducted with 21 women with newly diagnosed breast cancer who were awaiting surgery. Data were collected from February 2006 to February 2007 at a Norwegian university hospital. Transcripts were analysed using methods of qualitative content analysis. FINDINGS: Prominent themes about coping between diagnosis and surgery were: step-by-step, pushing away, business as usual, enjoying life, dealing with emotions, preparing for the worst and positive focus. The women were highly aware of the threat of death, but at the same time hopeful and optimistic. In general, they wanted to be treated as usual. Pity and compassion could increase their feelings of fear and vulnerability. Emotions were dealt with either by openness or by holding back. CONCLUSION: Avoiding being overwhelmed by emotional reactions was a major goal for the women. Their coping strategies displayed similar patterns but diverged on some points. In general they needed to manage the situation in their own way. By being aware of women's individual needs and different coping strategies, nurses and other healthcare professionals can improve support to women in this vulnerable situation.

Coping with a possible breast cancer diagnosis: demographic factors and social support.

AIM: This paper reports a study examining the relationships between demographic characteristics, social support, anxiety, coping and defence among women with possible breast cancer. BACKGROUND: Awaiting a possible breast cancer diagnosis is an anxiety-provoking situation that demands coping. Social support and demographic characteristics have been reported to influence coping and well-being, but the interconnection is insufficiently understood. DESIGN: A survey design was used, and self-administrated questionnaires were returned by a convenience sample of 117 women in Norway who had undergone breast biopsy. The data were collected from September 1998 to February 2000. INSTRUMENTS: The instruments consisted of: the Social Provisions Scale, State-Trait Anxiety Scale, Utrecht Coping List and Defence Mechanisms Inventory. In addition, data on age, level of education, employment, marital status, and household status were collected. RESULTS: Social support was positively related to instrumental-oriented coping and emotion-focused coping, unrelated to cognitive defence and defensive hostility. Educational level was positively related to instrumental-oriented coping. Educational level, employment and marital status were negatively related to cognitive defence. Educational level was the most important contributor to social support. Attachment and education were the most important contributors to instrumental-oriented coping, with education as the strongest predictor. CONCLUSION: Better coping was linked primarily to education, and secondly to attachment. Unemployment, low level of education and single/divorced/widowed status were related to greater use of cognitive defence. Women who used a defensive hostile style tended to receive poor social support. Nurses need to be aware of the influence of demographic characteristics on social support, coping and defence and to identify poor copers, as these patients are most in need of professional support.