Mapping interaction quality for nursing and medical students in primary care placement in municipal emergency care units: a systematic observational study.

Introduction: Primary care placement for nursing and medical students is vital for developing the competence to accommodate the increasing number of patients with multimorbid and complex conditions. Prior studies have suggested that interaction quality in primary care placement empowers learning. However, research mapping interaction quality in primary care placements in municipal emergency care units is lacking. This study aimed to systematically map interaction quality for nursing and medical students in primary care placement in two municipal emergency care units. Materials and methods: This study adopted a systematic descriptive observational design. Systematic observations (n = 201 cycles) of eight nursing students (n = 103 cycles) and six medical students (n = 98 cycles) were used to map interaction quality across six learning situations between March and May 2019. Observations were coded using the Classroom Assessment Scoring System-Secondary (CLASS-S). Data were analyzed using descriptive statistics and Spearman correlations. Results: Interaction quality is described in three domains: (I) emotional support, (II) framework for learning, and (III) instructional support, and the overall measure, student engagement. The results indicated middle-quality interactions in the emotional and instructional support domains and high quality in the framework for learning domain and student engagement. Correlations exhibited similar patterns and ranged from non-significant to strong correlations. Conclusion: The interaction qualities indicated a generally positive and supportive learning environment contributing to nursing and medical students' learning and active participation in work tasks related to their professional roles. Thus, this new form for primary care placement for nursing and medical students in the municipal emergency care units was found to be a positive learning arena. These results may enhance nursing and medical education programs in countries with similar health services and education. Health education, supervisors, peers, and others contributing to students' learning should recognize which interaction qualities may affect learning and how to improve quality, thus affecting supervisors' approach to training students. While the CLASS-S showed potential for mapping interaction qualities for nursing and medical students in primary care placement in municipal emergency care units, further studies are needed to validate the CLASS-S for use in clinical placement settings.

Public health nurses' experiences with mental health promotion for adolescent immigrants in schools: A qualitative study.

AIMS AND OBJECTIVES: This study aimed to explore public health nurses' experiences with mental health promotion for adolescent immigrants in lower secondary and high school, aiming to enhance knowledge and insights for effective mental health promotion. METHODOLOGICAL DESIGN AND JUSTIFICATION: A qualitative design employing a hermeneutic approach was chosen. Thirteen public health nurses were selected using purposive criterion sampling and snowballing. Thematic analysis was applied, adhering to COREQ guidelines for transparency. ETHICAL ISSUES AND APPROVAL: The research was approved by the Norwegian Centre for Research Data. The guidelines of the National Committee for Research Ethics in the Social Sciences and the Humanities were followed. RESEARCH METHODS, INSTRUMENTS, AND/OR INTERVENTIONS: Data were collected through three focus-group interviews (n = 13), using semi-structured interview guides to explore the experiences of public health nurses in promoting mental health among adolescent immigrants. OUTCOME MEASURES: This study identified three key themes: (i) Striving to understand adolescent immigrants' mental health aspects, including both positive and negative aspects; (ii) Different strategies for promoting mental health, viewing adolescents as both recipients and contributors to their well-being; and (iii) Barriers to public health nurses' promotion of mental health, including language, cultural, and knowledge-related obstacles and trust issues. RESULTS: Public health nurses noted that language barriers and trust issues often delayed adolescent immigrants from seeking help for mental health concerns. Cultural competence and empathy were deemed crucial. To meet these needs, public health nurses must build rapport with parents, collaborate with professionals, implement follow-up programmes, and advocate for policy changes. STUDY LIMITATIONS: Limitations of this qualitative study include potential bias from the authors' background and non-generalizability of results to other contexts. CONCLUSIONS: In conclusion, public health nurses' experiences reveal the need for enhanced cultural competence, language proficiency, and trust-building to better serve adolescent immigrants. Collaborative efforts, follow-up programmes, and policy advocacy are essential to improve mental health promotion in school settings.

A balancing act-midwives' and public health nurses' experiences with breastfeeding counselling.

AIMS AND OBJECTIVES: To explore midwives' and public-health nurses' experiences of breastfeeding counselling in order to provide a deeper insight into breastfeeding counselling. METHODOLOGICAL DESIGN AND JUSTIFICATION: A qualitative design was used, and qualitative content analysis was conducted to analyse the data in accordance with the phenomenological hermeneutic tradition. ETHICAL ISSUES AND APPROVAL: The Norwegian Centre for Research Data approved this study. All participants provided written consent. RESEARCH METHODS: Four focus-group interviews were conducted on a sample of eight midwives and 13 public-health nurses in Norway. RESULTS: Three interrelated themes describing the meaning of midwives' and public-health nurses' experiences with breastfeeding counselling emerged from the analysis: Breastfeeding Counselling Means Responsibility for Collaboration and Facilitation, Being Confident as a Breastfeeding Counsellor Means Striving for Professional Competence and Supporting the Individual Breastfeeding Family Means Being Sensitive and Adapting to Novel Situations. STUDY LIMITATIONS: The focus groups comprised a mix of midwives and public-health nurses, which may have inhibited honest declaration of these professionals' opinions of each other. CONCLUSION: Midwives and public-health nurses regard structural factors and prioritising breastfeeding support in society as important for providing good breastfeeding counselling. Midwives and public-health nurses strive to find a balance between relying on their own competence, promoting breastfeeding in accordance with guidelines and respecting mothers' choices. Healthcare professionals require knowledge about breastfeeding, good clinical judgement, a listening attitude and openness to how breastfeeding affects mother's everyday life to provide good breastfeeding care.

Scandinavian Online Cancer Information as Expressions of Governmentality: A Comparative Qualitative Study.

We compared online distributed information provided to patients with cancer in Scandinavian countries through the lens of governmentality. A secondary comparative qualitative analysis was conducted. Discourses in online patient information showed differences in governmentality techniques across the countries: Norway used a paternalist approach, Denmark an educative approach, and Sweden an individualistic approach and expected the patients to make the "right" decisions. Online information for patients with cancer in Denmark and Norway showed high professional and health care system involvement, whereas in Sweden, there was high patient involvement. There was almost no use of the person-centered approach among the online discourses.

Medical students' learning experience and participation in communities of practice at municipal emergency care units in the primary health care system: a qualitative study.

BACKGROUND: Medical education has been criticised for not adapting to changes in society, health care and technology. Internationally, it is necessary to strengthen primary health care services to accommodate the growing number of patients. In Norway, emergency care patients are increasingly treated in municipal emergency care units in the primary health care system. This study explores medical students' learning experience and how they participated in communities of practice at two municipal emergency care units in the primary health care system. METHODS: In this qualitative study, we collected data from March to May 2019 using semi-structured individual interviews and systematic observations of six ninth-semester medical students undergoing two-week clerkships at municipal emergency care units. The interview transcripts were thematically analysed with a social constructivist approach. A total of 102 systematic observations were used to triangulate the findings from the thematic analysis. RESULTS: Three themes illuminated what the medical students learned and how they participated in communities of practice: (i) They took responsibility for emergency care patients while participating in the physicians' community of practice and thus received intensive training in the role of a physician. (ii) They learned the physician's role in interprofessional collaboration. Collaborating with nursing students and nurses led to training in clinical procedures and insight into the nurses' role, work tasks, and community of practice. (iii) They gained in-depth knowledge through shared reflections when time was allocated for that purpose. Ethical and medical topics were elucidated from an interprofessional perspective when nursing students, nurses, and physicians participated. CONCLUSIONS: Our findings suggest that this was a form of clerkship in which medical students learned the physician's role by taking responsibility for emergency care patients and participating in multiple work tasks and clinical procedures associated with physicians' and nurses' communities of practice. Participating in an interprofessional community of practice for professional reflections contributed to in-depth knowledge of ethical and medical topics from the medical and nursing perspectives.

Norwegian public health nurses' competence areas.

OBJECTIVE: To explore the competence areas of public health nurses in Norway. DESIGN: A qualitative and comparative design was employed. SAMPLE: A purposive sample of 41 public health nurses participated. MEASUREMENTS: Data were gathered from focus groups and individual interviews. The interviews centered around an open question about public health nurses' knowledge. They also discussed 10 proposed competence areas for public health nursing, developed from the literature. A qualitative content analysis was conducted on the interview transcripts, followed by a synthesis of the data from the interviews and earlier developed competencies. The 10 competence areas for Norwegian public health nursing were then refined. Finally, we compared the affirmed competence areas with earlier developed cornerstones and the new educational guidelines. RESULTS: The interviews revealed 10 competence areas. These 10 competence areas were synthesized with the 10 proposed competencies from literature. Ten affirmed competence areas, which mostly corresponded with the competences from literature, were developed. The affirmed competencies were supported by the previously developed cornerstones and new educational guidelines. CONCLUSIONS: The affirmed competencies will help promote and explain the content and focus of PHNs' work in Norway and may have implications for education and international research.

Interprofessional collaboration between nurses and doctors for treating patients in surgical wards.

Interprofessional collaboration will be one of the main factors in the effort to increase patient safety in the coming years. Research has identified several challenges to interprofessional collaboration between nurses and doctors, where fragmentation of both education and clinical practice contributes to a strong affiliation to one's own profession with little emphasis on collaboration. The aim of this study was to generate more knowledge about how nurses and doctors experience interprofessional collaboration in observation and treatment of patients on a surgical ward. The study was conducted in 2018 and used an explorative qualitative design that was based on four semi-structured focus group interviews. The respondents were 11 nurses and seven doctors with experience from different surgical specialties and employed in three different surgical wards in a Norwegian hospital. The data were analyzed using systematic text-condensation. The following three main categories, each with two subcategories, emerged: 1) Organization and culture: a lack of interprofessional meeting places and experience-based hierarchy; 2) Communication: use of communication tools and little room for professional discussions; and 3) Trust and respect: dependence and recognition and a blurred distribution of responsibility. Both nurses and doctors wished for closer interprofessional collaboration in observation and treatment in the surgical ward; however, organizational limitations with few interprofessional meeting places and time pressure made this difficult.

The Nordic perspective on migration and empowerment.

International migration is a complex phenomenon that touches on a multiplicity of economic, social and security aspects affecting our daily lives. In the Nordic countries' migration is a contentious political topic as the number of migrants has significantly increased in recent decades. The aim of this study is to analyse governmental policy documents on migrants in Denmark, Finland, Norway and Sweden and to identify and compare how they are described within an empowerment perspective. A critical discourse analysis was undertaken of each Nordic country. The findings revealed that all four documents placed migrants in a passive position in regard to decision-making and that an empowerment perspective was lacking. Migrants are similarly treated in each Nordic country as a problem to deal with rather than as a possible resource for the society and the approach seeks to protect the welfare state and the culture of the country. The lack of empowerment perspective may be having a negative impact on the health and well-being of migrants and on their integration in the Nordic society. The article concludes by raising several questions in regard to migration and empowerment in the Nordic context.

Discursive construction of the patient in online clinical cancer pathways information.

AIM: To explore how the patient is constructed and socially positioned in discourses of web-based pathways information available to people with cancer in Norway. DESIGN: Mixed qualitative and quantitative design, using Corpus-Assisted Critical Discourse Analysis. METHODS: The study, conducted in January 2020, examined the language of one general and six specific web-based cancer pathways information brochures. The approach combines analysis of word frequencies and concordance lines using corpus analysis software to identify the 'linguistic fingerprint' or 'aboutness' of the text prior to further qualitative critical discourse analysis. RESULTS: The analysis identified three core discourses which constructed the patient differently: (a) a participating active person, in a brief, inclusive discourse; (b) a passive person lacking knowledge or perception of their situation in dominant, medical and interprofessional expert discourse; and (c) reduced to a disease and a code in the pathways discourse. CONCLUSION: This study offers insight into the construction of patients in online clinical pathways information for cancer treatment. The analysis revealed how governance systems such as New Public Management and its demands on efficiency and productivity influence the cancer pathways. The World Health Organization has promoted a person-centred approach, emphasizing the importance of participation and a partnership of equals. A person-centred approach to care was not evident in the discourse of the online documents. The dominant ideology of these pathways was paternalistic with patients constructed as passive persons who get standardized treatment. IMPACT: This study gives new insight that can be valuable for nurses, other healthcare professionals and the government. The lack of a person-centred focus in the cancer pathway information could have a negative impact on the patient's health outcomes by promoting a culture of inattention to the patients' needs and wishes among practitioners. The results may provide a stimulus for discussion about the role of patients in cancer treatment.

Construction of patients' position in Norway's Patients' Rights Act.

BACKGROUND: Since the adoption of the Universal Declaration of Human Rights by the United Nations in 1948, human rights as set out in government documents have gradually changed, with more and more power being transferred to individual. OBJECTIVES: The aim of this article is to analyze how the position of the patient in need of care is constructed in Norway's renamed and revised Patients' and Service Users' Rights Act (originally Patients' Rights Act, 1999) and published comments which accompanying this legislation from the Norwegian Ministry of Health and Care Service. RESEARCH DESIGN: A constructivist design was used, and Fairclough's critical discourse approach was adopted to analyze the text of the Patients' and Service Users' Rights Act and comments. FINDINGS: The analysis identified three discourses: (a) political discourse, containing ethical discourses about priority and economy, in which patients are constructed as powerless individuals; (b) expert discourse, containing a theme about patients' trust in the healthcare team and its knowledge, in which patients are constructed as helpless individuals lacking knowledge; and (c) patient participation and patient autonomy discourse, containing ethical discourses about decision-making, in which patients are constructed not only as individuals with needs and rights but also as "troublesome." CONCLUSION: Dominant paternalistic discourses in the legal text validate the power of medicine, the healthcare system, and heath personnel over the needs, rights, participation, and autonomy of the patient.

Challenges and demands in the population-based work of public health nurses.

AIMS: Government programs and the Norwegian Directorate of Health give public health nurses in Norway an explicit role in population-based health promotion and disease-prevention work. The aim of this paper is to explore Norwegian public health nurses' experiences with population-based work. METHODS: A phenomenological hermeneutic approach was adopted, involving face-to-face interviews with a purposeful sample of 23 public health nurses from urban and rural districts in two counties in Norway. RESULTS: Three themes were identified: the predominance of work at the individual level, a lack of resources, and adherence to administrative directives. The interviews revealed that the public health nurses were mostly occupied with individual problem-solving activities. Population-based work was hardly prioritized, mostly because of a lack of resources and a lack of recognition of the population-based role of public health nurses. CONCLUSIONS: The study indicates contradictions between the public health nursing practice related to population-based work and the direction outlined by the government and the public health nursing curriculum, which may mean that the public health nursing role is not sufficiently clarified. The implementation of practice models and administrative directives and resources, as well as an explicit emphasis on population health in public health nursing education, can contribute to increased population-based interventions. Greater knowledge of and emphasis on population-based work in public health nursing are needed.

Perceptions of experiences with interprofessional collaboration in public health nursing: A qualitative analysis.

In public health nursing interprofessional collaboration has become a goal, however, there is little clarity on the distribution of responsibility or approach to cooperation between the professional groups. The aim of the study was to explore public health nurses' perceptions of their experiences related to interprofessional collaboration. A qualitative content analysis was carried out. An interview study with a purposeful sample of 23 Norwegian public health nurses (PHNs) was conducted. Data were analysed using semi-structured interviews to identify categories and themes of PHNs' working lives. The data were classified into three major themes: institutionality: the institutional understanding of the professional roles; competence: clarifying jurisdictional borders, and recognition: professionals' recognition of different roles. There needs to be a robust strategy in collaborative working that involves public health nurses among other professionals to avoid role overlap, interpersonal and interprofessional conflict and reduce the damaging threat or stress that comes with informal or ad hoc rules of engagement and status claiming by one profession over another.

Meanings of knowledge and identity in public health nursing in a time of transition: interpretations of public health nurses' narratives.

BACKGROUND: A changing healthcare system affects the professional identity of nursing groups. Public health nursing has experienced challenges in balancing the paternalistic expert ideology and the empowerment participation ideology. A strong professional identity can legitimate nursing, and possibly influence the quality of nursing work. Narrations from practice can illuminate the nurses' theoretical and practical knowledge and help illustrate their collective professional identity. AIM: To illuminate the meaning of public health nursing knowledge and professional identity in a continuously changing public health nursing practice. METHOD: A qualitative interview study with a purposeful sample of 23 Norwegian public health nurses was carried out. Data were analysed using phenomenological hermeneutics, a descriptive method inspired by Ricoeur's philosophy of interpretation. FINDINGS: Three themes emerged (i) Being a generalist: emphasising the need for generalised knowledge and using clinical judgement, (ii) Being one who empowers: focusing on resources and coping strategies, (iii) Being occupied with individual problem solving: focusing on individuals with special needs, using standardised techniques and protocols, and lacking specialised knowledge. CONCLUSION: Interpretation of the nurses' stories illuminated their need for generalised evidence-based knowledge, but also the importance of using sound clinical judgement in a diverse complex practice, where service users need encouragement, support and expert advice. Time pressures can limit the nurses' involvement. Many had an individual problem-focus more than a primary prevention focus, in contrast to governmental regulations stating that Norwegian public health nurses should focus on health promotion and primary prevention. Public health nurses have a broad generalised knowledge of their special target group giving them a 'specialist generalist' role. Clarification of this role, in relation to jurisdictional borders, can create a strong identity at a time when healthcare policy promotes economic values, professional neutrality and increased collaboration.

Contradictory discourses of health promotion and disease prevention in the educational curriculum of Norwegian public health nursing: a critical discourse analysis.

AIMS: Health care is under constant change creating new and demanding tasks for public health nurses. The curriculum for public health nursing students is controlled by governmental directives that decide the structure and content of their education. This paper analyses manifest and latent discourses in the curriculum, in order to reveal underlying governmental principles for how public health nurses should promote health and prevent diseases. METHODS: A critical discourse analysis of the Norwegian public health nursing curriculum was conducted. RESULTS: The study indicates i) 'a competing biomedical and social-scientific knowledge-discourse', with biomedical knowledge dominating the content of the curriculum; ii) 'a paternalistic meta-discourse', referring to an underlying paternalistic ideology despite a clear focus on user participation; and iii) 'a hegemonic individual discourse'. Even though the curriculum stipulates that public health nurses should work at both an individual and a societal level, there is very little population focus in the text. CONCLUSIONS: Recent political documents concerning public health nursing focus more on health promotion, however, this is not sufficiently explicit in the curriculum. The lack of emphasis on social scientific knowledge, and the blurred empowerment and population perspective in the curriculum, can lead to less emphasis on health promotion work in public health nursing education and practice. The curriculum should be revised in order to meet the recent governmental expectations.

The meaning of ethically charged encounters and their possible influence on professional identity in Norwegian public health nursing: a phenomenological hermeneutic study.

BACKGROUND: In today's health care, new health reforms focus on market values and demands of efficiency influence health workers' professional practice. Norwegian public health nurses work mainly with healthy populations, but the children, families and young people they meet can be in vulnerable and even dependent situations. Strategies in coping with ethically challenging encounters can be important for the identity of the profession. AIM: The aim of the study was to illuminate public health nurses' experiences of being in ethically charged encounters and to reflect upon how these experiences can influence their professional identity. METHOD: A purposive sample of 23 Norwegian public health nurses with experience ranging from 0.5 to 25 years narrated about their work-related experiences. The interviews were interpreted with a phenomenological hermeneutic method inspired by the philosophy of Paul Ricoeur. FINDINGS: Four themes were identified: feeling responsible, being committed, feeling confident and feeling inadequate. These experiences were related to both work and private life and involved an emotional commitment to the well-being of children, young people and families. CONCLUSION: On the basis of the findings, it can be estimated that PHNs are committed to their work, and defending children's rights is a strong driving force. Responsibility for service users is a deciding factor that can overshadow institutional demands. It seems as if value conflicts mobilised courage which is essential in maintaining moral strength. This is in turn important for a strong professional identity and can have positive implications for the quality of public health nursing work.