Contextual influences on knowledge translation capacity in a nursing home organisation: A phenomenological hermeneutical study.

INTRODUCTION: The demand for advanced clinical care in nursing homes (NHs) is increasing. Evidence-based practices and knowledge translation (KT) initiatives are growing to bridge the gap between what is known and what is done. However, research on contextual influence on KT has primarily focused on hospital settings. AIM: To expand our understanding of contextual influences on KT capacity in a NH organisation. DESIGN AND METHODS: Lindseth and Norberg's phenomenological hermeneutical method was used to explore and describe practice development nurses' experiences, perspectives and practices regarding how contextual factors influence KT capacity in NHs. Focus group interviews, participant observations, in-depth interviews and non-participant observations provided the data. RESULTS: Two main themes and four subthemes were identified. (1) Continuous limited resources are a cultural condition that inhibits KT readiness; prioritising keeping the NH machinery running at all costs and having contrasting care philosophies undermines KT. (2) Organisational prioritisations leave KT as a missing cogwheel in the machinery; retaining a system of fragmented KT strategies and lacking a structure for collective KT effort. CONCLUSION: The study showed that KT held a minor role in the fast-paced NH machinery. Contradicting values characterise the NH organisation, resulting in a lack of a common vision and priorities. Building a sustainable KT capacity and providing evidence-based practice necessitates explicit responsibilities, dedicated resources and robust organisational support. Management has a critical role in strengthening the position of KT. Incorporating KT in daily NH practice can help staff become adaptable and confident, capable of meeting the increasing challenges of advanced care that alleviates suffering and promote the health and well-being of NH patients.

Stakeholder development of an implementation strategy for fall prevention in Norwegian home care - a qualitative co-creation approach.

BACKGROUND: The uptake of fall prevention evidence has been slow and limited in home care services. Involving stakeholders in the implementation process is suggested as a method to successfully tailor implementation strategies. The aim of this study was to develop an implementation strategy for fall prevention, targeting healthcare providers working in home care services. METHODS: This study used an explorative qualitative approach in a five-step co-creation process to involve researchers, service users, and healthcare providers. The first two steps consisted of workshops. This was followed by focus group interviews and individual interviews with key informants as steps three and four. Data from the first four steps were analyzed using reflexive thematic analysis. The fifth and final step was a workshop finalizing a strategy for implementing fall prevention evidence in home health services. RESULTS: Overall, our findings, resulted in an implementation strategy for fall prevention with four components: (1) Empower leaders to facilitate implementation, operationalized through what managers pay attention to regularly, resource priorities, and time spent on fall prevention, (2) Establish implementation teams, consisting of multidisciplinary healthcare providers from different levels of the organization, with formalized responsibility for implementation, (3) Tailor dual competence improvement, reflecting the need for knowledge and skills for fall prevention and implementation among healthcare providers and users, and (4) Provide implementation support, representing guidance through the implementation process. CONCLUSIONS: This study advances our understanding of implementation in home care services. Implementation of fall prevention requires an implementation strategy involving a blend of essential components targeting leaders, competent healthcare providers and users, and establishing structures enhancing the implementation process.

Individual and organizational features of a favorable work environment in nursing homes: a cross-sectional study.

BACKGROUND: The organizational context in healthcare (i.e., the work environment) is associated with patient outcomes and job satisfaction. Long-term care is often considered to be a challenging work environment, characterized by high job demands, low job control, a fast work pace and job dissatisfaction, which may affect patient care and increase staff turnover.This study aims to investigate the organizational context in nursing homes and the features of favorable or less favorable work environments. METHODS: This study is a cross-sectional study of registered nurses and licensed practical nurses in Bergen, Norway (n = 1014). The K-means clustering algorithm was used to differentiate between favorable and less favorable work environments, based on the Alberta Context Tool. Multilevel logistic regression analysis was used to investigate the associations between individual sociodemographic factors, nursing home factors and the probability of experiencing a favorable work environment. RESULTS: 45% of the sample (n = 453) experienced working in a favorable work environment. Contextual features (especially a supportive work culture, more evaluation mechanisms and greater organizational slack resources) and individual features (having a native language other than Norwegian, working day shifts, working full time and belonging to a younger age group) significantly increased the likelihood of experiencing a favorable work environment. CONCLUSION: The work environment in nursing homes is composed of modifiable contextual features. Action in relation to less favorable features and their associated factors should be a priority for nursing home management. This survey indicates that specific steps can be taken to reduce the reliance on part-time workers and to promote the work environment among staff working the night shift.

Integrated knowledge translation in nursing homes: exploring the experiences of practice development nurses.

BACKGROUND: Practice Development Nurses (PDNs) in Norwegian nursing homes (NHs) hold a specific responsibility for knowledge translation in this increasingly complex healthcare setting. They were involved as end users in an integrated knowledge translation (IKT) study, developing, testing and evaluating the IMPAKT (IMPlementation of Action to Knowledge Translation) intervention. PDNs participated in an educational programme tailored to their own defined needs. In a second intervention component, the PDNs applied their new skills with facilitation, in implementing the National Early Warning Score (NEWS2) in their respective NHs. The aim of this study was to explore 1) the PDNs' experiences of participating in an IKT educational intervention, and 2) how they applied the learning in planning, tailoring and initial implementation of the NEWS2. METHODS: This is a qualitative exploratory study based on a phenomenological hermeneutical method. Study participants were PDNs working in the nine NHs in the intervention group of the IMPAKT trial. We conducted nine in-depth interviews and eight non-participatory observational sessions of the intervention delivery. RESULTS: The PDNs expressed that the educational programme met their needs and enhanced their understanding about leading knowledge translation (KT). They reported a move from operating in a "big black box of implementation" to a professional and structured mode of KT. The gamechanger was a shift from KT as the PDNs' individual responsibility to KT as an organizational matter. The PDNs reported enhanced competencies in KT and in their ability to involve and collaborate with others in their facility. Organizational contextual factors challenged their KT efforts and implementation of the NEWS2. CONCLUSIONS: This study demonstrates that an IKT approach has the potential to advance and improve staff competencies and NH readiness for KT. However, individual motivations and competencies were challenged within an organizational culture which was less receptive to this new leadership role and level of KT activity.

Translation and validation of the Alberta Context Tool for use in Norwegian nursing homes.

PURPOSE: Organizational context is recognized as important for facilitating evidence-based practice and improving patient outcomes. Organizational context is a complex construct to measure and appropriate instruments that can quantify and measure context are needed. The aim of this study was to translate and cross-culturally adapt the Alberta Context Tool (ACT) to Norwegian, and to test the reliability and structural validity among registered nurses (RNs) and licenced practice nurses (LPNs) working in nursing homes. METHODS: This study was a validation study utilizing a cross-sectional design. The sample consisted of n = 956 healthcare personnel from 28 nursing homes from a municipality in Norway. In the first stage, the ACT was translated before being administered in 28 nursing homes. In the second stage, internal consistency and structural validity were explored using Cronbach's alpha and confirmatory factor analysis. RESULTS: A rigorous forward-and-back translation process was performed including a team of academics, experts, professional translators and the copyright holders, before an acceptable version of the ACT was piloted and finalized. The Norwegian version of the ACT showed good internal consistency with Chronbachs alpha above .75 for all concepts except for Formal interactions where the alpha was .69. Structural validity was acceptable for both RNs and LPNs with factors loadings more than .4 for most items. CONCLUSIONS: The Norwegian version of the ACT is a valid measure of organizational context in Norwegian nursing homes among RNs and LPNs.

Optimizing a knowledge translation intervention: a qualitative formative study to capture knowledge translation needs in nursing homes.

BACKGROUND: Knowledge translation (KT) has emerged as an important consideration to reduce knowledge-to-practice gaps in healthcare settings. Research on KT approaches in nursing homes (NHs) is lacking. There is a need to understand the challenges faced in NHs and how these can be managed. This study is part of the larger IMPAKT (IMPlementation and Action for Knowledge Translation) study which addresses KT in NHs. The aim of the study presented here was to identify crucial staff and organizational needs in order to inform the development of a KT intervention in NHs. METHODS: A multimethod qualitative approach was applied. We invited practice development nurses (PDNs) to describe current practice, and to identify problems and needs concerning KT in NHs. We followed the recommendations of the development phase of the MRC framework for developing complex interventions. Data were collected through four focus groups and participatory observations in six NHs. Analysis was conducted according to structural thematic analysis based on a phenomenological hermeneutic method. RESULTS: We identified three themes that expressed the PDNs' perceived needs for successful KT implementation: (1) narrowing the PDN role, (2) developing an EBP culture and (3) establishing collaborative alliances. Nine subthemes derived from the PDNs' experiences and current practice, illustrating needs at individual, relational and organizational levels. CONCLUSIONS: Rigorous development of complex interventions may add relevance to the intervention, increase the likelihood of success and reduce research waste. Insight into the NH context and organization have helped us define problems and articulate needs that must be addressed when tailoring the IMPAKT intervention. TRIAL REGISTRATION: The IMPAKT trial was retrospectively registered in the ISRCTN Registry (Trial ID: 12,437,773) on March 19th, 2020.

Evidence-based practice profiles among bachelor students in four health disciplines: a cross-sectional study.

BACKGROUND: Despite the recognition of integrating evidence-based practice (EBP) in educational programs, there is limited research about bachelor students' EBP profiles (EBP knowledge, attitudes and behaviour) in the health disciplines nursing, occupational therapy, physiotherapy and radiography. The aim of this study was to assess EBP profiles among bachelor students in health disciplines, and explore differences between health disciplines, educational institutions, students' assessment of EBP teaching and expectations of EBP performance. METHODS: A survey using the 'Evidence-Based Practice Profile - Norwegian version' (EBP2-N) was conducted among final year bachelor students in health disciplines from four educational institutions. The questionnaire consisted of five domains (Relevance, Terminology, Confidence, Practice and Sympathy) and assessed the five steps of EBP. We performed regression analyses to analyse mean differences in domain scores between health disciplines, Cohen's d to illustrate the magnitude of the largest difference in each domain, Omega squared to describe portion of variance in domain scores, and Spearman's rho (rs) to assess the monotonic relationship between EBP2-N domains and assessment of EBP teaching and expectations of EBP performance, respectively. RESULTS: Students reported highest overall mean score for Relevance, with an estimated standardized mean of 81.2 (CI 95% = 80.4-82.0). The other EBP2-N domains had estimated standardized means of 54 and less. Statistically significant differences (p < 0.03) between health disciplines were observed for all domains. The largest mean difference was found for Relevance with highest score for occupational therapy and lowest for radiography, with an estimated Cohen's d of 1.11. Moderate positive associations were observed between Relevance scores and students' assessment of EBP teaching (rs = 0.31), and expectations of EBP performance from teachers (rs = 0.36). We also observed a moderate positive correlation between Confidence and students' assessment of EBP teaching (rs = 0.46). CONCLUSION: Bachelor students in health disciplines found EBP relevant, but revealed low understanding of EBP terminology, low confidence with EBP skills, and low use of EBP in clinical situations. We observed differences in EBP profiles between health disciplines and between educational institutions. The differences in scores raise questions about the understanding of EBP within disciplines, and the complexity of EBP in educational settings.

Self-reported and objectively assessed knowledge of evidence-based practice terminology among healthcare students: A cross-sectional study.

BACKGROUND: Self-reported scales and objective measurement tools are used to evaluate self-perceived and objective knowledge of evidence-based practice (EBP). Agreement between self-perceived and objective knowledge of EBP terminology has not been widely investigated among healthcare students. AIM: The aim of this study was to examine agreement between self-reported and objectively assessed knowledge of EBP terminology among healthcare students. A secondary objective was to explore this agreement between students with different levels of EBP exposure. METHODS: Students in various healthcare disciplines and at different academic levels from Norway (n = 336) and Canada (n = 154) were invited to answer the Terminology domain items of the Evidence-Based Practice Profile (EBP2) questionnaire (self-reported), an additional item of 'evidence based practice' and six random open-ended questions (objective). The open-ended questions were scored on a five-level scoring rubric. Interrater agreement between self-reported and objective items was investigated with weighted kappa (Kw). Intraclass correlation coefficient (ICC) was used to estimate overall agreement. RESULTS: Mean self-reported scores varied across items from 1.99 ('forest plot') to 4.33 ('evidence-based practice'). Mean assessed open-ended answers varied from 1.23 ('publication bias') to 2.74 ('evidence-based practice'). For all items, mean self-reported knowledge was higher than that assessed from open-ended answers (p<0.001). Interrater agreement between self-reported and assessed open-ended items varied (Kw = 0.04-0.69). The overall agreement for the EBP2 Terminology domain was poor (ICC = 0.29). The self-reported EBP2 Terminology domain discriminated between levels of EBP exposure. CONCLUSION: An overall low agreement was found between healthcare students' self-reported and objectively assessed knowledge of EBP terminology. As a measurement tool, the EBP2 Terminology scale may be useful to differentiate between levels of EBP exposure. When using the scale as a discriminatory tool, for the purpose of academic promotion or clinical certification, users should be aware that self-ratings would be higher than objectively assessed knowledge.

Dysphagia screening after acute stroke: a quality improvement project using criteria-based clinical audit.

BACKGROUND: Dysphagia is common after stroke and represents a major risk factor for developing aspiration pneumonia. Early detection can reduce the risk of pulmonary complications and death. Despite the fact that evidence-based guidelines recommend screening for swallowing deficit using a standardized screening tool, national audits has identified a gap between practice and this recommendation. The aim was to determine the level of adherence to an evidence-based recommendation on swallow assessment and to take actions to improve practice if necessary. METHODS: We carried out a criteria-based clinical audit (CBCA) in a small stroke unit at a Norwegian hospital. Patients with hemorrhagic stroke, ischemic stroke and transient ischemic attack were included. A power calculation informed the number of included patients at baseline (n = 80) and at re-audit (n = 35). We compared the baseline result with the evidence-based criteria and gave feedback to management and staff. A brainstorming session, a root-cause analysis and implementation science were used to inform the quality improvement actions which consisted of workshops, use of local opinion leaders, manual paper reminders and feedback. We completed a re-audit after implementation. Percentages and median are reported with 95% confidence intervals (CI). RESULTS: Among 88 cases at baseline, documentation of swallow screening was complete for 6% (95% CI 2-11). In the re-audit (n = 51) 61% (95% CI 45-74) had a complete screening. CONCLUSION: A CBCA involving management and staff, and using multiple tailored intervention targeting barriers, led to greater adherence with the recommendation for screening stroke patients for dysphagia.

Translation, cross-cultural adaption and measurement properties of the evidence-based practice profile.

BACKGROUND: The evidence-based practice profile (EBP2) questionnaire assesses students' self-reported knowledge, behaviour and attitudes related to evidence-based practice. The aim of this study was to translate and cross-culturally adapt EBP2 into Norwegian and to evaluate the reliability, validity and responsiveness of the Norwegian version. METHODS: EBP2 was translated and cross-culturally adapted using recommended methodology. Face validity and feasibility were evaluated in a pilot on bachelor students and health and social workers (n = 18). Content validity was evaluated by an expert panel. Nursing students (n = 96), social educator students (n = 27), and health and social workers (n = 26) evaluated the instrument's measurement properties. Cronbach's alpha was calculated to determine internal consistency. Test-retest reliability was evaluated using the intra-class correlation coefficient (ICC) and standard error of measurement (SEM). Discriminative validity was assessed by independent sample t test. A confirmatory factor analysis (CFA) was performed to assess the structural validity of a five-factor model (Relevance, Sympathy, Terminology, Practice and Confidence) using the comparative fit index (CFI) and the root mean square error of approximation (RMSEA). A priori hypotheses on effect sizes and P values were formulated to evaluate the instrument's responsiveness. RESULTS: The forward-backward translation was repeated three times before arriving at an acceptable version. Eleven of 58 items were re-worded. Face validity and content validity were confirmed. Cronbach's alpha was 0.90 or higher for all domains except Sympathy (0.66). ICC ranged from 0.45 (Practice) to 0.79 (Terminology) and SEM from 0.29 (Relevance) to 0.44 (Practice). There was a significant mean difference between exposure and no exposure to EBP for the domains Relevance, Terminology and Confidence. The CFA did not indicate an acceptable five-factor model fit (CFI = 0.69, RMSEA = 0.09). Responsiveness was as expected or better for all domains except Sympathy. CONCLUSIONS: The cross-culturally adapted EBP2-Norwegian version was valid and reliable for the domains Relevance, Terminology and Confidence, and responsive to change for all domains, except Sympathy. Further development of the instrument's items are needed to enhance the instruments reliability for the domains Practice and Sympathy.

Implementing guidelines in nursing homes: a systematic review.

BACKGROUND: Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects of interventions to improve the implementation of guidelines in nursing homes. METHODS: A systematic literature search was conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, DARE, HTA, CENTRAL, SveMed + and ISI Web of Science from their inception until August 2015. Reference screening and a citation search were performed. Studies were eligible if they evaluated any type of guideline implementation strategy in a nursing home setting. Eligible study designs were systematic reviews, randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted-time-series studies. The EPOC risk of bias tool was used to evaluate the risk of bias in the included studies. The overall quality of the evidence was rated using GRADE. RESULTS: Five cluster-randomised controlled trials met the inclusion criteria, evaluating a total of six different multifaceted implementation strategies. One study reported a small statistically significant effect on professional practice, and two studies demonstrated small to moderate statistically significant effects on patient outcome. The overall quality of the evidence for all comparisons was low or very low using GRADE. CONCLUSIONS: Little is known about how to improve the implementation of guidelines in nursing homes, and the evidence to support or discourage particular interventions is inconclusive. More implementation research is needed to ensure high quality of care in nursing homes. PROTOCOL REGISTRATION: PROSPERO 2014: CRD42014007664.

Educating change agents: a qualitative descriptive study of graduates of a Master's program in evidence-based practice.

BACKGROUND: Health care professionals are expected to build decisions upon evidence. This implies decisions based on the best available, current, valid and relevant evidence, informed by clinical expertise and patient values. A multi-professional master's program in evidence-based practice was developed and offered. The aims of this study were to explore how students in this program viewed their ability to apply evidence-based practice and their perceptions of what constitute necessary conditions to implement evidence-based practice in health care organizations, one year after graduation. METHODS: A qualitative descriptive design was chosen to examine the graduates' experiences. All students in the first two cohorts of the program were invited to participate. Six focus-group interviews, with a total of 21 participants, and a telephone interview of one participant were conducted. The data was analyzed thematically, using the themes from the interview guide as the starting point. RESULTS: The graduates reported that an overall necessary condition for evidence-based practice to occur is the existence of a "readiness for change" both at an individual level and at the organizational level. They described that they gained personal knowledge and skills to be "change-agents" with "self-efficacy, "analytic competence" and "tools" to implement evidence based practice in clinical care. An organizational culture of a "learning organization" was also required, where leaders have an "awareness of evidence- based practice", and see the need for creating "evidence-based networks". CONCLUSIONS: One year after graduation the participants saw themselves as "change agents" prepared to improve clinical care within a learning organization. The results of this study provides useful information for facilitating the implementation of EBP both from educational and health care organizational perspectives.

Assessment of quality in psychiatric nursing documentation - a clinical audit.

BACKGROUND: Quality in nursing documentation facilitates continuity of care and patient safety. Lack of communication between healthcare providers is associated with errors and adverse events. Shortcomings are identified in nursing documentation in several clinical specialties, but very little is known about the quality of how nurses document in the field of psychiatry. Therefore, the aim of this study was to assess the quality of the written nursing documentation in a psychiatric hospital. METHOD: A cross-sectional, retrospective patient record review was conducted using the N-Catch audit instrument. In 2011 the nursing documentation from 21 persons admitted to a psychiatric department from September to December 2010 was assessed. The N-Catch instrument was used to audit the record structure, admission notes, nursing care plans, progress and outcome reports, discharge notes and information about the patients' personal details. The items of N-Catch were scored for quantity and/or quality (0-3 points). RESULTS: The item 'quantity of progress and evaluation notes' had the lowest score: in 86% of the records progress and outcome were evaluated only sporadically. The items 'the patients' personal details' and 'quantity of record structure' had the highest scores: respectively 100% and 71% of the records achieved the highest score of these items. CONCLUSIONS: Deficiencies in nursing documentation identified in other clinical specialties also apply to the clinical field of psychiatry. The quality of electronic written nursing documentation in psychiatric nursing needs improvements to ensure continuity and patient safety. This study shows the importance of the existence of a validated tool, readily available to assess local levels of nursing documentation quality.

Reducing hospital admissions from nursing homes: a systematic review.

BACKGROUND: The geriatric nursing home population is vulnerable to acute and deteriorating illness due to advanced age, multiple chronic illnesses and high levels of dependency. Although the detriments of hospitalising the frail and old are widely recognised, hospital admissions from nursing homes remain common. Little is known about what alternatives exist to prevent and reduce hospital admissions from this setting. The objective of this study, therefore, is to summarise the effects of interventions to reduce acute hospitalisations from nursing homes. METHODS: A systematic literature search was performed in Cochrane Library, PubMed, MEDLINE, EMBASE and ISI Web of Science in April 2013. Studies were eligible if they had a geriatric nursing home study population and were evaluating any type of intervention aiming at reducing acute hospital admission. Systematic reviews, randomised controlled trials, quasi randomised controlled trials, controlled before-after studies and interrupted time series were eligible study designs. The process of selecting studies, assessing them, extracting data and grading the total evidence was done by two researchers individually, with any disagreement solved by a third. We made use of meta-analyses from included systematic reviews, the remaining synthesis is descriptive. Based on the type of intervention, the included studies were categorised in: 1) Interventions to structure and standardise clinical practice, 2) Geriatric specialist services and 3) Influenza vaccination. RESULTS: Five systematic reviews and five primary studies were included, evaluating a total of 11 different interventions. Fewer hospital admissions were found in four out of seven evaluations of structuring and standardising clinical practice; in both evaluations of geriatric specialist services, and in influenza vaccination of residents. The quality of the evidence for all comparisons was of low or very low quality, using the GRADE approach. CONCLUSIONS: Overall, eleven interventions to reduce hospital admissions from nursing homes were identified. None of them were tested more than once and the quality of the evidence was low for every comparison. Still, several interventions had effects on reducing hospital admissions and may represent important aspects of nursing home care to reduce hospital admissions.

Acute hospital admissions from nursing homes: predictors of unwarranted variation?

BACKGROUND: The geriatric nursing home population is frail and vulnerable to sudden changes in their health condition. Very often, these incidents lead to hospitalization, in which many cases represent an unfavourable discontinuity of care. Analysis of variation in hospitalization rates among nursing homes where similar rates are expected may identify factors associated with unwarranted variation. OBJECTIVES: To 1) quantify the overall and diagnosis specific variation in hospitalization rates among nursing homes in a well-defined area over a two-year period, and 2) estimate the associations between the hospitalization rates and characteristics of the nursing homes. METHOD: The acute hospital admissions from 38 nursing homes to two hospitals were identified through ambulance records and linked to hospital patient journals (n = 2451). Overall variation in hospitalization rates for 2 consecutive years was tested using chi-square and diagnosis-specific variation using Systematic Component of Variation. Associations between rates and nursing home characteristics were tested using multiple regression and ANOVA. RESULTS: Annual hospitalization rates varied significantly between 0.16 and 1.49 per nursing home. Diagnoses at discharge varied significantly between the nursing homes. The annual hospitalization rates correlated significantly with size (r = -0.38) and percentage short-term beds (r = 0.41), explaining 32% of the variation observed (R (2) = 0.319). No association was found for ownership status (r = 0.05) or location of the nursing home (p = 0.52). CONCLUSION: A more than nine-fold variation in annual hospitalization rates among the nursing homes in one municipality suggests the presence of unwarranted variation. This finding demands for political action to improve the premises for a more uniform practice in nursing homes.

Acute hospital admissions among nursing home residents: a population-based observational study.

BACKGROUND: Nursing home residents are prone to acute illness due to their high age, underlying illnesses and immobility. We examined the incidence of acute hospital admissions among nursing home residents versus the age-matched community dwelling population in a geographically defined area during a two years period. The hospital stays of the nursing home population are described according to diagnosis, length of stay and mortality. Similar studies have previously not been reported in Scandinavia. METHODS: The acute hospitalisations of the nursing home residents were identified through ambulance records. These were linked to hospital patient records for inclusion of demographics, diagnosis at discharge, length of stay and mortality. Incidence of hospitalisation was calculated based on patient-time at risk. RESULTS: The annual hospital admission incidence was 0.62 admissions per person-year among the nursing home residents and 0.26 among the community dwellers. In the nursing home population we found that dominant diagnoses were respiratory diseases, falls-related and circulatory diseases, accounting for 55% of the cases. The median length of stay was 3 days (interquartile range = 4). The in-hospital mortality rate was 16% and 30 day mortality after discharge 30%. CONCLUSION: Acute hospital admission rate among nursing home residents was high in this Scandinavian setting. The pattern of diagnoses causing the admissions appears to be consistent with previous research. The in-hospital and 30 day mortality rates are high.