Barriers and enablers for externally and internally driven implementation processes in healthcare: a qualitative cross-case study.

BACKGROUND: Quality in healthcare is a subject in need of continuous attention. Quality improvement (QI) programmes with the purpose of increasing service quality are therefore of priority for healthcare leaders and governments. This study explores the implementation process of two different QI programmes, one externally driven implementation and one internally driven, in Norwegian nursing homes and home care services. The aim for the study was to identify enablers and barriers for externally and internally driven implementation processes in nursing homes and homecare services, and furthermore to explore if identified enablers and barriers are different or similar across the different implementation processes. METHODS: This study is based on an exploratory qualitative methodology. The empirical data was collected through the 'Improving Quality and Safety in Primary Care - Implementing a Leadership Intervention in Nursing Homes and Homecare' (SAFE-LEAD) project. The SAFE-LEAD project is a multiple case study of two different QI programmes in primary care in Norway. A large externally driven implementation process was supplemented with a tracer project involving an internally driven implementation process to identify differences and similarities. The empirical data was inductively analysed in accordance with grounded theory. RESULTS: Enablers for both external and internal implementation processes were found to be technology and tools, dedication, and ownership. Other more implementation process specific enablers entailed continuous learning, simulation training, knowledge sharing, perceived relevance, dedication, ownership, technology and tools, a systematic approach and coordination. Only workload was identified as coincident barriers across both externally and internally implementation processes. Implementation process specific barriers included turnover, coping with given responsibilities, staff variety, challenges in coordination, technology and tools, standardizations not aligned with work, extensive documentation, lack of knowledge sharing. CONCLUSION: This study provides understanding that some enablers and barriers are present in both externally and internally driven implementation processes, while other are more implementation process specific. Dedication, engagement, technology and tools are coinciding enablers which can be drawn upon in different implementation processes, while workload acted as the main barrier in both externally and internally driven implementation processes. This means that some enablers and barriers can be expected in implementation of QI programmes in nursing homes and home care services, while others require contextual understanding of their setting and work.

Usefulness of pedagogical design features of a digital educational resource into nursing home placement: a qualitative study of nurse educators' experiences.

BACKGROUND: The rapid advancement of technology-enhanced learning opportunities has resulted in requests of applying improved pedagogical design features of digital educational resources into nursing education. Digital educational resources refers to technology-mediated learning approaches. Efficient integration of digital educational resources into nursing education, and particularly into clinical placement, creates considerable challenges. The successful use of digital educational resources requires thoughtful integration of technological and pedagogical design features. Thus, we have designed and developed a digital educational resource, digiQUALinPRAX, by emphasizing pedagogical design features. The nurse educators' experiences of the usefulness of this digital educational resource is vital for securing improved quality in placement studies. AIM: To obtain an in-depth understanding of the usefulness of the pedagogical design features of a digital educational resource, digiQUALinPRAX, in supporting nurse educators' educational role in nursing home placements in the first year of nursing education. METHODS: An explorative and descriptive qualitative research design was used. Individual semi-structured interviews were conducted with six nurse educators working in first year of a Bachelor's of Nursing programme after using the digital educational resource, digiQUALinPRAX, during an eight-week clinical placement period in nursing homes in April 2022. RESULTS: Two main categories were identified: (1) supporting supervision and assessment of student nurses and (2) supporting interactions and partnerships between stakeholders. CONCLUSION: The pedagogical design features of the digiQUALinPRAX resource provided nurse educators with valuable pedagogical knowledge in terms of supervision and assessment of student nurses, as well as simplified and supported interaction and partnership between stakeholders.

Supporting the nurse educator in clinical education - a qualitative evaluation of a digital educational resource DigiVIS.

BACKGROUND: Despite the increased use of technology for teaching and learning in clinical nursing education, relatively little attention seems to be directed toward the usefulness of digital educational resources (DERs) to support nurse educators' educational role in clinical nursing education. METHODS: An interpretive descriptive qualitative study design was conducted to evaluate the usefulness of a DER to support nurse educators in clinical nursing education. Data were collected through two focus group interviews with part-time and novice educators (n = 5) and full-time, more experienced educators (n = 5), after they had overseen student nurses in nursing home placements. Data were analyzed using thematic analysis and Standards for Reporting Qualitative Research guidelines were used for this study. FINDINGS: The analysis identified three themes related to nurse educators' experiences of the usefulness of a DER to support their educational role while overseeing first-year students on clinical placements in nursing homes: (1) Provides academic support and a sense of security (2) promotes pedagogical efficacy, and (3) represents a flexible resource for educational planning. CONCLUSION: This study shows that a digital educational resource can be an efficient and useful supplementary strategy to support the nurse educator's role in clinical nursing education. Future research is required to systematize knowledge about the impact of DERs on orientation and training, as well as motivation and facilitators for, and barriers to, their use to enhance quality and strengthen the nurse educator's role in clinical nursing education.

A digital educational resource to support and enhance effective mentorship practices of nursing students in nursing homes: a qualitative study.

BACKGROUND: There is a grooving body of evidence emphasising the need to support and enhance effective mentorship practices for nursing students in nursing home placements, including strengthening of the pedagogical competence of registered nurse mentors. Owing to the necessity for multifaceted mentoring competence and the challenges of workload registered nurses are facing, the use of flexible digital educational resources has been suggested. However, current knowledge on the effectiveness of digital educational resources in enhancing mentorship practices in nursing homes is scarce. This study aimed to explore the perception of registered nurse mentors regarding the effectiveness of a digital educational resource, particular its usability and value-in-use in supporting and enhancing mentorship practices in nursing homes. METHODS: The study applied an exploratory descriptive qualitative design. Pre- and post-mentoring semi-structured focus group interviews were conducted among a total of 23 registered nurse mentors across three Norwegian nursing homes. The transcribed interviews were thematically analysed. Standards for reporting qualitative research were followed. RESULTS: The analysis yielded one pre-mentoring theme: (1) predominant enthusiasm and satisfaction and three post-mentoring themes: (2) enhanced confidence and motivation, (3) enhanced mentoring competence in supporting the nursing students' learning process, and (4) factors influencing the value-in-use of the digital educational resource. CONCLUSIONS: Digital educational resources support effective mentorship practices by enhancing the confidence and motivation in the mentor role and by enabling more goal-oriented supervision and assessment tailored to the learning goals of students. The implementation of digital educational resources to support and enhance effective mentorship practices is an important avenue for further research towards achieving high-quality learning environments in clinical nursing education in general and nursing homes. Based on the study findings, nursing educational institutions should consider offering digital educational resources to develop, support, and advance mentorship training, which may more effectively impact and improve the quality of clinical nursing education.

Exploring stakeholders' experiences in co-creation initiatives for clinical nursing education: a qualitative study.

BACKGROUND: Co-creation is an emerging approach in nursing education, wherein academics engage in multi-stakeholder collaborations to generate knowledge, ideate solutions, promote sustainability, and enhance educational quality. However, knowledge on stakeholders' experiences in participation in co-creation initiatives for nursing education is scarce. This study aimed to explore the experiences of student nurses, nurse educators, and e-learning designers in co-creation initiatives to design and develop a digital educational resource for clinical nursing education. METHODS: The study adopted an exploratory qualitative design. Data were collected via three separate semi-structured focus group interviews with student nurses (n = 7), nurse educators (n = 8), and e-learning designers (n = 3) who participated in co-creation workshops. Collected data were then thematically analyzed. RESULTS: Three themes related to the participants' experiences emerged: (1) The co-creation workshops were enjoyable, useful, and instructive; (2) power imbalances influenced the students' engagement; and (3) contextual factors influenced the participants' overall engagement. CONCLUSIONS: This study shows that co-creation through workshops is a novel, enjoyable, and instructive approach that facilitates knowledge exchange. It also highlights the needs and experiences of stakeholders, especially student nurses. However, the use of co-creation in nursing education presents some challenges. Recognizing and managing power differentials are essential for successful co-creation in clinical nursing education, alongside a mindset of collaboration and mutuality. Future research is required to systematize knowledge about the benefits and impacts of the processes and outcomes of co-creation initiatives, including stakeholders' motivation, barriers, and facilitators to participation in co-creation, to improve the quality of clinical nursing education.

Co-creating digital educational resources to enhance quality in student nurses' clinical education in nursing homes: Report of a co-creative process.

AIM: To report a methodological, co-creative approach for developing an interactive digital educational resource to enhance the quality of student nurses' clinical education in nursing homes and to elucidate the lessons learned from this approach. DESIGN: This study applied a co-design methodology that builds on participatory design principles. METHODS: Co-creating the digital educational resource included multiple sequential and interactive phases inspired by the design thinking framework. Workshops were employed as the primary co-creative activity. RESULTS: Seven separate homogenous or joint heterogeneous workshops were conducted with student nurses, nurse educators, registered nurse mentors and e-learning designers (n = 36) during the active stakeholder engagement phases to inform the educational content, design and functionality of the digital educational resource. These were informed by, and grounded in, learning theory and principles. CONCLUSION: Co-creative approaches in nursing education are an essential avenue for further research. We still lack systematic knowledge about the impact and benefits of co-created initiatives, stakeholders' motivations, barriers, facilitators to participation and the role of context in supporting effective co-creative processes to increase the quality of nursing education. IMPACT: This paper demonstrates how digital educational initiatives to enhance quality in clinical nursing education can be co-created with key stakeholders through a novel methodological approach inspired by design thinking. To date, the methodological development process of co-created educational interventions has received limited attention and compared with the content and theoretical underpinnings of such interventions, has rarely been addressed. Therefore, this paper facilitates knowledge exchange and documents vital aspects to consider when co-creating digital educational initiatives incorporating multistakeholder perspectives. This promotes a stronger academic-practice partnership to impact and enhance the quality of clinical nursing education in nursing homes. PUBLIC CONTRIBUTIONS: Student nurses, nurse educators, and registered nurse mentors worked alongside researchers and e-learning designers in the co-creative process.

Nurse educators' suggestions for a digital educational resource suitable for undergraduate student nurses' placement studies: Qualitative empirical research.

AIMS: To explore and describe nurse educators' suggestions regarding a digital educational resource addressing quality in placement studies for first-year student nurses in nursing homes. DESIGN: A qualitative, explorative, and descriptive research design. METHODS: Focus group interviews with eight nurse educators and individual interviews with six nurse educators. The interviews were audio-recorded and transcribed verbatim; subsequently, data were analysed in lines with content analysis as described by Graneheim and Lundman. RESULTS: The analysis revealed three main categories: 'Suggestions for a digital educational resource to strengthen and support nurse educators' role in follow-up students', 'Suggestions for a digital educational resource to complement and support interaction between stakeholders in placement', and 'Suggestions for a digital educational resource to facilitate student nurses' learning processes'. The categories were captured by the overarching theme, 'A digital educational resource facilitating interaction between stakeholders and students' learning processes. CONCLUSION: This study revealed nurse educators' suggestions regarding design elements, content, and use of a digital educational resource addressing placement studies for first-year student nurses' in nursing homes. Implications for the profession and/or patient care: Nurse educators should be involved in designing, developing, and implementing digital educational resources aiming to support student learning in nursing education placement studies. IMPACT: This study explored nurse educators' suggestions for a digital educational resource. They suggested a digital educational resource to strengthen and support their role, support interaction between stakeholders, and facilitate student nurses' learning processes. Further, they suggested a digital educational resource to be used as a supplement rather than as a replacement for nurse educators' physical presence in placements. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Research reporting guidelines were used. No Patient or Public Contribution.

In situ simulation-based team training and its significance for transfer of learning to clinical practice-A qualitative focus group interview study of anaesthesia personnel.

BACKGROUND: Anaesthesia personnel are an integral part of an interprofessional operating room-team; hence, team-based training in non-technical skills (NTS) are important in preventing adverse events. Quite a few studies have been done on interprofessional in situ simulation-based team training (SBTT). However, research on anaesthesia personnel's experiences and the significance for transfer of learning to clinical practice is limited. The aim of this study is to explore anaesthesia personnel's experience from interprofessional in situ SBTT in NTS and its significance for transfer of learning to clinical practice. METHODS: Follow-up focus group interviews with anaesthesia personnel, who had taken part in interprofessional in situ SBTT were conducted. A qualitative inductive content analysis was performed. RESULTS: Anaesthesia personnel experienced that interprofessional in situ SBTT motivated transfer of learning and provided the opportunity to be aware of own practice regarding NTS and teamwork. One main category, 'interprofessional in situ SBTT as a contributor to enhance anaesthesia practice' and three generic categories, 'interprofessional in situ SBTT motivates learning and improves NTS', 'realism in SBTT is important for learning outcome', and 'SBTT increases the awareness of teamwork' illustrated their experiences. CONCLUSIONS: Participants in the interprofessional in situ SBTT gained experiences in coping with emotions and demanding situations, which could be significant for transfer of learning essential for clinical practice. Herein communication and decision-making were highlighted as important learning objectives. Furthermore, participants emphasized the importance of realism and fidelity and debriefing in the learning design.

Registered nurse mentors' experiences from co-creation in higher education targeting enhancement of mentorship practices in nursing homes: A qualitative study.

AIM: To explore registered nurse (RN) mentors' experiences of participating in the co-creation of a digital educational resource intended to enhance mentorship practices of first-year nursing students in clinical placement in nursing homes. DESIGN: An interpretive, descriptive qualitative study design. METHODS: Data were collected through two focus group interviews with 15 RN mentors (n = 15) participating in co-creative workshops. The co-creative process entailed four co-creative workshops conducted over a 17-month period (June 2019 to end of Oct 2020). Focus group interviews were conducted following the second and third workshops (i.e., in Dec 2019 and in Oct 2020) and data were analysed using thematic analysis. The consolidated criteria for reporting qualitative research (COREQ) checklist was used to report the findings. RESULTS: The analysis identified three themes: (1) co-creative reflective dialogues contributed to knowledge development and increased motivation among mentors; (2) the co-creative approach facilitated and validated the nursing academic-practice tripartite partnership; and (3) effectiveness of workshop structure in facilitating collaboration and mitigating power inequities. CONCLUSION: A co-creative process provides notable opportunities to advocate for mentorship needs and to enhance mentorship practices in nursing homes. IMPACT: Our study adds to the evidence on co-creation in nursing education, providing insights on the co-creative process and methodology. Higher Education Institutions are uniquely positioned to act as a co-creative arena for the academic-practice collaboration and for the development of educational resources within nursing education. Co-creation may facilitate stronger academic-practice partnership that may more effectively impact mentorship practices in nursing homes and health care system effectiveness. PUBLIC CONTRIBUTIONS: The RNs included in the study were involved in the co-creative process as active contributors informing the digital educational resource content and design.

Creativity at the margins: A cross-country case study on how Dutch and Norwegian peripheries address challenges to quality work in care for older persons.

BACKGROUND: Peripheral areas are often overlooked in health-care research but they in fact deserve specific attention. Such areas struggle to maintain access to good quality health-care services due to their geographical context. At the same time, new interventions or promising innovations often emerge in places where creativity is urgently needed. In this paper, we explore this creativity at the margins in older persons care organizations in peripheral areas, which other healthcare providers and policymakers can learn from. METHODS: This exploratory study is based on two large research projects on the quality of care for older persons in Norway and the Netherlands. We performed secondary analysis of interviews with quality managers and other quality workers and used additional document analysis and expert interviews to deepen our analysis. RESULTS: The results show that older persons care organizations working in peripheral areas must deal with a number of challenges caused by their geographical context, e.g. geographical distances (between services and to the geographical center), workforce shortages, and landscape characteristics. We found that organizations use different strategies to tackle these challenges, such as scaling up, brightening up and opening up. These strategies, conceptualized as creativity at the margins, impact quality work in different ways, for example by enabling more person-centered care. CONCLUSION: We conclude that both policymakers and research should overcome their peripheral blindness by learning from and supporting creativity at the margins in future policies and research.

Exploring the formal assessment discussions in clinical nursing education: An observational study.

INTRODUCTION: According to EU standards, 50% of the bachelor education program in nursing should take place in clinical learning environments. Consequently, this calls for high quality supervision, where appropriate assessment strategies are vital to optimize students' learning, growth, and professional development. Despite this, little is known about the formal assessment discussions taking place in clinical nursing education. OBJECTIVE: The aim of this study was to explore the characteristics of the formal assessment discussions taking place during first-year students' clinical education in nursing homes. METHOD: An exploratory qualitative study was performed. The data consist of passive participant observations of 24 assessment discussions (12 mid-term and 12 final assessments) with first-year nursing students (n=12), their assigned registered nurse mentors (n=12) and nurse educators (n=5). The study was conducted in three public nursing homes in a single Norwegian municipality. Data were subjected to thematic analysis. The findings were reported using the Standards for Reporting of Qualitative Research. RESULTS: Three themes were identified regarding the characteristics of the formal assessment discussions: (1) adverse variability in structuring, weighting of theoretical content and pedagogical approach; (2) limited three-part dialogue constrains feedback and reflection; and (3) restricted grounds for assessment leave the nurse educators with a dominant role. CONCLUSION: These characteristic signal key areas of attention to improve formal assessment discussions to capitalize on unexploited learning opportunities.

Integrating simulation training during clinical practice in nursing homes: an experimental study of nursing students' knowledge acquisition, self-efficacy and learning needs.

BACKGROUND: Limited access to supervision, feedback and quality learning experiences pose challenges to learning in the clinical setting for first-year nursing students who are beginning their clinical experiences. Prior studies have indicated that simulation training, as a partial replacement of clinical practice hours, may improve learning. However, there has been little research on simulation training integrated as a partial replacement during first-year students' clinical practice in nursing homes. The primary aim of this study was to examine first-year nursing students' knowledge acquisition and self-efficacy in integrating a partial replacement of clinical hours in nursing homes with simulation training. Its secondary aim was to examine perceptions of how learning needs were met in the simulated environment compared with the clinical environment. DESIGN: The primary aim was addressed using an experimental design that included pre- and post-tests. The secondary aim was investigated using a descriptive survey-based comparison. METHODS: First-year students at a Norwegian university college (n = 116) were asked to participate. Those who agreed (n = 103) were randomly assigned to the intervention group (n = 52) or the control group (n = 51). A knowledge test, the General Self-efficacy Scale and the Clinical Learning Environment Comparison Survey were used to measure students' outcomes and perceptions. The data were analysed using independent samples t-tests, chi-square tests and paired samples t-tests. RESULTS: Knowledge scores from pre- to post-tests were significantly higher in the intervention group than in the control group with a medium to large effect size (p < 0.01, Hedges' g = 0.6). No significant differences in self-efficacy were identified. Significant differences (p <  0.05) were observed between the simulated and the clinical environment with regard to meeting learning needs; effect sizes ranged from small and medium to large (Cohen's d from 0.3 to 1.0). CONCLUSION: Integrating the partial replacement of clinical hours in nursing homes with simulation training for first-year nursing students was positively associated with knowledge acquisition and meeting learning needs. These findings are promising with regard to simulation as a viable partial replacement for traditional clinical practice in nursing homes to improve learning.

Using the 'huddle' to enhance interprofessional teamwork among nursing students through a podcast: a qualitative and exploratory pilot study.

BACKGROUND: Interprofessional teamwork is crucial for fostering healthcare performance and for minimizing adverse events. The daily huddle is an important arena for interprofessional interaction and communication between nurses and physicians in hospitals. Although prevalence strongly rooted in clinical practice, the huddle does not seem to be a prioritized area in nursing education programs. Taking part in a huddle is traditionally something nursing students learn in their clinical studies. Therefore, there is need for learning tools that can provide nursing students with quality assured training that can improve their preparation for interprofessional teamwork and strengthen the link between the educational institution and the field of practice. In this study, we have developed and tested a podcast to increase nursing students' competence in interprofessional teamwork when participating in huddles. The aim of the pilot study was to explore nursing students' experiences with utilizing a huddle-focused podcast as a learning tool during their clinical practice studies in the hospital. METHOD: This qualitative and exploratory pilot study used focus group interviews. Eleven third-year nursing students who had listened to the podcast during their practical studies at a medical hospital ward were included. The interviews were subjected to content analysis. RESULT: The analysis identified four categories that resonated across all participants in the focus group interviews: 1. understanding one's own role in the huddle; 2. being encouraged to speak up; 3. using the huddle as a flexible learning tool; and 4. being authentic but not always realistic. CONCLUSION: Findings indicate that the huddle-focused podcast seems to be valuable for nursing students learning about interprofessional teamwork. The podcast seemed especially useful in helping the students to understand their own role and to speak up in the huddle meetings. The positive experiences with the flexibility of the podcast learning tool are promising for use in other educational settings.

Is simulation-based team training performed by personnel in accordance with the INACSL Standards of Best Practice: SimulationSM?-a qualitative interview study.

BACKGROUND: Anesthesia personnel was among the first to implement simulation and team training including non-technical skills (NTS) in the field of healthcare. Within anesthesia practice, NTS are critically important in preventing harmful undesirable events. To our best knowledge, there has been little documentation of the extent to which anesthesia personnel uses recommended frameworks like the Standards of Best Practice: SimulationSM to guide simulation and thereby optimize learning. The aim of our study was to explore how anesthesia personnel in Norway conduct simulation-based team training (SBTT) with respect to outcomes and objectives, facilitation, debriefing, and participant evaluation. METHODS: Individual qualitative interviews with healthcare professionals, with experience and responsible for SBTT in anesthesia, from 51 Norwegian public hospitals were conducted from August 2016 to October 2017. A qualitative deductive content analysis was performed. RESULTS: The use of objectives and educated facilitators was common. All participants participated in debriefings, and almost all conducted evaluations, mainly formative. Preparedness, structure, and time available were pointed out as issues affecting SBTT. CONCLUSIONS: Anesthesia personnel's SBTT in this study met the International Nursing Association for Clinical Simulation and Learning (INACSL) Standard of Best Practice: SimulationSM framework to a certain extent with regard to objectives, facilitators' education and skills, debriefing, and participant evaluation.

Nursing students' experience with clinical placement in nursing homes: a focus group study.

BACKGROUND: A renewed interest in nursing homes as clinical placement settings for nursing students has been prompted by the growing healthcare needs of an ageing population. However, if future nurses are to be enthusiastic about working in this healthcare context, it is essential that higher education institutions that educate nurses and nursing homes that provide placement experiences to students do so with a supportive, positive, and enriched approach. METHODS: To explore first-year nursing students' placement experience in nursing homes, we conducted an exploratory qualitative study in three city-based nursing homes in western Norway. Thirteen first-year nursing students participated in the study. Three focus group interviews were conducted to explore the students' placement experiences. Data were analysed using thematic analysis. The findings were reported using the Standards for Reporting Qualitative Research (SRQR). RESULTS: The analysis describes five themes relating to first-year students' placement experience in nursing homes; (1) variations in utility of pre-placement orientation and welcome at placement site; (2) a challenging learning environment; (3) spending considerable placement time with non-registered nurses; (4) considerable variability in supervision practices; and (5) a vulnerable and demanding student role. CONCLUSIONS: The research provides insight into the contextual characteristics encountered by first-year students that influence the quality of their placement experiences. Consequently, these characteristics impede access to important role models who lend support to a student's growth and professional development, preventing full utilisation of the learning potential offered in nursing homes. Hence, we propose that targeted efforts are warranted to foster positive placement experiences and enhance students' clinical education in nursing homes.

Exploring managers' response to a quality and safety leadership intervention: findings from a multiple case study in Norwegian nursing homes and homecare services.

BACKGROUND: Improvement interventions would be easier to treat if they were stable and uninfluenced by their environment, but in practice, contextual factors may create difficulties in implementing and sustaining changes. Managers of healthcare organisations play an important role in quality and safety improvement. We need more research in the nursing home and homecare settings to support managers in their quality and safety improvement work. The aim of this study was to explore managers' response to a leadership intervention on quality and safety improvement. METHODS: This study reports findings from the SAFE-LEAD intervention undertaken from April 2018 to March 2019. The research design was a multiple case study of two nursing homes and two homecare services in four municipalities in Norway. We used a combination of qualitative methods including interviews, workshops, observations, site visits and document analysis in our data collection that took place over a 1-year period. RESULTS: Management continuity was key for the implementation process of the quality and safety leadership intervention. In the units where stable management teams were in place, the intervention was more rooted in the units, and changes in quality and safety practice occurred. The intervention served as an arena for managers to work with quality and safety improvement. We found that the workshops and use of the leadership guide contributed to a common understanding and commitment to quality and safety improvement among the managers. CONCLUSIONS: This is a longitudinal study of managers' response to a leadership intervention targeted to improve quality and safety work in nursing home and homecare settings. Our research demonstrates how the mechanisms of stable management and established structures are crucial for quality and safety improvement activities. Management continuity is key for participating in interventions and for using the leadership guide in quality and safety work.

Enhancing student nurses' clinical education in aged care homes: a qualitative study of challenges perceived by faculty staff.

BACKGROUND: Ageing populations are increasing the demand for geriatric care services. As nursing schools respond to this demand, more high-quality clinical placements are required, and aged care homes offer suitable placement sites. Although an aged care experience for students is beneficial, the basis for effective implementation of these placements is yet to be fully established. The aim of this study was to explore faculty staff perspectives on the challenges associated with providing effective clinical education in aged care homes for first-year student nurses. METHODS: An exploratory qualitative study was performed. Fifteen in-depth interviews were conducted with program leaders of nursing degree programs (n = 4), course leaders (n = 6) and practice coordinators (n = 5) in three Norwegian universities. Data were analysed using thematic analysis. The findings were reported using the Standards for Reporting Qualitative Research (SRQR). RESULTS: Five themes were identified regarding the perceived challenges to implementing effective clinical education in aged care homes: (1) low staffing levels of registered nurses limit the capacity to effectively host students; (2) prevalence of part-time teachers can compromise the quality of students' learning experiences; (3) tensions about the required qualifications and competencies of nurse teachers; (4) variation in learning assessments; and (5) lack of quality assurance. CONCLUSIONS: These challenges signal key areas to be addressed in quality assurance for effective aged care placements. Further research into the minimum staffing levels required to support student learning in the aged care setting is required. Methods for developing shared practices to facilitate learning in aged care homes need to address the prevalence of part-time teaching appointments. Further research into the levels of qualification and competence required to support student learning in aged care facilities can assist with setting standards for this sector. Finally, academic-practice institutions must engage with government officials and national nursing bodies to develop national standards for clinical education in aged care homes.

Talking about quality: how 'quality' is conceptualized in nursing homes and homecare.

BACKGROUND: The delivery of high-quality service in nursing homes and homecare requires collaboration and shared understanding among managers, employees, users and policy makers from across the healthcare system. However, conceptualizing healthcare professionals' perception of quality beyond hospital settings (e.g., its perspectives, defining attributes, quality dimensions, contextual factors, dilemmas) has rarely been done. This study therefore explores the meaning of "quality" among healthcare managers and staff in nursing homes and homecare. METHODS: The study applies a cross-sectional qualitative design with focus groups and individual interviews, to capture both depth and breadth of conceptualization of quality from healthcare professionals in nursing homes and homecare. We draw our data from 65 managers and staff in nursing homes and homecare services in Norway and the Netherlands. The participants worked as managers (n = 40), registered nurses (RNs) or assistant nurses (n = 25). RESULTS: The analysis identified the two categories and four sub-categories: "Professional issues: more than firefighting" (subcategories "professional pride" and "competence") and "patient-centered approach: more than covering basic needs" (subcategories "dignity" and "continuity"). Quality in nursing homes and homecare is conceptualized as an ongoing process based on having the "right competence," good cooperation across professional groups, and patient-centered care, in line with professional pride and dignity for the patients. CONCLUSION: Based on the understanding of quality among the healthcare professionals in our study, quality should encompass the softer dimensions of professional pride and competence, as well as a patient-centered approach to care. These dimensions should be factors in improvement activities and in daily practice.

Evidence of validity for the Norwegian version of the interprofessional collaborative competency attainment survey (ICCAS).

This was a validation study of the Norwegian version of The Interprofessional Collaborative Competency Attainment Survey (ICCAS). ICCAS consists of 20 retrospective pre- and post-questions, where respondents rate their agreement with regard to self-assessed competencies after participating in interprofessional education courses. It has been validated across various settings. The questionnaire was translated using the back-translation technique. We investigated evidence of validity regarding content, response process, and internal structure. Data were obtained from health and social care students (n = 1440, response rate 42.8%) participating in 12 different interprofessional courses in seven education institutions in Norway using a cross-sectional design. Exploratory factor analysis indicated one retracted factor for pre-scores and one retracted factor for post-scores. High McDonald's omega values indicated good internal consistency. Item deletion did not improve the scale's overall consistency on pre- or post-scores. We observed higher mean post-scores than pre-scores with moderate-to-large effect sizes, indicating a positive change in self-assessed interprofessional capabilities after training. Our findings indicate that the Norwegian version of ICCAS is a valid tool that may be implemented across a wide range of interprofessional education courses. Finally, our findings support earlier recommendations that ICCAS should be analyzed at an overall level to address change in interprofessional capabilities.