Fragility and Resilience: Stories of Recovering From Hip Fractures in the Oldest-Old Age.

This study uses a narrative approach to explore the experiences of adults in the oldest stage of old age after they suffered a hip fracture. The focus was on participants' perceptions and descriptions of the traumatic event, the recovery process, and the impact of the fracture on their lives. The study had a longitudinal design and included interviews with 10 participants (mean age 89) who had suffered hip fractures. Up to three semi-structured interviews were conducted with each of the participants (a total of 27 interviews) over a 3-month period. The first interviews were at the hospital, the second at municipal rehabilitation facilities, and the third at the participants' homes. The material was analysed by means of narrative analysis. The results show how the incident affected the participants' active and meaningful lives and how they seemed to mobilise their resources and motivation to train and recover to be able to come back home and resume the life they had before the hip fracture. The study provides nuances in the understanding of how a hip fracture can impact lives in old age. The stories emphasise the resources and capacity for resilience elderly people can possess and the importance of listening to the individual life stories, situation, personal goals, and needs when planning services for elderly people recovering from a hip fracture.

Nurse mentors' experiences with suitability assessments in clinical placement: A qualitative study.

AIM: This study aims to explore mentors' experiences with assessing the suitability of nursing students in clinical placements in a context where suitability assessment is required by law. BACKGROUND: It is the schools' responsibility to assess students, but mentors play an important role when students are in clinical placements. Clinical placements are typical arenas for assessing suitability. DESIGN: An explorative qualitative study METHODS: Participants were 17 registered nurses with experience as mentors for nursing students in clinical placement. The participants represented somatic and surgical wards from three different hospitals in Norway. Individual, semi-structured interviews were conducted. RESULTS: The analysis revealed a total of four themes: 1) the understanding of suitability, 2) experiencing borderline performance, 3) the heavy responsibility of doing the assessment and 4) the importance of support. CONCLUSIONS: The mentors found it difficult to assess suitability. They reported having little or no knowledge about leading rules and guidelines. The mentors experienced support from their colleagues, something which lightened the burden of assessing the students. This study indicates that mentors need more information about suitability and suitability assessments. REGISTRATION NUMBER: To be included in abstract after acceptance.

Kickstart in nursing home-Nursing students experiences of a model for active and collaborative learning in clinical placement.

AIMS AND OBJECTIVES: To explore students' experiences from a pilot project testing out a model for active, collaborative learning in first-year placement at a nursing home. BACKGROUND: There is a need for innovative learning activities and projects to improve clinical education in nursing homes. Active, collaborative approaches in placement learning may enhance students learning outcome. DESIGN: The study had a qualitative and explorative design, in which the experiences of students participating in the pilot were investigated through paired interviews at the end of their placement. METHODS: Twenty-two students participated in the study, and data from paired interviews were analysed using qualitative content analysis. COREQ reporting guidelines were used. RESULTS: Three themes emerged from the analysis: (1) The learning cell as facilitator for learning; (2) Discovering learning possibilities in nursing homes and (3) Applying tools and resources for learning. CONCLUSIONS: The model could reduce tension and anxiety while helping the students focus on learning options and use their environment more actively for learning. Working with a learning partner seems to increase student learning through common planning, feedback and reflection. The study emphasises the importance of facilitating active learning through the scaffolding structures and configuration of the students' learning space. RELEVANCE TO CLINICAL PRACTICE: This study indicates the potential for introducing active and collaborative pedagogical models in clinical placement. The model can promote nursing homes as a conducive learning arena for nursing students and help prepare students for a future work role in a rapidly changing health care field. PATIENT OR PUBLIC CONTRIBUTION: The result of the research is shared and discussed with stakeholders prior to finalising the article.

Suitable, fit, competent and safe to practice nursing? Assessing nursing students' personal qualities in clinical placement-An integrative review.

AIMS AND OBJECTIVES: This study aims to explore, describe, and synthesize the personal requirements student nurses are assessed in their clinical placement to be suitable, fit, competent, and safe for the nursing profession. BACKGROUND: There are different terms and concepts used when describing what nursing students are assessed by regarding personal requirements needed to be eligible to enter the nursing profession. This is regulated and enforced mainly by different standards and guidelines. DESIGN: An integrative review using Whittmore and Knafl's (2005) methodology. METHODS: Searches were systematically conducted in CINAHL, Education Source, ERIC, Academic Source Elite, MEDLINE and EMBASE, NORART, SveMed+, and Bibliotek.dk. The PRISMA checklist for systematic reviews was used. RESULTS: Eighteen studies were included in the review. The results present various factors student nurses are assessed by in clinical placements, which were categorized into three themes: attitude and personal characteristics, behavior, and basic knowledge. Assessing students is a complex and subjective endeavor, and decisions are based on a holistic assessment of several different aspects of the student's performance and behavior CONCLUSIONS: The personal requirements to be deemed suited for det nursing profession are complex and composed of several different components. Assessments are often based more on assessors' subjective standards and intuition than on the provided guidelines and standards. There is no universal understanding of which characteristics or qualities are considered necessary for a student to be deemed suited for the nursing profession. RELEVANCE TO CLINICAL PRACTICE: This study points at challenges with the assessment of nursing students today as there are no clear standards or understanding of the requirements needed.

Professional caregivers' participation in the International Caregiver Development Programme: A qualitative study of psychosocial care in nursing homes.

AIM: This paper aims to explore professional caregivers' experiences of psychosocial care for older persons living in nursing homes following the professional caregivers' participation in the International Caregiver Development Programme (ICDP). DESIGN: A qualitative study. METHODS: About 15 focus group interviews and 25 participatory observations of five ICDP group courses were conducted with 31 employees in nursing homes, including registered nurses, enrolled nurses and nursing aids. The findings emerged through hermeneutic analysis. RESULTS: Main findings: (i) Adjusting the communication to the residents' psychosocial needs, (ii) Seeing the residents as individuals and (iii) Adjusting to individual interaction with the residents. The professional caregivers experienced that the residents participated more in communication, interaction and activities, in addition to be more satisfied, calm, happy and thankful in interaction with the caregivers. Furthermore, they described that the environment in the units became calmer and that they were considering psychosocial care before medication. Work-related stress seems to impact ICDP participation and may be a barrier to implementation.

Nobody Dies Alone in the Electronic Patient Record-A Qualitative Analysis of the Textual Practices of Documenting Dying and Death.

In this study, we analyse the electronic patient record (EPR) as a genre and investigate how a death is documented as part of the EPR, that is, what kind of textual practices can be found, and how they can be understood based on extracts from 42 EPRs from medical wards in Norwegian hospitals. Following from our analysis, we see four distinct patterns in the documentation of patient death: a) registering the bare minimum of information, b) registering a body stopped working, c) documenting dying quietly and placing it in peaceful surroundings, and d) highlighting the accompanied death. The textual practices of documenting the transition to death in the EPR make death appear manageable and sanitised, depicting death as either uneventful or good. While the EPR genre is steeped in biomedical language, other discourses relating to death can be seen as ways to accommodate the ideal of a dignified death.

Compassion, emotions and cognition: Implications for nursing education.

Compassion is often understood as central to nursing and as important to ensure quality nursing and healthcare. In recent years, there has been a focus on strategies in nursing education to ensure compassionate nurses. However, it is not always clear how the concept of compassion is understood. Theoretical conceptualisations that lie behind various understandings of compassion have consequences for how we approach compassion in nursing education. We present some ways in which compassion is often understood, their philosophical underpinnings and the consequences these understandings can have for nursing education. We argue that it is useful for nursing education to understand compassion as a cognitive emotion and discuss how such an understanding can inform educational approaches to compassion.

Simulation as a joint learning activity in clinical placement-interaction between first-year nursing students and qualified nurses.

AIMS: The purpose of the study was to explore students' experiences from joint simulation training with qualified nurses that took place in students' first-year placement at a nursing home. BACKGROUND: Nursing students' clinical placement in nursing homes has been pictured as inadequate, boring and irrelevant. There is a need for innovative learning designs that include increased collaboration between the educational institution and clinical placement site to support student learning in practice. Simulation training is highlighted as a learning activity that enhances practical skills and reflection. DESIGN: The study had a qualitative evaluation design to explore and capture students' experiences and provide an understanding of the impact of the joint simulation activity during placement. METHODS: Three retrospective focus group interviews were conducted with a total of twenty nursing students. Written reflective notes from sixteen of the students were included in the study. The data were analysed by means of a thematic content analysis. COREQ reporting guidelines were used. RESULTS: Four themes were identified as follows: (a) anxiety and arrangements, (b) realistic scenarios-real nurses, (c) debriefing and reflection and (d) the aftereffect of the simulation training for the clinical placement. CONCLUSIONS: The joint simulation training gave the students an opportunity to actively participate in a complex clinical learning situation together with qualified nurses and within a safe environment. This learning activity provoked feelings and stress within the students. However, it also enriched the students' learning experience and strengthened the outcome of the clinical placement through an improved relationship between the students and qualified nurses. RELEVANCE TO CLINICAL PRACTICE: Creating collaborative learning activities between nursing homes and universities, such as joint simulation, can increase relevance and enhance learning and student satisfaction in their clinical placement. It can also promote nursing homes as interesting learning arena and future workplace for nursing students.

Planning and implementing quality improvement projects in clinical practice: Third-year nursing students' learning experiences.

AIMS AND OBJECTIVES: To evaluate the impact of an educational design to develop nursing students' competence to work systematically with quality improvement in clinical practice. BACKGROUND: Competence in how to improve the quality and safety of healthcare services based on new knowledge is crucial for healthcare quality. Nursing education should give students opportunities to engage in quality improvement projects to gain this competence. DESIGN: This project qualitatively evaluated the impact of the course on students' ability to plan and implement a quality improvement project in their clinical placement. METHODS: Data from retrospective focus group interviews and written project reports were analysed by means of qualitative content analysis. Fifty-five students participated in the study. COREQ reporting guidelines were used. RESULTS: Three themes were derived from the analysis: (a) the importance of anchoring the quality improvement project in the clinic; (b) experiencing the steps of a quality improvement project; and (c) challenging student role. CONCLUSIONS: Course design that facilitates student-run small-scale quality improvement projects under supervision can enhance nurse students' competence in quality improvement work, as well as raise the students' awareness of the responsibility they will undertake as future nurses. RELEVANCE TO CLINICAL PRACTICE: Nursing students work on quality improvement project in clinical placement may enhance their awareness and competence in developing quality and safety of healthcare services as future nurses.

Studying physiology within a flipped classroom: The importance of on-campus activities for nursing students' experiences of mastery.

AIMS AND OBJECTIVES: To explore the on-campus activities of the flipped classroom and their role in nursing students' experiences of mastering physiology. BACKGROUND: A nurse must be confident in their knowledge of physiology to feel confident as a nurse. However, many nursing students do not believe in their ability to master physiology. The flipped classroom design could facilitate active learning and promote students' confidence and competence in physiology. DESIGN: A design-based research design was employed. METHODS: Twenty-three nursing students enrolled in an anatomy and physiology course participated in two focus group interviews and wrote two individual reflective notes. The data were analysed by means of systematic text condensation and activity theory. Reporting was guided by the Consolidated Criteria for Reporting Qualitative Studies (COREQ). RESULTS: The study findings underscore the importance of careful design of on-campus activities within the flipped classroom to support students' experiences of mastery in physiology. Four themes were identified: (a) preparation which builds a foundation for learning; (b) the use of digital tools; (c) learning through dialogue with peers; and (d) experience of the expected learning outcomes. CONCLUSIONS: On-campus learning activities within a flipped classroom design could support students' experiences of confidence in and mastery of physiology. However, the study participants found learner-centred activities challenging and described feeling doubtful of their ability to master physiology. A didactic framework could take into account the circumstance that students perceive educational technology differently. When designing on-campus activities, emphasis should be placed on collaboration rather than competition to help students develop confidence in their knowledge of physiology. RELEVANCE TO CLINICAL PRACTICE: It is important to support nursing students' knowledge acquisition in bioscience and their development of confidence as these skills could enhance their clinical judgment in practice. Comprehension of bioscience is necessary to provide safe patient care and competent nursing.

Hospital nurses' professional accountability while using the National Early Warning Score: A qualitative study with a hermeneutic design.

AIM: To explore general hospital ward nurses' experiences with the National Early Warning Score and to determine its impacts on their professionalism. BACKGROUND: The National Early Warning Score has broad appeal; it is a patient safety initiative designed to ensure early identification of and response to deteriorating patients in hospitals. However, it is still unclear how the tool impacts nurses' professionalism. METHODS: A qualitative study with a hermeneutic design was conducted in autumn 2017; the study consisted of semi-structured, in-depth interviews with 14 hospital nurses. The data were analysed thematically to understand and interpret the nurses' experiences. Methods are reported using COREQ guidelines (see Appendix S1). RESULTS: The study examined nurses' experience with the National Early Warning Score and its perceived impact on their professionalism. Four themes were identified: (a) the National Early Warning Score and clinical judgement in patient assessment, (b) responding to the National Early Warning Score standard, (c) involving the professional community and (d) adjusting the tool. CONCLUSION: The National Early Warning Score may impact nurses' professionalism in diverse ways. Nurses are aware of the importance of incorporating all of their professional competence, comprising clinical judgement, discretion and accountability, with the National Early Warning Score to accurately assess patients' conditions. Findings indicated that the National Early Warning Score was beneficial to nurses' professional practice; however, accountability to this standard alone does not ensure quality care and patient safety. RELEVANCE TO CLINICAL PRACTICE: A greater understanding of the role of nurses' professional accountability when using the National Early Warning Score is needed to improve practice and ensure patient safety.

Introducing the National Early Warning Score - A qualitative study of hospital nurses' perceptions and reactions.

AIM: The aim of this study was to explore hospital nurses' perceptions and reactions to the National Early Warning Score during an introduction programme. DESIGN: A qualitative case study approach with participatory observations was used for this study. METHODS: In total, nine seminars and 23 simulation sessions attended by nurses were observed. An activity theory system analysis was applied to interpret the material. RESULTS: The findings revealed four tensions related to the working context: (a) tension between using a standardized tool and relying on clinical judgement (the tool could be either an aid or a barrier to patient assessment); (b) tension in the community of practice (the tool could be beneficial or increase stress and anxiety); (c) tension related to rules and compliance (the tool could be perceived as optional or compulsory); and (d) tension related to the division of labour (nurses feared more work).

Leadership in interprofessional collaboration in health care.

PURPOSE: There is a need to develop more knowledge on how frontline managers in health care services facilitate the development of new roles and ways of working in interprofessional collaborative efforts and the challenges they face in daily practice. The article is based on a study that examines the modes of governance adopted by frontline managers in Norway, with a special focus on leadership in collaborations between the Norwegian profession of social educator and other professions. MATERIALS AND METHODS: A qualitative research design was chosen with interviews of eleven frontline managers from district psychiatric centers, municipal health care services and nursing homes. RESULTS: The results show that frontline managers largely exercise leadership in terms of self-governance and co-governance and, to a lesser degree, hierarchical governance. Self-governance and co-governance can facilitate substantial maneuverability in terms of professional practice and strengthen both discipline-related and user-oriented approaches in the collaboration. However, one consequence of self-governance and co-governance may be that some occupational groups and professional interests subjugate others, as illustrated by social educators in this study. This may be in conflict with frontline managers' abilities to quality assure the services as well as their responsibility for role development in their staff. CONCLUSION: The results show that frontline managers experience challenges when they try to integrate different professions in order to establish new professional roles and competence. Frontline managers need to support individual and collective efforts in order to reach the overall goals for the services. They must be able to facilitate change and support creativity in a working community that consists of different professions. Moreover, the social educator's role and competence need clarifications in services that traditionally have been dominated by other clinical and health care professions.

Nursing students studying physiology within a flipped classroom, self-regulation and off-campus activities.

Nursing students experience physiology as a challenging subject to learn. A learner-centred approach could enhance their learning. This study explored nursing students' experiences of actively studying anatomy and physiology off-campus within a flipped classroom using various digital tools. The data from focus group interviews and students' reflective notes were analysed using a combination of systematic text condensation and activity systems analysis. In the students' activity system, three tensions were identified: tension between students' expectations and the teaching design, tension between a wish for more frequent attendance and being on their own and tension between the schedule and time needed. The use of digital tools could have facilitated learning and preparation for the course activities. However, students seemed to depend on social assistance, and they might not be ready to take full responsibility for studying adequately by themselves.

Lack of compassion or poor discretion? Ways of addressing malpractice.

In this article, our point of departure is the 'compassion crisis' in the National Health Service in the UK and the initiatives introduced in the aftermath of scandals that were intended to strengthen healthcare professionals' ability to show compassion. We look at the two main strategies, which we term the 'recruitment and staff development strategy' and the 'amelioration of the quality systems strategy' and the debate that has arisen related to them. Based on this analysis, we question whether compassion really is a helpful concept to understand the crisis and hence to underpin relevant strategies. We introduce the concept of discretion as an alternative and better concept to comprehend the situation. One of the benefits of the concept of discretion is that it clarifies how problems can be addressed, both as structural problems and as epistemic problems and how these aspects are intertwined. It also helps us to see how solving these problems is complicated and demands comprehensive, in-depth approaches, involving formative aspects related to healthcare education, as well as development of new healthcare policies.

Symptoms without disease: Exploring experiences of non-Western immigrant women living with chronic pain.

The aims of the researchers were to explore the experiences of non-Western immigrant women living with chronic pain in Norway. Nine individual interviews were conducted and analyzed with a phenomenological approach. We found that the women were wavering between different models to explain their pain. Our analysis of the women's stories makes us believe that a complexity of stressful factors in their lives as immigrant women are influencing their experience of pain and that encounters with health care personnel fail to meet their needs. Our findings reflect a need for broader approaches to help immigrant women with chronic pain.

The impact of Early Warning Score and Rapid Response Systems on nurses' competence: An integrative literature review and synthesis.

AIMS AND OBJECTIVES: To describe, interpret and synthesise the current research findings on the impact of the Early Warning Score and Rapid Response Systems on nurses' competence in identifying and managing deteriorating patients in general hospital wards. BACKGROUND: As patient safety initiatives designed to ensure the early identification and management of deteriorating patients, the Early Warning Score and Rapid Response Systems have broad appeal. However, it is still unclear how these systems impact nurses' competence when these systems are used in general hospital wards. METHODS: CINAHL, PubMed, Cochrane, EMBASE and Ovid MEDLINE databases were systematically searched for relevant articles. Articles were appraised, a thematic analysis was conducted, and similar and divergent perspectives on emergent themes and subthemes were extracted by a team of researchers. RESULTS: Thirty-six studies met the inclusion criteria. The analysis of findings showed how the Early Warning Score and Rapid Response Systems impacted three competence areas: (i) Nurses' competence in assessing and caring for patients related to the subthemes: (a) sensing clinical deterioration and (b) the development of skills and knowledge. (ii). Nurses' competence in referring patients, related to the subthemes: (a) deciding whether to summon help and (b) the language and communication lines in the referral process. (ii) Nurses' coping and mastery experiences. CONCLUSION: The impact of the Early Warning Score and Rapid Response Systems on nurses' competence in identifying and managing deteriorating patients is beneficial but also somewhat contradictory. RELEVANCE TO CLINICAL PRACTICE: A greater understanding of nurses' development of competence when using the Early Warning Score and Rapid Response Systems will facilitate the design of implementation strategies and the use of these systems to improve practice.

Nursing students' spiritual talks with patients - evaluation of a partnership learning programme in clinical practice.

AIMS AND OBJECTIVES: To evaluate the impact of a partnership learning programme designed to support undergraduate nursing students' competence in speaking with patients about spiritual issues. BACKGROUND: Spiritual care is an oft-neglected and underexposed area of nursing practice. Despite the increasing amount of research on spiritual care in educational programmes, little is known about nursing students' experiences with existential/spiritual talks and the process of learning about spiritual care in the clinical placement. DESIGN: The project used a qualitative evaluation design to evaluate the impact of a partnership-initiated intervention focusing on student learning of spiritual care in a hospital ward. METHODS: Data were collected through three focus group interviews with bachelor of nursing students from one Norwegian university college and supplemented with notes. Data were analysed by means of qualitative interpretative content analysis. RESULTS: The intervention was found to enhance students' competence in spiritual talks. The students developed an extended understanding of spirituality, became more confident in speaking with patients about spiritual issues and more active in grasping opportunities to provide spiritual care. Participating nurses significantly contributed to the students' learning process by being role models, mentoring the students and challenging them to overcome barriers in speaking with patients about spiritual issues. CONCLUSIONS: The partnership learning programme proved to be a useful model in terms of enhancing students' confidence in speaking with patients about spiritual concerns. RELEVANCE TO CLINICAL PRACTICE: Collaboration between nursing university colleges and clinical placements could help nursing students and clinical nurses to develop competencies in spiritual care and bridge the gap between academic education and clinical education, to the benefit of both.

Experiences of Older Men Living Alone: A Qualitative Study.

More and more old people live alone, and living alone is reported to be a key risk factor for experiencing loneliness and developing poor health. The purpose of this qualitative study was to explore the experiences of living alone for older men. Systematic text condensation and hermeneutic interpretation were used in analysis of the data. Four themes emerged: lonely at times, missing and longing for a shared life, keeping active, and some kind of freedom. The findings revealed that inner and outer resources come into play and have influence on the processes of managing and solving the situation of living alone. The findings are in accordance with theoretical perspectives on loneliness, aloneness, and solitude. The findings offer nurses in any clinical context valuable information to allow them to address the core emotional and potential mental health issues old men face in coping with the situation of living alone.

Enhancing students' moral competence in practice: Challenges experienced by Malawian nurse teachers.

BACKGROUND: Nurses and student nurses in Malawi often encounter challenges in taking a moral course of action. Several studies have demonstrated a need for increased awareness of ethical issues in the nursing education. OBJECTIVE: To explore the challenges experienced by nurse teachers in Malawi in their efforts to enhance students' moral competence in clinical practice. RESEARCH DESIGN: A qualitative hermeneutic approach was employed to interpret the teachers' experiences. PARTICIPANTS AND RESEARCH CONTEXT: Individual interviews (N = 8) and a focus group interview with teachers (N = 9) from different nursing colleges were conducted. ETHICAL CONSIDERATIONS: Ethical approval was granted and all participants signed their informed consent. FINDINGS: Two overall themes emerged: (1) authoritarian learning climate, with three subthemes: (a) fear of making critical comments about clinical practice, (b) fear of disclosing mistakes and lack of knowledge and (c) lack of a culture of critical discussion and reflection that promotes moral competence; and (2) discrepancy between expectations on learning outcome from nursing college and the learning opportunities in practice comprising three subthemes: (a) gap between the theory taught in class and learning opportunities in clinical practice, (b) lack of good role models and (c) lack of resources. DISCUSSION: Our findings indicated that showing respect was a central objective when the students were assessed in practice. A number of previous studies have enlightened the need for critical reflection in nursing education. Few studies have linked this to challenges experienced by teachers for development of moral competence in practice. This is one of the first such studies done in an African setting. CONCLUSION: There is a clear relationship between the two themes. A less authoritarian learning climate may enhance critical reflection and discussion between students, teachers and nurses. This can narrow the gap between the theory taught in college and what is demonstrated in clinical practice. Moral competence must be enhanced in order to ensure patients' rights and safety.