Norwegian nurse educators' self-rating of competencies: a nationwide cross-sectional web-survey.

BACKGROUND: Nurse educators' competencies play a crucial role in the educational quality of nurses. OBJECTIVE: This study aimed to investigate how Norwegian nurse educators self-rated their competence domains, and how these competencies were associated background variables. METHODS: The study was designed as a cross-sectional web-survey, and n=154 participated and filled out the Evaluation of Requirements of Nurse Teachers (ERNT) instrument. Educators' mean working experience was 12.9 years (SD 9.2); 86.3 % were permanently employed and 76.8 % had formal supervision training. RESULTS: The nurse educators rated their competence as good on all competence domains and single competence items, and ERNT total mean score was 4.62 (SD 0.28), with relationship with the students rated highest and personality factors rated lowest. The ERNT total mean score was significantly related to academic degree. CONCLUSIONS: Educational leaders in nursing education are recommended to establish a mentoring and supporting team for their educators.

Health-related quality of life in adults with drug-resistant focal epilepsy treated with modified Atkins diet in a randomized clinical trial.

Ketogenic diet, a high-fat, low-carbohydrate diet, is an established treatment for patients with severe epilepsy. We have previously reported a moderate reduction in seizure frequency after treatment with a modified Atkins diet. This study aimed to see whether dietary therapy impacts patients' health-related quality of life (HRQOL). In a randomized controlled design, we compared the change in self-reported HRQOL among adults with difficult-to-treat epilepsy after a 12-week diet intervention. Thirty-nine patients with drug-resistant focal epilepsy (age = 16-65 years) were randomized to eat a modified Atkins diet with maximum 16 g of carbohydrate per day (diet group, n = 19) or to continue eating habitual diet (control group, n = 20). No changes to the other epilepsy treatments were allowed. Patient-reported HRQOL was assessed with the Quality of Life in Epilepsy Inventory-89 (QOLIE-89). The diet group experienced a statistically significant improvement in mean total score of QOLIE-89 of 10 points compared to controls (p = .002). Moreover, although not statistically significant when using a cutoff of 50% seizure reduction, our data suggest an association between diet-induced reduction in seizure frequency and improvement in HRQOL. The improvement in HRQOL was not associated with diet-induced weight reduction.

Does who you live with matter for your health? The influence of partners' socioeconomic characteristics on self-rated health in Norway.

AIMS: Studies of the association between self-rated health and persons' income and education have almost invariably shown that people with higher education and incomes report better health. Less is known of the influence of household members' socioeconomic characteristics on individuals' health. This study thus aimed to assess the extent to which the socioeconomic characteristics of partners may contribute to explaining the variation in the respondents' self-rated health (SRH). METHODS: Using an observational design, we analysed cross-sectional Norwegian survey data on SRH (2015 and 2019), linked to register data on education and income for respondents (N = 7082) and their opposite-sex coresident spouse or partner. We employed logistic regression models to assess the associations between respondents' SRH and the relative income and education of their partner. Average marginal effects were calculated to enable cross-model comparisons. RESULTS: Net of individual characteristics, having a higher-educated partner was positively associated with SRH for both male (OR = 1.56) and female (OR = 1.36) respondents. Having a partner with an above median income (by age and sex) was positively associated with SRH for female (OR = 1.29) respondents only. For education, the positive SRH associations were roughly similar for respondents and partners. For income, the associations were more pronounced for respondents than partners. CONCLUSIONS: Our findings suggest that health is affected by the resources (or lack thereof) in one's immediate networks. To reduce social inequalities in health, health personnel might customise interactions to account for household resources. Such knowledge could also be used in health-promoting activities to enhance participation and health competency.

Nursing students' clinical judgment skills in simulation and clinical placement: a comparison of student self-assessment and evaluator assessment.

BACKGROUND: Clinical judgment is an important and desirable learning outcome in nursing education. Students must be able to self-assess their clinical judgment in both the simulation and clinical settings to identify knowledge gaps and further improve and develop their skills. Further investigation is needed to determine the optimal conditions for and reliability of this self-assessment. AIMS: This study aimed to compare the same group of students' self-assessment of clinical judgment with an evaluator's assessment in both simulation and clinical settings. The study further aimed to investigate whether the Dunning-Kruger effect is present in nursing students' self-assessment of clinical judgment. METHODS: The study applied a quantitative comparative design. It was conducted in two learning settings: an academic simulation-based education course, and a clinical placement course in an acute care hospital. The sample consisted of 23 nursing students. The Lasater Clinical Judgment Rubric was used to collect data. The scores were compared using a t-test, intraclass correlation coefficient, Pearson's correlation coefficient, and Bland-Altman plots. The Dunning-Kruger effect was investigated using linear regression analysis and a scatter plot. RESULTS: The results showed an inconsistency between student self-assessment and evaluator assessment of clinical judgment in both simulation-based education and clinical placement. Students overestimated their clinical judgment when compared to the more experienced evaluator's assessment. Differences between students' scores and the evaluator's scores were larger when the evaluator's scores were low, indicating the presence of the Dunning-Kruger effect. CONCLUSION: It is vital to acknowledge that student self-assessment alone may not be a reliable predictor of a student's clinical judgment. Students who had a lower level of clinical judgment were likely to be less aware that this was the case. For future practice and research, we recommend a combination of student self-assessment and evaluator assessment to provide a more realistic view of students' clinical judgment skills.

Substantial early changes in bone and calcium metabolism among adult pharmacoresistant epilepsy patients on a modified Atkins diet.

OBJECTIVE: The aim of this study was to investigate whether the modified Atkins diet (MAD), a variant of the ketogenic diet, has an impact on bone- and calcium (Ca) metabolism. METHODS: Two groups of adult patients with pharmacoresistant epilepsy were investigated. One, the diet group (n = 53), was treated with MAD for 12 weeks, whereas the other, the reference group (n = 28), stayed on their habitual diet in the same period. All measurements were performed before and after the 12 weeks in both groups. We assessed bone health by measuring parathyroid hormone (PTH), Ca, 25-OH vitamin D (25-OH vit D), 1,25-OH vitamin D (1,25-OH vit D), phosphate, alkaline phosphatase (ALP), and the bone turnover markers procollagen type 1 N-terminal propeptide (P1NP) and C-terminal telopeptide collagen type 1 (CTX-1). In addition, we examined the changes of sex hormones (estradiol, testosterone, luteinizing hormone, follicle-stimulating hormone), sex hormone-binding globulin, and leptin. RESULTS: After 12 weeks of MAD, we found a significant reduction in PTH, Ca, CTX-1, P1NP, 1,25-OH vit D, and leptin. There was a significant increase in 25-OH vit D. These changes were most pronounced among patients <37 years old, and in those patients with the highest body mass index (≥25.8 kg/m²), whereas sex and type of antiseizure medication had no impact on the results. For the reference group, the changes were nonsignificant for all the analyses. In addition, the changes in sex hormones were nonsignificant. SIGNIFICANCE: Twelve weeks of MAD treatment leads to significant changes in bone and Ca metabolism, with a possible negative effect on bone health as a result. A reduced level of leptin may be a triggering mechanism. The changes could be important for patients on MAD, and especially relevant for those patients who receive treatment with MAD at an early age before peak bone mass is reached.

Incidence and prevalence of psychogenic nonepileptic seizures in a Norwegian county: A 10-year population-based study.

OBJECTIVE: This study was undertaken to measure the incidence and prevalence of active psychogenic nonepileptic seizures (PNES) in a Norwegian county. METHODS: Using the Norwegian patient registry, we identified patients in Møre and Romsdal County in Norway diagnosed with F44.5 (conversion disorder with seizures or convulsions) or R56.8 (convulsions, not elsewhere classified) in the period January 2010 to January 2020. A review of the patients' medical records and an assessment of diagnostic validity were performed. PNES were diagnosed according to the recommendations by the International League Against Epilepsy Nonepileptic Seizures Task Force. Point prevalence of PNES on January 1, 2020 and incidence rates for the period 2010-2019 were determined. RESULTS: Based on PNES within the past 5 years, we found a PNES prevalence of 23.8/100 000 (95% confidence interval [CI] = 17.9-29.6), including all levels of diagnostic certainty. For the highest level of diagnostic certainty (video-electroencephalographically confirmed), the prevalence was 10.6/100 000 (95% CI = 6.7-14.5). The highest prevalence was found in the age group 15-19 years, at 59.5/100 000 (95% CI = 22.6-96.3). The mean annual incidence rate between 2010 and 2019 was 3.1/100 000/year (95% CI = 2.4-3.7). SIGNIFICANCE: We report for the first time a population-based estimate of the prevalence of PNES. Our findings suggest that the prevalence of PNES is within the range of estimates from non-population-based data. We found a strikingly high prevalence of PNES in the 15-19-year age group.

The safety attitudes questionnaire - ambulatory version: psychometric properties of the Norwegian version for nursing homes.

BACKGROUND: Patient safety culture involves leader and staff interaction, routines, attitudes, practices and awareness that influence risks of adverse events in patient care. The Safety Attitudes Questionnaire (SAQ) is an instrument to measure safety attitudes among health care providers. The instrument aims to identify possible weaknesses in clinical settings and motivate quality improvement interventions leading to reductions in medical errors. The Ambulatory Version of the SAQ (SAQ-A) was developed to measure safety climate in the primary care setting. The original version of the SAQ includes six major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions, and Stress recognition. Patients in nursing homes are particularly vulnerable to adverse events. We present the psychometric properties of the Norwegian translation of the SAQ-A for the nursing home setting. METHODS: The study was conducted in five nursing homes in Tønsberg, Norway, in February 2016. A total of 463 employees working more than 20% received a paper version of the translated SAQ-A adapted to the Norwegian nursing home setting and responded anonymously. Filled-in questionnaires were scanned and transferred to an SPSS file. SPSS was used to estimate Cronbach alphas, corrected item-total correlations, item-to-own and item-to-other correlations, and item-descriptive statistics. The confirmatory factor analysis was done by AMOS. RESULTS: Of the 463 health care providers, 288 (62.2%) responded to the questionnaire. The confirmatory factor analysis showed that the total model of the six factors Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions, and Stress recognition had acceptable goodness-of-fit values in the nursing home setting. CONCLUSIONS: The results of our study indicate that the Norwegian translated version of the SAQ-A, with the confirmed six factor model, is an appropriate tool for measuring patient safety climate in the nursing home setting. Future research should study whether there is an association between patient safety climate in nursing homes and occurrence of adverse events among the patients.

Patient safety culture in out-of-hours primary care services in the Netherlands: a cross-sectional survey.

OBJECTIVE: To examine patient safety culture in Dutch out-of-hours primary care using the safety attitudes questionnaire (SAQ) which includes five factors: teamwork climate, safety climate, job satisfaction, perceptions of management and communication openness. DESIGN: Cross-sectional observational study using an anonymous web-survey. Setting Sixteen out-of-hours general practitioner (GP) cooperatives and two call centers in the Netherlands. Subjects Primary healthcare providers in out-of-hours services. Main outcome measures Mean scores on patient safety culture factors; association between patient safety culture and profession, gender, age, and working experience. RESULTS: Overall response rate was 43%. A total of 784 respondents were included; mainly GPs (N = 470) and triage nurses (N = 189). The healthcare providers were most positive about teamwork climate and job satisfaction, and less about communication openness and safety climate. The largest variation between clinics was found on safety climate; the lowest on teamwork climate. Triage nurses scored significantly higher than GPs on each of the five patient safety factors. Older healthcare providers scored significantly higher than younger on safety climate and perceptions of management. More working experience was positively related to higher teamwork climate and communication openness. Gender was not associated with any of the patient safety factors. CONCLUSIONS: Our study showed that healthcare providers perceive patient safety culture in Dutch GP cooperatives positively, but there are differences related to the respondents' profession, age and working experience. Recommendations for future studies are to examine reasons for these differences, to examine the effects of interventions to improve safety culture and to make international comparisons of safety culture. Key Points Creating a positive patient safety culture is assumed to be a prerequisite for quality and safety. We found that: • healthcare providers in Dutch GP cooperatives perceive patient safety culture positively; • triage nurses scored higher than GPs, and older and more experienced healthcare professionals scored higher than younger and less experienced professionals - on several patient safety culture factors; and • within the GP cooperatives, safety climate and openness of communication had the largest potential for improvement.

Patient safety culture in Norwegian nursing homes.

BACKGROUND: Patient safety culture concerns leader and staff interaction, attitudes, routines, awareness and practices that impinge on the risk of patient-adverse events. Due to their complex multiple diseases, nursing home patients are at particularly high risk of adverse events. Studies have found an association between patient safety culture and the risk of adverse events. This study aimed to investigate safety attitudes among healthcare providers in Norwegian nursing homes, using the Safety Attitudes Questionnaire - Ambulatory Version (SAQ-AV). We studied whether variations in safety attitudes were related to professional background, age, work experience and mother tongue. METHODS: In February 2016, 463 healthcare providers working in five nursing homes in Tønsberg, Norway, were invited to answer the SAQ-AV, translated and adapted to the Norwegian nursing home setting. Previous validation of the Norwegian SAQ-AV for nursing homes identified five patient safety factors: teamwork climate, safety climate, job satisfaction, working conditions and stress recognition. SPSS v.22 was used for statistical analysis, which included estimations of mean values, standard deviations and multiple linear regressions. P-values <0.05 were considered to be significant. RESULTS: Out of the 463 employees invited, 288 (62.2%) answered the questionnaire. Response rates varied between 56.9% and 72.2% across the five nursing homes. In multiple linear regression analysis, we found that increasing age and job position among the healthcare providers were associated with significantly increased mean scores for the patient safety factors teamwork climate, safety climate, job satisfaction and working conditions. Not being a Norwegian native speaker was associated with a significantly higher mean score for job satisfaction and a significantly lower mean score for stress recognition. Neither professional background nor work experience were significantly associated with mean scores for any patient safety factor. CONCLUSIONS: Patient safety factor scores in nursing homes were poorer than previously found in Norwegian general practices, but similar to findings in out-of-hours primary care clinics. Patient safety culture assessment may help nursing home leaders to initiate targeted quality improvement interventions. Further research should investigate associations between patient safety culture and the occurrence of adverse events in nursing homes.

The safety attitudes questionnaire - ambulatory version: psychometric properties of the Slovenian version for the out-of-hours primary care setting.

BACKGROUND: Several tools have been developed to measure safety attitudes of health care providers, out of which the Safety Attitudes Questionnaire (SAQ) is regarded as one of the most appropriate ones. In 2007, it was adapted to outpatient (primary health care) settings and in 2014 it was tested in out-of-hours health care settings in Norway. The purpose of this study was to translate the English version of the SAQ-Ambulatory Version (SAQ-AV) to Slovenian language; to test its reliability; and to explore its factor structure. METHODS: This was a cross-sectional study that took place in Slovenian out-of-hours primary care clinics in March-May 2015 as a part of an international study entitled Patient Safety Culture in European Out-of-hours services. The questionnaire consisted of the Slovenian version of the SAQ-AV. The link to the questionnaire was emailed to health care workers in the out-of-hours clinics. A total of 438 participants were invited. We performed exploratory factor analysis. RESULTS: Out of 438 invited participants, 250 answered the questionnaire (response rate 57.1%). Exploratory factor analysis put forward five factors: 1) Perceptions of management, 2) Job satisfaction, 3) Safety climate, 4) Teamwork climate, and 5) Communication. Cronbach's alpha of the whole SAQ-AV was 0.922. Cronbach's alpha of the five factors ranged from 0.587 to 0.791. Mean total score of the SAQ-AV was 56.6 ± 16.0 points. The factor with the highest average score was Teamwork climate and the factor with the lowest average was Job satisfaction. CONCLUSIONS: Based on the results in our study, we cannot state that the SAQ-AV is a reliable tool for measuring safety culture in the Slovenian out-of-hours care setting. Our study also showed that there might be other safety culture factors in out-of-hours care not recognised before. We therefore recommend larger studies aiming to identify an alternative factor structure.

Association between general self-efficacy, social support, cancer-related stress and physical health-related quality of life: a path model study in patients with neuroendocrine tumors.

BACKGROUND: A diagnosis of neuroendocrine tumors (NET) provides challenges to patients and clinicians due to physical side effects of and mental response to treatment resulting in increased perceived stress. General self-efficacy, social support and cancer-related stress are key factors in coping. Thus, knowledge of these factors may be of value in improving health-related quality of life (HRQoL). The aim of the study was to examine the relationships between general self-efficacy, social support, cancer-related stress and HRQoL in patients with NET using a path model. METHODS: 196 Norwegian patients living with NET were enrolled in this cross-sectional study. Inclusion criteria were: patients with tumors restricted to the GI tract; ability to speak and write Norwegian; over 18 years of age; undergoing medical treatment for NET. Measures used in the study were background characteristics, Health-related Quality of Life (SF-36), the Impact of Event Scale (IES), General Self-efficacy and the Interpersonal Support Evaluation List (ISEL). Relationships between sociodemographic variables, general self-efficacy, social support, cancer-related stress and mental and physical components scores were tested by path analysis with AMOS 22 using maximum standard likelihood estimation. RESULTS: The sample consisted of 50.5 % women and the average age was 65 years and the median disease duration was 4 years. Sociodemographic variables of gender, education and whether the patient lived alone or with someone were unrelated (directly or indirectly) to HRQoL. Age was directly and negatively correlated with physical HRQoL, general self-efficacy and social support in a well-fitting path model. General self-efficacy modified the negative effects of age on physical HRQoL. Physical and mental HRQoL were not associated with cancer-related stress. Higher social support was related to less stress. CONCLUSION: Intervening to improve general self-efficacy and social support for patients with NET may improve their HRQoL.

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.

Dietary patterns and whole grain cereals in the Scandinavian countries--differences and similarities. The HELGA project.

OBJECTIVE: To identify dietary patterns with whole grains as a main focus to see if there is a similar whole grain pattern in the three Scandinavian countries; Denmark, Sweden and Norway. Another objective is to see if items suggested for a Nordic Food Index will form a typical Nordic pattern when using factor analysis. SETTING: The HELGA study population is based on samples of existing cohorts: the Norwegian Women and Cancer Study, the Swedish Västerbotten cohort and the Danish Diet, Cancer and Health study. The HELGA study aims to generate knowledge about the health effects of whole grain foods. SUBJECTS: The study included a total of 119 913 participants. DESIGN: The associations among food variables from FFQ were investigated by principal component analysis. Only food groups common for all three cohorts were included. High factor loading of a food item shows high correlation of the item to the specific diet pattern. RESULTS: The main whole grain for Denmark and Sweden was rye, while Norway had highest consumption of wheat. Three similar patterns were found: a cereal pattern, a meat pattern and a bread pattern. However, even if the patterns look similar, the food items belonging to the patterns differ between countries. CONCLUSIONS: High loadings on breakfast cereals and whole grain oat were common in the cereal patterns for all three countries. Thus, the cereal pattern may be considered a common Scandinavian whole grain pattern. Food items belonging to a Nordic Food Index were distributed between different patterns.

Prevalence of suspected developmental delays in early infancy: results from a regional population-based longitudinal study.

BACKGROUND: Prevalence estimates on suspected developmental delays (SDD) in young infants are scarce and a necessary first step for planning an early intervention. We investigated the prevalence of SDD at 4, 6 and 12 months, in addition to associations of SDD with gender, prematurity and maternal education. METHODS: This study is based on a Norwegian longitudinal sample of 1555 infants and their parents attending well-baby clinics for regular health check-ups. Moreover, parents completed the Norwegian translation of the Ages and Stages Questionnaires (ASQ) prior to the check-up, with a corrected gestational age being used to determine the time of administration for preterm infants. Scores ≤ the established cut-offs in one or more of the five development areas: communication, gross motor, fine motor, problem solving and personal-social, which defined SDD for an infant were reported. Chi-square tests were performed for associations between the selected factors and SDD. RESULTS: According to established Norwegian cut-off points, the overall prevalence of SDD in one or more areas was 7.0 % (10.3 % US cut-off) at 4 months, 5.7 % (12.3 % US cut-off) at 6 months and 6.1 % (10.3 % US cut-off) at 12 months. The highest prevalence of SDD was in the gross motor area at all three time points. A gestational age of < 37 weeks revealed a significant association with the communication SDD at 4 months, and with the fine motor and personal social SDD at 6 months. Gender was significantly associated with the fine motor and problem solving SDD at 4 months and personal- social SDD at 6 months: as more boys than girls were delayed. No significant associations were found between maternal education and the five developmental areas of the ASQ. CONCLUSION: Our findings indicate prevalence rates of SDD between 5.7 and 7.0 % in Norwegian infants between 4 and 12 months of age based on the Norwegian ASQ cut-off points (10.3-12.3 %, US cut-off points). During the first year of life, delay is most frequent within the gross motor area. Special attention should be paid to infants born prematurely, as well as to boys. Separate norms for boys and girls should be considered for the ASQ.

Predictors for assessing electronic messaging between nurses and general practitioners as a useful tool for communication in home health care services: a cross-sectional study.

BACKGROUND: Nurses providing home health care services are dependent on access to patient information and communicating with general practitioners (GPs) to deliver safe and effective health care to patients. Information and communication technology (ICT) systems are viewed as powerful tools for this purpose. In Norway, a standardized electronic messaging (e-messaging) system is currently being established in health care. OBJECTIVE: The aim of this study was to explore home health care nurses' assessments of the utility of the e-messaging system for communicating with GPs and identify elements that influence the assessment of e-messaging as a useful communication tool. METHODS: The data were collected using a self-developed questionnaire based on variables identified by focus group interviews with home health care nurses (n=425) who used e-messaging and existing research. Data were analyzed using logistic regression analyses. RESULTS: Over two-thirds (425/632, 67.2%) of the home health care nurses returned the questionnaire. A high proportion (388/399, 97.2%) of the home health care nurses who returned the questionnaire found the e-messaging system to be a useful tool for communication with GPs. The odds of reporting that e-messaging was a useful tool were over five times higher (OR 5.1, CI 2.489-10.631, P<.001) if the nurses agreed or strongly agreed that e-messaging was easy to use. The odds of finding e-messaging easy to use were nearly seven times higher (OR 6.9, CI 1.713-27.899, P=.007) if the nurses did not consider the system functionality poor. If the nurses had received training in the use of e-messaging, the odds were over six times higher (OR 6.6, CI 2.515-17.437, P<.001) that they would consider e-messaging easy to use. The odds that a home health care nurse would experience e-messaging as easy to use increased as the full-time equivalent percentage of the nurses increased (OR 1.032, CI 1.001-1.064, P=.045). CONCLUSIONS: This study has shown that technical (ease of use and system functionality), organizational (training), and individual (full-time equivalent percentage) elements had an impact on home health care nurses' assessments of using e-messaging to communicate with GPs. By identifying these elements, it is easier to determine which interventions are the most important for the development and implementation of ICT systems in home health care services.

The Thriving of Older People Assessment Scale: validity and reliability assessments.

AIM: To explore construct validity and reliability of the Thriving of Older People Assessment Scale. BACKGROUND: The concept of thriving emphasizes person-environment interaction in relation to well-being. The Thriving of Older People Assessment Scale has been developed and evaluated as a self-report and proxy scale based on the theory of thriving. DESIGN: Cross-sectional survey design. METHOD: The Thriving of Older People Assessment Scale was completed by a sample of 259 residents, 146 family members and 52 staff from 13 long-term care facilities in Norway and Sweden. Data were collected between April 2010-December 2011. Exploratory factor analysis was applied to explore construct validity in terms of factor structure and dimensionality of the 32-item scale in relation to the thriving theory. Reliability was explored through internal consistency estimation using Cronbach's alpha and through homogeneity evaluation using corrected item-total correlations. RESULTS: Exploratory factor analysis resulted in five factors (subscales) that corresponded meaningfully with the thriving theory and were labelled 1: Resident' attitudes towards being in long-term care; 2: Quality of care and caregivers; 3: Resident engagement and peer relationships; 4: Keeping in touch with people and places; and 5: Quality of the physical environment. The scale had satisfactory internal consistency and homogeneity estimates. CONCLUSION: The 32-item Thriving of Older People Assessment Scale can be regarded as construct valid and reliable. Its factor structure corresponded logically to the thriving theory and its factors showed satisfactory internal consistency and homogeneity. Nevertheless, the TOPAS would benefit from further testing in other populations and contexts.

Discrepancy between self-assessments and standardised tests of vision and hearing abilities in older people living at home: an ROC curve analysis.

AIMS AND OBJECTIVES: To determine whether there is consistency between self-assessments and standardised tests of vision and hearing abilities in older people. BACKGROUND: Home-based detection of vision and hearing impairments in older people are generally based on self-assessments of vision and hearing abilities. DESIGN: Cross-sectional descriptive study. METHODS: Receiver operating characteristic analysis was used to compare self-assessments of vision and hearing abilities with a gold-standard test. The vision and hearing abilities of 93 people aged ≥80 years in the home-care setting were screened with a LogMAR chart, a pure-tone audiometer, and a self-assessment screen. RESULTS: Comparison of findings using the cut-off points on the self-assessment scale with those of the gold-standard tests yielded 40 false negatives for vision and 18 false negatives for hearing, indicating that a significant proportion of older people report their vision and hearing abilities as being good when standardised tests indicate that they are not. Alternative cut-off points on the self-assessment scale were tested, but no cut-off point was found to provide a sound basis for identifying vision and hearing impairments. CONCLUSION: The area under the receiver operating characteristic curve for self-assessment of vision was 69%, indicating that the self-assessment questions constituted a poor test. It appears that results from self-assessments cannot be relied upon to accurately identify visual acuity. The area under the receiver operating characteristic curve for the self-assessment of hearing was 73%, which may therefore be considered a "fair" test. However, self-assessment of hearing is still insufficient for detecting hearing impairment. RELEVANCE TO CLINICAL PRACTICE: Vision and hearing abilities are crucially important to managing daily living. In addition to treatments for suppressing the further development of existing diseases, standardised tests could be a good starting point for health prevention and promotion. Nurses should apply standardised tests to detect sensory impairments in older people.

Person-centred ward climate as experienced by mentally lucid residents in long-term care facilities.

AIMS AND OBJECTIVES: To assess the content validity and reliability of the Person-centred Climate Questionnaire-Patient version in long-term care facilities, to describe residents' perceptions of the extent to which their ward climate was person-centred and to explore whether person-centredness was associated with facility and resident characteristics, such as facility and ward size, having a sensory garden and having a primary caregiver. BACKGROUND: The importance of the physical environment to persons with dementia has been investigated. However, research is lacking regarding the extent to which mentally lucid residents experience their physical and psycho-social ward climate as person-centred and the factors influencing their experience. DESIGN: Cross-sectional survey design. METHODS: The Person-centred Climate Questionnaire-Patient version was translated into Norwegian with forward and backward translation. The content validity index for scales was assessed. The Person-centred Climate Questionnaire -Patient version was completed by 145 mentally lucid residents in 17 Norwegian long-term care facilities. Reliability was assessed by Cronbach's α and item-total correlations. Test-retest reliability was assessed by paired samples t-test and Spearman's correlation. To explore differences based on facility and resident characteristics, independent-samples t-test and one-way anova were used. RESULTS: The content validity index for scales was satisfactory. The Person-centred Climate Questionnaire-Patient version was internally consistent and had satisfactory test-retest reliability. The climate was experienced as highly person-centred. No significant differences were found, except that residents in larger facilities experienced the climate as more person-centred in relation to everyday activities (subscale 2) than residents in smaller facilities. CONCLUSION: The Norwegian version of the Person-centred Climate Questionnaire-Patient version can be regarded as reliable in a long-term care facility context. Perceived degree of person-centredness was not associated with facility or resident characteristics, such as the number of residents, having a sensory garden or knowing that one has a primary caregiver. RELEVANCE TO CLINICAL PRACTICE: A person-centred climate can be attained in different kinds of long-term care facilities.

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.